MD & DO Taking a 5th year of med school to decide on specialty?

[BigSkyMontana45]

Hello, everyone's opinion is appreciated.

I am a MD (M3) student at a mid-tier school. We are now required to pick our 4th year schedule. However, I have absolutely no idea what I really want to do or is suited for. My interest right now are:

IM -> sub-specialty (I hate being a general internist)
EM (I like the focus on chief complaint)
Anesthesia (I like pathphys, procedural-heavy nature, and the potential income)
Radiology (I like solving puzzles, and don't mind not seeing patients, great income)
Neurology (I like the mystery of the brain and solving puzzles)

As of now, I do not finish up all my M3 clerkships until late August since I had a baby during one of the rotations.

My Dean/Advisor gave me an option to do this: If I still cannot decided when M3 year is winding down, take a LOA beginning of 4th year, and schedule my 4th year to go from January to December of 2018. That way, I have 9 months to rotate in various fields before residency, and thus more informed to make a decision. She suggest I pick up a research project to work on during my LoA to have something to show for it.

What do you all think? Is this a good plan? Thank you!!

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[Mr Roboto]

That one year LOA would be a $250,000+ mistake.

 

[BigSkyMontana45]

It is a 1 semester LOA, not 1 year. I am not in debt. I am not concerned about money. I want to make the correct choice regarding my career.

 

[Psai]

Just pick a field, you can always switch later.

 

[BigSkyMontana45]

I did bring up the possibility of during a prelim year first, but my dean told me being an MD senior is most desirable to residency program. It is also very difficult to go on many interviews during residency I was told.

Economically, yes it is best that I do not delay graduation/matching.
Career wise, it is best that I figure out my choice before applying to residency.

 

[BigSkyMontana45]

That one year LOA would be a $250,000+ mistake.

I am willing to retire 1 year later than planned, so I can choose a field I am best fit for the next 30+ years of practice.

 

[sazerac]

Gotta ask, did you at least sign up for a 4th year rotation with Dr. Daniels in Big Sky, Montana?

 

[BigSkyMontana45]

Gotta ask, did you at least sign up for a 4th year rotation with Dr. Daniels in Big Sky, Montana?

No, I am a native of Montana, but go to med school in ND.

 

[sazerac]

No, I am a native of Montana, but go to med school in ND.

Oh man this is an opportunity of a lifetime. Seriously consider it. We had students from all around the country rotate there, ski the morning powder and play doctor in the afternoon. Highly recommend.

As for your plan in the OP, that just sounds highly unusual. EM requires a bit of pre-planning but most of your other options would be happy with a sub-I in IM, so I would line up that kind of sub-I, rotate in the other fields, and not bother with the skipping a year thing.

 

[Smurfette]

I think you should wait and see after a few more clerkships as to what you are thinking. You may narrow things down enough to be able to pick one and graduate on time. My last rotation was what I ended up going into.

If you do delay things, you also want a "better" reason to tell programs as to why you did the 5 year option than "I couldn't pick my field". You don't want them thinking you are wishy-washy as to what you want to do, indecisive or incapable of making decisions, or suspicious that you had other health, AODA or other issues that prompted a LOA.

 

[BigSkyMontana45]

The problem is that my 3rd year does not end until late August. Residency application should ideally be complete by September 15th. I really need to rotate in fields like Anesthesiology, Radiology, Neurology, and EM to know if it is right for me and to obtain the proper letters of recommendation.

I shadowed these fields and liked them in different ways. But I don't know what I am suited for, or which one I am comfortable practicing for 30 years until I actually rotate in them.

 

[sazerac]

The problem is that my 3rd year does not end until late August. Residency application should ideally be complete by September 15th. I really need to rotate in fields like Anesthesiology, Radiology, Neurology, and EM to know if it is right for me and to obtain the proper letters of recommendation.

I shadowed these fields and liked them in different ways. But I don't know what I am suited for, or which one I am comfortable practicing for 30 years until I actually rotate in them.

Can you just skip some third year clerkships to get in your rotations? People at my school did that a lot (usually skipping psych and/or FM until later).

If your 3rd year is done in August, when do you guys take the Step 2 exams? Are you already on a delayed schedule, like had an emergency or took extra months for Step 1 or something?

If you are asking to turn an already delayed path in med school into a more delayed one, that changes the parameters of the question.

 

[BigSkyMontana45]

I had a baby during one of my clerkships (pediatrics), which will be made up in July + August. I won't take Step2CK until probably later this fall.

