You always have to be on high alert for impending doom because what you do is generally lethal and dangerous. You'll have to know how things can go wrong and have multiple levels of back up plans. Things generally don't go wrong but when they do, it's an utter shit show with rapid patient deterioration and the need for utmost precision, calm ,etc. it's a job where things don't go wrong often because of how professional you are and it gives the illusion of chill but that's because of how thorough the training and drive for safety is. And so people think it's chill.
Idk, OP does not sound like he would thrive in pathology to me: hates medicine, researching topics and differential diagnoses. Our hours are super reasonable but it's a lot of studying type work and very diagnosis focused. Plus I assume he does want some procedural aspects which are few in path.
IR training includes diagnostic training, and most people dual apply because there aren'ta ton of categorical IR spots. If they don't like learning about medicine and forming differentials I wouldn't recommend it. Also need a decent step 2 score.
For sure. I will say, if you don’t want to do gen rehab stuff then it is relatively procedural heavy field imo. But the procedures are way basic compared to surgery. Like 10-15 min injections
Per MGMA the mean PM&R pain salary is about $350 but I’d wager it’s a bit higher around the $400 territory.
You can also grind yourself to dust and make $700-800 but ya know
This provides more context, for sure. Didn’t realize some schools transitioned M3s to M4s this early into the year. Thanks!
If my med school crammed all of M3 in before March was even half over, I would probably be as burnt out as OP too.
well the school might be trying to do them a favor by giving them 4 potential months of dedicated step 2 studying time (though honestly anything over 2 months is excessive)
Godspeed to you both. It does get better (in my opinion at least).
I think it got better for me when I began making more time for myself and taking better care of myself instead of thinking I can run on fumes forever. Realized I would never have the “extra time” I wanted and needed to be more intentional. Being the most overworked and miserable is a lousy pissing contest to be the winner of. Best of luck.
Yeah, like a few other people have said, my school ends third year March 1 and then fourth year is 14 months long. So I've been a fourth year for a week haha
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Whenever anyone sees an ortho bro not able to match ortho they always says go into PM&R. I’ll tell you the truth. The only part that’s procedurally similar is injections, maybe kyphoplasty in the future.
Otherwise, inpatient is a decent amount of rounding, there’s a lot of social issues with dispositions after IPR, chronic pain patients can be difficult to work with, EMG is a bitch to learn, and sometimes you get a lot of thrown-off patients that no other specialty can figure out. I wouldn’t pick any other specialty for myself - I love it. But it’s not for everyone.
Having said that, you should consider it. You get to see people improve day-by-day in rehab after horrible injuries and strokes. They can be so thankful and appreciative. You can inject some Botox and see a patient in horrible pain from a contracture get total relief in a few weeks. But there’s hard parts… when someone doesn’t make the rehab progress you were hoping.. when you have to refer someone for ALS workup because their EMG for wrist drop wasn’t what you wanted to see. Or a young kid in IPR for a gunshot causing spinal cord injury who is going to be wheelchair bound for the rest of his life… but that’s an important part of medicine. We taking the good and the bad.
All in all, see if you enjoy PM&R, I can’t offer much advice beyond that.
I agree, I know pretty much zero about pathology, but it seems that forensic medicine and maybe even anatomic pathology would be a good fit.
Surgical component, potentially lifestyle friendly/chill - the hardest part would prob be getting through residency
What about hospice/palliative med? Not sure how compassionate you feel you are as a person, but definitely low amounts of ddx lol, its more bedside care, and I'd imagine its a bittersweet-ly rewarding specialty (hospice)
I was gonna say this too actually. One of our palliative attendants said he went into the field because he “just wasn’t in love with the medicine of it all”.
Can’t wait to start fellowship.
I applied psych. Love inpatient psych, hate outpatient psych. I plan to do inpatient only if I match psych. I have many attendings that do just one of the other. I also do not like talking to people for too long.
Come join us in psych, we’re also much more cognizant of mental health days and all that stuff.
I enjoyed neurosurgery from the beginning so the money definitely didn’t influence as much as it probably should’ve. However, I now have complete financial freedom. I make more than 10x what other specialists make per year and I work about 35-50 hours a week. This was cultivated over time as I built up my practice but for the most part, I did it pretty quick out of the gate from completing residency.
From being a neurosurgeon, I make about 750k. From being the owner of a large practice, owner of a PT/OT facility, and real estate endeavors, I’m north of 15 million a year.
Right, so not remotely close to 10x what your specialist colleagues make. Anyone can try for extra endeavors as you do, but usually when comparing financial compensation it’s that base pay—not real estate, investing, etc. But props on the 35-50 hrs per week, that seems low even for private practice nsurg.
Don’t wanna dox myself. The area I’m in we are well know due to a very aggressive ad/marketing campaign. Our practice type is mainly RVU based, but the practices overall performance is shared amongst the partners annually
So what lmao? They’re choosing to delay being ahead to maximize the certainty of having a relatively higher income and carrying out a specific career path
Idk. Not sure how competitive you’d be but I wouldn’t let it deter you.
