What to do with my life...

[keepsmiling10]

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I'm starting to get a bit frustrated trying to figure out what I want to do with my life. Everyone around me seems to be figuring this out little by little, but I think I'm kinda stuck...

So I really enjoy variety (both schedule-wise & diagnoses-wise), patient contact, hands on stuff and time outside the hospital.
Meaning, I don't want to do something that will consume my life (bye-bye surgery). I like to actually talk to my patients when awake (bye-bye anesthesia). I like a lot of variety and couldn't handle a ton of diabetes or HTN (bye-bye FM). No OB/Gyn, thank you. I need to do something with my hands...no psych. I like people...no pathology, no radiology.

Things I'm kinda on the fence about...IM, Peds, PM&R, Neuro, ER...and that's where I get stuck. Oh, and I'm also very interested in integrating Integrative Medicine. 🙂

Neuro has always been interesting to me. I'm crazy about the brain and think it's so fascinating. But I'm afraid of the whole "can't do that much for them" business as well as the lack of procedures (besides EEG's & LP's). Also, if stroke & seizures are the cream of the crop, I don't know how I feel about it...

ER seems pretty cool but I'm just afraid I'd have a hard time giving up my patients to someone else to take care of...and then always wonder what happened to that really interesting case...

PM&R seems pretty awesome, actually, but I just don't know enough about it (awaiting a rotation in it later in the year). Is it indeed more than PT-like stuff?

Medicine is only a possibility if in conjunction with something else (like Med-Neuro). I'm realizing, though, that adults a lot of times annoy me and have kinda boring diagnoses.

I'm just recently starting to really like Peds. Kids are fun. The diagnoses are awesome (but then again, I'm at a tertiary center)...is that why? However, parents are annoying and still no procedures. Maybe Peds/PM&R? But what's the prospect for a job in that?

Any tips/advice? Please don't tell me to talk to people in the specialties or do rotations in the specific rotations because I have that covered. But I'm still just as confused...
Your thoughts are more than welcome!

 

[Pinkertinkle]

What about balanced lifestyle surgical subspecialties like urology or ent? Family med from what I've seen actually isn't all htn and diabetes and can have a number of interesting procedures.

 

[smq123]

So I really enjoy variety (both schedule-wise & diagnoses-wise), patient contact, hands on stuff and time outside the hospital.
Meaning, I don't want to do something that will consume my life (bye-bye surgery). I like to actually talk to my patients when awake (bye-bye anesthesia). I like a lot of variety and couldn't handle a ton of diabetes or HTN (bye-bye FM). No OB/Gyn, thank you. I need to do something with my hands...no psych. I like people...no pathology, no radiology.

Things I'm kinda on the fence about...IM, Peds, PM&R, Neuro, ER...and that's where I get stuck. Oh, and I'm also very interested in integrating Integrative Medicine. 🙂

Neuro has always been interesting to me. I'm crazy about the brain and think it's so fascinating. But I'm afraid of the whole "can't do that much for them" business as well as the lack of procedures (besides EEG's & LP's). Also, if stroke & seizures are the cream of the crop, I don't know how I feel about it...

ER seems pretty cool but I'm just afraid I'd have a hard time giving up my patients to someone else to take care of...and then always wonder what happened to that really interesting case...

PM&R seems pretty awesome, actually, but I just don't know enough about it (awaiting a rotation in it later in the year). Is it indeed more than PT-like stuff?

Medicine is only a possibility if in conjunction with something else (like Med-Neuro). I'm realizing, though, that adults a lot of times annoy me and have kinda boring diagnoses.

I'm just recently starting to really like Peds. Kids are fun. The diagnoses are awesome (but then again, I'm at a tertiary center)...is that why? However, parents are annoying and still no procedures. Maybe Peds/PM&R? But what's the prospect for a job in that?

Any tips/advice? Please don't tell me to talk to people in the specialties or do rotations in the specific rotations because I have that covered. But I'm still just as confused...
Your thoughts are more than welcome!

PM&R is a lot of social work, and a lot of chronic diseases. A lot of procedures if you go into the Pain Medicine route.

