your specialty of choice

[obiwan]

Since we've been in clinicals for a couple of months now for most of us, just wondering if any of you have found the one?

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[ubcredfox]

One that doesn't involve seeing the rotating carousel of self-inflicted morbidity i.e. no patient contact.

Path it is. Or Rads.

 

[78222]

I've realized that I hate rounding and I like the OR.

 

[Sophie]

Psychiatry.

What I was considering upon med school admission: everything except psychiatry. Life is funny sometimes.

 

[LadyWolverine]

Not gonna lie, I'm pretty miserable right now. I was loving IM at the beginning...now, I dread the endless paperwork and other assorted BS that has very little to do with actual medicine/patient care. I hate being left hanging by the interns/residents, but at the same time, I understand how busy they are and how I am at the bottom of their priority list.

It's looking more and more like path to me. Rads is awesome but I'm so tired of the uber-competitive types. I can't live like that for the rest of my life. I've never before had migraines, and for the past 3 days I've had headaches so bad after getting off work that I need to vomit as soon as I get home. And I'm only on IM now. I'm sure it will be 10x worse come surgery in January.

 

[smq123]

Not gonna lie, I'm pretty miserable right now. I was loving IM at the beginning...now, I dread the endless paperwork and other assorted BS that has very little to do with actual medicine/patient care. I hate being left hanging by the interns/residents, but at the same time, I understand how busy they are and how I am at the bottom of their priority list.

It's looking more and more like path to me. Rads is awesome but I'm so tired of the uber-competitive types. I can't live like that for the rest of my life. I've never before had migraines, and for the past 3 days I've had headaches so bad after getting off work that I need to vomit as soon as I get home. And I'm only on IM now. I'm sure it will be 10x worse come surgery in January.

Maybe. Maybe not.

I found that there was significantly less social work BS in surgery than there was in IM. There's simply no time to do all that social work on surgical services (Trauma being the huge exception).

I loved surgery, and hated, hated, HATED IM. So don't lose hope yet.

 

[78222]

Maybe. Maybe not.

I found that there was significantly less social work BS in surgery than there was in IM. There's simply no time to do all that social work on surgical services (Trauma being the huge exception).

I loved surgery, and hated, hated, HATED IM. So don't lose hope yet.

Same here. IM got old real fast. The patients don't seem to improve and many that improve a little end up being social cases that you can't get rid of. There is way to much paperwork and the rounds never ****ing end.

Surgery is much more straightforward and there is much less BS involved. If you start to go off on a tangent when presenting they tell you to hurry the hell up and get to the important details. Patients are much more likely to get significantly better and are much more thankful. The hours suck but personally, staying extra didn't bother me that much* because I liked what I was doing.
*exception being long trauma calls

 

[obiwan]

I like the idea of internal medicine minus the rounding.

 

[Doctor Bagel]

I really don't know and haven't done surgery or IM yet, so eh. I know I like patients, and I don't like the OR (learned that in ob) or basic primary care (hate having to deal with multiple problems at each visit). So I'm still thinking it'll probably be psych or IM with a plan of definitely doing a fellowship. I'm doing IM and then psych next, so we'll see.

 

[MrBurns10]

Radiology: for the people who hated BOTH surgery and IM.

 

[Pontifex Maximus]

I've got it down to EM, PM&R, Peds, and I guess still considering Radiology, but I reeaaally doubt that. I've loved my ED exposure and kids, but also love the musculoskeletal stuff I have gotten a chance to do. Getting closer, moreso than when I started, but not quite there yet.

 

[LadyWolverine]

I know I like patients, and I don't like the OR (learned that in ob) or basic primary care (hate having to deal with multiple problems at each visit).

This is part of the reason why I am having such a struggle with IM. Don't get me wrong...I love dealing with people. I love sitting there and talking to patients, examining patients, doing procedures with patients, explaining things to patients. I'd do it all day, if I could. The issue is, each pt's problem list is, on average, 7-9 bullet points long. I have a pt right now with 12+ problems and a history of 40+ hospital admissions. I had to piece together a coherent history using the records from these admissions. It was over 6 pages long. It's ridiculous when you have to present something like that at morning walk rounds. The problem with IM is that anything that comes up during the hospital visit, no matter how irrelevant you may think it is, goes on the problem list. It eventually becomes impossible to feel like you are actually helping your patient when you look at the list and realize that just being in the hospital is making them sicker. Sometimes it's not anything that you are doing - the pt just happens to develop a random problem while in the hosp. But it still goes on the list. And then you have to deal with it, even though you might not be able to do anything about it, and maybe *gasp* the pt is better off by you not trying to do anything about it. But, IM just doesn't work that way.

