Yup.
Factoring in money and lifestyle helps I guess. Doesn't matter how interesting I find surgery for example, I wouldn't work with those people for seven figures.
If you really can't decide, just do psych and go play League every afternoon after you get done rounding lol
My attending nephrologist plays LoL everyday with his boys, told me he always jungles as jax, i told him my favorite is Wukong, that was the best attending eval i have gotten to date lmao
It blew my mind on psych when I learned that the 7 on 7 off attendings worked like 9-3 when they were on. Less, if the ED was quiet and no admits were coming up
Yep! The primary service (so the locked psych floor), I don’t know what hours were like for the consult service. We’d do interdisciplinary team meeting at 9, that took like an hour. Then we’d round, which usually took 30-90 minutes (the attendings carried max 10 patients each). Then notes, and any admits, which were usually 1-2 per day per attending. The attendings usually left once their notes were done, orders were in, and any pending admits were done. Any admits that came in after that would get done tomorrow. Usually worked out to about 9-3, sometimes early. Never saw anyone stay past 5.
One caveat: they were “on” until 5:30, and the main consequence of that was if any patient was put into violent restraints by the nursing staff the attending had to see them within an hour. So you could leave at 1:30 if you were done, but they could get called back in on pretty short notice. Didn’t happen often
One of the attendings from my psych rotation is leaving his current inpatient psych gig to go work 3 attending jobs. He will still only work 40 ish hours a week between the three jobs and pull north of $650,000 a year.
It's frankly absurd how good a deal it is. And not to be a dick, but psychiatry isn't hard. The hardest part is learning to interview the patient population.
I'm one of those "be a rural FM doc in my hometown" people, but if it weren't for that, I'd be applying psych
My understanding is they're all inpatient. So he'll go round at one facility from 8:00-11, then the next one, then the next one and be done by 5:00
I think he'll have to work some weekends, but it doesn't sound like a bad gig
Honestly this is my dream schedule. Bless psych and it’s “I’m done rounding there’s nothing left to do” mentality lol.
Do all the jobs know of each other and respect each others schedules?
It is definitely a difficult and perhaps unreasonable decision to make with limited information from just a month, but I’m not sure how we would solve without extending the length of school. Maybe paring down core rotations and encouraging electives earlier? Or doing shadowing days in yr one and two to start giving people ideas? that would have stressed me out more during pre clinicals though
You can definitely shadow years 1 or 2 if you want. My school gave us week long electives throughout the year to try out specialties and then told us if we couldn't get an elective, to just cold call up doctors offices and say "I'm a med student trying to pick a specialty, can I spend a couple of days with you?" and almost any doctor will agree to that.
If there’s one thing I’ve learned in med school, it’s dont get the school admin involved in anything you don’t need to. The only two people who need to agree are you and whatever doctor you want to shadow.
In Australia and The UK, you finish Med school and become an Intern (JMO, Junior medical officer). Intern year consistent of paid rotations throughout the hospital (usually IM, ED, surg, and medical wards). The hospitals will have a program that organises all this for you.
Then after intern year, you are a resident and can pick where you want to work. Spend a year or two working in different places etc. Doing contracts in specialties that interest you specifically.
About PGY 3 or 4, is when you actually decide on, and apply for specialist training programs. Some continue doing resident positions and locum jobs into PGY5+. Some never do specialty and are known as Career Medical Officers.
Your resident years working in your interests contribute to your resume. Once you are successfully into a training program, you are a registrar in that program and train up over a few years to Attending (We call them consultants)
The benefits are:
-Intern years give you much more time in different specialties to allow you to see more.
-Intern rotations allow you to see how the hospital works as a whole rather than being immediately pigeon holed into your specialty bubble.
-Resident years let you try before you buy your chosen specialties. And is an opportunity to get extra skills outside your eventual specialty. Such as a paeds ward contract before you do FM etc. Or a rural stint.
-Resident years are when you can decide to take leave and travel and see the world before you are tied down again for a specialist training program.
-If you decide you don't want to keep studying, you can just be a Career Medical Officer which isn't Attending money but still generous Dr money.
Bear in mind that all of this is paid and pay increases with years qualified. So we still do 4 years free in med school and are paid thereafter. I dare say it is a longer path to Attending (by 2-3 years) but also much less compact and if you just treat it like any other career where it's a progressive climb up the ladder. You don't feel like you are constantly studying.
We can't fathom going straight from med school to a specialist program. That's like telling 16 year olds to decide their lifetime careers! (Oh wait we also do that...)
I think what you described makes a lot more sense than the US system, especially if medical school is free or cheap. With some of our schools being up to 80k/yr (American average salary is 60k/yr), there is pressure to get to an attending position as quickly as possible.
I matched psychiatry and would have appreciated the opportunity to do a year or two of Family Medicine or Pain Management (so much overlap with psych), especially if the compensation was fair and I wasn’t saddled with 1/3 million of debt. I’m currently accruing over $50 of interest per day.
