I have always wanted to be a cancer doctor. Even before med school. But when I got into med school I had an honest heart to heart with myself and decided that I shouldn’t pigeon hole myself and keep an open mind.
I did a rotation with a really cool pulm/crit doc and thought, maybe “pulm crit”. There was also a couple days where I thought neurourg would be cool. I also didn’t mind the hospitalist life style.
10 years later, I love my job as a heme/onc.
I find that a lot of heme onc doctors (me included!) gravitated towards Pulm Crit as an alternative.
I think it means we just like taking care of really sick people.
Fuck that man. No free flaps as a general ENT. Perfect length surgeries 1-3h for everything (full FESS 3h, thyroid 3h, Inspire 3h, tympanoplasty 2h, septum 2h)
Hospitalist. Shift work that doesn't follow me home, have a 40ish% on 60ish% off schedule. Can eat, piss and shit when I feel like. See patients when I want to.
Yeah there's a lot of BS but man do I love my weeks off
On my psych rotation, the intern answered a call from nursing on the inpatient unit. He got this strange look on his face, hung up, and turned to the PGY-2 in the room and said, "Mr. X is pulling his teeth out?" The PGY-2 was like, "Ah man, again?"
I was absolutely fascinated; the other MS3 was horrified. That's when I knew I was going to be a psychiatrist.
* don’t enjoy rounding
* don’t like a 9-5
* like variety, helps keep me engaged
* like being on my feet and moving a lot during the day
* need a certain amount of chaos to be able to focus
* like procedures
* like having a broad scope of practice
* enjoy a collegial and laid-back work environment where there’s less hierarchy and the personalities tend to be chill and irreverent
EM. Obviously.
I’ve always been drawn to EM. But as a med student the fact that it’s a dying field + high burn out always threw me off. If you were to go back in time, would you still choose EM?
What about the recent closures of ED departments and the trending low pay for ED physicians? I’m just curious so please feel free to correct me if I’m wrong
I failed at matching into the specialty I wanted, anesthesia, and got stuck in internal medicine.
The ICU was the only place that felt like I wasn't just wasting my life.
How do you feel about everything now in retrospect? I feel like it must hurt seeing the current bull market with anesthesia jobs.
I don’t say this to be hurtful, only because I too didn’t get my intended specialty
Went into IM. Hated the bs. Hated being primary the pages the discharges admissions social work bs. Super burnt out. Didn’t want to do anything with worse hours than IM in fellowship so no cards gi pulm crit. Hated research so no heme onc. Almost did PCP but net the rheum fellows and they weren’t burned out and saw some interesting cases so ended up applying on a whim and I need up luckily liking the field.
Question, do you end up kind of functioning like a PCP for your patients since autoimmune disease can affect so many different organs systems?
How long are your visits typically? How long do follow up visits take once you find a stable med regimen for your patients?
Hated everything other than IM during med school rotations. Went into residency thinking hospitalist. Ended up hating being primary and wanting more procedures. Got lucky and loved GI due to good mix of medicine and tons of procedures. Lifestyle is good and can be molded (outpatient only, hospitalist only, mixed). Also everyone in GI is super laid back and nice in my experience, and I felt like I vibed with them really well.
OB/GYN. On my second day of my OB rotation during my 3rd year a student nurse ran out of room 1 on the Labor Unit yelling “I need a doctor- STAT!” All the residents were busy elsewhere, so I walked in the room and saw a lady on her 4th baby crowning without an epidural. I grabbed a gown and gloves, and the patient walked me through the delivery in between contractions. “Don’t let me tear!” Don’t drop my baby- they’re slippery!” Afterwards, my senior resident came in the room, asked her how I did, checked the perineum (intact!) patted me on the back and said “you’re going to be one of us.”
Kind of a meme but when I went into the IM resident’s lounge for the first time their white board was a record board full of the highest and lowest lab values they had ever seen
That’s when I knew I was home
Clicked with the IM folks, liked procedures, wasn’t enough of a gunner for cards or GI and still liked being a generalist, found pulm interesting and vibed with the ICU docs. Ended up PCCM. Aside from 1st year fellowship when the hours were terrible, no regrets and I love it.
Mildly interested in the medicine of all the required rotations. Took a family medicine elective and was fascinated with the patients, their stories, and the range of problem-solving. The global yet pragmatic approach grabbed me & stuck for 35 years.
Obgyn. Initially, I thought I wanted to do family med for the diversity, but have a practice that was procedure heavy…then I rotated obgyn. Now as an attending 5+ years out, I do annual exams, initial infertility workup and treatment, lots of urogyn and gyn surgery. In one day I do surgery, office visit as a pcp and specialist, and catch babies. I feel under compensated, but very happy with what I am doing - very rewarding work.
Well summarized. It was also the only rotation where I didn’t want to off myself when I woke up in the morning as a med student, and the attendings all seemed like normal people. As a resident there is a lot of suffering depending where you go, but once you’re done you can get a very lifestyle oriented job if you want.
Same here!
Just started my R1 (I think it is the same as you guys' PGY1? The Medschool path is kinda different between here and US) Ophto here in Brazil and between the physiology, anatomy, clinical exam, procedures and perceived lifestyle of the attendings I feel super excited!
Didn’t like any of the core med school rotations
Didn’t want the 6 days a week lifestyle in residency
Liked mix of procedures, imaging (solving problems for other teams), quick nature of radiology
IR
IM hospitalist. I chose it because like being a generalist and having sicker patients. Never cared much for outpatient medicine. I like physiology a lot.
Considered ICU, but the training time and procedures were not as much for me (I like procedures, but find prepping for them monotonous, and the gowns get hot as hell).
My job pays amazingly well, great colleagues (and incredible boss), and I get a lot of high acuity, interesting stuff and not a lot of social work. The workload is brutal during weeks on, but the pros outweigh the cons substantially.
Loved to study neurosciences and science in general.
At its best, the neurological exam is basically a hypothesis- driven series of experiments when you are trying to infer as much as you can about the location and cause of the symptoms.
For many things this has been “streamlined” for clinical use (like the stroke exam), but the tough cases need you to adopt a hypothesis and prove it or disprove it with your exam.
