MD & DO M3 trying to find a specialty

[random_hooligan]

Very confused M3 trying to navigate the waters of different medical specialties, and I was hoping I could get some help. Some thoughts on my likes/dislikes so far:

Likes:
Being in the OR

• I love the big long cases I got to be a part of in gen surg, like ex-laps, thoracotomies, etc. However, when I did an ophtho elective, I found back-to-back cataract cases all day long incredibly mind-numbing, doing the same thing over and over for like 8 hours

Diversity of day-to-day activities

• I loved the many different patients I got to see in IM, I felt like I was constantly learning about different diseases in different organ systems and I liked that. Conversely, I found general ophthalmology clinic incredibly dull because almost everyone had the same things (cataracts and/or dry eyes).

Feeling like you made a difference at the end of the day

• I felt this most during my gen surg rotation, such as days when I assisted on a hemicolectomy for colon cancer, or even repairing a giant hernia that was making life very painful. I also felt this during IM, when I was able to spend time talking to the patient and give them the time of day they needed.

Thinking through a differential diagnosis

• I liked this about IM. I haven't had neurology yet but I think I will enjoy how cerebral it is, and how much thinking is involved.

Having meaningful conversations with (adult) patients

• Like mentioned above, this was definitely important for me, and I'm struggling to find a way to incorporate longitudinal patient relationships with my desire for the OR.

Dislikes:
Lack of variety/diversity of what you do day to day

• While I liked gen surg, if I only did hernias and cholecystectomies I can imagine it getting very dull fast

Being more of a secretary/manager than a doctor

• The endless paperwork in IM was a nightmare. I know paperwork is a problem in every specialty but it was a big turn-off. Such a big chunk of the day for the resident was doing paperwork and contacting outside hospitals for paperwork.

Consulting everyone else

• I know teamwork is a good idea, but one thing that was frustrating on IM was consulting every other specialty even for routine IM things. When I was on a cardiology elective, the general cardiology team even consulted the heart failure team for some patients. The endless consulting and just writing down the consulting team's plan in your plan was not intellectually stimulating. I like actually "owning" the plan for your own patient if that makes sense.

Not having enough time to *truly* talk to patients

• I know time constraints are present in all specialties, but I felt this most in ophtho. When you have to get out of the room in <10 minutes, it leaves no time for connecting with the patient. There were times when the patient wanted to discuss something more, like their fears of undergoing surgery, but was not given a chance to do so.

Tl;dr: like operating, like connecting to patients, like thinking, like "owning" a plan for your patients, and I thrive on variety. Not sure if I'm willing to sacrifice any one of those things for the sake of the others, but I think the two I am least wiling to sacrifice are variety and connecting to patients.

I'm thinking: ENT, neurology, IM, or general surgery at this point (obviously these are all a bit different).

Any advice?

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[getdown]

Very confused M3 trying to navigate the waters of different medical specialties, and I was hoping I could get some help. Some thoughts on my likes/dislikes so far:

Likes:
Being in the OR

• I love the big long cases I got to be a part of in gen surg, like ex-laps, thoracotomies, etc. However, when I did an ophtho elective, I found back-to-back cataract cases all day long incredibly mind-numbing, doing the same thing over and over for like 8 hours

Diversity of day-to-day activities

• I loved the many different patients I got to see in IM, I felt like I was constantly learning about different diseases in different organ systems and I liked that. Conversely, I found general ophthalmology clinic incredibly dull because almost everyone had the same things (cataracts and/or dry eyes).

Feeling like you made a difference at the end of the day

• I felt this most during my gen surg rotation, such as days when I assisted on a hemicolectomy for colon cancer, or even repairing a giant hernia that was making life very painful. I also felt this during IM, when I was able to spend time talking to the patient and give them the time of day they needed.

Thinking through a differential diagnosis

• I liked this about IM. I haven't had neurology yet but I think I will enjoy how cerebral it is, and how much thinking is involved.

Having meaningful conversations with (adult) patients

• Like mentioned above, this was definitely important for me, and I'm struggling to find a way to incorporate longitudinal patient relationships with my desire for the OR.

Dislikes:
Lack of variety/diversity of what you do day to day

• While I liked gen surg, if I only did hernias and cholecystectomies I can imagine it getting very dull fast

Being more of a secretary/manager than a doctor

• The endless paperwork in IM was a nightmare. I know paperwork is a problem in every specialty but it was a big turn-off. Such a big chunk of the day for the resident was doing paperwork and contacting outside hospitals for paperwork.

