Those with higher Step scores who did IM...?

[Redpancreas]

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I got my step score and was ecstatic (250s) and have always been interested in IM (never thought id score highly for other things so I never put effort into them).

I have always been interested in IM (see myself not really being amazing in anything else). I am definitely not the best dexterity wise or with anything manual, but I'm ok. In the OR, cases bore me because I'm not sure of what I'm looking at and my feet hurt unlike some of my classmates who say they love being in the OR. I definitely like clinic better, but that's not to say I dislike procedures because I don't think I'd be content in just talking to patient. I want to perform procedures that improve QOL.

I see so many extremely competitive/hard working/intelligent people doing IM on SDN (260+ steps, AOA, All-Honors third year) matching IM. The thing is, I'm not really interested in research and none of my projects have fallen through and I'm not really interested in academic IM at Harvard, Penn, etc. My only goals for IM are to match into a competitive residency in a competitive area with mostly smart US grads so I can get solid training to pursue a competitive fellowship and maybe find someone among the millions of people in area to fall in love with.

Among classmates and my own family I'm hearing other things... A lot of my classmates with similar/higher scores are interested in this thing called Orthopedic surgery, I'm sure many of you have heard of it. Even my family is encouraging (not forcing me) me to take this path. While Orthopedics was on my mind before medical school, I was never sure about it. What everyone seems to be saying is that Cards (my current interest) is seeing massive cuts. No one is saying such things about ortho and as the population ages yet people continue to stretch human potential, I can just imagine how many people will want joint replacements/future unknown prosthetic technology to be functional as they age. My friends talk about ortho and how you can earn 400k from a 7-4 job and it just sounds very appealing when juxtaposed against the 200-250k I see from Cards in a competitive city while working more hours. Also, a few of my friends who've done work in cards say that it's very boring and most the patients just sit there and your job is to manage them, whereas in ortho you do procedures that will enable someone to go from bedridden to walking again.

I'd like to hear some more opinions regarding this matter. I'm still leaning towards IM just because I see myself as more of a medicine guy than a surgery one, but just want to hear from the SDN community.




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[Jabbed]

Do you even lift, bro?

 

[Redpancreas]

Do you even lift, bro?

I actually do . Before step I was at 225 for 3 reps on bench but it's gone down a bit now so it'll take a while before I'm at the 500 BP+Step score.

As an interesting side note, I've seen two types of ortho. One is the jock or alpha female who embraces the lifting stereotype or whatever the equivalent is for girls. The other is the dude who gets irritated by it and tries escape it

A constant I do see with Ortho is an extremely chill personality. They're all like it's ok, be chill, let's just fix the bone, etc. Or maybe that's just a coping mechanism to account for the fact that their life inside the OR is so stressful.

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[joker2400]

I got my step score and was ecstatic (250s) and have always been interested in IM (never thought id score highly for other things so I never put effort into them).

I have always been interested in IM (see myself not really being amazing in anything else). I am definitely not the best dexterity wise or with anything manual, but I'm ok. In the OR, cases bore me because I'm not sure of what I'm looking at and my feet hurt unlike some of my classmates who say they love being in the OR. I definitely like clinic better, but that's not to say I dislike procedures because I don't think I'd be content in just talking to patient. I want to perform procedures that improve QOL.

I see so many extremely competitive/hard working/intelligent people doing IM on SDN (260+ steps, AOA, All-Honors third year) matching IM. The thing is, I'm not really interested in research and none of my projects have fallen through and I'm not really interested in academic IM at Harvard, Penn, etc. My only goals for IM are to match into a competitive residency in a competitive area with mostly smart US grads so I can get solid training to pursue a competitive fellowship and maybe find someone among the millions of people in area to fall in love with.

Among classmates and my own family I'm hearing other things... A lot of my classmates with similar/higher scores are interested in this thing called Orthopedic surgery, I'm sure many of you have heard of it. Even my family is encouraging me to take this path. While Orthopedics was on my mind before medical school, I was never sure about it. What everyone seems to be saying is that Cards (my current interest) is seeing massive cuts. No one is saying such things about ortho and as the population ages, I can just imagine how many people will want joint replacements/future prosthetic technology to be functional as they age. My friends talk about ortho and how you can earn 400k from a 7-4 job and it just sounds very appealing when juxtaposed against the 200-250k I see from Cards in a competitive city while working more hours. Also, a few of my friends who've done work in cards say that it's very boring and most the patients just sit there and your job is to manage them, whereas in ortho you do procedures that will enable someone to go from bedridden to walking again.

