realizing it's about time to grow up...help!!

[bonedrone14]

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The title kind of sums up how I'm feeling. I'm nearing the end of third year and the prospect of committing to something is really hanging over my head and driving me nuts. One minute I'm sure, then the next I've got some serious doubts. I guess all this is maybe normal...but if anyone is willing, I'd like some advice. (it's gonna be kind of a long post so I apologize in advance...I'm on night float with nothing to do but think about whats coming next year and after lol)

I go to an MD school in the south, top 15% of my class, step 1 >260, honors in roughly half my third year rotations, a research poster at our school research day and a case report at a regional conference, not aoa or any of those things. Just a normal acting person who gets along with pretty much everyone. I really value family time and am married and have a young child with more to come. Not interested in big city or fast paced life. Don't need to make bank but would like to do well enough to take care of the family and have enough to help out others around me.

Things I've been considering

1-EM:this has been my number one for a while.
Pros: I love the breadth and the ability to know something about most things. I'm ok with not being an expert at anything in particular. I really enjoy acute care and don't want to bother with chronic management. Originally I thought I'd be a surgeon...I really enjoy seeing the change in someone that I've helped. The instant gratification part of me would be satisfied here. I also like the flexibility that life as an attending would provide as far as not having your own patients, possibilities of doing locums, stuff like that. I'm also pretty interested in toxicology. I've got my fourth year schedule set up for em.
Cons:I don't mind working late, but I'm not a huge of leaving work after the sun has risen. I've been having some serious misgivings about the whole circadian flip flopping and while as an attending you can theoretically just cut back hours, as a resident you cant. I know residency is a relatively short time but I guess I'm just a little hesitant to commit to something that so many people repeatedly complain about. This is actually what's caused me to write this post.

2-psych:
pros-I have always been really interested in psychotic and mood disorders, particularly their acute presentations. the patients can be really diverse and the same disease can present in many different ways. The lifestyle is good and apparently the job market is better than em even. There aren't the circadian disruptions of em. There is little to no call.
Cons: I worry I might miss medical workups. I really enjoy interpreting lab values and imaging. I'm not a big fan of depression. I've heard people say that psych can be emotionally draining.

3-Ophtho:this is a field I haven't had much exposure to and have been curious about partly due to my lack of info and partly due to the fact that a lot of people lump it into the good lifestyle group as well as allowing you to medically and surgically manage diseases. I'm really intrigued by the idea of being able to affect people in such a great way by changing their sight. I feel like this would be a great missions opportunity as well. I've been told the surgeries are quick, which would be nice as I'm not a huge fan of being scrubbed for hours on end.
Cons:I have zero ophtho experience or contacts and it's June. I don't know if it's too late. I also don't know if I like the field in theory or in practice.

has anyone else been in a similar position? what helped you make your decision? Any other specialties that anyone can think of?

I know this was gigantically long, especially at 0515. I'd really appreciate any advice anyone can give. Thanks!

 

[nardini46]

Sounds like you want to go into family medicine.

 

[the argus]

as you have mentioned, you need to make up your mind quickly. 2/3 specialties you have mentioned will require that you pretty much drop everything and do targeted rotations in July/August. That said, it sounds like you might actually be an ideal candidate for a transitional year program in the traditional sense (not just looking for cush intern year).

I don't know much about psych or ophtho, but for EM you will need at least 1 (2 is much better) SLOE to be competitive. Ideally you get 1 SLOE from each EM rotation you do, so you really need to do an EM rotation(s) before ERAS opens on 9/15. EM residents can correct me here, but I think nowadays the norm is for the SLOE to be a composite letter from the institution PD/chair, so in reality you need to do an away rotation to get your 2nd SLOE.

I really enjoy seeing the change in someone that I've helped. The instant gratification part of me would be satisfied here.

I'm not sure how much time you have spent in the ED, but in my experience (2 months during MS3/MS4) this was very rare. It was actually the reason that I chose not to go into EM. I never really felt like I had completely treated a patient, which makes sense, because that is not the mission of the emergency physician. Stabilize and ship out.

 

[ForeignMD12345]

Great job on your accomplishments thus far. In regards to your question, I am with you on the love for ER! But think- if you plan on having more children, will the hours agree with you and your family? Residency will be demanding in several fields, so I wouldn't necessary that that into account as much as the specialty you plan to focus on as that is clearly more long-term. You do bring up a good point in that you can eventually cut back on hours, but you will most likely still have evening shifts.

Psych: This is a tough one. As far as time demands, it's absolutely on the more flexible side, but mentally, it is a very difficult field. If you love ER, you are definitely going to miss out on a lot of components of medicine in the psych field.

Optho: try try try to get some exposure before you make a decision. If you are intrigued, you absolutely owe it to yourself to gain some experience, even if to quell your fears of wondering if you made the wrong decision five years down the road. Make as many phone calls as possible to people who can connect you with someone in order to do this. You might find that it is absolutely what you wanted all along or that it's nothing like you thought.