Consulting everyone else

• I know teamwork is a good idea, but one thing that was frustrating on IM was consulting every other specialty even for routine IM things. When I was on a cardiology elective, the general cardiology team even consulted the heart failure team for some patients. The endless consulting and just writing down the consulting team's plan in your plan was not intellectually stimulating. I like actually "owning" the plan for your own patient if that makes sense.

Not having enough time to *truly* talk to patients

• I know time constraints are present in all specialties, but I felt this most in ophtho. When you have to get out of the room in <10 minutes, it leaves no time for connecting with the patient. There were times when the patient wanted to discuss something more, like their fears of undergoing surgery, but was not given a chance to do so.

Tl;dr: like operating, like connecting to patients, like thinking, like "owning" a plan for your patients, and I thrive on variety. Not sure if I'm willing to sacrifice any one of those things for the sake of the others, but I think the two I am least wiling to sacrifice are variety and connecting to patients.

I'm thinking: ENT, neurology, IM, or general surgery at this point (obviously these are all a bit different).

Any advice?

I would suggest Anesthesia. You get to be in the OR doing and being a part of those big cases you liked. You also have procedural aspects of the specialty (Aline, central line, nerve blocks, TEE, etc). You also do all the medicine aspects of IM in considering differentials when things change as well as owning a plan for the Anesthesia technique, methods, lines, managemntm intraoperatively especially for the sick patients without the social work, long term follow up aspects of IM. And what's more than connecting with a patient within 5 minutes of meeting them during the most stressful part of their day/life.

However, also consider the negatives of the changing landscape of anesthesia with CRNAs, AMCs and your job being somewhat of the mercy of surgeons.

 

[InternistDO]

Critical care? Procedures, variety, thinking, and you usually 'own' all the patients on the ICU to a greater extent than the general IM service.

Downside is you can't talk to many of your patients because they're intubated, but there are some who are conscious and you need to communicate with families and such too. If you do pulm/CC or ID/CC you can have patient connection as part of an outpatient practice as well.

 

[random_hooligan]

I would suggest Anesthesia. You get to be in the OR doing and being a part of those big cases you liked. You also have procedural aspects of the specialty (Aline, central line, nerve blocks, TEE, etc). You also do all the medicine aspects of IM in considering differentials when things change as well as owning a plan for the Anesthesia technique, methods, lines, managemntm intraoperatively especially for the sick patients without the social work, long term follow up aspects of IM. And what's more than connecting with a patient within 5 minutes of meeting them during the most stressful part of their day/life.

However, also consider the negatives of the changing landscape of anesthesia with CRNAs, AMCs and your job being somewhat of the mercy of surgeons.

Thank you, this is helpful! Yeah the one thing about anesthesia is the CRNAs and I wonder if being in the OR but not doing the surgery would be enough (but we'll see, I have an anesthesia elective lined up!). I actually don't know about AMCs and what those are but I imagine that it is another hurdle for anesthesiologists?

 

[random_hooligan]

Critical care? Procedures, variety, thinking, and you usually 'own' all the patients on the ICU to a greater extent than the general IM service.

Downside is you can't talk to many of your patients because they're intubated, but there are some who are conscious and you need to communicate with families and such too. If you do pulm/CC or ID/CC you can have patient connection as part of an outpatient practice as well.

Yes that's a really good idea, thank you for the advice! I've rotated through the NICU and I liked how much teamwork there was as well. I'll definitely consider this and see if I can schedule an elective in it.

 

[doyouhaveaflag]

I may be biased (who isn't ) but you could consider plastic surgery. I think it hits a lot of your likes/dislikes, although with some key gaps. You'd have to decide what you're most attached to on your list.

Likes:
Being in the OR

• Plastic surgeons have a high ratio of operating vs other patient management stuff. There was what I think was a very interesting paper that came out in 2011 comparing 14 surgical specialties and they ranked them on how much time per week was spent in the OR (also ranked them on things like satisfaction, lifestyle, average call, etc) and plastics came in as 3rd most time in OR per week. Here's the paper for more: Distress and career satisfaction among 14 surgical specialties, comparing academic and private practice settings. - PubMed - NCBI

Diversity of day-to-day activities

• Extremely diverse surgeries, from skull/face to hand to breast to lower extremity. Ages from infants to geriatrics. We don't intentionally get into the chest or belly that often though.

