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I am in IM right now, mosty because I loved everything in medical school. I also really liked ob/gyn and anesthesia during medical school but decided that IM probably gave me the most flexibility.

Intern year has been great in that I finally have a job and it’s nice to get a paycheck. And to be honest, I really do love medicine a lot as a whole and feel very fortunate to be in medicine. I seriously can’t believe they pay me to do this.

HOWEVER- I think that mind-set wise I have more of an anesthesia/surgery style of thinking. You know- get to the point, cut the crap. I also like to see the results of what I do quickly. You might wonder why I didn’t think of this as an M4. Well, I did, but I got scared off because of lifestyle (ob/gyn) and cRNAs (anesthesia).

Thus far in intern year I have only gotten that experience once when catching a case of SBP, giving abx, and having the pt’s pain come down significantly afterward. Otherwise, I feel like medicine feels like a lot of throwing meds, doing things for theoretical reasons (don’t given Iron in the setting of infection), and not really knowing what intervention, if any worked. I initially thought GI might be a good fit, but seeing tons of functional disorders in clinic was not super fun. Also- not cool knowing that PAs are scoping now.

At the same time, I look at medscape surveys and GI routinely makes the top cut while ob/gyn loiters at the bottom. Which makes me wonder why ob/gyn is so competitive? I have the scores but I don’t think ob/gyn cares about scores based on the charting outcomes average.

I guess my question is- how long should I stick it out in IM? What is the safest option, to at least ensure I have a job during this pandemic while also exploring other options? I don’t want to bail out too soon but I also don’t want to miss out on a career that makes me feel most alive, in my element, and full of purpose (ob/gyn first, anesthesia second). Also, I do feel very fortunate to have a job in the pandemic and would hate to lose it because I tried switching specialties and failed. I also don’t have much accumulated savings if things went haywire. And while I have received positive feedback on rotations, I haven’t had a chance to really build a solid reputation yet. So idk what the PD would say.

Ideally, I would like to just switch specialties within the institution. Funding considerations aside, I thought that maybe I should proceed to pgy-2 year, get some money under my belt, test the waters of IM, build some sort of a reputation, and switch after 1 year of IM.

Any thoughts on what sort of game plan I should make that is safe, financially speaking, and also keeps my options opens? Any other perspectives on my situation are welcome. Thanks.


**The ob/gyn forum is dead which is why I opted for this forum between the two.
 

chocomorsel

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My whole life I wanted to be an ObGyne. Then I did a rotation in medical school and realized how miserable and evil those people were. Couldn't figure out if the specialty attracted a bunch evil b----- or if they worked so much that they were just miserable residents. Plus I realized they cut too much and I hated cutting people open and digging around inside them.

Since then I have figured out that I think it's just a miserable residency with mostly a bunch of catty women but improves some after residency. I have a couple of friends are ObGynes and they are trying to transition out of the hospital or do hospitalist shift work because Ob lifestyle with call sucks. Probably just as bad as anesthesia with call if not worse. And their liability till the kids are 21 is completely ludicrous in my opinion. I would stay far away from that field.

But if you love it, then go for it. I would wait honestly if I were you. It's too early to make that switch IMO.

Also, if you hate the idea of PAs scoping patients why would you think you would be any less perturbed by CRNAs claiming equality and doing your job?

Have you by chance thought about a critical care fellowship out of IM? Maybe ad some pulmonary to it to be more independent of hospitals? Lots of procedures and you get to see a quicker version of whether your interventions are working or not as well.
 
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IMGASMD

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At least three months. You’re an intern, you don’t really have a good grasp of what IM is yet.

Make sure whatever you switch into is what you really want. You most likely won’t get a third chance.
 
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anbuitachi

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OB is awful. I dont know what happens to them during residency or its just the population the field attracts but after training, they all come out knowing pretty much zero of the rest of medicine...

But with anesthesia, its often also a lifestyle issue (potential for lots of calls, unpredictable schedules) and nursing issues (CRNA).
But its an interesting field if you really are okay with the downsides
 
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Katheudontas parateroumen

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I think you should consider CCM. Pulm/Crit if wanted as well. If you enjoy medicine, then CCM is the place to be. As an attending, you can cut all the crap and get to the point as much as you like. You were right with your choice I think. IM truly offers you the most. You can go any direction cards, GI, pulm/cc for more procedures or immediate results. Anesthesia at the end of the day is about moving the meat as quick as possible. Sadly. It’s a fun job and I still find a lot of fulfillment as a resident, but I am one that has the IM itch and wish I did IM instead. I’ll be doing CCM fellowship though so who knows. I don’t know anything about OBGyn but seems like a rough residency and job life.
 
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Ronin786

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Pulm/CCM could be a good path for you or even EP/interventional cards if you want to wait that long.

Pulm/CCM in your own MICU owning your patients will let you cut whatever bull**** you want. You just have to be able to stomach a quarter to half your patients dying.
 
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kidthor

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Do not switch. Finish IM and consider a subspecialty - Pulm/CC, GI, Cardiology - these all meet your goal of cutting the crap and seeing the results of interventions.

You noted that GI bored your due to too many functional disorders. Consider - would you rather see those or get crushed on call for 24 hrs during Christmas? And if you don't like functional disorders then be a scope jockey and veer away from being an IBS specialist. Or do Pulm/CC.

What you suggest as selling points for anesthesia or ObGyn are unconvincing for these two specific fields. Rather, they suggest you don't love being a medicine intern.
 
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nimbus

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OB is awful. I dont know what happens to them during residency or its just the population the field attracts but after training, they all come out knowing pretty much zero of the rest of medicine...


OB or Ortho?
 
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dipriMAN

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I did an intern year in medicine, towards the second half of the year you might like it better, you’ll feel more confident, be more efficient, unfortunately the hours don’t get any better.

