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jeremyjams

Help me pick a specialty

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Hi all, 

I'm a third year student coming up against some challenges in figuring out what I'm interested in pursuing in residency. I've done a fair number of rotations (a bunch of core rotations including surgery, CTU, EM) and spent both preclerkship summers stocked full of  informal rotations/electives in neurology, cardiology, ENT, gen sx and 4 weeks of family medicine in various settings (broad-scope docs doing Obs, addictions, women's health). Came to med as a non-trad, so explored a TON of stuff because I had no frame of reference. 

Basically, I haven't really found anything I can see myself doing. Maybe I haven't cast my net as wide as I should and so I thought I'd ask the forum to see if anybody has any ideas. 

Here is a list of what I've thought about: 

-rapid, fast-paced, efficient (one hour long complex IM consults are not my cup of tea) 

-I enjoy working a little bit with my hands, but can't stand the rigidity of the OR or big long complex surgical cases 

-don't enjoy taking histories (prefer imaging, lab work, thinking about cases without actually talking to anybody)

-not family medicine, IM, psych or pathology

-preferably approach problems from a consultant's lens vs primary care 

-don't love ambiguity or unsolved problems (but can tolerate some)

 -ability to have my own space/clinic where I can make decisions myself

-not directly working as part of a team (can tolerate some interaction but don't like group rounds, CTU-style, or interdisciplinary-style rounds) 

-innovation / new things / lots of research / dislike "this is the way it's always been done" attitudes 

-I prefer working with serious people (rather than laid back, chill people) .

 

This all sounds so grouchy I'm sure. Please know clinically, I have ++ good people skills; I've won patient care recognition awards and been told I'm great with patients and having complex challenging conversations (but I do not enjoy it at all).  When I've floated these thoughts past colleagues they're all shocked, because it doesn't really match up with how I present myself in clinic. 

 So I am just hoping, from the view of total anonymous honesty, that somebody more experienced may be able to offer some non-judgmental insight into fields I might be suited for. 

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-rapid, fast-paced, efficient (one hour long complex IM consults are not my cup of tea)

-I enjoy working a little bit with my hands, but can't stand the rigidity of the OR or big long complex surgical cases

-don't enjoy taking histories (prefer imaging, lab work, thinking about cases without actually talking to anybody)

-not family medicine, IM, psych or pathology

Avoiding lengthy histories, avoiding lengthy procedures... this really leaves you with radiology/IR, anesthesiology/critical care, dermatology, and ophthalmology. I would imagine it's probably a bit too late to start on a dermatology/ophthalmology application though.

Quote

-don't love ambiguity or unsolved problems (but can tolerate some)

Critical care probably has the most information available about the patient compared to any specialty. In reality every specialty (except path) has a lot of uncertainty in the day-to-day.

Quote

-not directly working as part of a team (can tolerate some interaction but don't like group rounds, CTU-style, or interdisciplinary-style rounds)

-innovation / new things / lots of research / dislike "this is the way it's always been done" attitudes[/quote]

Of the above, critical care and IR are good for this. I would recommend looking into those two specialties.

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As the previous poster pointed out, rads and anesthesia jump to mind. I suspect anesthesia might not be your cup of tea either, because you'll probably find yourself in situations where you have to chit chat with colleagues etc., and you don't really have your own space. You're on the other side of the drape, but the pace of work is not something you can control. Also there's some research, but the field isn't changing by leaps and bounds, they've pretty much been using the same drugs for decades.

Rads fits with most everything you mentioned, so I'd definitely explore that first. It's very objective, you can work alone at your own pace (and it's high volume these days), don't have to take histories (but may have to chart review), you're a consultant, and it's less team based than most other specialties. I can't comment specifically about the research aspect, but I know plenty of research is done, and especially if you enjoy physics I'm sure there are some interesting projects you could get involved with.

Also it's good that you can distinguish the difference between what you're good at and what you actually enjoy, obviously the latter is much more important. Having good interpersonal skills is irrelevant if you don't enjoy working with people. I've also never heard of anyone who prefers working with people who AREN'T laid back, but hey, takes all kinds.

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If you're physics and math minded, maybe rad onc? And you can pursue the academic side of it--where the innovation happens.

Similarly with radiology.

However, IR will mean you have to communicate with patients...and if you really don't enjoy that, then maybe it isn't your bag...

Have you considered anatomical path, heme path, or neuropath? Med micro? Lots of room for lab work and no patients, and again, the academic side of things comes to the fore where innovation, research, thinking about stuff and no patient-centered rounds (moreso case centered rounds)...but no solo practise opportunities here.

 

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Seriously consider and make sure you definitely don't want to do FM. There is a lot of career and personal-life flexibility, which becomes more important as you get older. I agree with the other posts about also considering other specialties in lab medicine and radiation oncology.

