M3 still undecided on specialty -help!

[premedeq]

Hey everyone,
I'm an M3 (soon to be M4 in May 2022), still undecided on a specialty. So far I've completed Peds/FM/Neurology/Psych/IM- I've really enjoyed all of my rotations, but I've ruled out FM, peds, and psych. Top 30/40 med school. Top 25% of my class for the pre-clinical years. 269 on Step 1. Honors on all my rotations so far. I also have some obligatory research: a couple of manuscripts/presentations during med school, lots during undergrad.

Initially, I was thinking medicine (I love the pathophysiology/pharm of cardiology especially), but I've been on my surgery rotation for the past two weeks and have really enjoyed using my hands and my attending/chief have really been pushing me towards surgery; some have suggested I consider anesthesiology for the mix of medicine and procedures (haven't done this rotation yet).

Things that are important to me:
- Short residency/fellowship time: I'm eager to get past 80 hour weeks and horrible schedules
- Good work-life balance with a flexible schedule, ability to take 3-4 day weekends, or take a couple of weeks off at a time for traveling, shift work would be nice
- I don't need to go into the highest paying specialty, but I want to feel adequately compensated. I won't have any debt.
- Ample career opportunities in rural areas, preferably in the west/northwest- in a field that won't soon be oversaturated. I don't want to do research, but I would enjoy teaching.
- Ability to use my hands (procedures) and my mind (thinking through pathophysiology/pharmacology)

I would love to hear some suggestions based on my 'wish-list' above, of course I know there probably isn't one specialty that fits all these criteria, but I would appreciate some help!

TIA

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[spidermedic]

but I've ruled out FM, peds, and psych. Top 30/40 med school. Top 25% of my class for the pre-clinical years. 269 on Step 1. Honors on all my rotations so far. I also have some obligatory research: a couple of manuscripts/presentations during med school, lots during undergrad.


Things that are important to me:
- Short residency/fellowship time: I'm eager to get past 80 hour weeks and horrible schedules
- Good work-life balance with a flexible schedule, ability to take 3-4 day weekends, or take a couple of weeks off at a time for traveling, shift work would be nice
- I don't need to go into the highest paying specialty, but I want to feel adequately compensated. I won't have any debt.
- Ample career opportunities in rural areas, preferably in the west/northwest- in a field that won't soon be oversaturated. I don't want to do research, but I would enjoy teaching.
- Ability to use my hands (procedures) and my mind (thinking through pathophysiology/pharmacology)

DERM. Every specialty wants a piece of derm's pie (cosmetics). If you spend more than 10 minutes on social media you'll see everyone from FM, IM, ENT, Anesthesiology, and midlevels doing fillers, injections, etc.

As a derm doc you'll be the "expert" and there are people who only want the best (and will gladly pay top dollar for it). You'll be wiping your rear with benjamins

Please don't do medicine or surgery with your stats and you already stated you want a short residency with good work-life balance

 

[Barrel Proof]

It does sound like anesthesia would be a great fit for you. I understand your eagerness to have residency over and done with, but in the end an extra couple of years to end up in a field that makes you happy for a 30+ year career is worth it, in my opinion. If you can get on board with that, interventional radiology could be something to look into and consider.

 

[Phloston]

Hey everyone,
I'm an M3 (soon to be M4 in May 2022), still undecided on a specialty. So far I've completed Peds/FM/Neurology/Psych/IM- I've really enjoyed all of my rotations, but I've ruled out FM, peds, and psych. Top 30/40 med school. Top 25% of my class for the pre-clinical years. 269 on Step 1. Honors on all my rotations so far. I also have some obligatory research: a couple of manuscripts/presentations during med school, lots during undergrad.

Initially, I was thinking medicine (I love the pathophysiology/pharm of cardiology especially), but I've been on my surgery rotation for the past two weeks and have really enjoyed using my hands and my attending/chief have really been pushing me towards surgery; some have suggested I consider anesthesiology for the mix of medicine and procedures (haven't done this rotation yet).

Things that are important to me:
- Short residency/fellowship time: I'm eager to get past 80 hour weeks and horrible schedules
- Good work-life balance with a flexible schedule, ability to take 3-4 day weekends, or take a couple of weeks off at a time for traveling, shift work would be nice
- I don't need to go into the highest paying specialty, but I want to feel adequately compensated. I won't have any debt.
- Ample career opportunities in rural areas, preferably in the west/northwest- in a field that won't soon be oversaturated. I don't want to do research, but I would enjoy teaching.
- Ability to use my hands (procedures) and my mind (thinking through pathophysiology/pharmacology)

I would love to hear some suggestions based on my 'wish-list' above, of course I know there probably isn't one specialty that fits all these criteria, but I would appreciate some help!

TIA

If you're the surg type, you'll know. Your comment about enjoying using your hands tends to be a common theme among surgeon types. Plenty of people who choose internal medicine literally abhor surgery.

At the end of the day, there's no wrong decision about what field you choose to pursue. Your decisions are yours.

