HELP!! What Specialty Should I Go Into

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liquid magma

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Hey y'all,

I need major help picking my specialty. I am already a fourth year, and the clock is ticking...and I am starting to freak out!!

Right now, I am planning on choosing Medicine. But, I don't want to kill myself, and I am starting to think that Medicine may actually have the lowest quality of life factor (maybe second only to Surgery). Anyway, I was swamped in 3rd year, and don't want to spend the rest of my life always "working."

To add one more wrench into the works, I did surprisingly well in third year, so I now think that I will be competitive for most fields (which I never expected). Basically, I go to a top 25 school, and got Honors in Medicine, Surgery, Peds, Psych, Neuro, FP, and Anesthesia. I assume I'll be AOA. Plus, my Dean (a big Medicine guy) really wants me to look at MGH, UCSF, and Hopkins, and I can't talk to him about anything except Medicine. So, I've got no one who I can talk to, and it's bumming me out.

Here are my priorities:

1) Nationally Strong Academic Program
2) Quality of life
3) I hate writing long notes
4) Dislike being in the OR (mostly b/c I hate going w/out sleep and I think I suck at Surgery...was always missing the sutures when the surgeon asked me to cut).
5) Want to make big bucks
6) Be intellectually stimulated (and be around people who are also outgoing and have diverse interests).
7) Don't like the idea of taking call as an attending, though I'd put up with it so long as I don't spend most nights up and working in the hospital.


Is there any field out there like that? Will I be happy with Medicine? Should I just get an MBA or MPH instead? What about a year off (Docs w/out Borders or something...however I've been told that taking a year off after graduation screws you when you apply for top residecncies). So far, I am still considering Medicine and Psych (and have crossed Neuro, FP, OB, and Peds off the list).

Please help!!!
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Dermatology or Radiology.
 
liquid magma said:
4) Dislike being in the OR (mostly b/c I hate going w/out sleep and I think I suck at Surgery...was always missing the sutures when the surgeon asked me to cut).
Click to expand...

LOL, that's me too! Except I'm currently in OBGyn. Any advice on honoring surgery regardless (besides doing well on the shelf)?

Sorry I can't help...but quality of life is a concern for me as well, which is why I want to keep an open mind despite my having planned on medicine. It does suck since for example there are some areas of OBGyn that would definitely appeal to me, like prenatal counseling and REI. And I wouldn't mind the residency work itself, to my surprise (even the surgeries would be cool to learn, though I doubt I'd ever excell there). But I know the work hours, etc. would make me miserable, and I can't imagine how horrible it would be if the coworkers were truly malignant.

So I do hope medicine's not *so* bad. :) I don't even care too much about salary in comparison, as long as I have no problems paying back my loans and having a nice home.
 
RADIOLOGY. next question.
 
What about anesthesia?
You do have to be in the OR, but you won't actually be doing any surgery.
 
Harrie said:
What about anesthesia?
You do have to be in the OR, but you won't actually be doing any surgery.
Click to expand...

Well,....still Anesthesia is a procedure-based speciality, and you need to be good with your hands. Also, the on-call schedule might be similar to the surgeon's.

I also recommend Radiology. Maybe Radiation Oncology.
 
The rad onc docs I know work tons of hours because they have such heavy pt loads. Depends on how many there are in the area, but they can definitely be overworked.
 
Specialties you should consider: Dermatology, Radiation Oncology, Pathology and Radiology (as you could structure it so that call would not be as intense as it currently is right now). Also consider EM. If you dislike the OR, general anesthesia is out, but pain management could be a potential good area.
 
Definitely sounds like derm or rads. Derm if you want to see a lot of patients, rads if you dont.
 
Rad Onc - tough residency, but it's all gravy after that. It is intellectually stimulating, as newer technology and research continue to sprout up, calls are benign, I don't think I need to dwell into the $$ issue, and compared to other "lifestyle" specialities like Diag Rad and Derm, it's a lot more fulfilling.
 
dlbruch said:
Try this medical specialty aptitude test from U. of Virginia:

http://www.med-ed.virginia.edu/specialties/
Click to expand...

I'm applying right now and took that quiz just for fun. It gave me the strangest list of possible specialties (none of which are what I'm going into): radiology, urology, general surgery, psychiatry, preventative med, and thoracic surgery. There doesn't seem to be anything similar about those specialties.
 
Like I tell all med students..........follow the R-O-A-D to happiness!
 
What about Ophthalmology?
 
REI is the way to go!!