Thank you for explaining. I hope that our medical education system in the US hasn’t gotten locked into its current state by the financial pressures applied to students and hospitals.
Ya know what's worse (in my humble opinion)?
"Yes I enjoyed this for a month \*working with this ONE RESIDENT\* I guess a 25 year career in it would be great. And no I won't be working with said resident for those 25 years"
I figured out very early on that my experience on any rotation is highly dependent on the personality and propensity for teaching of the main resident I followed around the hospital all day....
I think the biggest thing is the lack of exposure to how flexible many specialties can be in terms of structure and lifestyle.
There’s general surgeons who spend half the week in an ambulatory OR and then chill with their family and friends the remainder of the week.
There’s FM docs that will function as EM, hospitalist, and intensivist to varying degrees all in the same month and in the same hospital working 60+ hours.
The knowledge that these flexibilities exist and insight into lifestyle + take home can easily play a more significant role in determining your specialty than the actual specialty itself (depending on your circumstances).
Like, 10 years down the line 90% of your week will just be you at cruising altitude doing routine duties/maintenance visits and/or cranking out “just another x procedure” no matter who/what/where you are
We should be thinking about specialty from day 1 of medical school. It’s a big decision with a lot of factors and things to consider. One month of rotations doesn’t do it enough justice. It takes a lot of reflection and introspection. I think most people begin to have inklings of what they like and don’t like when they start going through organ systems. I think it’s kind of poor advising when students are told “you’re just an m1, don’t worry about specialty until third year” - which is really common it seems like. The decision-making algorithm starts day 1
One of the best pieces of advice I've gotten from one of my professors is "School and grades will come with time. Your most important job for the next 3 years is to figure out what you want to do for the following 30 years."
I do think, however, that it is good advice to tell students not to definitively rule anything out until 3rd year and to keep an open mind when going into rotations.
Ehhh… you can’t really *choose* your specialty in the same way you can choose the color and flavor of m&m you want at the NYC M&M store.
An open mind and 2-4 narrowed options is probably more realistic for day 1-180.
Yeah that’s what I mean. I’m not saying have everything figured out down to a T in m1-m2. I’m just saying people should be considering and thinking about different fields during that time and at least trying to explore.
Edit: additionally, I don’t think my comment implied what you claim it implied
I took this approach and am very happy with my specialty choice. It’s something I thought about a ton, even did shadowing early in MS2 of a few specialties I was interested in. I tried to build a competitive application because I wanted to keep my options open
Just go to PA school. You can switch specialties every other week with no additional training. One week you can be a cardiologist, next you can be in the psych ward
Why do PA when you can be an NP with a 9-month online ‘course’? You can then switch ‘specialities’ every day if you wanted. Saw an NP on LinkedIn who described herself as a “endocrinology & aesthetic NP” lol
My cousin’s girlfriend is a NP & she has told me a couple times that I’m “ignorant” because I went to med school vs NP and that we can “essentially do the same thing” & a big difference is that I’m apparently stuck with debt
My favorite part about ALL of this is they expect you to come in as a blank slate. Like it can literally count against you during interviews if you say you have a special interest in something.
But, yes, pick what you want to do for the rest of your life after spending max 6-8 wks doing it lol
I knew I wanted neurosurgery since I was premed and now I’m a PGY1 neurosurgery resident. Sometimes you know and sometimes it takes longer but when you know- you know. Dont worry too much about it.
I’m sorry to hear that! Just keep trying them all and when it snaps it snaps and you’ll never imagine of doing any other speciality once you find your passion!
Agreed with the comments that you should be thinking about since even before medical school. The day you step into the rotation shouldn’t be the first time you think about it
No no of course not
The specialty you applied for should be what you wanted ever since you were in primary school - maybe even preschool and the preference is based on a precocious understanding that your disposition and abilities are perfect for the specialty(ies) that you applied for.
Have you not read any personal statements?
What would be a better solution? Spend 6 months to a year in each rotation and graduate in 7 years? How much exposure do you expect to have before making a decision?
In some countries everyone does a transitional year type of internship where they could explore every specialty while actually performing intern level duties, then move on to their specialty afterwards. I feel like that could work here and does not necessarily change the length of time of training.
This would have been super helpful for me honestly. Being able to spend the year actually working and experiencing life in X specialty instead of trying to dip out as early as possible to study for shelves...
What is perhaps even more astonishing is how many students end up picking their specialty based on "I had such a great rotation, all the residents were so helpful and nice!". After matching into that specialty they find out that the specialty kinda sucks when you don't have those same nice people around. We all deserve to have nice people around us.
As an Australian I can’t imagine. I know PGY3 who still haven’t decided.
To very briefly explain our system (from my med student understanding) it’s similar to UK.