Feeling like you made a difference at the end of the day

• Not necessarily a lot of life-saving surgeries but definitely a lot of quality of life improvement.

Thinking through a differential diagnosis

• Not so much with this. However, for reconstructive cases there is a lot of creativity that can go into operative planning.

Having meaningful conversations with (adult) patients

• This will likely be low with most surgical specialties

Dislikes:
Lack of variety/diversity of what you do day to day

• Lots of variety in plastics! (see above)

Being more of a secretary/manager than a doctor

• We are often a consulted service with few primary patients and thus the primary service does the majority of this stuff.

Consulting everyone else

• We are the consulted ones.

Not having enough time to *truly* talk to patients

• Again, this is low in most surgical specialities.

 

[Dr G Oogle]

Surgical subspecialty: ent, Uro, gyn subspecialties, especially gyn onc if you like big long cases (but have to survive obgyn residency), ortho (probably not a ton of differential diagnosis going on but not sure don’t have a ton of experience), Also the gen surge subspecialti may offer what you want

 

[random_hooligan]

I may be biased (who isn't ) but you could consider plastic surgery. I think it hits a lot of your likes/dislikes, although with some key gaps. You'd have to decide what you're most attached to on your list.

Likes:
Being in the OR

• Plastic surgeons have a high ratio of operating vs other patient management stuff. There was what I think was a very interesting paper that came out in 2011 comparing 14 surgical specialties and they ranked them on how much time per week was spent in the OR (also ranked them on things like satisfaction, lifestyle, average call, etc) and plastics came in as 3rd most time in OR per week. Here's the paper for more: Distress and career satisfaction among 14 surgical specialties, comparing academic and private practice settings. - PubMed - NCBI

Diversity of day-to-day activities

• Extremely diverse surgeries, from skull/face to hand to breast to lower extremity. Ages from infants to geriatrics. We don't intentionally get into the chest or belly that often though.

Feeling like you made a difference at the end of the day

• Not necessarily a lot of life-saving surgeries but definitely a lot of quality of life improvement.

Thinking through a differential diagnosis

• Not so much with this. However, for reconstructive cases there is a lot of creativity that can go into operative planning.

Having meaningful conversations with (adult) patients

• This will likely be low with most surgical specialties

Dislikes:
Lack of variety/diversity of what you do day to day

• Lots of variety in plastics! (see above)

Being more of a secretary/manager than a doctor

• We are often a consulted service with few primary patients and thus the primary service does the majority of this stuff.

Consulting everyone else

• We are the consulted ones.

Not having enough time to *truly* talk to patients

• Again, this is low in most surgical specialities.

Thank you for taking the time to go through what I wrote and offer so much insight, this is great! That article is interesting as well. I do have a couple questions though. What percent of the cases would you say are purely cosmetic (i.e. botox injections, face lifts, etc). Also, I know plastic surgery is a subspecialty but is there ever any further subspecialization (or is there a trend to do so for new grads) or do plastic surgeons generally get to experience the full variety?

 

[doyouhaveaflag]

Thank you for taking the time to go through what I wrote and offer so much insight, this is great! That article is interesting as well. I do have a couple questions though. What percent of the cases would you say are purely cosmetic (i.e. botox injections, face lifts, etc). Also, I know plastic surgery is a subspecialty but is there ever any further subspecialization (or is there a trend to do so for new grads) or do plastic surgeons generally get to experience the full variety?

The answers have to do with where you practice. With the exception of some programs that do more aesthetic surgeries, most academic centers see very little cosmetic surgery. Insurance doesn't cover it and the private practice surgeons tend to charge less, so patients tend to go there for their purely cosmetic needs. I haven't seen a single cosmetic breast augmentation in my entire med school/residency experience (granted, I'm an intern and I've only done 2.5 months plastics so far in residency). We do have one surgeon who likes to do facelifts, so I've assisted on a few of those. However, most of what I see is reconstructive surgery. Even the rhinoplasties tend to be either revisions of where surgeons did an unsatisfactory job before or partially functional where the patient has breathing issues. I haven't seen any botox but we do use laser for things like burns and rhinophyma.

There's a lot of things we do that non-medical folks don't realize, like facial reanimation, targeted muscle reinnervation, nerve transfer for tetraplegia, gender surgery (which includes facial feminization, mastectomy or augmentation, phalloplasty, etc). There's also a lot of wound care, which I like. The list of stuff plastic surgeons do is very long.

