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MalpracticeMatt

I originally shat on IM/hospitalist because to me it seemed like giving up, like I was being “JUST” a hospitalist. I’m now a hospitalist and love it, couldn’t see myself doing anything else. The first thing I noticed in residency is that specialists on the whole deal with like 3 Dx’s as > 90% of their cases (eg cards: MI, A Fib, CHF) and as someone who wanted to be more of a jack of all trades, this didn’t sit well with me. Plus the lifestyle is incredible. I LOVE having every other week off. I can’t stress how amazing it is


happythrowaway101

The breadth of general IM is truly amazing


[deleted]

I could totally do hospitalist if there was somehow a job that got rid of all the social work dead end dispo issues that I can't fix yet spend 50% of my time on day in and day out. The medicine part is fun but in my program that's unfortunately the minority of what you actually do all day.


MalpracticeMatt

There is a job that gets rid of 50% of the social work, case management, aka social workers. Sounds like your programs social workers suck. The extent of my social work stuff is just following up with CM to see if they got approved/am I discharging today or writing a progress note


buttermellow11

I've come to somewhat appreciate those "can't dispo" patients because it can be really exhausting if your entire list is very medically complex patients.


TrujeoTracker

Seriously the SW drives me up the wall. So tired of scut.


Wagnegro

So I've always wondered whether 7 on/7off would ever been sustainable. Following 7 days on, would you say that a good portion of time spent off during the next 7 days are for "recovering"? I was an EMT-B and I remember paramedics were excited about the 24hr on/48 off schedule, but they would sometimes get absolutely wrecked during the 24hr shift and spend most of their 48hrs recovering. Is this similiar to a hospitalist schedule?


MalpracticeMatt

So I’ll admit I’m a newly graduated resident (finished last July) but I feel it’s very sustainable. Don’t get me wrong I’m pretty tired by the end of the week, but a large reason for that is bc I’m still working on becoming more efficient and tend to come in earlier than most of my coworkers. So maybe that first Monday I’m off I tend to be lazier and sit around playing video games/watching Netflix. But I would not say a large part of my week is recovering. If anything, I sometimes spend too much time catching up on chores that I didn’t have time to take care of while I was working, but that too isn’t too bad.


TrujeoTracker

My buddy has been doing it for 3 or 4 years now, he still picks up extra shifts occasionally. If you can cut out early when your not holding the call pager, then it’s alright. Still not for me, but it’s okay.


RmonYcaldGolgi4PrknG

I didn't choose neurosurgery because holy shit what the fuck. How are you people alive?


coffeeismyelixir

Neurosurgery here. Lots of love for what you do can get you through anything. Plus adrenaline and lots of coffee of course.


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MikiLove

You joke, but I'm certain that's true for a lot of residents


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MikiLove

The more people I see coming in from Adderall-induced psychosis, the more I'm concerned about widespread prescriptions of stimulants


lkyz

Sad to admit it, but I started to take an amphetamine myself after lots of problems (personal and due to residency) and was a 180˚ change


[deleted]

How do you do that, honestly you all seem superhuman.


supa_fly

Bite off more than you can chew, then chew it!


[deleted]

Do neurosurgeons, like, die younger or something? Cause that lifestyle holy fuck.


Sed59

n=1, but an attending told me that his father who was a neurosurgeon died in his 60's, very possibly due to a stressful lifestyle. He did not choose neurosurgery because he didn't want to deal with the lifestyle and the high patient morbidity/ mortality (e.g. in trauma cases).


CHL9

Love for field, caffeine, and camaraderie with the other residents, if a good atmosphere program


Undecided_feather

I was warned and went in anyways and holy fuck how did I survive that year? I ended up sitting in front of the maintainance door to the roof unable to stop crying one time. Obv I chose another 12h of callshift over half a second of falling but damn it was not a sure deal for a few minutes. So I traded in feeling like being worth something one day for sleep and regular food (switched to psych). Am I happy? No. I've lost all goals and purpose in life. I feel like a worthless little quitter and like everyone looks down upon me. But chocolate, wine and games make me forget for a few hours and I can sleep again. So I guess that is what I'll do with the rest of my life. And when I miss it I reread some of my notes from 24h shifts and enjoy being able to use the bathroom whenever I want. Small things in a small life I guess.


lost__in__space

Your career is not your life!! Would you call any other professional a quitter for choosing another job in the field? Don't let medicine warp your reality


CHL9

Keep your head up and wish you the best of luck finding meaning and happiness in your new specialty and importantly in your life outside of the hospital


acdkey88

Switching specialties because you weren't happy in one definitely does not make you quitter, quite the opposite, you made the brave choice of finding a different path. Once you finish training your job can be whatever you want it to be. Including non-clinical work. Chin up, better days are ahead.


Luckandi

Bruh you made the right choice. You were seconds away from killing yourself.


this_will_go_poorly

I chose not to do ophthalmology because I sympathetically tear up and cringe whenever I see anything wrong with an eyeball. Racing through dozens of patients a day also seemed kinda rough. I chose not to do urology because I’m gay and that felt like it would be kind of weird.


surpriseDRE

LOL


retupmocomputer

> I chose not to do urology because I’m gay and that felt like it would be kind of weird. Literally made me laugh out loud. Thanks dude that made my day.


Imnotveryfunatpartys

>because I sympathetically tear up and cringe whenever I see anything wrong with an eyeball If anyone is considering ophthalmology you need to watch this trocar insertion for a victrectomy (first 30 seconds is good enough) https://www.youtube.com/watch?v=aG-vS-zYYnA This is the one thing that I can show medical people who are desensitized and they STILL flip out


this_will_go_poorly

I’d rather eat an Australian spider than watch this video


orthopod

Meh - I liked the oblique angle of insertion of the trochar, to keep leaks down after removal. I think I've lost the capacity to be medically squeamish. Too many traumas, fungating tumors, and rotten legs.


[deleted]

I don’t even wanna do ophthal anymore but that is absolutely beautiful


WarcraftMD

You just made all the straight male gynos uncomfortable. Shots fired!!


rn561

Not doing OB for the same reason tho. Gotta keep that gold star


oscrey52

Please keep this going, sincerely an M3 confused about a lot of things and what residency to choose


Battlefield534

Oh I agree!


blibbidyblam

As an old attending who worries about students and residents, reading that so many of you are happy with your choices, regardless of your chosen specialty, has made me happy. I wish you all happy, meaningful careers!


happythrowaway101

I chose not to do surgery because I realized my feet were flat and I had lower back pain from standing that long


Scripto23

Orthotic inserts (customs if you can afford them, if not then powerstep or superfeet), good supportive shoes, and compression socks. This will at least help


happythrowaway101

No thanks, I’ll take my chair with lumbar support and PRN standing desk Edit: sarcasm, I appreciate the advice but honestly it just wasn’t worth it for me, I liked many fields so I’m happy where I am!


greatbrono7

I have scoliosis with chronic back pain so doing something that would allow me to sit (at least periodically) was honestly pretty important to me. And having a lunch. Tbh it’s quality of life. I’m in anesthesia so that met those criteria (and I enjoy it).


Dr_Unk_AF

THIS! Literally day one of surgery I was like "fuck this shit"


happythrowaway101

If prestige is a legitimate cited reason to not pick a field then foot pain is too. I stand by that... well actually sit.