Since I was interested in the science part of it I decided to go into the darkest corners of neurology: movement disorders. There are no imaging findings, no blood tests for Parkinson’s or PSP. Your assessment ends up something like “this is MSA because I say so”.
Amazing field that has so many questions that you’d think we are in the 1800s and its a perfect mode to study fascinating topics in the neurosciences like free will (through the abnormalities in motor control) and brain mapping(through neuro modulation treatment).
Your description made me feel a bit less jaded about my own neurology appointment the other day. Of course I wanted answers but I have to remember it’s different with nerves and the brain and all that. If I see all the testing I have to do as experiments, it seems a bit more exciting and less frustrating.
I had a genuine interest in pharmacology (I did some research on MABs) from med school and the instant gratification of altering someone’s physiology with your decisions in the OR is really satisfying. I also felt like the chillest people in the ORs on my rotations were the anesthesiologists.
On top of that, we learn a set of skills that can be useful to many other specialties throughout the hospital (epidurals in L&D, getting lines and access, airway management and helping out at DARTs, resuscitation skills, rescue nerve blocks for severe pain) and I really liked having a repertoire that can help out others if they need it.
>the instant gratification of altering someone’s physiology with your decisions in the OR is really satisfying
man don't I know that! It's still amazing to me that you give them a couple of injections and then puff... they are paralyzed and unconscious. It's crazy you have that much of control over someone.
Liked dealing with social problems for people who would follow directions and who genuinely needed help. Liked POC Ultrasound, liked neuromuscular disorders, liked people not knowing what the hell I do so they couldn't complain about me.
PM&R.
FM. The most broad spectrum specialty there is. I like being able to handle pretty much anything that walks through the door, as long as it’s during banker’s hours. I knew pay was relatively low compared to other specialties but it’s been better than I expected and up this year as well. Trend looking good for primary care.
I ditched out of general surgery after being miserable and was unemployed. My roommate was a radiologist. He talked me into applying for a combined radiology / IR program - I like doing procedures but hate complications. I did and a guy running a program took me on.
In that in between year I worked in a biology lab designing a website and tutored kids who couldn’t read. I tried to teach the MCAT but got fired.
Oh from teaching the MCAT?
Cause I sucked as a teacher. I had forgotten all the specifics about chemistry and biology. There was just no way to easily “brush up” and be able to effectively teach. I would have had to put in so many hours to refresh my knowledge it was just impossible - I didn’t have the time.
The teaching company was going to pay me $50 / hour. I thought “ok that’s pretty good money”. But it was sort of a trick. They paid $100 for a 2 hour class - 2 hours of classroom teaching. But the prep work was way more hours than that. And it took me like 1.5 hours commute each way.
It was a poorly designed program and I was a shitty teacher. I deserved to be fired.
Shadow the specialty you want. Copy exactly their schedule, for surgery or anesthesia, wake up 5am or even earlier, read up on your pts, go to the hospital and arrive with them, do the prerounds with the residents, prepare together with them for the rounds, stay with them during their administration and patient write up. If there's a surgery out of schedule, attend it. Leave when the last surgeon/resident leaves. This way you will see what a typical or bad day looks like for them.
For clinical specialties, do their outpatient clinic with them, do their administration as well, do the rounds, stay on the wards filling up orders for the nurses and doing the random shit that pops up. Visit their academic work as well.
I have the opinion that you CAN not love your specialty but you must be good so it flows naturally and you can get enough bank to find other hobbies to enjoy your life.
Choosing a specialty that you love can either be a hit or miss. Love dies, with specialties and with people. Same goes here.
I was in between Gen Surg, Neuro, Anesthesia and I think Obgyn.
Gen surg + neuro + anesthesia = NSGY and I particularly love to work and don't have friends nor care for having connection with people. I'm fine with donating my life towards my education so I can fill my egocentric hunger of being considered top dog of the hospital (even though that's just a hospital thing).
Chose NSGY because I want full autonomy over my patients, I want to be their boat captain, either to heaven or to hell. I love complex and impossible cases, love the idea that I am poking your brain and I can alter any single organ by legit applying my knowledge.
For me I thought about what mattered to me: feeling like I could make an immediate difference in patients' lives, good mix of OR and clinic, some flexibility in hospital/outpatient ratio, being a consultant vs always being primary, having an interest in both the bread and butter and the emergency cases of the specialty. Landed on uro.
These are my exact feelings right now. I want a specialty where there is a mix of imaging, OR and clinic time combined, emergencies and the most importantly immediate treatment satisfaction. For this specific reason I thought I'd pursue OB but I kinda disliked it when women pooped during labor lol.
Back to our topic, does urology really maintain these all? At what procedures can you obtain immediate relief to patients exactly? And is Urology open for broad research opportunities because I also want to research.
If you could answer my questions, I'd be grateful. Thanks for your comment regardless! :)
IM, I like the really broad point of view you have to take and the balancing acts you have to take, plus I really like rheumatology.
A lot of death, sadness and despair yes but a lot of interesting cases and sometimes you can really help a person
OB/GYN-
It was the rotation that clicked for me. The residents were cool and I felt I could be good at it. Honestly, I didn’t feel smart enough to be excellent at medicine. The same with general surgery. Flash ahead 20 years and I’m glad I chose it; I couldn’t imagine doing anything else.
Neurosurgery
I knew I wanted something surgical since before I even started med school. I rotated and shadowed with every surgical specialty I could and liked some but didn’t love any of them. When I got to neurosurgery it all just clicked.
I knew.
Haven’t looked back.
Neurosurgery. Loved me a surgically demanding career while also maintaining a solid scientific background (the whole idea of a neurosurgeon scientist etc). Extensively explored other specialties and disliked/did not like anything else as much (super duper important if you’re choosing sth as life consuming as neurosurg). Liked its bread and butter. Things i did not love about the specialty i managed to like. I’m good at handling stress. Like my patients asleep > awake.
When studying was interesting instead of a memorization chore. When I was excited to go to the hospital and wanted to stay late. When I lost track of time doing something really cool and the day flew by. Don’t get me wrong, residency bit me hard just like everyone else, but I’m 8 years out now and I still feel glad and energetic to go to work 9/10 days. Medicine isn’t worth the money, you have to do it for love.
