Still lost on residency decision

Started by jrbirdy
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Burrell College of Osteopathic Medicine
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jrbirdy

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It's April of MS3 year, and by this time in the year 75% of my classmates are committed to a specialty. It seems the other 25% are down to two. Meanwhile, I am still grasping at straws and extremely nervous that I will end up applying Internal Medicine simply for the lack of a definitive (and timely) alternative choice. I'm posting here in hopes that someone will read my description and feel like their specialty of interest is something I should think hard about!

1) As of this time, I'm interested in DEFINITELY something procedural, but not 100% surgical (I need to have some clinic time/continuity of care).

2) I don't love rounding (ok I hate it), but I know that rounding isn't a reality in private settings, and rounding as an attending is much different than rounding as a student.

3) Obviously I'd like to make $$ to be comfortable, but would be willing to make less if it means I have a home life or less call.

4) I really want to have fallen in love with something like ENT/Ophtho/Ortho, but I felt pretty neutral about them (just as I feel neutral about IM or peds). Its hard for me to rationalize gunning one of those specialties and trying to outcompete people who are much more outwardly passionate than I am/could be about any specialty. Also it's already April.

5) It sounds like I'm not that into medicine, but this is just my personality. There's nothing else I'd rather do.

ME:
MS3 at top 20 medical school
Step 1: 255
Core rotations: H/H/HP/P <-- HP and P in rotations where only 10% honor and 10% HP
Elective rotations: H/H/H
Research: Three medicine projects, 1 abstract, 1 poster, no pubs. Hopefully soon.

I have two months before app season. What do I do?! What should I try? Am I down to IM/Peds/FM/GS at this point? Could I scramble to do an away? To do research? Is it reasonable to apply to a specialty having only done the core rotation? Core + one elective? Should I take a research year to get my head straight?

TL;DR
reasonably smart but indecisive MS3 seeks person who can see the future and tell me what specialty will make me most content
 
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These are all suggestions I've strongly considered at some point! Its just frustrating, though, because the clinical curriculum is such that I have had pretty minimal exposure to the more niche specialties. I almost signed up for a Uro elective, but chickened out because I got nervous that that would be too surgical for me (...and also the few uro residents i've met have been super burnt out and not that enthusiastic about recommending the specialty).

Regardless, Uro/Derm would require a research year at this point, would they not? Has anyone had luck scrambling to get an away + a few projects in progress within 3-4 months?

GI...would be nervous about doing IM with really only GI/Cards/Pulm as procedural options, as I am very much not interested in Pulm so I'd be down to two very competitive fellowships. But tbh this is kind of the front-runner plan at this point.
 
Derm, IM-->GI (if you can put up with 2-3 yrs of endless rounding), Uro, Anesthesia-->fellowship? maybe IR/rad onc??
 
I wonder if your threshold for liking a field is set a bit too high. It may not be - just a thought. But realize that not everyone has a moment where the heavens open up and angels sing and voice cries out from heaven saying, " this shall be thy specialty." Sometimes you just find something you like where you also like the people and the patients and feel like it sucks less than anything else and that you can tolerate the suckage there is. Obviously it's better to have a powerful conviction as it makes the decision easier, but a more subtle feeling is not a bad thing.

Other random thoughts:

--there's no such thing as 100% surgical. Every surgeon sees patients in the clinic even if you may not have spent time there as a student.

--your list definitely sounds like someone who would like emergency medicine. Seems to hit the most of your wants - all of them actually save for continuity of care.

--your path to a more competitive field will depend on exactly which core rotations you didn't honor. And research of course, but a pass in surgery would be a red flag for a surgical subspecialty.

--a research year would be great if you know what you want, but it's a lousy way to kill time waiting for the light bulb to come on.

--you might benefit from some honest soul searching as to why you want the things you say. I think we sometimes fall into the trap of saying what we are supposed to say so many times that we eventually start to believe it.

--when in doubt, pick lifestyle and money above all else. If you truly can't decide, aim to maximize those two things from the fields you're considering. There's a reason that people in high paying lifestyle friendly fields are consistently the happiest physicians. There's also a reason these are usually the most competitive fields.

