Specialties that provide opportunities (and time) to go down rabbit holes?

[wildfan1]

M3 here, US Allopathic student at mid tier school. I've enjoyed every rotation, like all types of patient populations and pathology. I loved and was great on my surgery rotation (and the small amount of subspecialty stuff I saw) but Step 1 not competitive and my wife would kill me haha. I also felt equally excited to come to the hospital for my medicine, psych, neuro, FM, elective, etc etc rotations - have just loved every minute of M3. I've also gotten along well with each group of residents and attendings, and have always been able to fit into multiple groups, was always a "social butterfly", etc. Luckily, I'll have at least 1 letter of rec from pretty much every rotation that I can use as needed based on what I decide to do.

The thing I keep coming back to is that I really enjoyed the patients that I had to "go down a rabbit hole" of information to figure out what is wrong, ie the opposite of bread and butter. Looking for advice on which specialties allow for this type of activity most often (obviously every specialty has its bread and butter). Also, part of it might be my ADHD and my ability to harness my hyperfocus on new problems or tasks (ie back in the day I wrote my 50+page thesis paper in one sitting over 2 days straight, was accepted without edits, but I am unfortunately terrible at the mundane - if it is routine I get bored). I also spent time in EM during the first 2 years, and while I enjoyed it I often left feeling unsatisfied as many problems were not solved, couldn't stand not knowing the outcome.

(**Or maybe I feel this way because I'm a med student learning new info? so then the question would change to: what specialty will require the MOST new learning over a lifetime of practice? Obviously we should be engaging in lifelong learning in every specialty, but which require it the most, which I think I'd desire...)

I'm especially interested in your thoughts as we select our M4 electives soon. Thanks for your time!

---

Members don't see this ad.

 

[Doctor Christmas]

M3 here, US Allopathic student at mid tier school. I've enjoyed every rotation, like all types of patient populations and pathology. I loved and was great on my surgery rotation (and the small amount of subspecialty stuff I saw) but Step 1 not competitive and my wife would kill me haha. I also felt equally excited to come to the hospital for my medicine, psych, neuro, FM, elective, etc etc rotations - have just loved every minute of M3. I've also gotten along well with each group of residents and attendings, and have always been able to fit into multiple groups, was always a "social butterfly", etc. Luckily, I'll have at least 1 letter of rec from pretty much every rotation that I can use as needed based on what I decide to do.

The thing I keep coming back to is that I really enjoyed the patients that I had to "go down a rabbit hole" of information to figure out what is wrong, ie the opposite of bread and butter. Looking for advice on which specialties allow for this type of activity most often (obviously every specialty has its bread and butter). Also, part of it might be my ADHD and my ability to harness my hyperfocus on new problems or tasks (ie back in the day I wrote my 50+page thesis paper in one sitting over 2 days straight, was accepted without edits, but I am unfortunately terrible at the mundane - if it is routine I get bored). I also spent time in EM during the first 2 years, and while I enjoyed it I often left feeling unsatisfied as many problems were not solved, couldn't stand not knowing the outcome.

(**Or maybe I feel this way because I'm a med student learning new info? so then the question would change to: what specialty will require the MOST new learning over a lifetime of practice? Obviously we should be engaging in lifelong learning in every specialty, but which require it the most, which I think I'd desire...)

I'm especially interested in your thoughts as we select our M4 electives soon. Thanks for your time!

I would say this meets IM criteria. It's not infrequent where a bunch of things could be causing pathology so you have to do extensive w/u. That's where your friendly internist/hospitalist comes in. Rheumatology also fits the bill, Heme/onc.

 

[psych md jd]

Forensic psychiatry.

Banker' s boxes of records: police reports, court transcripts, treatment records, interviews. Opportunities for travel. Work your own hours.

No two cases the same.

 

[ThoracicGuy]

M3 here, US Allopathic student at mid tier school. I've enjoyed every rotation, like all types of patient populations and pathology. I loved and was great on my surgery rotation (and the small amount of subspecialty stuff I saw) but Step 1 not competitive and my wife would kill me haha. I also felt equally excited to come to the hospital for my medicine, psych, neuro, FM, elective, etc etc rotations - have just loved every minute of M3. I've also gotten along well with each group of residents and attendings, and have always been able to fit into multiple groups, was always a "social butterfly", etc. Luckily, I'll have at least 1 letter of rec from pretty much every rotation that I can use as needed based on what I decide to do.

The thing I keep coming back to is that I really enjoyed the patients that I had to "go down a rabbit hole" of information to figure out what is wrong, ie the opposite of bread and butter. Looking for advice on which specialties allow for this type of activity most often (obviously every specialty has its bread and butter). Also, part of it might be my ADHD and my ability to harness my hyperfocus on new problems or tasks (ie back in the day I wrote my 50+page thesis paper in one sitting over 2 days straight, was accepted without edits, but I am unfortunately terrible at the mundane - if it is routine I get bored). I also spent time in EM during the first 2 years, and while I enjoyed it I often left feeling unsatisfied as many problems were not solved, couldn't stand not knowing the outcome.