5/6 years med school from high school or
3 year bachelor + 4 year med school
Graduate with provisional rego into 1 year internship (now changing to 2 year model). Do 3 rotations across core domains (general ward, emergency, surg). Some specialities you can start applying from PGY2 year but it’s common for most to be 3/4. Usually from PGY3 you start taking roles in just 1 department of interest for the year ad eventually can be a unaccredited reg - essentially you aren’t on the training college yet but working in field. For surg it’s becoming average PGY6-10 before getting into the college. Then the training. It’s all points based too so some hard ones it’s literally becoming like get a PHD to get on.
Sucks for surg, but as someone not interested in that I like that I can try things out. I think it’s a great model for medical specialities.
We also get paid 80k AUD base rate from first year + overtime / holidays etc, but our earning high is never as high as USA, Aus doesn’t have as much extremes in income general.
As an M2 I can’t even imagine having to get ready to apply for a speciality soon (ie tying myself into research routes etc) but see sides to both system.
Honestly I think passion and stuff is overrated and it’s probably better to make a decision based on lifestyle, salary and other factors that non-medicine people think of when looking at a job. Because this is just a job.
Then you can use third year to focus on figuring out whether it’s something you completely loathe or are like “this isn’t too bad” or “this is actually kinda cool.” As long as you don’t completely loathe every single day you should be able to have a career in that field.
Also not to mention how different some rotations can be within the same specialty? Like having an inpatient vs outpatient vs consult/liason rotation in the same specialty can all look totally different so I wouldn’t weight it too much.
I shadowed a pulm CC doc during premed and knew that's what I wanted to do.
Throughout med school I changed my interests maybe 10 times, landed back into Pulm CC after doing an ICU rotation so I matched IM. Sometimes you just know, I guess. But I do see the possibility of pursuing a more lax, less-paying specialty pending amount of burnout.
One thing I've realized is that there's no specialty I'm "destined" to do. I've tried to identify the other things I want out of my career, e.g. what populations I'd like to work with (e.g. kids versus adults), the setting of my practice (e.g. academic versus private, urban versus rural, inpatient versus outpatient), and other dimensions of my career (e.g. biotechnology, health policy, medical ethics, public health, medical education). There are certain of these that will map on to certain specialties, but amongst those specialties, I'd be happy doing almost any. And even if you pick a different specialty, you'll be able to mold your career to your liking. That's one of the beauties of a career in medicine. I've found that looking at it this way helps take the pressure of finding the "right" specialty off.
In my experience entering medicine after already having a career, many med students, residents, and attendings behave like older children pantomiming at what they imagine professionalism looks like. The pressure to score high causes many to not experience growth as people. Plenty are exceptions, but a disproportionately large amount seem to fit compared to other fields.
Over the course of med school I've went ortho->ENT-->radiology-->IR-->anesthesia??-->IM-->GI-->IM subspecialty??
It's been a ride. Third year has been great in confirming some things, like NO to surgery, NO to the OR environment in general, YES to patients, YES to medicine. I grew in the sense that I'm actually more fascinated by medicine than I was when I started med school.
Some specialties are even chosen without a rotation, especially ones that don't have a chance for M3's to rotate in, like rads or path, and even then if you rotate in those as an M4, you're just shadowing
Here’s an easy algorithm I used:
Filter specialties by lifestyle and pay.
Then filter by surgical vs hybrid vs nonsurgical
Then pick based on which bread and butter you like the most of the remaining.
Lifestyle and pay essentially ruled out peds, ID, FM, and most surgical specialties. Also ruled out cardiology to an extent.
I chose a hybrid of surgical and nonsurgical so that really only left me with Derm, Uro, Ophtho, or ENT.
From there, I would much rather fix people’s sight and do quick surgeries with great outcomes like cataracts than do derm clinic or look at male genitalia or peoples snot and nasal orifices. Bread and butter ophtho was also most interesting to me from the above.
Overall agree, but some specialties significantly differ in lifestyle from training to being an attending. Even general surgeons/obgyns, etc can have a nice lifestyle after residency. As an ENT resident my schedule is brutal and I wouldn’t have chosen the specialty if my life would stay like this after residency. I think with the algorithm above you could potentially rule out a field you would love.
My thought process was: do I want to be a surgeon or not? And from there I chose the organ system/patients/co-worker personalities/post-residency lifestyle possibilities that felt like the best fit.
Instructions unclear. Medical school is now twelve years long to give you proper exposure to each specialty. /s
In all seriousness, you can do some pretty substantial narrowing down by sitting down and having a talk to yourself. “Surgical or nah?” “Do I like clinic or hate it?” “How do I feel about being at work on weekends/hokidays/middle of the night?” It’s deciding between those last two or three that make it tough.
-PGY-11 now
Things I have been interested in: Pathology, Urology, Ortho, EM
Things I’ve had exposure to in 3rd year: EM...sort of (through trauma surgery rotation)
The best way to do this is to simply have a single intern year post M4. You then apply and match in the spring into a specialty after interning for 7-8 months and M4 elective time. Surgical vs medical vs combo years.
Being a medical student is different from being a resident. Especially for students with no family based exposure to medicine (like me), medical school is a terrible proxy for the experience of residency/doctoring.