Not sure if this is an option, but if you do IM, you can branch out from there in the future. Good luck with everything!

 

[Armadillos]

EM would seem to be the easy choice to me. But so many EM docs complain about burn out and the erratic schedule so always makes you wonder. Part of me kind of just thinks a lot of the EM people complaining assumed they would essentially never be working and just boating/skiing/hiking all day or whatever. So they are just pissed they ever even have to work and would be complaining 100 times worse if they were working IM hours.

 

[arkdoc]

I will give my 2 cents. I am starting my EM intern year pretty soon. I was worried about the EM lifestyle (weird hours and circadian switches), but when I did the actual rotation I found it wasn't as bad as I thought. Granted, I am still young, 26, but in the end I chose the field that I liked and could see myself doing the most. This is what you need to consider, what field of medicine is most enjoyable to you. This is because in the end you are going to be working, and if like most people you will working many hours. That being said, with your score you can do one EM away rotation and be very competitive for most if not all places. Just get your Step 2 ck in.

Now, like the above poster mentioned, have you considered Family Medicine. You get to practice medicine and dabble in much of the other stuff. You miss some of the acuteness of the ED, but the hours are more stable although usually more per week/month. I don't know much more about Psych other than it being less competitive and probably good hours overall. You will also be able to find a job easily. Ophtho is a pretty competitive field and has an early match so if you really want to do this you better get on the ball quick. The hours can be in between after you finish residency. I don't know much more about this field.

 

[clausewitz2]

Ophtho surgeries often are on the order of 20-30 minutes, and you generally do them sitting down (shoes frequently optional if you are using instruments that require manipulating pedals). The downside to this that I saw was that 30 minutes surgeries means you do a massive volume of them, so if you are someone who needs variety you would need to seriously consider the extent to which doing 10 cataracts a day every day ad infinitum would make you want to jump out a window.

That said, ophtho does have cooler surgeries that they do, they learn exam techniques that are mysterious to the rest of medicine, and you definitely get that medical/surgical mix, since nobody else is trying to touch eyes in clinic. I get the sense, though, that these days you need to be fellowship-trained or need to seriously hustle if you are wanting to make the big bucks, due to continuing reimbursement cuts.

EDIT: I forgot to mention the bit I found coolest as someone not going into ophtho - you get to directly visualize the internal structure and pathology of an organ without making a single cut.

 

[clausewitz2]

EM would seem to be the easy choice to me. But so many EM docs complain about burn out and the erratic schedule so always makes you wonder. Part of me kind of just thinks a lot of the EM people complaining assumed they would essentially never be working and just boating/skiing/hiking all day or whatever. So they are just pissed they ever even have to work and would be complaining 100 times worse if they were working IM hours.

I certainly know a lot of people intending at the moment to go into EM who seem to be under the impression that they can just leave their jobs for arbitrarily long amounts of time to climb mountains or scuba dive and still come back without any loss of income whatsoever. They will become the people you are talking about, I imagine.

 

[Mad Jack]

I will give my 2 cents. I am starting my EM intern year pretty soon. I was worried about the EM lifestyle (weird hours and circadian switches), but when I did the actual rotation I found it wasn't as bad as I thought. Granted, I am still young, 26, but in the end I chose the field that I liked and could see myself doing the most. This is what you need to consider, what field of medicine is most enjoyable to you. This is because in the end you are going to be working, and if like most people you will working many hours. That being said, with your score you can do one EM away rotation and be very competitive for most if not all places. Just get your Step 2 ck in.

Now, like the above poster mentioned, have you considered Family Medicine. You get to practice medicine and dabble in much of the other stuff. You miss some of the acuteness of the ED, but the hours are more stable although usually more per week/month. I don't know much more about Psych other than it being less competitive and probably good hours overall. You will also be able to find a job easily. Ophtho is a pretty competitive field and has an early match so if you really want to do this you better get on the ball quick. The hours can be in between after you finish residency. I don't know much more about this field.

Keep in mind OP has a family, so it isn't just about what works best for him- it's about what works best for him in the context of being a father. Circadian flips are nothing compared to missing holidays and weekend with your kids until you die, as well as what working an overnight does to your personality the next day.

 

[Frazier]

Anything but psych, seriously...

...I don't want to compete against you 😉

EDIT: oops, looks like you are heading into 4th year...in that case: Psych all day.

Like someone else mentioned, the surgeries in ophtho are cool, but make sure you are comfortable with the idea of doing high volume and if they will be as exciting after your 1,000th completed.

Even with your lack of contacts going into MS4, given your impressive stats, if you network these next several months I strongly doubt you'll have any problems whatsoever.

 

[ForeignMD12345]

I mean, that's just funny...

Anything but psych, seriously...

...I don't want to compete against you 😉

 

[Apoplexy__]

top 15% of my class, step 1 >260, honors in roughly half my third year rotations
...
I really value family time and am married and have a young child with more to come

You're awesome, man.