--you can always change fields later. It's easier to change from a competitive field to one equally or less so. Obviously you'd like to get it right the first time, but people do change fields during training.
 
doggydog said:
The whole 'falling in love with a specialty' doesn't happen for like 75% of people. Medical school is so romanticized it's insane.
Click to expand...

It didn't for me. I chose lifestyle over the surgical specialties because I was unsure and now seriously regret it. Something to think about it.
 
IM to GI sounds like you honestly, and if you have a 255 from a top-20 medical school you have the ability to get into a GI fellowship no problems.
 
operaman said:
I wonder if your threshold for liking a field is set a bit too high. It may not be - just a thought. But realize that not everyone has a moment where the heavens open up and angels sing and voice cries out from heaven saying, " this shall be thy specialty." Sometimes you just find something you like where you also like the people and the patients and feel like it sucks less than anything else and that you can tolerate the suckage there is. Obviously it's better to have a powerful conviction as it makes the decision easier, but a more subtle feeling is not a bad thing.
Click to expand...

Oh boy, do I know this. The things I'm considering I like a 5/10. I knew going into medical school that I wasn't going to fall in love with a specialty, but man would that have made my life easier.

operaman said:
--there's no such thing as 100% surgical. Every surgeon sees patients in the clinic even if you may not have spent time there as a student.
Click to expand...

True. I definitely rotated through several (3) surgery clinics. What I meant was I didn't necessarily want to do something like Gen Surg, where (at least at my institution) clinic is all post-op patients that you see once, maybe twice then discharge them from clinic.

operaman said:
--you can always change fields later. It's easier to change from a competitive field to one equally or less so. Obviously you'd like to get it right the first time, but people do change fields during training.
Click to expand...

Ideally this wouldn't happen, but its nice to remember that not all people finish the residency they start (and that this isn't necessarily a disaster).

Thanks for all the advice! Its nice to hear something other than "just pick something! what did you like best!!!!" which is what all of my friends/peers tell me.
 
jrbirdy said:
Oh boy, do I know this. The things I'm considering I like a 5/10. I knew going into medical school that I wasn't going to fall in love with a specialty, but man would that have made my life easier.



True. I definitely rotated through several (3) surgery clinics. What I meant was I didn't necessarily want to do something like Gen Surg, where (at least at my institution) clinic is all post-op patients that you see once, maybe twice then discharge them from clinic.



Ideally this wouldn't happen, but its nice to remember that not all people finish the residency they start (and that this isn't necessarily a disaster).

Thanks for all the advice! Its nice to hear something other than "just pick something! what did you like best!!!!" which is what all of my friends/peers tell me.
Click to expand...

I think the reality of some specialties is important to consider. Do you have an idea about what kind of environment you want to practice in eventually? What you want your hours to be like? Do you think you'll hate dealing with hospital administrators or insurance companies or both?

As you said above, Cards/GI are the top dogs for you. You clearly have the stats and aptitude to get into a quality IM program with strong fellowship ties. Do you have a cards/GI elective you could change around in your schedule? Or even shadow?
 
jrbirdy said:
ME:
MS3 at top 20 medical school
Step 1: 255
Core rotations: H/H/HP/P <-- HP and P in rotations where only 10% honor and 10% HP
Elective rotations: H/H/H
Research: Three medicine projects, 1 abstract, 1 poster, no pubs. Hopefully soon.

I have two months before app season. What do I do?! What should I try? Am I down to IM/Peds/FM/GS at this point? Could I scramble to do an away? To do research? Is it reasonable to apply to a specialty having only done the core rotation? Core + one elective? Should I take a research year to get my head straight?

TL;DR
reasonably smart but indecisive MS3 seeks person who can see the future and tell me what specialty will make me most content
Click to expand...

I never know whether to laugh or groan when read. Gets me every time.

Just do urology.
 
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jrbirdy said:
I have two months before app season. What do I do?! What should I try? Am I down to IM/Peds/FM/GS at this point? Could I scramble to do an away? To do research? Is it reasonable to apply to a specialty having only done the core rotation?
Click to expand...

What are you talking about here? ERAS applications are submitted on September 15th, not in two months. You still have time to do 1-2 electives and get letters of recommendation on time.

Anyway, some suggestions: Urology (as mentioned above), Ophthalmology (I did a community/outpatient elective and loved it), EM (although it sounds you are to snobbish to like it), or Anesthesia.
 