During my FM rotation, most pts had, at a maximum, 3-4 issues of note (although I guess this depends on where you are, your pt population, etc.) Most of the time, I just dealt with 1 or 2 major issues at a time. I felt like that was so much more incredibly rewarding than what I am doing right now. While I like the *idea* of internal medicine, in practice, it is mentally and physically very draining. You spend very little time actually DOING stuff, and most of the time just ordering/thinking/reading/talking/hearing/writing about said stuff. And it seems like you have to document everything at least 3 times over. The people who do this, day in and day out, and thrive on it, must be either 1) saints, 2) masochists, or 3) robots.

I can see the appeal of subspecialization. However, I don't know if I could last in this environment for 3 years of residency.

 

[SLUser11]

I really don't know and haven't done surgery or IM yet, so eh. I know I like patients, and I don't like the OR (learned that in ob)....

Not just for you, but for all undecided MSIIIs: you can absolutely hate being in the OR on OB/GYN and still love general surgery. They are completely different.


OB/GYN was my least favorite rotation, and I dreaded those OR cases. Yet, now I am a completely happy surgical resident......

 

[Doctor Bagel]

Not just for you, but for all undecided MSIIIs: you can absolutely hate being in the OR on OB/GYN and still love general surgery. They are completely different.


OB/GYN was my least favorite rotation, and I dreaded those OR cases. Yet, now I am a completely happy surgical resident......

Well, it wasn't so much the ob cases -- I just hated being in the OR in general. It made me tense, and I really felt stuck because I had to stand in one place for x amount of time. I'm guessing I'll hate surgery more because the atmosphere will be just as tense, and I'll be stuck in the OR for longer. And I really don't get jazzed about the idea of working with my hands, and I'm not at all a spatial/concrete type of person. Oh yeah, and I'm way too lazy for ob/gyn, so I figure that probably holds for surgery, too.

I've heard that statement before, though. What did you hate about OB surgery that wasn't there in general surgery?

 

[MrBurns10]

This is part of the reason why I am having such a struggle with IM. Don't get me wrong...I love dealing with people. I love sitting there and talking to patients, examining patients, doing procedures with patients, explaining things to patients. I'd do it all day, if I could. The issue is, each pt's problem list is, on average, 7-9 bullet points long.

You should consider Peds if you haven't done it yet. H&Ps were the bane of my existence on IM but they weren't remotely close to as bad for peds. Plus, kids are awesome and they don't get COPD flares (the backup bane of my existence on IM).

 

[Samoa]

I've heard that statement before, though. What did you hate about OB surgery that wasn't there in general surgery?

Mostly the estrogen level, and its associated adverse effects.


...but also the lack of art or finesse about it.

 

[SLUser11]

Well, it wasn't so much the ob cases -- I just hated being in the OR in general. It made me tense, and I really felt stuck because I had to stand in one place for x amount of time.

Well, it's not for everybody, but I promise it's more fun as your role becomes more essential and involved.

I'm guessing I'll hate surgery more because the atmosphere will be just as tense, and I'll be stuck in the OR for longer.

Most people I talk with from other specialties, including FP, ER, Anesth, sometimes IM, all say that they enjoyed the OR in general surgery. Maybe it's because we do a greater scope of procedures than OB, and it tends to be more "hero work," although I would opine that Gyn surgery involves plenty of heroics.....

It's usually the general surgery work outside the OR that makes people not want to go into it.

Oh yeah, and I'm way too lazy for ob/gyn, so I figure that probably holds for surgery, too.

Well, that holds for any specialty. You can't be lazy in most specialties, or you'll make a bad doctor.

I've heard that statement before, though. What did you hate about OB surgery that wasn't there in general surgery?

The people, the procedures, and the overall attitude/tone of the OR.

 

[sunshinedoc]

The more patient contact I have, the less I want. Rads or path look really nice right now. I really like anesthesia too, at least I can put them to sleep and they won't talk or complain.