You are correct, my M4 year is delayed, which prompt me to delay applying for match and graduation even further since I have not made a decision for a specialty choice.

 

[Warderino92]

A not insignificant number of people switch their residencies completely while they are in their intern year or beyond. For example you always hear stories of people ending up hating surg and switching into DR instead. If you can't make your mind up and you end up hating your choice you always have an out into something you find you enjoy more once you actually experience what life is like as an intern and not a med student.

 

[BigSkyMontana45]

A not insignificant number of people switch their residencies completely while they are in their intern year or beyond. For example you always hear stories of people ending up hating surg and switching into DR instead. If you can't make your mind up and you end up hating your choice you always have an out into something you find you enjoy more once you actually experience what life is like as an intern and not a med student.

My dean informed me that it is quite difficult to switch once you are in residency since PDs don't want to lose someone half-way through. I even brought up just doing a prelim/transitional year first, but she said it will be difficult to go on 10+ interviews, and my options for PGY-2 spots will be limited compared to a senior US medical student.

 

[BigSkyMontana45]

I understand that delaying 1 year means losing money - but if I can find a field I truly enjoy and is a good fit - that means I can work longer and make even more money. In any case, I am willing to retire 1 year later than planned, as a trade off to having this opportunity to make a better decision for my 30+ career.

 

[Tenk]

Whatever you do, do not delay graduation. It is a red flag for residency in this case.

If you have any specific questions I would be more than happy to answer them either on this thread or in PM. I am an EM attending but have friends/colleagues in every one of these specialties so I am pretty well versed.

 

[ConfusedChemist]

Whatever you do, do not delay graduation. It is a red flag for residency in this case.

If you have any specific questions I would be more than happy to answer them either on this thread or in PM. I am an EM attending but have friends/colleagues in every one of these specialties so I am pretty well versed.

Even if it was due to having a baby? Seems like that's the root cause here

 

[Tenk]

Even if it was due to having a baby? Seems like that's the root cause here

If you have the option to graduate on time you should always take that option. Sure it might be harder, but it always looks better on paper. If you don't have that option then you don't have that option.

 

[Promethean]

That one year LOA would be a $250,000+ mistake.

Choosing the "wrong" specialty could be a multi-million dollar mistake.

If OP has the great fortune to have this option offered to them, and to have the resources to take advantage of it without concern about debt, it might be better to do this than to rush into something that would later cause regret and an early termination of their career and/or having to find a way to go back and retrain in another specialty.

That said:
If it were me... I wouldn't do this. I'd take a weekend to do an assessment of who I am, what I care about, what sorts of problems I like to solve, and what kind of working conditions I'd prefer. Then I'd schedule a meeting with a career counselor or a trusted and sympathetic member of faculty and talk through my options over the course of an hour. Then, I'd commit. Make a choice, pull the trigger, and love the one you're with from then on.

Indecision has a way of becoming a destination all its own, and regrets can arise no matter how much thought you put into a choice. When you pick a direction, throw your heart into it and don't look back or play the what if game. Your fantasies about what you aren't doing can always be brighter and more intriguing than the sometimes dull realities of what you are engaged in. Ultimately, it matters less what you are doing than that you are doing it well and with enthusiasm.

 

[Gambler 101]

It's tough to decide on something without seeing it. As a person who entered fourth year and residency applications undecided, I'd recommend shadowing in each of these fields. I know third year is tough, but you have a day off every week. I'd use to get a sense of these fields. If you enjoy it when you're worn out, then you know it's a fit for you. I'd do everything in my power to graduate and match on time. You don't want to seem like someone who may lag behind in residency...

 

[cbrons]

I can't understand why people would ever want to be a medical student for one extra day let alone one extra year.

Sent from my SM-N910P using SDN mobile

 

[BigSkyMontana45]

Because, in the grand scheme of things, whats ONE more year if it allows you to be confident and happy in your career for the next THIRTY+ years? Everyone's situation is unique though. In regards to OP, she recently had a baby too. Maybe she wants to enjoy some time with her child?

Agreed.

I also don't get why people keep on telling me its a lost year of income - if I can find a field I enjoy and passionate about - I can work longer. Its not like every has a mandatory retirement age.

 

[cbrons]

Agreed.

I also don't get why people keep on telling me its a lost year of income - if I can find a field I enjoy and passionate about - I can work longer. Its not like every has a mandatory retirement age.