"you might benefit from some honest soul searching as to why you want the things you say. I think we sometimes fall into the trap of saying what we are supposed to say so many times that we eventually start to believe it."

This is so true. Probably why so many people end up changing fields from surgery to rads/etc.
 
mimelim said:
No it doesn't. It is a way for people at rank 16-20 schools to try to up-sell themselves and it is a convenient excuse for people in >21 as to why they don't match as well. Nobody on the residency side cares.
Click to expand...

If looking at OUWB's match list and comparing it to any school in the top 20 is all based on excuses (literally for 100% of the match) then I guess a lot of us from low tier medical schools are making a lot of excuses.
 
Anicetus said:
If looking at OUWB's match list and comparing it to any school in the top 20 is all based on excuses (literally for 100% of the match) then I guess a lot of us from low tier medical schools are making a lot of excuses.
Click to expand...

What you said has nothing to do with what I said.

There are a lot of variables that come into play when it comes to offering interviews and creating a residency's match list. There are inherent biases among different physicians about different medical schools, whether they be MD, DO, foreign, specific names (HMS, JHU) etc. These affect residency placement for people applying to the top programs in some specialties every year. For the vast majority of applicants it matters next to nothing. Frankly, "Look at the match list" demonstrates a level of naivete that I generally reserve for pre-meds, their advisers and parents. Further, the vast majority of PDs, faculty and practicing physicians do not keep up with US News rankings. I doubt that a single physician in this hospital knows the top 20 or frankly cares. Top 3? Sure, why not, especially if they went to one of them. But, top 20, 30, 50 etc? Not a chance.
 
IMO, IM is only for those who know for certain that they want to do it (or can't get anything else). Otherwise, avoid at all costs. This practically comes straight from the mouths of most IM attendings, fellows, and residents.

Things to consider for those in medical school who finish without any real passion for any particular specialty, and who have the academic record to have their pick of field (if not location of training):

-EM
-Rads (DR or IR; IR might suit you better, though DR do some procedures)
-Derm
-Rad Onc
-+/- Anesthesia, though the future of this specialty seems kinda wobbly
-PM&R if you don't care about prestige or $, and just want to have a good life (working spouse helps)

You could get into a fantastic EM, Rads, or Anesthesia program with your score, although you'd have to arrange an EM away to get the SLOE or whatever it's called. You MIGHT be able to pull off Rad Onc or Derm this cycle if you get hooked up with good mentors and get cracking on a few projects. Ophtho, ENT, and Ortho are not worth doing if you don't have the passion; Ortho and ENT residencies suck, and ophtho is a love-or-hate specialty that gets boring really quickly if there isn't a genuine interest (it's also not really a lifestyle specialty).
 
22031 Alum said:
I'll go ahead and suggest giving OB a look. While hating on the field is the cool thing to do on SDN, I love it and would be happy to answer any questions you have about life in practice.
Click to expand...

This post is proof positive that Ob/Gyns are not only masochists, but sadists as well.

😛
 
mimelim said:
Further, the vast majority of PDs, faculty and practicing physicians do not keep up with US News rankings. I doubt that a single physician in this hospital knows the top 20 or frankly cares. Top 3? Sure, why not, especially if they went to one of them. But, top 20, 30, 50 etc? Not a chance.
Click to expand...

While they may not keep up with the exact rankings, they have a gestault about where a school fals and that makes a difference in residency ranking. It is why those kids from JHU and HMS with a 220 match well while kids from Drexel with a 220 do not.
 
Instatewaiter said:
While they may not keep up with the exact rankings, they have a gestault about where a school fals and that makes a difference in residency ranking. It is why those kids from JHU and HMS with a 220 match well while kids from Drexel with a 220 do not.
Click to expand...

True, but it makes much less of a difference at the 255 + pubs level.
 
Dave89 said:
IMO, IM is only for those who know for certain that they want to do it (or can't get anything else). Otherwise, avoid at all costs. This practically comes straight from the mouths of most IM attendings, fellows, and residents.