 

[Doctor Bagel]

Well, it's not for everybody, but I promise it's more fun as your role becomes more essential and involved.

Most people I talk with from other specialties, including FP, ER, Anesth, sometimes IM, all say that they enjoyed the OR in general surgery. Maybe it's because we do a greater scope of procedures than OB, and it tends to be more "hero work," although I would opine that Gyn surgery involves plenty of heroics.....

It's usually the general surgery work outside the OR that makes people not want to go into it.

Well, that holds for any specialty. You can't be lazy in most specialties, or you'll make a bad doctor.

The people, the procedures, and the overall attitude/tone of the OR.

Well, maybe lazy is an exaggeration, but I don't want to work the amount that I see the ob/gyn docs work, which is what I've heard surgery docs do, too. I honestly don't have the energy for it, but then since I found the OR completely unexciting, that might have something to do with it. All docs work hard, but you can't deny that some specialties are more demanding than others.

We'll see if I like being in the OR during surgery. I've got to admit I'll be really surprised if I do. Most of my classmates who aren't surgery types have told me they didn't particularly enjoy it either. Now the pre-surgery types on my ob/gyn rotation all enjoyed the OB surgery part and thought being in the OR was super cool.

 

[Dancing Doctor]

I am leaning toward Geriatrics. I start my elective in it in two weeks. Not sure if I want the FP or IM route, though I am leaning toward FP. I don't really want to do inpatient care; I want to do outpatient care in nuring homes or in end of life care. But we'll cross that bridge later I think.

I hated surgery. It wasn't really the OR, because I didn't mind that. I hated the masks, the scrubbing, the attitudes, etc.... The mask made my face break out (heaven knows what I was allergic to in it), the scrubbing made my hands a peeling/craking mess (and this was in July...can't imagine it in Dec...!) and the gowning procedure was neccessary but painful. Then there are the ever present steriotypical surgeons that I just don't have the time or energy to deal with. Most of the surgeons during my month weren't like that, but the few that were really made the decision for me.

IM I really LOVED, but I am not really interested in hospitalist work, and unless the system changes there isn't much clinic or outpatient time devoted to most IM residency programs. I like kids, but I don't like parents too much and would never want to dedicate myself to dealing with them day in and day out, though they are cute and I wouldn't mind seeing them occasionally....another reason I am leaning towards FP. Still waiting to do my FP, OB/GYN and Psych so we'll see. It could all change soon....

 

[BigRedBeta]

As a fourth year, I'd just caution everyone from jumping to conclusions too quickly. It's only October, give yourself a little bit more time and start moving towards a general area, rather than something specific.

Also focus on the actual MEDICINE you're doing - not necessarily the people you work with. Programs/departments vary ALL over, and you may happen to be at a particularly mean program. Based on posts from SDN, I was absolutely dreading OB/GYN, but the group of residents I had were probably the best from my entire third year (and I had OB/GYN as my very last clerkship so I can say that with confidence). If you like doing procedures and working with your hands, but hate the surgery attending you had, that shouldn't be enough to cross surgery off your list. Keep in mind that hating extended problem lists doesn't mean you wouldn't love being a nephrologist, rheumatologist, ID or some other subspecialist who only needs to focus on one problem then follow from afar.

Guess I'm saying there are a lot of different things to consider, and you shouldn't jump to any just yet.

 

[DwyaneWade]

Still undecided.

I have done IM and surgery. On both rotations I was told (first in praise, then in mocking) that I would make a good internist (and my Myer-Briggs personality type seems to match it). I enjoyed some of the intellectual aspects of IM, however in general it was boring and redundant. The subspecialties are attractive but I would only do them in a hospital setting, and I do not know if I want to work in a hospital for the rest of my life.

I do not have the typical mindset or makeup of a surgeon. However, I really enjoyed scheduled cases. Regardless at how pisspoor my hands may be, I really liked suturing and being active while I work. The hours and lack of sleep on surgery, however, made me question my sanity.

Meanwhile on family now, I am feeling great just because I can sleep and the hours are great, leaving me plenty of free time. Work itself is easy but not really rewarding or boring.