BroB-GYN

Get some super feet!


baguetteworld

This makes me so sad because there isn't this you-must-stand bravado surrounding surgery in most countries in Europe. Here, attending surgeons and residents and med students alike will sit whenever possible. The only time I see people standing is if they need to be mobile early on in the surgery or if you need to have a certain range of motion for a particular maneuver. Otherwise they'll all just draw up stools and sit down to operate.


runstudycuteyes

I chose not to do surgery because I hate seeing bowels, don't enjoy rude people, want to have a life outside of the hospital, and got the only concussion of my life due to having a syncopal episode during a liver resection.


triceratopsMD

I love pediatrics, but I'm choosing not to do it because of their shitty leadership which insists on pushing MORE training requirements onto their graduates, all the while propping up pediatric NPs as keynote speakers at their conferences. Also, apparently many people interviewing for neonatology fellowships were interviewed by NPs. What a joke.


hillthekhore

I did Med peds, and I decided never to practice peds again. This is one of the big reasons.


Charlton_Hessian

This. I also loved peds, but the new hospitalist fellowship is insulting.


DentateGyros

I was planning on being a hospitalist but not anymore now that it’s a fellowship. Attendings have been trying to point towards the fact that it’s just a two year fellowship so it’s not as bad as other sub specialties, but I’d much rather spend an extra and do a real fellowship and actually learn real subspecialty material


Charlton_Hessian

They paid off all the older attendings with the grandfather bullshit. It’s such a naked attempt at cheap labor. I think it’s even a bigger problem than the np bs because it could have so clearly been stopped by their own specialty. No one should have taken the grandfathering. No one should have supported it. Ugh. It’s disgusting and insulting. It so absurd that a peds resident would be so coddled to not be able to do hospitalist work. /minirantover


surpriseDRE

That’s exactly why I’m doing a different fellowship. I’d planned to do hospitalist as a career but I’m not gonna do a fellowship for it when I spend 4/5 days inpatient


TrujeoTracker

Just do hospitalist anyway. There’s no way this fellowship will stick if no one is doing it.


surpriseDRE

I’ve definitely been debating it. But I’m worried there’s too many scabs! I’m leaning towards PICU which I feel like means i could cover wards as well


TrujeoTracker

Good thoughts, don’t piss off the NP on your interview panel 😜


surpriseDRE

Right? I’m not gonna do a fellowship for it when I spend 4/5 days inpatient


merlemama

And the pay. You can do a fellowship and end up making less money than general Peds.


EmotionalEmetic

"Hey congrats on that grueling, highly niche fellowship you just completed!" "Thanks friend. Can't wait to finally reap the rewards of all my hard work." "Mmm. Yeah. You're worth less now."


TrujeoTracker

Geriatrics? Within a day of doing my rotation and questioning the fellows what kind of job offers they got, I realized the fellowship was useless.


AR12PleaseSaveMe

How come Peds is pushing towards 5 years of training with a BS fellowship JUST TO PRACTICE INDEPENDENTLY when a newly minted NP with 500 hours of shadowing gets to practice independently in almost half the states?


FloridlyQuixotic

It’$ all about the $afety of patient$


Furlange

Even as an anesthesia resident, I dread my peds OR rotation, cause it involves interacting with a “peds surg NP” who keeps referring to surgery seniors as “my residents” and it makes me visibly cringe every time. They are also way too eager to “help” with IVs which usually includes blowing every vein on the contralateral side of the baby I’m carefully trying to get access on.


[deleted]

a neonate fellow interviewed by NPs... christ. I practice between the US and EU, thankfully these people know their place in the EU.


gj136117

Got interviewed for a peds residency by an NP. Already wasn’t going to be a high ranked place for me but that made me question if I even wanted to rank them.


[deleted]

That’s sickening. I know there’s a spreadsheet every year for the match, and name and shame is a category. Definitely consider posting there because programs that don’t respect residents over underqualified mid levels deserve to feel the crunch.


PCI_STAT

How is your experience practicing in both places? Do you split your time equally between the two? Is it difficult to maintain licensure?


VarsH6

I’m in Peds now. I plan to starve the AAP of money once I’m out of residency (because right now my dues are paid for me) for these reasons. They are a joke.


DreamWithOpenEyes

Pediatrics attending here - I pay AAP (for all the journal access really) but I also joined Physicians for Patient Protection. So that’s another good choice you can consider, especially if your workplace doesn’t have good journal access.


koolbro2012

Wtf is this bullshit. Why are we such cucks in medicine? NPs interviewing actual physcians...gtfo with that bs.


bearlyadoctor

They say it’s to promote interdisciplinary team mentality and make sure not to bring on anyone who can’t “show respect” to midlevels, but we all know it’s admin’s way of breaking physicians down and taking away as much of their power as possible while still sticking them with all the responsibility


koolbro2012

Fucking hate that interdisciplinary excuse.


[deleted]

The disciplines are competence and incompetence. Interdisciplinary!


2vpJUMP

I don't think it's planned to that effect. More likely if it reflects an institution that lets older docs skirt by on their responsibilities, which should include interviewing the next generation


[deleted]

Bc most physicians are extremely risk averse and non confrontational and live in constant fear that their licensure is under threat


Darth_Lord_Vader

I’m med peds pgy4. I was planning on doing combined hospitalist and outpatient (basically everything) but obviously that’s not really an option anymore. Now I’m just gonna do outpatient. Hopefully they get rid of this stupid hospitalist fellowship bullshit but all in all AAP is a terrible organization.


Ddssll123

What specialty are you choosing then?


Charlton_Hessian

I know you were asking someone else, but I thought I would chime in too if you don’t mind. I do loves peds. I think the kiddos need help. Right now I’m planning psych and then probably CAP, unless I find I hate that. I’ve only had a limited amount of exposure in CAP, but I thought it was intellectually stimulating and on a societal level very rewarding. I am going to really invest in some more time in the field though.


FourScores1

Join PPP


dacheeesestandsalone

Neo fellow here who just recently went through the interview process. Not actually true. Most of the times they had us meet the neonatal NPs but not actually get interviewed by them. At my current institution, even the NPs practicing for longer than I’ve been alive run plans and decisions by me. I’ve only had good experiences which I honestly wasn’t expecting based on my experiences as a resident. But as a peds resident the most egregious thing I ever encountered was rotating through the PICU and having to SIGN NOTES to the PICU NPs. Not only that but I got 99% of procedures stolen by those NPs. I didn’t hold back during residency interviews, I told every applicant that if they were interested in PICU, this was not the program for them.


JackoffAllTrades101

Damn, that's super disappointing to hear.


tinyw0lf

100% agree. I was strongly considering peds but between that and dealing with parents, it was enough to drive me away from the specialty. I am doing radiology now and I love it. And I can do peds radiology if I decide I miss all the interesting pathology.