Whether or not you get to do it all depends on how you set up your practice. Where I went to med school, the attendings all did various types of cases even if they had done fellowship. There wasn't really much specialization. However, in really big academic centers most surgeons are fairly subspecialized. Someone who did a hand fellowship will likely be doing mostly hand cases, etc. There are fellowships after residency that you can do from either the integrated six year programs or from the three year plastics fellowship after gen surg. They are all one year and include hand surgery, craniofacial surgery, microsurgery, burn, and aesthetics. You don't have to do a fellowship though. The majority of residents from big name places tend to go on to fellowship; however, there are plenty of programs where the majority of grads go straight into practice. Hope that answers your questions.

 

[random_hooligan]

The answers have to do with where you practice. With the exception of some programs that do more aesthetic surgeries, most academic centers see very little cosmetic surgery. Insurance doesn't cover it and the private practice surgeons tend to charge less, so patients tend to go there for their purely cosmetic needs. I haven't seen a single cosmetic breast augmentation in my entire med school/residency experience (granted, I'm an intern and I've only done 2.5 months plastics so far in residency). We do have one surgeon who likes to do facelifts, so I've assisted on a few of those. However, most of what I see is reconstructive surgery. Even the rhinoplasties tend to be either revisions of where surgeons did an unsatisfactory job before or partially functional where the patient has breathing issues. I haven't seen any botox but we do use laser for things like burns and rhinophyma.

There's a lot of things we do that non-medical folks don't realize, like facial reanimation, targeted muscle reinnervation, nerve transfer for tetraplegia, gender surgery (which includes facial feminization, mastectomy or augmentation, phalloplasty, etc). There's also a lot of wound care, which I like. The list of stuff plastic surgeons do is very long.

Whether or not you get to do it all depends on how you set up your practice. Where I went to med school, the attendings all did various types of cases even if they had done fellowship. There wasn't really much specialization. However, in really big academic centers most surgeons are fairly subspecialized. Someone who did a hand fellowship will likely be doing mostly hand cases, etc. There are fellowships after residency that you can do from either the integrated six year programs or from the three year plastics fellowship after gen surg. They are all one year and include hand surgery, craniofacial surgery, microsurgery, burn, and aesthetics. You don't have to do a fellowship though. The majority of residents from big name places tend to go on to fellowship; however, there are plenty of programs where the majority of grads go straight into practice. Hope that answers your questions.

This does answer my question, and it's clear to me that there's a lot more to plastic surgery than I had thought (including the things that non-medical people didn't know haha). I will definitely look into it more, thank you for your input!

 

[OrthoTraumaMD]

*waves
Hi OP. Ortho might be a good fit. We have a ton of variety within the field, though we only deal with the MSK system it’s never boring (unless you do joints all day long)....


Sent from my iPhone using SDN mobile

 

[operaman]

ENT would definitely fit your wants. It’s also incredibly easy to customize your practice to suit what you like when you’re finally done. Big cases may seem fun as an M3 but then the long cases as a resident and then taking care of all the complications afterward may slowly change your mind. With ENT and other surgical subs you can have a lot of freedom to build a practice that suits what your likes end up being 7 years from now.

All surgical fields are somewhat insulated from the EMR burden by our OR days so there’s less of feeling like a secretary. We still deal with it like anyone else but for fewer days each week. Lots of meaningful conversations with adult patients and with parents of pediatric patients.

We do a fair amount of consulting other services but usually just for management of things we aren’t set up to handle well. This used to bother me more early on but as the years go by I have less interest in managing some things. As the thinking and planning in my own field gets more and more nuanced, I have less interest in managing things outside of that.

I think you’d be hard pressed to find more variety in any other specialty. You can do big open cancer resection and micro vascular recons. You can do big lateral skull base and ear cases. You can do quick bread and butter tubes and tonsils if you want. Endoscopic sinus and ear procedures. Cosmetic and functional facial plastics and even hair restoration if you’re into that. Lots of micro surgery in ears and laryngeal procedures. Oh and lasers and robots and all sorts of other toys. Obviously you won’t end up doing ALL of that in any practice setup, but you can pick the things you like most and do those.

 

[WedgeDawg]

Lots of good suggestions above. Here's what I have to add.

