MD How do I pick a specialty?!

[deleted674723]

I've read and posted many threads over the last year trying to narrow my specialty choices. I have finished all of my core clerkships and still waiting for the "Ah ha!" moment. Well actually, I have completely given up on that. I just finished listening to 10+ of the Undifferentiated Medical Student podcasts hoping I would get some clarity or at least a line of thinking to help me decide. At this point, I need help outlining and organizing my thoughts to figure out what to do with my life.

I have narrowed it down to: Urology, Plastics, Derm, Radiology.
(Stats wise: 250+ Step 1. Top 20 academic institution. Multiple midauthor pubs in a surgical subspecialty)

This is how I got there:

I really, really love learning about medicine. My first couple years and studying for step 1 were my favorite parts of school. I also love teaching medicine and explaining things to people whether it is patients, colleagues, or students/residents. The actual practice of internal medicine made me want to die. I want nothing to do with inpatient medicine and want to be as far away from the hospital as possible. I don't like very sick people. I hate rounds. I hate notes.

I thought I wanted to do surgery. I came to med school to be a surgeon. I think surgery is the coolest part of medicine. I love learning about the surgeries, planning the surgeries, seeing great outcomes. However, the actual process of surgery doesn't get me going like I hoped it would. I don't get that spark when I get to cut or suture. It's cool and I like working with my hands, but I find most of my time in the OR to be tedious. After hearing the advice, "if you can picture yourself doing anything else do it" and "if you can envision yourself never setting foot in an OR again, don't do surgery" I am about ready to give up on Plastics/Uro. I absolutely need to do something with some sort of procedural component, but I don't know if I need to be in the OR.

Here is my pro's/con's for each choice:

Radiology
+Lots of learning, straight diagnosis, medicine without the bull****
+ No "notes" (dictating radiology reports doesn't count for me)
+ Opportunities to work with and explain things to colleagues
+ I'm an introvert and think I would be totally ok with reading in a dark room for the majority of my time
+ Minor procedures to break up the day with an option to pursue IR if I want more
-Not sure if I am ready to give up patient interaction (I know mammo gives me options, but in general)
-Uncertainty of job market with progression of AI (I know AI will not REPLACE radiologists, but they will likely improve the efficiency of radiologists and cause job market contraction)

Derm
+outpatient
+quick visits and most patients aren't "sick"
+options for procedures with cosmetic and Mohs
+lifestyle
+I have a personal pull towards this because of my own health issues
+still somewhat possible to hang your own shingle (a ton of my family are nurses/midlevels and a huge dream of mine is to work together with them)
- Very, very worried that it would get monotonous even though I find much of the pathology interesting (mostly from what others say about the field)
- If I don't match Mohs, I am unsure if I would be fulfilled in general dermatology unless I can manage to still do some procedures regularly

Plastics
+Love the concepts and learning about it
+Ample opportunities for private practice and business moves
+Huge range of operations
+enjoyed the clinic
-Often feels tedious in the OR
-Much of what I've seen in academic medicine is closing other specialties cases. This is incredibly boring and I don't have any interest in being the "surgeon's surgeon" that comes in to clean up other cases after the cool part is done.
-Apparently the better jobs are actually in academics unless you can establish yourself in private practice cosmetics which is insanely competitive (especially in the places I want to live). In the sense that in a community hospital, it is a lot of cleaning up messes of other services with wound closure after wound closure and a lack of interesting cases.

Uro
+Very interesting physiology/pathology
+Lots of medicine involved
+Procedural clinic
+Best variety which will hopefully keep things from becoming stale
+Robots
+more laid back personalities than other surgical subs in my experience
-This is still a surgical field and I really am not sure that I can take 6 years of surgical residency when the OR just isn't my favorite place in the world.
-DRE/sensitive anatomy (I know this is dumb. It's not that rectums gross me out or anything. I just want to be the kind of doctor that patients aren't nervous/miserable over. That's why I don't want to deal with very sick patients. If most of my patients know they're getting a finger in their bum when they come see me, they are likely gonna be nervous and stressed. that's a weird thought that I can't shake.)


If any of you have been in a similar place or have any advice on how I can figure out where to go from here, please let me know. I really need to focus down and have some true direction at this point. Anything at all is a big help. I'll be in the comments. Thanks so much!

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[Spodermin]

So you don't like surgery, but you're interested in plastics and urology?

 

[LoGo]

Obvious question. Choose derm and move on. You won’t regret it.

 

[deleted674723]

So you don't like surgery, but you're interested in plastics and urology?

I like surgery. I think it is the coolest thing that happens in the hospital. I like the mindset of surgeons and I appreciate the personalities. I just am unsure if I am ultra gung-ho about being in the OR. People say the OR has to be your favorite place in the world to do surgery... I don't know if thats me.

 

[deleted674723]

Obvious question. Choose derm and move on. You won’t regret it.

What makes you say that? Did you do derm?

 

[ricksimmonsrafowens]

radiology

 

[deleted674723]

radiology

Insightful haha

 

[ricksimmonsrafowens]

Insightful haha

lol

1. you can still do (a lot) of patient interaction if you do mammo, IR, pediatrics and probably other subspecialties of radiology I don't know about
2. AI is all just a meme and radiologists are not competing against AI for anything
3. you're an introvert and long days of having to argue with consultants, nursing, staff, etc will drain you on surgery
4. if you don't like the OR 1000% do not do a surgery residency you will regret it

 

[ricksimmonsrafowens]

why not anesthesia?