Just do research now, figure it out and pick one. What do you think an extra year is going to do for you in terms of helping you make a decision? Most of these medical school rotations are a waste of time, and give you more insight into how the specialty is practiced at that specific center vs. how it is practiced in general. Most of the time you are at an academic medical center, which can be very, very different from private/community practice (where the vast majority of physicians work). You will get far more mileage out of talking to attendings (on the physician forums of SDN or in real-life for example) than you will most likely get from an elective rotation in medical school.

 

[medicinewoman101]

Pick one. Just pick one. Ok. med students are delusional thinking there is some magic out there and they are destined for one field or another. Just pick one. The secret is that all fields have something youre going to love and something youre going to hate. If you want to value your life and outside relationships then pick something with a good lifestyle. To take a year off to figure this out is a mistake, a costly one too.

 

[MrChance2]

most of those require an intern year right? Seems like it wouldn't be terribly difficult to switch after year 1 except for EM.

 

[Entadus]

I understand that delaying 1 year means losing money - but if I can find a field I truly enjoy and is a good fit - that means I can work longer and make even more money. In any case, I am willing to retire 1 year later than planned, as a trade off to having this opportunity to make a better decision for my 30+ career.

Look at it this way, after landing your first attending job, you'll spend the rest of your life ~$200k poorer than you would have been if you'd had the attending job 1 yr sooner

Besides, in economics we say the value of a dollar today is not the same as the value 1 yr from now. Meaning, if you could be a resident/attending a year sooner, you could therefore begin investing 1 year sooner and have that extra time building compound interest, i.e. an extra year to generate return on your investments. Toward the end of a career, that relatively small 1 year could be significant. Who wouldn't want to have financial freedom 1 year earlier?

 

[sunealoneal]

IM -> sub-specialty (I hate being a general internist)
EM (I like the focus on chief complaint)
Anesthesia (I like pathphys, procedural-heavy nature, and the potential income)
Radiology (I like solving puzzles, and don't mind not seeing patients, great income)
Neurology (I like the mystery of the brain and solving puzzles)

I think a good exercise for you would be to really focus on the bread and butter of these fields. Your description hints at the possibility that you haven't done this yet. After a while, the thrill of the intellectual stimulation will be mostly gone. And it'll become just another day at the job. You need to think about which kind daily grind appeals to you the most. Outpatient vs inpatient, patient population, etc. Your attitude for many of these other factors can be gleaned from other rotations.

I agree with you that the one year of lost income isn't the biggest issue here, but I also agree with others warning you that any kind of delay is assumed to be a red flag pending explanation ftom you. So if you haven't already done this kind of thinking, maybe that will narrow the list significantly. If you have and you're truly stuck with the same list, perhaps that "research semester" is a good idea.

 

[zeppelinpage4]

Hello, everyone's opinion is appreciated.

I am a MD (M3) student at a mid-tier school. We are now required to pick our 4th year schedule. However, I have absolutely no idea what I really want to do or is suited for. My interest right now are:

IM -> sub-specialty (I hate being a general internist)
EM (I like the focus on chief complaint)
Anesthesia (I like pathphys, procedural-heavy nature, and the potential income)
Radiology (I like solving puzzles, and don't mind not seeing patients, great income)
Neurology (I like the mystery of the brain and solving puzzles)

As of now, I do not finish up all my M3 clerkships until late August since I had a baby during one of the rotations.

My Dean/Advisor gave me an option to do this: If I still cannot decided when M3 year is winding down, take a LOA beginning of 4th year, and schedule my 4th year to go from January to December of 2018. That way, I have 9 months to rotate in various fields before residency, and thus more informed to make a decision. She suggest I pick up a research project to work on during my LoA to have something to show for it.

What do you all think? Is this a good plan? Thank you!!

I'm of the belief that it's better to go slow and evaluate, then rush into things. So the fifth year seems like a nice idea.

Only downsides I could think of is that the LOA may not look great, but if you pick up a good research project and do something meaningful with the time, then I think that should be totally fine too...and might even boost your application? I know research years, if focused in your field of interest can be really helpful for the competitive residencies.

I'm not as experienced as others in the forum, so take my advice with a grain of salt, but I'd probably take the fifth year if I was in your situation and not in any rush to finish, but that's just what I would do. I'd talk to more experienced people before making that decision.

 

[racerwad]

I'm of the belief that it's better to go slow and evaluate, then rush into things. So the fifth year seems like a nice idea.

