Very torn about specialty--need another specialty that will fill my cup while also allowing me to be the dad/husband I want to be

[Wobbler12345]

Hi all! I would like some suggestions for specialties as I am lost and questioning my future. I am an MS3 at the end of my surgery rotation. I had always thought surgery was going to be for me. I love working with my hands, the immediate impact, the satisfaction of knowing I am "the guy" for this patient, critical/intense situations, and the patient/physican relationship. I do not enjoy rounding, office settings, or discussing patients that aren't really sick. Family medicine and outpatient neurology were horrible because I just didn't care about the small dosage changes we were making for chronic diseases. Having said this, the lifestyle of surgery especially residency is too much. It's not that I couldn't handle it, it's that I couldn't stomach the strain it would inevitably put on the relationship. My fiance has a very busy schedule (attorney) and we just did not get enough time together these last 10 weeks, and I'm not even working a full resident schedule. We both are very understanding of each other's schedules and both make sacrifices to carve out time to see one another. But I had a dad who worked all the time, not as a doctor, but enough that I know the impact not being there has on a spouse and kids. So my worry is, what would 5-8 years of this lifestyle look like with residency and fellowship? What would 40 years of this as a career look like? My career is important to me, but not to the point where I would ever be okay with it jeopardizing my relationship/future family.

I am trying to find a specialty that will allow me variability in terms of what I do on a daily basis and lifestyle flexibility. I need it to scratch that itch for stressful situations and taking care of sick patients. I also enjoy working hard while at work. However, I need to be able to scale it to the stage of life I am in so that I can work less when babies are being raised or if I ever have my child ask me the same thing I asked my dad "why are everyone else's parents at the soccer game and not you?".

Before anyone says it I know the saying is don't pick a specialty based on the residency, but I think that's wrong. Life doesn't happen in a vacuum, you can't just ignore the impact that not being present for nearly a decade has on relationships. Life happens every day around us, in medicine we like to think that it gets put on hold while we throw ourselves into our training, but it doesn't. I need to be able to live life and be a doctor. That's not saying I don't want to work hard. It's saying I want to work hard when I work, but also be able to enjoy my family and hobbies like backpacking, exercise, fishing, travel, ect.

About me:

• Low-tier MD school
• P/F step 1----> hoping for 250+ on step 2 given my step 1 practice tests predicted me in the 250's
• H on neurology, HP on family med (had an issue on shelf day but evals described me as performing at an honors level and wrote a detailed story about me), Most likely will H surgery
• Lead one of the student-run clinics
• Volunteer every week working with the elderly population
• Tutor M1's
• Student mentor
• Summer research internship at top children's hospital summer of M1
• 3 Oral presentations at national conferences
• 6 poster presentations
• 4-5 1st author publications (depending on how things pan out)

What I have considered:

• Anesthesia---->worry about lack of patient interaction, not being their "doctor", monotony
• EM----> Only issue is the job outlook and the constant schedule shifting seems hard. I loved working EMS before medical school but don't know if I would love that constant circadian rhythm change in my 60's
• Peds EM----> geographical locking in of needing to be at a children's hospital scares me a little because I want to get back to the west coast and there just is the same hospital density as the east coast
• Pulm/CC---> Don't know if I could handle IM if I wasn't able to get the fellowship
• Neonatologist----> no way to par it back from the ICU schedule lifestyle
• Psych----> think I would miss the medicine side of things
• Urology---> realistically hard to match given no connections and school ranking

Thanks for the input everyone, and any guidance is really appreciated!

---

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[wholeheartedly]

what about ophthalmology?

(disclaimer: no idea what training is like for that)

 

[operaman]

Take a good long look at surgical subs (Ophtho, ent, uro, Ortho).

It’s still a surgical residency but many programs have more lifestyle friendly schedules. I’m ent and my program had a busy pgy2 year but after that it was pretty chill on most rotations. My pgy4 year I had all golden weekends except 6, and then chiefs year I worked 4 weekends. Now as an attending my call schedule is the worst it’s ever been with 8 weekends a year.

