The Life Arc vs Specialty Plot

[Nasrudin]

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This other thread got me thinking about a topic I find interesting...

Nobody seems willing to admit that age brings changes of all sorts. Most of them...not so nice. Like...why the f@ck do I continue to exhibit hair growth in previously bare areas. That's not cool. I need a full time mansccape artist. Just to keep me looking non-cro-mangnon. This sort of thing.

And that yes. I'll admit it. I don't know what the kids are listening to. And unlike most you, clinging to your shell of youth, I don't give a f@ck.

But as to specialties. Nobody wants to admit that being the ancient rookie is some fields is ridiculous for everyone involved. I posit that there are career windows for age brackets.

Sure. There's always that guy or girl who competes in iron man competitions at 60. But f@ck that guy. I'm sick of the notion that the rest of us should feel less than in comparison.

Which elevates the next notion. At a certain point. That I apparently passed at some point in my sleep. I get sick of competing. It's just not the way the mature mind is supposed to think at a certain point. Does grandpa try to teach sonny boy how to fish by yelling... in your face!!! while reeling in a big one.

But such as it is. Running with the young and restless. Many fields demand fierce competitiveness just to get your foot in the door.

Am I supposed to enjoy that at this age? Am I supposed to agree and just hide my shame at feeling sick of it all?

I think age should not be hidden from. And I also think many specialties are made for younger more competitively oriented people.

For instance, had i gone into medicine in my 20's, I'd have likely applied to Emergency Medicine. And would have been a seasoned attending eyeing retirement now. Do i feel bad that I missed that window...not at all.

And my point is. Neither should you!

I have plenty of interesting career options that are much more well-suited to keeping me actively engaged until I'm in my 70's and beyond. Should nature decide to prolong my eventual entropy.

What do yall think?

 

[LupaCupcake]

Nothing wrong with that. It is simply the truth. Gotta do what makes you happy and what you can realistically do without growing to hate your position and hating your decision to go that route

 

[DrMidlife]

Nobody seems willing to admit that age brings changes of all sorts.

I'm totally willing to admit it. What I've learned is that there's no point, at all, in mentioning any of it to my younger classmates. I hang out with my older female professors when I need to talk about aches & pains. I get some value from talking with young-ish parents - they're exhausted and pragmatic and not hungover after exams.

And that yes. I'll admit it. I don't know what the kids are listening to. And unlike most you, clinging to your shell of youth, I don't give a f@ck.

If I may invoke my inner old codger, I know what the kids aren't listening to, and that's whoever's lecturing. I see news articles about how smartphones and gaming have introduced the greatest generational divide ever - but I disagree. Omnipresent, non-biodegradable, noisy-as-f*** snack wrappers did that. I can't go 5 minutes without checking email/IM either, but by god I can survive forever without a metallic-wrapped Rice Krispie Treat (tm).

As for competition, and career options, and keeping up with Mavis Lindgren/Dara Torres/Diana Nyad/Catherine Hamlin, and having some hope of financial well-being ever again, and surviving residency, and having a new-found appreciation for ROAD specialties, and having to admit that despite how much I feel like a 2 year old throwing a tantrum when I don't get enough sleep it doesn't make me feel young at all, and how it doesn't matter how fat/old/bald/boring most of my age group is I will obsess over that one couple who is sailing around the world in this their first year of retirement after which they're building a school in South Africa. They're younger than me. A**holes.

But. I know the path I'm on, graduating med school a couple weeks before I turn 50, is the only kind of path I could be on. I could be changing careers to be an economist or biostatistician or civil engineer, and I'd still be an old fart. It was never on the table for me to figure out who I am and what I can do before my late 30's. I love that I don't need to get my heart broken, or come up short on rent, or crash a car, or lose a loved one to suicide, for the first time, during med school. In my 20's I would have dropped out or failed out of school under those conditions. Now I don't have to stop working, for long, when the world comes crashing down. I have endurance and focus and patience and vision that I never knew I would grow up to have. (Insert Helen Reddy here.)

So I'll take being old during med school. I'll scamper for exam points like a mouse in a cog psych experiment. I'll hope to be smart about choosing a specialty that isn't a projection of ignorant fiction onto who I am. I love my background - I wouldn't trade back a single mistake for lessons I've learned - and I can't wait to bring that rocket fuel to the Bic lighter party.

Or it could just suck forever. I get that.

Good topic.

 

[Nasrudin]

I'm totally willing to admit it. What I've learned is that there's no point, at all, in mentioning any of it to my younger classmates. I hang out with my older female professors when I need to talk about aches & pains. I get some value from talking with young-ish parents - they're exhausted and pragmatic and not hungover after exams.

If I may invoke my inner old codger, I know what the kids aren't listening to, and that's whoever's lecturing. I see news articles about how smartphones and gaming have introduced the greatest generational divide ever - but I disagree. Omnipresent, non-biodegradable, noisy-as-f*** snack wrappers did that. I can't go 5 minutes without checking email/IM either, but by god I can survive forever without a metallic-wrapped Rice Krispie Treat (tm).

As for competition, and career options, and keeping up with Mavis Lindgren/Dara Torres/Diana Nyad/Catherine Hamlin, and having some hope of financial well-being ever again, and surviving residency, and having a new-found appreciation for ROAD specialties, and having to admit that despite how much I feel like a 2 year old throwing a tantrum when I don't get enough sleep it doesn't make me feel young at all, and how it doesn't matter how fat/old/bald/boring most of my age group is I will obsess over that one couple who is sailing around the world in this their first year of retirement after which they're building a school in South Africa. They're younger than me. A**holes.

But. I know the path I'm on, graduating med school a couple weeks before I turn 50, is the only kind of path I could be on. I could be changing careers to be an economist or biostatistician or civil engineer, and I'd still be an old fart. It was never on the table for me to figure out who I am and what I can do before my late 30's. I love that I don't need to get my heart broken, or come up short on rent, or crash a car, or lose a loved one to suicide, for the first time, during med school. In my 20's I would have dropped out or failed out of school under those conditions. Now I don't have to stop working, for long, when the world comes crashing down. I have endurance and focus and patience and vision that I never knew I would grow up to have. (Insert Helen Reddy here.)

So I'll take being old during med school. I'll scamper for exam points like a mouse in a cog psych experiment. I'll hope to be smart about choosing a specialty that isn't a projection of ignorant fiction onto who I am. I love my background - I wouldn't trade back a single mistake for lessons I've learned - and I can't wait to bring that rocket fuel to the Bic lighter party.

Or it could just suck forever. I get that.

Good topic.

Hehe.

Good to be swapping stories with you again.

I'm happy too. Being exactly old as I am. Older for effect. Body worn down from a years of physical labor. No sitting on my butt like I am now. Not ashamed of any of it. Ugly and all.

I'm glad we find the celebratory chord to resist notions of faking youth in common. If I spent my time faking youth in this orgy of fakeness. I might not make it out of the maze.

Yeah. And those retirees sailing the globe and doing charity. Flip them a bird for me too.

 

[ThreadStalker]

Which elevates the next notion. At a certain point. That I apparently passed at some point in my sleep. I get sick of competing. It's just not the way the mature mind is supposed to think at a certain point. Does grandpa try to teach sonny boy how to fish by yelling... in your face!!! while reeling in a big one.

But such as it is. Running with the young and restless. Many fields demand fierce competitiveness just to get your foot in the door.