To expand on my previous post:

Critical care: Your patients are mostly unconscious, so not much history-taking there. This also means there will be plenty of investigations done on them to help make decisions. There are quick simple procedures available (lines, chest tubes, etc.). You are a consultant and gatekeeper of ICU resources. Critical care always has a lot of research going on if you're interested in it—not so much new technology but lots of new evidence on various sorts of treatment protocols and risk stratification. You definitely don't work by yourself though (plenty of nurses, RTs, other MDs, etc.), and you don't 'own' your space. You will still do a lot of talking to patient families about serious issues.

IR: Your patients come to you for a procedure and usually any history-taking/talking is to ensure the procedure is indicated and to consent the patient. You usually have a lot of information about the patient because typically there is cross-sectional imaging available. It is a fast paced procedural specialty where in-between cases you will do some DR. Procedures are on average shorter than surgical ones, but there will occasionally be complicated cases that takes more time (e.g. complex tumour embolizations). There are constantly new innovations in technology and research. You definitely still work in a team with the techs and nurses and you don't 'own' your own space.

DR: Your patient contact revolves around the 0-15% of your day dedicated to procedures (depends on what you want and subspecialize in). Procedures are usually biopsies or injections with the occasional thora/paracentesis. It's also a specialty with lots of new technology and research. It is busy and fast-paced. Since volumes are high residency will train you to work quickly. You have your own reading room and you work fairly independently, though you will still consult colleagues in other radiology subspecialties and have surgeons and other docs coming by to ask questions. There can be a lot of ambiguity in diagnostic radiology, especially because the history you're given is often very limited.

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On 12/16/2019 at 2:08 PM, jeremyjams said:

Hi all, 

I'm a third year student coming up against some challenges in figuring out what I'm interested in pursuing in residency. I've done a fair number of rotations (a bunch of core rotations including surgery, CTU, EM) and spent both preclerkship summers stocked full of  informal rotations/electives in neurology, cardiology, ENT, gen sx and 4 weeks of family medicine in various settings (broad-scope docs doing Obs, addictions, women's health). Came to med as a non-trad, so explored a TON of stuff because I had no frame of reference. 

Basically, I haven't really found anything I can see myself doing. Maybe I haven't cast my net as wide as I should and so I thought I'd ask the forum to see if anybody has any ideas. 

Here is a list of what I've thought about: 

-rapid, fast-paced, efficient (one hour long complex IM consults are not my cup of tea) - This says surgery, emerg, IR, anesthesia, cardio

-I enjoy working a little bit with my hands, but can't stand the rigidity of the OR or big long complex surgical cases - Surgery, emerg, anesthesia, cardio, IR

-don't enjoy taking histories (prefer imaging, lab work, thinking about cases without actually talking to anybody) - surgery, emerg, anesthesia, cardio, IR

-not family medicine, IM, psych or pathology - to do cardio you'll have to survive IM

-preferably approach problems from a consultant's lens vs primary care - specialize

-don't love ambiguity or unsolved problems (but can tolerate some) - surgery, emerg, cardio, anesthesia, IR

 -ability to have my own space/clinic where I can make decisions myself - surgery, cardio, anesthesia, IR

-not directly working as part of a team (can tolerate some interaction but don't like group rounds, CTU-style, or interdisciplinary-style rounds) - emerg but if you like the OR/cath lab environment you will probably be able to do surgery, anesthesia cardio, IR

-innovation / new things / lots of research / dislike "this is the way it's always been done" attitudes - cardio, anesthesia, most surgical specialties (although you will encounter the "this is the way it's always been done" often regardless in surgery), IR

-I prefer working with serious people (rather than laid back, chill people) - surgery, cardio, IR

 

This all sounds so grouchy I'm sure. Please know clinically, I have ++ good people skills; I've won patient care recognition awards and been told I'm great with patients and having complex challenging conversations (but I do not enjoy it at all).  When I've floated these thoughts past colleagues they're all shocked, because it doesn't really match up with how I present myself in clinic. 

 So I am just hoping, from the view of total anonymous honesty, that somebody more experienced may be able to offer some non-judgmental insight into fields I might be suited for. 

See above

 

You sound similar to me actually. You definitely sound like you are born for the acute medical field. Serious hard working people, hands on, decision making, innovation, research, efficient.

I think Surgery, Anesthesia, IR, Cardiology and EM really fit your alley. They all have differences, so if interested, you can share any interest you have in any specific organ system, and lifestyle, also how many years of training you want to do and whether or not you want to do academics or are you open or interested in community. 

The one acute medical field I would throw some caution on is ICU, it is VERY team based. All day rounding anyone? Can be very medically complex! Not a lot of easy decisions. Very ambiguous. Most ICU trials have been negative recently and it is often sort of a put them on the ventilator and see how they do kind of thing. A lot of debate regarding what is the best management because there is a lot of mixed evidence and ambiguity. Lots of family meetings as well, interdisciplinary stuff is pretty important in ICU. Can still be a great option for you though, community ICU is probably a better fit for what you are saying as you can get away with less BS/teaching/rounding and you can do your own procedures. Academic ICU doctors don't do many procedures, usually left to the residents. 

 

 

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