Only downsides I could think of is that the LOA may not look great, but if you pick up a good research project and do something meaningful with the time, then I think that should be totally fine too...and might even boost your application? I know research years, if focused in your field of interest can be really helpful for the competitive residencies.

I'm not as experienced as others in the forum, so take my advice with a grain of salt, but I'd probably take the fifth year if I was in your situation and not in any rush to finish, but that's just what I would do. I'd talk to more experienced people before making that decision.

I think this is the crux of the problem. If the OP knew what they wanted to do, and then picked up a great research project that focused on their field of interest, then yeah, the 5th year might be worth it. However, as I understand it, the whole point of them wanting to do a 5th year is exactly because they don't know what they want so they'll spend some amount of time working through their decisions AND THEN working on finding a project that is somehow meaningful. Doing that all in a year is a pipe dream.

The honest reality is that this is probably a bad idea for all the reasons already mentioned. I can tell you already that you are going to hate EM. A huge portion of the specialty is focused on making critical decisions in a time and information limited setting. It sucks, it means we sometimes make mistakes, and it definitely allows for a lot of Monday morning quarterbacking from the "real experts." Unless you change your perspectives, it seems unlikely that EM is the right choice for you. The other specialties (except anesthesia) will allow some more time for decision making, but at the end of the day, you are a doctor and you need to make decisions and bear the responsibility of those decisions on behalf of your patients.

Focusing on the bread and butter rather than the intellectual stimulation as @sunealoneal mentioned is great advice. It will all become "just a job" eventually.

 

[BigSkyMontana45]

I'm of the belief that it's better to go slow and evaluate, then rush into things. So the fifth year seems like a nice idea.

Only downsides I could think of is that the LOA may not look great, but if you pick up a good research project and do something meaningful with the time, then I think that should be totally fine too...and might even boost your application? I know research years, if focused in your field of interest can be really helpful for the competitive residencies.

I'm not as experienced as others in the forum, so take my advice with a grain of salt, but I'd probably take the fifth year if I was in your situation and not in any rush to finish, but that's just what I would do. I'd talk to more experienced people before making that decision.

That is what my dean is recommending too. I brought up the lost income argument - and she thinks its ridiculous for 2 reasons.

1) I will not be short on cash to the point that 1 year would make a difference. If I find a field I am the best suited for, I will more than make it up by working longer.
2) If the 1 year lost income argument is valid - then no one should go into fellowships. Like - why go into 3 year fellowships in ID, Nephro, Rheum, and Allergy...etc - its 3 years of not making an attending hospitalist's salary.

 

[AndM17]

I find myself in a similar position (M3 year, not fully decided) except I am between two specialties
1) Gastroenterology:Now working on a small paper as the primary author. My interest in GI stemmed from personal experiences in med school but I really wouldn't like being an IM hospitalist if I can't fellowship match. I had a 4wk IM rotation on GI team (with GI attendings) I enjoyed.
2) Radiology: Really liked my 2wk rotation in general DR and my school's radiology program director was very encouraging about my future. The residents and attendings were so nice they even offered to help me get some radiology case reports. Plus, prelim year would fit perfectly with my spouse's internship year in her allied health profession.

As for the original question...
I also talked to my dean and mentioned a gap year to decide but they didn't advocate for it. The advice I got was that gap years would make sense if I was starting a research project to improve my resume for ultra-competitive specialties, could no longer attend school, or had an amazing once-in-a lifetime opportunity. Neither were true for me but your situation is quite different than mine. Also, I was encouraged to get as much exposure to these fields by doing after-hours shadowing right now if I feel my exposure wasn't enough (much easier said than done). Ultimately, it comes time for everyone make the fateful decision and I would rather make it soon that delay a year but others may disagree. I don't know how many people regret regret their residency, though. Sometimes I console myself by thinking about how in most fields you can switch to something very different if you find out that you don't like the "bread and butter" of it, e.g. IM--cardiology if you like imaging/angio, EM--critical care if you don't like the ED, Radiology--IR or breast imaging if you want to talk to patients, Neurology--vascular neuro, Anesthesiology--pain medicine if you want to be outpatient and not doing general anesthesia.