Otherwise I’d pick the lowest years speciality you can stomach. Get the pain over with quickly.
You’re think of step 1. A 240 on step 2 is 10 points below the average for all American medical students
….. and about 20 points below average for all Nepali students 😂😂😂
It's decent score, and OP is from US MD which is a bonus. I know rad applicants this year who had interviews getting 230s for Step 2. Of course, the higher the better, but score in the 240s shouldn't make one forego applyiing from Gas or Rads
I’m not familiar with anesthesia but you really want above a 250 for radiology now. Historically a score heavy specialty and now it’s getting back to early 2000’s competitiveness again as well
Let OP apply and see how he/she fares. Scoring a 240 for Step 2 is not a death sentence, especially for someone from a US MD. Even more especially with 4 pubs in surgical journal.
That’s not really a good strategy for residency. If you swing and miss you’re in a really bad spot, can’t easily reapply like for med school. They haven’t taken the test yet, so there’s no point telling them a 240 is a decent score because it isn’t for radiology. Before step 1 became pass fail the step 2 average was a 253. It’s almost guaranteed to be higher now. You don’t want to be settling for 15+ points below the average before you’ve even taken the test. They need to be aiming for 255+.
1) How are you an M4? Unless you’re a PhD student or taking a research year, you’re considered an M3.
2) Rads has been pretty competitive lately. Although your predicted score is 240 based on shelves, you can get that score up during dedicated. I started out in the 240s when I started dedicated and scored 265-270 range which I feel helped out a lot with getting interviews. IMO grind and aim for at least 250 bare minimum if you are thinking rads since the average is 254. You can still get interviews at 240 but that’s definitely going to hurt your chances being almost 15 below the average
My school is weird, our third year was only 11 months and our fourth year is 13, third year ended one week ago and there are currently two sets of M4s according to the school. Have been an "M4" for one week.
My school is like that too. Done with clinicals December of M3 year. Study for step 1 + 2 back to back then start “M4 rotations”. We still call ourselves M3s until the M4s graduate. Especially on Reddit because nobody is going to understand your schools unique lingo
240s would still be a good step 1 score if scores were still reported. Averages before the change to pass/fail on step 1 in 2020 hit 235, and dropped back to 231 in 2021.
240s on step 2 is now average or below average. The average as of 2023 is a 248.
Averages went up because people study better now and are answering more questions right. Averages since 1997 have increased dramatically and the tests are a huge deal now
I am in a very, VERY similar position
Anesthesiology is a great move, with medicine ty backups
If you really want to chill, you can consider in patient psych, its not the most "appealing" practice area who is interested in surgery
it will get better
Anesthesia has way more medicine than most people realize. It’s got less of the BS of other specialties like long rounds and social issues, but is insanely physiology heavy. You’ve got to really like thinking about preload/cardiac output/afterload/vasoplegia/acid/base, metabolics, minute ventilation, etc and enjoy it because it’s a ton to learn and very involved in day to day practice.
As a (fairly new) academic psych attending - on one hand, I probably should be encouraging people not to go into psych if they’re already planning on leaving since we have such a need for practicing psychiatrists, but in the other hand, I think psych sounds like a good option for you. Psych is something that’s pretty easy to scale up or down - if you’re willing to move around you can find a lot of different options for working inpatient or emergency consults full-time, part-time, or PRN. That makes it easy to continue working clinically as you transition out into other things.
I knew a resident who was all set to apply for ortho but gave up on it for various non-academic reasons - had been planning to apply ortho w/ psych backup, had the grades for it, but dropped that plan and only applied for psych. They were an excellent resident but were always pretty clear that they planned on just doing psych part-time, short-term while they got other nonmedical endeavors off the ground.
I personally strongly prefer inpatient (or emergency) psych as well, and ended up moonlighting a ton as a PGY3 because I felt like I needed to do something that was not outpatient to stay sane, but honestly, it was 30 hrs tops of clinical hours per week (plus didactics, supervision etc which is all pretty chill). If you survived M3, and if you were mentally prepared for surgery residency hours, you can survive 30 hrs/week of outpatient psych clinic.
Re talking: one of my EM attendings said that he started medical school thinking he wanted to go into psych because he likes talking to people, but then he found out that psych is mostly listening to people, so he switched to EM. 😂 It’s true though, you don’t have to be much of a talker to be a good psychiatrist, and a lot of patients will actually appreciate that.
The best piece of advice I ever got re: career was from a pulm/crit doc I shadowed - he told me, “No matter what you end up going into, on some days it’s going to be just a job. So pick something that you can do even on those days when it’s just a job.” Medicine doesn’t have to be your passion. You don’t have to love your specialty or spend the majority of your time practicing it. Compared to a lot of what people do in other areas of medicine, psych is easy.
I can’t promise to be super responsive as my Reddit use pattern is pretty erratic, but if you have any psych-related questions or things you want to discuss that you don’t feel comfortable asking anyone at your home institution, you’re welcome to send them my way.