Am I supposed to enjoy that at this age? Am I supposed to agree and just hide my shame at feeling sick of it all?

I think age should not be hidden from. And I also think many specialties are made for younger more competitively oriented people.

For instance, had i gone into medicine in my 20's, I'd have likely applied to Emergency Medicine. And would have been a seasoned attending eyeing retirement now. Do i feel bad that I missed that window...not at all.

Totally agree with this. I'll still be in my thirties (barely) when I graduate, provided I get in this year, but I'm done with the competitive, manly man bull of so many fields. I have no interest in "proving" anything that way. I don't know if this is a result of too many years spent being in an uber-competitive career, or if some part of my brain is finally developing, or a combination of factors, but I won't miss it.

I'm really glad to be starting on this path at this point, too. I think that if I had gone straight to med school after undergrad, I would have ended up in a specialty like EM or surgery, just because I would have been driven by my nature at that age. Now, I have a chance to totally change that path with an understanding eye towards the future. I can leave the tough guy (or gal) contests to to the kiddos.

I was just talking about this to a friend earlier, and it really hit me how fortunate I am to to enter this path with this perspective. If I was already a licensed physician working in one of those fields I wouldn't be approaching retirement, but I would be approaching burnout. This is a second chance to make the right choice, and I'm stoked!

 

[Nasrudin]

Totally agree with this. I'll still be in my thirties (barely) when I graduate, provided I get in this year, but I'm done with the competitive, manly man bull of so many fields. I have no interest in "proving" anything that way. I don't know if this is a result of too many years spent being in an uber-competitive career, or if some part of my brain is finally developing, or a combination of factors, but I won't miss it.

I'm really glad to be starting on this path at this point, too. I think that if I had gone straight to med school after undergrad, I would have ended up in a specialty like EM or surgery, just because I would have been driven by my nature at that age. Now, I have a chance to totally change that path with an understanding eye towards the future. I can leave the tough guy (or gal) contests to to the kiddos.

I was just talking about this to a friend earlier, and it really hit me how fortunate I am to to enter this path with this perspective. If I was already a licensed physician working in one of those fields I wouldn't be approaching retirement, but I would be approaching burnout. This is a second chance to make the right choice, and I'm stoked!

Yeah man. Just like that. That's the way I feel too. And it's a good feeling. Relaxing. To just you know. Work on getting there in your own stead. With your mind body and spirit working well together.

It depresses me to see older people trying to be something they're not. Trying to run to fast and furious. And ignoring this easy going but hard earned wisdom.

The hoohah! fields can go ahead on.

I need something that will utilize a different frequency. And make me better at it because of being able to tune that one in.

 

[QofQuimica]

It's an interesting question to consider, what specialty I would have picked if I had started residency at 26 instead of 36. I don't know. I don't think I had a clear idea about what I wanted to be when I grew up in my early twenties. I just loved organic chemistry and wanted to be with my ex. I could have gone to med school, but I wasn't that gung-ho about it, and he didn't get accepted to grad school anywhere in FL. So I went to grad school.

I would say that I'm still a competitive person, but it's different. I was a very high strung adolescent, so hard on myself. I wanted to do everything perfectly. People who know me now might find this surprising, but I've mellowed out quite a lot. I still push myself, and I did very well in medical school. But, I'm also able to step back and say, OK, objectively I'm a sucky doctor. But I'm not supposed to be an awesome doctor four months into my intern year. If I were, I wouldn't need to do a residency, right? That's what is different.

I also don't freak out when I don't know what to do about something or how to handle a situation. I stop, take a step back, think it out. It works for answering attending pimp questions, and it works for dealing with difficult people. I do better with letting things go and forgiving people for their flaws, myself included. And most of all, I can laugh at myself. If there is one thing I could tell my adolescent self not to do, it would be not to take herself so darn seriously. Well, that, and break up with the ex sooner. 😉

 

[Nasrudin]

It's an interesting question to consider, what specialty I would have picked if I had started residency at 26 instead of 36. I don't know. I don't think I had a clear idea about what I wanted to be when I grew up in my early twenties. I just loved organic chemistry and wanted to be with my ex. I could have gone to med school, but I wasn't that gung-ho about it, and he didn't get accepted to grad school anywhere in FL. So I went to grad school.

I would say that I'm still a competitive person, but it's different. I was a very high strung adolescent, so hard on myself. I wanted to do everything perfectly. People who know me now might find this surprising, but I've mellowed out quite a lot. I still push myself, and I did very well in medical school. But, I'm also able to step back and say, OK, objectively I'm a sucky doctor. But I'm not supposed to be an awesome doctor four months into my intern year. If I were, I wouldn't need to do a residency, right? That's what is different.

I also don't freak out when I don't know what to do about something or how to handle a situation. I stop, take a step back, think it out. It works for answering attending pimp questions, and it works for dealing with difficult people. I do better with letting things go and forgiving people for their flaws, myself included. And most of all, I can laugh at myself. If there is one thing I could tell my adolescent self not to do, it would be not to take herself so darn seriously. Well, that, and break up with the ex sooner. 😉

Yeah. Could be there's some ideal slack/tension for the most optimal result. that maybe I've just yet to find.

I went from. Wide-eyed and sideways in the world. To militant and hardened. I've needed an alternate synthesis for a long time now. It's hard to find the right notes. The thing just keeps moving. And me along with it. It's swell enough to be on board.

But keeping fit. Keeping motivated for more internal reasons. And trying to make the grade at every turn. Has prevented me from zeroing in. On what is the right traveler's state of mind. Given the choice to come this way.

I'm definitely looking to jive with the most ideal habitat I can come up with.

Hence to question to the crowd.


But yeah. ex's. I can't even muster an accurate sense of who I was or they were. Or what we were thinking. Some of us....?

 

[Nasrudin]

My other thought, Q, is that you flesh out my point exactly.

The act of learning to do what you do requires a certain competitiveness. Can Q run this code, do this procedure, manage this critical situation or that? With a dozen or so other aggressive minded, fresh from white water rafting and mountain biking adventures type of cats...ready to take over and one up you.

And that. Is what I'm getting at. Not exactly that any part of medicine is inherently mellow. Or doesn't require hard work. But that there must be something more well-suited for those of us who don't inherently like that frequency.

How would a naturally aggressive mindset work for a palliative medicine doc for example. Most medical trainees would shrink just from the perceived boredom of slower, unresolvable problems. (even though they fool themselves thinking they've resolved much of anything.)

There's an age component. Perhaps a personality component. But I also tend to think that as the 1000's of experiences pile up. We have more opportunity to arrive at a similar place or state of mind.

And furthermore that that natural progression is antithetical to the dogma of competitive fields and competition in general.

The fact that some of us enter the game already world weary but more smoothed out and mellow, I tend to think, means we should pick something that tracks this development. Certain fields have more opportunities for different types of interactions. That comprise this mellowed hue of mind.

 

[dmf2682]

Wow you guys are grizzled. It is fascinating to see your perspective, especially knowing I'm roughly on q's timeline. Interesting stuff.

 

[n3xa]

I would say that I'm still a competitive person, but it's different. I was a very high strung adolescent, so hard on myself. I wanted to do everything perfectly. People who know me now might find this surprising, but I've mellowed out quite a lot. I still push myself, and I did very well in medical school. But, I'm also able to step back and say, OK, objectively I'm a sucky doctor. But I'm not supposed to be an awesome doctor four months into my intern year. If I were, I wouldn't need to do a residency, right? That's what is different.

