you said it yourself, you're only half way. relax. don't choose yet.
Agreed
So far I think the best algorithm I've figured so far is:
1. Do you like the OR? (Not whether you like procedures, whether you physically enjoy being in the OR for hours and hours at a time)
- If you do, consistently, chances are you'll like surgical specialties
- If you don't, chances are you'll either like anesthesia or medical specialties
2. Following from this algorithm, your surgical options are:
- General surgery and its associated subspecialties (Vascular, Colorectal, Trauma, Surg/Onc, etc) - in terms of competitiveness, Gen Surg isn't that tough to get into (though it is getting tougher and some of the subspecialties are very competitive), but they have to know a good deal of medicine (esp the GI stuff), there's a decent amount of long-term followup and management. The con is that the lifestyle isn't that great - long hours, hard work, and the pay is okay but not great.
- Urology, ENT, Ortho, Plastics - much more competitive than general surgery but some of them have somewhat more reasonable lifestyles (Urology in particular) and much better pay. The match rate isn't great for Uro and ENT but if you have the grades/scores you probably have a decent chance of matching. Urology and ENT have some amounts of medical management and Uro in particular has a lot of very cool diagnostic studies which some people after they graduate focus solely on. Ortho hasn't got much in the way of medical management and is much more physical.
- Neurosurgery - I put this in its own category because it really is a beast of its own. The surgeries are very long, you get paid obscene amounts of money, but the lifestyle in general sucks - you work very long hours and most of the NSG residents and attendings I've met are either divorcing or are on their second/third marriages. However, if you really truly love it, you probably won't care.
3. Medical options:
- Internal Medicine - has a ton of different fellowships (Nephro, Cardio, GI, ID, etc) which are fairly competitive and have a lot of procedures, esp Cardio and GI. There's a lot of cerebral aspects to this field and you obviously do mostly medical management. Primary care has a pretty variable lifestyle depending on how you decide to practice ultimately. It can be pretty rewarding if you like to do long-term followup. The compensation for primary care is also pretty variable, though the subspecialties pay quite a bit more.
- Pediatrics - basically Medicine with little kids, though you can specialize in more specific fields such as Neonatology/NICU. This is probably tougher in some ways. The compensation is unfortunately not great (though markedly better in some of the subspecialties like Neonatal) but the lifestyle can be pretty good.
- Neurology - very tough, academic field. The stereotype in general is that the field tends towards being highly cerebral without being able to do much in the way of treatment, but there's a lot of up and coming treatments and it's becoming more feasible. Paid similarly to IM or a little bit more.
- Psych - lots of medical management of psychiatric issues and lots and lots of talking involved. Pays pretty reasonably, not competitive at all to get into, and hours can range from terrible to awesome depending on what you want to do.
4. Doesn't really fit/Middle of the road:
- Anesthesia - you have to know a decent amount of medicine, and it's a good option if you like the OR but don't enjoy doing surgery or being scrubbed in. Pretty relaxed field overall but there's a lot of states where CRNAs can practice on their own, so there is some uncertainty about the field and its compensation as a whole. I don't think it's compelling enough to dissuade anyone from going away from the field however.
- EM - very fast paced, relatively decent lifestyle field where you can do a lot of simple procedures as well as a lot of acute care medical management and you work shifts. The real disadvantage that I personally find is that you don't have much in the way of being able to practice independently if you so wish.
- OB/Gyn - yes, this is technically a surgical specialty, but there's a metric ton of medicine and management of obstetric and gynecologic problems. The big downside is that the malpractice for it is pretty awful even though you get paid well. The upside is that the lifestyle isn't awful depending on how you practice it, and it can be an incredibly rewarding field emotionally (usually).
5. What's that? You don't like any of these?
- Radiology - not much in the way of patient contact unless you do an interventional fellowship but it pays well and has decent hours. The downside is that it's an incredibly demanding specialty academically - you have to know anatomy and physiology on EVERY level, much like in primary care. You can practice in a hospital, privately, whatever. Also you work in the dark a lot, so depends on how you feel about that.
- Pathology - an indispensable field, though there's nothing in the way of patient contact (which might just make it more appealing for some). Lot of academics, lot of teaching in medical institutions where you have schools. Pays surprisingly well and has reasonable hours.
6. I hate all of these. I did well in school, now I want to work half days and make lots of money.
- Derm it is.
