Specialty Crisis

[freakingthefout]

Throughout med school I have struggled significantly with specialty choice. There was seemingly no specialty that fit me. So I decided upon IR as it seemed to fit most of the things I was wanting, such as procedures and cool technology and semi-decent hours even in residency.

Fast forward to today. We get a consult to the PICU for a 1 year old kiddo in multiorgan failure. We went to see the kid. While I readily admit I did literally nothing other than pulling the attending's gloves and watching, I felt alive in that moment. Never before have I felt that much compassion or desire to help. On surgery and medicine, I always had this thought in the back of my mind "well no crap you're out of breath you smoke 3 packs a day" or "Oh wow you need bariatric surgery? What a shocker with that diet". I know those people need help but they were just not people I felt particular sympathy for.

I initially kind of wrote off peds because I can't stand well-child checks or long rounds. And so this is where I am stuck. I want to work with kids, do a procedure here and there, and NOT round with the family until 2 PM every day. Perhaps a fellowship in PICU or NICU would fit, but I know they have long ass rounds too. I love surgery, but I’m not sure if I could survive a surgery residency (as much as I want to).

I've set up my entire ERAS for IR. What do I do now? Do I pursue peds? Throw IR away, try to make peds connections in literally 15 days, get new letters, etc? Something else? Peds IR is an option but is a really, really small field. Ugh. I don't know where to go from here.

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[DocWinter]

It's not too late and peds is not a difficult field to match into. Can you rotate in it next month and get a LOR, or get one from your peds core? Apps don't go out for a week..not too late to revise a PS and make some adjustments.

 

[Crayola227]

you basically just described how you like the only fun exciting 1 hour of a job and hate the rest of it

 

[thepoopologist]

I've always made life changing decisions based on single moments, when emotions are running high. That has always made sense to me.

 

[Dr G Oogle]

Do pediatric IR

Interventional Radiology | Children's Hospital of Philadelphia

 

[freakingthefout]

Maybe pediatric IR is the best fit then.

you basically just described how you like the only fun exciting 1 hour of a job and hate the rest of it

I hate parts of literally every specialty.

I've always made life changing decisions based on single moments, when emotions are running high. That has always made sense to me.

Awesome

 

[togaedere]

Yes, it's true that you are basing this huge life change based on one moment you had ... but everyone has lightbulb moments, and I think you're using this to really reflect on what you want to do. As a half pediatrician (i'm med-peds) I totally get the appeal of kids, and while I also really like working with adults (with all the things they do to themselves) there's something really sustaining about seeing a sick get get better.

So, talk to someone at your school. You need good advising going forward and every day is going to matter. Letters probably don't have to be uploaded until October 1st but if you are seriously going to change direction you gotta make sure you're primed in the best way possible. Maybe it's pediatrics, maybe peds IR is more realistic than you think it is. I even spent a day with a peds radiologist and it seemed like he was having a great time.

I guess what I'm saying is I would listen to that. Not quite the same, but I changed late in 3rd year cus of peds. I would just talk to a few people if you can in the next couple of days.

Maybe pediatric IR is the best fit then.



I hate parts of literally every specialty.



Awesome

 

[Peach Newport]

You used the phrase "kiddo." You know what that means - you pretty much have to go peds now.

 

[BigRedBeta]

Fast forward to today. We get a consult to the PICU for a 1 year old kiddo in multiorgan failure. We went to see the kid. While I readily admit I did literally nothing other than pulling the attending's gloves and watching, I felt alive in that moment. Never before have I felt that much compassion or desire to help. On surgery and medicine, I always had this thought in the back of my mind "well no crap you're out of breath you smoke 3 packs a day" or "Oh wow you need bariatric surgery? What a shocker with that diet". I know those people need help but they were just not people I felt particular sympathy for.

I initially kind of wrote off peds because I can't stand well-child checks or long rounds. And so this is where I am stuck. I want to work with kids, do a procedure here and there, and NOT round with the family until 2 PM every day. Perhaps a fellowship in PICU or NICU would fit, but I know they have long ass rounds too. I love surgery, but I’m not sure if I could survive a surgery residency (as much as I want to).

As a PICU attending, thank you for reminding me that my job looks pretty badass to outsiders.

I don't have the answers for you, but perhaps can provide some perspective that may help (or only make the situation worse).

1) Yes, kids haven't done anything to themselves usually. That is certainly a draw for those of us with a strong cynical streak. The flipside of course is that the people who are supposed to love and protect children sometimes do an incredibly ****ty job of it. That can be far more infuriating than the adults who simply make poor choices for themselves.

2) There are plenty of us in the NICU and PICU that specifically chose those fields because they don't have clinic, so you wouldn't be the first to walk into a peds residency with that sort of outlook. The key is to embrace the learning opportunities and recognize how being a great general pediatrician will make you a better pediatric subspecialist.

3) Students always are drawn to procedures, but the truth of the matter is they lose their appeal pretty quickly - particularly for the sort of procedures that are not particularly disease specific. By that I mean things like art lines, CVL's, intubations, chest tubes and LPs...not that they become boring, but they become more muscle memory than critical thinking exercise by the time youre through fellowship. And perhaps after your 300th gall bladder or embolization in IR or what have you, it's the same feeling, but I imagine that the OR (and even the IR suite) provides a different sort of intellectual satisfaction than the run of the mill stuff I mentioned.

4) Peds isn't hard to match into, and if you have scores good enough for IR, with a compelling personal statement that you could write, you should be okay for a number of programs, even without the peds letter. That doesn't mean you'll be looking at the Bostons/Baylors/CHOPs/Cinci's of the world, but a large number of clinically strong, academic, free standing children's hospitals would be certainly attainable, particularly if you don't have significant geographic limitations. And peds fellowships are easier to obtain so doing well as a resident is really all you need. If you want to PM me, I can give you a list of places that would be potential good fits.

5) you of course know yourself, but I will echo the sentiment above that one hour does not make a career. Perhaps that's just me, as I tend to be a planner and cautious in my decision making.