Yet another M3 struggling with specialty choice

[SunMouse]

I'm trudging through the last months of third year, feeling exhausted and pretty disillusioned with medicine. Feels like it's a pick your poison situation, so like many before me, I decided to solicit the help of internet strangers in my future career decisions.

At the moment, I'm kind of between IM->specialize/FM/Psych/Peds/Something yet undiscovered...

- I'm a below-average student so anything like Derm, ophtho etc is out
- I like outpatient >>> inpatient because I dislike the acuity of inpatient, but I worry this is just because I am a student and can't see the negatives of clinic
- I considered the idea of anesthesia which sounded cool to me because I'm an introvert and appreciate the complexity, but my anesthesia rotation was boring and I don't handle stress well
- I truly love being in the OR (a surprise to me) - but I think this is also the lustre of being a student and don't think I'd be happy as a surgeon
- The only way I could see myself doing IM is rheum/allergy because they are cool and interesting and low-stress, but the thought of doing an IM residency is awful
- I like working with kids more than adults

Psych: favorite rotation so far, the first and last time I can remember actually being excited to go into the hospital. However, I've heard that psych is usually outpatient and most of my experience was inpatient, so I feel I may be getting a skewed perspective. I'm also not sure if the content will take a toll over time.

FM: I also loved my FM rotation. Things that worry me: I had amazing preceptors, it was one of my only rotations where I truly felt like a person and had autonomy with seeing patients, and feel this could be influencing my decision. I've been told FM is a dying field because of PAs and NPs, other physicians constantly tell me they "don't know how anyone could do primary care" because it's too difficult nowadays while they simultaneously hate on PCPs for referring inappropriately, and the dreaded inbox.

Peds: I love seeing kids. But, I'm an older nontrad and have a lot of loans to pay off, so it's hard to want to do peds.

Least favorite rotation was IM, I wanted to drop out of school after my IM rotation.

Like everyone these days in my super lazy generation, lifestyle is extremely important to me. I don't want to work nights or holidays, I don't want to be on call (could probably live with minimal call and occasional weekends).

Help a sad med student out?

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[Tenk]

Do FM. You can be that amazing preceptor you had. People will always flock to a great doctor and you will have no problem building a practice.

You get to see kids and you get to see them turn into adults. You will still treat lots of psychiatric disorders (lots). You can also do minor procedures in the office to get that fix.

Psych works too but probably more competitive now and you will also lose pretty much all physical aspects of medicine (dunno if that matters or not).

 

[Dral]

Other than your issues with compensation and getting through the residency, I think you sound like you might like allergy/immuno. It's outpatient, there are some procedures, and I believe it can be peds heavy (maybe someone more in the know can weigh in on that).

I had to do intern year. Yes my prelim year sucked, but honestly, I look back on it now as an ok time (except my ICU rotations).

Peds psych might be something to look into. Also I'd keep FM on your radar.

Any way you can fit in some exposure to any of them before you have to submit your apps?

 

[mrbreakfast]

Few thoughts:
-You should strongly consider FM. It hits all your check-boxes, and who cares what other people think? Every medical specialty has other specialties that hate on it. You can also subspecialize in FM and do a variety of things.
-Not wanting to do IM specifically because of the residency is a little unusual. If it's because of the inpatient, you can survive it, many people who want to do only outpatient survive it. I'm not trying to be dismissive but I think you should really reconsider ruling out the largest/most flexible specialty out there because you are apprehensive about the residency. What was it specifically about the IM rotation that you hated?
-In my opinion you should not do psych unless you have experienced, and enjoyed, the outpatient side. I don't know the numbers but would assume 95%+ of psychiatry work is outpatient.

 

[Just D.O. it]

I think given what you’ve described, you would be best served going for academic IM. It would give you time to mature, explore, and still leave doors open to a variety of different practice environments whether it be PCP, outpatient subspecialist, proceduralist, hospitalist, or crit care. Also definitely keep in mind that experiencing IM as a med student or intern (or honestly academics in general) is not the best representation of its day to day in real life.

 

[SunMouse]

Few thoughts:
-You should strongly consider FM. It hits all your check-boxes, and who cares what other people think? Every medical specialty has other specialties that hate on it. You can also subspecialize in FM and do a variety of things.
-Not wanting to do IM specifically because of the residency is a little unusual. If it's because of the inpatient, you can survive it, many people who want to do only outpatient survive it. I'm not trying to be dismissive but I think you should really reconsider ruling out the largest/most flexible specialty out there because you are apprehensive about the residency. What was it specifically about the IM rotation that you hated?
-In my opinion you should not do psych unless you have experienced, and enjoyed, the outpatient side. I don't know the numbers but would assume 95%+ of psychiatry work is outpatient.

Thank you for the reply, I appreciate your thoughtful comments! I guess it’s not so much the IM residency (since realistically I can do anything for a few years), as that I don’t see a good reason to do IM over FM, considering I want to do outpatient and would prefer to see kids, both of which FM would allow me to do. So then the only reason would be specializing, which isn’t guaranteed and is more years of training?

I disliked my IM rotation because I didn’t like how sick the patients were, didn’t like rounding and endlessly discussing every problem only to end up consulting specialists anyway, didn’t like how social problems kept people in the hospital, but conversely didn't enjoy the fact there was no follow up.

 

[solitarius]

Three big questions every medical student needs to ask:

1. Procedures or not?
2. Patient interaction? How intense? How recurrent?
3. Generalist or specialist?

 

[SunMouse]

Three big questions every medical student needs to ask:

1. Procedures or not?
2. Patient interaction? How intense? How recurrent?
3. Generalist or specialist?

I feel like I don't have good answers to these questions, hence why I'm so lost...

1. Procedures or not? Would like some, I do enjoy using my hands, but it's not strictly necessary. I feel they would get boring and lose their appeal over time.
2. Patient interaction? How intense? How recurrent? Some. I'm introverted so I get tired easily talking to people, but honestly at least 50% of the time in any specialty appears to be spent on the computer, which is fine by me. I really want continuity of care.
3. Generalist or specialist? I think I'd be more likely to be bored as a specialist and I like the idea of doing all different things as a generalist, but worry the breadth of knowledge required to be a good generalist is overwhelming