Things to consider for those in medical school who finish without any real passion for any particular specialty, and who have the academic record to have their pick of field (if not location of training):

-EM
-Rads (DR or IR; IR might suit you better, though DR do some procedures)
-Derm
-Rad Onc
-+/- Anesthesia, though the future of this specialty seems kinda wobbly
-PM&R if you don't care about prestige or $, and just want to have a good life (working spouse helps)

You could get into a fantastic EM, Rads, or Anesthesia program with your score, although you'd have to arrange an EM away to get the SLOE or whatever it's called. You MIGHT be able to pull off Rad Onc or Derm this cycle if you get hooked up with good mentors and get cracking on a few projects. Ophtho, ENT, and Ortho are not worth doing if you don't have the passion; Ortho and ENT residencies suck, and ophtho is a love-or-hate specialty that gets boring really quickly if there isn't a genuine interest (it's also not really a lifestyle specialty).
Click to expand...

Curious as to why you don't consider Ophtho a lifestyle specialty. Its not derm but I don't see how its not one of the lifestyle specialties considering very few call, no inpatients, and pretty regular office hours. You can further specialize into areas that can increase the amount and type of surgery you do as well as increase the amount of pathology. I'm biased but as someone who struggled until recently to decide on what specialty to choose, I'll recommend looking further into ophtho as a choice. I hate rounding, I hate long term inpatient care, I like surgeries but not enough to work 80 hours/wk and take tons of call, i like clinic and dealing with diagnosis. Watch some videos of some of the surgeries/procedures they do on youtube including the different fellowship areas.

ENT is a tough residency but after residency is really nice depending on how you set up your practice. If I wasn't planning on doing Ophtho I think this would be a close second choice for me.

EM seems like a good field but the burnout rate is one of the highest and I don't believe its as simple as people saying those who burn out choose to do to many shifts.

Rads is good but I'd lump it in as a love-or-hate specialty because its not exactly exciting for everyone.

Derm is nice and I think it would be interesting to do academic derm to see some of the more rare pathology.

PMR seems pretty chill and has a little bit of procedural work but there is a lot of interdisciplinary stuff which involves lots of rounds and notes which OP says he doesn't like.
 
Dave89 said:
IMO, IM is only for those who know for certain that they want to do it (or can't get anything else). Otherwise, avoid at all costs. This practically comes straight from the mouths of most IM attendings, fellows, and residents.
Click to expand...

IM leaves the door open for a lot of things. It has lifestyle specialties like allergy. It has procedural specialties like cards and GI. It leaves outpaitient work wide open. Hospitalist work pays well. Yes there are many things that can be bad about it. But there are also many things that can be great about it as well.
 
gregoryhouse said:
Curious as to why you don't consider Ophtho a lifestyle specialty. Its not derm but I don't see how its not one of the lifestyle specialties considering very few call, no inpatients, and pretty regular office hours. You can further specialize into areas that can increase the amount and type of surgery you do as well as increase the amount of pathology. I'm biased but as someone who struggled until recently to decide on what specialty to choose, I'll recommend looking further into ophtho as a choice. I hate rounding, I hate long term inpatient care, I like surgeries but not enough to work 80 hours/wk and take tons of call, i like clinic and dealing with diagnosis. Watch some videos of some of the surgeries/procedures they do on youtube including the different fellowship areas.

ENT is a tough residency but after residency is really nice depending on how you set up your practice. If I wasn't planning on doing Ophtho I think this would be a close second choice for me.

EM seems like a good field but the burnout rate is one of the highest and I don't believe its as simple as people saying those who burn out choose to do to many shifts.

Rads is good but I'd lump it in as a love-or-hate specialty because its not exactly exciting for everyone.

Derm is nice and I think it would be interesting to do academic derm to see some of the more rare pathology.

PMR seems pretty chill and has a little bit of procedural work but there is a lot of interdisciplinary stuff which involves lots of rounds and notes which OP says he doesn't like.
Click to expand...

The office hours are longer than most people think. I've shadowed a number of PP ophthos, and 8-6 was fairly normal for them on non-operating days.
 
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Dave89 said:
The office hours are longer than most people think. I've shadowed a number of PP ophthos, and 8-6 was fairly normal for them on non-operating days.
Click to expand...