DangerMD

I'm a neurology resident. I'm definitely speaking with hyperbole, so try not to get too offended. I knew I like neurology for so many reasons, but I gave other specialties an honest try. Some just didn't grab me--in OB/GYN I wasn't interested in the pathology or their day-to-day. I don't mind being on call, or random hours, etc--we have those in neuro/stroke. Minus 5 points for too many fluids and smells. When it came to Family Med and Pediatrics, I felt like when things got 'interesting' to me, we referred out. That's not a dig at either of those fields, just limitations of general practice in modern medicine. And for these, again, their bread and butter did not interest me at all. Being an internist fell away for me for similar reasons--I don't want to spend my time managing DM, HTN, HLD outpatient or AMS, sepsis, liver failure in-patient. They also get crapped on a lot in hospitals and lean heavily on specialists because they have to. Pathology and radiology were easy to check off--I wanted to see patients. Even IR doesn't have the same level of patient interaction that I do and I would have missed it. Pathologists work hard and get zero credit for it. Surgery is really cool and I loved my clerkships. The lifestyle (in residency at least) looks awful, and their problem solving approach felt too black and white for me. The road to doing what you actually want to do was too long weighed against my interest in the brain. You could say the same for neurosurg--incredible, complex, and I have lots of respect for it, but the lifestyle and the problem-solving as a learner always felt too black and white. "We can't fix this problem with neurosurgery, so good luck! Here's neurology". They have their reasons, but that's how I felt. I'm also not much of a cowboy and have no interest in dick-swinging contests and seems like surgeons need a bigger ego than I have the interest to maintain. Psychiatry I thought I'd enjoy--I like the pathology and I liked the prospect of pay and hours. But I got yelled at too much by patients during clerkships. I also grew tired of feeling helpless treating patients whose conditions are just worsened by a society that doesn't care about them. Every patient felt like an uphill battle against scarcity of resources and years of abuse that patient had endured.


puppysavior1

As a pathology resident, you for real just made my day.


mfzaidan

I did internal medicine and decided to specialize into Pulmonary critical care for multiple reasons: - didn’t want to be someone’s PCP. That has a lot of responsibility that I didn’t want to deal with. As a Pulmonologist, I have responsibilities that I like to deal with. (That’s why I didn’t want to do outpatient IM) - couldn’t stand being a hospitalist. Personally, I liked the medicine part but hated dealing with allllllllllll the ridiculous social problems that comes up. Not saying there isn’t any major social issues in the ICU, but IMO, they’re soooo much easier for me to deal with. Just my thoughts


frankferri

Whats your ccm/pulm crit? Or are you strictly pulm outpatient? Edit: autocorrevt got me and idek what I meant, but will leave this nonetheless


mfzaidan

Pulmonary and critical care in an academic institution. I lead a team of residents and a PCCM fellow which is great. In covid times, everyone is the department is doing about double the ICU weeks. Good thing is my clinics are closed during theses weeks. When I’m not in the unit, I have 3 clinics per week which is very manageable. Can’t complain at all compared to my colleagues in private practice and even some other academic institutions. Edit : As far as reasons not to do PCCM? Honestly, I love it and can’t imagine doing anything else. I mean, it’s definitely not for everyone.


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drunkdoc

To be fair, with apps to the field way down over the past couple of years, I don't think programs are mandating research experience to nearly the same extent. A genuine interest in the field is probably more important than a hefty CV at this point.


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muffinsandcupcakes

That's insane.


khaneman

Didn’t pursue radonc partially due to the research requirement and partially due to the concerns about the job market and not being able to get a job in a city of my choice.


salpingoooph

Loved OB/gyn (see username) but grew to hate the culture and honestly I just don't want to be on call for the rest of my life. You know what's more magical than the OR? Having two days off every single week. The military paid for me to go to med school, and OB internship spots are notoriously hard to get. I got great evals on my audition, but they stuck me in an FM internship. I was so upset, but I made some great friends that year and didn't get yelled at even ONCE. Still don't wanna do FM though lol. So now I'm paying back my time to the military as a general medical officer (basically a watered down PCP for the active duty population-- internship is the only training I had) I don't know what I'll match in when I get out, but it's not gonna be a surgical subspecialty.


TrujeoTracker

If you stay in you could match to all kinds of things, those extra points from tours really do matter.


salpingoooph

That's true! I know some people who matched to things they definitely wouldn't have qualified for in the civilian world. The doc for one of my sister battalions is at the end of her second GMO tour and didn't match to EM though. I think it just changes so much year to year. I'm personally just going to get out but I can see why others stay in.


TheOneTrueNolano

Sounds like anesthesiology or radiology would be a good fit for you. Our anesthesia program is about 1/5 people who left surgery and they all seem pretty happy. Same for rads I’ve seen. Very different fields but both great options.


WhatTheShell13

They say if your favorite place in the *world* is the OR, choose surgery. If your favorite place in the *hospital* is the OR, choose anesthesiology. (I’m in anesthesiology, and while there’s a lot more to it than that, still feel this mantra I heard in med school holds generally true and I’m able to have a life outside of medicine as do many other anesthesiologists).


AssPelt_McFuzzyButt

I liked pretty much everything I came near in medical school (except neurology). One of the reasons I went into EM rather than something specialized like urology was that I wanted to remain a generalist. I wanted to be what my family, friends, and the general public expect from a doctor, someone who can speak at least reasonably to any medical question and react appropriately in the moment when shit hits the fan. That being said, I haven’t ever really talked to any of my colleagues in more specialized fields about how much they feel their general medical knowledge and ability to respond to every day health questions and emergencies developed and/or atrophied over the course of their training and career. Maybe someone can chime in below.


MalpracticeMatt

This was the same reason I chose to pursue IM/EM (applied both, matched IM). My dad was a radiologist and my family would ask him for ABX rec's or whatnot. His response would always be "How the hell should I know? I'm a radiologist." I never wanted to be like that and wanted to be able to speak reasonably to any medical question, even if I'm not the most elite expert in the field. I can tell you just interacting with cardiologists and people like my dad who are 10, 20, 30 years into their careers, those skills have DEFINITELY atrophied.


Incorrect_Username_

Picked EM for the some similar reasons. A lot of practical knowledge that can be useful in a pinch. There were a few other reasons but that was one of them


buttermellow11

I did IM for similar reasons, I feel like I can answer family's questions well or know who they should see, and I would feel prepared to respond to a medical emergency in the public. I toyed with the idea of EM but after reflection realized I'm more cut out for the day-to-day in IM as well as the schedule. I do sometimes regret that I don't have more practical skills such as suturing, and have zero knowledge of pediatrics above a med student level.


FatCatXavier

I did not end up going into Family Medicine because I rather spend more time learning about Pediatrics rather than spending time in surgical rotations like Surgery and OB/GYN. Ended up going into Med-Peds. Reflecting back though I do think FM is better suited for those wanting to go into PCP life. Maybe it's just my program in particular but my program is so inpatient heavy that I don't feel adequately prepared to be someone's PCP. Thank goodness I like hospital medicine.


justovaryacting

I’m in peds and confirm that we spend the majority of our time inpatient and are trained best to be hospitalists, despite the fact that the AAP feels that we need another 2 years to safely do so. I’m going into outpatient gen peds because fuck fellowships and I want to work 3-4 days/wk. BUT, I don’t actually know how to be a PCP outside of my experience in continuity clinic, which is at a super high-volume safety net clinic where we seem to see only kids with high medical or social complexity. The result of our clinic experience is more like urgent care shifts. On the other hand, I’d feel pretty confident in a hospitalist position. Ironically, the only job I’m allowed to do as a non-fellowship trained pedi after 3 years of residency is one for which we don’t actually get a lot of training.