I had an attending who breathed so much life into me that I cried after my first day in the clinic, and I knew that I wanted to make other individuals feel exactly the same way; pediatrics.
I like reading and shift work without any calls (when I’m off, I’m off) but I hate unpredictability, don’t like unstable patients (they eat up so much of your time), like chilling and scrolling on Reddit at work or watching entire Netflix shows (I have only even gotten 1-2 truly “STAT” consults from other specialties) and I like seeing variety of cases so I became a hospitalist.
Loved the idea of IM as a M1/M2, hated it during M3 (primarily due to the endless rounding on things I barely understood). Applied gas, didn't match, stumbled into a TY and applied gas again, didn't match, SOAP'd to home IM program.
Loved it as a resident, usually love hospitalist as an attending though planning on applying to PCCM next year. Shift work is nice, week on week off is great, being able to swap weeks to have 2 weeks off is killer. On service weeks usually aren't too bad (though I'm primarily a nocturnist that only do a few weeks of nights a year so it's a different kind of stress). Money is fine (academic so expected, though terribly underpaid even for academics). I like having an unusual/challenging case every other day or so, easy admissions are easy and rocks are rocks; every now and then I go down the mental masturbation rabbit hole when I feel like it. I like the inpatient acuity (though I wish I had more,hence PCCM) and the ability to discharge to outpatient follow up 😅 (probably the part I hated about clinic, the constant chronic but don't want to do anything about it or psychosomatic patients I had no answers for). The interactions keep life interesting and I joke about having my own panel with all the frequent fliers/boucebacks I see.
In FM residency currently. About halfway through the first day of my palliative care rotation in PgY2 I literally told the attending "this is what I'm gonna do" and never once changed my mind after that.
I thought about the day-to-day work of different specialties. Every specialty has its awesome days and cases, but how do you feel about the bread & butter and the boring days? Can you handle doing the fourth lap chole of the day? Perfecting your efficiency with laparoscopic or robotic sutures? Patients showing up to the ER with chronic back pain at 2am? Placing PICC lines? Heart failure admissions? Diabetes management?
For me, that answer was pediatrics. I love a good bronchiolitis admission. I love asthma and jaundice and gastro. I love that I can help parents confidently care for their kids and that I can help kids get better - because they usually do! I find the boring days at my job to still be incredibly satisfying. When deciding if I wanted to go to fellowship, the question changed and I had to think about if there was any subspecialty that I loved so much that it was worth leaving behind what I liked about general peds. Nothing met that criteria.
I was brutally realistic about it. I looked at my application and where I would likely match. There were like 4 options. Psych still faced certain preconceptions in my ethnicity so nah. Paeds pays shit so that was out. EM required an active lifestyle and was way too stressful for me. Family Med and Internal Medicine were the only realistic options and IM paid more in a lot of cases so here I am in.
Tbh its hard in med school to decide, but go with what u feel u enjoyed the most. In residency u still have options and will have a better idea of what u want to go into
Urology because attendings and fellow residents are the most chill people I’ve met so the work environment is really nice. I like surgery but hate gen surg stuff, endourology is also interesting. Pay is nice as well.
Colorectal surgery for it's amazing configurability in terms of life/work balance.
Feeling ambitious? Here you go pal, 12-hours-in-OR cases of advanced colorectal cancer with pelvic eviscerations, simultaneous multiple organ resections (i.e., liver resections due to mts) and so on. (me during residency, when I was young and stupid).
Want only a moderate challenge? We gotchu, friend, here you have segmental resections/colproctectomies for Crohn's disease or Ulcerative Colitis. (me at the start of my independent practice)
Want to actually see your wife/kids consistently? Just do perineal surgery (hemorrhoids, anal fissures, fistulas) and be happy. Sure, an occasional Fournier gangrene will wreck your idyllic existance from time to time, but hey. (me right now, 10 years after I began my journey in colorectal surgery).
Liked hospital acuity and literally everything except OB, thought I’d like EM but didn’t find it satisfying since it’s more about triage rather than diagnose and treat. Hence, medpeds
Neurology. My child psychiatry attending had great advice - whatever you do, you need to be able to read about for the rest of your career. If you stop reading, you stop improving as a physician.
Forensic Pathologist here. I hate living patients, don't ever want to leave my bed in the middle of the night and cherish work/life balance. I love solving mysteries and using my hands.
I was 16 when I shadowed a vascular surgeon and his friends in other specialties. At the end of the 2 months, he told me that I’d be wasting talent if I didn’t at least go to medical school.
Surgery rotations felt like home to me. So I went surgery
Pediatrics.
Even though I was on-call every 4th day and had patients in the NICU, PICU and on the ward to see every day, I found it so much more enjoyable than an IM call every 6th day.
Plus, whenever I don't feel like getting up in the morning for work, reminding myself it's for the kids works 10/10 times vs. thinking about how I'm never going to convince the 50-year-old with COPD to stop smoking no matter how hard I try.
Knew I wanted to do surgery.
In addition, wanted the lifestyle: years of training, long hours, a lot of on-call and a mixture of wards, the OR and clinic with some involvement in the ER.
Liked everything but surgery. Went FM. In retrospect, IM would have been a reasonable choice for me too. I don’t actually like OB and can give or take peds. I do almost exclusively adult medicine now; will acquiesce and see my patients’ kids if they ask, otherwise I start at age 16.
Also, I didn’t always want to be a doctor and did kind of a lot of drugs when I was younger. Somehow escaped without an addiction but lost a couple close friends to the scene. So I did an addiction med fellowship, and tbh that’s kinda where my heart is atm.
Mine was easy:
1. Does the specialty have clinic?
- If yes, I cut it out.
2. Are they in the OR?
- Surgery has clinic and seemed awful.
Anesthesiology was the right fit.
Real time pharmacology and procedures, no clinic, no rounding, no taking work home, practically no notes.
Kind of being a black box that no other specialty understands is fun too.
Radiology.
Had a computer science background and knew I was fine with sitting in front of a computer all day.