1) Nationally Strong Academic Program

Well this is not specialty-specific. You first decide the specialty and then find
the best program.
2) Quality of life
No night call. Very exciting and rewarding. Little malpractice problems. Young healthy grateful patients.
3) I hate writing long notes
Short specific targeted notes only. Often, you just tell your staff the plan and they write the note for you to co-sign.

4) Dislike being in the OR (mostly b/c I hate going w/out sleep and I think I suck at Surgery...was always missing the sutures when the surgeon asked me to cut).
Laparoscopic surgery, clean, fun and outpatient without postop hassles. Ultrasound guided egg retreivals, clean fast easy surgery, almost like playing video game

5) Want to make big bucks
Work 40 hours/week = 300-400K. Work 70+ hours and = $1 MIL

6) Be intellectually stimulated (and be around people who are also outgoing and have diverse interests).
Each new couple is like a mystery to be solved. And even if you can't find the exact reason, you can just shotgun it and do IVF. Solves almost all sperm and tubal problems. And if the couple is willing to use donor eggs, then the egg problems are solved also. Technology always changing. Fun topic of discussion with non-medical people. Everyone is interested in how to have babies.
7) Don't like the idea of taking call as an attending, though I'd put up with it so long as I don't spend most nights up and working in the hospital.
Never on call.
 
Fermata said:
You still gotta survive a residency in OB/GYN to get there, though.
Click to expand...


Yes I was about to add that. And there are very few fellowship spots so if you don't get in, then you will have to continue on as a general OB/Gyn, which is quite different.
 
WilliamHung said:
Yes I was about to add that. And there are very few fellowship spots so if you don't get in, then you will have to continue on as a general OB/Gyn, which is quite different.
Click to expand...

What's an average day like for a REI specialist?
 
It varies for different individuals, but here's ONE RE's schedule. Overall work consists of Diagnosis (figuring out why a couple has not gotten pregnant), low-tech treatment (fertility drugs with insemination), high-tech treatment (in-vitro) and surgery (outpatient laparoscopic procedures)

7:30 AM - 9:30
Ultrasounds and Inseminations in office.
Transvaginal ultrasound are done to measure how many eggs (actually, follicles) are growing. This is actually full of variety and suspense, because you can't fully predict how the stimulation will go from month to month. Based on ultrasounds and blood tests (run instantly in office), decisions are made for dosage adjustment on fertility medications. About 1-3 Inseminations are done daily. Each patient visit is 5-15 min, but these are patients that you see every 2-4 days during the course of their treatment, so it's not impersonal. Also will be doing early prenatal ultrasound on the successful cases from the past weeks. Very rewarding as happy couple sees heartbeat for first time.
9:30-12:00 Egg Retrievals (ultrasound-guided needle aspirations). Very quick and clean and skill-dependent (you get better and better each year). Line up the follicles on the screen and advance the needle, trying to catch as many eggs as you can. As I said in earlier post, like video game. Embryo Transfers - Also very skill dependent procedure. The less traumatically you do them, the more likely the chance of success. Laparoscopic surgery scheduled once/week

12-1:30 lunch

1:30 -3:30. New patient consultations. You get to talk to each new couple for one hour and really get to know them. You also do reconsultations for patients who you saw previously and for whom you ordered tests. Now you sit and discuss with them the findings and then together decide on a treatment option (inexpensive low tech vs very effective high tech)
3:30-4:30. Get lab results (wait anxiously to see who got pregnant and who didn't). Make treatment adjustments based on hormone values.
Some days you don't have new patients so can get caught up on administrative stuff or go to the mall.

Patients often drop in to show you their babies that you helped them get, so there is a lot of Public Relations type stuff, but it's actually fun.
 
DISCLAIMER: There is a lot of stuff that I didn't mention yet

1. Have to do OB/Gyn residency, preferably at a strong program
2. Have to get into a good fellowship (not that easy)
3. Have to do 3 year fellowship, although it's pretty fun, and not too demanding, it's still 3 years of your life
4. Very hard to find a good job. You can't just open up your own practice unless you somehow make arrangements to share somebody's embryology lab. The quality of the embryology lab will dictate your success rates.
5. Limited geographic locations. Practically all RE practices are in big cities. So you can't choose to live in scenic rural Wyoming or Alaska, for example.
6. To have a successful practice, you have to have some business sense and be good at interpersonal counseling. It's not a good job for very introverted people, IMO. For those who love personal interaction, complex medical problem-solving and dexterity-dependent procedures, it's great!
7. Lose a lot of medicine knowledge. I know a recently graduated RE who is excellent, but he admits he knows almost nothing of medicine (HTN, cirrhosis, HIV, dementia etc). A full infertilty H&P takes 10 minutes and does not necessarily involve any physical exam other than a quick transvaginal ultrasound. Basically you lose a lot of your medicine knowledge and would be pretty worthless answering general medical questions from your friends, for example. BUT if the questions are about reproduction and infertility, you are the guru. :)
 
I couldn't find REI programs on FREIDA. :confused:
 
WH - thanks for the REI info! I really wish there was a way to do it without going through four years of OBGyn...or if it were at least guaranteed at the end. :(
 
Why are there no REI programs on FREIDA?
 