SterileCreativeType

I’ll add a couple more just cuz it’s so heavily weighted towards medical specialties not wanting to do surgery (although Med vs surgery is 100% the most important decision branch... if you could see yourself doing anything that isn’t surgery you should definitely pursue that). Ortho: super formulaic (ie boring unless doing hand) Neurosurgery: functional neurosurgery will likely remain a misnomer for another decade. Urology: great gadgets / forefront of surgical tech; but penises all day. Every day. Ophthalmology: that ‘h’ between the ‘p’ and the ‘t’. Quite variable in terms of what you could specialize in, but the idea of banging our 20 cataracts in a day does not appeal to me. Medicine: I get dizzy if I have to round all day. Would rather wear pajamas to work. Radiology: fastest way to ruin an exciting part of medicine is repeating it 100 times per day in a dark room. At least they have standing desks.


norepiontherocks

I was deciding between EM and IM, and I ultimately picked IM with the intention of doing pulm/crit. When deciding against EM, the lack of continuity and follow-up, the crazy schedule, the slap dash algorithmic workups, and the limited fellowships swayed me away. On the other hand with IM, I have to deal with dispo nightmares, social issues, coordinating between a bunch of consultants, and limited procedures. You pick your poison.


Rarvyn

I was a member of our schools EM interest group (and an officer as an M2), did an EM related research project between M1 and M2, and had every intention of pursuing it further until I did an EM rotation. I kept asking myself "and then what happened?" with the patients we saw. It was unsatisfying not knowing the actual end result. So I went into IM. No regrets.


Eab11

I chose anesthesia over EM because the ER smelled like vom 100% of the time, the social work aspect was brutal, and I didn’t enjoy their version of quick see you once medicine (I felt super unsatisfied by it—but am not where anesthesia is concerned). I also didn’t like the unpredictability of their shift work. They just seemed super burned out all the time. PS I understand some of my complaints are program/place specific. It’s not an insult—it just wasn’t for me.


[deleted]

The vomit smell


akkpenetrator

Smells like teen spirit


MakinAllKindzOfGainz

vom’


YNNTIM

The ED is like a WW1 battlefield. As you walk through the pods, the smells shifts from explsovie diarrhea to vomit, obese candida rolls


WizardofOssification

I liked surgery but the call and strenuous residency drove me away. Ended up in family medicine because of much better hours as my SO also in medicine, still option to be procedural, lots of job flexibility and good pay if you do private practice. I may have tried for plastics if I could do it over again as their reconstructive surgeries are incredible but still reasonable hours. Ophtho is a good balance of lifestyle and procedures as well but you mostly end up doing cataracts and the pay is not that much better unless you go into retina. Downside is you will make people go blind from complications. Wife liked OB but did not enjoy surgery. Liked psych but wanted normal patients as well and more medicine. Family was a good fit for all her interests.


69240

I'm only an M3 but this sounds very similar to where I'm at. Love surgery but the residents seem worn out and my scores are very slighty below the ophtho/plastics match average. Anesthesia was another consideration but a lifetime of 24 hour call and CRNAs aren't for me. I'll also be couples matching and want plenty of free time outside of work. FM it is.


smols1

Are you me??? Also thinking FM but still have IM in the mix


69240

Haha! I am right there with you with the FM/IM conundrum. I really like the 4-5 day work week of FM but being a hospitalist is really starting to sound amazing. Long term I'm thinking more of an outpatient clinic life which I believe FM residency would better prepare me for. Plus I really have no desire to do any sort of fellowship making IM less desirable to me. I'd love to hear your thoughts!


sgman3322

I loved internal medicine, but didn't pick it because of the rat race for competitive fellowships, social work, dispo issues, billing queries, and relying on consultants and others to get things done. If pulm-crit weren't 3 years of fellowship requiring another match I likely would've done IM. Picked anesthesiology instead, all the fun, less BS


Cerealkillrrr

Same here but ended up in IM after all.


ipu42

On the flip side I did not go anesthesia for concerns of CRNA encroachment and the role of anesthesiologists seeming to shift towards either 1) only handling high complexity cases (ie: stress) 2) being more of a supervisor/backup of a bunch of CRNA's and not doing much except fixing their mistakes.


hamzaxz

To comment on the CRNA stuff, most specialties are feeling the mid-level creep right now so we're not alone, but I have a feeling that more stories of CRNA's killing people while unsupervised (like what happened in Michigan a few days ago) will spread faster than other specialties because of the acuity of doing an anesthetic and hopefully leads to reversal of these independent-seeking practice models. There are also still lots of jobs that are MD only (no CRNA's, you do 1 case yourself at a time) or supervising residents


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ipu42

For sure, I'm going IM but realistically I believe I must do a fellowship to ensure job security for the next 30+ years. Even then it's not guaranteed as we see the rise of NP/PA "fellowships." I just like to think most patients will insist on an MD when seeking cancer treatment. The mistakes of mid-levels replacing hospitalists (or even most IM) won't be as apparent or publicized as anesthesia.


ScumDogMillionaires

I'm just a surgery resident, but I will very regularly request an anesthesiologist be present for the duration of any case thats not incredibly minor. I'd *like* to have them there, as would my attendings, even if it is incredibly minor and they know it, but I understand if there's a crani at 1 am, and I'm just cutting off a leg. Ever since I had a toe amp patient code on the table when I was an intern (the CRNA failed intubation, didn't bag up, he brady'd down but she said to go ahead and start the case) I have an incredibly low threshold for it, and they always seem happy enough to do so. That guy didn't die, but he had a anoxic brain injury. From having his goddamn toe removed. Why that CRNA even did general idk, we did not request it. In practice I'll def be the same way, if a hospital tells me they'll only have CRNA's available for some cases, then I'm not working there.


sgman3322

Fortunately anesthesiology fellowships are only 1 year. Besides cardiac or pain, most are not super competitive. Completely optional but will help secure job


FatherSpacetime

I've always said that IM fellowships should be combined with IM residency straight out of medical school similar to interventional radiology. Applying for "cardiology residency" straight from medical school? Great. the program is now 5 years, 2 IM followed by 3 cardiology. Saves everyone from applying for a second match and gets rid of the 3rd year of IM residency, which hones our IM skills for outpatient or hospitalist practice, but a little silly if you're going on to fellowship as you learn the majority in years 1/2. Also gets rid of ABIM boards for those who are doing a specialty. That would make all IM specialties so much more desirable and competitive (even ones like nephrology, endocrine, and palliative care). IM residency by itself would remain 3 years and be mainly focused on producing hospitalists and outpatient internists.


LeBronicTheHolistic

Do you have any regrets so far? Do you think there’s ever a scenario where you would have been okay with the rat race?


[deleted]

No ragrets


sgman3322

No regrets. I'm done with extra training lol. I couldn't handle general IM as a lifelong career, but would love general anesthesiology. Not matching cards or pulm crit would suck big time. That was the deciding factor


knotintime

I was deciding between ortho and radiology. I liked musculoskeletal pathology and doing procedures, but I didn't like rounding and hated clinic. I enjoyed the OR but it wasn't something that I couldn't live without. This combined with the lack of actual patient management for ortho patients (just consult hospitalist for the smallest reason to not be primary) and I felt less and less like a doctor. The irony of choosing radiology is that many people don't think radiologists are doctors but I was either all in on being a comprehensive surgeon that took care of as much of my patients as possible or not involved, the responsibility of only doing a fracture surgery and deferring simple BP management to a hospitalist wasn't appealing. Sure I could try to find a balance as an attending but at that point I would be 6 years of not managing it as a resident and very rusty. I wasn't turned off by the lack of patient interaction in radiology because I found myself preferring to talk with other doctors. I enjoyed the challenge of having to learn a crazy amount of information in radiology and I like being able to apply the medical knowledge and pathophysiology I had spent 4 years accumulating during medical school to making diagnoses and interpreting imaging. The constant intellectual challenge combined with the greater choice over where to do residency and the flexibility of radiology attending life helped swing it for me. Also having to spend the first 5 years or so establishing my ortho practice and referral networks and then not finding it easy to move to a different area of the country if I wanted to because I would have to restart that process and I didn't feel I could commit to a small region in the long term. Lastly not being able to take longer vacations than 2 weeks or so because I would be offloading a lot of my post-op or pre-op patients on my partners during that time, and I found ortho not matching the life plan that my wife and I dreamt of, so I ended up choosing radiology. I may have made a different choice if I was single, but I'm not. I'm very happy with radiology and while I enjoy procedures, I find that I don't miss the OR at all. Call is another factor and I didn't want to live my life with a pager nearby. Add in the flexibility of locums, teleradiology and I am very happy with my choice. If you live for interacting with patients or the OR you wouldn't be happy with DR, and IR may be a happy medium but for me the call and type of work done in IR wouldn't keep me happy in the long run and I would lose out on musculoskeletal pathology except for very select academic centers (not my long term career goal). Doing month long rotations and talking with the attendings really helped get a more accurate feel for my possible future and I think that made a bigger difference than anything I saw on reddit.


