Undecided specialty, need advice.

[flufighter]

Hi all,
I'm a current M3 who is lost on what specialty to apply to. M4 scheduling is coming up and with VSLO opening I'm beginning to panic. I have finished OB/Gyn, Surg, and Peds. I am finishing up IM and have Psych and FM to go. Competitiveness wise I'm top 25% of my class, but go to a low tier MD. Step 1 would've been in the 260-270 range based on practice exams. I've honored OB/Gyn and Peds, high passed Surg. I don't have much research, 1 first author pub with another non-first author pub submitted. Working on 3 projects currently all IM related.

I enjoyed the clinic on OB/Gyn as well as L&D, but hated Gyn surg. Surgery was awful and Peds I only liked outpatient clinic. Anesthesia was extremely boring and I cannot read scans for crap so Rads is a no go. I scribed in the ED in the past as well and do not enjoy ED. Additionally I did a little Derm shadowing and found clinic to be a little tiring with their volume, and am not very good at rashes.

IM I've tolerated IP floors, but hated ICU. Heme/onc clinic was by far my favorite so far. Rounding and note writing sucks in all honesty. What I have also hated is the limited time in seeing patients, I hate having to prechart and rush through each encounter.

So far I'm considering IM -> Heme/onc or other chill subspecialty, or Psych (did Crisis Text Line counseling a little and did not like it much probably won't like Psych).

What I'm looking for in a specialty would be:
- Chill lifestyle
- I'm fine with any residency up to 6 years total.
- I want reasonable pay, doesn't have to be the highest paying specialty
- Enjoy less invasive procedures

This is a train wreck, but hopefully someone is able to provide some advice.

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[VA Hopeful Dr]

Let's see how your FM rotation goes

 

[DO2015CA]

Peds clinic is super reasonable but the pay is going to be the worst. It’s in line with other primary care specialties.

No med student can read imaging. Hell most residents can’t. If you enjoyed rads, the skill will come.

psych would be a good gig if you can deal with the clientele

 

[mrbreakfast]

I would just note that being bad at a specific skill does not necessarily mean you cannot do a specialty, as your proficiency in that skill will increase. There are exceptions, but being bad a suturing, or at reading imaging, etc, as a medical student just means you'd have to work at it to become good at it.

I always recommend thinking of what rotations you enjoyed the most, or what rotations you spent the least time looking at the clock.

Based on what you wrote, it sounds as though you enjoy clinic more than the hospital, and prefer a lower-volume clinic (with potentially longer patient encounters) than a high-volume clinic (though you enjoyed peds clinic, which gives you more flexibility).

I think you may end up liking psych and/or FM, but even if you don't, pay attention to what aspects of those specialties you liked and didn't like, as that can further point you towards a specialty.

You can look into other subspeciality, outpatient IM fields (some types of cardiology, AI, endo, etc) as that might be more your speed.

If you have elective time, the other two specialties to look into might be PM&R, or neurology (subspeciality neurology = complex but fewer patients). You might really enjoy neurology.

Last point: for people who are undecided, I always recommend looking at a broad field with many practice models. You don't actually know for sure whether you prefer inpatient vs outpatient, etc, until you've tried them in residency. Medical students, for example, do not have a message box, the bane of any outpatient physician...

 

[flufighter]

I would just note that being bad at a specific skill does not necessarily mean you cannot do a specialty, as your proficiency in that skill will increase. There are exceptions, but being bad a suturing, or at reading imaging, etc, as a medical student just means you'd have to work at it to become good at it.

I always recommend thinking of what rotations you enjoyed the most, or what rotations you spent the least time looking at the clock.

Based on what you wrote, it sounds as though you enjoy clinic more than the hospital, and prefer a lower-volume clinic (with potentially longer patient encounters) than a high-volume clinic (though you enjoyed peds clinic, which gives you more flexibility).

I think you may end up liking psych and/or FM, but even if you don't, pay attention to what aspects of those specialties you liked and didn't like, as that can further point you towards a specialty.

You can look into other subspeciality, outpatient IM fields (some types of cardiology, AI, endo, etc) as that might be more your speed.

If you have elective time, the other two specialties to look into might be PM&R, or neurology (subspeciality neurology = complex but fewer patients). You might really enjoy neurology.

Last point: for people who are undecided, I always recommend looking at a broad field with many practice models. You don't actually know for sure whether you prefer inpatient vs outpatient, etc, until you've tried them in residency. Medical students, for example, do not have a message box, the bane of any outpatient physician...

100% spot on with the practice setting. I think inpatient and the amount of things going on overwhelms me at this point, I don't think it would be as bad if I were to be a specialist in the future and be able to focus on more of a niche. I'm highly considering an outpatient IM sub as I do enjoy working with adults more than kids.

I'm more on the fence with FM just because I like to see tangible results. Hopefully with my psych rotation coming up I can get a more clear picture.

