Speciality Choices

[mustardyellow]

Hello,

As an incoming medical student I am starting to think about my plans and future for the next 4 years. I understand the importance of figuring out what you want to do as early as possible seeing how competitive residencies are getting. My question is - how do you figure it out?!? I know there are classical starting points like medicine vs. surgery, but how does one even know without having seen these specialities first hand? I know most of the learning will come within the hospitals but are there any resources or tips out there to help start my search? Does shadowing really help narrow things down and if so, is it easy to shadow in medical school? 

[GrouchoMarx]

Start competitive and work your way down. 

[blah1234]

I found shadowing easy enough at my medical school. As a staff I don't mind having learners shadow either. I think it is hard for students to gain a sense of what they like pre-clerkship. Pathologies that sound interesting on paper and in the classroom may not be that fun to deal with on a daily basis as your fulltime job. 

I think shadowing and asking residents/staff about what they like/dislike about their job might be a good starting point. Unfortunately, people do change as they grow older and their priorities shift. What you love as a medical student may not be what you love as a resident or as a staff physician. I would suggest keeping an open mind and finding a field where you would be okay with the bread and butter (80+ percent) of the job. 

It is also important to note that academic vs community practices can be very different and I think a lot of the exposure you get as a medical student is skewed towards academic practice which can inaccurately push you towards or away from a field. 

[ChemPetE]

In addition to the above, I would try and Tyhink about what kind of practice you want to have(location, academic vs community, into/output, etc), and what specialties have projected employment difficulties and other large barriers to that kind of practice. I suspect that will eliminate 3/4 off the bat at least. Save yourself some heartache - go into a field where you’re sought over. This can include competitive specialties, and can exclude others for what it’s worth.

[ellorie]

Given how much of your early career you will spend working at ridiculous hours of the night seeing bread and butter stuff, pick something with bread and butter stuff that you don’t hate seeing at 3 am. 

It’s easy to fall in love with the “cool” aspects of whatever specialty and miss the reality of what the other 95% of the job is like. 

In psychiatry we do all kinds of cool stuff in practice but on call we see a lot of run of the mill depression/anxiety, substance intoxication, acute psychosis. The management is very routine but I don’t hate it. Whereas the classic GIM and surgical consults make me want to stab my eyes out with a fork. 

So pick the thing you can stand to get out of bed for, is the best advice I ever got. 

[sangria]

My take: do what makes you happy. I'm not referring to a specific job title but the things in life that give you the most joy. Then decide whether you can put up with the things you hate in that field x 30-40 years.

I really enjoy getting to know patients and digging deep into their lives. I like the concepts behind procedures, but I find the actual procedures more or less tedious. I value having time of my own, and being able to spend it with people I love. I like job market flexibility, and cannot tolerate the nebulous promise of a FT position 3 years after I'm done. Then based on my experiences in clerkship, I was able to narrow my selection down.

My point is, don’t stress out too much trying to fit into a certain specialty because of the pressure to decide on day 1. I think some dissatisfaction comes from the incongruence between expectations and reality and it is made worse by getting pigeonholed too early.  It is important to go out and experience as much as you can, but try to get a feel for yourself, instead of relying on second hand information or biased opinions.

 

 

 

[GrouchoMarx]

7 hours ago, ellorie said:

Given how much of your early career you will spend working at ridiculous hours of the night seeing bread and butter stuff, pick something with bread and butter stuff that you don’t hate seeing at 3 am. 

It’s easy to fall in love with the “cool” aspects of whatever specialty and miss the reality of what the other 95% of the job is like. 

In psychiatry we do all kinds of cool stuff in practice but on call we see a lot of run of the mill depression/anxiety, substance intoxication, acute psychosis. The management is very routine but I don’t hate it. Whereas the classic GIM and surgical consults make me want to stab my eyes out with a fork. 

So pick the thing you can stand to get out of bed for, is the best advice I ever got. 

Or, if you never want to get out of bed ever again, do pathology (very easy to get into) or dermatology (very hard to get into). Radiation oncology too (medium to get into).

[anonymouspls]

6 minutes ago, GrouchoMarx said:

Or, if you never want to get out of bed ever again, do pathology (very easy to get into) or dermatology (very hard to get into). Radiation oncology too (medium to get into).

You're saying radiation oncology is a lifestyle specialty? 

[anonymouspls]

9 minutes ago, GrouchoMarx said:

Or, if you never want to get out of bed ever again, do pathology (very easy to get into) or dermatology (very hard to get into). Radiation oncology too (medium to get into).

Actually, please list all the specialties that are the most lifestyle oriented like dermatology ... not sure if that's what I want yet, but it will be useful to know as someone starting med school in the fall 

[X Æ A-12]

21 hours ago, ysera said:

Actually, please list all the specialties that are the most lifestyle oriented

Radiology Ophthalmology Anesthesia Dermatology (ROAD) 

Family medicine 

GI Interventional cardiology

[anonymouspls]

2 minutes ago, swoman said:

Radiology Ophthalmology Anesthesia Dermatology (ROAD) 

Family medicine 

GI Interventional cardiology

I've been interested in Radiology for a while and it doesn't seem particularly lifestyle oriented from the research I've done ... If the others are like radiology then I might as well forget about having a life outside of medicine 

[Edict]

59 minutes ago, swoman said:

Radiology Ophthalmology Anesthesia Dermatology (ROAD) 

Family medicine 

GI Interventional cardiology

Lifestyle specialties include non-procedural internal medicine specialties, family medicine, physiatry, neurology, psychiatry, public health, peds, emergency medicine, anesthesia, dermatology. Anything clinic based is pretty lifestyle. 