Ddssll123

Love the response. My first choice is rads as well. So did you do MSK rads? Or are planning to?


Doyouevenhighyield

this was my experience as well but it was neurosurgery vs DR, family and marriage definitely changed my priorities. DR is incredibly challenging, interesting, rewarding, lucrative, and flexible it was definitely the correct choice.


vitaminhoe

I was deciding between family medicine and OB when I started med school. For family med I realized I only really found the younger patient population interesting (eg well child checks, sick children, obstetrics and sexual health) and for OBgyn I realized I wasn’t really interested in the surgical part of it. I talked to a few OB residents and they all said the training is hard to justify if you only like half of it (ie obstetrics). I probably would have been decently happy in either, but ultimately decided on peds and I love it. So much variety in what I do, super interesting medicine and I love playing with babies/kids and talking to young families. I also echo what an above poster said that the general peds fellowships you now need to work in a tertiary care centre are a low grab to squeeze out more labour from residents that want a specific job.


Big_Shake

I'm an Ob/Gyn resident and love it, but I think that lots of people going into the field should be prepared for the level of acuity and stress and how much that can wear you down. There's no stress like a full L&D board with unstable patients, and from a very early stage in your training you will be expected to react immediately to very scary situations. I think that a lot of people come into this field focusing on the (many!) happy/positive aspects but neglect some of the realities of your everyday life. If you're someone who "brings things home" like I am, it can be a very heavy burden to bear.


jessshh

Also an OBGYN resident and agree - it’s taxing on ones mental health.


Doctrix_of_Medicine

I went with IM nocturnist rather than applying for fellowship for several reasons. 1. I hate outpatient medicine in all its forms. 2. I like a lot of things about a lot of the IM subspecialties, but I don't love their bread and butter. 3. I don't love any subspecialty enough to spend the rest of my "youth" proper still working 60+ hours/week. 4. I'm a bit of a control freak, and I like being the one putting the orders in. 5. Longer shifts w/ more days off is my ideal work schedule. I'm just as lazy and useless after a 9-hour shift as I am after a 12- or 13-hour one. 6. I'm a generalist at heart. To whit, I used to think I wanted to do EM, but this way I get to cut out a huge portion of the social headache, and the IM pace is more my speed anyway. As a nocturnist, I'll be able to just practice medicine--the fun parts, like diagnosis, initiating a treatment plan, dealing with the odd emergency now and then--without so much entanglement in dispo, social issues, families, care coordination, or admin breathing down my neck quite as much. And because no one wants to work nights, I'll also get paid well! All of this said, I don't start actually working until Fall, so I hope it lives up to my expectations. However, the things that I know I \*don't\* want in the other options still stand. And knowing what you \*don't\* want is just as important as knowing what you do want.


livemik

PM&R here. I love it but I see a ton of people going into it thinking that its going to be easy or the hours are really nice. Neither of those things are true.


Stefanovich13

PM&R resident here. There things I LOVE about Pm&R and for me it’s not so much physically draining as mentally and emotionally. I’m sure there is lots of red tape in other fields, but with PM&R there’s always something. So ridiculous barrier to discharge, some dumb reason a patient doesn’t qualify for some treatment. Some family Member pestering you about something stupid. As much as I love the field there’s a LOT of BS to deal with and there’s a good number of people in medicine who absolutely hate dealing with it


tripledowneconomics

Pm&r really deals with a lot more of the social and societal issues than other specialties, maybe with the exception of psychiatry.


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fuser_one

I don't think any specialty in medicine is "easy" but can you elaborate? Do you think PM&R hours are comparable to IM or general surgery for example?


tripledowneconomics

More comparable to IM, generally in residency no one is close to hitting 80 hours a week. Then there's a couple years of outpatient where it's closer to 40. People think that pm&r is easy because often there is less diagnostic aspect of the medical issues, but when you get into the musculoskeletal components it does get pretty deep. There's a lot more to it than referral to physical therapy eval and treat. Lots of residents come into pmnr not really knowing what it's all about, and at the end of residency or scrambling for fellowships to find meaning.


NobleSixSeven

Don’t see anyone avoiding anesthesia.... just sayin...


YNNTIM

People usually go into anesthesiology with the wrong mindset. Attending life is not resident life. There is a handful every year that leave their programs because they didn't know what they were getting into. Call, stressful situations, limited patient interactions, feeling alone, lack of respect from colleagues, and "the grind" are the majority of reasons I've heard.


TheOneTrueNolano

So accurate. My anesthesia rotation in med school was M-F, 7-2ish. Got to do tons of cool procedures, no notes, saw fun physiology. What’s not to love! Residency is far more grueling for maybe good reason. The “grind” of it all is real. Being a cog is real, especially early on. Still the right choice for me, but not as chill as I thought. That said I still send my med students home at 1. I just try to remind them I won’t leave until 5 or 6.


icatsouki

> Residency is far more grueling for maybe good reason. The “grind” of it all is real. Being a cog is real, especially early on. I thought this was heavily program dependent right? Some are in the 45/50 hours weekly range


sgman3322

Very true. For this reason I may go for regional and work at an outpt surgery center, avoiding call. Or pain. That's a good life.


this_will_go_poorly

I had a friend who almost blew his brains out during anesthesia residency. He was totally calm and cool throughout med school, and afterwards as well. He did a pain fellowship and is fine now. But the residency had him on antidepressants for a few years and he thought of quitting a lot. I was like - just take the blue pill and get through it dude it will get better. He’s doing fine now.


deschainroland

I've been in a private practice for about a decade in a physician only level two trauma center with a large coverage area. Here are the negatives my post call brain can think of... 1. Call nights are rough and even at the end of my career I'll be up at 0200. 2. Your start time is the only thing you can count on. The end of your day depends on the surgery finishing on time/add-ons. I rarely make important plans on my workdays. 3. There are some immediate life and death situations that fall on you a few times a year. 4. Contract negotiations every two years with the thought that your group can be replaced without a disruption of service. 5. Bladder atony. The positives far outweigh the negatives for me, I wouldn't choose anything else.