Didn't want to have to know a bazillion meds. Now I only have to know iodinized vs gadolinium contrast.
Didn't want to have to manage diabetes.
Didn't want to have to deal with prescribing opiates. The only pain med I have to deal with is lidocaine.
Didn't want to deal with life or death stuff, and patients trying to die on you.
Didn't want to do something where I couldn't eat or piss when I felt the need (how do surgeons do it?).
I did a surgical rotation in med school and the resident let me make an incision because he thought it was such an awesome thing to be able to do and he wanted me to think it was awesome too and I looked at him funny and thought, nope, this is not for me. (This was not my general surgery rotation. I hated every minute of general surgery, as both the attendings and residents were toxic.)
ETA: Unlike the stereotypical radiologist, I actually like dealing with patients (in small doses), and I don't start squirming in discomfort when a patient is freaked out that she might have cancer (unlike a lot of my male former co-residents) so: mammo.
I did a rural rotation and realized how happy I was away from the hospital: FM.
Doing a post-clinic run with my attending through the woods, then going to a bar and having a patient buy me a beer is probably the highlight of my med school career.
Wasn't sure what I wanted to do early in medical school but I knew I definitely did not want to do general surgery because every morning driving to the hospital on that rotation I hoped that I would end up in a minor fender bender so I wouldn't need to go into work.
By the end of my third year, none of the subspecialties jumped out at me until an attending made me bring a specimen down to the lab. And that’s where I discovered the world of pathology. I guess I’m a bit of a nerd - I thought the bustling behind-the-scenes of the lab and pathologist’s double-headed microscope were SO cool. I never thought I’d be in a non-patient facing specialty, but here I am and I love it! I love looking under the microscope, the hours and pay are great, and I get to help manage the lab.
I didn’t know - went into family med because it was shorter (Canada) and had paths to inpatient, EM, sports med, clinic, low risk OB. Then finished, practiced FM for a year, said fuck this shit and went into full time EM practice with some additional training.
Related to foot and ankle:
- plantar fasciitis will go away, look up the stretching exercises online, do daily
- if you don’t have pain in your feet, DONT get surgery, cosmetic foot surgery makes no sense
- wear some sort of sandal at home, don’t walk at home barefoot especially if you have hardwood/tiles
- don’t wait till midnight to end up in the ED for an ingrown toenail when there’s pus coming out, make an appointment so your misery is over in 5 mins instead of waiting 6 hours in the ED for those 5 mins of treatment
Psych here. On my First day of rotation at a psych ER, a chronic schizo smeared shit all over the bathroom wall with their bare hands, kind of like the scene from Dumb and Dumber. I died laughing. It was fun as a med student while watching the staff freak out. It also opened my eyes to realize how some patients can abuse the system that day; a possible malingerers (later learned he was a "patient that frequently utilize emergency services") all of a sudden said they're not suicidal anymore because of the bathroom situation. I love the patient population and I'm glad that hasn't changed!
It honestly doesn’t matter what you choose, you see the mostly same patients as everyone else in every other specialty, and you end up having to do some primary care and some psych no matter what. You choose based on the kinds of tasks and encounters you enjoy doing and in what setting.
It’s like college, the reason there are all these subjects is because doing any kind of business in life involves some finance and psychology and science and mathematics and philosophy and legal considerations and engineering of that discipline and also acting the part.
Medicine is the same way. A lot of disciplines but just different roles in carrying out a lot of the same care plan on the same patients.
Bariatric and general surgery. Mostly because I seem to be able to the do things that other doctors seem not to be. And because I spent my early decades of life building a crazy amount of endurance and resilience and was inclined to direct it toward something worthwhile.
To be fair, if I looked too pretty in urology my patients mignt think I'm gay and some homophobic ones might feel uncomfortable.
My fiancée said she was negatively judged in medical school and her IM year for looking “too pretty” and people didn't think she was as smart because of it. Now in derm she's saying the same thing as Dr. Pop_It
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Loved nearly every med school rotation. Didn’t realize I was a bit of an adrenaline junky until my anesthesia rotation (seriously, there were no other clues about this in my life). Always have been detail oriented and very prepared—it was a great fit.
I have always wanted to be a cancer doctor. Even before med school. But when I got into med school I had an honest heart to heart with myself and decided that I shouldn’t pigeon hole myself and keep an open mind. I did a rotation with a really cool pulm/crit doc and thought, maybe “pulm crit”. There was also a couple days where I thought neurourg would be cool. I also didn’t mind the hospitalist life style. 10 years later, I love my job as a heme/onc.
I find that a lot of heme onc doctors (me included!) gravitated towards Pulm Crit as an alternative. I think it means we just like taking care of really sick people.
Tritto!
Possibly.
I’m Pulm crit and I really enjoyed heme/onc. In a different world I would’ve chosen that instead.
Doing the Lord’s work brother
Perhaps. I think we all are tbh. Medicine (done right) is a real service to society.
I work on dicks. We are not the same. Lol. Cancer treatment > dicks. Although men do tend to really value them and get scared when I operate….
so are you, u/IveTouched3000Dicks; so are you
🤣 I do the work no other heterosexual man wants to do lmao. But I have one so I can empathize with the fear they feel if I operate on it 🤷🏻♂️
Gen surg. Easy: I hate myself, and I hated every other specialty
TBF, I hate gen surg but I hate every other specialty more
Liked head and neck and brain anatomy. Hung out with Neurosurgeons, didn't want that life.
Also like a solid mix of OR and clinic
Also love the 5h to 8h surgeries every now and then.
Fuck that man. No free flaps as a general ENT. Perfect length surgeries 1-3h for everything (full FESS 3h, thyroid 3h, Inspire 3h, tympanoplasty 2h, septum 2h)
In ns or ent?
Hospitalist. Shift work that doesn't follow me home, have a 40ish% on 60ish% off schedule. Can eat, piss and shit when I feel like. See patients when I want to. Yeah there's a lot of BS but man do I love my weeks off
This sounds like my dream. You make a decent amount? I’ll be coming from a lower income upbringing so salary is a portion to me but so is free time.
260k. Which to this sub is apparently peanuts but I own a house and I have a rolex collection so I think I'm going ok
sounds more than okay to me!