 

[mrbreakfast]

Three suggestions to think about:
1) If you decide you really like doing surgery, consider plastics. Not a short or super-cush residency, but still.

2) If you decide you really like procedures but not surgery, derm could be good fit.

3) It's not "prestigious," but neurology is something you should really think about. It's the only specialty that really checks all the boxes for you: four year residency/five with a fellowship, good work-life balance and compensation (e.g. you could work 7 on/14 off and start at >300K as a neurohospitalist in a small-medium city) you can easily be the only neurologist in miles, plenty to teach even in a non-academic institution (even seasoned attendings in other fields know nothing about neurology, and in my experience are generally very interested in hearing your thought process), and good combination of using your hands (physical exam is by far the main diagnostic tool) and pathophysiology/pharmacology. As a neurologist I'm biased, but something to think about - neurology wasn't even on my radar until midway through M3.

 

[Dr Meow]

RADS get that lazy 1M. Work from a tropical island while naked in the shower.

 

[DOVinciRobot]

ENT.

 

[operaman]

ENT or Derm, though you’re a little behind in terms of research and connections starting at this point in M3. It’s certainly doable, but will take some ball busting.

ENT hits all your wants minus the short residency thing. Derm seems to hit all of them to some extent. Both are great fields and opportunities are unlimited.

It may not be intuitively obvious, but there’s a lot of thinking involved in these fields too if you’re interested. They can also be much more procedure monkey fields where you shuck tonsils or freeze skin lesions all day and make bank and leave at 4.

If you want to practice in a rural area then you can do whatever you want and refer the rest to the nearby academic center in the city.

 

[Ole_Toe]

I would really consider ophthalmology with your excellent stats. Lots of people come to it late so you can prob find a way to get exposure and get your pubs without a gap year. Competitive but checks a lot of the boxes you mention, especially in regards to lifestyle and training (3 years residency with a hopefully cush transition year). Derm, Ophtho, ENT all seem like good fits but will require a last minute scramble and research. Anesthesia would be the one exception as I understand far less competitive. good luck!

 

[NickNaylor]

Whatever you decide, I would just make sure that it's something that really interests you in some way such that the prospect of doing it for much of your life seems doable. Income, considerations about residency training, etc. are all very reasonable concerns, but just remember that doing a brief residency in a field you don't enjoy, making a bunch of money while hating every aspect of your job, etc. are not pathways to a sustainable career. No amount of money is going to make a job you abhor enjoyable, and focusing on the next few years at the expense of multiple decades is relatively short-sighted.

You have plenty of options based on the information you provided and will likely be competitive no matter what you decide, assuming there aren't any red flags in your history. Try and do some electives and explore fields that you haven't had a chance to and see if you can imagine liking the work.

 

[Gilakend]

ENT.

Is it realistic to consistently take multiple weeks off at a time as a surgeon? I realize ENT is one of the "lifestyle" surgery specialties and could definitely do the 3-4 day weekends as OP mentioned. But I was under the impression multiple weeks off consistently was hard to swing in almost any surgery* (which is one huge con of a surgical specialty for me as I gear up to apply).

*I realize it is theoretically possible, especially if you make your own schedule in private practice. I mean realistic from a standpoint that also includes not upsetting other partners, paying overhead, keeping to your call schedule, being able to maintain/building your patient base, etc.

 

[flapjack3d]

PM&R, derm, radiology
Honestly ER sounds like a good fit, but with that step do derm for sure if you have an interest

 

[DOVinciRobot]

Is it realistic to consistently take multiple weeks off at a time as a surgeon? I realize ENT is one of the "lifestyle" surgery specialties and could definitely do the 3-4 day weekends as OP mentioned. But I was under the impression multiple weeks off consistently was hard to swing in almost any surgery* (which is one huge con of a surgical specialty for me as I gear up to apply).

*I realize it is theoretically possible, especially if you make your own schedule in private practice. I mean realistic from a standpoint that also includes not upsetting other partners, paying overhead, keeping to your call schedule, being able to maintain/building your patient base, etc.

Taking multiple weeks off in a row is difficult in any specialty…

 

[Gilakend]

Taking multiple weeks off in a row is difficult in any specialty…

Definitely, but I mean compared to the specialties that traditionally get more vacation, i.e. rads, anesthesia, EM (I think?), etc. I was told this is significantly harder in a surgical sub than those I mentioned, I was just wondering if you had a different perspective. I thought OPs desire for a "shift work" type job and vacation would have eliminated all surgical subs.

 

[ACSurgeon]

Taking multiple weeks off in a row is difficult in any specialty…

Except acute care surgery.

 

[DOVinciRobot]

Except acute care surgery.

I mean, but then you have to actually DO acute care surgery.... groce

 

[ACSurgeon]

I mean, but then you have to actually DO acute care surgery.... groce

Touche

 

[Faster Horses]

Please choose derm or optho... You have put yourself in a position where you do not have to fight the mid-levels (i.e. Primary care, Anesthesia). Both are short, derm 4 and optho 4/5. Easy life, not really dealing with "sick people" like the rest of your peers. Throw your stethoscope away and eat ribeye steak 7 nights a week. Oh, and only work 15 days a month from 9:00-3:00. I'm foaming at the mouth just thinking about it

 

[Dral]

I agree with some others that have posted:

ENT
Ophtho
Derm -> Mohs

All those sound like they may hit all your wants. However, while Mohs can be cerebral with how to approach lesions/accomplish repairs, there isn't much in the way of thinking through physiology.