I think there are a few surgical specialties that might make a good fit for you. Believe it or not, neurosurgery fits a lot of your criteria. You're in the OR a LOT with a very high diversity of cases, your day to day can be different depending on what pathologies your patients have and what kind of cases you do (e.g. doing a multilevel spinal fusion is very different than decompressing a subdural which is again different from taking out a meningioma and the perioperative care needs of each patient is going to be quite different). You can make a big difference in the lives of your patients in very different ways depending on what their problems are (reducing pain, increasing functionality, saving their life, reducing morbidity/mortality from cancer, etc etc etc). The surgical style of thinking in terms of "differential" is different from the medically oriented specialties, but there is still certainly an element of that, though the management decisions (preoperatively, intraoperatively, and postoperatively) definitely give you a similar type of opportunity. And although you're super busy in the OR (as you will be in all surgical fields), you do get the chance to have meaningful conversations with your patients both in the hospital and in the clinic. For many patients with brain tumors, you are the first person they see after they have their imaging done and you'll be playing a big part in guiding / managing their care. For patients with devastating hemorrhages, you will be involved in a lot of family discussions about level of care, prognosis, withdrawal, etc. In clinic, you'll have longitudinal follow up for many patients. For tumor patients, you'll follow them for years, same with aneurysm or AVM patients. Spine will be more varied in terms of how longitudinally you follow them (in general simpler procedures such as discs and single level decompressions you would follow for less time than say deformity cases) but you have a lot of control over what types of patients you see and what pathologies you mostly treat. Regarding paperwork, in neurosurgery you get to dictate a lot and your notes are much shorter than they would be in, say, medicine. And while you will still be consulting for certain problems and working closely with radiology, neurocritical care, and other specialties, it will be much more likely that you get consulted and that you take a leadership role in directing care.

I think there would be a lot of similarities with other surgical specialties, and I think any surgical field that deals with cancer may be right up your alley.

 

[random_hooligan]

ENT would definitely fit your wants. It’s also incredibly easy to customize your practice to suit what you like when you’re finally done. Big cases may seem fun as an M3 but then the long cases as a resident and then taking care of all the complications afterward may slowly change your mind. With ENT and other surgical subs you can have a lot of freedom to build a practice that suits what your likes end up being 7 years from now.

All surgical fields are somewhat insulated from the EMR burden by our OR days so there’s less of feeling like a secretary. We still deal with it like anyone else but for fewer days each week. Lots of meaningful conversations with adult patients and with parents of pediatric patients.

We do a fair amount of consulting other services but usually just for management of things we aren’t set up to handle well. This used to bother me more early on but as the years go by I have less interest in managing some things. As the thinking and planning in my own field gets more and more nuanced, I have less interest in managing things outside of that.

I think you’d be hard pressed to find more variety in any other specialty. You can do big open cancer resection and micro vascular recons. You can do big lateral skull base and ear cases. You can do quick bread and butter tubes and tonsils if you want. Endoscopic sinus and ear procedures. Cosmetic and functional facial plastics and even hair restoration if you’re into that. Lots of micro surgery in ears and laryngeal procedures. Oh and lasers and robots and all sorts of other toys. Obviously you won’t end up doing ALL of that in any practice setup, but you can pick the things you like most and do those.

I'm hoping ENT will fit my wants, and I have an elective coming up in it! Do I need to love doing tubes and tonsils to love ENT?

 

[random_hooligan]

Lots of good suggestions above. Here's what I have to add.

I think there are a few surgical specialties that might make a good fit for you. Believe it or not, neurosurgery fits a lot of your criteria. You're in the OR a LOT with a very high diversity of cases, your day to day can be different depending on what pathologies your patients have and what kind of cases you do (e.g. doing a multilevel spinal fusion is very different than decompressing a subdural which is again different from taking out a meningioma and the perioperative care needs of each patient is going to be quite different). You can make a big difference in the lives of your patients in very different ways depending on what their problems are (reducing pain, increasing functionality, saving their life, reducing morbidity/mortality from cancer, etc etc etc). The surgical style of thinking in terms of "differential" is different from the medically oriented specialties, but there is still certainly an element of that, though the management decisions (preoperatively, intraoperatively, and postoperatively) definitely give you a similar type of opportunity. And although you're super busy in the OR (as you will be in all surgical fields), you do get the chance to have meaningful conversations with your patients both in the hospital and in the clinic. For many patients with brain tumors, you are the first person they see after they have their imaging done and you'll be playing a big part in guiding / managing their care. For patients with devastating hemorrhages, you will be involved in a lot of family discussions about level of care, prognosis, withdrawal, etc. In clinic, you'll have longitudinal follow up for many patients. For tumor patients, you'll follow them for years, same with aneurysm or AVM patients. Spine will be more varied in terms of how longitudinally you follow them (in general simpler procedures such as discs and single level decompressions you would follow for less time than say deformity cases) but you have a lot of control over what types of patients you see and what pathologies you mostly treat. Regarding paperwork, in neurosurgery you get to dictate a lot and your notes are much shorter than they would be in, say, medicine. And while you will still be consulting for certain problems and working closely with radiology, neurocritical care, and other specialties, it will be much more likely that you get consulted and that you take a leadership role in directing care.

