Indecision in 3rd Year

[NecrotizingFasciitis]

Our school e-mailed that we should be getting prepared to apply for away rotations soon (Dec/Jan) & I have locations picked out where I would like to rotate, the problem is I am getting less & less sure of what I want to do. Anybody else in the same position? Any other residents or 4rth year students have advice on what to do? I have tried the AMA quiz before, listened to several The Undifferentiated Medical Student (TUMS) podcasts, talked with several people.

When I first decided I wanted to go to medical school, I wanted to do family medicine, but was talked out of it by several people; I didn't know much about things at the time & everybody said I should try to specialize or do surgery or ya know, stuff like that.. but since I was so malleable & new to things I kinda got away from the idea.

After my first two years of school I wanted to do internal medicine, but didn't have the greatest experience on one of my rotations (not the best environment for learning.. one attending that was with us made it kind of miserable) & now I'm on family medicine having a great time. I've been told I would be a good fit for emergency, but I've never really thought about doing that, & won't have exposure until the end of this year anyways. I don't think I would ever be interested in surgery (haven't had it yet but I don't think my lower back couldn't take it honestly, lol.. & idk sounds kinda boring (no offense to future/current surgeons on here!))

The stress comes from needing to apply for away rotations soon & still not really knowing what I want to do at the moment.

Thanks for any replies/advice.
-NF



Edit: clarified a little bit about what I meant by "talked out of family medicine"

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[SLC]

Family Med for the win. With the right employment situation this is a very satisfying field. I love going to work every single day. (Not that I’m saying I work every single day, but that I love everything I do)

 

[NonTrad16]

Talked out of it by whom? It’s a very personal decision, and I know some people loved rotations that I hated — it’s about your fit, not theirs.

If possible, I think it could be helpful to speak to a FM physician (either someone at your school, or the site you were at that you enjoyed). I was surprised how much I liked EM, but crossed it off for a variety of reasons. I liked FM most so far as well, and the more rotations I do the more it seems to feel like FM would be a good decision. But again, it’s about what you will enjoy.

I’d also say, there’s a lot more variety of practice (for any specialty) than what you’d likely see in one rotation at one site. Additionally, you’ll have more and more flexibility/autonomy/control as you go forward. So I’m personally looking to see what will minimize my pains (I don’t want the OR, etc) and allow me to do more of what I like (at a more superficial level now, with hopes that time will provide more clarity and confidence!).

I’m any case, you’re definitely not facing uncertainty alone!

 

[curbsideconsult]

If FM is what you want, then go for it. It's a shorter residency (but there are still fellowship options open to you if you want to go that route) and you'll have no shortage of job offers.

As for away rotations, if you're going for FM, you don't need to do them, but I think it would be beneficial to do one just so you can see what other health systems are like. I wouldn't stress too much about it.

 

[Espressso]

I've seen some sort of decision tree for this on here in the past. It goes something like this:

OR or no OR? Then,
Procedure-based vs. non-procedure based?
Longevity of care with patients vs short-term care?

Then at that point, you should have it down to a few options.


I'm just a third year too. But I'm of the opinion that one lame/bad rotation during third year shouldn't eliminate a potential residency for the future. If one attending treated everyone like crap, should that translate to so many students not going into that field when they were planning on pursuing it before meeting that attending? Maybe this does happen frequently, but I think it shouldn't.

It seems like for you it's between FM vs EM vs IM (if you still consider that). If not then FM vs EM. And assuming board scores are good for EM then you have to decide if you prefer caring for patients over the span of years in an outpatient setting or do you like the hustlin'-bustlin' stabilize and discharge action in the ER.

 

[FindersFee5]

I've seen some sort of decision tree for this on here in the past. It goes something like this:

OR or no OR? Then,
Procedure-based vs. non-procedure based?
Longevity of care with patients vs short-term care?

Then at that point, you should have it down to a few options.


