Which specialty?

[hughnguyen22]

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After jumping through all the hoops, I managed to claw myself into a MD program. Now the real question begins: Which specialty I should pursue. I am considering between anesthesiology and internal medicine. I will be starting doing some anesthesiology research soon but still want input from people who have a lot of experience in the two fields. Thanks for reading.

 

[KinesiologyNerd]

No, the real question is "will I pass my pre-clinical classes and step 1?"

 

[xroc]

After jumping through all the hoops, I managed to claw myself into a MD program. Now the real question begins: Which specialty I should pursue. I am considering between anesthesiology and internal medicine. I will be starting doing some anesthesiology research soon but still want input from people who have a lot of experience in the two fields. Thanks for reading.

I hear the job market for middle-earth anesthesiologists is pretty awful.

 

[Daodejing]

you don't decide which specialty you pursue. step 1, and vis-a-vis the NBME, decides for you.


jk..

..not really.

 

[rodmichael82]

No, the real question is "will I pass my pre-clinical classes and step 1?"

LOL! True

 

[DermViser]

After jumping through all the hoops, I managed to claw myself into a MD program. Now the real question begins: Which specialty I should pursue. I am considering between anesthesiology and internal medicine. I will be starting doing some anesthesiology research soon but still want input from people who have a lot of experience in the two fields. Thanks for reading.

Sorry, but you no longer get to "choose" your specialty. Your USMLE Step 1 score effectively decides that for you. If you had to claw in undergrad, you've seen nothing yet.

 

[hughnguyen22]

I hear the job market for middle-earth anesthesiologists is pretty awful.

The elves need a lot of patching up after fighting the goblins, so the demand for anesthesiologists is very high.

 

[hughnguyen22]

No, the real question is "will I pass my pre-clinical classes and step 1?"

Thanks for the snarky answer, but I am going to pass.

 

[tantacles]

Thanks for the snarky answer, but I am going to pass.

DON'T. **** it up.

 

[tantacles]

Thanks for the snarky answer, but I am going to pass.

Also, unrelated, JUDGE JUDY ON SNATCH GAME.

 

[HooliganSnail]

Thanks for the snarky answer, but I am going to pass.

It is a snarky time of year in medical school world.........

Choosing a specialty is a journey.

The four years of medical school are times of tremendous growth. You will not be same person the day the graduate as you are when you get that acceptance letter. (Congrats btw, that is no small feat. You should take time to bask in your awesomeness, but not too long....) That being said, what you think is cool changes. You are introduced to the full gamut of medicine in third year, and that is when most people really decide what to do. I always thought I would do IM, but I ended up choosing Family Medicine.

The above posters are right, you only need to worry about passing your pre-clinicals, and then ultimately the Step 1. Time for speciality choosing comes later.

 

[Arkangeloid]

Thanks for the snarky answer, but I am going to pass.

One of my friends used to repeatedly brag about how easy MS-1 was. He failed out of MS-2 halfway through Renal and will be repeating the year at his med school (not mine). Before, he used to talk excitedly about his future career in Urology or ENT. Now, he tells me he just wants to pass and survive.

I would advise you to temper your arrogance, lest you share his fate. Medical school is harder than you think.

 

[DermViser]

Thanks for the snarky answer, but I am going to pass.

One of my friends used to repeatedly brag about how easy MS-1 was. He failed out of MS-2 halfway through Renal and will be repeating the year at his med school (not mine). Before, he used to talk excitedly about his future career in Urology or ENT. Now, he tells me he just wants to pass and survive.

I would advise you to temper your arrogance, lest you share his fate. Medical school is harder than you think.

^^^THIS. @hughnguyen22, humility is a great virtue, you'll be humbled very quickly in medical school, when you realize that this is no longer undergrad, and sometimes getting a "Pass" takes tremendous effort.

 

[Substance]

^^^THIS. @hughnguyen22, humility is a great virtue, you'll be humbled very quickly in medical school, when you realize that this is no longer undergrad, and sometimes getting a "Pass" takes tremendous effort.

The preclinical years are not particularly difficult. Since its pass/fail for most schools, it is not as "difficult" as say undergrad, where the marks matter.