I also don't freak out when I don't know what to do about something or how to handle a situation. I stop, take a step back, think it out. It works for answering attending pimp questions, and it works for dealing with difficult people. I do better with letting things go and forgiving people for their flaws, myself included. And most of all, I can laugh at myself. If there is one thing I could tell my adolescent self not to do, it would be not to take herself so darn seriously. Well, that, and break up with the ex sooner. 😉

Bolded for complete and utter agreement. 👍

Except I wasn't competitive at all in high school. I had to work, my family was broke, my dad was bedridden, and no one wanted to talk about it. So I spent my weekends throwing raves in abandoned warehouses, not giving a ****. And barely skated by hs. In college I did a complete 180, but constantly felt like I had impostor syndrome the entire time. I mellowed out considerably in graduate school.

As far as faking youth goes, I'm not going to stop lifting heavy weights around the gym but the thought of giving myself botox injections like one doctor acquaintance I had lunch with after not seeing her for years during my interview kind of weirds me out. Also, the frozen face weirds me out too.

As long as you do what makes you happy, then so be it. If you're being something you're not, then that sucks for you. I'm too busy getting my stuff done and trying to keep a sane head on my shoulders.

 

[Autarkeia]

For me, the shift came when I stopped living for a destination and started living for the here and now. My perspective is rather antithetical to overt competition since competition is inherently goal-oriented. And I'll gladly leave competition to the younger set.

That's not to say I'm content with mediocrity. Focusing on what's around me without the distraction of the next step allows me to maximize my opportunities. I imagine I'll be quite competitive for anything.

The nice thing about age is that it has freed me from the desire to prove myself. That allows me to focus my energies on what I think is important. I may be working with less, but I am doing a whole lot more.

 

[Isoprop]

For me, personally, the best thing about being an older medical student is not being afraid of failure. A lot of the kids around me freak out over a difficult exam or assignment. I take solace knowing that if I f*** up, I will learn from my mistakes and move on.

 

[Valadi]

The nice thing about age is that it has freed me from the desire to prove myself.

I'm waiting for the day I no longer feel this.

This is a deep thread. As a 25 year old, I loved hearing all of your stories and insight.

 

[QofQuimica]

My other thought, Q, is that you flesh out my point exactly.

The act of learning to do what you do requires a certain competitiveness. Can Q run this code, do this procedure, manage this critical situation or that? With a dozen or so other aggressive minded, fresh from white water rafting and mountain biking adventures type of cats...ready to take over and one up you.

And that. Is what I'm getting at. Not exactly that any part of medicine is inherently mellow. Or doesn't require hard work. But that there must be something more well-suited for those of us who don't inherently like that frequency.

How would a naturally aggressive mindset work for a palliative medicine doc for example. Most medical trainees would shrink just from the perceived boredom of slower, unresolvable problems. (even though they fool themselves thinking they've resolved much of anything.)

There's an age component. Perhaps a personality component. But I also tend to think that as the 1000's of experiences pile up. We have more opportunity to arrive at a similar place or state of mind.

And furthermore that that natural progression is antithetical to the dogma of competitive fields and competition in general.

The fact that some of us enter the game already world weary but more smoothed out and mellow, I tend to think, means we should pick something that tracks this development. Certain fields have more opportunities for different types of interactions. That comprise this mellowed hue of mind.

I think you're being overly dichotomous with how you categorize different specialties. The thing is, there are many career trajectories in every specialty. Even in the most hard core, balls to the wall specialties, not all jobs are the power trip type that you're wanting to avoid. And even among similar jobs (say, academic versus community), there are unique institutional personalities, just as there are unique individual personalities. If you have the opportunity to rotate at a few different hospitals during medical school, you will see what I mean about how radically different institutional cultures can be.

Rather than focus so much on the stereotypes of a particular specialty itself, it might behoove you to focus more on the type of job that you want to end up in. Then pick your specialty based on what you like, as well as what will get you the kind of job you want. Along those lines, I hope you'll try to avoid getting caught up in the intensity of what you see the residents going through when you start your rotations this summer. Because residency doesn't last forever (even though it feels like it sometimes!), and there are often many paths to reach your shangri-la.

Speaking of which, it's interesting that you chose EM and palliative medicine as your two polar opposites of specialty mindsets. For all of your angst about the aggressiveness of EM personalities, ABEM is actually one of the sponsoring boards for certification in hospital and palliative medicine. This is a perfect example of what I meant when I said that there are often many paths that will get you to the same place in the end. 🙂

 

[Nasrudin]

I think you're being overly dichotomous with how you categorize different specialties. The thing is, there are many career trajectories in every specialty. Even in the most hard core, balls to the wall specialties, not all jobs are the power trip type that you're wanting to avoid. And even among similar jobs (say, academic versus community), there are unique institutional personalities, just as there are unique individual personalities. If you have the opportunity to rotate at a few different hospitals during medical school, you will see what I mean about how radically different institutional cultures can be.

Rather than focus so much on the stereotypes of a particular specialty itself, it might behoove you to focus more on the type of job that you want to end up in. Then pick your specialty based on what you like, as well as what will get you the kind of job you want. Along those lines, I hope you'll try to avoid getting caught up in the intensity of what you see the residents going through when you start your rotations this summer. Because residency doesn't last forever (even though it feels like it sometimes!), and there are often many paths to reach your shangri-la.

Speaking of which, it's interesting that you chose EM and palliative medicine as your two polar opposites of specialty mindsets. For all of your angst about the aggressiveness of EM personalities, ABEM is actually one of the sponsoring boards for certification in hospital and palliative medicine. This is a perfect example of what I meant when I said that there are often many paths that will get you to the same place in the end. 🙂

Will definitely keep this in mind. And do understand what your indicating.

But is there not a culture being generated even here in the womb that begins in broad, sterotypic strokes to separate the flock? It is not only I who am doing the painting and parsing. By feeling my way along in different spheres, trying to intuit my fitness for the various fields. The game is competition. And it works with cold efficiency.

I've known some fine finish carpenters and cabinet builders who have the innate skill and strength and coordination and 3-dimensional vision to become excellent orthopedic surgeons. And yet. Take the one such as that who gets through to a medical school. And tell me how you like their prospects with a 210 on the Step. Or who fails to outwit the competition in garnering the precious commodity of the departmental support. Surgeon so-n-so who likes his balls buffed before morning coffee.

So for the benefit of any premed readers. We should level with them about what the game entails and how's it played. And how getting there means pay the ferryman.

The fare is different depending on the destination, is it not?

Your field is heating up. More of our cohorts want the shift work. And the Saturday night lights to go with it. Attracting a fierce competition.

Fine once you survive Hamburger Hill. Sure you can scale down. But there are fundamental demands of each fields. With varying frequencies in a variety of interactions.

And there is most certainly distinctions in culture. Not universal. Sure. But without being really competitive, competitive fields are not going to afford you the luxury of selecting for your own preferences in this regard.

Which turns back to my original point. Cultural natural selection is fact. And is taking place around both of us. In our separate stages of the process.

 

[mcdtheta]

In reading this thread, I wonder what specialties you are considering due to "age contraints" and ones that you have ruled out and why? I am now 35, hoping to enter med school by 38 and I think about the similar things you all have addressed in this thread.

