MD Specialty decision...

[Palindr0me]

Hey all, as an MS3 who had my clinical year already, thinking about what specialty to apply into is rapidly approaching. Thoughts of sub-I’s, gathering letters of rec, etc. are starting to stir and I’m hoping for some candid advice — personal experience would be helpful in this regard:

I was diagnosed with generalized anxiety and depression years ago (currently managing well with meds), and recently an idiopathic sleep disorder dx that is also somewhat well managed. With this in mind, I struggled quite a bit with clinical year and the demands that long work days, stressful situations, constant communication with patients/colleagues/EMR, etc had on me. I did well on all clerkships, but nonetheless felt a deep and heavy impact on my spirit from the work environment. My question is: should I still pursue internal medicine even if it might tear me apart (exaggerating, possibly...), or go into something like pathology/rads where I can better compartmentalize between work and my personal life?

Thank you ahead of time. This isn’t a medical advice question as much as it is seeking those who may have insight into this kind of circumstance and what you did to circumvent negative outcomes!


Sent from my iPhone using SDN mobile

---

Members don't see this ad.

 

[Radology]

You think radiology isn’t anxiety provoking?

Imagine have every single case you read available for review and second guessed by the entire hospital, every typo available for review by the patient, every miss available for review by the lawyer.

10 hours at a computer isn’t exactly good for sleep hygiene either.

You gotta get your problems treated or you’ll struggle in any field

 

[Palindr0me]

You think radiology isn’t anxiety provoking?

Imagine have every single case you read available for review and second guessed by the entire hospital, every typo available for review by the patient, every miss available for review by the lawyer.

10 hours at a computer isn’t exactly good for sleep hygiene either.

You gotta get your problems treated or you’ll struggle in any field

I think you’re conflating your insecurity about your specialty with my struggles in clinical medicine — if you want more detail you could ask for that, too. Thanks for the snarky answer, I guess?


Sent from my iPhone using SDN mobile

 

[MerYangBey]

Do you actually want to be a pathologist or radiologist
As in are you interested in them at all or is it just the hours/lifestyle you desire?

 

[getdown]

I think you’re conflating your insecurity about your specialty with my struggles in clinical medicine — if you want more detail you could ask for that, too. Thanks for the snarky answer, I guess?


Sent from my iPhone using SDN mobile

Radiology's answer is perfectly legitimate. Every field of medicine is associated with particular stressors unique to that field. If you're having trouble dealing with stressful situations than you need to fix that as there is no field without any kind of threat of litigation if you **** up. Radiology is exactly as Radiology posted. You're on call at night alone and responsible for looking at STAT imaging where a missed diagnosis can lead to a severely bad outcome for patients. Same with pathology. Sure the hours probably aren't as bad and minimal call but you get ****ty tissue that you have to read and diagnose usually for cancer. Miss that cancer diagnosis cause you can barely see any cells on the stain? Well patient dies from cancer. So, the ultimate answer is for you to get these issues under control prior to getting into residency or you're going to flame out regardless of what specialty you go into.

 

[831929]

How about hospitalist (adult or peds)? You can consult with other fields on most issues.

 

[Radology]

I think you’re conflating your insecurity about your specialty with my struggles in clinical medicine — if you want more detail you could ask for that, too. Thanks for the snarky answer, I guess?


Sent from my iPhone using SDN mobile

I’m legitimately curious which part of my response you think is snarky (and lol @ calling me snarky after psychoanalzing my comment as my insecurities).

You’re implying that rads or path is your escape from the anxiety that comes with clinical medicine. I’m telling you there are plenty of stressors in any field, giving you examples in radiology

 

[differentiating]

I was diagnosed with generalized anxiety and depression years ago (currently managing well with meds), and recently an idiopathic sleep disorder dx that is also somewhat well managed. With this in mind, I struggled quite a bit with clinical year and the demands that long work days, stressful situations, constant communication with patients/colleagues/EMR, etc had on me. I did well on all clerkships, but nonetheless felt a deep and heavy impact on my spirit from the work environment. My question is: should I still pursue internal medicine even if it might tear me apart (exaggerating, possibly...), or go into something like pathology/rads where I can better compartmentalize between work and my personal life?

As everyone before me said - path/rads isn't going to shelter you from the stresses and demands of medicine; those will still exist. You mention that you are managing well with meds, but perhaps your anxiety/depression/sleep issues aren't being as fully treated as they could be. I had baseline anxiety that worsened over the course of medical school, and started medications partway through my clinical years - and once I found a dose that worked well for me, it was like night and day.