(**Or maybe I feel this way because I'm a med student learning new info? so then the question would change to: what specialty will require the MOST new learning over a lifetime of practice? Obviously we should be engaging in lifelong learning in every specialty, but which require it the most, which I think I'd desire...)

I'm especially interested in your thoughts as we select our M4 electives soon. Thanks for your time!

IM in an academic setting may be something what you are looking for. The only thing to remember is that even with the crazy stuff that isn't necessarily straightforward, it will all often become routine.

 

[LucidSplash]

Check out the Department of Diagnostic Medicine at Princeton-Plainsboro Teaching Hospital. The guy that runs the department is a little out there, but it sounds like it might be a good fit for you.

 

[wildfan1]

Check out the Department of Diagnostic Medicine at Princeton-Plainsboro Teaching Hospital. The guy that runs the department is a little out there, but it sounds like it might be a good fit for you.

Haha was only a matter of time until a House reference. To be clear, I'm not interested in doing all the lab work for patients myself, as seems to be the operating procedure at Princeton-Plainsboro

 

[doc05]

M3 here, US Allopathic student at mid tier school. I've enjoyed every rotation, like all types of patient populations and pathology. I loved and was great on my surgery rotation (and the small amount of subspecialty stuff I saw) but Step 1 not competitive and my wife would kill me haha. I also felt equally excited to come to the hospital for my medicine, psych, neuro, FM, elective, etc etc rotations - have just loved every minute of M3. I've also gotten along well with each group of residents and attendings, and have always been able to fit into multiple groups, was always a "social butterfly", etc. Luckily, I'll have at least 1 letter of rec from pretty much every rotation that I can use as needed based on what I decide to do.

The thing I keep coming back to is that I really enjoyed the patients that I had to "go down a rabbit hole" of information to figure out what is wrong, ie the opposite of bread and butter. Looking for advice on which specialties allow for this type of activity most often (obviously every specialty has its bread and butter). Also, part of it might be my ADHD and my ability to harness my hyperfocus on new problems or tasks (ie back in the day I wrote my 50+page thesis paper in one sitting over 2 days straight, was accepted without edits, but I am unfortunately terrible at the mundane - if it is routine I get bored). I also spent time in EM during the first 2 years, and while I enjoyed it I often left feeling unsatisfied as many problems were not solved, couldn't stand not knowing the outcome.

(**Or maybe I feel this way because I'm a med student learning new info? so then the question would change to: what specialty will require the MOST new learning over a lifetime of practice? Obviously we should be engaging in lifelong learning in every specialty, but which require it the most, which I think I'd desire...)

I'm especially interested in your thoughts as we select our M4 electives soon. Thanks for your time!

You are being unrealistic. Situations like this are few and far between, and so many of these patients cannot be adequately helped because their diagnoses are so rare that there isn't effective treatment anyway.

Consider a career in research, because pretty much all clinical jobs will be routine.

 

[LucidSplash]

Haha was only a matter of time until a House reference. To be clear, I'm not interested in doing all the lab work for patients myself, as seems to be the operating procedure at Princeton-Plainsboro

Yeah. See the comments by doc05. That was what I was getting at in a smartass kind of way. What you are looking for is not a realistic view of any medical specialty. It only exists in fiction.

 

[wildfan1]

You are being unrealistic. Situations like this are few and far between, and so many of these patients cannot be adequately helped because their diagnoses are so rare that there isn't effective treatment anyway.

Consider a career in research, because pretty much all clinical jobs will be routine.

Yes great points - to be clear while I "really enjoy" going down the rabbit hole, i still certainly enjoyed the bread and butter parts of each specialty. Every so often, we'd get a patient needing the deep dive, and it was a treat, but that didn't mean I disliked anything not unique. And furthermore I was able to really show make a big impact for those patients requiring a deeper dive, and I attribute some of my success grade-wise in the clinical environment to how my attendings reacted to my involvement with these types of cases. Maybe I've been trained by the feedback to feel like these types of cases provide the greatest reward/praise...idk

Also I am looking forward to continuing with my clinical and health education research efforts long term. thanks!

 

[wildfan1]

Yeah. See the comments by doc05. That was what I was getting at in a smartass kind of way. What you are looking for is not a realistic view of any medical specialty. It only exists in fiction.

yes for sure, see my reply to doc05

and also I don't play the electric guitar, ride a motorcycle, get aroused by saying sarcoidosis or lupus every 10th word, am not a drug addict, and don't try to kill people to prove a diagnosis is correct haha

when I started med school i was thinking EM, which couldn't be further from where I would likely fit best. Based on the above replies, I'm probably looking at something inpatient (IM or Neuro) in academic setting or an IM subspecialty (the psych idea was interesting too)

 

[UTsksk]

It'll come down to what bread and butter stuff can you tolerate on a daily basis. Each field has their own rare disorders that sound cool. It was the day to day stuff that helped me figure out my specialty. Plus you need to figure out if you want to do procedures or not. That can help you narrow down your list.