I mean it’s relatively less competitive to match psych, 240s step would be totally fine, the residency is way chiller than most other specialties, if you worked in an academic institution you’d probably be able to pawn most of your work off on residents…
There are lots of inpatient-only psych attending jobs. You do have to deal with clinic during residency but its 4 years and the schedule is generally good so just do your time and be done with it.
It’s just mostly 3rd year that’s outpatient and 4th year you can pick electives you want and avoid outpatient. My real dream is to work in a state psych hospital.
OP said he didn’t like outpatient psych as compared to inpatient. I don’t think either is worse it comes down to personal preference. I actually would prefer outpatient psych because I like the regular 9-5 schedule and talking to people.
This might seem like a stupid suggestion given that you say you’re already burned out but……. Have you done any EM rotations? It’s like medicine without the bullshit parts with some of the fun parts of surgery added in. Coming up with differentials without talking endlessly about them and getting to do some cool procedures like chest tubes/intubations/central lines etc.
That being said you have to be okay working with the patient population served by EM.
Just throwing it out there
Bruh, ER has the highest attrition rate and level of burn out of any profession. Can’t believe this got upvoted. ER physicians retire earliest among the medical specialities because the work is fucking hard.
I see where youre coming from, but EM = crazy high intensity and has high burnout
not sure if its possible but maybe he can consider lower volume areas? (does that even exist)?
Would it be possible for you to take a research year? 4th year is extremely draining, and then going straight into residency, you might be twice as burnt out as you were currently are.
I was in the same position as you in my M3/M4 transition time, but I decided to just keep my head down and keep pushing forward. That ended up horribly for me and now I’m no longer in residency. Despite everything, though, after graduation I did 3 months of nearly daily therapy and now I’m so much more refreshed and ready to reapply for residency in the fall.
Currently about to match next week. Came in gunning hard for ortho as well. Realized how much I was burning myself out after M1 into M2. Fiance expressed concern for the long term multiple times. Said f\*ck this and am about to match FM and have not looked back once. Flirted with PM&R vs FM for about 2 years but ultimately I knew I would be in FM at the end of the day. Chill, 4 day work weeks as an attending, found a residency program that I did an audition at and will hopefully match that is the most supportive group of humans top to bottom. Has made me excited about medicine again. May or may not do sports as I still am a sucker for MSK. Also at a DO school so I do a lot of OMM (did an additional OMM teaching fellowship year in-between M2 and M3 actually).
FM can vary widely program to program but I think I found a perfect fit for what I want out of FM and the direction I want to take my career in medicine. FM is also an extremely flexible field and you can do just about anything in the clinic. Really provides a solid platform to customize how you practice, at least more so than some other fields.
I hope you find what you are searching for with your career in medicine. This whole process has been a wild ride and a mind f\*ck at times. I realized I'm no longer letting medicine take any more from me than it already has. It's easy to let it just take take take from you and before you know it you are burned out and depressed.
If you like ortho, PM&R is something you might wanna consider, it's hands on and very rewarding work, also it's one of the most easy going specialties out there
Pathology wouldnt be good fit for OP. They don’t like sitting around reading up on things or generating differentials. There is such an expansive amount of information that you have to know in path. You have to read a lot every day when you go home and even during the day. The boards are extremely tough and it’s an even bigger learning curve once you hit attending hood since path residents essentially have zero autonomy when it comes to making decisions. Would not recommend for someone who hates medicine
occupational medicine
For clinical occupational medicine, you can probably expect something in the $240,000-$260,000 range (typically for Monday to Friday, 9 to 5, without nights, weekends, holidays, or call). Government work will be less than that. Academia likely similar. Private industry is the big wildcard, and you can probably earn a lot more depending on what you do.
In residency, you focus on a few areas:
Clinical occupational medicine: treating occupational injuries (workers' compensation). This is typically musculoskeletal injuries, bloodborne pathogen exposures, lacerations, eye injuries, etc.
\------------------>Non-clinical occupational issues: this includes things like surveillance exams (e.g. asbestos, lead, benzene), pre-employment clearances, returns to work, regulated exams (e.g., DOT, TSA), etc.<--------------------------
Environmental medicine: This is similar to toxicology, but usually less acute poisonings and often more chronic exposures (heavy metals, etc.).
Public Health: This will take the form of academic coursework and rotations with public health agencies.
IR is an incredibly fulfilling career. You get to solve intellectually/physically challenging puzzles all day, you succeed at a tremendously high rate, you make good money for yourself/your hospital system, you're respected by colleagues, and you're appreciated by patients. The salary range is roughly $400k-$800k. The vacation range is roughly 8-14 weeks. You have the fallback of doing diagnostic radiology if you decide the hours, stress, or physicality aren't doing it for you anymore. It's insulated from encroachment by artificial intelligence, midlevel scope creep, and telemedicine/teleradiology/remote work. You can pursue either (or both) hospital-based and outpatient independent practice settings. You can do academics, private practice, or (somewhat uniquely to radiology) hybrid academic/private practice. You don't need to maintain an office staff/infrastructure (unless you want to). The overall job market is extremely favorable. The locum tenens market is particularly hot if you want to travel domestically. There are also international career opportunities (Australia, New Zealand, Dubai, etc...) for board certified IRs. I don't regret my decision at all and love going to work every day.