 

[Nasrudin]

In reading this thread, I wonder what specialties you are considering due to "age contraints" and ones that you have ruled out and why? I am now 35, hoping to enter med school by 38 and I think about the similar things you all have addressed in this thread.

hmmm. Ok. Fair enough since I broached the subject.

Worth noting before I get hate mail is that aging is an individual process. I have physical concerns that are mileage related and not just age related. If I'd sat in an air-conditioned library for my late teens twenties and thirties I might be a pristine beauty queen livin the dream. And be more able to pick certain fields.

My age--38. Is tempered by daily struggle with pain management. Stress and stooping forward aggravates my underlying problems.

And given my financials. I will retire upon dying or being unable to work.

Lastly. Most importantly my interests are skewed toward things uninteresting to most. And then also I love California like lindsay lohan likes booze. It's competitive. I'm driven towards competency but not statistical dominance. That's a mismatch. In the match game. For some things. So...

You were perhaps not interested in that. But how else would you compare my career interests to your own if you didn't have a rough outline of the character typing this crap.

So I'm liking psych. Working with Internal medicine as secondary interest. And also maybe family medicine with a ultimate career goal via those two as being a Palliative medicine doc.

I think psych complaints are inherently interesting. Encountering an altered consciousness. One that must be determined at some pathological separation from my own. That seems dangerous. To make that call. I feel my inclinations make me potentially good at this field. Whereas they don't for many. I discovered during an ED internship. The ED doc had me do histories on all her psych patients. Not one of them was dull. And the history taking is my favorite activity so far in medical school. The history is all important to the care of the mentally ill.

Why I rule out surgery is intensity of the training. I can in my current rectified by exercise state handle consistent hard work. Within a reasonable ebb and flow.

Surgical fields propose an all out assault on the physical self. I have no inclination for this. I also don't like macho insecurity. I leave others to debate the stereotype truth. But I see what I see, use my judgment and move on. Others can have at it.

ED is something I've always liked. But only as a tech working there. Which is task oriented with one-on-one patient care being all that comprises it. But I don't like extreme multi-tasking. I prefer to be more deeply, intimately engaged with an encounter directly in front of me. This is one of the purest age related changes that's happened to me. But perhaps I've always been like that. Just more so now. I feel the demands on the the ED doc are too frenetic.

Mother's and babies are not the thing for a childless older dude. I like peds a lot. But they always want to know if you have your own. And if it were treating just the kids it'd be more tempting. But messed up parents. Especially the co-dependent kind who see no problem with endowing their 4 y/o with the cardiovascular system of a hypertensive, type II diabetic middle aged adult is too much for my nerves. I'm too honest. And would be out of business.

OB/gyn. Simple. I don't like all female environments. Especially not in hormone crisis mode.

Medicine seems like it has some things i find interesting. But i'm not sure I'd like to manage the typical chronic trainwreck.

So yeah. Psych. Unless my mind changes with 3rd/4th year experience.

I'm testing my match for psych as often as I can. We'll see. I'm not an easy sell. I want to do this right. One residency-once happy career before checking out.

 

[Nasrudin]

yeah path seems chill.

But a little to nerdy and boring.

If you like all the labby sort of stuff in your path classes 2nd year then you might like path. I don't find those types of things that interesting.

 

[mcdtheta]

I love California like lindsay lohan likes booze.

Too Funny - reading this at work and I almost fell off my chair!

Best of Luck. I am a believer that folks who choose psych are called to do it - so if you are interested in the medicine behind it and you enjoy the patients, you should go that route. I sometimes feel that due to my past work in the OR and in critical care areas I feel more drawn to those areas in medicine - I am really trying to keep my mind open to all of the things I will eventually learn and experiences in other departments.

 

[unhappyrnstudnt]

I can't go 5 minutes without checking email/IM either, but by god I can survive forever without a metallic-wrapped Rice Krispie Treat (tm).

Haha, I LOVE this. I'm currently in the same age group as these video game addicted, "I should have my metallic-wrapped Rice Krispie Treat holster surgically implanted onto my hip" age group (I'm 27), but I'm in nursing school and by the time I'd be able to enter medical school, I'll be well into my 30s (just started nursing school and I'd switch to premed, but I have a lot of personal reasons for needing to complete this first). So I'm researching around on here to make sure it's what I want to do (it definitely is ATM, but is a HUGE decision) as I will definitely be non-traditional and probably making the same comments by the time I'm in med school, lol. I'm gonna steal the Rice Krispie Treat quote, though. That's awesome.

On another note, how long are residencies for neurology and is that a competitive field? I suppose I should do more digging around on here (there are usually threads for everything on here), but I also thought this would be a good area to ask. Are any of you non-trads doing neurology? What specialties do you all want to go into?

 

[Nasrudin]

Too Funny - reading this at work and I almost fell off my chair!

Best of Luck. I am a believer that folks who choose psych are called to do it - so if you are interested in the medicine behind it and you enjoy the patients, you should go that route. I sometimes feel that due to my past work in the OR and in critical care areas I feel more drawn to those areas in medicine - I am really trying to keep my mind open to all of the things I will eventually learn and experiences in other departments.

Yeah. It's like that for me too. I've worked in peds and ED. Both of which I like. And if those were my only choices I'd certainly still be happy to be here.

I guess. The original idea for the thread was kind of a pre-exam release rant. I really do get sick of competing for grades. Even with myself. It misdirects my natural curiosities into something darker.

The other notion. Was that, at least, as i feel and perceive it. There seems to be vastly different vibes in the subsets of the medical school population. I think if your're a naturally competitive and aggressive personality you'd be less likely to be sensitive to the differences. That's fine. I'm not so critical of that. As long as it can be externalized from my natural mental state. For all I know this is necessary to produce the next generation of cutters of various sorts.

But that. What if you're not. And you think kindergarten is the ideal society. Where we all take naps. Get prizes. And get reminded how to share and help our neighbor. And play nice.

I like that sort of thing. Fine. It's goofy. But it puts you on an antique moped on the freeway in medical school. And good luck getting your chickens to market like that.

I'm exaggerating for effect. But their is an extreme parsing effect taking place here. Where you get the ticket to ride based on your score. Your score is a composite of your life. It effects how the deans and professorly types see you. Oh...this kid...smart f'er. Noted check. Oh that one.... a little slow.... and that one.... We should just walk around with our exact Score to 5 decimal points and that would be our rank. It's effectively like that. Especially, it seems to me, from the top down. And that's kind of what bothers me.

These mf'ers are supposed to be the ones who know that in some distant reality it can be much more about one's ability to work well with team members than any score but does that stop them from propagating this Creation Myth. No. It does not.

And so on. So that by degree. The culture of Score intensifies around certain subsets of the prestigious classes of medicine. The Surgiliteraiat being a prime example of intensified competition. Particularly the sub-specialists.

Be aware of this if that's what you want. Is what I'm saying. The more competitive or desirable the specialty the ****tier the cultural environment. And that will be your cohort for your career. Think about that.

And so yeah. I'm saying as you get older, how does this not become disgusting. It's always been gross to me. But at my age. Forgettaboutit.

This is sad to me. More because I think about all the naturally interested people in certain aspects of medicine that might get trampled by the stampeding herd.

I somehow. Always end up lucky. In that my interests have always been anti-herd. By luck. Or zodiac. Or who cares. As long as I don't have to spend all of my years in training competing against aggressive @ssholes for a space in the sun.