 

[nlax30]

Probably a big thing to decide is if you want to be in the OR in a surgical specialty or not..... if you still enjoy the OR then certainly fields like ENT, Urology, Plasitkcs would be attractive I’d think. Though w/ Uro still going to involve likely fair amount of hospital inpatient work.

I’ve always been fascinated by IR (not my field) but I think it’s a great field with a good mix of procedures. Obviously hospital based though and more on the sicker patient spectrum.

There’s Rheum....... can do mostly if not all outpatient with small office based procedures (injections). May not be procedural enough to satisfy you though and would have to go through IM first.

Honestly a medicine subspecialty like GI would also be worth looking at it. Decent mix of outpatient clinic, inpatient and outpatient and inpatient procedures. Obviously it puts you back into doing IM first but I think IM tends to get a bad rap as pretty much no one actually enjoys rounding for hours but that’s just the structure of a lot of inpatient academic IM teams. IM at its core is much more than that and can be rewarding.

I enjoy hospital work, wide mix of procedures and some sick patients and the cardiac sub-specialty I’m in is a great fit but 8yrs in total post grad training is a hard sell to most and it’s a very self-selected group in this field.

Pain medicine? Outpatient clinic and procedures.

 

[deleted674723]

lol

1. you can still do (a lot) of patient interaction if you do mammo, IR, pediatrics and probably other subspecialties of radiology I don't know about
2. AI is all just a meme and radiologists are not competing against AI for anything
3. you're an introvert and long days of having to argue with consultants, nursing, staff, etc will drain you on surgery
4. if you don't like the OR 1000% do not do a surgery residency you will regret it

Eh, I'm still confrontational and don't mind working with other people. I'm a totally normal dude. I just ALSO am totally cool being by myself and sometimes enjoy it more.

 

[deleted674723]

why not anesthesia?

Way too boring for me and entubation grosses me out.

 

[ricksimmonsrafowens]

Way too boring for me and entubation grosses me out.

anesthesia looks boring because 100% of med students don't understand what physiologically, etc happens when patients receive anesthesia - it's not really our fault, but there is a lot of finesse that goes into practicing anesthesia (including intubations) and although anesthesia looked boring to me too, it was 100% because I did not understand what was going in and why attending or the resident was choosing a particularly approach to anesthetizing patients. it was after experiencing cardiovascular anesthesia (like routine CABG, valves) and working with a fellow who would explain her every step to me like I was a child that I did begin to understand the precision that thought process that happens behind the scenes in anesthesia. I did end up matching a surgical sub though.

 

[UnoMas]

anesthesia looks boring because 100% of med students don't understand what physiologically, etc happens when patients receive anesthesia - it's not really our fault, but there is a lot of finesse that goes into practicing anesthesia (including intubations) and although anesthesia looked boring to me too, it was 100% because I did not understand what was going in and why attending or the resident was choosing a particularly approach to anesthetizing patients. it was after experiencing cardiovascular anesthesia (like routine CABG, valves) and working with a fellow who would explain her every step to me like I was a child that I did begin to understand the precision that thought process that happens behind the scenes in anesthesia. I did end up matching a surgical sub though.

so anticlimactic lol
But at least now you have some level of appreciation for your anesthesia colleagues

 

[deleted674723]

Probably a big thing to decide is if you want to be in the OR in a surgical specialty or not..... if you still enjoy the OR then certainly fields like ENT, Urology, Plasitkcs would be attractive I’d think. Though w/ Uro still going to involve likely fair amount of hospital inpatient work.

I’ve always been fascinated by IR (not my field) but I think it’s a great field with a good mix of procedures. Obviously hospital based though and more on the sicker patient spectrum.

There’s Rheum....... can do mostly if not all outpatient with small office based procedures (injections). May not be procedural enough to satisfy you though and would have to go through IM first.

Honestly a medicine subspecialty like GI would also be worth looking at it. Decent mix of outpatient clinic, inpatient and outpatient and inpatient procedures. Obviously it puts you back into doing IM first but I think IM tends to get a bad rap as pretty much no one actually enjoys rounding for hours but that’s just the structure of a lot of inpatient academic IM teams. IM at its core is much more than that and can be rewarding.

I enjoy hospital work, wide mix of procedures and some sick patients and the cardiac sub-specialty I’m in is a great fit but 8yrs in total post grad training is a hard sell to most and it’s a very self-selected group in this field.

Pain medicine? Outpatient clinic and procedures.

I really can't do medicine. I think I may enjoy some of the subspecialties, but I just do not think of myself as a medicine person.

 

[afib123]

well inpatient medicine and sick patients are big parts of medicine and surgery (not sure how sick patients are in plastics or urology specifically). you pretty much ruled out your choices to derm or rads considering you are competitive

 

[WedgeDawg]

I think this choice should be between Derm and Rads. Your sentiments about the OR strongly suggest that plastics and urology aren’t the right fit for you.

 

[PhillyMed777]

Dont do derm if you only see yourself doing mohs. Theres no guarantee you will match mohs.

 

[Spikebd]

Derm. Or pathology if you really want to get crazy.

 

[PugsAndHugs]

What about Interventional Radiology? Seems like a good fit.

 

[mrbreakfast]

I agree that your notes about the OR/surgery in general probably rule those out for you. Need to decide if you like seeing patients (a lot) or not at all.