 

[Darrow O'Lykos]

RADS get that lazy 1M. Work from a tropical island while naked in the shower.

As opposed to being fully clothed in the shower?

 

[Mass Effect]

The most successful way to insure burnout and hate your life is to choose your career based on your Step score. You need to do some rotations or at least shadow for a day or two in things like derm, ENT, anesthesia and optho if you are considering them.

 

[Smurfette]

Is it realistic to consistently take multiple weeks off at a time as a surgeon? I realize ENT is one of the "lifestyle" surgery specialties and could definitely do the 3-4 day weekends as OP mentioned. But I was under the impression multiple weeks off consistently was hard to swing in almost any surgery* (which is one huge con of a surgical specialty for me as I gear up to apply).

*I realize it is theoretically possible, especially if you make your own schedule in private practice. I mean realistic from a standpoint that also includes not upsetting other partners, paying overhead, keeping to your call schedule, being able to maintain/building your patient base, etc.

The issue with taking multiple weeks off as a surgeon include:
1. How far out are you booking cases? Because you need the income from cases to support yourself, and patients are going to go to other surgeons to address their problems faster if you are booking too far out and working cases around your vacations.
2. Who is covering your complications if you aren't around to see and manage them yourself?
3. Call coverage.
4. Referral base. If you are known to be someone who doesn't work much or are out for prolonged amounts of time and can't get patients in to see you quickly, PCPs will find someone else to refer to.
5. What do you do with your office support staff if you are gone for a long time? They need income too.
6. Building skills. When you first go into practice, your learning curve is crazy as you adjust to real life without residents, attending mentors around you all the time, and no longer being in academics. The less you work, the longer it takes to find your comfort zone.
These are just off the top of my head.

 

[Gilakend]

The issue with taking multiple weeks off as a surgeon include:
1. How far out are you booking cases? Because you need the income from cases to support yourself, and patients are going to go to other surgeons to address their problems faster if you are booking too far out and working cases around your vacations.
2. Who is covering your complications if you aren't around to see and manage them yourself?
3. Call coverage.
4. Referral base. If you are known to be someone who doesn't work much or are out for prolonged amounts of time and can't get patients in to see you quickly, PCPs will find someone else to refer to.
5. What do you do with your office support staff if you are gone for a long time? They need income too.
6. Building skills. When you first go into practice, your learning curve is crazy as you adjust to real life without residents, attending mentors around you all the time, and no longer being in academics. The less you work, the longer it takes to find your comfort zone.
These are just off the top of my head.

This is along the lines of what I was thinking. Didn't even think about things like office support staff, that's a great point.

 

[DoctwoB]

Things that are important to me:
- Short residency/fellowship time: I'm eager to get past 80 hour weeks and horrible schedules
- Good work-life balance with a flexible schedule, ability to take 3-4 day weekends, or take a couple of weeks off at a time for traveling, shift work would be nice
- I don't need to go into the highest paying specialty, but I want to feel adequately compensated. I won't have any debt.
- Ample career opportunities in rural areas, preferably in the west/northwest- in a field that won't soon be oversaturated. I don't want to do research, but I would enjoy teaching.
- Ability to use my hands (procedures) and my mind (thinking through pathophysiology/pharmacology)

You forgot the best specialty in medicine: Urology!

-5 years of training and no need for fellowship unless you want a specific niche or be in academics and even then not always mandatory. No lie though residency is often tough/long hours.
-able to have a good lifestyle post residency
-very good compensation
-near unbeatable job market. Rural areas, suburban, desirable urban metros, whatever you want.
-Ton of procedures/surgeries that run the gamut from office procedures to endoscopy to robotics to major open surgery
-Great mix of medicine/surgery as we are our own medical specialty when it comes to the urinary and male genital tracts outside of medical renal disease. Because of this we are very protected. No one does what we do and areas of encroachment and overlap are minimal (share prolapse work with urogyn, pediatric hernias with Gensurg, some cash business with shysters offering T injections or penile shockwave therapy in “mens health clinics”)
Most of our surgeries affect major quality of life issues or curable cancers and our patients have great outcomes.

 

[DoctwoB]

This is along the lines of what I was thinking. Didn't even think about things like office support staff, that's a great point.

How much this matters will depend a lot on your practice setting as much as specialty. Are you solo or in a 2 person group? Finding coverage for your 2 week vacation is more imposing when you’re gone and it slows down your office more. Group of 5 or more? Less of an issue. Also different practices have very different cultures regarding covering for partners who are off and taking vacation time. Some are very work to live, some are live to work, some are more work hard play hard (work hard while here but take a lot of Vacay, etc). Make sure you end up in a place that aligns with your values.