Yet another lost MS3 - help me choose a specialty

[terminus98]

Tlr: I like procedures/surgery + hate clinic, but want balance/sleep/avg grades

I am yet another M3 who is lost on what specialty to apply to. Any and all advice would be appreciated, because the more I think about what to pursue, the more I don't know what to do.

• Surgical vs. non-Surgical: I am content with surgical procedures but I prefer shorter 1-2 hr cases. The more I'm in the OR the more I feel like doing what the surgeon is doing. The main drawback is an unbalanced lifestyle and me not being very competitive. As long as I'm working with my hands, I will be happy - so im absolutely open to a procedural non-OR field.
• Lifestyle: I want a balanced life. I want to be a good doctor but also a good future father/husband who is actually there for his loved ones. I am not a workaholic, so I appreciate shift work. I am ok with a "I show up, give it my all, and then I rest." mentality. I need/value good sleep. That being said, I do not mind working odd hours (nights/weekends) if I love what im doing.
• Patient interaction: I don't need much patient interaction, and prefer less. Working alone is fine, but not a requirement. I have no issue talking and interacting with other specialties.
• Competitive: I am not super competitive. I am open to gap/research years and will be taking an abbreviated 6 month one between my M3 and M4 year. I have 1 review paper and 3 case reports pending publication. I am not the best test taker but passed Step 1, and im probably average in medical knowledge. My MD program is mid tier.
• Rotations: Medicine and Primary care = HP
  • Medicine was ok. Not crazy about rounding for hours.
    • Hospitalist I worked with was awesome. Came in at 630 and was out by 11 after rounds to go care for his kid.
  • Hated pcm/clinic. I was drained by noon from the boredom/monotony
    • However I liked giving patients steroid pain injections with physician guidance
  • Surgery (in progress)
    • I like being in the OR. Went to med school to be a surgeon actually. I want to learn to use the robot and even teach others how to use it once I'm proficient. Trauma surgery seems incredibly exciting. The lack of lifestyle + Standing gets painful even with decent shoes + lack of superior academics make me think im not cut out for it
  • Peds, Psych, OB pending
    • Inpatient psych seems like a good fit on paper but the one psych patient I saw in medicine was maybe too nuanced for me
      • I don’t mind/fear combative environments but I doubt I can diagnose and serve my patients correctly other than “Vitamin H”
    • I do not want to work in Peds
    • OB/C-sections/Delivering kids intrigue me - but being a male physician and political volatility surrounding the practice push me away
• Money: not my first or even second motivator, but I enjoy the idea of building generational wealth and I already have an investing portfolio. I’m not after making millions, but I do want to be smart with what I will be making. I also want to make sure i'm not undervaluing my worth as a specialized physician.
• Training: I would like to specialize. I don’t mind extended training as I am on the younger side. Nothing excessive though.
• Personality
  • I like visual instant gratification (hence surgery over FM)
  • I like inpatient vs outpatient
  • I don’t mind getting my hands dirty
  • I like crude procedures vs minimally invasive
  • I hate research/paperwork but will do it if necessary
  • Im super chill/laidback, on the quieter side, and I like being direct and to the point. If I wasn’t in medicine I’d be working on cars or marine corp medic.

What i’m considering:

• General Surgery - lifestyle is main issue
• Orthopedic Surgery - this was the dream but I dont think im competitive enough
• Trauma Surgery - shift work but terrible lifestyle?
• CT Surgery - lifestyle/not competitive enough?
• Anesthesia - procedural, no notes, good lifestyle, but super competitive
• Radiology - Sitting back and reading films also seems fun/good lifestyle
  • I wish I knew more about IR, seems cool as hell.
• Medicine - potential for GI + Cards but not crazy about medicine residency.
• Hospitalist - seems like a good lifestyle but I want to specialize
• EM - I would probably enjoy the chaos but 60%+ burnout rate seems too high

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[LunaOri]

How about anesthesiology-->pain medicine?