But good luck. To everyone in finding their niche. Which is important to make all this work worthwhile.

 

[ChemMed]

I think you're being overly dichotomous with how you categorize different specialties. The thing is, there are many career trajectories in every specialty. Even in the most hard core, balls to the wall specialties, not all jobs are the power trip type that you're wanting to avoid. And even among similar jobs (say, academic versus community), there are unique institutional personalities, just as there are unique individual personalities. If you have the opportunity to rotate at a few different hospitals during medical school, you will see what I mean about how radically different institutional cultures can be.

Rather than focus so much on the stereotypes of a particular specialty itself, it might behoove you to focus more on the type of job that you want to end up in. Then pick your specialty based on what you like, as well as what will get you the kind of job you want. Along those lines, I hope you'll try to avoid getting caught up in the intensity of what you see the residents going through when you start your rotations this summer. Because residency doesn't last forever (even though it feels like it sometimes!), and there are often many paths to reach your shangri-la.

Speaking of which, it's interesting that you chose EM and palliative medicine as your two polar opposites of specialty mindsets. For all of your angst about the aggressiveness of EM personalities, ABEM is actually one of the sponsoring boards for certification in hospital and palliative medicine. This is a perfect example of what I meant when I said that there are often many paths that will get you to the same place in the end. 🙂

Yay for toxicology and all of its mellow crazy poisons 🙂 🙂 🙂 🙂

 

[NuttyEngDude]

Am I supposed to enjoy that at this age? Am I supposed to agree and just hide my shame at feeling sick of it all?

I think age should not be hidden from. And I also think many specialties are made for younger more competitively oriented people.

...
And my point is. Neither should you!

I have plenty of interesting career options that are much more well-suited to keeping me actively engaged until I'm in my 70's and beyond. Should nature decide to prolong my eventual entropy.

What do yall think?

I waver back and forth. I get tired of obnoxious, low-classed competition and politics. I can play it, I can probably win, I can compete, but I don't really want to nor enjoy it. I will have to think a good amount of time about this during my first two years of med school (assuming I get accepted).

 

[lkthlttr]

I enjoyed reading through the responses of this thread. I will be in my late 30s by the time I graduate from medical school and so I've thought about many of these same issues. I would love to hear some more opinions on specialties which people feel are particularly well or ill suited to older graduates and the reasoning for feeling that way.

 

[startoverat40]

i think there's a reason they call it "over the hill". when you get the feeling that "half your life's been wasted" if you don't do what you've always wanted, then you dig deep and pull out everything you've got so you can do it before you get back to base camp.

as for specialty, i'm thinking of going for clinical + public health (during residency), and doing more of the former at first, and more of the latter later on.

 

[LifeTake2]

It's an interesting question to consider, what specialty I would have picked if I had started residency at 26 instead of 36.

WAIT....I'm matriculating at 36....you mean I'm going to be older than Q 😱

Just kidding.

Actually this has occured to me, by the time I'm a 'real' Dr and done with training I'm going to be mid-40's, but that means with the right path I still have 25-30 years of practice left.

But I also realize that being an intern at 40 will a lot different that doing it at 26 just from the realities of being 'old'.

 

[Law2Doc]

It's an interesting question to consider, what specialty I would have picked if I had started residency at 26 instead of 36. I don't know... 😉

Im not 100% sure hat the OP is getting at, but ill chime in on this sentence of Qs post and hope its applicable. I think neurosurgery is probably the only unrealistic field for older premeds. I have also had attendings in ER and trauma surgery both say that their field was a "young man's game", but they were both in their 60s when they said this. Other than that I don't think being a nontrad really has that much impact in what you CAN go into. Whether it impacts self selection because what you are a different person now than you were at 20, I don't know. We all have different priorities now, and know ourselves a lot better. But I'm not sure that really changes the ultimate specialty choice, it just makes us more clear on why it is the right one.

 

[Ellipsis1104]

Psych for the win!

 

[Nasrudin]

Im not 100% sure hat the OP is getting at, but ill chime in on this sentence of Qs post and hope its applicable. I think neurosurgery is probably the only unrealistic field for older premeds. I have also had attendings in ER and trauma surgery both say that their field was a "young man's game", but they were both in their 60s when they said this. Other than that I don't think being a nontrad really has that much impact in what you CAN go into. Whether it impacts self selection because what you are a different person now than you were at 20, I don't know. We all have different priorities now, and know ourselves a lot better. But I'm not sure that really changes the ultimate specialty choice, it just makes us more clear on why it is the right one.

The sentence you quote is a good enough synopsis. And your response is germane.

But I was also getting at what it's like aging in an aggressive, ageist, Type A heavy game. And how some of the real wisdom that comes from life experience is so poignantly useful to some fields and scoffed at in others.

So that many of our "highly successful" predecessors on this board are of the. I ain't old!!! Watch me run this 5 minute mile, score a 250, publish in the big show, variety of individuals.

Whereas I'm in the-- Yeah. I'm old. I've got jeans older than you f'ers. My body has been beat the **** up with decades of hard physical work and stress. So it's 5 oclock. I'll see you f'ers later I'm going to yoga --Camp.

And my camp is seen as less than in this game. More so in some fields than others. But I'm quite certain that cultivation of diligent self care and a deeply peaceful presence is valuable in certain fields. As it just so happens. In all the fields I find inherently interesting anyway.

And lastly. A 65 y/o surgeon. A 65 y/o psychiatrist. And A half a million in debt at middle age. The math and the actuarial science is a matter of common sense.

 

[Law2Doc]

...
And lastly. A 65 y/o surgeon. A 65 y/o psychiatrist. And A half a million in debt at middle age. The math and the actuarial science is a matter of common sense.

actuarial science is sometimes not just an "older is worse" analysis. A 65 year old in great health probably has an actuarial lifespan of 90 years. A 35 year old with lots of comorbidities and high risk behaviors probably has the same lifespan of 25 years. So the tables adjust upwards the further slong you get in good shape. At 25 the tables say youll probably die at 75, but if you make it to 55 in good health, the actuaries throw out that 75 year old expiration date and give you another ten years, and so on. Bottom line is if you get to a greater age in good health,you will live to a riper old age than the guy who hasn't made it that far yet. So if you want to be a surgeon, and are in good health, you probably have as good a window as that younger guy with obesity, smoking and a family history of hypertension in his resume.

 

[Nasrudin]

actuarial science is sometimes not just an "older is worse" analysis. A 65 year old in great health probably has an actuarial lifespan of 90 years. A 35 year old with lots of comorbidities and high risk behaviors probably has the same lifespan of 25 years. So the tables adjust upwards the further slong you get in good shape. At 25 the tables say youll probably die at 75, but if you make it to 55 in good health, the actuaries throw out that 75 year old expiration date and give you another ten years, and so on. Bottom line is if you get to a greater age in good health,you will live to a riper old age than the guy who hasn't made it that far yet. So if you want to be a surgeon, and are in good health, you probably have as good a window as that younger guy with obesity, smoking and a family history of hypertension in his resume.

Right. Because medical culture and it's overseers prize and reward self care, fitness, stress coping strategies. And are so accepting of the aging and experienced mind.

That most older folks who fit themselves squarely into this stressful culture are oh so likely to maintain the physical conditioning to be septuagenarian surgeon.

If this that this and that. Then sure. You make sense.