Once you hit the clinical years, then you've got another thing coming. It stops being about skill and more about playing a role. I sure hope you like standing around watching people do stuff, because there's a lot of that. Also a lot of nurses treating you poorly just because they can. You will also get to see the true colors of many of your classmates, many of whom will sport various shades of brown.

 

[Psai]

One of my friends used to repeatedly brag about how easy MS-1 was. He failed out of MS-2 halfway through Renal and will be repeating the year at his med school (not mine). Before, he used to talk excitedly about his future career in Urology or ENT. Now, he tells me he just wants to pass and survive.

I would advise you to temper your arrogance, lest you share his fate. Medical school is harder than you think.

You are such a negative nancy

 

[Arkangeloid]

You are such a negative nancy

While I usually take pleasure in seeing my enemies suffer, it breaks my heart to see a good friend of mine going through this. I wish it were not true. But it is.

The preclinical years are not particularly difficult. Since its pass/fail for most schools, it is not as "difficult" as say undergrad, where the marks matter.

It probably seems easy to you because you're an attending looking back years into the past. But I'm a student who was always at the top of his class before medical school, and MS1 is the hardest thing I've ever had to do.

I guess it's the same reason why adults say "high school is the best time of your life," when it really isn't.

Once you hit the clinical years, then you've got another thing coming. It stops being about skill and more about playing a role. I sure hope you like standing around watching people do stuff, because there's a lot of that. Also a lot of nurses treating you poorly just because they can. You will also get to see the true colors of many of your classmates, many of whom will sport various shades of brown.

I'll bet that this depends a lot on the rotation, though. A lot of MS3's I know don't mind things like Internal Medicine and Psychiatry, but have very rude words to say about Surgery and OB/GYN.

 

[DermViser]

The preclinical years are not particularly difficult. Since its pass/fail for most schools, it is not as "difficult" as say undergrad, where the marks matter.

Once you hit the clinical years, then you've got another thing coming. It stops being about skill and more about playing a role. I sure hope you like standing around watching people do stuff, because there's a lot of that. Also a lot of nurses treating you poorly just because they can. You will also get to see the true colors of many of your classmates, many of whom will sport various shades of brown.

Sorry to bust your bubble, but only the top schools are true P/F (bc being top schools they can afford to be). Not to mention there are ones that are P/F but still rank internally. Most schools in the middle and lower tiers are still Honors/Pass/Fail or Honors/High Pass/Satisfactory Pass/Marginal Pass/Fail or even letter-graded in the preclinical years.

 

[JoshSt]

After jumping through all the hoops, I managed to claw myself into a MD program. Now the real question begins: Which specialty I should pursue. I am considering between anesthesiology and internal medicine. I will be starting doing some anesthesiology research soon but still want input from people who have a lot of experience in the two fields. Thanks for reading.

Those are two extremely different fields. Our explanations/opinions of them would be useless to you at this point - you need to go through clinical rotations to get an overview of the different fields. Shadowing is okay but before clinical rotations, it's typical for every med student to have an overly-positive impression the specialty they shadowed for the day. It is very hard to develop a general overview of all the different fields before you experience them and very hard to develop that overview outside of your clinical rotations.

If you want to do anesthesiology research, do it. It won't lock you into going into that field and publications/presentations will look good on your CV. You can always change your research focus later.

As other have said, focus on your preclinical grades, knowledge base, and Step-1 score. Spend your free time searching these forums for studying advice, not which specialty to commit to before starting medical school. And before med school starts - play videogames, watch Netflix, have fun - that'll go away once med school starts.

 

[DermViser]

I'll bet that this depends a lot on the rotation, though. A lot of MS3's I know don't mind things like Internal Medicine and Psychiatry, but have very rude words to say about Surgery and OB/GYN.

Surgery and OB-Gyn have a high proportion of malignant personalities. Not surprising. That being said someone on SDN once said that choosing a specialty is like a liquor store, you're exposed to stuff in the front (MS-3: Surgery, OB-Gyn, Internal Medicine, Psych, Peds) but the good stuff is in the back - ROAD specialties, PM&R, ENT, Urology, etc.