Most weekdays were long - usually 6am - 5/6pm. Some were definitely later on select rotation but those were the exception. Now as an attending my clinics are 8am-1:30pm 3 days a week and 1-1.5 OR days a week which are usually done by 5pm.

The subs give you the things you like about surgery without the same misery and with substantially more income. Definitey nowhere near as lifestyle friendly as derm and the like, but pretty darn good in my book.

Definitely worth a look!

 

[Gilakend]

Agree with the above. Cardiac anesthesia could also fit. Procedures, sick patients, and SHTF scenarios at work, chillin' at home, pick how much you wanna work. Could do a lot of cardiac, a little cardiac, or no cardiac depending on what you want and what stage of life you're in.

 

[voxveritatisetlucis]

Wouldn’t optho, ent, uro, and ortho all require research year in this case unless maybe AOA? My school is low tier and although some people match into these specialties each year, they usually have more like 10+ pubs (with a bunch being specialty specific) and or AOA (not sure if this applies). Many with impressive metrics fail to match (I think like 3 didn’t match ortho out of 9 who applied or something like that this past cycle and that was with scored step 1

Just putting it out there because I feel like an M3 trying for one of these would probably have to start coordinating this sooner rather than later if interested in research year

 

[Ole_Toe]

Yeah anesthesia + fellowship prob checks a lot of boxes for you. Sick pts, more contact/direct care, better hours, good pay, attainable. Ophtho residency is hard but shorter than others and has more clinic with tons of patient satisfaction etc. issue is that match is competitive and depending on how things pan out may mean gap year for you. Rads —> IR is worth a look too. You’re going to have to sacrifice something but props for not making that something your loved ones and personal life. Great post

 

[operaman]

Wouldn’t optho, ent, uro, and ortho all require research year in this case unless maybe AOA? My school is low tier and although some people match into these specialties each year, they usually have more like 10+ pubs (with a bunch being specialty specific) and or AOA (not sure if this applies). Many with impressive metrics fail to match (I think like 3 didn’t match ortho out of 9 who applied or something like that this past cycle and that was with scored step 1

Just putting it out there because I feel like an M3 trying for one of these would probably have to start coordinating this sooner rather than later if interested in research year

Good point. I think a highly motivated and clinically sharp m3 could probably put together a solid app starting now. I’ve seen students bang out 5 pubs between January of M3 and ERAS submission until September.

Key is getting buy in from your department for good letters and help getting on projects. Then a good performance clinically and I think someone would have a decent shot. Your best chance for matching anywhere in any field is your home program. If you’ve been productive in a short period of time they will weight that very favorably. 10+ pubs may look great on paper, but if you’ve got 3-4 pubs and are well liked, thats more than enough to give you an edge over the rando with a stronger CV.

 

[h23]

Yeah anesthesia + fellowship prob checks a lot of boxes for you. Sick pts, more contact/direct care, better hours, good pay, attainable. Ophtho residency is hard but shorter than others and has more clinic with tons of patient satisfaction etc. issue is that match is competitive and depending on how things pan out may mean gap year for you. Rads —> IR is worth a look too. You’re going to have to sacrifice something but props for not making that something your loved ones and personal life. Great post

I do want to make a comment that IR is not the same as surgery. While there are some similarities, OP would still have to go through a radiology residency, which some people might not be a fan of. Additionally, private practice IR, at least from what I've heard, you're basically getting all the things that the surgeons, GI specialists, etc don't want (depending on where you are and what your practice is like, I guess). The point being, if OP finds himself attached to surgery, I don't think he'll find the same amount of happiness in IR, at least in my opinion. Maybe he'll like the 1 or 2 years of IR fellowship, but from what I've seen, there's a large chance that he won't be seeing those kinds of things from fellowship all the time in his daily life.

 

[WashingtonR]

There are some back doors to intervention focused specialties that don't involve a surgery residency:
Obgyn + gyn-onc fellowship
Obgyn + urogyn fellowship
Neuro + stroke fellowship + interventional neuro fellowship
IM + nephro + interventional nephro (basically a year of teaching a nephrologist to do their own fistula)
IM + Cards + EP or interventional cards (admittedly very competitive)

Also you can do CC (without Pulm) from gas or neuro CC from neuro.