So right now the list is really populated with everything: IM, Psych, ENT, Optho, Rad Onc, and Neurodevelopmental medicine. Ortho has entered my list, although the hours are bad I actually enjoyed doing some ortho stuff on trauma.

I can't see myself doing Urology or Plastics, nor anesthesia, rads, or path. EM? No. Ob-Gyn, PMR, FM are pretty much out just based on feeling. Derm is always there but I am not really into that. Neurosurgery was my first love but I enjoy cranium>spine and I just simply do not have the temperament to cope with those insane hours.

 

[SLUser11]

Still undecided.

I have done IM and surgery. On both rotations I was told (first in praise, then in mocking) that I would make a good internist (and my Myer-Briggs personality type seems to match it).......

Meanwhile on family now, I am feeling great just because I can sleep and the hours are great, leaving me plenty of free time. Work itself is easy but not really rewarding or boring.

So right now the list is really populated with everything: IM, Psych, ENT, Optho, Rad Onc, and Neurodevelopmental medicine. Ortho has entered my list, although the hours are bad I actually enjoyed doing some ortho stuff on trauma.

I can't see myself doing Urology or Plastics, nor anesthesia, rads, or path. EM? No. Ob-Gyn, PMR, FM are pretty much out just based on feeling. Derm is always there but I am not really into that. Neurosurgery was my first love but I enjoy cranium>spine and I just simply do not have the temperament to cope with those insane hours.

Maybe you should do a month of Neurology and see what you think. You may really like it, based on your interests........

 

[Pewl]

RAD ONC. All the way.

 

[QofQuimica]

I'm entertaining the idea of not doing any residency at all. I will definitely be doing a post doc next, and after that, I will at least do an internship so that I can take Step 3 and get a license. It's only one more year, and I think it's worth doing so that my MD won't be totally useless. But I'm not sure it makes sense for me to complete a residency when I don't plan to ever practice. If you forced me to pick a specialty, I'm most interested in anesthesiology.

Edit: FWIW, I'm in the camp that loves the OR.

 

[DwyaneWade]

Maybe you should do a month of Neurology and see what you think. You may really like it, based on your interests........

We are required by our school to take Neuro anyways so I will be rotating in February.

However, my main interest in neurology is in the pediatric population (autism, epilepsy). I am applying to take a year off in pediatric neuro research.

 

[DwyaneWade]

RAD ONC. All the way.

Cool. And why?

 

[DwyaneWade]

I'm entertaining the idea of not doing any residency at all. I will definitely be doing a post doc next, and after that, I will at least do an internship so that I can take Step 3 and get a license. It's only one more year, and I think it's worth doing so that my MD won't be totally useless. But I'm not sure it makes sense for me to complete a residency when I don't plan to ever practice. If you forced me to pick a specialty, I'm most interested in anesthesiology.

Does residency even matter if you plan to do full-time research?

 

[QofQuimica]

Does residency even matter if you plan to do full-time research?

My thought exactly.

As I said before, I do think it's worth getting a license, which only requires one year of internship. If I did a residency, I would want to do something that involves procedures and that also gives me time to do research. I enjoyed surgery, but that is a very time-intensive residency for an older student like me who doesn't want to primarily be a clinician. Plus, it's not a specialty that is historically very research-oriented. Anesthesiology isn't necessarily the most research-oriented specialty either, but I think it would be more realistic to mix those clinical duties with research. I've met a lot more MD/PhD anesthesiologists than I have MD/PhD surgeons. Plus, I dig the drugs.

 

[MSKalltheway]

Before clinicals, it was PM&R all the way. About halfway through, its still PM&R all the way.

So far I've done surgery and am almost finished with Peds. I enjoyed surgery overall but either (a) some of the subspecialties are out of my reach, (b) the hours are too long for my taste, (c) not "mediciney" enough for me, (d) due to personality conflicts, I'd kill half of my colleagues/residents or (e) mix and match any or all of the previous options.

I have surprisingly enjoyed my Peds rotation. Its got almost everything I want in a specialty. Almost. I just dont want to have to be that available to my patients...the nature of Peds requires you to take a certain amount of call. Also, this is last on the list of reasons but that pay for that much work/call, to me, is not financially worth it.