 

[Arkangeloid]

Sorry to bust your bubble, but only the top schools are true P/F (bc being top schools they can afford to be). Not to mention there are ones that are P/F but still rank internally. Most schools in the middle and lower tiers are still Honors/Pass/Fail or Honors/High Pass/Satisfactory Pass/Marginal Pass/Fail or even letter-graded in the preclinical years.

Even if the school is pass/fail, students can't deprogram themselves out of their neuroticism. My tutor told me a story during a Micro exam, when there was an obscure question on Parasitology. The Class of 2016 started a borderline riot to get the question thrown out, and when that didn't work, a flurry of angry emails soon followed. Well, they got the question removed, and the scores of some people moved up less than 1%. Yay.

I've been to some of the exam reviews myself. Even in easy crap like longitudinal public health courses, students turn every exam review into a verbal brawl against the professor, as they demand that up to a fourth of the exam be thrown out (seriously). And for what? A score that goes from 92% to 94%. Who even cares?


The standard deviation of our class's exam scores is very low, and grade distributions are tight. That, combined with an internal ranking system, makes people really uptight about grades even in a pass/fail system.

 

[Substance]

Sorry to bust your bubble, but only the top schools are true P/F (bc being top schools they can afford to be). Not to mention there are ones that are P/F but still rank internally. Most schools in the middle and lower tiers are still Honors/Pass/Fail or Honors/High Pass/Satisfactory Pass/Marginal Pass/Fail or even letter-graded in the preclinical years.

I wasn't aware of that. I'm all for marks and rankings.

 

[Arkangeloid]

I wasn't aware of that. I'm all for marks and rankings.

If my class is this crazy about grades in a "P/F" system, I would hate to see what happens in an A/B/C/F system. I wouldn't be surprised if fistfights broke out, given how heated up people get already.

 

[DermViser]

Even if the school is pass/fail, students can't deprogram themselves out of their neuroticism. My tutor told me a story during a Micro exam, when there was an obscure question on Parasitology. The Class of 2016 started a borderline riot to get the question thrown out, and when that didn't work, a flurry of angry emails soon followed. Well, they got the question removed, and the scores of some people moved up less than 1%. Yay.

I've been to some of the exam reviews myself. Even in easy crap like longitudinal public health courses, students turn every exam review into a verbal brawl against the professor, as they demand that up to a fourth of the exam be thrown out (seriously). And for what? A score that goes from 92% to 94%. Who even cares?

The standard deviation of our class's exam scores is very low, and grade distributions are tight. That, combined with an internal ranking system, makes people really uptight about grades even in a pass/fail system.

"True" P/F in the first 2 years means that the only grades are "Pass" or "Fail", with no internal ranking.

 

[DermViser]

I wasn't aware of that. I'm all for marks and rankings.

I'm not. Not in the first 2 years anyways. Grading in the first 2 years leads to ridiculous levels of neuroticism with very little return bc when it comes to residencies, Step 1 is the measurement used to thoroughly evaluate your basic science knowledge by PDs, not your grade of "Honors" in Biochemistry on professor-made exams. Medicine is a life-long learning profession. If you need a grade as a reward to motivate yourself to study during the first 2 years, you're in trouble.

 

[Substance]

I'm not. Not in the first 2 years anyways. Grading in the first 2 years leads to ridiculous levels of neuroticism with very little return bc when it comes to residencies, Step 1 is the measurement used to thoroughly evaluate your basic science knowledge by PDs, not your grade of "Honors" in Biochemistry on professor-made exams. Medicine is a life-long learning profession. If you need a grade as a reward to motivate yourself to study during the first 2 years, you're in trouble.

I see what you're saying, and yes, I do believe that a fair standardized exam like Step 1 is a better gauge of knowledge than some useless PhD-made exams. I agree. I guess I am commenting as a Canadian trained doctor where our licensing exam isn't written until after we've matched, and the scores therein are pretty useless and impossible to gauge nonetheless.

 

[Anastomoses]

Thanks for the snarky answer, but I am going to pass.

Don't mind the riff raff. SDN threads can go any number of ways depending on who gets to it first. You will pass and if you're hungry and consistent enough, you'll make things happen. Do it.

