Specialty choice crisis...

[SLC]

I'm in a bit of a bind over whether to apply to Internal Medicine or Family Medicine. It's making me sick since applications (ACGME) get submitted in September.

I was fairly certain I'd be applying for Internal Medicine until April when I did a medicine rotation with the residency program at a local community hospital. That was the worst month of my life, and I think that the malignancy of the program was only half the problem. I just didn't even enjoy the work anywhere near like I thought I would. It was so monotonous, doing the exact same thing over and over again. The only thing that changed from one patient to another was the issue they were hospitalized for; but in general we went through the same motions with everyone. I think if I had to do that day in and day out for 3 years I might quit residency completely.

Problem is, I did an elective in HemeOnc and fell in love with it. Unfortunately this was before the bad experience in IM so I didn't have that to temper my enthusiasm. If only there was such a thing as a HemeOnc residency so I could skip the 3 years of IM completely.

On the other hand, I really really liked my outpatient medicine, pediatrics, family medicine, OBGyn, and Surgery rotations, so I think a residency in Family Med would suit me well since it incorporates things from all of these fields. And there is an excellent Family Med residency in the hospital I've been doing most of my rotations in. With another about 45 mins away that has taken graduates of my school. I know 3 or 4 docs who recently graduated that program. I have good board scores, and access to good LOR's; and I think I would have a great shot at good FM programs. But would I regret not doing HemeOnc for the rest of my career? I honestly don't know the answer to that question.

Has anyone here faced such a dilemma? How did/would you go about deciding what to do? I honestly don't know what I should do between now and September...

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[koan]

Why not peds with a heme/onc fellowship? I've always felt like a peds residency would be vastly more interesting, tolerable and even fun than IM. I would never make it through IM, personally. And with peds there is still a wide net of fellowship opportunities. Less so it seems with FM.

 

[AMEHigh]

Are you able to do another heme-onc elective over the next few months? If so, then I'd probably do that and in the mean time just apply to both. It sucks to waste money on extra application fees but it might be worth it to make sure you're choosing correctly.

Also, remember that many (most?) family med residency programs do a lot of inpatient rotations as well. So going with family med isn't going to get you completely out of inpatient medicine.

I also really, really dislike medicine, so I feel your pain, but if it were the means to something greater (heme-onc) then I could probably tolerate it for a few years.

Good luck in your decision!

 

[DermViser]

Problem is, I did an elective in HemeOnc and fell in love with it. Unfortunately this was before the bad experience in IM so I didn't have that to temper my enthusiasm. If only there was such a thing as a HemeOnc residency so I could skip the 3 years of IM completely.

On the other hand, I really really liked my outpatient medicine, pediatrics, family medicine, OBGyn, and Surgery rotations, so I think a residency in Family Med would suit me well since it incorporates things from all of these fields. And there is an excellent Family Med residency in the hospital I've been doing most of my rotations in. With another about 45 mins away that has taken graduates of my school. I know 3 or 4 docs who recently graduated that program. I have good board scores, and access to good LOR's; and I think I would have a great shot at good FM programs. But would I regret not doing HemeOnc for the rest of my career? I honestly don't know the answer to that question.

Has anyone here faced such a dilemma? How did/would you go about deciding what to do? I honestly don't know what I should do between now and September...

LOL! You know it's important to have a good IM background before doing Heme/Onc right?

I think the question is what you're looking for in your career. And only you can answer that.

 

[SLC]

LOL! You know it's important to have a good IM background before doing Heme/Onc right?

I think the question is what you're looking for in your career. And only you can answer that.

Yes I know that, and if you're referring to my elective rotation, I somehow managed to honor it without a prior IM rotation.

But the requirement of a good IM background is what gives me pause. Not that I don't want the skills/knowledge I could get. Just that I'm not sure I would stay sane for it. It may be bad enough that I'd struggle to keep myself elligible for a good fellowship anyway.

 

[DermViser]

Yes I know that, and if you're referring to my elective rotation, I somehow managed to honor it without a prior IM rotation.

But the requirement for a good IM background is what gives me pause. Not that I don't want the skills/knowledge I could get. Just that I'm not sure I would stay sane for it. It may be bad enough that I'd struggle to keep myself elligible for a good fellowship anyway.

Well, yes, Hematology/Oncology is a very competitive fellowship, as is GI or Cardiology. Some people do "chief" years, if they aren't competitive enough to get into those spots. But yes, with IM there is very much the possibility that you may end up as a General IM doc. You'll have to decide whether you feel this is a risk worth taking.

 

[SLC]

Well, yes, Hematology/Oncology is a very competitive fellowship, as is GI or Cardiology. Some people do "chief" years, if they aren't competitive enough to get into those spots. But yes, with IM there is very much the possibility that you may end up as a General IM doc. You'll have to decide whether you feel this is a risk worth taking.

I'm less worried that I can be competitive, Onc research is something I think I would love and excel at. The only thing is that I could forsee some good burnout happening early on on the wards, which may make putting in the necessary effort consistently, a tough thing to do.

But if I'm going to be a Primary Care doc, I'd much rather do FM and have some Peds and OB, as well as small procedures etc. mixed in there.

 

[DermViser]

I'm less worried that I can be competitive, Onc research is something I think I would love and excel at. The only thing is that I could forsee some good burnout happening early on on the wards, which may make putting in the necessary effort consistently, a tough thing to do.

But if I'm going to be a Primary Care doc, I'd much rather do FM and have some Peds and OB, as well as small procedures etc. mixed in there.

You won't have much protected time to do Onc research during IM residency. Also for FM, you'll have to see the FM thread, but I believe the procedures you are allowed to do will depend on whether you live in a rural or suburban area.

 

[SLC]

You won't have much protected time to do Onc research during IM residency. Also for FM, you'll have to see the FM thread, but I believe the procedures you are allowed to do will depend on whether you live in a rural or suburban area.

Yeah, all my FM rotations have been Urban/Suburban. I'm happy with the procedures they do. Anything above and beyond that would be gravy as far as I'm concerned.

 

[SurgeDO]

look into academic IM. i have heard others complain of monotony at community IM rotations.

 

[cliquesh]

Intern year kind of sucks in IM, but it gets significantly better as you become more senior, at least where I am.

2/3's of DOs applying for hem/onc match.

 

[meliora27]

Assuming you match at an ACGME university program for your internal medicine residency that has numerous in-house fellowships to provide ample research/publication experience as well as perhaps an easier time matching down the road for fellowship, does the DO bias that exists for residency subside at all when applying to fellowships if you're university trained?

 

[hallowmann]

Intern year kind of sucks in IM, but it gets significantly better as you become more senior, at least where I am.

2/3's of DOs applying for hem/onc match.

I'm very glad to see that things have improved for you!