I'm sure there are others I'm not thinking of right now. I would also question what you don't like about rounds? As an M3, I found surgery rounds to be a useless exercise in following the residents around the hospital without learning anything.You haven't done IM wards yet, which is kind of the essence of rounds. CC is on your list, but that has very long rounds. You'll spend a lot more time discussing cardiorenal syndrome than putting in A lines.

 

[Dunkthetall]

Take a good long look at surgical subs (Ophtho, ent, uro, Ortho).

It’s still a surgical residency but many programs have more lifestyle friendly schedules. I’m ent and my program had a busy pgy2 year but after that it was pretty chill on most rotations. My pgy4 year I had all golden weekends except 6, and then chiefs year I worked 4 weekends. Now as an attending my call schedule is the worst it’s ever been with 8 weekends a year.

Most weekdays were long - usually 6am - 5/6pm. Some were definitely later on select rotation but those were the exception. Now as an attending my clinics are 8am-1:30pm 3 days a week and 1-1.5 OR days a week which are usually done by 5pm.

The subs give you the things you like about surgery without the same misery and with substantially more income. Definitey nowhere near as lifestyle friendly as derm and the like, but pretty darn good in my book.

Definitely worth a look!

I know there’s some variation between programs, but aren’t Ortho resident hours just as bad as general and vascular?

 

[operaman]

I know there’s some variation between programs, but aren’t Ortho resident hours just as bad as general and vascular?

Would have to ask Ortho folks to be sure. I know my friends definitely got crushed as juniors but senior years were much easier. Surgical easier that is - nothing is nearly as good as derm and the like!

 

[NITRAS]

Attendings can control their schedule in most specialties. Residents cannot. Residency is 3-6 years. It is only a season. I am not saying you need to do a surgical residency, I’m just saying that it is ok to spend a few years working really hard and still be a good husband/father.

 

[Slack3r]

I was torn between ENT/facial plastics, plastics, and derm/Mohs. I was similarly apprehensive about the surgery residency, although I loved my surgical subIs as a 4th year. I liked DOING things, but I was nervous about the surgery culture, and I found myself getting antsy during longer cases.

I ultimately went into derm->Mohs. I still do the type of small reconstructive procedures I enjoyed in plastics/facial plastics, but I also make a boatload, home for dinner every night, and my most involved procedures only take about an hour. While my fellowship had longer hours (still no weekends!), derm residency was a relative cake walk.

 

[Gilakend]

I know there’s some variation between programs, but aren’t Ortho resident hours just as bad as general and vascular?

At my institution PGY1 and PGY2 are 65-80, trauma service or others can be more (one resident told me as a trauma 2 he didn't leave before 11 PM for 3 weeks straight). As a PGY3 - PGY5 60-70. Some rotations might be less, some more, but these are the averages I was given by residents.

FWIW at my institution ortho resident life is way better on average than gen surg resident life. Don't know anything about vascular.

 

[CyrilFiggis]

Don’t do PEM. It’s 6 years of training (3 peds + 3 fellowship) all to make $265k. Critical care is also 6-7 years.

Look, residency sucks for almost every specialty when you have a family. I went through weeks on end where I didn’t see my daughter and my wife and I only saw each other for an hour or so as I was waking up or about to fall asleep.

Have options, but the real discussion you need to have is with your fiancé. You’ve both chosen to be high demand professionals and right now it sounds like you’re making the major sacrifice in potentially changing your preferred specifically.

 

[DarkHorizon]

I know there’s some variation between programs, but aren’t Ortho resident hours just as bad as general and vascular?

Probably just as long hours, but for some reason Ortho residents seem much happier across the board. Speaking from personal experience, we worked just as hard as general surgery residents if not harder at times at my hospital.

 

[RangerBob]

Psych typically has an easy resident. Uur psych residents were 40hrs or less for PGY3-4. Intern year is always busy, and PGY2 (mostly inpatient for psych) is "busy."

PM&R (not one you mentioned) is the same. My PGY2 year I worked maybe 50hrs/week on average. PGY3-4 averaged 40. As an attending now I average about 40.