 

[QofQuimica]

WAIT....I'm matriculating at 36....you mean I'm going to be older than Q 😱

Nope, I'm going to be 37, so I'm a year older than you. 😛

But I also realize that being an intern at 40 will a lot different that doing it at 26 just from the realities of being 'old'.

Being an intern at any age and in any specialty is going to be tough. Maybe tough in different ways, but very few people, if any, find intern year to be a walk in the park. You have the worst schedule, the least control over your life, and the most (and crappiest) work hours. I really miss having the ability to set my own hours like I could when I was in the lab.

I posted about the other PhD in my med school class in another thread a few weeks ago. She wound up dying during the week between Christmas and New Years. I've been thinking about her often, and also thinking about some larger, existential type questions. Like, would I have wanted to spend the last six months of my life working as an intern? That's a no-brainer: heck no. Obviously, I'm still working as an intern because I don't anticipate dying in the next six months. But at some point as we get older, the amount of time between when we stop delaying gratification and when we die gets shorter and shorter. It's something to think about if you're going to choose a long, hardcore residency, especially if you're already middle-aged when you start out.

 

[lkthlttr]

I posted about the other PhD in my med school class in another thread a few weeks ago. She wound up dying during the week between Christmas and New Years. I've been thinking about her often, and also thinking about some larger, existential type questions. Like, would I have wanted to spend the last six months of my life working as an intern? That's a no-brainer: heck no. Obviously, I'm still working as an intern because I don't anticipate dying in the next six months. But at some point as we get older, the amount of time between when we stop delaying gratification and when we die gets shorter and shorter. It's something to think about if you're going to choose a long, hardcore residency, especially if you're already middle-aged when you start out.

That is basically all I've been thinking about since I got my acceptances to med school a little while ago. I mean, obviously not about dying during intern year - that is really sad - but rather, about the trade off between length of training and time being able to practice. At this admittedly premature point, I think that I want to go into oncology but I am daunted by the prospect of 4 years of medical school followed by 3 years of internal medicine and then 3 more years of fellowship. And somewhere in there trying to start a family. All the while having to prove myself all over again and compete for an attending physician's approval with a bunch of 22 year olds during rotations every 6 weeks. I just hope I can manage to keep perspective and focus on my own goals.

 

[Nasrudin]

Losing people. Paying dues. Of all sorts. Getting the life sucked out of you during this epic process from premed to attending. This type of thing moves certain minds to the reflective and certain minds not. There is a huge push in medicine for a certain kind of career development. That brings accolades to individuals and institutions. There is a synergistic pathology in that. That is not referred to at all for what it is--Stress mongering careerism. And it is not only normal but elevated to primacy. By deans. Professors. And colleagues.

If one's life is to be reclaimed. And not mortgaged for some ever distant future. You will have to resist. Everything.

This is simply not possible for certain fields. And the competition for those starts in the womb. Oncology, for instance is a research heavy field. Arrive at the application period without pubs at your peril.

That means overtime in a lab. In addition to keeping up your performance in the classroom. And on an on. The perpetual race.

To some degree you will always have to push yourself. I'm picking up steam steadily going into the Step 1 phase. Q is taking a beating as an intern. Between her and I there's a few slack phases here an there. But it doesn't smooth out until your up to speed in your field and the pressure of the learning curve becomes less intense.

In that firey babtism. From student to physician. We all must go.

Don't think that I'm advocating not working hard. Or ducking responsibility. Not even remotely am I suggesting that.

But I can tell you this as an example of where resistance has taken me. My daily workout takes 2.5-3.0 hours round trip. I think I am in a class myself amongst my peers. Not in accolades. Or honors. Or notations from my superiors. But in feeling good being in my body. And feeling masterful in cultivating a resilient and buoyant contentment.

That takes more guts than it seems.

And that's what I hope for all of you.

Or in the very least a cold realization of the sacrifice it will take to go certain routes in medicine. There is extreme variability in this that wouldn't be obvious until you get here.

Now. I am also not saying that you shouldn't pursue what interests you. I couldn't imagine making these sacrifices without having a field of interest. Discovering Psychiatry has done wonders to reenergize my whole outlook on my prospects in medicine.

But just that it's important for an aging introspective to not pulverize yourself to reach some abstract implanted notion.

Just know what your doing to yourself and why.

 

[Law2Doc]

Nope, I'm going to be 37, so I'm a year older than you. 😛


Being an intern at any age and in any specialty is going to be tough. Maybe tough in different ways, but very few people, if any, find intern year to be a walk in the park. You have the worst schedule, the least control over your life, and the most (and crappiest) work hours. I really miss having the ability to set my own hours like I could when I was in the lab....

a lot of getting through intern year is having the right attitude. If you forever are focused on the fact that you aren't getting any sleep and are getting scolded at every turn, you will have a tough time of it. If you have a positive attitude and look at your shifts as "experiences" doing things none of your non medical friends will ever get to do or understand, it goes down easier. Thats the think that makes me think it's actually easier to be an intern as a nontrad than if you were right out of school -- you have more of a context of what other things you could be doing. In retrospect intern year ends up not being all that bad. By the end of the year, once you And your cohorts are efficient, it's pretty painless actually. And intern shifts are considerably shorter now than when some of us were interns anyhow.

 

[Law2Doc]

That is basically all I've been thinking about since I got my acceptances to med school a little while ago. I mean, obviously not about dying during intern year - that is really sad - but rather, about the trade off between length of training and time being able to practice. At this admittedly premature point, I think that I want to go into oncology but I am daunted by the prospect of 4 years of medical school followed by 3 years of internal medicine and then 3 more years of fellowship. And somewhere in there trying to start a family. All the while having to prove myself all over again and compete for an attending physician's approval with a bunch of 22 year olds during rotations every 6 weeks. I just hope I can manage to keep perspective and focus on my own goals.

First, bear in mind that once you finish med school you are a doctor. You are practicing medicine, not still in school. Your hours and pay will be lousy, but you are in the work force with an MD or DO behind your name. Don't arbitrarily decide you haven't reached any goals until you are an attending oncologist. Second, not all of those 10 years will be equally painful. In med school, third and half of fourth year will be crazy hours, the rest won't be worse than a long houred professional job. Intern year will likely be the worst of your years time wise. As for starting a family, there won't be a perfect time, ever, so best to have lots of family support and try to shoot for one of the windows you will have during med school.

 

[Nasrudin]

a lot of getting through intern year is having the right attitude. If you forever are focused on the fact that you aren't getting any sleep and are getting scolded at every turn, you will have a tough time of it. If you have a positive attitude and look at your shifts as "experiences" doing things none of your non medical friends will ever get to do or understand, it goes down easier. Thats the think that makes me think it's actually easier to be an intern as a nontrad than if you were right out of school -- you have more of a context of what other things you could be doing. In retrospect intern year ends up not being all that bad. By the end of the year, once you And your cohorts are efficient, it's pretty painless actually. And intern shifts are considerably shorter now than when some of us were interns anyhow.

Law,

What field are you in?

As to the topic and being in an aged vessel. Are you suggesting a homogeniety of experience across all people in all fields?

I hear what you're saying. But painless for who? And in what context. 100 hour weeks is not something I would ever consider. Nor would I suggest to anyone that being a nontrad would make this palatable. Surgeon hours are considered flat wimpy if they don't approach those. And in some programs recording hours correctly is being a traitor.