Like I said its not as cush as derm but 8-6 M-F beats the hell out of most of medicine jobs IMO. I'd say it also depends on the individual ophtho and where they work. I know an OMD who takes every other week off and another who sees 85 patients a day crammed into an 8-6 clinic. Some cram all their duties into a 4 day schedule. As in most specialties I think you can curtail your practice to your desire but I think ophtho, ent, and derm probably give you the strongest ability to do this.

Anesthesia definitely works harder imo then most people think especially when on call.
Derm and Rads are probably the only ones I can think of the are consistent with their nice schedule.
 
gregoryhouse said:
Like I said its not as cush as derm but 8-6 M-F beats the hell out of most of medicine jobs IMO. I'd say it also depends on the individual ophtho and where they work. I know an OMD who takes every other week off and another who sees 85 patients a day crammed into an 8-6 clinic. Some cram all their duties into a 4 day schedule. As in most specialties I think you can curtail your practice to your desire but I think ophtho, ent, and derm probably give you the strongest ability to do this.

Anesthesia definitely works harder imo then most people think especially when on call.
Derm and Rads are probably the only ones I can think of the are consistent with their nice schedule.
Click to expand...

Rads schedule is also pretty bad, TBH. Per CIM, they work ~58 hours/week on average. But at least they can chill in the reading room most of the time.
 
Dave89 said:
Rads schedule is also pretty bad, TBH. Per CIM, they work ~58 hours/week on average. But at least they can chill in the reading room most of the time.
Click to expand...

I was going to make a disparaging remark about rads but something dawned on me in the midst of making said disparaging remark... With the dawn of the everyone-is-the-same-and-should-get-paid-the-same-no-matter-their-effort-qualifications-or skill movement it is funny that radiologists who are often lemented as the lazy in the realm of medicine work hard. The LOWEST quartile of radiologists on average work more hours (45) than what most Americans would consider full time. That is astounding.

http://www.ncbi.nlm.nih.gov/pubmed/19770339
 
Instatewaiter said:
I was going to make a disparaging remark about rads but something dawned on me in the midst of making said disparaging remark... With the dawn of the everyone-is-the-same-and-should-get-paid-the-same-no-matter-their-effort-qualifications-or skill movement it is funny that radiologists who are often lemented as the lazy in the realm of medicine work hard. The LOWEST quartile of radiologists on average work more hours (45) than what most Americans would consider full time. That is astounding.

http://www.ncbi.nlm.nih.gov/pubmed/19770339
Click to expand...
I take it you're not feeling the Bern? 😀
 
Why not EM? You largely can decide how much you work. You do procedures. No rounding.
 
gregoryhouse said:
Curious as to why you don't consider Ophtho a lifestyle specialty. Its not derm but I don't see how its not one of the lifestyle specialties considering very few call, no inpatients, and pretty regular office hours. You can further specialize into areas that can increase the amount and type of surgery you do as well as increase the amount of pathology. I'm biased but as someone who struggled until recently to decide on what specialty to choose, I'll recommend looking further into ophtho as a choice. I hate rounding, I hate long term inpatient care, I like surgeries but not enough to work 80 hours/wk and take tons of call, i like clinic and dealing with diagnosis. Watch some videos of some of the surgeries/procedures they do on youtube including the different fellowship areas.

ENT is a tough residency but after residency is really nice depending on how you set up your practice. If I wasn't planning on doing Ophtho I think this would be a close second choice for me.

EM seems like a good field but the burnout rate is one of the highest and I don't believe its as simple as people saying those who burn out choose to do to many shifts.

Rads is good but I'd lump it in as a love-or-hate specialty because its not exactly exciting for everyone.

Derm is nice and I think it would be interesting to do academic derm to see some of the more rare pathology.

PMR seems pretty chill and has a little bit of procedural work but there is a lot of interdisciplinary stuff which involves lots of rounds and notes which OP says he doesn't like.
Click to expand...
I always chuckle when people bring up the burnout rate of EM. Have you actually looked at burnout rates by specialty? EM is maybe only 5% higher than the average. "Why choose EM with their burnout rate of 55% when you can do anesthesia and burnout 'only' 50% of the time?"
 
Cinematographer said:
What are you talking about here? ERAS applications are submitted on September 15th, not in two months. You still have time to do 1-2 electives and get letters of recommendation on time.