I'm just a third year too. But I'm of the opinion that one lame/bad rotation during third year shouldn't eliminate a potential residency for the future. If one attending treated everyone like crap, should that translate to so many students not going into that field when they were planning on pursuing it before meeting that attending? Maybe this does happen frequently, but I think it shouldn't.

It seems like for you it's between FM vs EM vs IM (if you still consider that). If not then FM vs EM. And assuming board scores are good for EM then you have to decide if you prefer caring for patients over the span of years in an outpatient setting or do you like the hustlin'-bustlin' stabilize and discharge action in the ER.

I like this decisional tree, but I would add "Do you like patients or not?" as a first branch point to include pathology and radiology.

 

[NecrotizingFasciitis]

I've seen some sort of decision tree for this on here in the past. It goes something like this:

OR or no OR? Then,
Procedure-based vs. non-procedure based?
Longevity of care with patients vs short-term care?

Then at that point, you should have it down to a few options.


I'm just a third year too. But I'm of the opinion that one lame/bad rotation during third year shouldn't eliminate a potential residency for the future. If one attending treated everyone like crap, should that translate to so many students not going into that field when they were planning on pursuing it before meeting that attending? Maybe this does happen frequently, but I think it shouldn't.

It seems like for you it's between FM vs EM vs IM (if you still consider that). If not then FM vs EM. And assuming board scores are good for EM then you have to decide if you prefer caring for patients over the span of years in an outpatient setting or do you like the hustlin'-bustlin' stabilize and discharge action in the ER.

I'm glad you brought the algorithm up I think I've seen that around the forums too.

I don't think I want OR
I wouldn't mind doing some procedures here & there but nothing too crazy
And I'm not sure about longevity of care.. I think I like the idea of short term.

I feel like this points to EM but I have never really thought about doing EM. & I don't know if I like the hours they have to deal with either?

I've heard this piece of advice (the bolded/underlined in your post) a couple times speaking with people about this. I have a couple electives in internal medicine subspecialties left the remainder of the year so maybe this will help? But I'm not sure if I want to do a subspecialty either. I liked the idea of maybe being a hospitalist.

Kind of going off of that, I've been trying to figure out the major differences between becoming a hospitalist via the internal medicine route vs. the family medicine route. If you end up at the same end point, & some family medicine programs spend a hefty amount of time rounding in the hospital.. I wonder why someone would choose the internal medicine route. But my first attending I rotated with insisted that if I wanted to become a hospitalist, I needed to match academic IM in order to get good training. He didn't explain why, he just mentioned it one day.

As for EM, I am good score-wise, but I am a little concerned that if I end up liking it (it's literally my first rotation of fourth year), my application won't have enough EM interest on it by the time I apply. But at the same time you can work in the ER through family medicine too so I'm not sure.



P.S. thank you to everyone for commenting, I have read & thought about all of the comments & I really do appreciate it; this issue has been stressing me out a lot the past month or so

 

[fldoctorgirl]

Kind of going off of that, I've been trying to figure out the major differences between becoming a hospitalist via the internal medicine route vs. the family medicine route

Just a 2nd year but I've looked into this as being a hospitalist is high on my interest list. I was told it's harder but not impossible to get hospitalist job offers being FM trained, particularly if you're looking at living in a city/large metro. Don't think it matters whether you go to an academic center considering you wouldn't be pursuing fellowship.

 

[Espressso]

I'm glad you brought the algorithm up I think I've seen that around the forums too.

I don't think I want OR
I wouldn't mind doing some procedures here & there but nothing too crazy
And I'm not sure about longevity of care.. I think I like the idea of short term.

I feel like this points to EM but I have never really thought about doing EM. & I don't know if I like the hours they have to deal with either?

I've heard this piece of advice (the bolded/underlined in your post) a couple times speaking with people about this. I have a couple electives in internal medicine subspecialties left the remainder of the year so maybe this will help? But I'm not sure if I want to do a subspecialty either. I liked the idea of maybe being a hospitalist.

