Undecided MS3 help me choose a specialty please

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drkk2021

drkk2021

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Honestly I am so lost at this point. I jump all over the place and I am perfectly aware that my interests seem to be totally unrelated polar opposites but I’m really panicking and hoping maybe some advice/input here could help 🙁

Was planning for ortho because I thought I loved MSK and surgery. Did not enjoy my surgery clerkship (3 weeks Peds and 3 weeks vascular). Did not enjoy my ortho 2 week elective. Been back to the drawing board very late in 3 year.
  • Lifestyle is really important to me. I want medicine to be a job. A job I love, but nonetheless I want a life outside of medicine. I really want a family and plenty of time to spend with them.
  • Pay is whatever. I feel like I’ll be well compensated as a physician no matter what but also I have (as we all have) invested a lot of time and would like to reap the benefits.
  • I ~think~ I would like to do something that requires procedures/being hands on but not necessarily in the OR, at least not for long cases.
  • Of all my core rotations, I’ve loved being in clinic over inpatient and over the operating room. I like being on the go, seeing patient after patient or writing notes or moving around and not spending much time on the computer or standing still.
  • I like working with both adults and children.
  • I ~think~ I’d prefer to have a relationship with my patients that extends more than just one or two visits. I want to see them get better.
  • I’m not sure about acuity. I think I’d generally like to see healthier patients but I don’t know.
  • I think I’d prefer to be a specialist who knows a lot and hopefully has the answer about one field over being someone who knows a little about a lot more variety.
  • Additionally, I’d prefer to feel like I’ve “fixed” something over managing chronic diseases and their consequences.
  • Finally, I really love people. I truly want to feel like I’ve helped them get better and learn about patients both in terms of their disease/health and also just appreciate learning about their lives and experiences.
Lately I’ve been thinking about:

Derm (personal and family history of skin problems. Feel like it would fit the idea of fast paced clinic with minor procedures. Like the idea of helping people feel comfortable/confident and obviously improving health)

EM (—> sports med) (EM = mix all these fields I like into one. Sports = previous athletic and current fitness experience. Still do Love MSK)

Psych (family and personal history of mental health difficulties. Loved my psych rotation. Not much opportunity to be hands on)

ObGyn (I truly love women’s health and advocacy and pregnancy. Scared of the culture and schedule though)

Ophtho (have had multiple people suggest I check this out given my interest in clinic and smaller procedures. Haven’t shadowed yet)


I would prefer to not take a year off. But I really want to get this decision right the first time and go into something I love so I’m willing to do what it takes to end up in the field I want if that means taking an extra year for research or whatnot.

For reference:
Top tier medical school
6 Honors. 1 High Pass. On clerkships
Step 1 pass. Taking Step 2 soon
Some research done in ortho, IM, psych, trauma surgery.
Some involvement in leadership/teaching/service.
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Was thinking derm as I read your post. Seems like it checks all the boxes and probably does offer the best quality of life to pay ratio. Could do a mohs fellowship if you wanted to be even more procedural, lots of cosmetic cash pay options as well.

Ophtho is up there too. Tougher residency than derm but pretty awesome life in practice. Still a good bit of surgery especially in training, but usually much shorter procedures.
 
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Thank you so much for your replies! Do you think it's a bad sign that I hadn't had a passion for/been thinking about eyes or skin in these first 2.5 years? I guess what I am asking is do enough people discover these fields this late and find that it's something they truly love. I just worry since so many of my classmates knew they were interested in these from the get go. Nonethless I am excited for my upcoming derm rotation after step and maybe will schedule an ophtho one as well!
 
It's fine. Not everyone decides early they want to do competitive specialties. Sure, those people may have a leg up with connections and research, but there are plenty of people who decide late and get a residency spot.
 
Remember it’s not so much about finding a speciality you love, but rather one that you like and can tolerate and find somewhat interesting. It also needs to fit your needs as far as fitting in with your other life goals.

I love my job but some days are just boring regular days and nothing exciting happens. At the least I find it somewhat interesting, I’m good at it, and the quality of life allows me to enjoy plenty of time outside the office as well.
 
I am an incoming intern who matched dermatology after being dead set on ortho for the first 2.5+ years of medical school. Your bullet points are almost the exact ones I had when I decided to make the switch out from pursuing ortho, derm is the way to go. I would say the vast majority of derm attendings/residents I have met believe derm is a job and not their identity.

A research year might be needed but I would talk to your derm PD first and get their thoughts. An additional year is nothing in the grand scheme of things, especially if it greatly improves your chances of matching. Derm continues to be one of the toughest specialties to match and risking a reapplication is not worth it imo. I also considered IR but the lifestyle in IR is going to be more like that of a surgical sub than that of ROAD specialty. Happy to talk more if you'd like.
 