I'd like to hear some more opinions regarding this matter. I'm still leaning towards IM just because I see myself as more of a medicine guy than a surgery one, but just want to hear from the SDN community.




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*orthopaedic surgery

 

[deleted641888]

.

 

[muhali3]

do interventional rads. /problem solved

 

[eteshoe]

Why not IM then sub specialize?

 

[Redpancreas]

do interventional rads. /problem solved

Have you been following my posts? IR has actually been on my mind since undergrad. Only problem is it's even more competitive to match than ortho and I have no headway into the field.


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[Redpancreas]

Why not IM then sub specialize?

Cardiology has been seeing massive pay cuts supposedly (even though they're not on medscape yet). GI is also awesome but what happens if USPTF says no more colonoscopies for 50+ people.





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[Warderino92]

Have you been following my posts? IR has actually been on my mind since undergrad. Only problem is it's even more competitive to match than ortho and I have no headway into the field.


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IR is pretty sweet but I don't know if i'd enjoy wearing lead goggles, a thyroid shield, and a 20 pound lead apron every single day for the rest of my career.

 

[Redpancreas]

IR is pretty sweet but I don't know if i'd enjoy wearing lead goggles, a thyroid shield, and a 20 pound lead apron every single day for the rest of my career.

That and what happens if I commit to IR? Probably won't match DIRECT as there's like 1-2 positions per program I've heard and so then I'll have to do radiology for 5 years and may never get a fellowship which would then be an additional 2 years so yeah not sure if that's my jam but I can always dream...also seems a bit disingenuous to do something only interested in one particular aspect of the field.


http://forums.studentdoctor.net/threads/competitiveness-of-integrated-ir-residencies.1222458/

http://forums.studentdoctor.net/threads/integrated-ir-and-step-1.1221002/


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[Hangry]

Are you a new third year? Can you do a rotation in ortho? That should definitively clear this up either way.

From a distance it sounds like you are experiencing post high step 1 career confusion which should settle out with a few months of third year rotations.

 

[Redpancreas]

Are you a new third year? Can you do a rotation in ortho? That should definitively clear this up either way.

From a distance it sounds like you are experiencing post high step 1 career confusion which should settle out with a few months of third year rotations.

I'm one month into rotations and OB/gyn right now. There's no rotations in ortho but some of my friends have been able to see ortho within surgery for a week.

I'm just confused though, this has to be a common problem. What do all these people settle on? Do they start sprinting towards ortho or do stay with IM?

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[marstonne]

Cardiology has been seeing massive pay cuts supposedly (even though they're not on medscape yet). GI is also awesome but what happens if USPTF says no more colonoscopies for 50+ people.





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Someone posted something in a thread about specialty choice a while ago that really stuck with me.

Choose your speciality based on the patients and pathology you enjoy most, not based on the procedures/compensation/whatever. The latter may change dramatically and leave you working in a field that isn't what you thought you were signing up for. The example given was vascular surgery: not long ago vascular was all open, now, at least from my basic understanding of the field, it is majority endovascular. Same diseases, same patients, but a very different practice compared to just a decade or two ago.

I have a hard time imagining you not being very well compensated as a cardiologist. If it's what interests you, go for it.

 

[Warderino92]

Since you mentioned big city living, i'd imagine anything thats cosmetic based with no insurance to worry about would probably give you the best compensation in that environment if money is a issue for you.

 

[Redpancreas]

Since you mentioned big city living, i'd imagine anything thats cosmetic based with no insurance to worry about would probably give you the best compensation in that environment if money is a issue for you.

Plastics doesn't really appeal to me for similar reasons as Derm.

I'm sure it's a great field being lucrative, potentially life changing, etc. but my heart wouldn't be in it.

I'm wondering if Urology would be similar to ortho in terms of intensity. Even though I don't like the patient population in OB/GYN, I like the mix of clinical and surgery involved which is similar to Uro. I don't really see Urology going out and advertising the field and they're kinda like their own thing with their own application, etc.


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[akwho]

An old quote that is applicable here. If your favorite place in the hospital is the OR, you should be an anesthesiologist. If your favorite place in the world is the OR you should be a surgeon. Sounds like neither of these apply to you, you're smart, want to do procedures and see clinic patients, and make money, you should be looking at #1 GI, #2 Cards, #3 Pulm/crit care.

 

[Hangry]

I'm just confused though, this has to be a common problem. What do all these people settle on? Do they start sprinting towards ortho or do stay with IM?