Secondly. There is something to letting people feel things. When they're in the middle of it.

I understand that you defend the queen. In all cases. And in a certain light. I respect that. But this is not a thread where defending her honor is in order.

 

[QofQuimica]

a lot of getting through intern year is having the right attitude. If you forever are focused on the fact that you aren't getting any sleep and are getting scolded at every turn, you will have a tough time of it. If you have a positive attitude and look at your shifts as "experiences" doing things none of your non medical friends will ever get to do or understand, it goes down easier.

I never said anything about how much sleep I do or don't get; it's actually pretty rare that I can't get at least 6 hours of sleep unless I deliberately choose to stay up to do other things instead of sleeping. Nor did I lament being scolded; I've read your Gen Res posts, and there's no doubt in my mind that my program is about a zillion times less malignant than yours is. But this existence of sleeping, going in to work 12-14 hours, then coming home to sleep again with an hour of reading in there ain't exactly something to write home about. It also isn't something that will impress your nonmedical friends, assuming you even have the time/energy to regularly keep in touch with them. As hard as this may be for some on SDN to believe, not everyone wishes they could be a doctor. And the lack of understanding that your nonmedical friends have may ultimately lead to distancing and alienation of those relationships. It unfortunately happens to most of us, I think, and it's especially sad when it happens between spouses.

What it comes down to in my case is that, although I like what I do, I don't love it. And I'd dearly like to do less of it, which I will be once I start fellowship.

Thats the think that makes me think it's actually easier to be an intern as a nontrad than if you were right out of school -- you have more of a context of what other things you could be doing.

See, that's the thing. I *do* have a context of what other things I could be doing, and I reckon I'd rather be doing them instead of being an intern.

In retrospect intern year ends up not being all that bad. By the end of the year, once you And your cohorts are efficient, it's pretty painless actually. And intern shifts are considerably shorter now than when some of us were interns anyhow.

Nothing is ever as bad in retrospect as it was while you were going through it....unless you're one of those "you kids have it so easy. Why, back in *my* day, we had to (fill in x or y unpleasant experience, often an implausible or even impossible one)," types. 😛

 

[lkthlttr]

I really appreciate your individual perspectives. Luckily, I have 4 more years to steel myself before taking on intern year.

Nasrudin, it seems to me that you've made a great decision and have found a niche that you'll thrive in. I understand what you're saying about surgery and the macho-bs that goes along with it. Does IM have a lot of similar characteristics though? Pimping and back stabbing and the rest? Is it program dependent?

Q - are you nearly finished with training? Would you change any decisions you've made along the way?

 

[QofQuimica]

I really appreciate your individual perspectives. Luckily, I have 4 more years to steel myself before taking on intern year.

Just be aware that nothing will prepare you for intern year. July 1 is the universal ultimate smackdown. You think you know what you're getting into, but you don't. No one does.

Does IM have a lot of similar characteristics though? Pimping and back stabbing and the rest? Is it program dependent?

Definitely program dependent. Order your rank list carefully when the time comes.

Q - are you nearly finished with training?

No, I'm an intern. I have 4.5 years total left to go for residency + fellowship.

Would you change any decisions you've made along the way?

I think I'd have gone to pharmacy school if I could do it all again. I had no idea before I was in med school how much more you could do with a PharmD besides work at CVS. There are pharmacy residencies just like there are medicine residencies, only their residencies are optional and mainly geared toward those who, like me, want to do academic types of practice. So, you can be a cards pharmacist, or a GI pharmacist, etc. You can also go into clinical or translational research as a pharmacist; my best friend from grad school is a PharmD/PhD and has a job like this.

Assuming that we're talking medicine-only changes, I don't think so. I absolutely made the correct choice of medical school; they couldn't have bent over backwards any more than they did to make my time in med school go any more smoothly. Among other things, I was completely scholarshipped (including living expenses), which in and of itself made med school (and now residency) infinitely less stressful than it would have been had I been saddled with a quarter million dollars worth of debt like some of my classmates. Although I'm not especially enjoying my intern year, I don't think I would have greatly enjoyed it in a different program or specialty either. Guess I'm just not cut out to be a professional intern.

That being said, I do expect things to be different once I'm a fellow. I felt kind of guilty at first about not loving general medicine, but then I came to realize that many subspecialists felt that way. Like, how many cards fellows wish they could be doing gen med? I'm not going into cards, but it was kind of an epiphany for me there in the sense that hey, these guys and gals get where I'm coming from. And feel the same way. So I guess one thing I would do differently would be to not be as hard on myself for not loving every second of training. Some parts of it suck for just about everyone. Some people are masochists and love even the sucky parts, and more power to 'em.

 

[lkthlttr]

That being said, I do expect things to be different once I'm a fellow. I felt kind of guilty at first about not loving general medicine, but then I came to realize that many subspecialists felt that way. Like, how many cards fellows wish they could be doing gen med? I'm not going into cards, but it was kind of an epiphany for me there in the sense that hey, these guys and gals get where I'm coming from. And feel the same way. So I guess one thing I would do differently would be to not be as hard on myself for not loving every second of training. Some parts of it suck for just about everyone. Some people are masochists and love even the sucky parts, and more power to 'em.

a lot of getting through intern year is having the right attitude. If you forever are focused on the fact that you aren't getting any sleep and are getting scolded at every turn, you will have a tough time of it. If you have a positive attitude and look at your shifts as "experiences" doing things none of your non medical friends will ever get to do or understand, it goes down easier. Thats the think that makes me think it's actually easier to be an intern as a nontrad than if you were right out of school -- you have more of a context of what other things you could be doing. In retrospect intern year ends up not being all that bad. By the end of the year, once you And your cohorts are efficient, it's pretty painless actually. And intern shifts are considerably shorter now than when some of us were interns anyhow.

The way I am thinking about it (and again, not have been through any of it, but having been through something perhaps similar/related) is that I'll be alright with working my 15th consecutive hour for the 18th consecutive day if it is in the name of learning. That is what I'm doing this for, to prepare myself for a career in which people's lives (or at least the quality thereof) hang on decisions that I make. I recognize that in order to do that, I will need thousands of hours of training and I welcome it. What I don't look forward to is doing scut work at 3 in the morning when I'd rather be home in bed. And I don't look forward to being the whipping boy for some maladjusted doc who treats all his/her residents like dirt just because their attending treated them like dirt when they were training. I don't know if it's possible to find a residency where people treat the trainees with even a modicum of respect, but if so, I'd like to hear about it.

 

[QofQuimica]

What I don't look forward to is doing scut work at 3 in the morning when I'd rather be home in bed.

I don't think anyone looks forward to that. It ain't so great being neck deep into doing it, either.

And I don't look forward to being the whipping boy for some maladjusted doc who treats all his/her residents like dirt just because their attending treated them like dirt when they were training. I don't know if it's possible to find a residency where people treat the trainees with even a modicum of respect, but if so, I'd like to hear about it.

It *is* possible. We work hard at my program, and I don't enjoy the hours, but I would never say that we are "whipping boys" or that we are not treated with respect. Even on off service rotations, I have felt respected and been treated well. I would have no problem recommending my program, which, incidentally, is a high-octane academic type program, to future applicants.

 

[Nasrudin]

I really appreciate your individual perspectives. Luckily, I have 4 more years to steel myself before taking on intern year.