You can always dual apply, but if you only want to do Mohs, choosing derm would be risky.

 

[Fission Chips]

I'm trying to match into Uro, but for what it's worth, I've always said that if I could find anything I liked about Derm then I'd go for that. All the dermatologists I've talked to are extremely happy people inside and (especially) outside of work. I honestly vote Uro (obviously biased), because IMO it's the best mix of surgery and medicine, but you gotta enjoy the OR. Maybe you'd like it more if you got to do more as you move up the ranks?

Otherwise, definitely go derm and enjoy the lifestyle. I doubt the 50-year old version of you would regret that choice, unless you hate having dinner with your family.

 

[deleted674723]

What about Interventional Radiology? Seems like a good fit.

IR seems cool but it seems like they get stuck with a lot of the stuff basic drains/lines cases of pretty sick patients. Helping inpatients circle the drain is dead last on my list. Also slightly worried about the increased risk of brain cancers etc.

 

[deleted674723]

I'm trying to match into Uro, but for what it's worth, I've always said that if I could find anything I liked about Derm then I'd go for that. All the dermatologists I've talked to are extremely happy people inside and (especially) outside of work. I honestly vote Uro (obviously biased), because IMO it's the best mix of surgery and medicine, but you gotta enjoy the OR. Maybe you'd like it more if you got to do more as you move up the ranks?

Otherwise, definitely go derm and enjoy the lifestyle. I doubt the 50-year old version of you would regret that choice, unless you hate having dinner with your family.

That is spot on exactly how I feel about Uro/Plastics. I like everything about it, except actually doing the operations. I'm trying to get myself to feel passionate about the OR, but it ain't coming.

 

[Angus Avagadro]

Look at the literature you enjoy reading in your spare time. This might help guide you. 30 yrs is a long time and the subject should still interest you.

 

[Bobcat18]

You sound exactly like me. Always wanged do surgery until actually rotating in the field. LOVED the first two years of medical school and learning about the intricate details of details but also did not like my IM rotation due to rounds / social work nonsense. Ended up picking diagnostic radiology and so happy that I did. I think liking the first two years of medical school is usually a good indicator that someone could be a good fit for radiology given the isolated nature of those years. Would highly recommend radiology and suspect (by the sound of your post) that you would be a perfect fit. Good luck choosing and PM me if you have any questions!!!

 

[deleted674723]

Look at the literature you enjoy reading in your spare time. This might help guide you. 30 yrs is a long time and the subject should still interest you.

I don't read literature in my spare time. I go to the gym or work on my hobbies or spend time with my gf. Medicine isn't my whole life and I want to pursue a specialty where that is ok.

 

[Dr. Doctor MD]

I've read and posted many threads over the last year trying to narrow my specialty choices. I have finished all of my core clerkships and still waiting for the "Ah ha!" moment. Well actually, I have completely given up on that. I just finished listening to 10+ of the Undifferentiated Medical Student podcasts hoping I would get some clarity or at least a line of thinking to help me decide. At this point, I need help outlining and organizing my thoughts to figure out what to do with my life.

I have narrowed it down to: Urology, Plastics, Derm, Radiology.
(Stats wise: 250+ Step 1. Top 20 academic institution. Multiple midauthor pubs in a surgical subspecialty)

This is how I got there:

I really, really love learning about medicine. My first couple years and studying for step 1 were my favorite parts of school. I also love teaching medicine and explaining things to people whether it is patients, colleagues, or students/residents. The actual practice of internal medicine made me want to die. I want nothing to do with inpatient medicine and want to be as far away from the hospital as possible. I don't like very sick people. I hate rounds. I hate notes.

I thought I wanted to do surgery. I came to med school to be a surgeon. I think surgery is the coolest part of medicine. I love learning about the surgeries, planning the surgeries, seeing great outcomes. However, the actual process of surgery doesn't get me going like I hoped it would. I don't get that spark when I get to cut or suture. It's cool and I like working with my hands, but I find most of my time in the OR to be tedious. After hearing the advice, "if you can picture yourself doing anything else do it" and "if you can envision yourself never setting foot in an OR again, don't do surgery" I am about ready to give up on Plastics/Uro. I absolutely need to do something with some sort of procedural component, but I don't know if I need to be in the OR.

Here is my pro's/con's for each choice:

Radiology
+Lots of learning, straight diagnosis, medicine without the bull****
+ No "notes" (dictating radiology reports doesn't count for me)
+ Opportunities to work with and explain things to colleagues
+ I'm an introvert and think I would be totally ok with reading in a dark room for the majority of my time
+ Minor procedures to break up the day with an option to pursue IR if I want more
-Not sure if I am ready to give up patient interaction (I know mammo gives me options, but in general)
-Uncertainty of job market with progression of AI (I know AI will not REPLACE radiologists, but they will likely improve the efficiency of radiologists and cause job market contraction)

Derm
+outpatient
+quick visits and most patients aren't "sick"
+options for procedures with cosmetic and Mohs
+lifestyle
+I have a personal pull towards this because of my own health issues
+still somewhat possible to hang your own shingle (a ton of my family are nurses/midlevels and a huge dream of mine is to work together with them)
- Very, very worried that it would get monotonous even though I find much of the pathology interesting (mostly from what others say about the field)
- If I don't match Mohs, I am unsure if I would be fulfilled in general dermatology unless I can manage to still do some procedures regularly

Plastics
+Love the concepts and learning about it
+Ample opportunities for private practice and business moves
+Huge range of operations
+enjoyed the clinic
-Often feels tedious in the OR
-Much of what I've seen in academic medicine is closing other specialties cases. This is incredibly boring and I don't have any interest in being the "surgeon's surgeon" that comes in to clean up other cases after the cool part is done.
-Apparently the better jobs are actually in academics unless you can establish yourself in private practice cosmetics which is insanely competitive (especially in the places I want to live). In the sense that in a community hospital, it is a lot of cleaning up messes of other services with wound closure after wound closure and a lack of interesting cases.

