Specialty advice

[JJArms22]

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At the beginning of 2nd year I was drifting towards doing IM. I had just finished a cardiology elective, and while it was not the most stimulating, it was interesting. I figured I'd get a decent step 1 score and that'd be it since middle of the road IM isn't that competitive. In all reality though I was and still am open to pretty much anything other than primary care and surgery (and even still, I'm probably open to surgery if I like my clerkship, but I doubt it). Forward to yesterday. I got a 253 on my exam. Now I'm not sure what that hell I wanna do. All I know is I need to figure it out relatively soon if I end up liking something competitive. I really liked ENT 1st year based off a few workshops and just a fascination with the physiology/anatomy. I quickly rescinded the possibility after figuring out how competitive it is. Now, i'm not saying I wanna be an ENT, but if I did, I would obviously need to get on the ball with research, networking, etc. The bottom line though is that I still don't know what I wanna do, and I'm not sure where to go from here. Any advice would be much appreciated. Thanks!

 

[TBV]

Yeah pretty much this except replace ENT with Derm... what to do

 

[Psai]

Start looking into research and become buddies with the big wigs

 

[Burla]

You said you don't want to do surgery, but then you're going on about ENT? You don't need to let your score change your specialty interests to a more competitive specialty. A good score can do other things for you like landing the residency location you want

 

[ItsAboutThePatient]

The right choice is ortho. They make the most money. The lifestyle can be very good. You can do something like hand surgery where you get to sit down and operate all day. I just did my ortho rotation and afterwards I just wished that I'd taken step 1 more seriously. Do an ortho rotation. You'll dig it.

 

[JJArms22]

You said you don't want to do surgery, but then you're going on about ENT? You don't need to let your score change your specialty interests to a more competitive specialty. A good score can do other things for you like landing the residency location you want

I meant more so general surgery. The location doesn't matter to me right now. My goal right now is to figure out what I like not where I want to go.

 

[JJArms22]

The right choice is ortho. They make the most money. The lifestyle can be very good. You can do something like hand surgery where you get to sit down and operate all day. I just did my ortho rotation and afterwards I just wished that I'd taken step 1 more seriously. Do an ortho rotation. You'll dig it.

I've never thought about ortho because I honestly don't know much about it. The money isn't the reason, even if that sounds cliche. I just don't want to do primary care, ever.

 

[Hangry]

Honestly my biggest advice is to wait and see what third year brings. I got a much higher step score than I was expecting back in second year and considered jumping onto the competitive surgical subspecialty train. Unfortunately there isn't much you can do to help your case at this point besides make sure you schedule electives in fields you may be interested in (the earlier in 3rd year the better) and maybe start doing some janky research that you can kind of sort of do around clinical responsibilities but really ends up being a half-assed case report/chart review and sucks the life out of you.

My point is, third year sucks. The grind is HARD, and you need to be grinding for those honors if you want to do a competitive specialty. Adding research onto your plate is miserable, especially when you are just getting your feet wet in the clinics and going through that adjustment period. Now HARD isn't necessarily the end of the world, but I would recommend waiting to sacrifice your free time (and potentially your grades) until you are fairly certain you are going for that specialty. Probably after an elective in that field or at least doing some OR/not OR and Inpatient/not Inpatient rotations to start narrowing your future career down. Then when you are sure you are ready to give that dream competitive career 100%, go ahead and embrace the suck and go for it. Most people that I have observed at my own medical school that decided on competitive specialties late pick up some crap project mid to late third year, work at it until interview season so they can put the experience on their eras, then drop it like a hot potato and still match fine.

Now you are asking, Hangry, did you follow your own advice? No OP, I did not. I went into my first rotation with projects lined up in my hypothetical competitive field, would go in to rotations at 545am, work until 6pm, come home, eat, study for the shelf, then stay up til midnight chart reviewing for a crap project that I would get to be probably third author on (if it ever got published, which of course it didn't, because the first author on it was one of those "late deciders" I alluded to above that is just doing research to play the game and doesn't give two sh*ts about actually getting anything done.) Now I take tests well and am generally likable, so my grades didn't get affected too much, but I have friends pushing for Derm and ENT who have taken hits grade-wise because they spent too much time on research. And in the end, here I am a new fourth year going into Gen Surg because those subs have too much damn clinic and office/outpatient surgery really isn't my thing.

TLDR- I would get my feet wet into third year before trying anything drastic to make myself competitive for any certain specialty. Don't let your step 1 choose your specialty for you, use it as a tool to open doors to what you actually want to do.

 

[bc65]

My advice is to fall in love with derm.
I'm serious.
This is not a joke.
Thank me later.
That is all.

 

[psychhopefull2016]

To totally mimic what people above said. Just because you CAN match into something competitive doesn't mean that is what will be right with you. Do whatever lights a fire under you, competitive or not. My scores and grades could get me into derm if I wanted them too. My passion lies with psych. Find your spark and run with it, let those scores make PDs take notice but don't change your life based upon them

 

[Stagg737]

The right choice is ortho. They make the most money. The lifestyle can be very good. You can do something like hand surgery where you get to sit down and operate all day. I just did my ortho rotation and afterwards I just wished that I'd taken step 1 more seriously. Do an ortho rotation. You'll dig it.