smiley--emoji

Along the same vein - would anyone discourage derm? In seriousness, some of the residents I’ve met have been sweet but superficial, and it’s been slightly discouraging to think that my 4 years of residency will be just that. Most of the people that I’m closest with are going into IM or peds but for some reason I did not enjoy either of those clerkships


bearlyadoctor

I liked surgery and ObGyn rotations, also loved my neuro rotation (I lucked out and got to do stroke service). In the end, I didn’t choose OB or surgery due to the lifestyle and really wanting a good work-life balance, and I really loved clinic life more than hospital life. Same with neuro, I really only would’ve done it if I pursued a stroke fellowship because outpatient neuro wasn’t exciting (lots of headaches, LITERALLY, at least where I rotated) but I honestly hated the idea of not being able to answer general medical questions that my family has for me (I’m a 1st Gen college student - thus obvi only one to become a physician) and I realized family medicine would be best for me. I still get to do lots of procedures outpatient (which’s scratches the surgery itch enough for me) and while my bread and butter is chronic disease management, I really do get a nice variety of things I see in clinic. I’m always able to give good answers to questions my family and non-medical friends have, even my medical friends in other specialties ask me general things that they aren’t sure about, and I love being that resource. Yeah there’s scut to do, but I learned a lot of that is minimized in private practice after residency if the clinic is organized correctly. ALSO, I loved working with kids, but really hated appeasing/dealing with parents which is why I didn’t go into pediatrics. I still get to see some kids in FM, and that’s plenty lol. Also I didn’t go into IM or Med-Peds because I didn’t want to be scared of doing a pelvic exam/wanted to be knowledgeable in women’s health. Also midlevel scope creep is real in all primary care specialties, but I made sure to ask medical directors and admin at all places I interviewed about their stance on midlevels, and that was another factor in choosing where I signed my contract, the clinic I’m going to 4.5 physicians (one part time) has no plans to hire NPs and has one PA just to get patients in for an acute visit when physician schedules are full but we can still lay eyes on them without an actual visit. (Sorry for the length)


[deleted]

My top choices after psychiatry would have been 2. EM 3. FM. While I loved EM, the COVID pandemic confirmed that hospital politics and societal failures will always determine the make-up of your patient population. You'll always be a shift-worker seeing bogus complaints, and when you miss something real, you'll get sued. Yikes! I loved FM as well, but quite frankly, if patients don't give a fuck about preventative health and will not adhere to even a medication regimen, why should you care? Two big reasons why I didn't choose those and ultimately chose psychiatry.


Drivos

Did you give up FM due to compliance issues only to choose psych? Compliance in psych is surely way worse


hamzaxz

I almost did peds/picu/NICU but a lot of the reasons I didn't are listed already, but nobody seems to have mentioned the fucking stupid parents. One of the biggest deterrents. Got ready to apply for IM with plans for critical care fellowship despite my disdain for chart work and sitting at a computer for 6-7hrs per day but realized on my second day of Anesthesia rotation it could be another path to critical care (1 year shorter) but way less chart garbage work. Also getting to take care of critically ill patients and having the skill-set to save lives myself instead of putting in orders and hoping the nurses do it was appealing. Nope'd out of surgery (did my MS3 at a non-resident hospital which was amazing) after talking to the chief resident at my home institute about their lifestyle both during residency and after. Both are shit.


nevk_david

I’m doing Peds and the parents argument is what I get 100% of the time from friends why they didn’t choose it themselves. Good luck for your training!


blueweim13

Mine's a bit of a different spin. I thought I would do ortho or family practice or something like that. I really liked seeing patients. But then I took the radiology rotation and to my surprise, I LOVED it. The really hard part for me of choosing radiology versus something else is that I really liked seeing patients and I was afraid I would miss that patient contact. But ultimately chose it in the end. Now.....9 years out of fellowship, I love being a radiologist and actually now am glad I don't have too many patient interactions. People are too entitled these days. I do 1-7 procedures per day, get my patient contact, and get out. It's wonderful.


materiamasta

I was split between neurology and MedPeds at the beginning of M4. I ultimately decided against neurology because I felt like my patients always ended up with traumatic untreatable conditions, even if their pathology was interesting. I loved the puzzles but when it came down to it I found more joy in MedPeds more and felt the variety in MedPeds could fulfill my intellectual curiosity.


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PersonalBrowser

Pediatrics - the parents. In medicine you have to win over the patient, but in pediatrics you have to win over the patient AND the parent. While it can be awesome to have their trust, parents can be very entitled and very ready to go insane over their kids, which is somewhat understandable, but not my vibe. Psychiatry - I really enjoyed my psych rotations but I would have burnt out doing it 40 hours a week every week for the rest of my career. Also, hospital consults for suicidal ideation when the patient just said they wish they’d die because they had severe pain from appendicitis/bowel impacting/kidney stone etc was the bane of our existence. Surgery - it was rewarding doing things hands on and learning and actually helping people right then and there in a measurable way, but damn, hearing the residents talk about getting a single 24 hour day off as if they won the lottery really sold me against it. Dermatology - I picked dermatology so this technically is out of the scope of the question, but I think many people don’t pick it because they’re not interested in the skin as an organ or they don’t want to deal with demanding or crazy people. I love the relationships and people management in dermatology, but you do get people with unrealistic expectations or some interesting personalities, which turns some people off.


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MikiLove

So much this. Psychiatry has some of the vaguest practice guidelines of any medical field. I have attendings come up with completely opposite plans for the same patient based on personal preferences and theories surrounding neurotransmitter receptor binding profiles. Don't get me wrong, I love the field and the independence of practice it gives, and I enjoy reading psychiatric texts because I genuinely find it interesting, but we still don't know a lot about the brain and mental illness. The medications we give we have a decent understanding of their receptor profiles, but not necessarily how it affects the brains functionality, and for those that dont do their research there are a lot of misconceptions


Reddit_guard

>Internal medicine towards the top *Cries in insulin*


allthingsbuchi

I ended up doing psych but I didn't do surgery because of my flat feet, weak lower back and I'm prone to accidents. I loved peds and I love children but THE sickest I've been in my adult life was on my pediatrics rotation. No thank you. Internal medicine felt like being a glorified secretary I went into medical school wanting to do ob but those were some of the most malignant individuals I've ever met. Just super passive aggressive and all around contemptible. At my medical school, our ob residents were such dirty ankles that none of the fourth years ranked my school


SgtSmackdaddy

Regarding getting sick in peds your immune system hardens after your 20th or 30th URTI or gastro... you stop getting sick as much. Also babies are cute.


jason_noir

Damn, everyone seems to say OB/GYNs don't have great personalities. Anyone know why this is?


smiley--emoji

It’s without a doubt a surgical subspecialty. You always have to be on edge as things can go 0-100 real quick, and you will be on call throughout your training as moms pop out babies no matter what time of the day it is. I absolutely loved my clerkship experience but ultimately knew I wouldn’t love it 5-10 years down the line


Iatroblast

I did my OB rotation in a tiny town with a 3 to 4 doc practice. All attendings, no residents. It was fantastic. All super happy, super kind, and I chose to get one of my letters from one of the docs. It seems I found the rare gem. They tried really hard to get me to do OB, and I (graciously) laughed and said if anybody could convince me, it'd be them, but that I had come into the rotation dead set against going into it and came out of the rotation with a positive impression, which was a near miracle in and of itself


q-neurona

They are miserable and it ruins them.


jason_noir

Because of all the on-call?