I was really interested in psych (it was my second choice after PM&R), but it might be worth thinking about again. You may not miss the medical side of things when you realize you make a great income and can have a great/flexible lifestyle. It's the easiest specialty by far to open up your own practice with whatever hours you want. You could work 3 days a week. And you can literally work anywhere (especially now that tele-psych is catching on).

One thing to keep in mind is most jobs lose their luster/excitement after time. People often say follow your passion, but passion typically matures/fades. Find something where you're content--in terms of hapilly content, not settling. Find something where you're OK with the everyday stuff (every specialty has the boring daily stuff--we all have to chart, some more than others) and enjoy the work environment/schedule/lifestyle, because once you've been doing something a few years, those things matter a lot more.

 

[ACSurgeon]

Hi all! I would like some suggestions for specialties as I am lost and questioning my future. I am an MS3 at the end of my surgery rotation. I had always thought surgery was going to be for me. I love working with my hands, the immediate impact, the satisfaction of knowing I am "the guy" for this patient, critical/intense situations, and the patient/physican relationship. I do not enjoy rounding, office settings, or discussing patients that aren't really sick. Family medicine and outpatient neurology were horrible because I just didn't care about the small dosage changes we were making for chronic diseases. Having said this, the lifestyle of surgery especially residency is too much. It's not that I couldn't handle it, it's that I couldn't stomach the strain it would inevitably put on the relationship. My fiance has a very busy schedule (attorney) and we just did not get enough time together these last 10 weeks, and I'm not even working a full resident schedule. We both are very understanding of each other's schedules and both make sacrifices to carve out time to see one another. But I had a dad who worked all the time, not as a doctor, but enough that I know the impact not being there has on a spouse and kids. So my worry is, what would 5-8 years of this lifestyle look like with residency and fellowship? What would 40 years of this as a career look like? My career is important to me, but not to the point where I would ever be okay with it jeopardizing my relationship/future family.

I am trying to find a specialty that will allow me variability in terms of what I do on a daily basis and lifestyle flexibility. I need it to scratch that itch for stressful situations and taking care of sick patients. I also enjoy working hard while at work. However, I need to be able to scale it to the stage of life I am in so that I can work less when babies are being raised or if I ever have my child ask me the same thing I asked my dad "why are everyone else's parents at the soccer game and not you?".

Before anyone says it I know the saying is don't pick a specialty based on the residency, but I think that's wrong. Life doesn't happen in a vacuum, you can't just ignore the impact that not being present for nearly a decade has on relationships. Life happens every day around us, in medicine we like to think that it gets put on hold while we throw ourselves into our training, but it doesn't. I need to be able to live life and be a doctor. That's not saying I don't want to work hard. It's saying I want to work hard when I work, but also be able to enjoy my family and hobbies like backpacking, exercise, fishing, travel, ect.

About me:

• Low-tier MD school
• P/F step 1----> hoping for 250+ on step 2 given my step 1 practice tests predicted me in the 250's
• H on neurology, HP on family med (had an issue on shelf day but evals described me as performing at an honors level and wrote a detailed story about me), Most likely will H surgery
• Lead one of the student-run clinics
• Volunteer every week working with the elderly population
• Tutor M1's
• Student mentor
• Summer research internship at top children's hospital summer of M1
• 3 Oral presentations at national conferences
• 6 poster presentations
• 4-5 1st author publications (depending on how things pan out)

What I have considered:

• Anesthesia---->worry about lack of patient interaction, not being their "doctor", monotony
• EM----> Only issue is the job outlook and the constant schedule shifting seems hard. I loved working EMS before medical school but don't know if I would love that constant circadian rhythm change in my 60's
• Peds EM----> geographical locking in of needing to be at a children's hospital scares me a little because I want to get back to the west coast and there just is the same hospital density as the east coast
• Pulm/CC---> Don't know if I could handle IM if I wasn't able to get the fellowship
• Neonatologist----> no way to par it back from the ICU schedule lifestyle
• Psych----> think I would miss the medicine side of things
• Urology---> realistically hard to match given no connections and school ranking

Thanks for the input everyone, and any guidance is really appreciated!