 

[DO2015CA]

100% spot on with the practice setting. I think inpatient and the amount of things going on overwhelms me at this point, I don't think it would be as bad if I were to be a specialist in the future and be able to focus on more of a niche. I'm highly considering an outpatient IM sub as I do enjoy working with adults more than kids.

I'm more on the fence with FM just because I like to see tangible results. Hopefully with my psych rotation coming up I can get a more clear picture.

Inpatient medicine slows down as you transition into the senior resident role.

Good part about subspecialty clinic is its slower, interesting pathology, and can filter broad questions back to pcp. Def recommend. Although depending on the subspecialty, you’ll have call weeks in the hospital.

 

[flufighter]

Inpatient medicine slows down as you transition into the senior resident role.

Good part about subspecialty clinic is its slower, interesting pathology, and can filter broad questions back to pcp. Def recommend. Although depending on the subspecialty, you’ll have call weeks in the hospital.

That's reassuring to hear! I wouldn't mind call weeks as long as they aren't too often.

 

[DrStephenStrange]

What I'm looking for in a specialty would be:
- Chill lifestyle
- I'm fine with any residency up to 6 years total.
- I want reasonable pay, doesn't have to be the highest paying specialty
- Enjoy less invasive procedures

Radiology —> IR
Anesthesiology
Ophthalmology
Psych (less procedures but still some)
IM —> Cards (Less chill lifestyle)

 

[eyeeye_captain]

What I'm looking for in a specialty would be:
- Chill lifestyle
- I'm fine with any residency up to 6 years total.
- I want reasonable pay, doesn't have to be the highest paying specialty
- Enjoy less invasive procedures

Good news, bad news:

Good: I can tick every single box you have with Ophthalmology.
- Almost exclusively outpatient. Usually <40 hours of clinical work weekly with minimal overnight and weekend emergencies.
- 4 year residency, fellowships are 1-2 years
- We usually do at least as well as previously mentioned specialties. Some substantially better.
- 1+ OR day weekly with surgeries ranging from 10-60 minutes for the most part. Most cases don't require sutures. Large number of in-office minor procedures.

Bad:
- I suspect you haven't actually been around the field, as most students have practically no exposure in med school.
- I don't know if you have a home program with you saying your school is low tier. That limits your options for rotating, research, and networking, though there are a couple of low tier schools with monster departments (Wills Eye Hospital at Thomas Jefferson, for example). The timeline is somewhat against you, potentially leading to a research year.
- Clinic is probably about the same pace as Derm.

You could look PM&R -> pain as an alternative.

 

[VA Hopeful Dr]

100% spot on with the practice setting. I think inpatient and the amount of things going on overwhelms me at this point, I don't think it would be as bad if I were to be a specialist in the future and be able to focus on more of a niche. I'm highly considering an outpatient IM sub as I do enjoy working with adults more than kids.

I'm more on the fence with FM just because I like to see tangible results. Hopefully with my psych rotation coming up I can get a more clear picture.

There's more of that than most people realize, especially outside of teaching clinics.

 

[DO2015CA]

There's more of that than most people realize, especially outside of teaching clinics.

What’s your biggest draw to FM?

 

[Doc mu]

What’s your biggest draw to FM?

It was one of my favorite rotations in med school.
I'd say the pt relationships, low acuity/stress/call, and variety are nice (my doc was on her last month and the pts started crying when she told them she was retiring!)
Job market is great, you can work in the ED, clinic, as a hospitalist, open a DPC clinic, conceirge, private practice, locum, urgent care...etc
Pay increasing yearly for some reason while decreasing for specialists
Quick residency
I don't buy the encroachment, nurses have been about to take over the specialty for a 100 years now.

cons:
Pay still not as high as specialists
Paperwork, enough said
Pts are either too easy (flu, cough, fever, wellness...etc) and too complex with a 100 problems
mostly manage instead of cure
need to know too much about too much
sometimes get dumped on when others don't know what to do "you need to check with your PCP for that"
don't have as much pull over admin as surgeons
maybe less prestigious among drs? didn't seem like it at the hospital or any clinic but its the feeling i get on sdn

 

[VA Hopeful Dr]

What’s your biggest draw to FM?

I like the longitudinal care.

I like the breadth of knowledge.

I like the variety in my day. Today I saw: controlled diabetes, uncontrolled diabetes, blood pressure, high cholesterol, covid, gout, fractured lumbar fusion hardware, lung cancer, ADHD, bipolar, depression, annual physical, UTI, PAD, CAD, COPD exacerbation. And that was just today.

I like working 8 hour days (actually less) with a guaranteed lunch.

I like no nights, weekends, or holidays.

I like the job market. I can find a job almost literally anywhere.

I like the job variety: traditional clinic, urgent care, hospitalist, ED work, FQHC, free clinic, locums, travel medicine, employment med, women's health, college health clinics, prisons, and more I'm sure I'm forgetting.

I like low malpractice.

I like that most of my patients like me and trust me, often more than the specialists they see.

I like 6+ weeks off per year.

I like making 400k+ per year.

I liked the 3 year residency.

I like that FM is a fairly chill bunch. We're the least type A doctors out there.