 

[operaman]

Agree with anesthesia as a nice option, lots of fellowships.

PM&R may be worth a look too.

I will say that clinic as an attending is better than it was as a student or resident. Trainees in clinic these days tend to function more as scribes which sucks. It is more interesting when you’re the one making the big decisions.

I would also add that procedures get boring after awhile too. I love operating but it’s definitely not as cool as it was in training. It’s interesting and it’s a nice break from clinic and office procedures, but not as exciting as it was when it was new.

I would always say err on the side of lifestyle. There’s a reason all the lifestyle fields are so competitive and their burnout rate so low. It’s rare for the work itself to compensate for poor life outside of work.

 

[Kuratz]

Having been through this dilemma twice now myself (first with choosing to NOT apply Ortho/surg residency due to lifestyle, and then again choosing NOT to apply IR fellowship due to lifestyle) I can 100% say it was undoubtedly the correct decision to choose the lifestyle path for myself. I chose Radiology.

Residency has been extremely manageable with a wife and young kids. I feel like I’m extremely present in their lives and not missing out. I don’t feel that my life is wound up with medicine like it was during surgical rotations or internship (stupidly did a prelim surgery year on a “just in case” basis). The work is interesting and comfortable. I can listen to some background music and do some non-medicine tasks like return emails and take phone calls when I need to throughout the day. I can focus on a niche like Neuro or MSK and become an expert, but still read general cases. You can carve out a job working entirely from home, doing a hybrid tele and on-site position, or do something like breast where you are still seeing patients throughout the day. The money as an attending is great $500k+ with lots of vacation.

Nothing is perfect. Yes call is nonstop busy. Yeah we have to work more weekend and evening shifts than I would like. Yeah the training is long and mentally taxing. No I don’t get the “atta-boys” or adrenaline rush of truly savings someone’s life.

If you are honest with yourself about your values and goals and put aside any ego (no one cares anyway) then you will have your answer and won’t make the “wrong decision”. I’m fortunate to have had the clarity to prioritize my family and I thank god every day that I didn’t pursue something crazy out of pride. If that’s you, then whether you choose Anesthesia, Rads or any other lifestyle field you will be content. Some people wind their whole identity up with being a top notch surgeon. That’s awesome and I am thankful that we have people like that. But you kinda have to be a little nuts for that and if this is just a job to you then I strongly advise you to go the path that will give you the greatest balance.

Please feel free to PM me about Rads.

 

[Styrene]

Tlr: I like procedures/surgery + hate clinic, but want balance/sleep/avg grades

I am yet another M3 who is lost on what specialty to apply to. Any and all advice would be appreciated, because the more I think about what to pursue, the more I don't know what to do.