-OB/Gyn and psych are big "no's" based on feeling.
-IM requires too much patience, rounding, and thinking rather than doing for my taste. Specializing would be a solution, but theres not much I would actually want to do. GI would be about it for me and I dont think thats enough to want to do medicine.
-Neuro would be right up my ally but is not enough treatment and too much rounding and thinking (no pun intended) like IM .
-FM is fundamentally cool, but I think I'd rather specialize.
-EM? Pretty awesome except theres no real patient continuity, which would bug me after a while.
-Gas has too much sitting around and watching; great from a learning and teaching perspective, but could I do it 20yrs out with no students/residents? Not a chance.

Basically in the end, I like the blend of neuro and MSK medicine, sports med, prodecures and lifestyle PM&R provides. Patients and their families are generally very appreciative, and I just get a great feeling from it. I had a CT surg attending tell me that he didnt know its value until his mother needed rehab from hip surgery. That's what I'm talkin' about.

 

[Doctor Bagel]

Edit: FWIW, I'm in the camp that loves the OR.

Weirdo.

MSKalltheway, I'm with you on the patient continuity, too. I really like seeing the same patients, so EM is out for me, too.

 

[MrBurns10]

I really like seeing the same patients, so EM is out for me, too.

To be fair, you'll probably get some great patient continuity in the ED.

You: "Weren't you here 3 days ago?"
Patient: "Yes, doctor."
You: "For goodness sakes, stop doing drugs!"
Patient: "Sure. See you next week."

 

[obiwan]

how much exposure do your schools give you for other specialties like gas, rads, IM subspecialties, and EM etc

it seems like my school doesn't provide too much time during 3rd year so one doesn't really get to try it out before applying

 

[QofQuimica]

Weirdo.

Can't we all just get along???

To be fair, you'll probably get some great patient continuity in the ED.

You: "Weren't you here 3 days ago?"
Patient: "Yes, doctor."
You: "For goodness sakes, stop doing drugs!"
Patient: "Sure. See you next week."

Ain't that the truth.

Dr. B, in all seriousness, you really will see some of the same patients over and over and get to know them. There is a subset of patients who are addicted to pain medications, homeless people, psych pts, etc. and they are regulars in the ED.

 

[Doctor Bagel]

Can't we all just get along???


Ain't that the truth.

Dr. B, in all seriousness, you really will see some of the same patients over and over and get to know them. There is a subset of patients who are addicted to pain medications, homeless people, psych pts, etc. and they are regulars in the ED.

Yeah, but I kinda doubt that's enjoyable patient continuity.

 

[Hurricane95]

The list so far:

Internal medicine - cardiology (interventional preferably)
Internal medicine - GI
Anesthesiology
ENT / head & neck surgery
Ophthalmology
Orthopedics
General surgery
Straight internal medicine (VIP practice?)
Radiology


Basically, I still have some work to do in terms of making up my mind...

 

[myry]

Doctor Bagel--

Do peds

 

[Doctor Bagel]

Doctor Bagel--

Do peds

Only problem is that I'm not a kid person. I'm one of those weirdos who thinks my cats are 50 million times cuter than any baby.

 

[Doctor Bagel]

how much exposure do your schools give you for other specialties like gas, rads, IM subspecialties, and EM etc

it seems like my school doesn't provide too much time during 3rd year so one doesn't really get to try it out before applying

I really think that's a problem with most schools. We get 4 weeks total of selectives in 3rd year. You can do 2 two week selectives or one 4 week selective. EM and anesthesia are both 4 week selective, which didn't fit with my schedule this year. I did 2 weeks of derm and want to do 2 weeks of radiology. I might get stuck optho or ENT, though.

 

[Baditude]

I loved Anesthesia, delivering babies but not gyne, radiology and EM. Since I am not a 260+ radiology is out so I am leaning toward EM with anesthesia as a 2nd.
I hated IM and cardiology. Family med was ok.
I have surgery and peds left and I can tell you that neither one is appealing.

 

[MrBurns10]

Since I am not a 260+ radiology is out

I hope you're just joking here...you definitely don't need a 260 to match rads. Go for it if it's what you really want.

 

[mtDNA]

I hope you're just joking here...you definitely don't need a 260 to match rads. Go for it if it's what you really want.