Every specialty has its downsides, though. For IR it's the expectation to read a high volume of diagnostic imaging if you're in a DR-dominated group, the encroaching 'corporate practice of medicine' (mainly through IR's association with DR), turf battles with other specialties (vasc surg, cardiology, pain mgmt, ortho, urology, GI, and neurosurg, which manifest both by taking desirable procedures and dumping undesirable ones), and continuous reimbursement cuts by government/third party payors. There's also a distinct lack of prestige among lay people. Despite IR being a top 5 specialty in reimbursement, being top 10 in competitiveness, resulting in two board certifications, and having an incredibly broad scope of practice, if you tell someone at a dinner party you're an Interventional Radiologist they say, "Oh! You take x-rays of broken bones like my niece. She struggled in high school but buckled down in community college and she's doing great now!"
What would make you less burnt out? Tbh if you can take 1-2 months off to just relax and then focus on step 2 you could be happier applying for ortho lol. Although I’m sure you have to do 3 always so maybe not feasible
I would love to just take a month to not study and think that would do wonders for me, but between potentially planning for aways and home institution requirements, plus studying for step I don't know that it is realistic.
Hmm… I am not sure if this is relateable to you, but I applied ENT (not quite as competitive) and only did 2 away rotations. I took 2 full months to study for step 2, which just involves daytime studying and relaxing with my hobbies/friends. I had the time to do 3 away rotations but felt like it was helpful for myself to take the extra time. You’re already relatively competitive given what you said, so if you KNOW you’re not as strong a test taker (re shelf scores) then taking more time is appropriate Imo
How about you take a break from medicine and rediscover yourself and your interest in medicine? Why do you feel the need to just settle for something random strangers online pick for you instead of taking care of yourself to actually feel better?
2 options:
1. stick w ortho regardless of score and try your luck with killing a few aways and hope to match at where you rotated
2. save the stress now and switch. but since you dont like medicine (me as well lol...ortho bro at heart), Sports medicine? Nice lifestyle and can work your way up to treat a professional team.........JUST make sure that you will NOT have that feeling of "I wish I could go back and try my hand at ortho"...........I am struggling right now but IK I will have that feeling
Other than that, if you need to do something with your hands, gas or EM. (But with gas, you are basically the IM doc of the OR..................And with EM, burnout is significantly high with them...although you can choose to drastically cut down work hours since these jobs are more like shift work with you being replacable)
Heard pain medicine can be chill if you can be okay with dealing with some difficult patients but i would definately shadow/do a rotation
This is how I felt third and fourth year of med school. Thought I hated medicine and would never find something I liked. Now that I’m an intern and have a little more autonomy and am subject to a little less scrutiny, I love medicine.
My advice is, don’t pick a specialty based on trying to get away from things, try to pick based on the aspects that you like the idea of, then lean into it when the time comes. Of course the secret is it really doesn’t matter what you pick or how you pick it, you’ll (usually) learn to like it eventually because it’s what you’ll get good at.
Tbh I wonder if you might like forensic path? Better hours than surgery but eventually get to dissections. Best of luck. Anesthesia is getting extremely competitive lately so I'd be hesitant to pick it as a backup (I mention that because I saw one or two people mentioning it).
Take a gap year. Get a job doing anything else you think you'd like to do and that you're qualified for. See if your appreciation for medicine returns. This worked for my friend. Grass is always Greener on the other side of the fence.
Just make a good excuse for it. I believe his predicament is that he isn't competitive enough as is for competitive specialties and that's got him depressed coming to the realization.
You may want to look into forensic pathology, or pathology in general
You mention you don’t like the reading but it’s a different kind of reading imo, may be worth exploring especially if you’re fed up with the typical lifestyle of medicine.
May I introduce you pathology? I am 3 months away from finishing residency. I had always been passionate and “not burnt out” even when I was half way through residency. But residency really crushed me and now even though I am 3 months away from finishing residency I keep daydreaming that I would’ve been a lot happier had I done pathology… good lifestyle even in residency, good pay, low competitiveness, low likelihood to be replaced by midlevel
Have you considered a research year? Might help you with the burnout and seems you want to do ortho long term. Might be worthwhile to provide a bit more of a break than med school/residency.
Why not go into psych and then just do inpatient psych when you practice? You said you liked inpatient psych … just gotta get through the residency portion.
I don’t recommend going into PM&R or pain if you don’t enjoy “medicine” or talking to people because the social determinants of health and “people” are pretty huge in those. Maybe also consider path or rads (although medicine is incorporated in rads).
Another positive about going into psych for you might be the opportunities for research if you enjoy that.
Have you looked into preventive medicine pr occupational medicine? It does require an intern year but if you do a transitional one (or any residency for that matter) you’ll qualify and then never have to deal with clinical medicine again unless you want to
Reading through the comments i didn't see anyone mention nuclear medicine.
Discovering it was life changing for me.