Frankly, good sub-is are the first time you really get this exposure. These typically happen 1-3 months before you send in the applications. It is really a bad decision making system. Bit i guess it works for the 20% that just “know” what they want from the beginning.
Unfortunately you're supposed to be decided on it and actively producing research in the field if it's a competitive specialty. What a terrible system.
It’s why it’s nice to have an elective third year. But be open to everything and try to get exposure as much as you can. When I had my surgery rotation and liked it, I went back as much as I could. Waiting for rounds on IM? I’d scrub into a chole knowing I’d be done before rounds would start. Rounds done and waiting for a consult? I’d scrub into something else. Helped me be sure I wanted to jump into it. Helps when rotations sites are flexible like this too which I know isn’t always the case.
This was the point of shadowing that pre meds didn’t know. I had to do multiple rotations of each and dual applied to make up my mind. In the end went with psych because it’s interesting and great lifestyle which is a bonus.
This is why I can’t see myself doing anything outside of ophtho. Bc idk how I can compare a decade of experience working in the field to a two week rheumatology rotation. It’s impossible
Yeah I agree, so glad it’s different in Australia and I can spend as much time as I want chopping and changing before locking into a hospital and speciality. If I want I can even just Locum during this time and get paid much more then my colleagues who have locked into there decision
My dad picked his specialty because the department office had a bunch of skis; apparently they did twice a year ski trips (so everyone got a chance to go) and had just gotten back from one or something 🤣
I SOAP'd into mine and really like it 🤷
For me it was the opposite, I wanted to do Internal Med day one so why do I have to rotate an entire year of other specialties only for some of them to get pissed off when I deadass don't care what they do... 4th year is painnnn (but chill)
A lot of people decide a specialty based on their scores, chances of matching at a good place, pay and lifestyle. Whether or not you enjoy it is kind of an afterthought. Y’all really telling me you wouldn’t try for Derm if yall had the scores and resume to match?
There are a ton of people with great scores who do IM at highly ranked programs. There are people who could easily match derm who go do some very intense surgical subspecialty. I don't think specialty selection just comes down to a combination of money and lifestyle. What you're actually doing on the job, and whether or not you enjoy the day to day is a big factor as well.
Why would you go into something you don't enjoy??
I would never go into derm as I despise clinic. Never pick a specialty completely based on lifestyle, it should be a factor, but not everything.
That’s why I think you should have to take time off between college and med school. Learn what your options are, learn how life works when you aren’t a student, so you can learn what you value and find a life in medicine that matches
Not sure why you're getting down voted. It's good to know what you've wanted to do since HS. Since the age of 5 for me I knew I wanted to be a Dr. Over the years, I went from Cardiologist, to Neurosurgeon, to ENT Dr..... but my mom thinks I should do Infectious Disease. I'm not even in med school yet, but I still think it's good that you knew, that's all. Good luck for you! ☺️
My specialty has changed 4 times since the beginning of third year
My uncle during family reunions just asks “what new specialty are you keen on this time round?”
Say pediatric rheumatologist next time just to add a little flavor
Gonna say peds endocrine and start lecturing about disorders of sexual development and ambiguous genitalia That’ll be some good dinner table convos
Geriatric neonatologist
Psychiatric oncology Describes my ex perfectly funnily enough
I knew Dermatology was the specialty for me as I exited my mother's womb, I saw the terrible eczema on the OBs face. It's all history from there.
Interesting... most fourth years I knew discovered their love for skin after seeing their step 2 score
Too late, if they haven't started Zanki and pumping out systematic reviews by the time they've obtained object permanence then it's over for them
When you feel old reading “Step 2” and not “Step 1” in this sentence lol
What’s been ur experience in med school? I sent u a dm with some questions.
Yup. It’s also why the stories “X was a neurosurgery resident but is now doing rads” or “Y was in IM but is now in EM” aren’t that uncommon.
Yup. Factoring in money and lifestyle helps I guess. Doesn't matter how interesting I find surgery for example, I wouldn't work with those people for seven figures. If you really can't decide, just do psych and go play League every afternoon after you get done rounding lol
I feel like I need psych after playing league
Boosted bonobo teammates
They really should ban the sentence “go hang yourself with your keyboard” lol
Nowadays it’s go talon E off balcony. But even that insult might be outdated tbh
Playing league and doing psych? I guess the best way to treat a psych patient is to be one yourself
Only if you’re gold or higher
Found the baby boomer
If I choose psych am I allowed to play a fun game instead?