I think there would be a lot of similarities with other surgical specialties, and I think any surgical field that deals with cancer may be right up your alley.

Thank you for your input and all the details you're provided! I've thought about neurosurgery (my undergrad degree is in neuroscience and I came in interested in neurology, so neurosurg definitely piqued my interest) but there are a couple things that have pushed me away from pursing it further. One is that I heard from more than one person not to do neurosurgery unless it's the only thing you can picture yourself doing, because of how intense the residency is. I'm not sure I'm that focused/committed. Second is the mortality rate--I've only had to cope with one patient passing away so far in my medical career and I took it really hard, and I know that neurosurgery has a higher mortality rate than other specialties, and I just don't know if I am the type to handle that well.

 

[operaman]

I'm hoping ENT will fit my wants, and I have an elective coming up in it! Do I need to love doing tubes and tonsils to love ENT?

Well you probably shouldn’t hate it but really depends on your ultimate practice model. If you’re mainly doing big head and neck cancer operations then probably won’t do many tubes or tonsils. If you’re a general ent in private practice, those tubes and tonsils are part of how you make a ridiculously good salary. They wouldn’t be all you’d do though even in that situation.

 

[Tenk]

This is the absolute worst way to pick a specialty yet it is the most common thing people do.

What is more important to you: working or having a life? If the answer is working, then sure, pick a specialty doing whatever it is that is fun and exciting. I used to think lots of stuff was fun until I had done it over 100 times. If you actually want to have a life as an attending, you need to work backwards.

First you need to figure out if you want to be on call or not. This is huge. A pager is a ball and chain. For me this was a big hell no. Other people seem to not mind.

Next you need to decide if you want to work nights or not. If you can’t or don’t want to work nights that cuts out a lot too.

Next you need to decide if you’re ok working weekends. You might not have a family now but things change. Something to consider.

Once you figure all this out, find the specialty you hate the least that builds you the life you want to live. Your 10 year future self is welcome.

 

[BigRedBeta]

This is the absolute worst way to pick a specialty yet it is the most common thing people do.

What is more important to you: working or having a life? If the answer is working, then sure, pick a specialty doing whatever it is that is fun and exciting. I used to think lots of stuff was fun until I had done it over 100 times. If you actually want to have a life as an attending, you need to work backwards.

First you need to figure out if you want to be on call or not. This is huge. A pager is a ball and chain. For me this was a big hell no. Other people seem to not mind.

Next you need to decide if you want to work nights or not. If you can’t or don’t want to work nights that cuts out a lot too.

Next you need to decide if you’re ok working weekends. You might not have a family now but things change. Something to consider.

Once you figure all this out, find the specialty you hate the least that builds you the life you want to live. Your 10 year future self is welcome.

I get what you are trying to convey, but I think only focusing on lifestyle is also very problematic. A great majority of people want work they enjoy (not hate the least). Even if you are only going to be working 35 hours a week, that's still a 1/3 of your waking hours per week spent doing something that may be barely tolerable, for decades. Given the administrative/paperwork/insurance company burden across all fields, barely tolerable may quickly devolve into utterly miserable. Yes find balance, but don't put the cart before the horse.

To the OP:

The most important detail you've given is that you like the OR. In my experience with friends and colleagues, people that love the OR in fact need the OR to be fulfilled professionally. Procedures are nice, but there's something about the ritual of the OR that really speaks to them.

With that in mind, stick to surgical fields, and based on what you've said, I'm not sure that anesthesia fits for you due to the lack of ownership.

Beyond that, I'd suggest surgical critical care as your ultimate destination. It will blend the portions of IM that you like but still keep you in the OR.