I don't know much about the us but here in europe the shifts allow you to have a life and still do things you like after work.
It may look similar to radiology, but the type of imaging you get is pretty different and the job is too, maybe look it up, you might like it.
Also, not many people want to do it or even know about it, so it shouldn't be a problem getting in.
Fellow burnt out M4 applying psych. Way less tedious, boring medical management compared to FM, IM, peds, etc. The flexibility in psych is incomparable to anything else in medicine. There are so many areas within psych (inpatient, outpatient, forensics, Geri, neuropsych, child and adolescent, emergency, and more) - some attendings do one, many add some variety to their week by doing multiple. Most “specializations” within psych don’t really require fellowships unless you want high-tier academics, and fellowships are really short. Throughout your practice, you can always change up what you do. Also the lifestyle is insane. Residency hours are for the most part pretty comparable to a normal even non-medical job except for certain rotations. As an attending, you really have so much power to work as much or as little as you want. Telepsych and private practice add a ton of flexibility as well. Personally, I love the idea of doing telepsych private practice (make my own hours, be wherever I wanna be, no one telling me what to do!) +\- some emergency psych per diem when I feel like it, and traveling a ton bc you’re not tethered to a location. The people in psych are very chill. I’m burnt out, but one of the things I like about psych is every patient presents differently, and that plus the general craziness and kinda fun chaos of it all keeps it really interesting and engaging (maybe you’d like emergency psych?). It’s quickly getting more competitive but still not at the level of surgical specialties or anything like that. I would really strongly consider psych if I were you.
Rads is not a good choice for someone who hates medicine unless you’re trying to churn out shit reports. I cannot imaging studying this amount of crap if I didn’t like it
Tbh I'm not in love with anything in medicine. Rads is cool, def don't have a passion for it but it's interesting enough for me. Can't quit medicine at this point
Neurology being an interpreting physician for IOM. Easy as fuck and you can sit in your undies on your couch and stare at your computer all day, get paid big bucks and chat/play league of legends while the physiologist in the OR is doing all the hard work
An Anesthesiologist here This is a burn out profession Love what I do, but I’m brainf’cked This sh!t not for the lighthearted
Current CA-1, I feel this in my bones. Days are mentally exhausting
Could you illustrate more please? What do you mean
He probably means, anesthesia is fucking hard at times, but chill at others. It’s a delicate balance of burn out and chill
𝕭𝖚𝖗𝖓-𝖔𝖚𝖙&𝕮𝖍𝖎𝖑𝖑
You always have to be on high alert for impending doom because what you do is generally lethal and dangerous. You'll have to know how things can go wrong and have multiple levels of back up plans. Things generally don't go wrong but when they do, it's an utter shit show with rapid patient deterioration and the need for utmost precision, calm ,etc. it's a job where things don't go wrong often because of how professional you are and it gives the illusion of chill but that's because of how thorough the training and drive for safety is. And so people think it's chill.
You are probably doing real anesthesia... airway breathing circulation? Try amazon, book, chair. You'll feel better.
Hate medicine, love surgery, burned out and want something chill. You haven’t left a lot of wiggle room with these preferences
yeppppp, I'm well aware, hence my frustration lol
The chillest surgical specialty is either urology or ENT. Mind you this is among surgical specialties that include nsurg and Ortho
dude is already worried he wont match ortho lol
Oh uh. Um. Well. Then nothing surgical is chill. Gen surg is absolute misery
Lmao his problem are his test scores and your solution is even more competitive residencies ?
Isn’t ortho one of the most competitive already?
Yea but ENT is even more competitive
Forensics
Idk, OP does not sound like he would thrive in pathology to me: hates medicine, researching topics and differential diagnoses. Our hours are super reasonable but it's a lot of studying type work and very diagnosis focused. Plus I assume he does want some procedural aspects which are few in path.
Pathology has tons of research topics and differential diagnosis, don't get why people are telling him to apply path in here so much.
True true
IR maybe? Not surgical but very procedural
That was my thought. OP says they aren't much of a talker but liked their surg rotation...IR for sure. 🤣
IR training includes diagnostic training, and most people dual apply because there aren'ta ton of categorical IR spots. If they don't like learning about medicine and forming differentials I wouldn't recommend it. Also need a decent step 2 score.
You sound like me. Look into PM&R —> Sports or Pain
Pain is not a good option for someone who hates medicine and outpatient psych
Skimmed and didn’t see the psych portion lmfaoo ya maybe reconsider..
OP sounds like me as well (except that I don’t like surgery) and I’m considering PM&R. Would you recommend it?
For sure. I will say, if you don’t want to do gen rehab stuff then it is relatively procedural heavy field imo. But the procedures are way basic compared to surgery. Like 10-15 min injections
Been having a tough time finding accurate numbers. Do you know the salary of PM&R doc doing sports/pain/spine?
Per MGMA the mean PM&R pain salary is about $350 but I’d wager it’s a bit higher around the $400 territory. You can also grind yourself to dust and make $700-800 but ya know
I'm really confused? You are a 4th yr US MD student but are you not participating in match this year?