Regarding surgical fields: if you want to be the surgeon for whatever indication, that takes years of perfecting your skills after residency. So, it’s not just 5-7 years of intense training. It’s another 5-7 years as a junior attending perfecting your skills. That’s very time and emotionally consuming….

Most surgery fields these days have options for some kind of work-life balance options. Maybe you’re an acute care surgeon who’s on call 7-10 days a month and off most of the rest of the time. Maybe you’re an elective surgeon who mostly works 8-5 Mon-Fri with a few cross cover (easy calls) a month. Still, you’re trying to be great at what you do, it needs a real investment from you.

Once you have a family and kids, priorities change, and you have to decide if you want to be around for the kids big milestones or you want to be the most expert surgeon in town.

Similarly, you can find satisfaction in any medical field. You’re making your living by helping people live healthier or with less complications from their chronic illness.

You can’t have your cake and eat it too. If you want a lot of family time and predictability, you’ll have to settle for doing something more “average” and less glamorous. However, an average doctor doing their job is still doing something substantially cooler than most people in tech or business or engineering etc.

Good luck!

 

[Lost in Translation]

I know there’s some variation between programs, but aren’t Ortho resident hours just as bad as general and vascular?

They can be, but not as around the clock as Gen Surg; only really when you’re on trauma.

As an attending, depending on what you do, your hours can be pretty lousy, too. Academic orthos who take trauma call will often do 60+ hour weeks. Even PP can have high hours if your practice covers local hospital(s). The lifestyle subspecialties in ortho are joint and hand, though they aren’t terribly competitive.

 

[GBurdell]

Pediatrics residency could be a consideration - it's a (relatively) easier residency, and allows for NICU, PEM, Pulm, PICU all of which are on your list. General pediatrics may be more palatable to you than IM as well. As far as your specific concern about finding a PEM job - I can't speak to the west coast but I know several PEM docs who took jobs at community (non children's hospitals) where they see the significant number of children who come in and adult EM colleagues the rest. Most of the pediatric subspecialties score highly on the physician satisfaction surveys (although admittedly lower in terms of frank compensation).

 

[mistafab]

Gotta be honest bro. As a dad / husband, I’d say chose what you are most interested in. I cant imagine 10 years out from residency being bitter at my family, working a specialty I was less interested in for the rest of my life.

Life is too short to do work you dont really like.

 

[Entadus]

Pediatrics residency could be a consideration - it's a (relatively) easier residency, and allows for NICU, PEM, Pulm, PICU all of which are on your list. General pediatrics may be more palatable to you than IM as well. As far as your specific concern about finding a PEM job - I can't speak to the west coast but I know several PEM docs who took jobs at community (non children's hospitals) where they see the significant number of children who come in and adult EM colleagues the rest. Most of the pediatric subspecialties score highly on the physician satisfaction surveys (although admittedly lower in terms of frank compensation).

yeah let the lawyer wife make the $$

 

[Gilakend]

Gotta be honest bro. As a dad / husband, I’d say chose what you are most interested in. I cant imagine 10 years out from residency being bitter at my family, working a specialty I was less interested in for the rest of my life.

Life is too short to do work you dont really like.

I understand this sentiment and partially agree, but I think it should be "don't do something you hate" not "don't do something you're less interested in".

I think the absolute craziest advice I hear in medicine is "do whatever you like most". If psych for someone is a 95% and neurosurgery is 100% it seems crazy to me to pick neurosurgery, especially if you have a family. At the end of the day, this is just a job. You shouldn't do something you hate, but I also don't think you should donate huge chunks of your life to the hospital just because you like something a little more.

The situation you describe is 100% real and I have 100% met docs who regret not pursuing something else for outside reasons (age, family, lifestyle, etc.). But I think the much more common situation is someone who regrets not doing a job they would've liked that also would've given them a lot more balance.

 

[Neopolymath]

Gotta be honest bro. As a dad / husband, I’d say chose what you are most interested in. I cant imagine 10 years out from residency being bitter at my family, working a specialty I was less interested in for the rest of my life.

Life is too short to do work you dont really like.

As another dad/husband, I agree, especially when they all go to school, have hobbies, leave the house because they don't think you are cool (cyclical). You will have a job you don't like with a little more free time and the people who you did it for won't constantly be there to validate it.