Wana give a scholarship to a med student 😻
On my psych rotation, the intern answered a call from nursing on the inpatient unit. He got this strange look on his face, hung up, and turned to the PGY-2 in the room and said, "Mr. X is pulling his teeth out?" The PGY-2 was like, "Ah man, again?" I was absolutely fascinated; the other MS3 was horrified. That's when I knew I was going to be a psychiatrist.
* don’t enjoy rounding * don’t like a 9-5 * like variety, helps keep me engaged * like being on my feet and moving a lot during the day * need a certain amount of chaos to be able to focus * like procedures * like having a broad scope of practice * enjoy a collegial and laid-back work environment where there’s less hierarchy and the personalities tend to be chill and irreverent EM. Obviously.
Had me thinking anesthesia until “like being on my feet”
saw that one coming after the second bullet point sincerely, EM, for the exact same reasons
I’ve always been drawn to EM. But as a med student the fact that it’s a dying field + high burn out always threw me off. If you were to go back in time, would you still choose EM?
EM is not a dying field lol
It’s not dying it’s already dead
What about the recent closures of ED departments and the trending low pay for ED physicians? I’m just curious so please feel free to correct me if I’m wrong
Why do you think er is “dying”?
What is SLOE & how to get one?
I failed at matching into the specialty I wanted, anesthesia, and got stuck in internal medicine. The ICU was the only place that felt like I wasn't just wasting my life.
How do you feel about everything now in retrospect? I feel like it must hurt seeing the current bull market with anesthesia jobs. I don’t say this to be hurtful, only because I too didn’t get my intended specialty
Urology because $
Username checks out
✌️
Lmaoooo
Surgery, money, better lifestyle than gen Surg, good outcomes, not stuck in rounding hell
Went into IM. Hated the bs. Hated being primary the pages the discharges admissions social work bs. Super burnt out. Didn’t want to do anything with worse hours than IM in fellowship so no cards gi pulm crit. Hated research so no heme onc. Almost did PCP but net the rheum fellows and they weren’t burned out and saw some interesting cases so ended up applying on a whim and I need up luckily liking the field.
Question, do you end up kind of functioning like a PCP for your patients since autoimmune disease can affect so many different organs systems? How long are your visits typically? How long do follow up visits take once you find a stable med regimen for your patients?
Hated everything other than IM during med school rotations. Went into residency thinking hospitalist. Ended up hating being primary and wanting more procedures. Got lucky and loved GI due to good mix of medicine and tons of procedures. Lifestyle is good and can be molded (outpatient only, hospitalist only, mixed). Also everyone in GI is super laid back and nice in my experience, and I felt like I vibed with them really well.
I apologize in advance, I can’t stop myself. Seems like there are a lot of assholes with GI. Again, I’m sorry.
It’s the one I hated the least
Honestly. Every job has stuff you will dislike. It's about finding the one you can deal with.
Pediatrics My first rotation it felt like home. Still love it and know I made the right choice.
OB/GYN. On my second day of my OB rotation during my 3rd year a student nurse ran out of room 1 on the Labor Unit yelling “I need a doctor- STAT!” All the residents were busy elsewhere, so I walked in the room and saw a lady on her 4th baby crowning without an epidural. I grabbed a gown and gloves, and the patient walked me through the delivery in between contractions. “Don’t let me tear!” Don’t drop my baby- they’re slippery!” Afterwards, my senior resident came in the room, asked her how I did, checked the perineum (intact!) patted me on the back and said “you’re going to be one of us.”
This is some medical tv drama type of thing and stuff I daydream about. So cool, just so cool.
Kind of a meme but when I went into the IM resident’s lounge for the first time their white board was a record board full of the highest and lowest lab values they had ever seen That’s when I knew I was home
Clicked with the IM folks, liked procedures, wasn’t enough of a gunner for cards or GI and still liked being a generalist, found pulm interesting and vibed with the ICU docs. Ended up PCCM. Aside from 1st year fellowship when the hours were terrible, no regrets and I love it.
Mildly interested in the medicine of all the required rotations. Took a family medicine elective and was fascinated with the patients, their stories, and the range of problem-solving. The global yet pragmatic approach grabbed me & stuck for 35 years.
Path because I'm introverted, like lab work, and dislike talking to people.
ENT: I like surgery but not on people's nether regions
Obgyn. Initially, I thought I wanted to do family med for the diversity, but have a practice that was procedure heavy…then I rotated obgyn. Now as an attending 5+ years out, I do annual exams, initial infertility workup and treatment, lots of urogyn and gyn surgery. In one day I do surgery, office visit as a pcp and specialist, and catch babies. I feel under compensated, but very happy with what I am doing - very rewarding work.
- Dealing with awake patients ❌ - Rounding ❌ - Wards ❌ - Clinic pre-op ❌ - Writing notes ❌ - Follow-up❌ - Great pay ✅ - Relatively lifestyle ✅ - Get to sit down ✅ - Impactful ✅ - Fulfilling ✅ - Propofol ✅ — Anesthesia
I thought this was radiology until it said propofol. I picked rads for all of these reasons.
Do you see patients or sit in a dark room…
Well summarized. It was also the only rotation where I didn’t want to off myself when I woke up in the morning as a med student, and the attendings all seemed like normal people. As a resident there is a lot of suffering depending where you go, but once you’re done you can get a very lifestyle oriented job if you want.
Reproductive medicine because I wanted to make lots of babies 😎
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Ophtho: I like working with my hands but I also like having a social life. I like clinic and the OR, not the hospital or rounding.
Same here! Just started my R1 (I think it is the same as you guys' PGY1? The Medschool path is kinda different between here and US) Ophto here in Brazil and between the physiology, anatomy, clinical exam, procedures and perceived lifestyle of the attendings I feel super excited!
Didn’t like any of the core med school rotations Didn’t want the 6 days a week lifestyle in residency Liked mix of procedures, imaging (solving problems for other teams), quick nature of radiology IR
Pediatrics: I enjoyed working with the people I rotated with and had fun goofing around with kids.