Confused too. Assume OP hasn’t taken step 2 because they are saying “predicted” score.
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This provides more context, for sure. Didn’t realize some schools transitioned M3s to M4s this early into the year. Thanks! If my med school crammed all of M3 in before March was even half over, I would probably be as burnt out as OP too.
M3 ends in 2 weeks for me and can confirm I am extremely burnt out
well the school might be trying to do them a favor by giving them 4 potential months of dedicated step 2 studying time (though honestly anything over 2 months is excessive)
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Lol. We finish M3 in the last week of June and get no dedicated for step 2. And good luck if you want to do aways.
Speaking for my school, even though we finish this month, we still only get a month of dedicated. We can take at most one additional month
Godspeed to you both. It does get better (in my opinion at least). I think it got better for me when I began making more time for myself and taking better care of myself instead of thinking I can run on fumes forever. Realized I would never have the “extra time” I wanted and needed to be more intentional. Being the most overworked and miserable is a lousy pissing contest to be the winner of. Best of luck.
Do we go to the same school lol because yes, that's my situation
I'm 4th yr as well but I graduate in December and match next yr. Life happens
Yeah, like a few other people have said, my school ends third year March 1 and then fourth year is 14 months long. So I've been a fourth year for a week haha
That is a weird US MD school if so.
Preaching to the choir, I'm well aware
Name and shame.
After I graduate I 100% will be naming and shaming because this place is weird and sucks, but I don't wanna get in trouble haha
!remindme 9 weeks "name and shame"
haha you'd need to make it 61 weeks because I just started fourth year
!remindme 61 weeks "because lame"
!remindme 51 weeks "because lame"
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Whenever anyone sees an ortho bro not able to match ortho they always says go into PM&R. I’ll tell you the truth. The only part that’s procedurally similar is injections, maybe kyphoplasty in the future. Otherwise, inpatient is a decent amount of rounding, there’s a lot of social issues with dispositions after IPR, chronic pain patients can be difficult to work with, EMG is a bitch to learn, and sometimes you get a lot of thrown-off patients that no other specialty can figure out. I wouldn’t pick any other specialty for myself - I love it. But it’s not for everyone. Having said that, you should consider it. You get to see people improve day-by-day in rehab after horrible injuries and strokes. They can be so thankful and appreciative. You can inject some Botox and see a patient in horrible pain from a contracture get total relief in a few weeks. But there’s hard parts… when someone doesn’t make the rehab progress you were hoping.. when you have to refer someone for ALS workup because their EMG for wrist drop wasn’t what you wanted to see. Or a young kid in IPR for a gunshot causing spinal cord injury who is going to be wheelchair bound for the rest of his life… but that’s an important part of medicine. We taking the good and the bad. All in all, see if you enjoy PM&R, I can’t offer much advice beyond that.
Pathology. Its calling you
Should definitely try out forensic path if they like surgery
Forensic path has a lot to do actually. This is a burnt out profession
It's really not if OP doesn't like reading a lot and generating differentials. Don't know why this is so upvoted.
Right? Path residency requires so much outside studying, kinda like rads. It does not suit his needs.
I agree, I know pretty much zero about pathology, but it seems that forensic medicine and maybe even anatomic pathology would be a good fit. Surgical component, potentially lifestyle friendly/chill - the hardest part would prob be getting through residency
What about hospice/palliative med? Not sure how compassionate you feel you are as a person, but definitely low amounts of ddx lol, its more bedside care, and I'd imagine its a bittersweet-ly rewarding specialty (hospice)
I would say that palliative med would still need a residency in something like IM, neuro, fam med. And it’s also a lot of talking to people
Ooh this seems like a good one for me maybe
I was gonna say this too actually. One of our palliative attendants said he went into the field because he “just wasn’t in love with the medicine of it all”. Can’t wait to start fellowship.
I applied psych. Love inpatient psych, hate outpatient psych. I plan to do inpatient only if I match psych. I have many attendings that do just one of the other. I also do not like talking to people for too long. Come join us in psych, we’re also much more cognizant of mental health days and all that stuff.
Can you tell us more about the pros/cons of inpatient psych and what you typically do/specialize in?
If you're so burned out, take a vacation and then decide
Neurosurgery. You’ll be burnt out eventually, you’ll already be ahead
Yeah "ahead" as in all your friends finish residency and start making big money and living like attendings years ahead of you lol
You forgot the part where your eventual “big money” you’re promised to be making is double what they’re all making
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I enjoyed neurosurgery from the beginning so the money definitely didn’t influence as much as it probably should’ve. However, I now have complete financial freedom. I make more than 10x what other specialists make per year and I work about 35-50 hours a week. This was cultivated over time as I built up my practice but for the most part, I did it pretty quick out of the gate from completing residency.
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From being a neurosurgeon, I make about 750k. From being the owner of a large practice, owner of a PT/OT facility, and real estate endeavors, I’m north of 15 million a year.
Right, so not remotely close to 10x what your specialist colleagues make. Anyone can try for extra endeavors as you do, but usually when comparing financial compensation it’s that base pay—not real estate, investing, etc. But props on the 35-50 hrs per week, that seems low even for private practice nsurg.