Choosing a lifetime career based on a single small period in your life is ill-advised. Hopefully your kids don't see you all the time so you can work, be with your spouse, and they are successful and experiencing the world. Everyone will be happier.

 

[Neopolymath]

I understand this sentiment and partially agree, but I think it should be "don't do something you hate" not "don't do something you're less interested in".

I think the absolute craziest advice I hear in medicine is "do whatever you like most". If psych for someone is a 95% and neurosurgery is 100% it seems crazy to me to pick neurosurgery, especially if you have a family. At the end of the day, this is just a job. You shouldn't do something you hate, but I also don't think you should donate huge chunks of your life to the hospital just because you like something a little more.

The situation you describe is 100% real and I have 100% met docs who regret not pursuing something else for outside reasons (age, family, lifestyle, etc.). But I think the much more common situation is someone who regrets not doing a job they would've liked that also would've given them a lot more balance.

This is reasonable and balanced. It's kind of how I decided what to do but everyone has their own threshold for "worth it."

 

[DOVinciRobot]

I’m a surgery dad. I don’t regret doing surgery, sometimes I regret pursuing medicine in general, but I’ve never once regretted doing surgery.

 

[voxveritatisetlucis]

This has to be the best thing about being single/childless.

Want to spend 90 hours a week at the hospital/library? Fine

Want to eat ramen 8 days a week? Go for it

Want to fly to some tropical island or Vegas casino after a rough exam or week on the ward? So be it

 

[Neopolymath]

I’m a surgery dad. I don’t regret doing surgery, sometimes I regret pursuing medicine in general, but I’ve never once regretted doing surgery.

Do what instead though? Go 180 and really just be a lazy piece of garbage middle management guy and phone it in for 25 hours a week?

 

[Neopolymath]

This has to be the best thing about being single/childless.

Want to spend 90 hours a week at the hospital/library? Fine

Want to eat ramen 8 days a week? Go for it

Want to fly to some tropical island or Vegas casino after a rough exam or week on the ward? So be it

Yes, people without kids have a big advantage here in specialties that require outside studying more than on the job learning.

 

[sloop]

The situation you describe is 100% real and I have 100% met docs who regret not pursuing something else for outside reasons (age, family, lifestyle, etc.). But I think the much more common situation is someone who regrets not doing a job they would've liked that also would've given them a lot more balance.

I think this is true. In residency, obviously I would often introduce myself as a psych resident on off-service rotations and in med school the topic of what specialty I was pursuing often came up on other rotations. I can’t even count the number of times I got the response “yeah, I actually wish I went into psychiatry.” The sentiment was basically that they had pursued the specialty they were most interested in but then came to regret it because they could have had a better balance of they had chosen a different path.

 

[DOVinciRobot]

Do what instead though? Go 180 and really just be a lazy piece of garbage middle management guy and phone it in for 25 hours a week?

Nah. High school teacher and coach sports OR work for the division of wildlife in my home state. It would have been a simple life, but I would have also been happy doing either of those.

Having said that most of the time I absolutely love my job, even when I’m on 24hr trauma call

 

[voxveritatisetlucis]

Nah. High school teacher and coach sports OR work for the division of wildlife in my home state. It would have been a simple life, but I would have also been happy doing either of those.

Having said that most of the time I absolutely love my job, even when I’m on 24hr trauma call

Is there a specific year when/if most general surgery residents start having regrets? Or do the ones who love it usually love it throughout?

 

[DOVinciRobot]

Is there a specific year when/if most general surgery residents start having regrets? Or do the ones who love it usually love it throughout?

I don’t know very many surgery residents that actually regret doing surgery. The ones that do typically regret it very soon after starting intern year.

Honestly most of the residents that regret their specialty are IM in my experience.

 

[ACSurgeon]

Is there a specific year when/if most general surgery residents start having regrets? Or do the ones who love it usually love it throughout?

I think 2nd-3rd year is when most residents realize it’s not for them and they jump ship. The rest genuinely enjoy it I think. Or we are too stubborn/proud to admit otherwise lol

 

[Slack3r]

I don’t know very many surgery residents that actually regret doing surgery. The ones that do typically regret it very soon after starting intern year.