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It is a common problem. "It's the oh **** I could actually do one of those competitive fields. Surely they are competitive for a reason, I should see if I like it."

There is no one thing all those people settle on. If I had to generalize, I would guess that most stick with what they were originally drawn to, but that could just be my peer group.

It just depends on the person and what they actually enjoy, which you really tease out during your third year rotations. Do you like the OR, wards, or clinic? How much do you like patients? Do you want follow up? Long or short term? Do you want to be a specialist or a generalist? Do you like procedures? All these things will sort themselves out. Eg you said you did/are doing ob, so you have seen the ORs, clinic, some floor stuff, so even if you know you hate ob you can start to get some inkling of where and how you would like to work.

 

[Mad Jack]

*orthopaedic surgery

Brit spelling? Groce.

 

[WheezyBaby]

I pity the person who doesn't want to do surgery but for some reason chooses to do surgery. Good luck with your depression goals in residency. If you haven't really experienced surgery, well, experience it and then make a decision. Not sure what else there is to talk about. If you choose a field trying to predict how reimbursements going to be, youre likely to end up disappointed

 

[Rekt]

Never rule in specialties due to getting a certain Step I score, only rule them out.

It sounded like you wanted to do IM, stick with that.

 

[Favoritefarm]

Your acting like 250s automaticallly gets you in ortho. Noone cares about your board score, its not that impressive. 250s are a dime a dozen in ortho... multiple applicants get rejected each year with 250s homeboy. But if you want to do IM, you may be impressive to them ... not in surgery

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[Redpancreas]

Your acting like 250s automaticallly gets you in ortho. Noone cares about your board score, its not that impressive. 250s are a dime a dozen in ortho... multiple applicants get rejected each year with 250s homeboy. But if you want to do IM, you may be impressive to them ... not in surgery

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I actually have one of the lower Step scores among my friends and don't think I'm entitled to anything. I don't know where you got that from. It's just kind of what Hangry said that I'm worried that I'll miss out on something awesome that I was qualified to do. If anything, it's you who's being snarky..."But if you want to do IM, you may be impressive to them... not in surgery"...What the heck is that supposed to mean? I'm sure 250s are a dime a dozen in certain IM programs as well. You literally added nothing of value to this conversation as I don't need another person telling me such an obvious thing in such a condescending way and making me feel bad

 

[failedatlife]

Ortho doesn't give a crap about research. If you want to do it, don't let anyone talk you out of it. They are about Board scores and away rotations. My buddy goes to Georgetown and got a 250+ and is applying to ortho right now. That school apparently matches 20+ kids every year and according to my friend VERY VERY few of them have any substantial research (he also has no research).

Those telling you otherwise are prob bitter incapable fools like myself who FAILED the most important test of their life and will forever be deemed incompetent by PDs of competitive specialties.

 

[managedcarefin]

Your acting like 250s automaticallly gets you in ortho. Noone cares about your board score, its not that impressive. 250s are a dime a dozen in ortho... multiple applicants get rejected each year with 250s homeboy. But if you want to do IM, you may be impressive to them ... not in surgery

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Found the group hardo.

 

[Jabbed]

I actually do . Before step I was at 225 for 3 reps on bench but it's gone down a bit now so it'll take a while before I'm at the 500 BP+Step score.

As an interesting side note, I've seen two types of ortho. One is the jock or alpha female who embraces the lifting stereotype or whatever the equivalent is for girls. The other is the dude who gets irritated by it and tries escape it

A constant I do see with Ortho is an extremely chill personality. They're all like it's ok, be chill, let's just fix the bone, etc. Or maybe that's just a coping mechanism to account for the fact that their life inside the OR is so stressful.

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I meant to give a genuine response after the obligatory troll, but I forgot to check back on this thread.

As another poster pointed out, it's pretty common to have the "fear of missing out" once you get a solid step score in hand. That said, the nature of orthopedic surgery has not changed significantly since your test date. Try and spend some time in the ortho OR during 3rd year, but be honest with yourself about whether or not you actually like it. As numerous posters have alluded, it's impossible to predict what the job market/reimbursement will look like 7+ years from now when you get into practice.

The way that I see it: pretend that regardless of what specialty you choose, you will work more than you expect to and only make $200K a year. Within those constraints, what specialties do you still find interesting?

PS: Read your write-up on the step 1 section. Congrats on your score!

 

[akwho]

Ortho doesn't give a crap about research. If you want to do it, don't let anyone talk you out of it. They are about Board scores and away rotations. My buddy goes to Georgetown and got a 250+ and is applying to ortho right now. That school apparently matches 20+ kids every year and according to my friend VERY VERY few of them have any substantial research (he also has no research).