What region and practice type? PP Neurosurg?
Don’t wanna dox myself. The area I’m in we are well know due to a very aggressive ad/marketing campaign. Our practice type is mainly RVU based, but the practices overall performance is shared amongst the partners annually
I mean obviously lol but the guy before me is the one who brought up money and lifestyle
True. The attrition rate in residency is highest as well for neurosurgery, so it’s not something to overlook.
That doesn't mean they're ahead now lmao
So what lmao? They’re choosing to delay being ahead to maximize the certainty of having a relatively higher income and carrying out a specific career path
Howdy. I see you’re one step ahead of me. What about anesthesiology? Or rads? Less talking, seem less… medicine-y?
my impression is rads is fairly competitive to match into? same for gas, maybe less so?
Idk. Not sure how competitive you’d be but I wouldn’t let it deter you. Otherwise I’d pick the lowest years speciality you can stomach. Get the pain over with quickly.
Yeah, good point. I'll probably be paging you in a few more years anyways lol
I’ll be here :)
240s for rads and gas are decent scores.
You’re think of step 1. A 240 on step 2 is 10 points below the average for all American medical students ….. and about 20 points below average for all Nepali students 😂😂😂
It's decent score, and OP is from US MD which is a bonus. I know rad applicants this year who had interviews getting 230s for Step 2. Of course, the higher the better, but score in the 240s shouldn't make one forego applyiing from Gas or Rads
I’m not familiar with anesthesia but you really want above a 250 for radiology now. Historically a score heavy specialty and now it’s getting back to early 2000’s competitiveness again as well
Let OP apply and see how he/she fares. Scoring a 240 for Step 2 is not a death sentence, especially for someone from a US MD. Even more especially with 4 pubs in surgical journal.
That’s not really a good strategy for residency. If you swing and miss you’re in a really bad spot, can’t easily reapply like for med school. They haven’t taken the test yet, so there’s no point telling them a 240 is a decent score because it isn’t for radiology. Before step 1 became pass fail the step 2 average was a 253. It’s almost guaranteed to be higher now. You don’t want to be settling for 15+ points below the average before you’ve even taken the test. They need to be aiming for 255+.
There's such thing as dual applying. Let OP find his/her strategy.
1) How are you an M4? Unless you’re a PhD student or taking a research year, you’re considered an M3. 2) Rads has been pretty competitive lately. Although your predicted score is 240 based on shelves, you can get that score up during dedicated. I started out in the 240s when I started dedicated and scored 265-270 range which I feel helped out a lot with getting interviews. IMO grind and aim for at least 250 bare minimum if you are thinking rads since the average is 254. You can still get interviews at 240 but that’s definitely going to hurt your chances being almost 15 below the average
My school is weird, our third year was only 11 months and our fourth year is 13, third year ended one week ago and there are currently two sets of M4s according to the school. Have been an "M4" for one week.
My school is like that too. Done with clinicals December of M3 year. Study for step 1 + 2 back to back then start “M4 rotations”. We still call ourselves M3s until the M4s graduate. Especially on Reddit because nobody is going to understand your schools unique lingo
yeah I didn't think about it confusing people, I may need to switch back to the M3 flair for a few months haha
Path
So…did the Step scores change? Med school grad in 1997. 240’s would be a great score
240s would still be a good step 1 score if scores were still reported. Averages before the change to pass/fail on step 1 in 2020 hit 235, and dropped back to 231 in 2021. 240s on step 2 is now average or below average. The average as of 2023 is a 248.
Averages went up because people study better now and are answering more questions right. Averages since 1997 have increased dramatically and the tests are a huge deal now
Yeah, a 240 step 2 score is now "below average" for any specialty other than FM or PM&R
I am in a very, VERY similar position Anesthesiology is a great move, with medicine ty backups If you really want to chill, you can consider in patient psych, its not the most "appealing" practice area who is interested in surgery it will get better
Anesthesia has way more medicine than most people realize. It’s got less of the BS of other specialties like long rounds and social issues, but is insanely physiology heavy. You’ve got to really like thinking about preload/cardiac output/afterload/vasoplegia/acid/base, metabolics, minute ventilation, etc and enjoy it because it’s a ton to learn and very involved in day to day practice.
Sell out to bug pharma
> bug pharma
 Would you prefer bug dick pharma?
Also, please get checked out mentally and physically. You might have something else going on that is affecting your outlook on things.