Hah, in SDN land you do. You also need at least a 240 to match family medicine

 

[Llenroc]

Well, it wasn't so much the ob cases -- I just hated being in the OR in general. It made me tense, and I really felt stuck because I had to stand in one place for x amount of time. I'm guessing I'll hate surgery more because the atmosphere will be just as tense, and I'll be stuck in the OR for longer. And I really don't get jazzed about the idea of working with my hands, and I'm not at all a spatial/concrete type of person. Oh yeah, and I'm way too lazy for ob/gyn, so I figure that probably holds for surgery, too.

I've heard that statement before, though. What did you hate about OB surgery that wasn't there in general surgery?

I hated OB/GYN and Surgery, but if the OR had a redeeming aspect in OB (C-section) or gynecology it's that you always knew the procedure had a defined length, and never more than about 2 hours. In Surgery, you can be stuck in that **** all day, and to add insult to injury they might stick an addon case at 6:30 p.m. and make you scrub for it.

 

[Doctor Bagel]

I hated OB/GYN and Surgery, but if the OR had a redeeming aspect in OB (C-section) or gynecology it's that you always knew the procedure had a defined length, and never more than about 2 hours. In Surgery, you can be stuck in that **** all day, and to add insult to injury they might stick an addon case at 6:30 p.m. and make you scrub for it.

This is what I've heard from other students on surgery. The 2 hour cases I scrubbed in for on OB were way too freaking long for me, so I'm really not down for 8 hour cases or whatever.

 

[Law2Doc]

To be fair, you'll probably get some great patient continuity in the ED.

You: "Weren't you here 3 days ago?"
Patient: "Yes, doctor."
You: "For goodness sakes, stop doing drugs!"
Patient: "Sure. See you next week."

Yep. And if you give them what you want, they will tell you how great a doctor you are, and you can almost guarantee that they won't be a no-show in a few more days.

 

[yohimbine1]

One that doesn't involve seeing the rotating carousel of self-inflicted morbidity i.e. no patient contact.

Path it is. Or Rads.

Always been Path or Rads for me. No patients, good lifestyle, and good pay in the latter.

 

[obiwan]

This is what I've heard from other students on surgery. The 2 hour cases I scrubbed in for on OB were way too freaking long for me, so I'm really not down for 8 hour cases or whatever.

Yeah, I was starting to hit the wall when the hysterectomy I was watching was approaching the 3 hour mark so I can't really imagine standing in for surgery for something any longer than that.

 

[DD214_DOC]

I like the OR, don't like the hours/lifestyle of a surgeon. My attention span doesn't last more than 2 hours or so.

Thought I wanted psych, didn't like the rotation. After about 5 minutes I just wanted the patient to stfu and go away.

Hated OB/Gyn.

Peds was ok, but not interest in only kids.

Favorite so far was ICU.

 

[lilnoelle]

I'm pretty sure that I'm gonna go into rural Family Medicine with a psych emphasis. I really like psychosocial stuff but am on the fence as to whether I want to deal with major psychiatric disorders (and be a psychiatrist) or just focus on things in which counseling/therapy can make a huge impact.
Its a shock to most people but I really enjoy dealing with depression, anxiety, chronic pain, ADHD, behavioral issues, etc.

I'm thinking I'll get into a practice and act as a Family Practitioner and over time build up my patient load to be mostly patients that require a little more time and attention (as mentioned above). This should allow my partners to see more patients (and focus on more medically related complaints) and thus make more money for the practice. I'd want to continue to act as my patients' primary care provider, but my appointments with them would be longer than the typical 15 minutes and probably more frequent.

My options (as I see them) to do the above is to do a FM residency and take lots of Psych electives or do a dual residency in FM/Psych (if I want to see more complex Psych patients).

Similar to the above scenerio, I'm thinking about Peds and then a fellowship in Developmental peds and sort of doing the same thing (ADHD, behavioral issues, depression, anxiety, etc). If not Developmental Peds, then perhaps triple boarding in Peds/Psych/Adolescent Psych.

And of course then there is the option of just doing Psych or Adolescent Psych.

 

[Baditude]

Hah, in SDN land you do. You also need at least a 240 to match family medicine

For a USIMG you really do need ridiculous high scores or you need to know someone to get Radiology. I have been told 240 or more to even get looked at for residency. If you happen to "know" for sure of a program that doesn't require this than please share it.