Derm can be boring. I get where you're coming from. Lifestyle perks get old.

But what can you do in the OR that you can't do outside with power tools and gutsy ECs?

Another thing that jumped out at me from your post was emphasis on "I think" "maybe" "prefer." Surgery REQUIRES these things. Medicine is not worth it at all if you're not in the OR and you're supposed to do surgery. Yes procedures are more interesting. Procedures are in IR, like you said, but that is even more boring than derm.

Is it worth it to re-train and do ortho too? Idk. I feel like the underlying issue doesn't have to do with medicine perse, but something tangential to the process. Maybe I am coming out of left field here.

I'm sorry if this was offensive. Just my $.02.
 
drkk2021 said:
Honestly I am so lost at this point. I jump all over the place and I am perfectly aware that my interests seem to be totally unrelated polar opposites but I’m really panicking and hoping maybe some advice/input here could help 🙁

Was planning for ortho because I thought I loved MSK and surgery. Did not enjoy my surgery clerkship (3 weeks Peds and 3 weeks vascular). Did not enjoy my ortho 2 week elective. Been back to the drawing board very late in 3 year.
  • Lifestyle is really important to me. I want medicine to be a job. A job I love, but nonetheless I want a life outside of medicine. I really want a family and plenty of time to spend with them.
  • Pay is whatever. I feel like I’ll be well compensated as a physician no matter what but also I have (as we all have) invested a lot of time and would like to reap the benefits.
  • I ~think~ I would like to do something that requires procedures/being hands on but not necessarily in the OR, at least not for long cases.
  • Of all my core rotations, I’ve loved being in clinic over inpatient and over the operating room. I like being on the go, seeing patient after patient or writing notes or moving around and not spending much time on the computer or standing still.
  • I like working with both adults and children.
  • I ~think~ I’d prefer to have a relationship with my patients that extends more than just one or two visits. I want to see them get better.
  • I’m not sure about acuity. I think I’d generally like to see healthier patients but I don’t know.
  • I think I’d prefer to be a specialist who knows a lot and hopefully has the answer about one field over being someone who knows a little about a lot more variety.
  • Additionally, I’d prefer to feel like I’ve “fixed” something over managing chronic diseases and their consequences.
  • Finally, I really love people. I truly want to feel like I’ve helped them get better and learn about patients both in terms of their disease/health and also just appreciate learning about their lives and experiences.
Lately I’ve been thinking about:

Derm (personal and family history of skin problems. Feel like it would fit the idea of fast paced clinic with minor procedures. Like the idea of helping people feel comfortable/confident and obviously improving health)

EM (—> sports med) (EM = mix all these fields I like into one. Sports = previous athletic and current fitness experience. Still do Love MSK)

Psych (family and personal history of mental health difficulties. Loved my psych rotation. Not much opportunity to be hands on)

ObGyn (I truly love women’s health and advocacy and pregnancy. Scared of the culture and schedule though)

Ophtho (have had multiple people suggest I check this out given my interest in clinic and smaller procedures. Haven’t shadowed yet)


I would prefer to not take a year off. But I really want to get this decision right the first time and go into something I love so I’m willing to do what it takes to end up in the field I want if that means taking an extra year for research or whatnot.

For reference:
Top tier medical school
6 Honors. 1 High Pass. On clerkships
Step 1 pass. Taking Step 2 soon
Some research done in ortho, IM, psych, trauma surgery.
Some involvement in leadership/teaching/service.
Click to expand...
Why not PMR with a pain fellowship?

Thought of that while reading your post. In patient and clinic, chill life style, plenty of non-high acuity procedures (steroid epidurals, nerve blocks, RF ablation) can follow patients and be satisfied by helping patients manage their chronic pain. Fits your love of MSK and your research already sets you up for applying.
 
Derm or obgyn for sure! I resonated with most of your points and that's why I loved working in derm/chose to pursue the speciality
 
yougotquestions said:
Why not PMR with a pain fellowship?

Thought of that while reading your post. In patient and clinic, chill life style, plenty of non-high acuity procedures (steroid epidurals, nerve blocks, RF ablation) can follow patients and be satisfied by helping patients manage their chronic pain. Fits your love of MSK and your research already sets you up for applying.
Click to expand...
Oooooo same thoughts
 
My first thoughts were also Derm or any specialty (there's a bunch) that could lead to a pain fellowship. I'm psych and people talk about TMS/ECT/Ketamine as procedures. There's technical details to it to modify, but it's about as much a "procedure" as hooking a patient up to EKG leads.
 
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