Uro
+Very interesting physiology/pathology
+Lots of medicine involved
+Procedural clinic
+Best variety which will hopefully keep things from becoming stale
+Robots
+more laid back personalities than other surgical subs in my experience
-This is still a surgical field and I really am not sure that I can take 6 years of surgical residency when the OR just isn't my favorite place in the world.
-DRE/sensitive anatomy (I know this is dumb. It's not that rectums gross me out or anything. I just want to be the kind of doctor that patients aren't nervous/miserable over. That's why I don't want to deal with very sick patients. If most of my patients know they're getting a finger in their bum when they come see me, they are likely gonna be nervous and stressed. that's a weird thought that I can't shake.)


If any of you have been in a similar place or have any advice on how I can figure out where to go from here, please let me know. I really need to focus down and have some true direction at this point. Anything at all is a big help. I'll be in the comments. Thanks so much!

I think the following would be best for you:

ENT
Interventional Radiology
Gastroenterology
Interventional Cards

ENT is surgical but many of them operate far less than most other surgical subspecialties. You can run a clinic and do all sorts of minor procedures in clinic. You also have OR time but not nearly as much as say Ortho/Gen Surg/CT/Neuro etc. Good lifestyle, amazing job market, ample opportunity for making your own business. This is my #1 recommendation for you.

IR is also amazing. Incredible pay, high demand, growing field. I know you said you hate sick patients but as IR, you don't manage patients (at least not at my hospital). Patient gets wheeled down to your suite, you do your procedure, fix whats wrong, and send them back to IM/Surgery to manage. It's like being a surgeon but with none of the work or responsibilities that come from taking ownership of the patients. Also many IRs in the community do 50/50 or some other split with their time. This gives you the best of both worlds and you can switch between the two based on what you want at different point in your career. Also the cancer stuff is almost entirely brought up by non-IR people. Actual attendings will tell you that with proper technique the additional radiation is essentially negligible. If there was a link we would have seen it by now. But that's a whole nother topic. Check out the IR board. Overall IR/DR combined is my #2 recommendation.

Interventional Cardiology/GI
Lots of medicine and "intellectual stuff", but on top of it you get to do super cool, super well reimbursed procedures. You really get a lot of medicine with a lot of hands on stuff as well. I would say these are the only 2 specialties off of IM that get to really be proceduralists and "play surgeon" sort of. I still think the other two specialties are better for you, but these two might be another option to consider.


As for what you mentioned that I don't think are great fits:

Plastics: need to operate a lot, amazing field for private practice and business, but again to be successful you need to operate a lot. Probably not a great fit for you.

Derm: You need to read in this field, and read a lot. I have yet to meet surgical residents who read nightly if even weekly (I'm kidding, I'm sure they do, but the point is that 2 hours a week is a lot for most surgical residents) In derm you'll read 2 hours per day. The other thing is that if you don't love derm, then you will be miserable. Sure lifestyle is good, but 8-5 of something you take no pleasure/enjoyment in will be miserable. My psych rotation was the easiest one ever. 6-8 hours per day and super chill. But I was miserable. It was so easy, repetitive and mundane and I really hated coming in each day. I much preferred OB-GYN which was double the hours but actually interesting. Ignore the 5000 people on SDN who tell everyone to do derm, but haven't ever even been in a derm clinic. Derm gets glorified, but the reality is that they deal with a lot of the same challenges as other fields. Not saying it's not a great specialty, but the conventional wisdom that 100% of med students should be dermatologists is just wrong, and is perpetuated by the people who know the least about dermatology. There are miserable derm residents and attendings as well because they picked the field without any interest in it. You just don't hear them glorified. Also Mohs is a bloodbath to get into and is oversaturated. Horrendous job market and more new Mohs surgeons are coming out every year. Even if you happen to land a fellowship, you'd be lucky to get a job with even 2 days Mohs a week. I would highly recommend against dermatology. I don't see you enjoying general dermatology at all.

Uro: They still operate a decent amount but they can be do a good amount of clinic as well. I think URO is kind of like a slightly more surgical version of ENT. I don't think it would be ideal for you, but I don't think you'd hate it either. They also have a lot of short procedures as well. U/S, Terp, vasectomy, etc.

Finally, I think Derm and IR are likely out of reach without a research year. Despite stellar stats and CV, you have nothing even remotely related to either of those fields, which is a huge red flag, as both want to see serious dedication to the field and specialty specific research. I think the boat sailed for these this late in the year.

Your surgical research can easily qualify you for ENT/Plastics/URO/ or any other surgical subs and I think you would comfortably match at a top 10-20 program with your application.


