Internal Medicine vs. Surgery

[batmanisthebestsuperhero 1]

What is it about your specialty that you look forward to? For example emerg docs have told me they live for intubations, and how exciting you find that will tell you if you want to be a emerg doc. What is a good indication that you will like internal medicine? I am about to start clerkship and I am stressed because I still cannot pick between medicine or surgery. My thought process so far is that physiology and pathophysiology is really cool and interesting to think about mechanisms of diseases (especially rare ones) and for that reason I think i should do internal. I was thinking of doing a subspecialty in Nephrology, ICU, Interventional Cards, or just GIM, but I am not sure yet about that part. 

In terms of surgery, I really like cardiac, I like the procedures, I like the acuity, I like that you can 'fix' problems. I really like the Heart so I don't know about gen surg. Aside from the job market being awful, i don't know if I can deal with the length of training. 

Shadowing in surgery has always been exciting, shadowing on CTU felt boring but I suspect thats because I don't know enough to understand whats going on and appreciate the process of thinking. Also there didn't seem to be a lot of diagnostic workup happening when I was there at least. I do like surgery, not a fan of the length of training necessary to get a job, I am hoping I will like medicine but I just don't know. 

[Bambi 1,712]

You will figure it out! I am in a small surgical specialty, however, I also applied to 2 other fields, including FM, received all my interviews and left it to others to select my ultimate career field. I would have been happy with any of these 3 fields. 

[NLengr 782]

Do you like doing 6 years of residency, 2-3 fellowships (for an extra 3-6 years of training) and a PhD followed by fighting for the one cardiac surgery job in the country available in Newfoundland or Saskatchewan or Manitoba which you can never leave if you are lucky enough to get it, due to basically zero job market/mobility? If those things don't sound like the most amazing time of your life, stay the hell away from Cardiac Surgery. 

Hell, if you like a reasonable job market and not having to do pointless extra training, stay away from any surgery. 

If you like physiology, pathophysiology and disease mechanisms, you are probably more suited to internal. We tend to be less focused on those ans more solution focused in surgical specialties. 

[Aetherus 199]

I think you are approaching this question in the wrong way. You should not focus on one specific aspect of the specialty you find the coolest to determine if it is a right match but instead focus on the mundane everyday tasks and figure out if that is something you enjoy. Every specialty has something cool they perform, however these are usually not your bread and butter. 

I think medical students pre-clerkship tend to focus on finding a specialty based on the pathophysiology they find interesting. I would say that is not the best way of approaching this. The pathophysiology and science behind a specialty is usually only tangentially related to your every day work. 

These are the things I would focus on to determine what specialty you prefer:

Acuity: Acute vs Chronic

Setting: Inpatient vs Outpatient (Hospital vs Clinic)

Procedure: Low amount of procedures vs high amount of procedures

Level of Care: Primary care vs Specialty Care

Lifestyle: Good work life balance vs Bad work life balance.

 

I’m sure there are more metrics to consider, but approaching this question with these questions in mind will ensure you pick a specialty you are happy with in your day to day life.

[blah1234 137]

59 minutes ago, Aetherus said:

I think you are approaching this question in the wrong way. You should not focus on one specific aspect of the specialty you find the coolest to determine if it is a right match but instead focus on the mundane everyday tasks and figure out if that is something you enjoy. Every specialty has something cool they perform, however these are usually not your bread and butter. 

I think medical students pre-clerkship tend to focus on finding a specialty based on the pathophysiology they find interesting. I would say that is not the best way of approaching this. The pathophysiology and science behind a specialty is usually only tangentially related to your every day work. 

These are the things I would focus on to determine what specialty you prefer:

Acuity: Acute vs Chronic

Setting: Inpatient vs Outpatient (Hospital vs Clinic)

Procedure: Low amount of procedures vs high amount of procedures

Level of Care: Primary care vs Specialty Care

Lifestyle: Good work life balance vs Bad work life balance.

 

I’m sure there are more metrics to consider, but approaching this question with these questions in mind will ensure you pick a specialty you are happy with in your day to day life.

This is the right approach. Every job in medicine gets mundane to some degree once you finish your training. The big thing to think about is can you live with the bread and butter of your specialty for the rest of your professional life. 

[NLengr 782]

1 hour ago, blah1234 said:

This is the right approach. Every job in medicine gets mundane to some degree once you finish your training. The big thing to think about is can you live with the bread and butter of your specialty for the rest of your professional life. 

I agree too. 

My thoughts would be to decide what you want to do with your life outside of medicine and then pick whatever job facilitates that life. 

I would strongly emphasize that if you have any desire at all to work in a certain location in the country, pick something with a good job market and lots of flexibility (family, psych, general internal etc). Picking something with a less than good job market runs a HUGE risk of being stuck working in a town/province you hate. Trust me, you don't ever want to be stuck in that situation. Work will get old quickly and you will still be stuck somewhere you don't want to be. If you want to have kids, these concerns should be near the forefront of your mind. Family support close by is immeasurably valuable. 

[IMislove 562]

3 hours ago, NLengr said:

I agree too. 

My thoughts would be to decide what you want to do with your life outside of medicine and then pick whatever job facilitates that life. 

I would strongly emphasize that if you have any desire at all to work in a certain location in the country, pick something with a good job market and lots of flexibility (family, psych, general internal etc). Picking something with a less than good job market runs a HUGE risk of being stuck working in a town/province you hate. Trust me, you don't ever want to be stuck in that situation. Work will get old quickly and you will still be stuck somewhere you don't want to be. If you want to have kids, these concerns should be near the forefront of your mind. Family support close by is immeasurably valuable. 

In terms of surgery, I've been looking at areas within 4 hours or so of my family (hour away from GTA). Fair number of them are reaching ages of 55+, and by the time I am ready to work they'll be in their 60s. Is it a fair strategy to try and contact them during residency to do community electives and potentially start slowly working with them as they may slowly start slowing down? Most people in my class are focusing strictly on GTA are (within 30 minutes even) and that is not something I am concerned with.

[ZBL 210]

Medical interests + CTU boredom + excitement from procedures/surgery + hate for endless training, poor job markets and wanting a decent lifestyle 

=
EM, Ophtho or Derm

[NLengr 782]

13 minutes ago, IMislove said:

In terms of surgery, I've been looking at areas within 4 hours or so of my family (hour away from GTA). Fair number of them are reaching ages of 55+, and by the time I am ready to work they'll be in their 60s. Is it a fair strategy to try and contact them during residency to do community electives and potentially start slowly working with them as they may slowly start slowing down? Most people in my class are focusing strictly on GTA are (within 30 minutes even) and that is not something I am concerned with.

Yes. Very smart idea to make contact as early as possible. Make sure you do electives in places you are serious about if it is possible. You want to experience the place for yourself. Make sure they aren't painting an overly rosey picture of the place. 

Speaking as a parent, I'd say being within 2 hours of family is a huge difference to being 4 hours from family. 2 hours or less can easily be done as a day trip back and forth. 4 hours requires an overnight stay 90% of the time. But 4 hours is better than 14 hours. 

[robclem21 484]

16 hours ago, ZBL said:

Medical interests + CTU boredom + excitement from procedures/surgery + hate for endless training, poor job markets and wanting a decent lifestyle 

=
EM, Ophtho or Derm

+ Anesthesiology