Managing your depression and anxiety is step one. From there, you should determine what specialty you're most interested in, with lifestyle being one factor. I love the specialty I chose, and I noticed that I was happier/healthier on that rotation than on most others.

 

[ACSurgeon]

While there will be stress in every field of medicine, let’s not pretend the frequency and severity is similar. It’s one thing to deal with stress or sleep deprivation occasionally; totally different thing when it happens daily.

Not sure which fields have the lowest stress. Members of any field can emphasize the stress the experience because they’re in it.

Nonetheless, agree that better management of anxiety will be 1000 times better than trying to avoid stress. You might just end up in a residency with more stress than average for that given specialty

 

[Lnsean]

Radiologists have one of the highest rates of lawsuits. It's tic for tat. If you want cushy and non stressful...what about derm?

 

[Ho0v-man]

Family med or psych. Once you get out of residency, you can work as much or as little as you want. 4 days/week 8-4 no call is pretty typical for the FM docs back home. I’m strongly considering both myself.

Radiology is super stressful. How do you think you’d do being an hour behind on reads by yourself in the middle of the night fielding multiple pages about stat reads, ER doc questions, tech questions, surgeon questions, etc?

Path is probably less stressful bc of better hours, but you get crap samples and have to somehow piece together a dx. Our path teachers do brag A LOT about how good their schedules are, though.

 

[Raney Schauer]

It's tic for tat.

You don't really think that the saying is "tic for tat", do you? The C and the T keys are way too far apart for me to think that this is a typo.

 

[Lnsean]

You don't really think that the saying is "tic for tat", do you? The C and the T keys are way too far apart for me to think that this is a typo.

I was thinking tic tacs when typing this. For various reasons, typos happen...why is it such a big deal if the context is there? You couldn't figure it out?

 

[Raney Schauer]

Oh I figured it out all right. Figured out a lot about you, too, just now.

 

[Man o War]

Derm, Psych, PM&R, family medicine, internal medicine. I would say peds but I imagine the middle of the night phone calls interrupting your sleep would be more frequent in peds than office based FM or IM. Those in primary care feel free to correct if I’m wrong.

 

[Phile98]

I think you should heed these wise words...
“If you want to become a really good doctor, you have to learn to take advice you don’t want, from people you don’t like, said in a way you don’t enjoy.”
It’ll only get more stressful if you start getting triggered every time someone says something you don’t want to hear.

 

[Newyawk]

PM and R has got to be the cushiest field out there in terms of stress.

 

[appalachian_man]

This thread is a great example of why SDN has the reputation it does.

OP, your description of your issues don't sound like they would be unique to one field. I think you could still do IM and find a job that suits your work-life balance desires (after residency of course), which is the case with every specialty. As an attending, your schedule is determined largely by the kind of job you take. Want to make a lot of money as a surgeon? You're gonna work a lot. Don't care about money? Just operate one or two days a week. Same idea applies to IM. IM docs are needed across the country, and there is plenty of opportunity to work relaxed, relatively low-stress jobs as an attending. Do what you love.

 

[Chibucks15]

This thread is a great example of why SDN has the reputation it does.

OP, your description of your issues don't sound like they would be unique to one field. I think you could still do IM and find a job that suits your work-life balance desires (after residency of course), which is the case with every specialty. As an attending, your schedule is determined largely by the kind of job you take. Want to make a lot of money as a surgeon? You're gonna work a lot. Don't care about money? Just operate one or two days a week. Same idea applies to IM. IM docs are needed across the country, and there is plenty of opportunity to work relaxed, relatively low-stress jobs as an attending. Do what you love.

I've always been told once you get out of residency, you can pretty much set up your practice however you want if you look around hard enough. Sure you may have to be okay with a pay cut if you want to work less, but there are still jobs out there. I don't get the sentiment on here sometimes

 

[appalachian_man]

I've always been told once you get out of residency, you can pretty much set up your practice however you want if you look around hard enough. Sure you may have to be okay with a pay cut if you want to work less, but there are still jobs out there. I don't get the sentiment on here sometimes

Me either. People just feel comforted by stereotypes and generalizations I guess. And sure, there are general trends in every field, but people act like choosing a specialty is locking you into a job. Jobs as an attending are crazy variable. That's part of why medicine is such an attractive field.