Tldr;
Look into ENT, I think it is the ideal mix of everything you're into

----------------------------------------------------------------------------------
Also side note: Optho could be an amazing fit for you as well

 

[LebronManning]

I think the following would be best for you:

ENT
Interventional Radiology
Gastroenterology
Interventional Cards

ENT is surgical but many of them operate far less than most other surgical subspecialties. You can run a clinic and do all sorts of minor procedures in clinic. You also have OR time but not nearly as much as say Ortho/Gen Surg/CT/Neuro etc. Good lifestyle, amazing job market, ample opportunity for making your own business. This is my #1 recommendation for you.

IR is also amazing. Incredible pay, high demand, growing field. I know you said you hate sick patients but as IR, you don't manage patients (at least not at my hospital). Patient gets wheeled down to your suite, you do your procedure, fix whats wrong, and send them back to IM/Surgery to manage. It's like being a surgeon but with none of the work or responsibilities that come from taking ownership of the patients. Also many IRs in the community do 50/50 or some other split with their time. This gives you the best of both worlds and you can switch between the two based on what you want at different point in your career. Also the cancer stuff is almost entirely brought up by non-IR people. Actual attendings will tell you that with proper technique the additional radiation is essentially negligible. If there was a link we would have seen it by now. But that's a whole nother topic. Check out the IR board. Overall IR/DR combined is my #2 recommendation.

Interventional Cardiology/GI
Lots of medicine and "intellectual stuff", but on top of it you get to do super cool, super well reimbursed procedures. You really get a lot of medicine with a lot of hands on stuff as well. I would say these are the only 2 specialties off of IM that get to really be proceduralists and "play surgeon" sort of. I still think the other two specialties are better for you, but these two might be another option to consider.


As for what you mentioned that I don't think are great fits:

Plastics: need to operate a lot, amazing field for private practice and business, but again to be successful you need to operate a lot. Probably not a great fit for you.

Derm: You need to read in this field, and read a lot. I have yet to meet surgical residents who read nightly if even weekly (I'm kidding, I'm sure they do, but the point is that 2 hours a week is a lot for most surgical residents) In derm you'll read 2 hours per day. The other thing is that if you don't love derm, then you will be miserable. Sure lifestyle is good, but 8-5 of something you take no pleasure/enjoyment in will be miserable. My psych rotation was the easiest one ever. 6-8 hours per day and super chill. But I was miserable. It was so easy, repetitive and mundane and I really hated coming in each day. I much preferred OB-GYN which was double the hours but actually interesting. Ignore the 5000 people on SDN who tell everyone to do derm, but haven't ever even been in a derm clinic. Derm gets glorified, but the reality is that they deal with a lot of the same challenges as other fields. Not saying it's not a great specialty, but the conventional wisdom that 100% of med students should be dermatologists is just wrong, and is perpetuated by the people who know the least about dermatology. There are miserable derm residents and attendings as well because they picked the field without any interest in it. You just don't hear them glorified. Also Mohs is a bloodbath to get into and is oversaturated. Horrendous job market and more new Mohs surgeons are coming out every year. Even if you happen to land a fellowship, you'd be lucky to get a job with even 2 days Mohs a week. I would highly recommend against dermatology. I don't see you enjoying general dermatology at all.

Uro: They still operate a decent amount but they can be do a good amount of clinic as well. I think URO is kind of like a slightly more surgical version of ENT. I don't think it would be ideal for you, but I don't think you'd hate it either. They also have a lot of short procedures as well. U/S, Terp, vasectomy, etc.

Finally, I think Derm and IR are likely out of reach without a research year. Despite stellar stats and CV, you have nothing even remotely related to either of those fields, which is a huge red flag, as both want to see serious dedication to the field and specialty specific research. I think the boat sailed for these this late in the year.

Your surgical research can easily qualify you for ENT/Plastics/URO/ or any other surgical subs and I think you would comfortably match at a top 10-20 program with your application.


Tldr;
Look into ENT, I think it is the ideal mix of everything you're into

----------------------------------------------------------------------------------
Also side note: Optho could be an amazing fit for you as well

OP doesn’t want to deal with sick patients. IC deals with arguably the most acutely ill patients on earth on a daily basis.

 

[nlax30]

I don't read literature in my spare time. I go to the gym or work on my hobbies or spend time with my gf. Medicine isn't my whole life and I want to pursue a specialty where that is ok.

Do ER

In all seriousness I think you missed his point. Which organ system or subject do you enjoy reading/learning about?

For me Nephro and Neuro were systems I just had no interest in. The heart made sense to me and what I ended up going into. I think their point was medicine will hopefully be a long career and will be much more satisfying if you’re working in a field where you actually enjoy and have a curiosity about that particular system instead of just trying to find something that will give you a certain lifestyle.

 

[mistafab]

Any reason why you didn’t list FM on your interest list?

It sounds up your alley. You enjoyed all the varied subjects studied for in step 1. You don’t want to work in the hospital. You could work outpatient, really do all of medicine, and do a bunch of procedures in your office (joint injections, biopsy, I/D...). You could hang your own shingle anywhere you like. Also, you work 1 on 1 with the patient instead of having to navigate with a team all the time (unless that’s what you want to do, which you could).

Plus you could always staff an ER if you felt like it. And in the end, you could make your practice focus on “derm” stuff (botox, mole removal, etc) without exclusively doing derm.

 

[LebronManning]

Any reason why you didn’t list FM on your interest list?

Because OP wants to make good money and has the Step score to match a specialty consistent with this. Notice how his specialties of choice are all in the top 8 for income lol.