 

[evilbooyaa]

After jumping through all the hoops, I managed to claw myself into a MD program. Now the real question begins: Which specialty I should pursue. I am considering between anesthesiology and internal medicine. I will be starting doing some anesthesiology research soon but still want input from people who have a lot of experience in the two fields. Thanks for reading.

Do some shadowing in specialties you won't see in 3rd year. You will see IM (what in IM btw? subspecialty or hospitalist or outpatient medicine?) during 3rd year, and depending on whether your surgery rotation allows for in terms of sub-specialties, you may be able to do a couple weeks of anesthesia.

All this being said, do as well as you can at every step so that every door is open to you, and you can take the pick of which one to walk through. At the same time, understand that 50% of the medical school class is below average (and it's not the end of the world if you fall into it, especially for Anes/IM)

 

[dyspareunia]

It's nice that everyone here is focusing on the word "pass". Last I checked, anesthesia is reasonably competitive and "pass" isn't going to cut it. People went unmatched in FM this year.. cmon.

 

[DermViser]

Do some shadowing in specialties you won't see in 3rd year. You will see IM (what in IM btw? subspecialty or hospitalist or outpatient medicine?) during 3rd year, and depending on whether your surgery rotation allows for in terms of sub-specialties, you may be able to do a couple weeks of anesthesia.

All this being said, do as well as you can at every step so that every door is open to you, and you can take the pick of which one to walk through. At the same time, understand that 50% of the medical school class is below average (and it's not the end of the world if you fall into it, especially for Anes/IM)

Yes the key is to effectively keep as many doors OPEN for you. That being said there are many good specialties in which you don't have to be the very top of your class.

 

[evilbooyaa]

It's nice that everyone here is focusing on the word "pass". Last I checked, anesthesia is reasonably competitive and "pass" isn't going to cut it. People went unmatched in FM this year.. cmon.

And anesthesia had multiple residency spots for which nobody matched (for like 2-3 years now). What's your point?

If someone has average stats (including passes in pre-clinical) and applies broadly to Anesthesia, I wouldn't think it would be hard to get A residency (not necessarily a top of the line one)

 

[dyspareunia]

And anesthesia had multiple residency spots for which nobody matched (for like 2-3 years now). What's your point?

If someone has average stats (including passes in pre-clinical) and applies broadly to Anesthesia, I wouldn't think it would be hard to get A residency (not necessarily a top of the line one)

Just "passing" isn't average. If you merely "pass" you are literally the worst applicant out there statistically.

 

[evilbooyaa]

Just "passing" isn't average. If you merely "pass" you are literally the worst applicant out there statistically.

Unless >50% of your class gets honors/high pass in a given class, passing is at least close to average. Obviously do the best you can, sprinkle in a couple honors/high passes in the pre-clinical years, and then shoot for HP/H in the clinical years.

Merely 'passing' doesn't make you the worst applicant. What about anyone who goes remediates (F/P) or repeats a year? People with serious red flags match in Anesthesia. In fact, I don't know a single person in my allopathic med school class (250ish) that went for Anesthesia and didn't match.

 

[dyspareunia]

Unless >50% of your class gets honors/high pass in a given class, passing is at least close to average. Obviously do the best you can, sprinkle in a couple honors/high passes in the pre-clinical years, and then shoot for HP/H in the clinical years.

Merely 'passing' doesn't make you the worst applicant. What about anyone who goes remediates (F/P) or repeats a year? People with serious red flags match in Anesthesia. In fact, I don't know a single person in my allopathic med school class (250ish) that went for Anesthesia and didn't match.

I see your point about remediation or repeating a year. But if you just pass everything there's no way you are average because everyone applying for residency at least passed. You can't get below passing grades and still graduate med school. I guess I'm overlapping "median" with "average/mean", but the point is the same; Passing is the bare minimum and if you get a 70% on all your exams and a 192 (or whatever the new passing score is) there is nobody statistically worse than you except those who needed to repeat a year or remediate.

Minor point.. just playing devil's advocate here.

 

[DermViser]

Just "passing" isn't average. If you merely "pass" you are literally the worst applicant out there statistically.

True. It's expected as a medical student that you won't be "failing" a rotation. Passing is supposed to be easy. It's when you're at the High Pass/Honors mark which is where it gets ridiculous.