 

[getdown]

I get what you are trying to convey, but I think only focusing on lifestyle is also very problematic. A great majority of people want work they enjoy (not hate the least, which is asinine advice quite honestly). Even if you are only going to be working 35 hours a week, that's still a 1/3 of your waking hours per week spent doing something that may be barely tolerable, for decades. Given the administrative/paperwork/insurance company burden across all fields, barely tolerable may quickly devolve into utterly miserable. Yes find balance, but don't put the cart before the horse.

To the OP:

The most important detail you've given is that you like the OR. In my experience with friends and colleagues, people that love the OR in fact need the OR to be fulfilled professionally. Procedures are nice, but there's something about the ritual of the OR that really speaks to them.

With that in mind, stick to surgical fields, and based on what you've said, I'm not sure that anesthesia fits for you due to the lack of ownership.

Beyond that, I'd suggest surgical critical care as your ultimate destination. It will blend the portions of IM that you like but still keep you in the OR.

BOOOO hisss ... That's the best part of Anesthesia. You're not fielding calls in the middle of the night or when you're on vacay.

 

[BigRedBeta]

BOOOO hisss ... That's the best part of Anesthesia. You're not fielding calls in the middle of the night or when you're on vacay.

Right, for some people, that's entirely the draw...the OP specifically stated they were hoping for some sort of longitudinal patient relationship and wanting time to have meaningful conversations with them...not exactly anesthesia material.

 

[Tenk]

I get what you are trying to convey, but I think only focusing on lifestyle is also very problematic. A great majority of people want work they enjoy (not hate the least). Even if you are only going to be working 35 hours a week, that's still a 1/3 of your waking hours per week spent doing something that may be barely tolerable, for decades. Given the administrative/paperwork/insurance company burden across all fields, barely tolerable may quickly devolve into utterly miserable. Yes find balance, but don't put the cart before the horse.

To the OP:

The most important detail you've given is that you like the OR. In my experience with friends and colleagues, people that love the OR in fact need the OR to be fulfilled professionally. Procedures are nice, but there's something about the ritual of the OR that really speaks to them.

With that in mind, stick to surgical fields, and based on what you've said, I'm not sure that anesthesia fits for you due to the lack of ownership.

Beyond that, I'd suggest surgical critical care as your ultimate destination. It will blend the portions of IM that you like but still keep you in the OR.

This is how people end up divorced, disgruntled, and is also probably a huge contributing factor to physician suicide rates. Whatever negativity you described with your job is amplified 100 times over when your home life is miserable. One of my good friends is the nicest surgeon I have ever met and he was becoming disgruntled with work. Why? He was working too much and it was affecting his life. He has now found a balance and is much happier.

You can’t tell me going into the hospital at 2 am to do your 576th appy when you’re in your 50s is a jolly good time for anyone. What a lot of med students don’t understand is that over time none of this is fun and exciting anymore. Most everything I do is boring and routine and I’m in EM. I’m supposed to be the adrenaline specialty. Work is work and it will always become routine in the end. It’s easy to fall back on what you enjoy because everything is fresh and new and for a lot of students has been romanticized for years.

Life > work. If you flip the alligator mouth, one day you will burn out no matter how much you love your job. The only difference is you won’t have a life to fall back on.

 

[LoGo]

The answer is always derm.

Where else in medicine can you cut out a tumour (and do a complicated reconstruction of you want), dish out massive amounts of prednisone and a $20,000 biologic medication, Dx a GI/Endo/Heme/Rheum/Neuro disease based on the skin rash, bill privately for cosmetics, all in one day while having long-term or short-term patients be very grateful, not having to deal with other consultants and still having evenings and weekends off for the majority of the year while still getting paid very well. That’s variety.

 

[ortnakas]

Everyone is giving feedback on their specialties already, but just remember every specialty is going to have its bread and butter and a routine of sorts. The trick is finding out which bread and butter you can actually enjoy on a daily basis (or on bad days, at least tolerate). Make sure you’re keeping the routine parts in might, not just the exciting parts.

 

[random_hooligan]

This is the absolute worst way to pick a specialty yet it is the most common thing people do.

What is more important to you: working or having a life? If the answer is working, then sure, pick a specialty doing whatever it is that is fun and exciting. I used to think lots of stuff was fun until I had done it over 100 times. If you actually want to have a life as an attending, you need to work backwards.