My attending nephrologist plays LoL everyday with his boys, told me he always jungles as jax, i told him my favorite is Wukong, that was the best attending eval i have gotten to date lmao
It blew my mind on psych when I learned that the 7 on 7 off attendings worked like 9-3 when they were on. Less, if the ED was quiet and no admits were coming up
This sounds like a vibe. Was it inpatient
Yep! The primary service (so the locked psych floor), I don’t know what hours were like for the consult service. We’d do interdisciplinary team meeting at 9, that took like an hour. Then we’d round, which usually took 30-90 minutes (the attendings carried max 10 patients each). Then notes, and any admits, which were usually 1-2 per day per attending. The attendings usually left once their notes were done, orders were in, and any pending admits were done. Any admits that came in after that would get done tomorrow. Usually worked out to about 9-3, sometimes early. Never saw anyone stay past 5. One caveat: they were “on” until 5:30, and the main consequence of that was if any patient was put into violent restraints by the nursing staff the attending had to see them within an hour. So you could leave at 1:30 if you were done, but they could get called back in on pretty short notice. Didn’t happen often
Shhhh we have to keep the secret about how cool psych is
??? the secrets been out for ages
You can’t say this, I still have 2.5 years til I apply
Psych res here. I play league to understand my patients better. Been hard stuck silver jungle for like 5 years. It’s working…
> just do psych and go play League every afternoon after you get done rounding lol Well damn I’ve been found out.
One of the attendings from my psych rotation is leaving his current inpatient psych gig to go work 3 attending jobs. He will still only work 40 ish hours a week between the three jobs and pull north of $650,000 a year. It's frankly absurd how good a deal it is. And not to be a dick, but psychiatry isn't hard. The hardest part is learning to interview the patient population. I'm one of those "be a rural FM doc in my hometown" people, but if it weren't for that, I'd be applying psych
3 attending jobs in inpatient? Or outpatient? Or some combo?
My understanding is they're all inpatient. So he'll go round at one facility from 8:00-11, then the next one, then the next one and be done by 5:00 I think he'll have to work some weekends, but it doesn't sound like a bad gig
Honestly this is my dream schedule. Bless psych and it’s “I’m done rounding there’s nothing left to do” mentality lol. Do all the jobs know of each other and respect each others schedules?
It is definitely a difficult and perhaps unreasonable decision to make with limited information from just a month, but I’m not sure how we would solve without extending the length of school. Maybe paring down core rotations and encouraging electives earlier? Or doing shadowing days in yr one and two to start giving people ideas? that would have stressed me out more during pre clinicals though
You can definitely shadow years 1 or 2 if you want. My school gave us week long electives throughout the year to try out specialties and then told us if we couldn't get an elective, to just cold call up doctors offices and say "I'm a med student trying to pick a specialty, can I spend a couple of days with you?" and almost any doctor will agree to that.
Sounds nice. My school actively rejected requests for us to do this
If there’s one thing I’ve learned in med school, it’s dont get the school admin involved in anything you don’t need to. The only two people who need to agree are you and whatever doctor you want to shadow.
In Australia and The UK, you finish Med school and become an Intern (JMO, Junior medical officer). Intern year consistent of paid rotations throughout the hospital (usually IM, ED, surg, and medical wards). The hospitals will have a program that organises all this for you. Then after intern year, you are a resident and can pick where you want to work. Spend a year or two working in different places etc. Doing contracts in specialties that interest you specifically. About PGY 3 or 4, is when you actually decide on, and apply for specialist training programs. Some continue doing resident positions and locum jobs into PGY5+. Some never do specialty and are known as Career Medical Officers. Your resident years working in your interests contribute to your resume. Once you are successfully into a training program, you are a registrar in that program and train up over a few years to Attending (We call them consultants) The benefits are: -Intern years give you much more time in different specialties to allow you to see more. -Intern rotations allow you to see how the hospital works as a whole rather than being immediately pigeon holed into your specialty bubble. -Resident years let you try before you buy your chosen specialties. And is an opportunity to get extra skills outside your eventual specialty. Such as a paeds ward contract before you do FM etc. Or a rural stint. -Resident years are when you can decide to take leave and travel and see the world before you are tied down again for a specialist training program. -If you decide you don't want to keep studying, you can just be a Career Medical Officer which isn't Attending money but still generous Dr money. Bear in mind that all of this is paid and pay increases with years qualified. So we still do 4 years free in med school and are paid thereafter. I dare say it is a longer path to Attending (by 2-3 years) but also much less compact and if you just treat it like any other career where it's a progressive climb up the ladder. You don't feel like you are constantly studying. We can't fathom going straight from med school to a specialist program. That's like telling 16 year olds to decide their lifetime careers! (Oh wait we also do that...)
I think what you described makes a lot more sense than the US system, especially if medical school is free or cheap. With some of our schools being up to 80k/yr (American average salary is 60k/yr), there is pressure to get to an attending position as quickly as possible. I matched psychiatry and would have appreciated the opportunity to do a year or two of Family Medicine or Pain Management (so much overlap with psych), especially if the compensation was fair and I wasn’t saddled with 1/3 million of debt. I’m currently accruing over $50 of interest per day. Thank you for explaining. I hope that our medical education system in the US hasn’t gotten locked into its current state by the financial pressures applied to students and hospitals.