Peds PM&R is actually pretty interesting, because the diagnoses can be pretty diverse.

Have you considered doing peds GI, peds cards, or neonatology? More procedures, with a HUGE variety of diagnoses.

ENT and urology have fun procedures, but a limited variety of diagnoses and they're still fairly demanding, schedule wise.

 

[Pinkertinkle]

Oh don't forget derm, if you're up to it.

 

[87138]

Family med from what I've seen actually isn't all htn and diabetes and can have a number of interesting procedures.

This is particularly true the farther you get, geographically, from large academic centers (or even large metropolises) where there's a super-specialized doc for every little need.

In a more rural/isolated area (if you're up for it), your scope of practice probably expands noticeably.

 

[BigRedBeta]

Some thoughts based on what you've said:

FP indeed does offer a lot of variety, but you do have to go to smaller locations to get that (people in big cities just head to the appropriate specialist). My FP clerkship was rural and the doctors I followed in a town of 2300 did most of the OB including sections, did all the easy scopes (both upper and lower), served as the ER docs, did a lot of minor procedures (stiches, biopsies of all sorts, occasional botox), and saw everyone from the newborns to the 100+ year olds.

Peds does have the advantage of being fun. Most residency programs are tied to tertiary care centers (there are only so many Children's Hospitals), and the number of zebras that come up in childhood far outpaces anything the adults can come up with (pediatric Cardiology is a million times more interesting than adult cards). Personally (I'm starting as a peds intern in July), I enjoy the variety that comes from the different ages - how you interact with a 4 month old, a 2 year old, a 6 year old, a 10 year old and a 15 year old varies A LOT, even if they all have the same problem.

For both peds and IM, don't forget about the subspecialties. In both specialties, GI, Cards, Critical Care, Pulm, and even Renal and Rheum offer the chance to do procedures. Certainly there's a spectrum of frequency between everyday to only occasionally, but the opportunities are there.

When it comes to variety, I had a great attending make the point that no matter what you end up doing, every specialty has it's 5 things that are going to show up over and over and over and over and over and over again...and it's all about finding the field where you're content to get up at 3am to answer a call about diagnosis #2 for the millionth time. I think there's a lot of truth in that.

I'm exactly like you, I want a variety of cases and the chance to do some procedures. Where I see myself headed is Pediatric Critical Care. It has the right balance of procedures and variety of cases from trauma to post cardiac surgery to DKA to respiratory distress to pre/post transplant kids. I'll get to place central lines, intubate, float Swan-Ganz catheters, perform ECMO, tinker with vents and use the HFOV. The variety is enhanced by the different ages that come through the PICU (on my PICU rotation as a 4th year, I saw kids from 3 days to 21 years), and you get to bypass a lot of the social admits (or the kids who are better but mom is worried about going home). While there's a lot of positives, I'll be the first to admit, it's not a perfect field - among other things, you do have to deal with the death of childrent (though the PICU is nothing like the Adult ICU in terms of death), and it's one of the few fields I know of where attendings take really significant amounts of in-house call. Obviously it's not for everyone, but hopefully - since we share a couple of high priority preferences - my choice gives you something to think about.

 

[45408]

What about balanced lifestyle surgical subspecialties like urology or ent? Family med from what I've seen actually isn't all htn and diabetes and can have a number of interesting procedures.

Agreed. I actually enjoyed family medicine a lot more than I thought I would. It gets a bad rap.

 

[phoenix0610]

PM&R is perfect if you're looking for a good mix of medicine, patient interaction and procedures (Botox and phenol injections for spasticity management, peripheral joint and trigger point injections, EMG, all of the interventional pain procedures). Lifestyle is not the cake walk everyone makes it out to be (especially during residency) but it's better than 90% of other specialties I've seen. I actually feel like I deal less with social work issues because of the interdisciplinary care model PM&R uses--every inpatient is assigned a social worker and clinical case manager that takes care of insurance, placement issues, etc. There is a huge need for Peds/PM&R if that's your interest and you will see a lot of different pathologies. Take the elective and see what you think--PM me if you have any questions!