 

[Aurum]

It's like being a surgeon but with none of the work or responsibilities that come from taking ownership of the patients.

Folks in IR leadership are trying to shift IR away from this model. They want IR to own their patients and practice in more of a surgical/clinical model rather than just doing the procedure and sending the patient on their way. I too view the lack of ownership as a perk, but practice patterns may shift in the coming years.

OP, you sound like you'd be happy in DR. As you mentioned, there are enough procedures to break up the day and you can always do IR if you're itching to primarily be a proceduralist. I had similar thoughts to you regarding patient interaction when I chose DR, but now that I'm almost done intern year I find patient interaction highly overrated lol. The caveats with IR are the shifting practice model (as I mentioned above) and extreme competitiveness; the latter should not be a problem if you can get in some research, good letters, and aways. You are right in that AI will likely result in a contraction of the DR job market in the future, so DR is more of a gamble than derm in that regard. Like another poster mentioned, I think that even general derm folks do small procedures like lump/bump excisions, biopsies, injections, etc.

 

[Frogger27]

Id look into GI...You sound like a person who may like procedures better than actual surgery. "I dont see myself as a medicine person" IMO is not a good enough reason to disregard it.

Yes you will have to complete IM residency, but with your scores/CV you should not have too much difficulty matching into great IM program/GI

 

[nlax30]

Because OP wants to make good money and has the Step score to match a specialty consistent with this. Notice how his specialties of choice are all in the top 8 for income lol.

If you’re business savvy and/or have the right practice set up you can make good money in FP. I know several FPs/IMs (primary care) who do extremely well, whether it’s from their own practice model (such as direct primary), owning a building, medical directorships with nursing homes, industry/research involvement, etc...

 

[Chibucks15]

If you’re business savvy and/or have the right practice set up you can make good money in FP. I know several FPs/IMs (primary care) who do extremely well, whether it’s from their own practice model (such as direct primary), owning a building, medical directorships with nursing homes, industry/research involvement, etc...

shhh this is SDN and anything less competitive than EM is the devil

 

[LebronManning]

Folks in IR leadership are trying to shift IR away from this model. They want IR to own their patients and practice in more of a surgical/clinical model rather than just doing the procedure and sending the patient on their way.

I don't know how this could ever happen. IR is literally a consulting service for relatively minor procedures. No patient would ever need to see an IR without seeing another doc first who would be the primary on the issue.

If you’re business savvy and/or have the right practice set up you can make good money in FP. I know several FPs/IMs (primary care) who do extremely well, whether it’s from their own practice model (such as direct primary), owning a building, medical directorships with nursing homes, industry/research involvement, etc...

I agree completely. But it will always be half of what you can do in the other specialties with the same business savviness.

 

[mcat_taker]

I don't know how this could ever happen. IR is literally a consulting service for relatively minor procedures. No patient would ever need to see an IR without seeing another doc first who would be the primary on the issue.


I agree completely. But it will always be half of what you can do in the other specialties with the same business savviness.

IR also is extremely fast growing and making up procedures as they go. Everything is going more minimally invasive if it can. You would be surprised as what IR is doing these days. Anything they can get their hands on. As for it being "relatively minor procedures" sure compared to open surgery but you still get to do cool stuff like break up clots in stroke care and the procedures are fast so monotony won't be as much of an issue when you're not operating for 6 hours on the same case.

@Tankstah have you looked into OBGYN? You mention you like the medicine and surgical aspect of Urology plus the variety. OBGYN has a good amount of medicine involved, lots of endocrine and pharm, OR cases, and in office procedures, plus L and D is its own beast. You can do robotic cases just like urology but yea probably not the same level of surgical variety. And different pathways depending on your interests after residency, i.e. more surgical or medicine oriented fellowships depending what you like.

Granted it takes a certain personality fit if you're a guy seeing as you deal with private female parts all day every day but the patient population is generally healthy which you say you prefer.

 

[Cognovi]

I really, really love learning about medicine. My first couple years and studying for step 1 were my favorite parts of school. I also love teaching medicine and explaining things to people whether it is patients, colleagues, or students/residents.

This is exactly how I feel and is why I enjoy diagnostic radiology. If one prioritizes learning about all of medicine (minus the minutiae of pharmacology) and teaching others, radiology and pathology should be the primary considerations.

I don't know how this could ever happen. IR is literally a consulting service for relatively minor procedures. No patient would ever need to see an IR without seeing another doc first who would be the primary on the issue.

The clinical model merely consists of, in addition to doing the procedure, a pre-procedure clinic visit in which the IR evaluates the appropriateness for the procedure and counsels the patient; post-procedure inpatient recovery with IR as the primary service; follow-up outpatient clinic visits; and showing up to tumor board. This can work for plenty of higher end IR procedures, including vascular work and interventional oncology.

 

[LookForZebras]

Radiology. You only have two cons for this ones, and I don't think they are very strong.

There are ways to continue to be directly involved in patient care as a radiologist! As you mentioned there's IR. Or, you might start residency and find that you never even miss patients.

I feel that many specialties evolve with new technologies and changes related to health trends, politics, population shifts, and other factors. But evolving and changing is much different than dying. Radiologists are here to stay. Just embrace new technology and figure out how it can help you do your job better, rather than fret about how it might replace your job.