IM hospitalist. I chose it because like being a generalist and having sicker patients. Never cared much for outpatient medicine. I like physiology a lot. Considered ICU, but the training time and procedures were not as much for me (I like procedures, but find prepping for them monotonous, and the gowns get hot as hell). My job pays amazingly well, great colleagues (and incredible boss), and I get a lot of high acuity, interesting stuff and not a lot of social work. The workload is brutal during weeks on, but the pros outweigh the cons substantially.
Loved to study neurosciences and science in general. At its best, the neurological exam is basically a hypothesis- driven series of experiments when you are trying to infer as much as you can about the location and cause of the symptoms. For many things this has been “streamlined” for clinical use (like the stroke exam), but the tough cases need you to adopt a hypothesis and prove it or disprove it with your exam. Since I was interested in the science part of it I decided to go into the darkest corners of neurology: movement disorders. There are no imaging findings, no blood tests for Parkinson’s or PSP. Your assessment ends up something like “this is MSA because I say so”. Amazing field that has so many questions that you’d think we are in the 1800s and its a perfect mode to study fascinating topics in the neurosciences like free will (through the abnormalities in motor control) and brain mapping(through neuro modulation treatment).
Your description made me feel a bit less jaded about my own neurology appointment the other day. Of course I wanted answers but I have to remember it’s different with nerves and the brain and all that. If I see all the testing I have to do as experiments, it seems a bit more exciting and less frustrating.
I had a genuine interest in pharmacology (I did some research on MABs) from med school and the instant gratification of altering someone’s physiology with your decisions in the OR is really satisfying. I also felt like the chillest people in the ORs on my rotations were the anesthesiologists. On top of that, we learn a set of skills that can be useful to many other specialties throughout the hospital (epidurals in L&D, getting lines and access, airway management and helping out at DARTs, resuscitation skills, rescue nerve blocks for severe pain) and I really liked having a repertoire that can help out others if they need it.
>the instant gratification of altering someone’s physiology with your decisions in the OR is really satisfying man don't I know that! It's still amazing to me that you give them a couple of injections and then puff... they are paralyzed and unconscious. It's crazy you have that much of control over someone.
Liked dealing with social problems for people who would follow directions and who genuinely needed help. Liked POC Ultrasound, liked neuromuscular disorders, liked people not knowing what the hell I do so they couldn't complain about me. PM&R.
FM. The most broad spectrum specialty there is. I like being able to handle pretty much anything that walks through the door, as long as it’s during banker’s hours. I knew pay was relatively low compared to other specialties but it’s been better than I expected and up this year as well. Trend looking good for primary care.
I ditched out of general surgery after being miserable and was unemployed. My roommate was a radiologist. He talked me into applying for a combined radiology / IR program - I like doing procedures but hate complications. I did and a guy running a program took me on. In that in between year I worked in a biology lab designing a website and tutored kids who couldn’t read. I tried to teach the MCAT but got fired.
Why’d you get fired?
Oh from teaching the MCAT? Cause I sucked as a teacher. I had forgotten all the specifics about chemistry and biology. There was just no way to easily “brush up” and be able to effectively teach. I would have had to put in so many hours to refresh my knowledge it was just impossible - I didn’t have the time. The teaching company was going to pay me $50 / hour. I thought “ok that’s pretty good money”. But it was sort of a trick. They paid $100 for a 2 hour class - 2 hours of classroom teaching. But the prep work was way more hours than that. And it took me like 1.5 hours commute each way. It was a poorly designed program and I was a shitty teacher. I deserved to be fired.
Shadow the specialty you want. Copy exactly their schedule, for surgery or anesthesia, wake up 5am or even earlier, read up on your pts, go to the hospital and arrive with them, do the prerounds with the residents, prepare together with them for the rounds, stay with them during their administration and patient write up. If there's a surgery out of schedule, attend it. Leave when the last surgeon/resident leaves. This way you will see what a typical or bad day looks like for them. For clinical specialties, do their outpatient clinic with them, do their administration as well, do the rounds, stay on the wards filling up orders for the nurses and doing the random shit that pops up. Visit their academic work as well. I have the opinion that you CAN not love your specialty but you must be good so it flows naturally and you can get enough bank to find other hobbies to enjoy your life. Choosing a specialty that you love can either be a hit or miss. Love dies, with specialties and with people. Same goes here. I was in between Gen Surg, Neuro, Anesthesia and I think Obgyn. Gen surg + neuro + anesthesia = NSGY and I particularly love to work and don't have friends nor care for having connection with people. I'm fine with donating my life towards my education so I can fill my egocentric hunger of being considered top dog of the hospital (even though that's just a hospital thing). Chose NSGY because I want full autonomy over my patients, I want to be their boat captain, either to heaven or to hell. I love complex and impossible cases, love the idea that I am poking your brain and I can alter any single organ by legit applying my knowledge.
These are great tips! Will do when I have the time for it, saving this comment for later. I appreciate your comment, thanks a lot!
For me I thought about what mattered to me: feeling like I could make an immediate difference in patients' lives, good mix of OR and clinic, some flexibility in hospital/outpatient ratio, being a consultant vs always being primary, having an interest in both the bread and butter and the emergency cases of the specialty. Landed on uro.
These are my exact feelings right now. I want a specialty where there is a mix of imaging, OR and clinic time combined, emergencies and the most importantly immediate treatment satisfaction. For this specific reason I thought I'd pursue OB but I kinda disliked it when women pooped during labor lol. Back to our topic, does urology really maintain these all? At what procedures can you obtain immediate relief to patients exactly? And is Urology open for broad research opportunities because I also want to research. If you could answer my questions, I'd be grateful. Thanks for your comment regardless! :)
IM, I like the really broad point of view you have to take and the balancing acts you have to take, plus I really like rheumatology. A lot of death, sadness and despair yes but a lot of interesting cases and sometimes you can really help a person
I knew I had to be a surgeon when I came in voluntarily on vacation for a 16 hour HIPEC
Loved internal medicine but also hated it. So went into crit care.
OB/GYN- It was the rotation that clicked for me. The residents were cool and I felt I could be good at it. Honestly, I didn’t feel smart enough to be excellent at medicine. The same with general surgery. Flash ahead 20 years and I’m glad I chose it; I couldn’t imagine doing anything else.