This is false. Georgetown also matches like 18 out of 35 ortho applicants every year.

 

[Cyberdyne 101]

@MeatTornado should be able to give you some insight. iirc, he had a similar step score and is now doing a cc fellowship.

 

[KinasePro]

Ortho brah, checking in.

Research is a huge deal in ortho. I talked about it at every interview, from community programs to top 5 academic programs.

Ortho residency is a grind. Be sure you love it before committing. The most brutal aspect of our residency is call-- both physically and mentally. We have (arguably) the busiest call pager in the hospital. Reductions, traction pins, revision digit amputations, nailbed repairs, spine disasters, emergent OR cases, etc... If you want to rule ortho out or in, go take call at a trauma center and see if its something you can tolerate q3 for 30+ hrs. If so, great. If not, better to find out now.

The culture of the field requires machismo and a worker bee mentality, don't let anyone tell you (or try to convince yourself) differently. We're a chill crowd on a personal level but we also take a beating regularly.

 

[Redpancreas]

Thank you everyone for your feedback!


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[235009]

@MeatTornado should be able to give you some insight. iirc, he had a similar step score and is now doing a cc fellowship.

Stalker much? ;-)

I scored just under 250. After I got my step 1 score I tried really hard to like "competitive" specialties like ortho, ENT, derm but you can't fit a square peg in a round hole. IM was the right path for me and I would've been miserable doing any of those others. Looking back I would pick IM again...this time without hesitation. IM is actually extremely competitive at the top. I got zero interviews from top programs with that score. After IM the doors are wide open for fellowship, administration, academics, PP, etc etc. Part of the reason I hadn't responded earlier is because I'm confused by what you're asking. If you think IM is beneath you then don't do it....your loss.


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[Warderino92]

Stalker much? ;-)

I scored just under 250. After I got my step 1 score I tried really hard to like "competitive" specialties like ortho, ENT, derm but you can't fit a square peg in a round hole. IM was the right path for me and I would've been miserable doing any of those others. Looking back I would pick IM again...this time without hesitation. IM is actually extremely competitive at the top. I got zero interviews from top programs with that score. After IM the doors are wide open for fellowship, administration, academics, PP, etc etc. Part of the reason I hadn't responded earlier is because I'm confused by what you're asking. If you think IM is beneath you then don't do it....your loss.


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Now that you mention it I just noticed the vast amount of admins at my school are either IM docs or psych.

 

[Slack3r]

Ortho doesn't give a crap about research. If you want to do it, don't let anyone talk you out of it. They are about Board scores and away rotations. My buddy goes to Georgetown and got a 250+ and is applying to ortho right now. That school apparently matches 20+ kids every year and according to my friend VERY VERY few of them have any substantial research (he also has no research).

Those telling you otherwise are prob bitter incapable fools like myself who FAILED the most important test of their life and will forever be deemed incompetent by PDs of competitive specialties.

Do not listen to this person.

 

[WellWornLad]

I'm hearing a lot of "what ifs," certainly more than I'd expect with someone who's got more options than most with a step 1 of 250. In any case, you've probably heard the old chestnut that you shouldn't go into surgery unless there's nothing else you'd rather do. I think that's fantastic advice that's applicable to just about all of medicine. Surgery is grueling but in my experience I've heard the most griping from medicine residents. Life may suck for those going into surgery but they tend to go in with their eyes open. More people go into IM as a sort of default or a way to delay decision-making until subspecialization, and that is a mistake.

I agree that ortho absolutely cares about research. It's also one of those fields where the people who match tend to be super enthusiastic about the field - just about everyone in my school who ended up in ortho were planning on ortho from day freaking one. If you go in with an attitude of "I dunno, seems alright," they will sniff that out immediately. Which is all well and good, because ortho would be hell to anyone who hasn't drunk the kool aid on replacing joints and resetting bones. I find them all to be great people though, very high functioning and very happy with what they do, which is refreshing compared to, well, IM.

IR is still very much a possibility, and a very cool field. A lot of uncertainty right now, and bound to get even more difficult with the transition to independent IR residencies and loss of training spots, at least in the short term. I'm going into IR and somewhat biased, however. I enjoy procedures and had a blast during surgical internship. I also don't have back or foot problems and my lead is 10 lbs, doesn't bother me at all. I actually like the feeling of finishing a case and taking off the literal weight as well as the proverbial one.