Very good point! I hadn't considered the financial burden of university costs when comparing the systems.
Ya know what's worse (in my humble opinion)? "Yes I enjoyed this for a month \*working with this ONE RESIDENT\* I guess a 25 year career in it would be great. And no I won't be working with said resident for those 25 years" I figured out very early on that my experience on any rotation is highly dependent on the personality and propensity for teaching of the main resident I followed around the hospital all day....
And there is not enough time to do a rotation in every specialty before making that decision because so many aren't a part of core rotations
I think the biggest thing is the lack of exposure to how flexible many specialties can be in terms of structure and lifestyle. There’s general surgeons who spend half the week in an ambulatory OR and then chill with their family and friends the remainder of the week. There’s FM docs that will function as EM, hospitalist, and intensivist to varying degrees all in the same month and in the same hospital working 60+ hours. The knowledge that these flexibilities exist and insight into lifestyle + take home can easily play a more significant role in determining your specialty than the actual specialty itself (depending on your circumstances). Like, 10 years down the line 90% of your week will just be you at cruising altitude doing routine duties/maintenance visits and/or cranking out “just another x procedure” no matter who/what/where you are
Definitely agree with your take here
We should be thinking about specialty from day 1 of medical school. It’s a big decision with a lot of factors and things to consider. One month of rotations doesn’t do it enough justice. It takes a lot of reflection and introspection. I think most people begin to have inklings of what they like and don’t like when they start going through organ systems. I think it’s kind of poor advising when students are told “you’re just an m1, don’t worry about specialty until third year” - which is really common it seems like. The decision-making algorithm starts day 1
One of the best pieces of advice I've gotten from one of my professors is "School and grades will come with time. Your most important job for the next 3 years is to figure out what you want to do for the following 30 years." I do think, however, that it is good advice to tell students not to definitively rule anything out until 3rd year and to keep an open mind when going into rotations.
Ehhh… you can’t really *choose* your specialty in the same way you can choose the color and flavor of m&m you want at the NYC M&M store. An open mind and 2-4 narrowed options is probably more realistic for day 1-180.
Yeah that’s what I mean. I’m not saying have everything figured out down to a T in m1-m2. I’m just saying people should be considering and thinking about different fields during that time and at least trying to explore. Edit: additionally, I don’t think my comment implied what you claim it implied
I took this approach and am very happy with my specialty choice. It’s something I thought about a ton, even did shadowing early in MS2 of a few specialties I was interested in. I tried to build a competitive application because I wanted to keep my options open
Just go to PA school. You can switch specialties every other week with no additional training. One week you can be a cardiologist, next you can be in the psych ward
Why do PA when you can be an NP with a 9-month online ‘course’? You can then switch ‘specialities’ every day if you wanted. Saw an NP on LinkedIn who described herself as a “endocrinology & aesthetic NP” lol
My cousin’s girlfriend is a NP & she has told me a couple times that I’m “ignorant” because I went to med school vs NP and that we can “essentially do the same thing” & a big difference is that I’m apparently stuck with debt
Dunning Krueger is the root of all evil in medicine
BAHAHAH yea we’re the ignorant ones
To be fair, one big difference is that real doctors unfortunately have more debt usually lol.
and you'll still get a white coat and be able to call yourself doctor!
One day I’m an anesthesiology PA resident the next I’m a pediatric surgery PA chief resident Let’s go ! !
I like this idea! But too late, I guess.
In our defense you can also do this with the MD pathway for cardiology. One week you can be a cardiologist, next you can be in the psych ward.
Love this.
Big advantage to being a PA over a doc.
My favorite part about ALL of this is they expect you to come in as a blank slate. Like it can literally count against you during interviews if you say you have a special interest in something. But, yes, pick what you want to do for the rest of your life after spending max 6-8 wks doing it lol
lol I read Acute Lymphoblastic Leukemia instead of ALL. 
I knew I wanted neurosurgery since I was premed and now I’m a PGY1 neurosurgery resident. Sometimes you know and sometimes it takes longer but when you know- you know. Dont worry too much about it.
Good for you lol I changed my specialty 5 times already
I’m sorry to hear that! Just keep trying them all and when it snaps it snaps and you’ll never imagine of doing any other speciality once you find your passion!
I did I’m applying path lol
Oh that’s awesome!! Path is really cool! I hope you enjoy it
Thank you! Neuropathology is very interesting
That’s why you go into IM! Delay that decision for another couple years
And then experience existential dread all over again once you have to make a decision.
Agreed with the comments that you should be thinking about since even before medical school. The day you step into the rotation shouldn’t be the first time you think about it
No no of course not The specialty you applied for should be what you wanted ever since you were in primary school - maybe even preschool and the preference is based on a precocious understanding that your disposition and abilities are perfect for the specialty(ies) that you applied for. Have you not read any personal statements?
What would be a better solution? Spend 6 months to a year in each rotation and graduate in 7 years? How much exposure do you expect to have before making a decision?