Kind of going off of that, I've been trying to figure out the major differences between becoming a hospitalist via the internal medicine route vs. the family medicine route. If you end up at the same end point, & some family medicine programs spend a hefty amount of time rounding in the hospital.. I wonder why someone would choose the internal medicine route. But my first attending I rotated with insisted that if I wanted to become a hospitalist, I needed to match academic IM in order to get good training. He didn't explain why, he just mentioned it one day.

As for EM, I am good score-wise, but I am a little concerned that if I end up liking it (it's literally my first rotation of fourth year), my application won't have enough EM interest on it by the time I apply. But at the same time you can work in the ER through family medicine too so I'm not sure.



P.S. thank you to everyone for commenting, I have read & thought about all of the comments & I really do appreciate it; this issue has been stressing me out a lot the past month or so

Just a 2nd year but I've looked into this as being a hospitalist is high on my interest list. I was told it's harder but not impossible to get hospitalist job offers being FM trained, particularly if you're looking at living in a city/large metro. Don't think it matters whether you go to an academic center considering you wouldn't be pursuing fellowship.

I'm pretty sure I'm set on IM-hospitalist myself but again, still a third year so take my 0.02 as just that. But I don't think you need academic IM for that. But having it does open up more doors (location wise). I agree with @fldoctorgirl I think if you're set on hospitalist IM is a better route. It's in a way, designed to get you to that point. And FM doesn't guarantee you to get there.

As for your comment about EM. Don't a lot of MD schools don't do EM rotations until the start of fourth year? I don't think that necessarily stops them from applying and pursuing it. You just have to be efficient in terms of getting your auditions set up after in the circumstance that you end up wanting to pursue it after your first EM rotation.

I think for the EM hours, it's basically shift work. And it's not always 7 on 7 off like what everyone says. And hospitalist work is often shift work in nature too. I think when it comes to IM vs FM, you have to think how much of having an outpatient practice means to you. For me, I hate outpatient. So ideally I'd do IM and do hospitalist work only. A FM route can help you build a future with a mix of both inpatient and outpatient. IM can do this too but it's much more common (and easier I'd imagine) for you to get this after doing FM.

 

[NecrotizingFasciitis]

I'm pretty sure I'm set on IM-hospitalist myself but again, still a third year so take my 0.02 as just that. But I don't think you need academic IM for that. But having it does open up more doors (location wise). I agree with @fldoctorgirl I think if you're set on hospitalist IM is a better route. It's in a way, designed to get you to that point. And FM doesn't guarantee you to get there.

As for your comment about EM. Don't a lot of MD schools don't do EM rotations until the start of fourth year? I don't think that necessarily stops them from applying and pursuing it. You just have to be efficient in terms of getting your auditions set up after in the circumstance that you end up wanting to pursue it after your first EM rotation.

I think for the EM hours, it's basically shift work. And it's not always 7 on 7 off like what everyone says. And hospitalist work is often shift work in nature too. I think when it comes to IM vs FM, you have to think how much of having an outpatient practice means to you. For me, I hate outpatient. So ideally I'd do IM and do hospitalist work only. A FM route can help you build a future with a mix of both inpatient and outpatient. IM can do this too but it's much more common (and easier I'd imagine) for you to get this after doing FM.

After asking around a bit it seems that you are right about the bolded.

I think also you & @fldoctorgirl are correct in that IM would probably be the better route if you are set on becoming a hospitalist. From the bit of reading I did yesterday I think if you do FM --> hospitalist route it is more likely to happen in rural areas, & I'm guessing it's the same for the FM --> ER route.

I'll have to do some more thinking to try & figure out what kind of patient population I think I'd want to see I guess. I was pretty opposed to rural stuff before medical school & during 1st/2nd year, but I'm not as opposed anymore as long as I am within short driving distance to a decent sized city.