Also, some surgical specialties can be lifestyle in certain subspecialties, primarily as staff though, like ophthal, ent, ortho even certain subspecialties and practice types of gen surg, neurosurg, plastics, uro, ob/gyn etc. Typically, you take a pay cut if you do a more lifestyle subspecialty though. Resident lifestyle is different however, surgical specialties almost all have bad residency hours. 

[blah1234]

52 minutes ago, swoman said:

Radiology Ophthalmology Anesthesia Dermatology (ROAD) 

Family medicine 

GI Interventional cardiology

I wouldn't say my friends in interventional cardiology have a good lifestyle. They are often up late at night to cover emergencies and the training can be brutal. From what I understand it's hard to find a full-time position in Canada as well. 

[Edict]

3 minutes ago, blah1234 said:

I wouldn't say my friends in interventional cardiology have a good lifestyle. They are often up late at night to cover emergencies and the training can be brutal. From what I understand it's hard to find a full-time position in Canada as well. 

Haha it must've been a joke, interventional cardiology is one of the least lifestyle friendly specialties. STEMI call means you need to live within 15 minutes of your hospital and is one of the few conditions that genuinely requires you to get in the hospital asap. 

[MarsRover]

Depends what you define as lifestyle is the simple answer.

For example, Family medicine, psychiatry, endo, rheum, community peds, perhaps derm (IDK i never cared to look into it) . You are largely in chill clinics, and you can chose your hours. IE aside from perhaps a call requirement you could take 3 day weekends constantly. Psychiatry at least where I am you'd have a waitlist for about a year or two just upon opening your clinic it seems. The downside, is you have patients that you take care of and are expected to follow up on. So you can't get as much time off, particularly in blocks. 

Alternatively, you have radiology, anesthesia, CCM, hospitalist. These people tend to play harder, as in more hours a week. However, radiology and anesthesia at least can then get a pretty decent amount of time off in blocks. Radiology can be around 10-12 weeks - theoretically more if you were willing to be paid less. Anesthesia you can work locums and time off between. CCM and hospitalists have 2 weeks on 2 weeks off gigs. Although CCM is harder to get into. Hospitalists can also suck the life out of you - so you need to do all this stuff to know if you like it in clerkship. 

Then there is ER, which can be both. You could work full time at ~13 shifts a month but then likely 3 overnights a month, and 50% of the weekends a month. With some places having a 30 hours a week requirement you may be doing 3-4 shifts a week. Sounds not bad but if they are randomly distributed you may then have time off but not time you can use with anyone. Although there are a lot of 75% FTE positions available. Taking block time off at least in my centre seems easy enough. Downside is ER is usually packed to the gills. UP side it is a lot of fun if you have the right personality, like procedures and interesting stories. 

 As you may be able to tell lifestyle is very important to me too. So there is nothing wrong with prioritizing how you want your lifestyle to look. Some people will say you can do that with any specialty. I say don't believe that advice. Look at what the average preceptor in that specialty does and then go with that. IE it may be possible to work only say part time as a cardiologist, but then there can also be a fair amount of resentment toward someone who isn't carrying their load. 

 

 

Actual word of advice as I said lifestyle is important to me, but what I have noticed in medical school is how inefficient most people are with their time. If you want time for hobbies and life, make that time now. You have the time. Med 1 and 2 aren't easy for sure. However, just blocking time off for activities you want is possible. Study early, actually study when you study (many med students are notorious for "studying" for 4-5 hours with their group of friends and getting about 1 hour of solo studying done). Clerkship is much the same, busier, but still possible to make time the key is stay organized. 

[MarsRover]

Tl:dr

clinic based specialties = better hours per week, less flexibility with time off especially in blocks. 

 

Shift based specialties = more hours per week, more time off in blocks. IE radiology 10 weeks off a year, hospitalist 2 weeks on 2 weeks off . . . 

[NLengr]

My advice as someone who is done all training and now working:

Decide how important living where you want is. Once you decide, think about it again because if you have any doubt what so ever that you would be happy working in rural NL, northwestern Ontario or northern Saskatchewan, you should make sure you pick something with good flexibility for location and that does not rely on hospital resources (psych, family etc.). 

The shine of work fades pretty quickly but if you hate where you live, it lasts forever and you could be stuck there for decades. 

[blah1234]

1 hour ago, NLengr said:

My advice as someone who is done all training and now working:

Decide how important living where you want is. Once you decide, think about it again because if you have any doubt what so ever that you would be happy working in rural NL, northwestern Ontario or northern Saskatchewan, you should make sure you pick something with good flexibility for location and that does not rely on hospital resources (psych, family etc.). 

The shine of work fades pretty quickly but if you hate where you live, it lasts forever and you could be stuck there for decades. 

I would agree with this point. Medicine is a busy career and it becomes a large portion of our identity. However, not everyone equates life with working.

I have many friends and colleagues that went into their fields for genuine passion and interest. However, they had to give up a lot in other aspects of their lives that is now causing them grief. 

I think a lot of people want it all (probably due to having worked so hard to get through this path) but I have to emphasize that the vast majority of people will have to make compromises in areas of their life and you may have to choose a field you are "okay" with to help balance out the other priorities in your life.