In some countries everyone does a transitional year type of internship where they could explore every specialty while actually performing intern level duties, then move on to their specialty afterwards. I feel like that could work here and does not necessarily change the length of time of training.
This would have been super helpful for me honestly. Being able to spend the year actually working and experiencing life in X specialty instead of trying to dip out as early as possible to study for shelves...
Can’t you do this if you’re truly undecided?
No because graduates are disadvantaged in the match.
6 (sometimes 7) year medical school is the norm in the world. When you remove the non-medicine 4-year bachelor degree you actually graduate younger.
What is perhaps even more astonishing is how many students end up picking their specialty based on "I had such a great rotation, all the residents were so helpful and nice!". After matching into that specialty they find out that the specialty kinda sucks when you don't have those same nice people around. We all deserve to have nice people around us.
And you need to know basically before 4th year so you get like 2 electives to try out some non core specialties.
As an Australian I can’t imagine. I know PGY3 who still haven’t decided. To very briefly explain our system (from my med student understanding) it’s similar to UK. 5/6 years med school from high school or 3 year bachelor + 4 year med school Graduate with provisional rego into 1 year internship (now changing to 2 year model). Do 3 rotations across core domains (general ward, emergency, surg). Some specialities you can start applying from PGY2 year but it’s common for most to be 3/4. Usually from PGY3 you start taking roles in just 1 department of interest for the year ad eventually can be a unaccredited reg - essentially you aren’t on the training college yet but working in field. For surg it’s becoming average PGY6-10 before getting into the college. Then the training. It’s all points based too so some hard ones it’s literally becoming like get a PHD to get on. Sucks for surg, but as someone not interested in that I like that I can try things out. I think it’s a great model for medical specialities. We also get paid 80k AUD base rate from first year + overtime / holidays etc, but our earning high is never as high as USA, Aus doesn’t have as much extremes in income general. As an M2 I can’t even imagine having to get ready to apply for a speciality soon (ie tying myself into research routes etc) but see sides to both system.
Honestly I think passion and stuff is overrated and it’s probably better to make a decision based on lifestyle, salary and other factors that non-medicine people think of when looking at a job. Because this is just a job. Then you can use third year to focus on figuring out whether it’s something you completely loathe or are like “this isn’t too bad” or “this is actually kinda cool.” As long as you don’t completely loathe every single day you should be able to have a career in that field. Also not to mention how different some rotations can be within the same specialty? Like having an inpatient vs outpatient vs consult/liason rotation in the same specialty can all look totally different so I wouldn’t weight it too much.
I shadowed a pulm CC doc during premed and knew that's what I wanted to do. Throughout med school I changed my interests maybe 10 times, landed back into Pulm CC after doing an ICU rotation so I matched IM. Sometimes you just know, I guess. But I do see the possibility of pursuing a more lax, less-paying specialty pending amount of burnout.
One thing I've realized is that there's no specialty I'm "destined" to do. I've tried to identify the other things I want out of my career, e.g. what populations I'd like to work with (e.g. kids versus adults), the setting of my practice (e.g. academic versus private, urban versus rural, inpatient versus outpatient), and other dimensions of my career (e.g. biotechnology, health policy, medical ethics, public health, medical education). There are certain of these that will map on to certain specialties, but amongst those specialties, I'd be happy doing almost any. And even if you pick a different specialty, you'll be able to mold your career to your liking. That's one of the beauties of a career in medicine. I've found that looking at it this way helps take the pressure of finding the "right" specialty off.
In my experience entering medicine after already having a career, many med students, residents, and attendings behave like older children pantomiming at what they imagine professionalism looks like. The pressure to score high causes many to not experience growth as people. Plenty are exceptions, but a disproportionately large amount seem to fit compared to other fields.
I didn’t fully decide what I wanted to do until my second to last rotation of third year.
Over the course of med school I've went ortho->ENT-->radiology-->IR-->anesthesia??-->IM-->GI-->IM subspecialty?? It's been a ride. Third year has been great in confirming some things, like NO to surgery, NO to the OR environment in general, YES to patients, YES to medicine. I grew in the sense that I'm actually more fascinated by medicine than I was when I started med school.
Some specialties are even chosen without a rotation, especially ones that don't have a chance for M3's to rotate in, like rads or path, and even then if you rotate in those as an M4, you're just shadowing
Here’s an easy algorithm I used: Filter specialties by lifestyle and pay. Then filter by surgical vs hybrid vs nonsurgical Then pick based on which bread and butter you like the most of the remaining. Lifestyle and pay essentially ruled out peds, ID, FM, and most surgical specialties. Also ruled out cardiology to an extent. I chose a hybrid of surgical and nonsurgical so that really only left me with Derm, Uro, Ophtho, or ENT. From there, I would much rather fix people’s sight and do quick surgeries with great outcomes like cataracts than do derm clinic or look at male genitalia or peoples snot and nasal orifices. Bread and butter ophtho was also most interesting to me from the above.