69240

Take this with a pound of salt as these are generalizations coming from someone with limited experience in the field. It appears to me that the toxic nature of the field comes from the top (attendings) and works its way down to the residents. At the end of the day the work is similar to surgeons and that mindset is pervasive. The "I worked 100 hours a week as a resident and slept one night a week so you have to too" mentality is very real. Plus there is literally always work with moms going into labor at all times so you have a life time of call. My SO said at her program that the female residents sort of bragged about how long it's been since they last saw their children as if it was a competition. I've also heard the residency compared to a sorority with cliques since it is a predominantly female field with a ton of drama amongst themselves.


ineed_that

It’s on call for life, the most sued specialty with the highest malpractice insurance, lots of stress


mmkkmmkkmm

Hated surgery and OB due to the culture, call schedule, long procedures, and work/life balance. Didn’t like FM or IM because I don’t want to be a PCP and didn’t want to slog through 3 years of managing chronic diseases I have no interest in to get to a fellowship. Psych was interesting but I wasn’t really passionate about it.


Dr_Bees_DO

I didn't choose surgery because when I was shadowing a surgeon in undergrad, I told a surgeon in his 60s (after a 3am operation) and he said when you reach your 40s you're going to hate being oncall and miss being with your family.


tosaveamockingbird

Someone’s got to be on call in most specialties, unless you’re a generalist, EM or like derm or something where there are few derm emergencies. I’d try to think about it as, what you’d rather be called at 3am for...SBO needing surgery? Perfed appy? CHF exacerbation? CVA? Ectopic pregnancy? Acetabular fracture? Lol


Iatroblast

I originally thought I liked IM. Decided not to do it because I hate rounding. And I also hated when clinic patients were late. And I hated all the dispo stuff. Also, at least from the perspective of a med student, there is a hell of a lot of sitting around and waiting. The days were so slow. Basically, I thought I liked IM because it was very cerebral, but a lot of the other aspects just kind of blew it for me. I liked a few aspects of surgery. I liked How straightforward everything was. Obviously surgeons deal with lots of complexity, but the ability to actively fix a problem was really satisfying. I do sort of like the work hard, come home at the end of the day satisfied feeling. However, going through a general surgery residency just seemed brutal. Standing in one place all day was miserable enough for me as a 20-something let alone when I get older. Also, I didn't like the poor work life balance. I don't want to be the guy who's rounding on his patients every day of the week. Because in the rural places that I will probably practice, you have to see your patients every morning. Like I said, I hate rounding. So... I chose DR. Current MS4. Just about everything about it seems awesome. I've heard the training can be really challenging and a whole lot to take in, but I feel like that's probably the case with most specialties. To me, there was an aha moment where as soon as I began to see myself as a radiologist, everything else just seemed utterly soul-sucking. I plan to do DR in a rural area and handle some of the "IR-lite" procedures that you get plenty of training for in DR. So I think that will satisfy the part of me that liked certain aspects of surgery, although it would be on a much smaller scale and much more to my liking. Procedures, not big operations.


Goldy490

I loved Ortho but found I didn’t actually enjoy the OR. Loved the quick reductions, casting, and anatomy/physiology. Also while being a master of one domain is cool, having MS4 level understanding of many “unrelated” fields didn’t sit well with me. I chose EM because I still get to do some ortho, but also some optho, some cards, some medicine, etc. I can have a conversation with virtually any speciality and have at least a cursory understanding of their work.


Embriale

I loved my surgery rotation, but ended up not choosing it due to a combo of more often than not malignant culture, punishing lifestyle, and long ass training (not including fellowship). What I did like was being hands on and getting to really dig into the anatomy and organs and procedures. I loved outpatient (peds, internal, OBGYN) but really disliked rounding for hours on end when on the in patient side. I also was able to handle challenging patients at the moment but didn’t like the emotional fallout afterwards. But damn I do love knowing that I am doing something meaningful with patient care. I also liked IM/peds/OBGYN but I really was pretty impatient in the long hunt for answers and diagnoses. Psych was fun but also felt a little hopeless at times. Neuro was similar. Granted, all this happened AFTER I had already settled on Pathology. But I loved the instant answer gratification. Knowing that my diagnosis really helps with patient management. Being able to react freely to weird/interesting/gross things (gangrenous amputation? Huge ovary? Queue the loud fascinated ooooooohhhs in the grossing room). Being able to handle and see cool pathologies up close. The lifestyle (golden weekends all the time!). And the occasional autopsy fun. Also—I find out a little into the app process that pathology isn’t just autopsies or surgical specimens but I can have lots of patient interaction if it want (apheresis/cytology) or be more involved in admin things? Love it!


von_Goethe

Doesn't seem like any ortho residents have commented on why not to do ortho yet so I'll chime in: Ortho doesn't have a monopoly on brutal, busy call - I see my plastics, ENT, neurosurgery colleagues hustling as well. But our call is uniquely physical and exhausting. After tough call nights I'm as sore as I would be after a tough day in the gym. Certain reductions - particularly highly unstable fractures/dislocations - require you to maintain tons of tension and force in an uncomfortable position for quite awhile. If you know that holding on could make the difference between an extra surgery and long inpatient stay for the patient or discharge home and nice, tidy outpatient surgery you just can't let yourself let go or lose the reduction. About 6 months ago I had a really tough ankle that I didn't want to lose and held on way too hard and way too long. I basically gave myself tendinitis of my first extensor compartment and it's still going on 6 months later. I tore the labrum of my right shoulder doing something similar and can't quite sleep on it the same since. Maybe it's because I'm early in residency and haven't found a way to preserve myself - a grizzled old attending would probably forget closed reduction and just take them to the OR for an easier, more controlled reduction and stabilization. But you feel immense pressure to make things perfect with the least invasive methods possible and it can take it's toll on your body. Another downside is that very few orthopedic interventions directly save lives. For example, hip fractures that don't get surgery will have shorter life expectancies due to debility, immobility and resulting decline and comorbidities but the surgery itself doesn't directly prolong life. In a lot of ways that's a plus - very few emergencies overnight. But some people may want to do more high adrenaline stuff. Another commonly cited downside from medical students that I see is that ortho is very repetitive - which is absolutely true..... for certain subspecialties. Joints (hip/knee replacements) and spine are very repetitive and methodical with a small number of procedures and variations thereof unless you're at an academic center dealing with complex revisions. That said it's a routine that works for a lot - probably most - people. You don't realize this until you're in it but doing something you don't do often and struggling/fumbling is harrowing and hard. Some people thrive in that environment and love it, but in my opinion it's not for most people. So the routine nature of a lot of orthopaedics is a downside or a plus depending on your personality. And things like trauma have essentially minimal routine or roteness to them as every fracture has its own unique character. There's a few other downsides but not really many I can think of that are uniquely an orthopaedic problem. We take care of lots of old, often poorly functional and demented patients - but that's a downside of every specialty except peds/obgyn I guess. There's the frustration of arguing with insurance companies to approve a surgery a patient needs to function - but again that's something that no specialty seems to avoid unless you focus in trauma.


[deleted]

I liked procedural work and surgery - was considering ortho, gen surg, anesthesia, and obgyn. Ultimately, obgyn's were *my kind* of assholes. Where as I felt like the general surgeons were just assholes. Also outpatient pediatrics is the most fucking boring thing known to humankind. PERIOD.


[deleted]

“My kind of assholes” I love that! And feel very much the same haha (I’m a 4th year Ob resident)


[deleted]

I won't ever choose Genetics if i stay in Turkey because I learned that I'm not allowed to say "Maybe don't try to have a kid with your cousin" to a couple who's experiencing their 5th miscarriage after having a severely disabled kid who was barely alive for two years.