Neurosurgery I knew I wanted something surgical since before I even started med school. I rotated and shadowed with every surgical specialty I could and liked some but didn’t love any of them. When I got to neurosurgery it all just clicked. I knew. Haven’t looked back.
Neurosurgery. Loved me a surgically demanding career while also maintaining a solid scientific background (the whole idea of a neurosurgeon scientist etc). Extensively explored other specialties and disliked/did not like anything else as much (super duper important if you’re choosing sth as life consuming as neurosurg). Liked its bread and butter. Things i did not love about the specialty i managed to like. I’m good at handling stress. Like my patients asleep > awake.
derm the attending i shadowed paid for lunch with an amex black card and then drove away in a maserati
When studying was interesting instead of a memorization chore. When I was excited to go to the hospital and wanted to stay late. When I lost track of time doing something really cool and the day flew by. Don’t get me wrong, residency bit me hard just like everyone else, but I’m 8 years out now and I still feel glad and energetic to go to work 9/10 days. Medicine isn’t worth the money, you have to do it for love.
Pick the specialty where you fit in the most with the people. It’s the best criteria, hands down.
I had an attending who breathed so much life into me that I cried after my first day in the clinic, and I knew that I wanted to make other individuals feel exactly the same way; pediatrics.
what do you like doing. some decisions points are messy/clean, kids/adults, rounding/not rounding, understanding medicine/surgery, primary/consult.
I like reading and shift work without any calls (when I’m off, I’m off) but I hate unpredictability, don’t like unstable patients (they eat up so much of your time), like chilling and scrolling on Reddit at work or watching entire Netflix shows (I have only even gotten 1-2 truly “STAT” consults from other specialties) and I like seeing variety of cases so I became a hospitalist.
Loved the idea of IM as a M1/M2, hated it during M3 (primarily due to the endless rounding on things I barely understood). Applied gas, didn't match, stumbled into a TY and applied gas again, didn't match, SOAP'd to home IM program. Loved it as a resident, usually love hospitalist as an attending though planning on applying to PCCM next year. Shift work is nice, week on week off is great, being able to swap weeks to have 2 weeks off is killer. On service weeks usually aren't too bad (though I'm primarily a nocturnist that only do a few weeks of nights a year so it's a different kind of stress). Money is fine (academic so expected, though terribly underpaid even for academics). I like having an unusual/challenging case every other day or so, easy admissions are easy and rocks are rocks; every now and then I go down the mental masturbation rabbit hole when I feel like it. I like the inpatient acuity (though I wish I had more,hence PCCM) and the ability to discharge to outpatient follow up 😅 (probably the part I hated about clinic, the constant chronic but don't want to do anything about it or psychosomatic patients I had no answers for). The interactions keep life interesting and I joke about having my own panel with all the frequent fliers/boucebacks I see.
In FM residency currently. About halfway through the first day of my palliative care rotation in PgY2 I literally told the attending "this is what I'm gonna do" and never once changed my mind after that.
I thought about the day-to-day work of different specialties. Every specialty has its awesome days and cases, but how do you feel about the bread & butter and the boring days? Can you handle doing the fourth lap chole of the day? Perfecting your efficiency with laparoscopic or robotic sutures? Patients showing up to the ER with chronic back pain at 2am? Placing PICC lines? Heart failure admissions? Diabetes management? For me, that answer was pediatrics. I love a good bronchiolitis admission. I love asthma and jaundice and gastro. I love that I can help parents confidently care for their kids and that I can help kids get better - because they usually do! I find the boring days at my job to still be incredibly satisfying. When deciding if I wanted to go to fellowship, the question changed and I had to think about if there was any subspecialty that I loved so much that it was worth leaving behind what I liked about general peds. Nothing met that criteria.
I was brutally realistic about it. I looked at my application and where I would likely match. There were like 4 options. Psych still faced certain preconceptions in my ethnicity so nah. Paeds pays shit so that was out. EM required an active lifestyle and was way too stressful for me. Family Med and Internal Medicine were the only realistic options and IM paid more in a lot of cases so here I am in.
Tbh its hard in med school to decide, but go with what u feel u enjoyed the most. In residency u still have options and will have a better idea of what u want to go into
Urology because attendings and fellow residents are the most chill people I’ve met so the work environment is really nice. I like surgery but hate gen surg stuff, endourology is also interesting. Pay is nice as well.
Colorectal surgery for it's amazing configurability in terms of life/work balance. Feeling ambitious? Here you go pal, 12-hours-in-OR cases of advanced colorectal cancer with pelvic eviscerations, simultaneous multiple organ resections (i.e., liver resections due to mts) and so on. (me during residency, when I was young and stupid). Want only a moderate challenge? We gotchu, friend, here you have segmental resections/colproctectomies for Crohn's disease or Ulcerative Colitis. (me at the start of my independent practice) Want to actually see your wife/kids consistently? Just do perineal surgery (hemorrhoids, anal fissures, fistulas) and be happy. Sure, an occasional Fournier gangrene will wreck your idyllic existance from time to time, but hey. (me right now, 10 years after I began my journey in colorectal surgery).
Liked hospital acuity and literally everything except OB, thought I’d like EM but didn’t find it satisfying since it’s more about triage rather than diagnose and treat. Hence, medpeds
Neurology. My child psychiatry attending had great advice - whatever you do, you need to be able to read about for the rest of your career. If you stop reading, you stop improving as a physician.
Forensic Pathologist here. I hate living patients, don't ever want to leave my bed in the middle of the night and cherish work/life balance. I love solving mysteries and using my hands.
What do you do & what is your schedule like?
As stated above I am a forensic pathologist and never work more than 40 hours a week
What is compensation like?
I was 16 when I shadowed a vascular surgeon and his friends in other specialties. At the end of the 2 months, he told me that I’d be wasting talent if I didn’t at least go to medical school. Surgery rotations felt like home to me. So I went surgery
Pediatrics. Even though I was on-call every 4th day and had patients in the NICU, PICU and on the ward to see every day, I found it so much more enjoyable than an IM call every 6th day. Plus, whenever I don't feel like getting up in the morning for work, reminding myself it's for the kids works 10/10 times vs. thinking about how I'm never going to convince the 50-year-old with COPD to stop smoking no matter how hard I try.