First you need to figure out if you want to be on call or not. This is huge. A pager is a ball and chain. For me this was a big hell no. Other people seem to not mind.

Next you need to decide if you want to work nights or not. If you can’t or don’t want to work nights that cuts out a lot too.

Next you need to decide if you’re ok working weekends. You might not have a family now but things change. Something to consider.

Once you figure all this out, find the specialty you hate the least that builds you the life you want to live. Your 10 year future self is welcome.

As a woman, I feel like I get told left and right by people (usually men) to consider the "lifestyle" aspects of medicine so much that it starts to wear on me. Yes, I understand that lifestyle is important. But there are only a handful of those lifestyle specialties to choose from and none of them really get me excited. And I also know that I had much more fulfillment as a medical student working ~70 hrs/week on my gen surg rotation than I did on my pediatrics rotation working more like ~40.

I'm not a sadist who likes to torture myself with working 24/7. Rather (and I know this might sound naive and too bright-eyed for some of the older folks here), I think that if you love what you do and feel called to it, then you will find more fulfillment and be less likely to experience burnout. And at the end of the day, if I'm experiencing burnout in a more intense/ less lifestyle friendly specialty, it's not impossible to take time off or to find an arrangement where I work part-time (esp for specialties with shift-work). I would much rather do that than go into a specialty I am not enthused about purely for the sake of possibly warding off burnout that may or may not occur in the future.

 

[Tenk]

As a woman, I feel like I get told left and right by people (usually men) to consider the "lifestyle" aspects of medicine so much that it starts to wear on me. Yes, I understand that lifestyle is important. But there are only a handful of those lifestyle specialties to choose from and none of them really get me excited. And I also know that I had much more fulfillment as a medical student working ~70 hrs/week on my gen surg rotation than I did on my pediatrics rotation working more like ~40.

I'm not a sadist who likes to torture myself with working 24/7. Rather (and I know this might sound naive and too bright-eyed for some of the older folks here), I think that if you love what you do and feel called to it, then you will find more fulfillment and be less likely to experience burnout. And at the end of the day, if I'm experiencing burnout in a more intense/ less lifestyle friendly specialty, it's not impossible to take time off or to find an arrangement where I work part-time (esp for specialties with shift-work). I would much rather do that than go into a specialty I am not enthused about purely for the sake of possibly warding off burnout that may or may not occur in the future.

Then you fall into the work > life category which I already said sure, pick whatever you enjoy. That was the first step in my algorithm. Just keep in mind, nobody ever says on their deathbed: “man, I wish I could have worked more!”

 

[OrthoTraumaMD]

if you love what you do and feel called to it, then you will find more fulfillment and be less likely to experience burnout

Absolutely true.


Sent from my iPhone using SDN mobile

 

[mrbreakfast]

I haven't had neurology yet but I think I will enjoy how cerebral it is, and how much thinking is involved.

I'm an M4 who was recently in your shoes (debating between surgery and a number of other fields), and I ended up picking neurology. Since deciding I've gotten more and more pumped for my future and have zero regrets. My acting internship was my favorite rotation, moreso than my "chill" rotations.

Neurology offers enormous case/activity diversity, tons of differential diagnosis, get to play the "expert" with a large field of patients no one else in the hospital can diagnose or manage, aren't a "manager" like IM (which was one of my least favorite rotations), lots of high-acuity if you want it.

Also, you get to spend a ton of time with patients, have very serious conversations with them (or their families) and build rapport, and, if you want it, can live in the neuro ICU, or in the endovascular suite. I also found the surgical OR monotonous at times, yet am seriously considering interventional neurology, which is quite surgical in nature.


You gotta decide if you're a thinker or a doer. Ultimately, I'm a thinker, I don't know exactly what I want to do yet and wanted options (extreme acuity vs. daily hospital medicine vs. outpatient), and I wanted to feel like I was making a huge difference in patients' lives and be the person patients could rely on, either acutely or longitudinally. Also, I wanted to work with people I admired, who were cerebral and empathic, and who I could aspire to be like. For me, that was neurology. I went from thinking I could only be happy as surgeon living in the OR to realizing I could be happy pulling clots, rounding for hours, or holding an outpatient headache clinic. The realization that I could round, work 7 on/14 off, hold clinic, teach med students/residents, do research, or any combination of the above, and still make a good living, is just icing on the cake.

Plus, neurologists are super chill.

PM me if you want the M4 perspective.