Honestly most of the residents that regret their specialty are IM in my experience.

The only time I was genuinely unhappy during all of training was my IM intern year. Can’t imagine anyone picking that career on purpose, but different strokes…

 

[Mad Jack]

Hi all! I would like some suggestions for specialties as I am lost and questioning my future. I am an MS3 at the end of my surgery rotation. I had always thought surgery was going to be for me. I love working with my hands, the immediate impact, the satisfaction of knowing I am "the guy" for this patient, critical/intense situations, and the patient/physican relationship. I do not enjoy rounding, office settings, or discussing patients that aren't really sick. Family medicine and outpatient neurology were horrible because I just didn't care about the small dosage changes we were making for chronic diseases. Having said this, the lifestyle of surgery especially residency is too much. It's not that I couldn't handle it, it's that I couldn't stomach the strain it would inevitably put on the relationship. My fiance has a very busy schedule (attorney) and we just did not get enough time together these last 10 weeks, and I'm not even working a full resident schedule. We both are very understanding of each other's schedules and both make sacrifices to carve out time to see one another. But I had a dad who worked all the time, not as a doctor, but enough that I know the impact not being there has on a spouse and kids. So my worry is, what would 5-8 years of this lifestyle look like with residency and fellowship? What would 40 years of this as a career look like? My career is important to me, but not to the point where I would ever be okay with it jeopardizing my relationship/future family.

I am trying to find a specialty that will allow me variability in terms of what I do on a daily basis and lifestyle flexibility. I need it to scratch that itch for stressful situations and taking care of sick patients. I also enjoy working hard while at work. However, I need to be able to scale it to the stage of life I am in so that I can work less when babies are being raised or if I ever have my child ask me the same thing I asked my dad "why are everyone else's parents at the soccer game and not you?".

Before anyone says it I know the saying is don't pick a specialty based on the residency, but I think that's wrong. Life doesn't happen in a vacuum, you can't just ignore the impact that not being present for nearly a decade has on relationships. Life happens every day around us, in medicine we like to think that it gets put on hold while we throw ourselves into our training, but it doesn't. I need to be able to live life and be a doctor. That's not saying I don't want to work hard. It's saying I want to work hard when I work, but also be able to enjoy my family and hobbies like backpacking, exercise, fishing, travel, ect.

About me:

• Low-tier MD school
• P/F step 1----> hoping for 250+ on step 2 given my step 1 practice tests predicted me in the 250's
• H on neurology, HP on family med (had an issue on shelf day but evals described me as performing at an honors level and wrote a detailed story about me), Most likely will H surgery
• Lead one of the student-run clinics
• Volunteer every week working with the elderly population
• Tutor M1's
• Student mentor
• Summer research internship at top children's hospital summer of M1
• 3 Oral presentations at national conferences
• 6 poster presentations
• 4-5 1st author publications (depending on how things pan out)

What I have considered:

• Anesthesia---->worry about lack of patient interaction, not being their "doctor", monotony
• EM----> Only issue is the job outlook and the constant schedule shifting seems hard. I loved working EMS before medical school but don't know if I would love that constant circadian rhythm change in my 60's
• Peds EM----> geographical locking in of needing to be at a children's hospital scares me a little because I want to get back to the west coast and there just is the same hospital density as the east coast
• Pulm/CC---> Don't know if I could handle IM if I wasn't able to get the fellowship
• Neonatologist----> no way to par it back from the ICU schedule lifestyle
• Psych----> think I would miss the medicine side of things
• Urology---> realistically hard to match given no connections and school ranking

Thanks for the input everyone, and any guidance is really appreciated!

Pulm/CC is notorious for having an awful lifestyle throughout the career unless you do outpatient so I'd write that one off. Depending on where you live it can also be geographically limiting due to heavy saturation in some areas. I leaned away from it because the only way to get a CC job within 90 minutes of me was for one of the intensivists to relocate or die.

