confusedMedKid Posted February 25, 2020 Report Share Posted February 25, 2020 Hello, I'm currently feeling uncertain about what to do with my future. I have my electives primarily booked in internal medicine with a few in family medicine as that is what I found I was having to back up with. However, in the midst of everything, I find myself thinking back to being unhappy in MTU. I specifically want to do a subspecialty (not too competitive, but just want to say that MTU is not my ultimate end goal). I can't tell anymore if it would be worth it. I felt so beat down with the feedback from there - my personality just seems not good enough and yet no other rotation has had an issue with it. I also felt so stupid which I know everyone says is normal but even comparing myself to my peers, I felt like my knowledge was so far below baseline. I get no joy out of discussing a 15-disease long differential for something that's obviously a pneumonia for the "academics" of it. Some small parts of medicine bring me joy but they're mainly related to my subspecialty of interest as well as a few others that spark my interest a touch more. I attend teaching sessions and resent it whereas some of my peers seem to thrive and enjoy it. On the other hand, family doesn't seme too attractive right now either. I initially leaned towards internal of the two because I had very little interest in dermatology or MSK issues which would make up the bulk of the complains for an FM. I'm also more attracted to the acute presentation and more occasional follow-up than the active chronic disease management model. I just don't know where that leaves me and what to do, with many electives booked in the subspecialties of internal medicine. I don't know what I'm supposed to do and if I'm just having some mid-med-life crisis or if I'm genuinely realizing something about my interests. Any advice? Quote Link to comment Share on other sites More sharing options...
Lactic Folly Posted February 25, 2020 Report Share Posted February 25, 2020 You've mentioned a preference for acute presentations and occasional followup. Are you able to provide more information on what subspecialty interests you, or what the common factors are among this subspecialty and the others that "spark your interest a touch more"? Quote Link to comment Share on other sites More sharing options...
MedZZZ Posted February 25, 2020 Report Share Posted February 25, 2020 I am kinda in the same boat ... debating FM and IM and have reasons to equally like both! Why don't you do electives in both and decide which one to rank first later in CaRMS? that's what I am going to do. Although it would have been more helpful to know for sure what we want but I think a lot of people are in the same situation. Quote Link to comment Share on other sites More sharing options...
confusedMedKid Posted February 28, 2020 Author Report Share Posted February 28, 2020 On 2/24/2020 at 11:33 PM, Lactic Folly said: You've mentioned a preference for acute presentations and occasional followup. Are you able to provide more information on what subspecialty interests you, or what the common factors are among this subspecialty and the others that "spark your interest a touch more"? Hey! Thanks for your reply. I'm interested in a variety including endocrinology, hematology, oncology, palliative care. I like being able to spend a longer time with people and deal with more emotional situations including cancer. I like being able to be there and build a solid relationship while we work through the illness management but being able to switch to not seeing them as often once it is well managed. I don't really want to see someone for every single lump or bump that they might see in family medicine. The common components that I've enjoyed are longer consults with opportunity to get a feel for who the person is, strong integration of goals of care into the plan of action, time-limited relationship (i.e. I am happy to see someone during their hospital admission and then follow once annually for a specific issue until resolved) and honestly, being able to hand off parts of care that I'm not interested in. I have little interest in dermatology, for example, so I love that I would not be expected to decipher rashes. I do also enjoy doing some procedures, but I'm not too keenly interested in that and I wouldn't necessarily want to do them in emergencies so not too interested in ICU/Critical Care. At the same time, I want to do rather than think too long. I sometimes hate having the discussions of the unnecessarily long differentials when the diagnosis is something quite straightforward: If it's genuinely possible for it to be disease X, mention it, if not, we don't need to rattle off every single possible disease that can cause anything tangentially related but has no other real bearing to the case... On 2/25/2020 at 12:13 AM, MedZZZ said: I am kinda in the same boat ... debating FM and IM and have reasons to equally like both! Why don't you do electives in both and decide which one to rank first later in CaRMS? that's what I am going to do. Although it would have been more helpful to know for sure what we want but I think a lot of people are in the same situation. I'm doing both but with the limited number of electives, I'm getting stuck on how to set them up! I'm scared that I will make myself "uncompetitive" for medicine by having a limited number of electives and taking an even split to family. But I also don't want to end up not interviewing for family because I only did 1 elective in it. That's where I'm feeling "stuck". Quote Link to comment Share on other sites More sharing options...
Lactic Folly Posted February 28, 2020 Report Share Posted February 28, 2020 12 minutes ago, confusedMedKid said: Hey! Thanks for your reply. I'm interested in a variety including endocrinology, hematology, oncology, palliative care. I like being able to spend a longer time with people and deal with more emotional situations including cancer. I like being able to be there and build a solid relationship while we work through the illness management but being able to switch to not seeing them as often once it is well managed. I don't really want to see someone for every single lump or bump that they might see in family medicine. The common components that I've enjoyed are longer consults with opportunity to get a feel for who the person is, strong integration of goals of care into the plan of action, time-limited relationship (i.e. I am happy to see someone during their hospital admission and then follow once annually for a specific issue until resolved) and honestly, being able to hand off parts of care that I'm not interested in. I have little interest in dermatology, for example, so I love that I would not be expected to decipher rashes. I do also enjoy doing some procedures, but I'm not too keenly interested in that and I wouldn't necessarily want to do them in emergencies so not too interested in ICU/Critical Care. At the same time, I want to do rather than think too long. I sometimes hate having the discussions of the unnecessarily long differentials when the diagnosis is something quite straightforward: If it's genuinely possible for it to be disease X, mention it, if not, we don't need to rattle off every single possible disease that can cause anything tangentially related but has no other real bearing to the case... This sounds well thought out to me. Have you considered GP oncology or palliative care as additional options? Given that you see yourself enjoying the work in these subspecialties, I'm not sure how much your MTU experience should factor in; hopefully some of the internal med people on here can chime in. Quote Link to comment Share on other sites More sharing options...
Edict Posted February 29, 2020 Report Share Posted February 29, 2020 Stick with Internal Med. Based on your description, you still would really enjoy IM subspecs. The important thing to realize is that not liking CTU is incredibly common amongst IM applicants, in fact it is almost the elephant in the room. You only spend maybe 15 months on CTU/GIM in your entire 3 years. That is peanuts in the grand scheme of things. In other countries you may spend 2-3 years doing a rotating internship of sorts. The only thing to keep in mind is that not everyone who wants an IM subspec gets into it, so it is important to be willing to do GIM. The truth though is if you are keen and interested this early on in subspec, its unlikely you will find yourself unable to match. On top of that, community GIM is very different from CTU. A lot less academic debate and a lot more "get it done and go home". IM is a big tent specialty and you can find almost every kind of practice setting so you can really mix and match and find your own preference. There's a joke about IM which is that its for people who don't know what they want to do and want to put that decision off for a few years. Quote Link to comment Share on other sites More sharing options...
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