• Surgical vs. non-Surgical: I am content with surgical procedures but I prefer shorter 1-2 hr cases. The more I'm in the OR the more I feel like doing what the surgeon is doing. The main drawback is an unbalanced lifestyle and me not being very competitive. As long as I'm working with my hands, I will be happy - so im absolutely open to a procedural non-OR field.
• Lifestyle: I want a balanced life. I want to be a good doctor but also a good future father/husband who is actually there for his loved ones. I am not a workaholic, so I appreciate shift work. I am ok with a "I show up, give it my all, and then I rest." mentality. I need/value good sleep. That being said, I do not mind working odd hours (nights/weekends) if I love what im doing.
• Patient interaction: I don't need much patient interaction, and prefer less. Working alone is fine, but not a requirement. I have no issue talking and interacting with other specialties.
• Competitive: I am not super competitive. I am open to gap/research years and will be taking an abbreviated 6 month one between my M3 and M4 year. I have 1 review paper and 3 case reports pending publication. I am not the best test taker but passed Step 1, and im probably average in medical knowledge. My MD program is mid tier.
• Rotations: Medicine and Primary care = HP
  • Medicine was ok. Not crazy about rounding for hours.
    • Hospitalist I worked with was awesome. Came in at 630 and was out by 11 after rounds to go care for his kid.
  • Hated pcm/clinic. I was drained by noon from the boredom/monotony
    • However I liked giving patients steroid pain injections with physician guidance
  • Surgery (in progress)
    • I like being in the OR. Went to med school to be a surgeon actually. I want to learn to use the robot and even teach others how to use it once I'm proficient. Trauma surgery seems incredibly exciting. The lack of lifestyle + Standing gets painful even with decent shoes + lack of superior academics make me think im not cut out for it
  • Peds, Psych, OB pending
    • Inpatient psych seems like a good fit on paper but the one psych patient I saw in medicine was maybe too nuanced for me
      • I don’t mind/fear combative environments but I doubt I can diagnose and serve my patients correctly other than “Vitamin H”
    • I do not want to work in Peds
    • OB/C-sections/Delivering kids intrigue me - but being a male physician and political volatility surrounding the practice push me away
• Money: not my first or even second motivator, but I enjoy the idea of building generational wealth and I already have an investing portfolio. I’m not after making millions, but I do want to be smart with what I will be making. I also want to make sure i'm not undervaluing my worth as a specialized physician.
• Training: I would like to specialize. I don’t mind extended training as I am on the younger side. Nothing excessive though.
• Personality
  • I like visual instant gratification (hence surgery over FM)
  • I like inpatient vs outpatient
  • I don’t mind getting my hands dirty
  • I like crude procedures vs minimally invasive
  • I hate research/paperwork but will do it if necessary
  • Im super chill/laidback, on the quieter side, and I like being direct and to the point. If I wasn’t in medicine I’d be working on cars or marine corp medic.

What i’m considering:

• General Surgery - lifestyle is main issue
• Orthopedic Surgery - this was the dream but I dont think im competitive enough
• Trauma Surgery - shift work but terrible lifestyle?
• CT Surgery - lifestyle/not competitive enough?
• Anesthesia - procedural, no notes, good lifestyle, but super competitive
• Radiology - Sitting back and reading films also seems fun/good lifestyle
  • I wish I knew more about IR, seems cool as hell.
• Medicine - potential for GI + Cards but not crazy about medicine residency.
• Hospitalist - seems like a good lifestyle but I want to specialize
• EM - I would probably enjoy the chaos but 60%+ burnout rate seems too high

Emergency medicine or trauma surgery is what comes to mind reading the points you've made. I would definitely warn against completing IM residency just to do GI or cardiology (you've said as much). Best of luck.

 

[Cognovi]

Balanced life/shift work, less patient interaction, no issue talking with other doctors, visual gratification, specialization, non-surgical procedures, money, laid back.

I would say all of those are perfect for radiology, with the later decision to choose a subspecialty that has more or less procedures.

Radiology is a big enough field that there is a place for even mid-tier applicants. However I would note that there is a bit of self-selection for radiology because your medical knowledge needs to be broad and strong. Before Step 1 was pass fail, among the specialties that had a 90%+ match rate, radiology had the highest Step 1 average at 240+. Nowadays, the match rate is <85% and more competitive but it is still not the norm to do gap years as it is in the smaller competitive specialties.

The second thing I would consider is anesthesiology. The choice between radiology and anesthesia will come down to what you want to do. Anesthesiologists medically manage physiology, put in support devices, sit in the OR, and have alternating periods of stress and boredom. Radiologists make diagnoses, put needles in things occasionally, sit in a quiet reading room, and have constant periods of cognitive activity with little emotional ups or downs.

 

[Mr.Smile12]

Just listing

Medical Specialty Selector

Quiz to find the best medical specialty match for your personality, interests and abilities. Based on How to Choose a Medical Specialty by Anita Taylor.

www.studentdoctor.net

 

[terminus98]

Emergency medicine or trauma surgery is what comes to mind reading the points you've made. I would definitely warn against completing IM residency just to do GI or cardiology (you've said as much). Best of luck.

Thanks for your reply, can you please explain this further?