Psych can give you plenty of bread and butter medicine if you're working certain inpatient units. You can manage all of your patient's medications that you're comfortable with, and I find myself having to sort out medical issues more often than I'd like to be honest. Even in places that have hospitalist coverage, psychiatric patients' medical conditions often aren't taken seriously. The result of this is that if you don't recognize medical issues and help advocate for your patient to receive care they often simply won't get it. Consult psych can also keep your medical skills sharp, especially if you're at an academic center. And if you're on a geri psych unit, well... Get ready for all the medicine you could want and some that you would rather not have to deal with. The nice thing about psych is that it gives you an opportunity to help patients in a way no other field can, but it's a special kind of job that honestly can be challenging to know whether it's the right fit until you're in it.

The other fields are ones I'll leave to those with more experience to explore, but I will say that the idea that you won't feel like a real doctor in psychiatry fades very quickly. Whether it's the type of doctor you want to be is something only you can answer, however.

 

[Dantes]

Psych can give you plenty of bread and butter medicine if you're working certain inpatient units. You can manage all of your patient's medications that you're comfortable with, and I find myself having to sort out medical issues more often than I'd like to be honest. Even in places that have hospitalist coverage, psychiatric patients' medical conditions often aren't taken seriously. The result of this is that if you don't recognize medical issues and help advocate for your patient to receive care they often simply won't get it. Consult psych can also keep your medical skills sharp, especially if you're at an academic center. And if you're on a geri psych unit, well... Get ready for all the medicine you could want and some that you would rather not have to deal with. The nice thing about psych is that it gives you an opportunity to help patients in a way no other field can, but it's a special kind of job that honestly can be challenging to know whether it's the right fit until you're in it.

The other fields are ones I'll leave to those with more experience to explore, but I will say that the idea that you won't feel like a real doctor in psychiatry fades very quickly. Whether it's the type of doctor you want to be is something only you can answer, however.

I understand still needing to be aware of medical conditions on psych floors but you're not generally treating those right? Coming from a small sample size, but I've seen patients shipped out for not being medically stable or being too complex. Usually medicine is consulted first. Even on the med-psych units I see IM hospitalists staff those.

 

[sloop]

I understand still needing to be aware of medical conditions on psych floors but you're not generally treating those right? Coming from a small sample size, but I've seen patients shipped out for not being medically stable or being too complex. Usually medicine is consulted first. Even on the med-psych units I see IM hospitalists staff those.

Depends on where you are and what the arrangement is for medical coverage. In most cases the psychiatrist is the primary and medicine consults, but medicine can be varying levels of involved. Sometimes, they do an H&P on every patient and will independently order somatic meds, and simply inform the psychiatrist of the plan. In other places, there is no automatic medicine consult and the internists expect actual consult questions to see people like they would on any other service. In that case, how much medicine gets involved depends entirely on the comfort level of the psychiatrist.

 

[Candidate2017]

• Psych----> think I would miss the medicine side of things
• Urology---> realistically hard to match given no connections and school ranking

I find it ironic that med students feel they'd miss "medicine" if they were to go into psychiatry, but not if they'd go into a surgical specialty.

 

[Mad Jack]

I understand still needing to be aware of medical conditions on psych floors but you're not generally treating those right? Coming from a small sample size, but I've seen patients shipped out for not being medically stable or being too complex. Usually medicine is consulted first. Even on the med-psych units I see IM hospitalists staff those.

A couple of the places I've worked expect psychiatrists to manage basic medical care and medical dlctors to be involved once you hit things like insulin, anticoagulants, and more complex antihypertensive regimens. The real issue is that often even in the places where you have hospitalist coverage the hospitalist only comes initially to see each patient and if you're juggling older or more medically complex patients that have mental illness, you need to be able to recognize medical issues quickly to have them addressed. I've had everything from spinal compressions to bizarre metabolic conditions to strange infections pop up over the years and have some very interesting case reports. Consults have been similarly fascinating, as things are very often missed by the primary team. I've seen NMS misdiagnosed as sepsis, antibiotic-induced psychosis, epilepsy-induced psychosis, NMDA receptor encephalitis, and terribly mismanaged Charles-Bonnet syndrome to name just a few fun favorites. Missing many of these diagnoses would have been potentially life altering or fatal for the patients involved, so knowing your psych vs med differential becomes incredibly important