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IM all the way!!!! 
your specialty of choice
- Thread starter obiwan
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So any thoughts on stuff that's like derm but not derm and preferably doesn't require an IM residency beforehand? So far that's the one thing I liked, and I don't have the research for that.
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I did a selective at my school that was in the primary care procedural clinic (part of FM). We did a lot of mole removals and biopsies, so that may be an option for you.
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I liked the intellectual aspects -- seeing stuff and having to figure out what it is, which isn't always easy. I liked that we weren't dealing with critical care stuff; no one was going to die (well, immediately) if we screwed up. The procedures sprinkled throughout the day were a nice distraction, and you got to talk to patients without having to assess their entire health history. Limited physical exams. I've got to admit the hours and lifestyle are also appealing, but that wasn't the main appeal.
I think psych might still fit with most of this stuff. Path does seem appealing, but I like patients.
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I worked with a dermatologist in Hawaii who is certified in IM, Derm, and derm path, so he read his own slides. He had the pathologists prepare them.
He did the derm route through IM, and then did the derm path stuff somehow in there. I know you said you didn't want to do IM though. But if you really like derm, that could be an option, and if you read your own slides, you get a lot of what you're looking for.
He did say that at the end of his derm residency, he thought about doing MOHS, but he didn't want to make his training any longer.
He kept trying to get me to switch into derm mainly because he said it's a great lifestyle, especially for women. It was great for a month, but it wasn't for me.
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Have you considered ophtho? It's a little bit more cerebral, I felt, than plain surgery, very few critical care issues, and you focus on a limited part of their health history. Good hours, too.
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huh...I always thought you were a guy. I should know not to assume anything considering everyone thinks I'm a guy. My apologies
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huh...I always thought you were a guy. I should know not to assume anything considering everyone thinks I'm a guy. My apologies
lol, no worries. Yeah, I've gotten that a few times. Probably because I'm doing ortho.
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You guys taken the MSAT through UVA? I took it before starting rotations and didn't think much of it. I went back to look at my rankings and it was surprisingly accurate.
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You really have to remind me to introduce you to Dr. Glick over here. He just ran his annual addiction seminar weekend. I'm sure you would have enjoyed it. Note: Dr Glick was an MD/PhD, and he didn't do a residency...
In my former job I shadowed/assisted in the OR a lot, and though it was stressful at times, I learned where to be and how not to piss off the surgeon. Now on OB, it is heaven as I never get stressed, I know where to be, and I can concentrate on what's happening during the procedure....Edit: FWIW, I'm in the camp that loves the OR.
I really couldn't care less about continuity. Don't get me wrong - I'd like to know if I got the diagnosis right and I like talking to patients. But I don't care if I ever see them again.
I like figuring out the problem and getting the solution started. I have the patience for procedures in the OR, yet I like making a (long) differential. I've been having fun f/u on biopsies, but that's 'cause it's familiar to me. So I've been toying with Path, IM, and EM (which are all specialities of breadth...
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I took it before med school and it was pretty off, but that's mainly because the things I thought would be important turned out not to be. I'm the poster student for rotations altering your perception of yourself and your career. Awkward sentence but you get my point.
QofQuimica
Seriously, dude, I think you're overreacting....
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Sounds like my kind of guy.
I PMed you.
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Funny, I took it in the spring and then later after I thought I had really been disillusioned by the wards and ended up with the same top 3 (although tbh lifestyle specialties jumped up quite a bit
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Pretty sure I'm down to EM and FM at this point. But we shall see in the second half of the year..
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I just took it again and am still getting medical subspecialties some of the top results, which is weird since I'm not digging my medicine rotation. Pediatrics was given as my #1, but I'm not a kid person so that's probably out. Derm was #2 (it's always been near the top), but yeah, super hard, focused on researchy types, etc.. Then rheum, oncology, psych ....
I seriously think I'd dig rheum or oncology, but I'm just not so sure about this medicine residency thing. So psych is probably what it is.
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At least you don't have the stigma in your classroom of being the weird crazy cat woman like I am!!
Who says I don't?
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My Timeline:
5th grade: "I'm going to be an obstetrician!"
6th grade: "You mean the obstetricians don't get to hang out with the baby after it's born???? I guess I'll be a pediatrician instead...."
11th grade: "Maybe I'll be an elementary school teacher instead of a pediatrician- I love teaching, and it would be fewer years of school..."
After a year as teaching 1st and 2nd grade Sunday school to a group where 3 kids had ADHD and one had Downs--- "I think maybe being a professor of general pediatrics is better... One kid at a time, and then teach a group that has a longer attention span...."
Since then, I haven't wavered on wanting to do academic peds... People keep telling me that a lot of people change their minds when they get to rotations, but a few months in I haven't seen anything that can compare...
I keep going into elderly patients' hospital rooms and wanting to talk with the grandkids instead of the elderly man with the stroke...
QofQuimica knows me in real life--- maybe she can tell me what my true calling is--- path? neurosurg? radiology?
5th grade: "I'm going to be an obstetrician!"
6th grade: "You mean the obstetricians don't get to hang out with the baby after it's born???? I guess I'll be a pediatrician instead...."
11th grade: "Maybe I'll be an elementary school teacher instead of a pediatrician- I love teaching, and it would be fewer years of school..."
After a year as teaching 1st and 2nd grade Sunday school to a group where 3 kids had ADHD and one had Downs--- "I think maybe being a professor of general pediatrics is better... One kid at a time, and then teach a group that has a longer attention span...."