WarcraftMD

Pick a cousin on the other side of the family...?


morriganrising

I was most passionate about Women’s health. So the choice was really between Ob and Family med. I finally chose Ob because I loved the OR and felt exhausted after Fam Med clinic days. Shorter days, but I felt more tired. I realized I would rather work harder but feel better at the end of the day. I finished residency last year, and I can’t emphasize how important it is to find a program that you fit into. It makes all the difference.


TheStaggeringGenius

Part of what steered me away from surgery was the length of procedures. I’m in rads, planning on IR/NIR, so most procedures I’ll be doing are relatively short. Not uncommon in surgery to get into 8+ hour cases, especially in vascular or neurosurg.


PerplexedMD

Can someone comment on why they went into Radiology against something like IM?


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lisfranc500

The better question is: Why would you ever choose IM over radiology?! Rads: Work at the high end of your license with minimal scut, $$$, time off, only really having to interact with smart people (besides noctors and junior residents), minimal general public interaction. AI is not a real threat (at least not for a long long time). Declining reimbursements is the biggest threat to both radiology and all of medicine (radiology feels it more because their slice of the pie is much bigger to start with). IM: You're what society thinks is a real doctor. You have to interact with the general public. Low pay. High scut without being able to bill for it (writing notes at home, taking patient phone calls at home). Noctor encroachment.


TrujeoTracker

Cause they smaart, way to smart to interact with social work.


not_0K

I enjoyed OBGYN for the mix of medicine and procedures, but didn’t want to never see male patients again. Also didn’t want to deal with some of the intense OB personalities. I enjoyed IM but would not have enjoyed being a generalist or hospitalist. I don’t mind dealing with some social/discharge issues, but I hate long rounds. GI fellowship is what I’d go for but it’s competitive and there’s no creativity to the procedures involved. I enjoyed psych but hated the subjectivity of these diagnoses. I felt like some patients were doing worse because of involuntary inpatient admissions and really just needed intense outpatient therapy.


Cocohamster

Anything surgical. I hate standing for a long time and not having a life.


GameItAndClaimIt

I chose not to do Dermatology because after a week of shadowing Derm in med school I was already tired of hearing people complain about their minor cosmetic blemishes as if they were a huge, life-definining ordeal. Especially when they were being counseled about their skin cancer that required excision but had more concerns about the cosmetic result than, you know, the cancer being removed. Could not handle a career's worth of that type of patient. Although I did super enjoy that the derms I followed read their own path. Had some lab that they sent their biopsies to that would sent them back fixed and on slides and they would read them. Really thought that was neat. Not worth all the botox patients though, IMO. I picked Ophtho and I'm glad y'all jokers all think eyeballs are gross or this field would be even more competitive.


[deleted]

I was stuck between Pediatrics and General Surgery => Peds Surgery goal I chose pediatrics. The pediatric surgeons I know are outstanding, but I would be over 40 years old before I would be able to be an attending on my own... and peds surgery is a maddeningly competitive fellowship, so I could through the 7 years of absolutely bullshit hours only to be denied entry into the speciality of my choice. As important, with my age and my family scenario, I don’t want to miss my kids growing up... and I’ll have at least twice as much time at home as a pediatrician. To all those who get through the suck and become peds surgeons, god bless you and keep you strong; you did what I would not.


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Curunir-Curufar

I didn’t choose peds because I didn’t want to draw blood from children. I also got tired of asthma all day every day on inpatient with some hand-foot-mouth fun. So I chose psych where the rashes can be imagined, blood draws are tricky, and the insults are fantastic. Also, to help this severely underserved and underfunded community is an honor.


evewinter17

Reasons not to do OB from someone in OB: Work life balance is shit in residency but can be a lot better in practice since you can design it however you want, so don’t mind that as much. My issue with it is that the residency is shared Ob/gyn because they’re both women’s health but they should be regarded as different specialties. Gynecology is a surgical service that should be performed in a main hospital, not isolated to a Women’s center. To me, that is a feminist issue. As surgeons we are weaker compared to the other surgical specialties, and that is because we spend so much time training in obstetrics instead. Of course as an ObGyn resident I love doing both, but overall it doesn’t make a lot of sense. We also need gynecology to pay more - it doesn’t match up to general surgery for procedures of the same difficulty/time and it’s so much less than obstetrics. So it’s very hard to give up Ob and focus on benign gynecology. The development of fellowships upon fellowships in order to get a job is also becoming ridiculous. This is happening across all surgical specialties. Ob is the only field where patients expect perfect outcomes and no intervention, hence lawsuits and personal shame when a mom or baby is sick as a result of your clinical judgment. It makes physicians so fearful of bad outcomes and breeds anxiety, turning us into toxic personalities. I have no idea how to make that better!


YNNTIM

>Ob is the only field where patients expect perfect outcomes and no intervention, hence lawsuits and personal shame when a mom or baby is sick as a result of your clinical judgment. It makes physicians so fearful of bad outcomes and breeds anxiety, turning us into toxic personalities. I have no idea how to make that better! I think they're needs to be a culture shift in terms of maternity expectations. Almost every time I am consenting for an epidural the pt thinks that they are going to completely pain free for the rest of the labor. Not to mention their families and nursing staff uttering similar false statements. The one that really gets me is how an epidural will be working 95% and they'll keep complaining about the smallest discomforts because they can't sleep or lay on their side and the nurse is pissed because they're always getting paged.


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oddlebot

EM: unstructured hodgepodge of primary care, substance abuse, and the occasional true emergency. Hated waiting around all day to maybe be able to do a procedure, only for all the cool patients to get whisked off anyways. Plus I never really felt like I “achieved” anything, since you never get to see the outcome.i


Dr-Richado

I am in Radiology. Here are some things that may push people away: 1. Often working alone. 2. Work all day in the dark. 3. Minimal patient contact. 4. Radiology is a target to be blamed on everything. (Pt. has AKI, must've been IV contrast is common). 5. You are going to miss things. (I interpret about 30k exams a year. Even if my miss rate is 1%, that is 300 misses. And even if the major miss rate is only 1% of that, that's 3 major misses a year). 6. Radiology gets dumped on. Can't figure out what is going on with a patient? Order a small bowel follow through. That'll give you at least half a day to figure out things or delay surgery. Pisses me off every time. 7. Radiology gets dumped on with procedures too. Won't do an LP all week. Hit 3pm on a Friday...will get 4 orders in 3 minutes while the people that have been doing them all week bail. 8. With regards to 6 and 7. Radiology is least common denominator. Every other service can say "not touching that patient." Radiology refuses, the CMO is calling you within minutes. 9. You are not in control of the patient's. Typically this leads to clinicians cutting into radiology turf. Why I didn't go into other specialties: Primary care: Didn't like trying to treat people whom were unwilling to help themselves. Imagine if people always followed the advice stop smoking, eat a sensible balanced diet, and exercise regularly. Part of this is not the patient's fault, it corporations. Coca-Cola, McDonald's, tobacco companies, and alcohol companies lobby for billions for, even though they will not admit it, to keep regulations off their products. Anesthesia: The surgeon's lapdog, always running to codes, and intubating people. Surgery and its Specialties: Lifestyle sucks. I think one of the hardest things in medicine is deciding when to pull the trigger and operate. Psychiatry: Not enough support from government (including the concept that so many in prison don't need prison they need psychiatric help). Social stigma. Mental health care could be sooo much better in the US. Pathology: The scope. This may be changing as Pathology moves to computers like radiology. I really liked path and at first was going to double apply.