 

[DermViser]

Unless >50% of your class gets honors/high pass in a given class, passing is at least close to average. Obviously do the best you can, sprinkle in a couple honors/high passes in the pre-clinical years, and then shoot for HP/H in the clinical years.

Merely 'passing' doesn't make you the worst applicant. What about anyone who goes remediates (F/P) or repeats a year? People with serious red flags match in Anesthesia. In fact, I don't know a single person in my allopathic med school class (250ish) that went for Anesthesia and didn't match.

Umm. Psst.....250 is more than 1 standard deviation above the mean. Hardly average.

 

[username456789]

Umm. Psst.....250 is more than 1 standard deviation above the mean. Hardly average.

I think 250 is the number of students, not a Step I score (I may be misinterpreting your response, but it seemed as though that was your initial reaction).

Then again, 250 medical students in a class is probably >1 SD above the mean number of students . . .

 

[DermViser]

I think 250 is the number of students, not a Step I score (I may be misinterpreting your response, but it seemed as though that was your initial reaction).

Then again, 250 medical students in a class is probably >1 SD above the mean number of students . . .

You were correct in interpreting my response. Although, yes, now that I look at it, even 250 students seems to be like a lot. Although the I don't know a "single person in my allopathic med school class (250ish) that went for Anesthesia and didn't match." - has no meaning.

 

[evilbooyaa]

Umm. Psst.....250 is more than 1 standard deviation above the mean. Hardly average.

As stated above, 250ish people in my med school class, not discussing Step 1 scores.

A number of them went for Anesthesia (I forget the actual number, but it was prob something like 10-20?). Since the people applying to Anesthesia all know who each other are, it would be instantly apparent if someone didn't match. All I'm saying, is that as a n=1, we didn't have anyone not match into Anesthesia. It's not serious evidence. Let's go to the serious evidence.

According to 2011 outcomes,
1095 of US (allopathic) Seniors matched while 41 didn't. 96% of US Seniors matched, putting it on par (+/- 2%) with Rads, FM, IM, Neurology, OB/Gyn, Pathology, Pediatrics, and Psychiatry.

There were 1.1 applicants per position (460 of which were independent applicants). This was tied for lowest with Radiology and Pediatrics (FM was 1.3, IM was 1.5). This stat doesn't mean a lot since Rad Onc was at 1.2 (self-selection for each of the lowest ratio specialties)

Mean Step 1 was 226, Step 235, 8.9% AOA for those who matched as US Seniors. the IQR For Step 1 was 215-235, Step 2 225 - 245ish.

Here are the match vs unmatched stats for Step 1 score ranges for US Seniors:
181-190: 14 match vs 8 unmatched
191 - 200: 50 vs 16
201 -210: 121 vs 8
211 - 220: 223 vs 2
221+: 674 vs 6

If you had greater than a 200, you had a 80-85% of matching. > 220? Close to 95%.

I just don't know why you guys think Anesthesia is 'competitive'? It used to be more competitive, and the top tier places obviously are still competitive, but it's going through a small spell of uncompetitiveness similar to Radiology. This is most easily recognized by the number of unmatched spots in both Anes and Rads (at least 2 years now there have been 40(?)ish spots in both specialties).

So assuming an average Step 1 (mid 220s) and an average Step 2 (230s), OP would have a 95% shot of matching anesthesia. I don't know see where the argument against the evidence is here.


On a side note - someone who only passes everything is NOT the worst applicant. Anyone who remediates (F/P) or repeats a year is a worse applicant, period. All this being said, discussing only pre-clinical grades (without at least Step 1 or clinical grades) in discussion of residency placement is generally fruitless and a significant exercise in mental mastrubation.

Last point - Just passing (70%) on all pre-clinical classes is absolutely not the same as just passing Step 1 (192 or whatever). I will agree on that. When I meant 'passing' I meant in regards to the pre-clinical curriculum, not on just passing Step 1.

 

[kreme]

The elves need a lot of patching up after fighting the goblins, so the demand for anesthesiologists is very high.

Nice try. Everyone knows there aren't any goblins in Middle Earth.