I can tell you that you might be excited to do anesthesia for the first couple months, but than it will get boring too. Everything interventional eventually becomes routine. Try and look past it and consider if IM will be fulfilling for other reasons, because you will for sure dislike a lot of the bull**** in anesthesia and the operating room.
 

pjl

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I would imagine you could be very happy as a hospitalist in PP, or many sub specialists from IM.
Imagine your job now, but completely get rid of rounds. Literally go home after seeing your morning patients, then come back for afternoon rounds. Instant removal of much of the bull**** you are worried about.
You may end up “stuck” in house while on a shift, but really even walking around, checking on your patients 2-3x over 12 hours and dealing with acute issues is not that bad. Our hospitalist are some of our happiest MDs. They do a 7 on, 7 off 13 hour shift rotation

OB is full of misery. You have ****ty clinic, ****ty overnight labor call, you are bad at surgery, and everyone is around you is a bitch. Plus you are likely to be dicked around by the hospital that employs you. The only happy OBs I know are miserable bitches who like to complain. Also, who wants to say push that much in their life?

Anesthesia is great for a small subset of people. I am one of them, many are not, which is why you hear all the complaining here. See any of the thousands of threads addressing our issues.
 
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Intern year has been great in that I finally have a job and it’s nice to get a paycheck. And to be honest, I really do love medicine a lot as a whole and feel very fortunate to be in medicine. I seriously can’t believe they pay me to do this.
Do you realize how lucky you are? People that would intern for free because it's so awesome come around as often as an Einstein, a Shaquille O'Neal, and Haley's comet, all at once... and in anesthesia they don't even come around that often. We are in anesthesia largely to get away from clinical medicine.

We all think grass is greener elsewhere, but when your own grass is greener than dollar bills, pump the brakes on looking elsewhere. I say keep doing what you're doing and reevaluate later.
 
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bigdan

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Just a couple random thoughts on OB:

1. You’ll be someone’s doctor, which you’ll get in IM but rarely in Anesthesiology. There’s potentially some intrinsic reward to that.

2. Just like IM and Anesthesiology, you can subspecialize a fellowship after base training. My wife did REI after OB; she has the most benign physician schedule that I have ever seen.
 
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nimbus

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Do you realize how lucky you are? People that would intern for free because it's so awesome come around as often as an Einstein, a Shaquille O'Neal, and Haley's comet, all at once... and in anesthesia they don't even come around that often. We are in anesthesia largely to get away from clinical medicine.

We all think grass is greener elsewhere, but when your own grass is greener than dollar bills, pump the brakes on looking elsewhere. I say keep doing what you're doing and reevaluate later.


I’ve actually worked with people who interned for free.
 

chocomorsel

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Just a couple random thoughts on OB:

1. You’ll be someone’s doctor, which you’ll get in IM but rarely in Anesthesiology. There’s potentially some intrinsic reward to that.

2. Just like IM and Anesthesiology, you can subspecialize a fellowship after base training. My wife did REI after OB; she has the most benign physician schedule that I have ever seen.
And probably makes a killing. People pay a lot of money to get pregnant.
How competitive is REI? The promised land of OB ain’t easy to come by.
 
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Twiggidy

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I would also add that COVID should open any MS4/Interns outlook on the future as well. The pandemic has shown what happens when procedural bases specialties have to come to a halt. I’m not saying I’d rather sit in a clinic all day but it shows how much our field of anesthesia is reliant on someone else. Just things to keep in mind when thinking “anesthesia seems great”. It’s is great....in a functioning environment
 
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IMGASMD

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I would also add that COVID should open any MS4/Interns outlook on the future as well. The pandemic has shown what happens when procedural bases specialties have to come to a halt. I’m not saying I’d rather sit in a clinic all day but it shows how much our field of anesthesia is reliant on someone else. Just things to keep in mind when thinking “anesthesia seems great”. It’s is great....in a functioning environment

I will “counter” this by some of the hospitals then relied on anesthesia to staff their ICU. Of course, I feel this is the minority than “elective cases cancelled, you all take mandatory time off....”
 

Arch Guillotti

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I would also add that COVID should open any MS4/Interns outlook on the future as well. The pandemic has shown what happens when procedural bases specialties have to come to a halt. I’m not saying I’d rather sit in a clinic all day but it shows how much our field of anesthesia is reliant on someone else. Just things to keep in mind when thinking “anesthesia seems great”. It’s is great....in a functioning environment
Yes. But the OR is the gravy train. Can’t keep it down for too long!
 
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bigdan

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And probably makes a killing. People pay a lot of money to get pregnant.
How competitive is REI? The promised land of OB ain’t easy to come by.

Regarding money, she makes a killing for the hospital, that’s for sure. Regarding personal income, it’s safe to say the mortgage is paid on time and we have food on the table, but she doesn’t make the Top 10 Salary list that gets printed in the papers at tax time.

I don’t have the recent Match data for OB subspecialties committed to memory, but REI was competitive if I recall correctly. But what field that allows for lifestyle control and reasonable pay doesn’t require some extra effort to get into? I’m just saying that all OB grads aren’t remanded to some hellscape of 24/7 baby catching and off-hrs STAT sections. Most of these “should I do Anesthesia?” threads devolve into folks stating what they would have done, or what the OP “should do”, and then list all sorts of super-competitive stuff that is notoriously difficult to get into.

If the OP of this thread wants to consider OB, does it and wants out of the classic OB lifestyle, (s)he has options, that’s all I’m sayin’.
 
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SaltyDog

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I would think running a successful REI practice would involve a lot of practice management, overhead, staffing, and self-promotion that might not be "clinical" hours, but still be rather time consuming.
 
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