& I'm not sure how much continuity of care I want with patients either. I think my favorite part of medicine is the problem solving part, & I feel like if you have too much continuity of care (for lack of a better way of phrasing that) there might be less "problems to solve" & it becomes more of a management over time job (diabetes meds, COPD inhaler stuff.. ya know?) Which doesn't sound super exciting.. But I could see myself being happy with a good mix of the two. & I like both the hospital environment & the outpatient clinic environment so it would be nice to get a little of both if possible.

I'll figure it out eventually (hopefully), lol.

 

[fldoctorgirl]

& I'm not sure how much continuity of care I want with patients either. I think my favorite part of medicine is the problem solving part,

This is exactly what I love about medicine and it's why I'm heavily considering being a hospitalist. The only downside to me is the hours (not just 9-5 M-F) but I've also heard that there will always be someone to hire you for the kind of contract you want. Also, you can always just transition from being a hospitalist to working outpatient.

 

[Espressso]

This is exactly what I love about medicine and it's why I'm heavily considering being a hospitalist. The only downside to me is the hours (not just 9-5 M-F) but I've also heard that there will always be someone to hire you for the kind of contract you want. Also, you can always just transition from being a hospitalist to working outpatient.

I'm the same way. But there was a thread on here a while ago I think an IM/hospitalist AMA and he was talking about how you have so much flexibility in terms of how you want your hours to look. I think he said he does 12 or 14 12-hour shifts a month and does call for two of the four weekends. And then can moonlight on any of his off days. That's a really awesome schedule IMO.

 

[fldoctorgirl]

I'm the same way. But there was a thread on here a while ago I think an IM/hospitalist AMA and he was talking about how you have so much flexibility in terms of how you want your hours to look. I think he said he does 12 or 14 12-hour shifts a month and does call for two of the four weekends. And then can moonlight on any of his off days. That's a really awesome schedule IMO.

I think the flexibility of it is what's really attractive...like you said, you can knock out a bunch of 12 hour shifts and then have half of the month off, or you can follow the 4 on/3 off --> 4 off/3 on schedule, you can work 7 or 8 hour shifts and just work more shifts. You can get sick of working weekends and transition to outpatient if you want.

 

[NecrotizingFasciitis]

Have either of you heard what the difference is between outpatient IM & outpatient FM? @fldoctorgirl @Espressso

 

[Espressso]

Have either of you heard what the difference is between outpatient IM & outpatient FM? @fldoctorgirl @Espressso

A FM or IM trained doc on here would obviously be better to ask. But, from my limited experience, it seems to be virtually the same thing. FM docs can see younger kids obviously. And IM sticks with adult medicine.

 

[fldoctorgirl]

Have either of you heard what the difference is between outpatient IM & outpatient FM? @fldoctorgirl @Espressso

To echo what @Espressso said, I haven't noticed any difference, especially since I'm from a large metro area. My PCP is an FM doctor and he actually straight up refuses to see kids (I asked him if he would see my younger brother once and he literally said "why would I when there are 10 pediatricians right across the street?") and doesn't do anything ob/gyn related as far as I know. The other FM doc in his practice will do routine gyn care like pap smears, but I also don't think she does OB care or anything else. I've only heard of a difference in rural places, where the FM doc really does everything.

 

[austintr]

I always kind of wondered that as well, and in my experience (which is really just 3 rotations between outpt IM and FM) the IM doc I was with was dealing with slightly more complex patients. She didn't do kids, although her two partners did. One of them specialized in developmental disabilities as well, but they were all former hospitalists turned outpatient generalists. They still pick up occasional hospitalist shifts. The FM docs work slightly better hours, one employed and one private practice.

All in all, there's not that much difference. The IM and one of the FM docs both worked for the same hospital system and other than the FM clinic being slightly less chaotic, pretty much identical gigs.