 

[arkdoc]

Keep in mind OP has a family, so it isn't just about what works best for him- it's about what works best for him in the context of being a father. Circadian flips are nothing compared to missing holidays and weekend with your kids until you die, as well as what working an overnight does to your personality the next day.

While this is true, going into a field just because better hours might mean that you are miserable and you bring that home to your family as well. You need to consider this as well.

 

[Mad Jack]

While this is true, going into a field just because better hours might mean that you are miserable and you bring that home to your family as well. You need to consider this as well.

Obviously. But saying "do what you love" is kind of bull**** in the context of a family. Some things just aren't realistically going to wok with the lifestyle a person hopes to enjoy with their loved ones. You should be working to live, not living to work.

 

[ImportedKamariya]

your best bet would be primary care especially if you settle into a nice community. you will have an upstanding job and your child (and wife) will look up to you. remember, no one is promised tomorrow. that includes health, not just death. we all thought michael j. fox had a nice life till he hit age 29 or something and now he is permanently handicapped and dependent on someone all the time. you already work in a prestigious field. time to focus on family and get a nice work-life balance going. no matter what you do, you will either end up losing money or family time. can't have your cake and eat it too.

or to put it another way, that fat guy running away from the twin towers on 9/11 (he is in a famous photo) said in an interview he lived for his career but after that day, he spent more time with his family. i can go on with tragedies but that isn't the point. it's to remember what is the most important thing in your life. money is very important for everyone obviously but for most people, i have found, nothing is more valuable than family. they feel happiest in the presence of loved ones which requires time and energy, not just having little johnny in your room while you do paperwork or talk to clients on the phone. bet on your wife and kid is what i say. schedule a specialty/practice you can manage with a good amount of passion around them rather than the other way around or the 20-something version of you when all that existed was you.

 

[arkdoc]

Obviously. But saying "do what you love" is kind of bull**** in the context of a family. Some things just aren't realistically going to wok with the lifestyle a person hopes to enjoy with their loved ones. You should be working to live, not living to work.

This is a view that can be relevant, but you still have to take into consideration what I mentioned. If you hate going to work everyday there is going to be consequences to that. I too have a family. I will miss holidays, but I will probably have the next day off to celebrate it afterwards. Hamstringing yourself into a career that you regret because you believe that it will be better hours is a horrible idea. No field in medicine is going to be what it is now and if you pick a field because the hours are most likely better, in 10 years it can be the opposite and now your stuck with a job you hate working hours you hate. Instead pick something you can be happy with and then work to adjust your life to what it needs to be. Work less, ask for better hours, wait on the right job.

 

[bonedrone14]

Thanks everybody for all of your responses. This is definitely what I was looking for...just some more perspective. I did FM the previous rotation and went into it with my eyes wide open really thinking I might want to do it. Plus I only worked 4 days a week. But I really just didn't like it. The annual physicals, bp/lipid management, etc stuff just made me really dread going in every day. So unfortunately that crossed that off the list. Sports med after EM is something that might be an interesting option at least.

Also, I went home and talked with my wife this morning and we kind of tossed around some of what I've been thinking and I really think that EM is where I'll continue to head at this point. Like ark doc said, I think I'll be in a much more informed position after my away and things may be much clearer. As far as holidays and things like that, my wife is super understanding and we really don't mind missing the actual calendar day as long as we have a day we can all be together to celebrate. I'll probably try to shadow an ophtho once my schedule lightens up in the next couple weeks. But as someone alluded to earlier, I really tire of repetition quickly. So the same surgery 30 times a day may not be something I'm looking to do either. I've also seen some people talking about switching out of em (or other things) into psych so if I absolutely feel during residency that I've made a mistake then there's that option.

Thanks again for all the supportive responses...this has been really helpful.

 

[WingedOx]

If you love ER, you are definitely going to miss out on a lot of components of medicine in the psych field.

Not if you don't suck at your job. (or don't go to a sh-tty program.)

 

[pd1112]

What about ENT?

 

[bonedrone14]

What about ENT?

I shadowed an ent during second year for a while both in his clinic and the or. It was definitely neat and his schedule was great. However, it really just didn't interest me like I had hoped it would. Plus..we had someone at my school who applied and didn't match, and had awesome stats so I'd definitely be nervous trying to jump into it this late in the game.

 

[doc05]

you should consider anesthesiology. short patient interactions (think hours, not years). good schedule flexibility because you don't have to establish or maintain a practice (similar in that way to EM). and I think a lot less likely to burn out after a few years in the field (quite common in EM).

 

[Kaustikos]

you should consider anesthesiology. short patient interactions (think hours, not years). good schedule flexibility because you don't have to establish or maintain a practice (similar in that way to EM). and I think a lot less likely to burn out after a few years in the field (quite common in EM).

Wait, when do you guys talk to patients? Jk