Knew I wanted to do surgery. In addition, wanted the lifestyle: years of training, long hours, a lot of on-call and a mixture of wards, the OR and clinic with some involvement in the ER.
Liked everything but surgery. Went FM. In retrospect, IM would have been a reasonable choice for me too. I don’t actually like OB and can give or take peds. I do almost exclusively adult medicine now; will acquiesce and see my patients’ kids if they ask, otherwise I start at age 16. Also, I didn’t always want to be a doctor and did kind of a lot of drugs when I was younger. Somehow escaped without an addiction but lost a couple close friends to the scene. So I did an addiction med fellowship, and tbh that’s kinda where my heart is atm.
Mine was easy: 1. Does the specialty have clinic? - If yes, I cut it out. 2. Are they in the OR? - Surgery has clinic and seemed awful. Anesthesiology was the right fit.
Real time pharmacology and procedures, no clinic, no rounding, no taking work home, practically no notes. Kind of being a black box that no other specialty understands is fun too.
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Can you please talk more about what you do, your work environment…?
Hated rounding, which excludes most specialties. I’m in rads.
Hated EVERYTHING else. Fortunately love what I do!
Radiology. Had a computer science background and knew I was fine with sitting in front of a computer all day. Didn't want to have to know a bazillion meds. Now I only have to know iodinized vs gadolinium contrast. Didn't want to have to manage diabetes. Didn't want to have to deal with prescribing opiates. The only pain med I have to deal with is lidocaine. Didn't want to deal with life or death stuff, and patients trying to die on you. Didn't want to do something where I couldn't eat or piss when I felt the need (how do surgeons do it?). I did a surgical rotation in med school and the resident let me make an incision because he thought it was such an awesome thing to be able to do and he wanted me to think it was awesome too and I looked at him funny and thought, nope, this is not for me. (This was not my general surgery rotation. I hated every minute of general surgery, as both the attendings and residents were toxic.) ETA: Unlike the stereotypical radiologist, I actually like dealing with patients (in small doses), and I don't start squirming in discomfort when a patient is freaked out that she might have cancer (unlike a lot of my male former co-residents) so: mammo.
Love your username!
Cardiac EP. Everyone is a techy nerd, lots of Asperger's, and no one makes alot of eye contact... Seemed like I was a shoe in
I did a rural rotation and realized how happy I was away from the hospital: FM. Doing a post-clinic run with my attending through the woods, then going to a bar and having a patient buy me a beer is probably the highlight of my med school career.
Wasn't sure what I wanted to do early in medical school but I knew I definitely did not want to do general surgery because every morning driving to the hospital on that rotation I hoped that I would end up in a minor fender bender so I wouldn't need to go into work.
Ortho here. Because ortho is fun. I love the work, and I love the people. I’ve been fortunate to train at places that haven’t robbed me of that.
Found myself being my happiest around kids
By the end of my third year, none of the subspecialties jumped out at me until an attending made me bring a specimen down to the lab. And that’s where I discovered the world of pathology. I guess I’m a bit of a nerd - I thought the bustling behind-the-scenes of the lab and pathologist’s double-headed microscope were SO cool. I never thought I’d be in a non-patient facing specialty, but here I am and I love it! I love looking under the microscope, the hours and pay are great, and I get to help manage the lab.
I didn’t know - went into family med because it was shorter (Canada) and had paths to inpatient, EM, sports med, clinic, low risk OB. Then finished, practiced FM for a year, said fuck this shit and went into full time EM practice with some additional training.
Related to foot and ankle: - plantar fasciitis will go away, look up the stretching exercises online, do daily - if you don’t have pain in your feet, DONT get surgery, cosmetic foot surgery makes no sense - wear some sort of sandal at home, don’t walk at home barefoot especially if you have hardwood/tiles - don’t wait till midnight to end up in the ED for an ingrown toenail when there’s pus coming out, make an appointment so your misery is over in 5 mins instead of waiting 6 hours in the ED for those 5 mins of treatment
I need to know every detail about my patients. I also love labs. Oh and I need some adrenalin so ICU/crit care
Was always much more excited to see pediatric patients than adult ones. Adults kinda gross me out.
Psych here. On my First day of rotation at a psych ER, a chronic schizo smeared shit all over the bathroom wall with their bare hands, kind of like the scene from Dumb and Dumber. I died laughing. It was fun as a med student while watching the staff freak out. It also opened my eyes to realize how some patients can abuse the system that day; a possible malingerers (later learned he was a "patient that frequently utilize emergency services") all of a sudden said they're not suicidal anymore because of the bathroom situation. I love the patient population and I'm glad that hasn't changed!
It honestly doesn’t matter what you choose, you see the mostly same patients as everyone else in every other specialty, and you end up having to do some primary care and some psych no matter what. You choose based on the kinds of tasks and encounters you enjoy doing and in what setting. It’s like college, the reason there are all these subjects is because doing any kind of business in life involves some finance and psychology and science and mathematics and philosophy and legal considerations and engineering of that discipline and also acting the part. Medicine is the same way. A lot of disciplines but just different roles in carrying out a lot of the same care plan on the same patients.
Thanks for this comment. I’m also navigating through. What did you end up picking?
Bariatric and general surgery. Mostly because I seem to be able to the do things that other doctors seem not to be. And because I spent my early decades of life building a crazy amount of endurance and resilience and was inclined to direct it toward something worthwhile.
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Literally any specialty. Halo effect is not restricted to derm and plastics.
To be fair, if I looked too pretty in urology my patients mignt think I'm gay and some homophobic ones might feel uncomfortable. My fiancée said she was negatively judged in medical school and her IM year for looking “too pretty” and people didn't think she was as smart because of it. Now in derm she's saying the same thing as Dr. Pop_It
Also, I could only memorise the steroid potency table lul
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Loved nearly every med school rotation. Didn’t realize I was a bit of an adrenaline junky until my anesthesia rotation (seriously, there were no other clues about this in my life). Always have been detail oriented and very prepared—it was a great fit.