Which specialty to choose?

[Spikebd]

Hi SDN,
Been a member for awhile now and I've gotten lots of good advice from here over the years, and now I'm looking for some more feedback. Im a 3rd year DO student stuck between a few specialties. I have a top 3 or 4, but can't commit to any single specialty yet. Step 1 >245, COMLEX low 600's, other than that pretty solid student but not a superstar or anything. I do get good feedback from my attendings too. I'm aiming for specialties that do procedures and enjoy the OR. With all of the ACGME AOA merger stuff going on I worry about how many AOA spots will be left. Anyhow, I'll run through some of my top choices.

IR-I enjoy the technology, the chance to consult on patients and be an expert in a field. There is a nice variety of vascular and oncology work seems fun to me as well. I have pretty limited exposure to this field though, and I haven't looked into the DIRECT pathway much.

Anesthesia- I like the OR and really enjoy watching patients get sedated. Had the chance to intubate patients during my surgery rotation and it was pretty thrilling for me. I enjoy physio and pharm as well as some anatomy they need to know for regional blocks. The early morning hours really appeals to me as well. Day to day I could see myself really enjoying anesthesia. The only cons are a lot of the SDN anesthesia guys scare med students away from it due to the business environment.

Ortho- I enjoy reductions, fractures, the radiology, the quick fixes. The bread and butter ortho appeals to me more than general surgery (knee scopes, hip fractures, arthritis). The huge downside for me is it's ultra competitive and I really don't want to SOAP. Plus I'm worried a lot of AOA programs will get shut down in the merger making it even more competitive.

ER - Something about being a jack of all trades appeals to me, and I like how much time off they can have. I'd feel good about myself serving humanity as an ER doc, but I can see how the malingering and alcoholics could wear on me. I'd probably be able to match in a good program too and that would be cool. Cons for me would be nights and maybe too much free time.

I really could see myself happy in any of these specialties, I just want to get advice on how to pick one soon so I can strengthen my application.

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[hallowmann]

Advice that I seem to get from most older docs:

1) Look at the lifestyle of private practice docs in those specialties. Are they happy? Could you see yourself doing what they do? Most docs are in private practice, you don't get a good grasp of the real day-to-day in most med school rotations.

2) Don't think about what is exciting for you as a med student now, think about 10 years from now when you've done the same procedure 1,000-10,000 times, is the excitement of the procedure enough to get you through 10,001. Is there something else in the specialty that would make you love doing it even when the procedures have become boring to you?

I'm still up in the air a bit in terms of what I want, and it feels like it may even be not specializing, but regardless, this seems like good advice.

 

[Dr. Death]

Hi SDN,

Anesthesia- I like the OR and really enjoy watching patients get sedated.

This is creepy

 

[ToKingdomCome]

How competitive is direct pathway IR?

 

[KP2AZ]

Advice that I seem to get from most older docs:

1) Look at the lifestyle of private practice docs in those specialties. Are they happy? Could you see yourself doing what they do? Most docs are in private practice, you don't get a good grasp of the real day-to-day in most med school rotations.

2) Don't think about what is exciting for you as a med student now, think about 10 years from now when you've done the same procedure 1,000-10,000 times, is the excitement of the procedure enough to get you through 10,001. Is there something else in the specialty that would make you love doing it even when the procedures have become boring to you?

I'm still up in the air a bit in terms of what I want, and it feels like it may even be not specializing, but regardless, this seems like good advice.

I talked with a retired EM physician (what I want to go in to), and what stuck with me was exactly what @hallowmann is saying. What makes you excited now should be considered, but also think about 10 or even 20 years from now. EM is a great field, it's just hard on the doc long term.

 

[deleted564680]

It's important to think of the longevity of the career as well. ER has a very short practice life with most of the attendings out of the field in 10-15 years. After that, you pretty much have to work in an urgent care and then you're working as a primary care physician. The other thing is that ERs are starting to hire a lot of NPs/PAs and the EM physicians role will likely change over the next 10-15 years.

IR is VERY COMPETITIVE right now within DR and the DIRECT pathway is only available at some programs. Of note though, all subspecialties of radiology do procedures and neuro and MSK do a pretty good amount of them.

I wouldn't ever call anesthesia a procedure-based field unless you do a pain management fellowship but even then...Anesthesiologists are supervisors these days.

Seems like you've already ruled out Ortho.

 

[Ddrumem]

It's important to think of the longevity of the career as well. ER has a very short practice life with most of the attendings out of the field in 10-15 years. After that, you pretty much have to work in an urgent care and then you're working as a primary care physician. The other thing is that ERs are starting to hire a lot of NPs/PAs and the EM physicians role will likely change over the next 10-15 years.

IR is VERY COMPETITIVE right now within DR and the DIRECT pathway is only available at some programs. Of note though, all subspecialties of radiology do procedures and neuro and MSK do a pretty good amount of them.

I wouldn't ever call anesthesia a procedure-based field unless you do a pain management fellowship but even then...Anesthesiologists are supervisors these days.

Seems like you've already ruled out Ortho.

your assumption of EM is very misinformed.

 

[Spikebd]

This is creepy

Lol I worded that poorly.