 

[neurodjent]

I think that a lot of medical students think that when they find the specialty that they're right for, or is right for them, it'll hit them like a ton of bricks and they'll just know that's the right one and they'll love everything about it. I don't think that is actually how it happens and there are gonna be aspects of each specialty that you'll love and some that you'll hate. I honestly think that if you're having a good time in a certain specialty, that's as good a reason to pursue it as any. You're going to want to enjoy what you're doing. Sometimes there is a fear of missing out or a sensation of "what if" about other specialties but the fact is that you're not going to get a chance to experience them all and we don't get a lot of time to really think about what we wanna do. I wish you luck man and if you're having a good time with FM and that's what you thought you wanted to go into coming into med school, go for that. At least at the end of the day your lifestyle will be pretty good.

 

[OnePunchBiopsy]

OR or no OR? Then,
Procedure-based vs. non-procedure based?
Longevity of care with patients vs short-term care?

Building on this, I always recommend:

Patient Contact? Y/N
Kids/Babies? Y/N
OR? Y/N
Procedures? Y/N
Hospital-based or Clinic-based?
Long-term care vs. Short-term care

 

[SLC]

Have either of you heard what the difference is between outpatient IM & outpatient FM? @fldoctorgirl @Espressso

I’m an FM attending. The difference is that IM docs don’t see kids, generally in my experience they also don’t do women’s health. Most IM outpatient docs I know end up basically practicing geriatrics.

I see all ages and stages. I have newborns on my panel, and I have a few patients in their 90’s.

I also focus a lot on family planning/contraception and women’s health. I place IUD’s, Nexplanon, etc. I practice in a college town so I do lots of them. I also rx isotretinoin and do other things for acne. My patient panel skews toward the younger end of the spectrum as a result; and I have significantly more females than males.

I also am the only provider in my office who’s doing circumcisions right now, which brings me a lot of newborns and young families.

im also suboxone certified, but not currently prescribing. I’ll tell ya, that will get a clinic schedule packed full quickly.

I’m also rural so I get a lot of walk in traumas. I’ve seen finger amputations, farm machine injuries, closed and open head injuries, and more fractures than I can count.

I don’t do OB though, I got trained but didn’t really enjoy it much so I don’t do it. But I do a bit of everything else. No IM doc that I’m aware of sees the variety I do.

 

[Drrrrrr. Celty]

I'm not entirely sure outpatient IM is anymore geriatrics based than FM is. I'm in a resident clinic and I get a lot of variety and most of my patients are under or around 50.

I think the major difference between IM and FM is also stratified onto program quality. A lot of good solid FM programs with a lot of inpatient training have as strong if not stronger backbones in inpatient medicine than some poorer quality IM programs. Alternatively some FM programs who are exclusively outpatient based have so little inpatient training that they learn how to understand and manage a lot of more serious conditions by exclusively consulting.

I think a lot of medicine is really only learnable when you can see a patient for multiple days and see how medications work and or how disease progresses. Cirrhosis for example or ESRD isn't something you learn in the clinic, it's something you learn because you are horrified how quickly they can turn into absolute messes.

Alternatively I don't in clinic have a lot experience with minor procedures. I can put a central line in, but I don't really know how to do many of the above that SLC mentioned. Albeit since I intend to practice in an urban environment I can always say that for most women's health aside from mammos I can defer to Obgyn.

As far as the subspecialization v.s not topic. It's really hard to anticipate. But I can say that for myself I love general medicine a lot. I love treating non-psychotic psych issues, I love managing chronic diseases, and I enjoy having to learn more about how to approach different diseases because I've forgotten. But I do think that it's exhausting having to manage 20 different conditions in a day and I feel like I wouldn't have been as good a doctor than if I stayed more narrow and focused on one thing.
For other people this is the opposite. They live and breath variety and treating two types of diseases over and over again wouldn't be medicine.

 

[sunshinefl]

Have either of you heard what the difference is between outpatient IM & outpatient FM? @fldoctorgirl @Espressso

Also a 3rd year, but my generalizations from my cumulative life experience: besides FM being able to see Peds and ObGyn stuff, they also seem more likely to have in office extras like joint injections, POC testing, ear irrigation, etc. This may just be coincidence though in the practices I have seen. But I’m basing this on what I’ve experienced as a patient, nurse, and medical student in multiple cities.