Torn between neurosurgery and ophthalmology - I have 24 weeks of electives. How should I plan?

[GOODATGETTINGREJECTED]

Hi all, 

M3 at UBC. Needing to pick electives this week. I am leaning towards Neurosurgery or Ophthalmology, the latter being frighteningly competitive. At this point, I have not had sufficient exposure to know which specialty I prefer more, and I am concerned that if I do 8 weeks of both, I will look wishy washy on my applications. 

Anyone have any advice here? I'm feeling frustrated with this process - Can't people have multiple interests and still achieve excellence in whichever one they are selected for?

[robclem21]

Disclaimer: I am in neither of those specialties and so my advice is not based on personal experience.

For a specialty like Ophtho. It is highly competitive and most people will use the first 2-3 years of medical school to network, do research, complete informal electives, and already have a full understanding of the specialty. For you to start doing that now puts you at a significant disadvantage. That being said, it is not impossible but it would require you to fully dedicate yourself to it going forward and of course, you should back up with something like family medicine if that is the route you want to take.

Neurosurgery, while not as competitive, would likely still require your full interest and networking since most departments are very small. They would not be impressed if you split your time between them and Ophtho, and also would require connections and research to match. Unfortunately, you would likely need to pick one and then dedicate yourself to it and probably still back-up with something less competitive or highly risk going unmatched.

To be honest, it sounds like you are already way behind the curve for both of these specialties. I understand that a lot of people make decisions late in medical school and change career paths, but to have no exposure to either of these specialties and be convinced one of them is for you is a bit odd. However, mostly I'm curious why you are leaning towards either of these specialties without having any sufficient exposure to each. They are both very niche fields that you can't possibly be attracted to for any reason other than the perceived "prestige" after not having spent any time actually doing them. I would think longer and harder about what you want to put yourself through this (competition for Ophtho and 7+ years of residency and fellowship for NSx) before committing to one of them.

People can and do have multiple interests, but rarely in fields that are so vastly different with not much overlap in practice style, knowledge, skills, or competitiveness.

The only helpful thing I could think of would be to split the first 4-8 weeks to decide which one you like and then use the rest of your time as best you are allowed to focus on one and supplement with relevant other electives.

[MDinCanada]

Those are two very niche specialties and it would likely raise a lot of questions during CaRMS.

From the perspective of the program, unless you're a stellar candidate, they would likely consider someone who's completed dedicated to their specialty. Often, these specialties are resident-dependent, so they often need reliable residents to run the service... This means, they don't want someone who's on the fence or considering switching to a different program. 

From my experience, the people in ophthalmology and neurosurg usually have strong ties with the department before going into CaRMS. Usually they've worked closely or done research with them throughout medical school. 

All this being said, in Quebec, I have heard of people deciding on ophthalmology last minute and getting in with little or no specific ophtho experience on their CV. I have never heard of this being the case in neurosurg (I think there are like 1 or 2 spots per year in the entire province... so across 4 medical schools) with candidates more often than not doing a M.Sc for their CV but also to align their application with the year when their desired program will have a spot.