I thought for the longest time I was going to be an intensivist because of complex patients, small procedures, and vents. When it came down to it, I hated ICU rounding (they round forever), which is a basic thing that has to be done.

 

[michaelrack]

Infectious diseases or rheumatology

 

[WingedOx]

Check out the Department of Diagnostic Medicine at Princeton-Plainsboro Teaching Hospital. The guy that runs the department is a little out there, but it sounds like it might be a good fit for you.

Just be careful, I've heard some questionable stuff about the PD...

 

[wildfan1]

Just be careful, I've heard some questionable stuff about the PD...

Yea seems like quite a narcissist. Maybe instead I'll look into Grey-Sloan Memorial hospital, shouldn't be too competitive as I'm sure applicants are scared away by the high incidence of residents and staff dying.

 

[WingedOx]

Yea seems like quite a narcissist. Maybe instead I'll look into Grey-Sloan Memorial hospital, shouldn't be too competitive as I'm sure applicants are scared away by the high incidence of residents and staff dying.

Don't act like people wouldn't be going great lengths to be at a malignant program if said program was in the Pacific Northwest.

 

[siliso]

Please consider the excellent and engaging field of Internal Medicine. If you love to nerd out you’ll love us. If you want to know the rest of the story after the ED you belong with us. If you’re interested in what’s happening with all the organs and not just your symptom or procedure you’re our kind of person. I guess I have to mention neuro too, but really, Medicine! Good old medicine!

 

[Mad Jack]

Yeah. See the comments by doc05. That was what I was getting at in a smartass kind of way. What you are looking for is not a realistic view of any medical specialty. It only exists in fiction.

I'd disagree. Forensic psychiatry provides extremely challenging cases on the regular

 

[siliso]

Yeah forensic psych also extremely cool. I had a great 4th yr rotation doing that that’s served me well as a medicine doc believe it or not. Also path. Forensic path, autopsies. But when you love and are curious about everything I’m still gonna plug for medicine, you will see everyone (adult, sick kids make me too sad) with every disease and you can look at slides, images, whatever in the context of your relationship with your actual patient whose story you get to follow. ❤️IM. Never leaves me bored (inpatient/outpatient mix) and I’m extemely susceptible to boredom.

 

[LucidSplash]

Forensic path isn’t a good path (pun interested) for the OP. I did a rotation as a 4th year student at a very very busy ME office. While it was great for anatomy and a good experience, we didn’t really go down any rabbit holes. If there isn’t an obvious COD, most people get labeled as CV disease if the wall of the LV is a little thickened, without ever looking at the coronary arteries. That can change pending the results of the standard tox panels that take weeks to come back.

Unless you are really interested in the decomp cases but even the forensic path people didn’t like those.

 

[wildfan1]

Please consider the excellent and engaging field of Internal Medicine. If you love to nerd out you’ll love us. If you want to know the rest of the story after the ED you belong with us. If you’re interested in what’s happening with all the organs and not just your symptom or procedure you’re our kind of person. I guess I have to mention neuro too, but really, Medicine! Good old medicine!

This is exactly what I'm looking for, thanks for confirming my suspicions!

 

[siliso]

I see freaking cool rabbit hole cases every week at the good old midwestern VA. Treat a lot of COPD and CHF and DM too but there is pride and satisfaction in skillfully diagnosing and managing them. Your description of yourself is very resonant with me and with our best residents. So with that said, if you will pursue IM then you can take one of two paths 4th yr.
1, what I did: take electives in everything interesting that you might not get to do again like autopsies and forensic psych
2, what a lot of people do: take electives in IM specialties where you’d like to brush up your content knowledge.
I think either is fine and 2 might be more advisable if you have content area weaknesses or need to buff up your residency application for whatever reason.

 

[wildfan1]

I see freaking cool rabbit hole cases every week at the good old midwestern VA. Treat a lot of COPD and CHF and DM too but there is pride and satisfaction in skillfully diagnosing and managing them. Your description of yourself is very resonant with me and with our best residents. So with that said, if you will pursue IM then you can take one of two paths 4th yr.
1, what I did: take electives in everything interesting that you might not get to do again like autopsies and forensic psych
2, what a lot of people do: take electives in IM specialties where you’d like to brush up your content knowledge.
I think either is fine and 2 might be more advisable if you have content area weaknesses or need to buff up your residency application for whatever reason.

thanks so much, extremely helpful!!!