 

[ThrowawayShmoaway]

Surprisingly Ophtho has only gotten mentioned once here. Why not Ophtho, OP? Seems like it could match a lot of your interests since it seems to be a good mix of clinic and procedures, and most of the surgeries are relatively short (I think?)

 

[username456789]

Re: derm and not getting to do procedures regularly unless you do Mohs...I may be wrong, but based on my limited experience with general derm it seems like they do a lot of office-based procedures? I mean sure you have your acne visits and skin checks and stuff, but don't they also do a lot of biopsies, I&D/cyst excisions, skin tag removals, stuff like that? And then you can always get into the cosmetic side of things and do like botox and fillers and stuff if you want more procedures.

You’re actually missing something huge. Most skin cancer surgeries of non-facial skin are not Mohs and are performed just as often by general Dermatologists. I am not a Mohs surgeon and I do 3-4 skin cancer excisions daily at the end of my clinic. Melanomas, BCC, SCC, sometimes cancers you guys have never heard of.

Also, yes derm residency is close to or at the top in terms of amount of required reading.

 

[Solodyn]

Derm... it is as good as they say...

There are a lot to do in derm. You can become a dermatologists with special interests in contact derm, psoriasis, cosmetic derm, pediatric derm, surgical derm, dermpath as your career or different part of your career. You can play with the latest lasers, technology or simply focus on bread and butter derm. You can develop your own product line.. Instagram yourself to become a celebrity derm, or build a derm empire by opening many clinics with mid-levels or other derm and become a CEO and phase out on seeing patient. You can start hair transplant practice while have your general derm practice to sustain your new venture. You can go into academic and easily establish yourself as a dermatology educator and professor. You can literally have many career change within derm if you get bored with one aspect of it.

Why derm is not even more glorified than it is now is beyond me.

 

[LebronManning]

Derm... it is as good as they say...

There are a lot to do in derm. You can become a dermatologists with special interests in contact derm, psoriasis, cosmetic derm, pediatric derm, surgical derm, dermpath as your career or different part of your career. You can play with the latest lasers, technology or simply focus on bread and butter derm. You can develop your own product line.. Instagram yourself to become a celebrity derm, or build a derm empire by opening many clinics with mid-levels or other derm and become a CEO and phase out on seeing patient. You can start hair transplant practice while have your general derm practice to sustain your new venture. You can go into academic and easily establish yourself as a dermatology educator and professor. You can literally have many career change within derm if you get bored with one aspect of it.

Why derm is not even more glorified than it is now is beyond me.

You can literally do everything you mentioned except obviously the Derm specific disease in any specialty

 

[deleted674723]

I think this choice should be between Derm and Rads. Your sentiments about the OR strongly suggest that plastics and urology aren’t the right fit for you.

I can't tell if truly dislike the OR or if I am just burned out. When I am in the OR, I can think of a billion things I'd rather be doing. This applies to almost all of medical school in general though. How can I tell if I'm miserable or I just don't like the OR? This seems like a stupid question, but I legitimately can't figure it out.

 

[deleted674723]

I think the following would be best for you:

ENT
Interventional Radiology
Gastroenterology
Interventional Cards

ENT is surgical but many of them operate far less than most other surgical subspecialties. You can run a clinic and do all sorts of minor procedures in clinic. You also have OR time but not nearly as much as say Ortho/Gen Surg/CT/Neuro etc. Good lifestyle, amazing job market, ample opportunity for making your own business. This is my #1 recommendation for you.

IR is also amazing. Incredible pay, high demand, growing field. I know you said you hate sick patients but as IR, you don't manage patients (at least not at my hospital). Patient gets wheeled down to your suite, you do your procedure, fix whats wrong, and send them back to IM/Surgery to manage. It's like being a surgeon but with none of the work or responsibilities that come from taking ownership of the patients. Also many IRs in the community do 50/50 or some other split with their time. This gives you the best of both worlds and you can switch between the two based on what you want at different point in your career. Also the cancer stuff is almost entirely brought up by non-IR people. Actual attendings will tell you that with proper technique the additional radiation is essentially negligible. If there was a link we would have seen it by now. But that's a whole nother topic. Check out the IR board. Overall IR/DR combined is my #2 recommendation.

Interventional Cardiology/GI
Lots of medicine and "intellectual stuff", but on top of it you get to do super cool, super well reimbursed procedures. You really get a lot of medicine with a lot of hands on stuff as well. I would say these are the only 2 specialties off of IM that get to really be proceduralists and "play surgeon" sort of. I still think the other two specialties are better for you, but these two might be another option to consider.


As for what you mentioned that I don't think are great fits:

Plastics: need to operate a lot, amazing field for private practice and business, but again to be successful you need to operate a lot. Probably not a great fit for you.

Derm: You need to read in this field, and read a lot. I have yet to meet surgical residents who read nightly if even weekly (I'm kidding, I'm sure they do, but the point is that 2 hours a week is a lot for most surgical residents) In derm you'll read 2 hours per day. The other thing is that if you don't love derm, then you will be miserable. Sure lifestyle is good, but 8-5 of something you take no pleasure/enjoyment in will be miserable. My psych rotation was the easiest one ever. 6-8 hours per day and super chill. But I was miserable. It was so easy, repetitive and mundane and I really hated coming in each day. I much preferred OB-GYN which was double the hours but actually interesting. Ignore the 5000 people on SDN who tell everyone to do derm, but haven't ever even been in a derm clinic. Derm gets glorified, but the reality is that they deal with a lot of the same challenges as other fields. Not saying it's not a great specialty, but the conventional wisdom that 100% of med students should be dermatologists is just wrong, and is perpetuated by the people who know the least about dermatology. There are miserable derm residents and attendings as well because they picked the field without any interest in it. You just don't hear them glorified. Also Mohs is a bloodbath to get into and is oversaturated. Horrendous job market and more new Mohs surgeons are coming out every year. Even if you happen to land a fellowship, you'd be lucky to get a job with even 2 days Mohs a week. I would highly recommend against dermatology. I don't see you enjoying general dermatology at all.