Since then, I haven't wavered on wanting to do academic peds... People keep telling me that a lot of people change their minds when they get to rotations, but a few months in I haven't seen anything that can compare...
I keep going into elderly patients' hospital rooms and wanting to talk with the grandkids instead of the elderly man with the stroke...
QofQuimica knows me in real life--- maybe she can tell me what my true calling is--- path? neurosurg? radiology?
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Emergency Medicine? I loved diverse populations and complex problem-solving but hated rounding that goes along with IM.
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Disclaimer: I'm a fourth-year student, so my specialty of choice is based on a lot more clinical experience. At this point last year, all I knew was that surgery was out and I was considering ophtho/radiology/EM/psych/PM&R (more or less, in that order--as you can see, I didn't have any idea) and awaiting my internal medicine rotation which I scheduled for January so that I'd have some amount of experience under my belt to do well on the IM rotation in preparation for possible IM residency.
But all that aside, what I really wanted to comment on is patient interaction. I saw a couple posts about not wanting patient contact in this thread and therefore are considering rads or path, and I remember another about how family med work wasn't very rewarding. I would suggest that if you're on a rotation where you're mentally and physically drained from seeing patients, try and figure out if there's a particular aspect of patient care that you don't like. For example, it may be the time constraints of, perhaps, outpatient IM, does not allow you to address every problem on the list if the patient has comorbid diabetes + physical sequelae, hypertension, hyperlipidemia, depression, COPD, and all the preventive medicine you'd like to integrate into the visit. It may be that you're doing a primary care rotation, where continuity is one of the appeals of the specialty because it's rewarding, and six weeks just isn't long enough to have continuity (especially with those with multiple chronic illnesses who follow up every 1-3 months) with anything but the acutely ill.
Those things happened on a regular basis during the outpatient portions of my core clerkships and for those reasons, I was seriously considering radiology during the latter half of third year. It took a long time for me to understand that continuity was actually rewarding (not until early 4th year). Because I knew that I didn't like time constraints of the 15-minute office visit, I am planning to take care of primarily inpatients, and definitely in an academic setting.
This is not to imply anything negative about radiology; in fact, there are many reasons why I think I'd fit in with that field. The radiologists I've worked with are awesome at reading as well as at teaching students and residents, and it's very rewarding to have your days filled with interesting cases (some unremarkable cases too, but always intriguing, every time, to consider the patient history and then go look at your not-yet-read study to see whether there is pathology, or not), working and consulting with physician colleagues in all departments of the hospital. Time constraints aren't as rigid as they are in office-based practice where the patients have set appointment times (where you don't want to leave them waiting too long).
For me, it came down to enjoying working with kids, as well as being confident that I can eventually have the continuity that I want, in a setting (academic, inpatient) where time is not partitioned out in 15-minute blocks to allow for some flexibility in spending more time with the complicated patients. The (potential) mountains of paperwork and pain of billing that may ensue is not as much of a concern if I feel that the work I'm doing is worthwhile and rewarding.
Especially if you're ambivalent about entering a patient-care specialty, try and think about what specifically you don't like about it, and what you do like. There may be ways to avoid many of the things you dislike. Otherwise, perhaps a specialty where there isn't direct patient care is the best choice.
But all that aside, what I really wanted to comment on is patient interaction. I saw a couple posts about not wanting patient contact in this thread and therefore are considering rads or path, and I remember another about how family med work wasn't very rewarding. I would suggest that if you're on a rotation where you're mentally and physically drained from seeing patients, try and figure out if there's a particular aspect of patient care that you don't like. For example, it may be the time constraints of, perhaps, outpatient IM, does not allow you to address every problem on the list if the patient has comorbid diabetes + physical sequelae, hypertension, hyperlipidemia, depression, COPD, and all the preventive medicine you'd like to integrate into the visit. It may be that you're doing a primary care rotation, where continuity is one of the appeals of the specialty because it's rewarding, and six weeks just isn't long enough to have continuity (especially with those with multiple chronic illnesses who follow up every 1-3 months) with anything but the acutely ill.
Those things happened on a regular basis during the outpatient portions of my core clerkships and for those reasons, I was seriously considering radiology during the latter half of third year. It took a long time for me to understand that continuity was actually rewarding (not until early 4th year). Because I knew that I didn't like time constraints of the 15-minute office visit, I am planning to take care of primarily inpatients, and definitely in an academic setting.
This is not to imply anything negative about radiology; in fact, there are many reasons why I think I'd fit in with that field. The radiologists I've worked with are awesome at reading as well as at teaching students and residents, and it's very rewarding to have your days filled with interesting cases (some unremarkable cases too, but always intriguing, every time, to consider the patient history and then go look at your not-yet-read study to see whether there is pathology, or not), working and consulting with physician colleagues in all departments of the hospital. Time constraints aren't as rigid as they are in office-based practice where the patients have set appointment times (where you don't want to leave them waiting too long).
For me, it came down to enjoying working with kids, as well as being confident that I can eventually have the continuity that I want, in a setting (academic, inpatient) where time is not partitioned out in 15-minute blocks to allow for some flexibility in spending more time with the complicated patients. The (potential) mountains of paperwork and pain of billing that may ensue is not as much of a concern if I feel that the work I'm doing is worthwhile and rewarding.
Especially if you're ambivalent about entering a patient-care specialty, try and think about what specifically you don't like about it, and what you do like. There may be ways to avoid many of the things you dislike. Otherwise, perhaps a specialty where there isn't direct patient care is the best choice.