(nicedream) said:
Why are there no REI programs on FREIDA?
Click to expand...

It seems that none of the OB fellowships (MFM, Gyn-Onc, Urogynecology) are on FREIDA.

For your information, in the 2004 match, there were 33 spots filled this year. That's barely more than 1 new fellow for every 2 states in the Union. Compare this to 4751 Internal Medicine spots or 2864 Family Med spots available. It's no wonder people don't really notice nor seem to give a whole lot of interest to us with such an underrepresented field.
 
Any recommendations on ob/gyn residency programs if you're interested in REI in the future? (This especially applies to schools in NY, DC, MD, VA, CA, TX). Thanks!
 
Anecdotally from personal experience, I'd say connections are important. I did not decide to do a REI fellowship until I totally fell in love with the field my 3rd year of residency. So I did not have time to do any research. I went to my nationally-renown GynOnc chairman who had mentioned he could help me get a GynOnc fellowship and I told him my desire to do infertility. He picked up the phone and called his friend who was the chair at a very prestigious program. He then told me to get my application in as soon as possible as the REI chair of the prestigious program would be looking for it. Now I did go through the usual match and I was never really sure what was going to happen until the match results came back. But I did get my #1 choice and have reason to suspect that I could have gotten my #3 choice as well, but we'll never know for sure, will we?

I did not have awesome CREOG scores. But I feel that I'm pretty solid clinically. In addition, I was very well liked by attendings, nursing, fellow residents and students as being very diligent, caring, but easy-going.

So from my limited experience, I'd say being well liked and respected is one helpful factor no matter where you do your residency, don't make enemies. Having the blessing or good fortune of knowing the right person and having them be your advocate was key for me, so I'd say go to a program where the faculty is fairly well-known and has connections. Also it didn't hurt that my OB residency was a well respected one.

My personal opinion is UCLA / USC / UC Irvine / UCSD / UCSF for CA, Cornell / Yale for east coast. San Antonio for Texas. It might be a tad helpful to go to a residency that has a REI fellowship, because of the edge in just staying in the same place.

Nothing is absolute. Some general principles. 1. go to a good residency, not just in name, but also in life style and educational value 2. be a good person, work hard, value your reputation, don't be lazy/nasty/bitter, don't make enemies

And this may sound like a William Hung joke, but humbly just give it your best and have no regrets at all.
 
can you tell me what REI stands for and what they do? Pardon my ignorance. Thanks

WilliamHung said:
REI is the way to go!!

1) Nationally Strong Academic Program

Well this is not specialty-specific. You first decide the specialty and then find
the best program.
2) Quality of life
No night call. Very exciting and rewarding. Little malpractice problems. Young healthy grateful patients.
3) I hate writing long notes
Short specific targeted notes only. Often, you just tell your staff the plan and they write the note for you to co-sign.

4) Dislike being in the OR (mostly b/c I hate going w/out sleep and I think I suck at Surgery...was always missing the sutures when the surgeon asked me to cut).
Laparoscopic surgery, clean, fun and outpatient without postop hassles. Ultrasound guided egg retreivals, clean fast easy surgery, almost like playing video game

5) Want to make big bucks
Work 40 hours/week = 300-400K. Work 70+ hours and = $1 MIL

6) Be intellectually stimulated (and be around people who are also outgoing and have diverse interests).
Each new couple is like a mystery to be solved. And even if you can't find the exact reason, you can just shotgun it and do IVF. Solves almost all sperm and tubal problems. And if the couple is willing to use donor eggs, then the egg problems are solved also. Technology always changing. Fun topic of discussion with non-medical people. Everyone is interested in how to have babies.
7) Don't like the idea of taking call as an attending, though I'd put up with it so long as I don't spend most nights up and working in the hospital.
Never on call.
Click to expand...
 
HiddenTruth said:
can you tell me what REI stands for and what they do? Pardon my ignorance. Thanks
Click to expand...

Reproductive Endocrinology / Infertility

help people get pregnant through drugs surgery in-vitro
 
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