Nasrudin, it seems to me that you've made a great decision and have found a niche that you'll thrive in. I understand what you're saying about surgery and the macho-bs that goes along with it. Does IM have a lot of similar characteristics though? Pimping and back stabbing and the rest? Is it program dependent?

Q - are you nearly finished with training? Would you change any decisions you've made along the way?

A lot can be gleaned from reading the residency forums. If you read consistently. And can read between lines. You get a feel for the different characters and what their experiences mean to them and by intuitive leap for you.

IM is on the hours intensive side. But not quite of surgical implications. At least on average. Highly variable according to Q and others. They run the hospital. The hospital stays open all the time. And sick people run on their own schedule. I can't comment on the culture.

I have a lot of colleagues and one friend who are subsepecialist surgical interestees. And have done internships and rotated on rounds and are going through the rungs of building their applications for these extremely competitive fields.

It's a different ball game than other fields like psych or peds. Not that psych and peds residents and aspirants don't work hard. But I set my criteria at being able to maintain good but not excellent physical conditioning.

I don't even plan to have kids. That's something very serious that needs to be addressed by those that do or plan on having. I have nothing to add on that. Just that you should be suspicious of super hero mythologies. Look deeper into those. And you almost invariably see nannies, live in grandmas or stay at home spouses. The trouble is they don't bother to mention that. They. Like most in medicine. Are of the sort that like the sound of their own horn. Over the concern that others not become overly stressed out in the pursuit of an ideal. False or otherwise.

Abuse is more common in highly intense and competitive fields. Psych programs, for instance, that develop a reputation for malignancy will be summarily avoided by US grads. And will stick out like a sore thumb.

I'm not sure that integrated plastics aspirants would give a ****. Having already swallowed the shame and seed of their previous attendings.... just to have the shot at more of same. you catch my drift. You'll see.

Just investigate all of your interests at this point.

 

[NuttyEngDude]

As someone, hopefully, about to start all this, i am scared to death about being in a malignant or abusive program. I dont really have anything add, carry on and thanks for posting. 🙂

 

[Nasrudin]

As someone, hopefully, about to start all this, i am scared to death about being in a malignant or abusive program. I dont really have anything add, carry on and thanks for posting. 🙂

Me too. But I've largely ruled against that possibility by my choice of specialty. Psych residents work some IM hours for months at a time spurts. And malignant programs go south quickly.

The other thing I like to ploy is this: Unlike what most will indicate here. You should absolutely start to investigate field of interest now. Early and often.

People who came to medicine from outside healthcare have little respect for how much you can learn working along side physicians of various sorts. They poo poo thousands of clinical hours as it they mean nothing in informing your career.

And while I understand what Q means by not knowing until you get to intern year what it will be like. I don't extend that to mean you just wait until clinical rotations because all else is outside the circle of trust. The inner sanctum.

Nonsense.

Use your worldly experience as a relational tool. It took many of us a long time to get here. We don't want to do that while working on our medical careers.

I knew psychiatry was a good match for me the first time I was allowed free reign to interview a few psychiatric chief complaints. But it took a while for my mind to catch up to the idea of doing something with my life that was so unfamiliar to my imagination.

Secondly. It takes a while to sense culture. To read enough man on the street conversations to get an idea of what sort of folk, manner, behaviors, and ideas populate the future street of your daily existence in a particular field.

Clinical rotations can be guesswork. And it is grossly overestimated what can be obtained in them.

Read the thousands of confused rotating med students. Whoops. I guess those thousands of hours in healthcare weren't so poo-y after all.

 

[Nasrudin]

addendum:

I worked so closely with ED physicians and pediatricians. I knew the daily ups and downs. What sort of personalities did well. Acclimated positively for all. What the differences in culture were. My gigs also brought me into contact with a variety of other services. IM, radiology, surgery, ortho, etc.

So that having a interest piqued in radiology. I went directly to some departmental meetings with my school's very inviting radiology service. 3 meetings in....no f'n way could I spend my last 40 or less years on the planet doing that.

But it takes time, effort, and use of intuition. To actively engage in a process of elimination.

I thought I had interest in PMR due to an abiding interest in exercise physiology. But as with ED. Liking something in one way is different than liking it's medicine. I like ED culture. Variety of social interactions. But I don't want that bull by the horns. I like exercise physiology, but don't want to hash out the minutia of stroke recovery.

All of these can be picked up on. If you understand well the nature of a daily practice of one or more fields. And the culture of those. Similar to how triangulation, a sexton, a timepiece, and a map of the constellations could allow for people with no previous knowledge knowledge of a navigate the seas of the world.

You can do this for yourself. And should.

Having foreknowledge of my goals--Western or metropolitan psych residency. Has allowed me the confidence to get myself in peak physical condition amidst a caravan of fattening and atrophying youth.

Knowing how to put together your whole candidacy. Making necessary contacts. Is easier with sincere interest. And a longer span of interest.

 

[lkthlttr]

So that having a interest piqued in radiology. I went directly to some departmental meetings with my school's very inviting radiology service. 3 meetings in....no f'n way could I spend my last 40 or less years on the planet doing that.

Can I ask you how/why you reached this conclusion? Myself, I feel the same way based on my experience shadowing a radiologist (I found it to be extraordinarily dull), but I'd like to hear your reasoning if you are willing to share.

 

[Nasrudin]

Can I ask you how/why you reached this conclusion? Myself, I feel the same way based on my experience shadowing a radiologist (I found it to be extraordinarily dull), but I'd like to hear your reasoning if you are willing to share.

Sure. But keep in mind. I make very intuitive decisions. I worry when saying that too much that people will think I use a Luigi board. No. I mean. We make intuitive decisions when we have to all the time. Is this person full of ****....? But we fail to use it for crucial situations like judging whether or not to do this or that thing for the rest of our lives... So.

I'm sitting in these meetings where the extremely nice and very good teaching radiologists who are bringing the most interesting cases that they collected in recent clinical work for their discussions are our education. I consider myself very good at forecasting my own harmonious fit with situations. And I probed what I could sense was their enthusiasm for what they were teaching us. And flatly. Could never be enthusiastic about how they teased anatomical pathology from shades of white gray and black. Ever.

So I thanked them. Smiled and don't plan on going back. Unless for a senior elective to learn neuroimaging for psych applications in my future. Since I know they're good teachers.

Off my list within the first semester of first year.

Maybe I am overstating the importance of this based on my own technique of networking. In order for me to ask for a LOR from my premed phase. I needed to have earned it. Or have been offered it.

I can't do this casually.

I made a good connection to a cool older geriactric psychiatrist who is also a dean. Because i like him so much. And am genuinely interested. I don't feel awkward about asking to shadow him regularly. And I do.

I guess. I need the romance for these things. So it takes me more time. And thus more sincerity and foreknowledge. So color your perception of my sentiments with that.

 

[Nasrudin]

Oh just to complete the pattern for your evaluation.

My secondary goal to psychiatry is palliative medicine. But again from hanging around one. And gauging the focus of the career. I realized that end of life medicine is actually very complex. You have to be a good internist. And that takes a passion for nuts and bolts pathophys. And the whole tour of duty managing chronically horribly trainwreckingly out of shape america.

While the psycho/social aspects are intriguing. An IM tour of duty is less so. As is any of the other reasonable preparatory fields.

Psych is interesting. The training is doable with my personal fitness goals. The life arc fits.

Done.

Slow cultivation--comfortable in my sincerity--of allies begun.