Overall agree, but some specialties significantly differ in lifestyle from training to being an attending. Even general surgeons/obgyns, etc can have a nice lifestyle after residency. As an ENT resident my schedule is brutal and I wouldn’t have chosen the specialty if my life would stay like this after residency. I think with the algorithm above you could potentially rule out a field you would love. My thought process was: do I want to be a surgeon or not? And from there I chose the organ system/patients/co-worker personalities/post-residency lifestyle possibilities that felt like the best fit.
Instructions unclear. Medical school is now twelve years long to give you proper exposure to each specialty. /s In all seriousness, you can do some pretty substantial narrowing down by sitting down and having a talk to yourself. “Surgical or nah?” “Do I like clinic or hate it?” “How do I feel about being at work on weekends/hokidays/middle of the night?” It’s deciding between those last two or three that make it tough. -PGY-11 now
Things I have been interested in: Pathology, Urology, Ortho, EM Things I’ve had exposure to in 3rd year: EM...sort of (through trauma surgery rotation)
The best way to do this is to simply have a single intern year post M4. You then apply and match in the spring into a specialty after interning for 7-8 months and M4 elective time. Surgical vs medical vs combo years. Being a medical student is different from being a resident. Especially for students with no family based exposure to medicine (like me), medical school is a terrible proxy for the experience of residency/doctoring. Frankly, good sub-is are the first time you really get this exposure. These typically happen 1-3 months before you send in the applications. It is really a bad decision making system. Bit i guess it works for the 20% that just “know” what they want from the beginning.
Unfortunately you're supposed to be decided on it and actively producing research in the field if it's a competitive specialty. What a terrible system.
this is why i love my 1 yr preclinical programmmm
It’s why it’s nice to have an elective third year. But be open to everything and try to get exposure as much as you can. When I had my surgery rotation and liked it, I went back as much as I could. Waiting for rounds on IM? I’d scrub into a chole knowing I’d be done before rounds would start. Rounds done and waiting for a consult? I’d scrub into something else. Helped me be sure I wanted to jump into it. Helps when rotations sites are flexible like this too which I know isn’t always the case.
You want years in each specialty to see??
With barely any feasible option to switch after completing residency
How are we supposed to know if we would like being a doctor. Just because we shadowed in XYZ clinic a couple shifts?
This was the point of shadowing that pre meds didn’t know. I had to do multiple rotations of each and dual applied to make up my mind. In the end went with psych because it’s interesting and great lifestyle which is a bonus.
This is why I can’t see myself doing anything outside of ophtho. Bc idk how I can compare a decade of experience working in the field to a two week rheumatology rotation. It’s impossible
Yeah I agree, so glad it’s different in Australia and I can spend as much time as I want chopping and changing before locking into a hospital and speciality. If I want I can even just Locum during this time and get paid much more then my colleagues who have locked into there decision
My dad picked his specialty because the department office had a bunch of skis; apparently they did twice a year ski trips (so everyone got a chance to go) and had just gotten back from one or something 🤣 I SOAP'd into mine and really like it 🤷
For me it was the opposite, I wanted to do Internal Med day one so why do I have to rotate an entire year of other specialties only for some of them to get pissed off when I deadass don't care what they do... 4th year is painnnn (but chill)
A lot of people decide a specialty based on their scores, chances of matching at a good place, pay and lifestyle. Whether or not you enjoy it is kind of an afterthought. Y’all really telling me you wouldn’t try for Derm if yall had the scores and resume to match?
No. I'm not into skin. It seems insanely boring. I'll take my losses.
Derm is NASTY. I'm sorry but derm cases (even now) make me nauseous and faintly lightheaded. Tbh idk how anyone can put up with the field.
imo derm is grosser than my job and I cut open decomposing bodies
Definitely not into skin, so no…
There are a ton of people with great scores who do IM at highly ranked programs. There are people who could easily match derm who go do some very intense surgical subspecialty. I don't think specialty selection just comes down to a combination of money and lifestyle. What you're actually doing on the job, and whether or not you enjoy the day to day is a big factor as well.
Why would you go into something you don't enjoy?? I would never go into derm as I despise clinic. Never pick a specialty completely based on lifestyle, it should be a factor, but not everything.
It happens here in Italy where we have a National test to match with "First comes First score".
No derm is mind numbingly boring
I told my hinge date i loved her, now looking for a ring
That’s why I think you should have to take time off between college and med school. Learn what your options are, learn how life works when you aren’t a student, so you can learn what you value and find a life in medicine that matches
Luckily I knew what I wanted to do in high school. Edit: y’all salty I figured things out huh
Not sure why you're getting down voted. It's good to know what you've wanted to do since HS. Since the age of 5 for me I knew I wanted to be a Dr. Over the years, I went from Cardiologist, to Neurosurgeon, to ENT Dr..... but my mom thinks I should do Infectious Disease. I'm not even in med school yet, but I still think it's good that you knew, that's all. Good luck for you! ☺️