Anyway, some suggestions: Urology (as mentioned above), Ophthalmology (I did a community/outpatient elective and loved it), EM (although it sounds you are to snobbish to like it), or Anesthesia.
Click to expand...
Sorry - two free months that I can use for electives, research, etc. Other months I have core rotations to complete.
 
mimelim said:
No it doesn't. It is a way for people at rank 16-20 schools to try to up-sell themselves and it is a convenient excuse for people in >21 as to why they don't match as well. Nobody on the residency side cares.
Click to expand...

I know several people have already replied to this, but just wanted to clarify as well why I thought this was relevant: I know the IM residency director at my home program decently well and he has specifically stated that programs (such as ours) take into account if you come from a school where they know you are well prepared -- this may mean the school is 'ranked highly' (ie has a good reputation) OR that program has had good experiences with residents from that school.
 
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jrbirdy said:
Sorry, but no. I know the IM residency director at my home program decently well and he has specifically stated that programs take into account if you come from a school where they know you are well prepared -- this may mean the school is ranked highly or that program has had good experiences with residents from that school.
Click to expand...

Yeah because your own IM director would surely badmouth his own program?
 
Rekt said:
Yeah because your own IM director would surely badmouth his own program?
Click to expand...

What? I don't even know what you're trying to say here. I'm suggesting that our program director takes into consideration the medical school an applicant comes from, so I extrapolated to assume that other PDs might as well. I said nothing about my home IM program/its prestige/quality of training.
 
mimelim said:
What you said has nothing to do with what I said.

There are a lot of variables that come into play when it comes to offering interviews and creating a residency's match list. There are inherent biases among different physicians about different medical schools, whether they be MD, DO, foreign, specific names (HMS, JHU) etc. These affect residency placement for people applying to the top programs in some specialties every year. For the vast majority of applicants it matters next to nothing. Frankly, "Look at the match list" demonstrates a level of naivete that I generally reserve for pre-meds, their advisers and parents. Further, the vast majority of PDs, faculty and practicing physicians do not keep up with US News rankings. I doubt that a single physician in this hospital knows the top 20 or frankly cares. Top 3? Sure, why not, especially if they went to one of them. But, top 20, 30, 50 etc? Not a chance.
Click to expand...
Practicing physicians definitely do know the top programs. I've heard many of them gossiping about whose kid got into what top med school. They're definitely aware, some excessively so.
 
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chipwhitley said:
Practicing physicians definitely do know the top programs. I've heard many of them gossiping about whose kid got into what top med school. They're definitely aware, some excessively so.
Click to expand...

Again, top programs, sure. Top 20? Not a chance. Maybe some in academic settings, especially those on the coasts are more so. But, across the country? The prestige factor of your school matters next to nothing in 90%+ of cases.
 
Zebra Hunter said:
I always chuckle when people bring up the burnout rate of EM. Have you actually looked at burnout rates by specialty? EM is maybe only 5% higher than the average. "Why choose EM with their burnout rate of 55% when you can do anesthesia and burnout 'only' 50% of the time?"
Click to expand...

I have nothing against EM at all. I'm just saying if its not what u actually want to do it shouldnt be something people choose for lifestyle reasons considering the burnout rate.
 
mimelim said:
Again, top programs, sure. Top 20? Not a chance. Maybe some in academic settings, especially those on the coasts are more so. But, across the country? The prestige factor of your school matters next to nothing in 90%+ of cases.
Click to expand...
If that's the case, why did 53% of program directors across all specialties cite "Graduate of highly regarded medical school" as a factor in selecting applicants to interview? http://www.nrmp.org/wp-content/uploads/2013/08/programresultsbyspecialty2012.pdf
 
chipwhitley said:
If that's the case, why did 53% of program directors across all specialties cite "Graduate of highly regarded medical school" as a factor in selecting applicants to interview? http://www.nrmp.org/wp-content/uploads/2013/08/programresultsbyspecialty2012.pdf
Click to expand...

Seriously? Basic reading comprehension... based on that, 47% care zero. 53% care somewhere between next to zero and care a lot. It is also according to that document far less important than a whole lot of other things. It also does not define "highly regarded medical school" which is hard to determine for all PDs across the country. Again, having trained and spent time in the Northeast Vs middle America, there are stark differences in deference for the "top" schools that tend to cluster on the coasts.
 
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