 

[Fenixak]

Have you been following my posts? IR has actually been on my mind since undergrad. Only problem is it's even more competitive to match than ortho and I have no headway into the field.


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No it's not, you can still become IR from diagnostic radiology. There is the integrated program, the ESIR certification, and the 2 year post DR residency that will replace current fellowships (ESIR brings it down to 1 year).

Interventional cards is also awesome. If money is your thing, ic also makes bank.

 

[Redpancreas]

Stalker much? ;-)

I scored just under 250. After I got my step 1 score I tried really hard to like "competitive" specialties like ortho, ENT, derm but you can't fit a square peg in a round hole. IM was the right path for me and I would've been miserable doing any of those others. Looking back I would pick IM again...this time without hesitation. IM is actually extremely competitive at the top. I got zero interviews from top programs with that score. After IM the doors are wide open for fellowship, administration, academics, PP, etc etc. Part of the reason I hadn't responded earlier is because I'm confused by what you're asking. If you think IM is beneath you then don't do it....your loss.


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By no means is IM beneath me and, again, nowhere is that stated...I haven't even had IM or surgery yet. The main reason I put this out there MT is because as I'm sure that as you know it takes a lot of planning and work to prepare for any competitive residency whether that be IM/Surgery/whatever. While clinical honors and good step scores are a commonality, type of research of experience, which first-come-first-serve elective I should pick, whether I should be practicing knots, and who I need to talk with to network with all sorta depends on preliminarily picking something now and temporarily going with it.

In fact, I've actually wanted to do IM for quite some time and it's probably what appeals to me most as a career with lifestyle and pay aside. As always, I just wanted to hear more people and as I said before, I'm sure this is a common thing many medical students feel (i.e., don't feel special whatsoever) so that's why I came on here to ask about it.




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[failedatlife]

Do not listen to this person.

Yeah don't listen to me. I have a low step score which means I'm ignorant and inadequate. Obviously if you pubmed 1st year residents at most Ortho programs they have TONS upon TONS of first author publications. Not really...

 

[Señor S]

Yeah don't listen to me. I have a low step score which means I'm ignorant and inadequate. Obviously if you pubmed 1st year residents at most Ortho programs they have TONS upon TONS of first author publications. Not really...

Posts like this are why I rapidly lose interest in this forum. SDN has been overrun by freaks with various personality disorders and as a result it's become nearly a full time job to separate the totally nonsensical crap posts from the more or less substantial ones.

 

[KinasePro]

Yeah don't listen to me. I have a low step score which means I'm ignorant and inadequate. Obviously if you pubmed 1st year residents at most Ortho programs they have TONS upon TONS of first author publications. Not really...

You're just digging your hole deeper. Many people have zero pub med publications as applicants but 10+ abstracts and podiums, and a shiit ton of papers accepted or in press. I've had 5 med school pubs come out since I've been a resident. Research is an X factor in ortho that helps a lot of people match. Stop giving advice on something you know little-to-nothing about.

 

[Donald Juan]

This thread has gone off topic a bit, but to address the original post:

1) Do not, and I mean do not do anything surgical because outside influences pressure you to. You shouldn't do any specialty for other people, but especially surgery.

2) I don't know where you get the idea of 200-250 for a cardiologist. I read averages closer to 400k/year, and over 500k for interventional. I don't know what "big cuts" to cardiology you're hearing, but I've heard the sky is falling from orthopedic surgeons as well.

Bottom line you need to hopefully get a chance to rotate in ortho during your surgery rotation and cardio during your IM or elective time. This should give you a better idea than anything you can read online.

 

[FindMeOnTheLinks]

Do not listen to this person.

nobody listens to him anyway


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[sliceofbread136]

Hey man I would say you should definitely stick with IM. Your score alone should get you into a nice somewhat competitive program where you'll work with some smart people. The super upper tier ones are just as hard as ortho etc and it takes more than just a 250s step, but it doesn't sound like that is too important for you anyway.

Good luck man, congrats on the score and enjoy your rotations

 

[Redpancreas]

Hey man I would say you should definitely stick with IM. Your score alone should get you into a nice somewhat competitive program where you'll work with some smart people. The super upper tier ones are just as hard as ortho etc and it takes more than just a 250s step, but it doesn't sound like that is too important for you anyway.

Good luck man, congrats on the score and enjoy your rotations

Yeah, I don't want to go to Hopkins/Harvard/Penn but a nice, competitive, program with few IMGs and solid fellowship matches would be awesome. At this point, I think I'm good and will likely stick to my IM plan unless anything major happens that turns me towards surgery.