Uro: They still operate a decent amount but they can be do a good amount of clinic as well. I think URO is kind of like a slightly more surgical version of ENT. I don't think it would be ideal for you, but I don't think you'd hate it either. They also have a lot of short procedures as well. U/S, Terp, vasectomy, etc.

Finally, I think Derm and IR are likely out of reach without a research year. Despite stellar stats and CV, you have nothing even remotely related to either of those fields, which is a huge red flag, as both want to see serious dedication to the field and specialty specific research. I think the boat sailed for these this late in the year.

Your surgical research can easily qualify you for ENT/Plastics/URO/ or any other surgical subs and I think you would comfortably match at a top 10-20 program with your application.


Tldr;
Look into ENT, I think it is the ideal mix of everything you're into

----------------------------------------------------------------------------------
Also side note: Optho could be an amazing fit for you as well

Thank you so much for this response. Very detailed and exactly what I needed to organize my thinking. I really wnat to consider ENT now, although it is very late. Do you think that pursuing ENT is possible for someone who isn't totally in love with the OR like I described? GI seems doable, but I think I would like DR/IR more so I am not even going to go down that road. If my prelim year somehow awakens a tolerance of medicine in me, maybe I could adjust.

 

[deleted674723]

Do ER

In all seriousness I think you missed his point. Which organ system or subject do you enjoy reading/learning about?

For me Nephro and Neuro were systems I just had no interest in. The heart made sense to me and what I ended up going into. I think their point was medicine will hopefully be a long career and will be much more satisfying if you’re working in a field where you actually enjoy and have a curiosity about that particular system instead of just trying to find something that will give you a certain lifestyle.

I wish I could do ER but that patient population would burn me out in a matter of hours.

 

[deleted674723]

Any reason why you didn’t list FM on your interest list?

It sounds up your alley. You enjoyed all the varied subjects studied for in step 1. You don’t want to work in the hospital. You could work outpatient, really do all of medicine, and do a bunch of procedures in your office (joint injections, biopsy, I/D...). You could hang your own shingle anywhere you like. Also, you work 1 on 1 with the patient instead of having to navigate with a team all the time (unless that’s what you want to do, which you could).

Plus you could always staff an ER if you felt like it. And in the end, you could make your practice focus on “derm” stuff (botox, mole removal, etc) without exclusively doing derm.

Not about the money like others were saying. I just hate managing chronic conditions. I want zero part of diabetes and hypertension checks. More interesting pathologies like the autoimmune conditions in derm are cool, but the standard fare in a FM clinic is my nightmare.

 

[deleted674723]

Folks in IR leadership are trying to shift IR away from this model. They want IR to own their patients and practice in more of a surgical/clinical model rather than just doing the procedure and sending the patient on their way. I too view the lack of ownership as a perk, but practice patterns may shift in the coming years.

OP, you sound like you'd be happy in DR. As you mentioned, there are enough procedures to break up the day and you can always do IR if you're itching to primarily be a proceduralist. I had similar thoughts to you regarding patient interaction when I chose DR, but now that I'm almost done intern year I find patient interaction highly overrated lol. The caveats with IR are the shifting practice model (as I mentioned above) and extreme competitiveness; the latter should not be a problem if you can get in some research, good letters, and aways. You are right in that AI will likely result in a contraction of the DR job market in the future, so DR is more of a gamble than derm in that regard. Like another poster mentioned, I think that even general derm folks do small procedures like lump/bump excisions, biopsies, injections, etc.

I honestly don't think I would miss interacting with patients, but I am worried about losing the interaction with other people and being part of a team. I haven't had too much experience yet with rads so I'm not sure at this point how solitary it is, but many suggest that it is the most of any specialty at minimum.

 

[deleted674723]

IR also is extremely fast growing and making up procedures as they go. Everything is going more minimally invasive if it can. You would be surprised as what IR is doing these days. Anything they can get their hands on. As for it being "relatively minor procedures" sure compared to open surgery but you still get to do cool stuff like break up clots in stroke care and the procedures are fast so monotony won't be as much of an issue when you're not operating for 6 hours on the same case.

@Tankstah have you looked into OBGYN? You mention you like the medicine and surgical aspect of Urology plus the variety. OBGYN has a good amount of medicine involved, lots of endocrine and pharm, OR cases, and in office procedures, plus L and D is its own beast. You can do robotic cases just like urology but yea probably not the same level of surgical variety. And different pathways depending on your interests after residency, i.e. more surgical or medicine oriented fellowships depending what you like.

Granted it takes a certain personality fit if you're a guy seeing as you deal with private female parts all day every day but the patient population is generally healthy which you say you prefer.

I actually loved OBGYN. The variety is awesome, the people aren't sick. Babies are dope. I decided I really don't think I have the personality to deal with being a male in that field and I moved on.