 

[Anicetus]

Why does everyone assume there is a field out there for everyone that they could be passionate about? In reality some people don't ever find this field and waste a lot of time and effort waiting for something to come along that they enjoy more than anything else and hop out of bed every morning extremely excited to get to work to start their day. Delaying a year for the sake of waiting for this feeling to come along is naive for some people, but if they have a feeling that a specific field may be that ecstasy then by all means take the year off to pursue it. Taking the year off to explore more with absolutely no idea what is going to be their passion is like signing up for a lottery.

 

[BigSkyMontana45]

Why does everyone assume there is a field out there for everyone that they could be passionate about? In reality some people don't ever find this field and waste a lot of time and effort waiting for something to come along that they enjoy more than anything else and hop out of bed every morning extremely excited to get to work to start their day. Delaying a year for the sake of waiting for this feeling to come along is naive for some people, but if they have a feeling that a specific field may be that ecstasy then by all means take the year off to pursue it. Taking the year off to explore more with absolutely no idea what is going to be their passion is like signing up for a lottery.

I am taking a semester off - so I begin again next Janurary with 9 months to rotate in various fields until Residency application is due. If I don't find the right field - then so be it - I would be content with my final decision.

 

[Señor S]

...

 

[MSTP18]

If you sit on your ass for a year that's a red flag but 25% of the class each year at my school does a research year after M3 and many of them are matching into the top programs/specialties. Kind of confused about all these people saying it's a red flag.

 

[DrfluffyMD]

It's perfectly reasonable. OP just had a kid too.....

 

[yungspleen]

You probably aren't going to find the "perfect specialty" and even if you really like one of your rotations it will probably be due to the fact that you just like the people in that department at that specific hospital. If you haven't figured out anything by now you won't figure out much more in the next nine months. Just pick something and make the best of it.

 

[cyanide12345678]

Pick one. Just pick one. Ok. med students are delusional thinking there is some magic out there and they are destined for one field or another. Just pick one. The secret is that all fields have something youre going to love and something youre going to hate. If you want to value your life and outside relationships then pick something with a good lifestyle. To take a year off to figure this out is a mistake, a costly one too.

This is true. You can spend another year as well, explore several other fields, but what guarantee do you have that you'll then know what you want to do ? The more fields you'll explore, the more you'll get confused. At the end of the day, a medical student will never truly be able to make an informed decision because you only get an outsiders perspective without truly participating in a lot of the things that one must do on a day to day basis while as a practicing physician. Lets face it..most physicians feel burnt out. Infact most people after many years would rather spend time at home on a weekend than be at work, or go on vacation. Work at the end of the day becomes just work. Also, from your post it seems like you're interested in a lifestyle specialty, there is nothing wrong with that. I think everyone should prioritize lifestyle. Lets just all admit that at the end of the day there is more to life than work. You can never have a meaningful life without meaningful relationships and a family. So as the above poster said, just pick a field. You'll never know if it's the right choice or not. Just look into your soul and figure out what your priorities are as a person. And if you can't decide at all, just pick a lifestyle specialty, because at the end of the day, most people enjoy being off work more than being at work

 

[cyanide12345678]

Also...when you say that radiology and anesthesiologists make a lot of money, you're banking on the future not changing. Those two fields in particular have quite a few challenges ahead of themselves. Radiology is facing increasing pressure as images can easily be shipped over seas for someone to read them for half the cost. And anesthesiologist jobs are tightening up as anesthesiologists are now becoming more like managers of nurse anesthetists, decreasing the total number of anesthesiologist positions (especially in the bigger cities). I've talked to anesthesia residents, a lot of them say that you need a fellowship now to get a job in a big city. So supply and demand principles may soon catch up. So essentially, don't make a decision based on todays salaries. It might not be the same in 5-10 years.

 

[Misterioso.]

Of the OP's list, the one that stands out as indecisive people is radiology. Clinical correlation is recommended.

 

[kineticdeux]

I thought people who couldn't decide went into EM?

After all, they act like they're a surgeon, anesthesiologist, family doctor and cowboy all in one Something for everyone and only 12 hours a week!

 

[Misterioso.]

I thought people who couldn't decide went into EM?

After all, they act like they're a surgeon, anesthesiologist, family doctor and cowboy all in one Something for everyone and only 12 hours a week!

In EM they think they know but the diagnosis always turns out to be wrong. So I guess if the OP ends up changing fields, EM may be the way to go.

 

[kineticdeux]

In EM they think they know but the diagnosis always turns out to be wrong.

Well that's because half the time they don't even see the patient; they just pan order and consult.

OP, do you have good typing and phone dialing skills? If so, EM might be for you.