I wouldn't trust this advice. Even if you do somehow manage to get into a fellowship and become one of the hand guys, you've gotta finish residency first, which is 5 years of working harder than 90% of the other residents out there. Then after fellowship it'll probably take 3-5 years to build up a decent patient base before you could really consider the lifestyle to be 'very good', and that's if you go into private practice. Yes, the money in ortho is great, but the lifestyle before and right after residency is not.

 

[JJArms22]

Thanks for all the advice, guys. I agree with you all about not letting grades change your decision to choose a certain specialty. However, that's not really my dilemma here. If I fall in love with peds, cool. I'm not shutting it out based on my score. I'd be shutting it out based on prior experience with me not liking it. I basically ruled out anything competitive at the beginning of second year because I thought I didn't have the potential or motivation to compete with others. Now that I see that I have the ability if I put in the work, I want to look into those specialities that I excluded off the bat. That's the point. But unfortunately as we all know, other than a couple electives, you won't be able to do rotations in every field that interests you doing third year. What I wanted was advice on how to expose myself to these specialities during third year without it being too late in the year for me to even consider it.

 

[Tenk]

Go to the program director of X department you are interested in. Ask their secretary if you can schedule a short meeting or just email them. Tell them your situation, ask if you can shadow them or someone else who would be interested. PDs generally like to help students succeed. I agree with the above though, if you go into the wrong field you will just wind up hating everything.

 

[GoodWillShunting]

Go to the program director of X department you are interested in. Ask their secretary if you can schedule a short meeting or just email them. Tell them your situation, ask if you can shadow them or someone else who would be interested. PDs generally like to help students succeed. I agree with the above though, if you go into the wrong field you will just wind up hating everything.

This. You have the scores, so now it's about interest. Get out and shadow (tough during M3), and /or meet with advisors. That's really all it is. Nobody here knows what the you like, and the best thing to do is actually just take a look at fields that seem interesting to you.

 

[NWwildcat2013]

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[Psai]

I came into medical school thinking anesthesia, as I entered the clinical years with a high step 1, thought I would like surgery. I thought pretty hard about ent, did some electives but decided it wasn't for me and stuck with anesthesia. Some advice I got here was that you shouldn't think that your high score should limit you to competitive specialties. It's just as hard to get interviews from competitive locations and a high step score helps you get there.

So far I'm really happy about where I'm at but ask me again in a few years. Or maybe February.

 

[JJArms22]

I am similar. Was an average med school applicant but med school just clicked and I wasn't expecting it. Honored everything in MS1 and 2 and hit 270+ on step. I always thought surgical subs were super cool (except neurosurg) but I didn't trust in myself and self selected out the first two years and focused on other somewhat procedural specialties (GI via IM, anesthesia, OBGYN, crit care, even gen surg etc.)

Now I'm open about liking ortho and everyone thinks I'm not being genuine or am not "committed". Don't worry what other people think... If you even have a slight interest you should check it out. With your score you'd be foolish not to at least investigate some of these options if you think you may like them.

All the people I've talked to at my school (faculty and high scoring people who decided late on hyper competitive specialties) said the tipping point is around fall. You kinda need to start getting on projects and networking by then if you want to avoid a gap year.

I actually think ENT is a tricky beast. I did some research into it and it is a SUPER small field where research and connections become more important. Maybe even more than in something like ortho.

I hate the timeline for selecting a specialty. There is no way I can make a fully informed decision until the end but that would mandate a gap year for the competitive specialties. I can't afford to do that at this point in my life. It's frustrating.

@JJArms22 when is your surgery clerkship? If it's early maybe wait to decide after that (my plan). Also what is junior AOA based on at your school?

Congrats on that ridiculously amazing score! That's awesome! I agree, I think the whole process of deciding on a speciality in such small amount of time is pretty unfortunate. I like your advice. I do think it'd be foolish to not even investigate some of these specialties I had initially ruled out. I guess my first goal though is to start figuring out what I genuinely like and dislike and go from there. The research aspect sucks though since I have to start that pretty soon and yet, I have no idea what I'd be doing research in and if it'd be pertinent to what I'll end up liking.
I'm not sure about junior AOA at my school. As far as my surgery clerkship goes, that's not until January. So that really doesn't help me out.

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[NWwildcat2013]

Hmm... that is too bad about the surgery timing. I think you should try to get into the OR and observe ENT cases and start to attend grand rounds even.

Think of it this way... if you do research in the most competitive thing you may like (ENT) and end up doing it then you are safe. If you don't then that research is still a benefit in a less competitive field.

 

[bc65]

I wouldn't do a surgical specialty if you're not really interested in surgery. It's too miserable a lifestyle and too hard a residency to do if you're not really motivated.

Serious advice here: As much as I like my specialty and as well suited as I found myself to that specialty, in retrospect I think I would have been fine in almost any field. After a while I came see that the similarities between specialties were greater than the differences. The exciting and challenging aspects soon become mundane. That's why I would suggest putting lifestyle and income very high up on your list of considerations when choosing a specialty.

Despite that, there are lots of reasons to dislike derm, but I would still take a long hard look at it.

I don't know what you like about ENT, but I think the most interesting surgical procedures are the facial reconstructions done after skin cancer excisions, and you can do most of those by doing derm followed by a Mohs fellowship.

If you like pedes because you want to work with kids, you could always do derm and then a pedes derm fellowship.