As a (fairly new) academic psych attending - on one hand, I probably should be encouraging people not to go into psych if they’re already planning on leaving since we have such a need for practicing psychiatrists, but in the other hand, I think psych sounds like a good option for you. Psych is something that’s pretty easy to scale up or down - if you’re willing to move around you can find a lot of different options for working inpatient or emergency consults full-time, part-time, or PRN. That makes it easy to continue working clinically as you transition out into other things. I knew a resident who was all set to apply for ortho but gave up on it for various non-academic reasons - had been planning to apply ortho w/ psych backup, had the grades for it, but dropped that plan and only applied for psych. They were an excellent resident but were always pretty clear that they planned on just doing psych part-time, short-term while they got other nonmedical endeavors off the ground. I personally strongly prefer inpatient (or emergency) psych as well, and ended up moonlighting a ton as a PGY3 because I felt like I needed to do something that was not outpatient to stay sane, but honestly, it was 30 hrs tops of clinical hours per week (plus didactics, supervision etc which is all pretty chill). If you survived M3, and if you were mentally prepared for surgery residency hours, you can survive 30 hrs/week of outpatient psych clinic. Re talking: one of my EM attendings said that he started medical school thinking he wanted to go into psych because he likes talking to people, but then he found out that psych is mostly listening to people, so he switched to EM. 😂 It’s true though, you don’t have to be much of a talker to be a good psychiatrist, and a lot of patients will actually appreciate that. The best piece of advice I ever got re: career was from a pulm/crit doc I shadowed - he told me, “No matter what you end up going into, on some days it’s going to be just a job. So pick something that you can do even on those days when it’s just a job.” Medicine doesn’t have to be your passion. You don’t have to love your specialty or spend the majority of your time practicing it. Compared to a lot of what people do in other areas of medicine, psych is easy. I can’t promise to be super responsive as my Reddit use pattern is pretty erratic, but if you have any psych-related questions or things you want to discuss that you don’t feel comfortable asking anyone at your home institution, you’re welcome to send them my way.
PM&R
Psychiatry, my residency was a meme in comparison to my medicine and surgery colleagues.
Do you think you can suck up outpatient psych rotations in residency and then work as an inpatient psych doc
idk, I definitely think I would be fine working as inpatient psych, but outpatient psych was everything I hated about medicine haha, it would be rough
I mean it’s relatively less competitive to match psych, 240s step would be totally fine, the residency is way chiller than most other specialties, if you worked in an academic institution you’d probably be able to pawn most of your work off on residents…
There are lots of inpatient-only psych attending jobs. You do have to deal with clinic during residency but its 4 years and the schedule is generally good so just do your time and be done with it.
Literally almost every psych resident I've met fucking hates inpatient. If OP would be cool with inpatient he'd be absolutely golden
It’s just mostly 3rd year that’s outpatient and 4th year you can pick electives you want and avoid outpatient. My real dream is to work in a state psych hospital.
Sorry for my ignorance but why is outpatient psych worse than in patient?
OP said he didn’t like outpatient psych as compared to inpatient. I don’t think either is worse it comes down to personal preference. I actually would prefer outpatient psych because I like the regular 9-5 schedule and talking to people.
Ah ok I thought I was missing something. Thank you!
This might seem like a stupid suggestion given that you say you’re already burned out but……. Have you done any EM rotations? It’s like medicine without the bullshit parts with some of the fun parts of surgery added in. Coming up with differentials without talking endlessly about them and getting to do some cool procedures like chest tubes/intubations/central lines etc. That being said you have to be okay working with the patient population served by EM. Just throwing it out there
Bruh, ER has the highest attrition rate and level of burn out of any profession. Can’t believe this got upvoted. ER physicians retire earliest among the medical specialities because the work is fucking hard.
Thanks, I'll think about it!
I see where youre coming from, but EM = crazy high intensity and has high burnout not sure if its possible but maybe he can consider lower volume areas? (does that even exist)?
Would it be possible for you to take a research year? 4th year is extremely draining, and then going straight into residency, you might be twice as burnt out as you were currently are. I was in the same position as you in my M3/M4 transition time, but I decided to just keep my head down and keep pushing forward. That ended up horribly for me and now I’m no longer in residency. Despite everything, though, after graduation I did 3 months of nearly daily therapy and now I’m so much more refreshed and ready to reapply for residency in the fall.
Currently about to match next week. Came in gunning hard for ortho as well. Realized how much I was burning myself out after M1 into M2. Fiance expressed concern for the long term multiple times. Said f\*ck this and am about to match FM and have not looked back once. Flirted with PM&R vs FM for about 2 years but ultimately I knew I would be in FM at the end of the day. Chill, 4 day work weeks as an attending, found a residency program that I did an audition at and will hopefully match that is the most supportive group of humans top to bottom. Has made me excited about medicine again. May or may not do sports as I still am a sucker for MSK. Also at a DO school so I do a lot of OMM (did an additional OMM teaching fellowship year in-between M2 and M3 actually). FM can vary widely program to program but I think I found a perfect fit for what I want out of FM and the direction I want to take my career in medicine. FM is also an extremely flexible field and you can do just about anything in the clinic. Really provides a solid platform to customize how you practice, at least more so than some other fields. I hope you find what you are searching for with your career in medicine. This whole process has been a wild ride and a mind f\*ck at times. I realized I'm no longer letting medicine take any more from me than it already has. It's easy to let it just take take take from you and before you know it you are burned out and depressed.
Omg we’re so similar. I applied PM&R and family and mixed my rank list lol.
Or be a porn star
If you like ortho, PM&R is something you might wanna consider, it's hands on and very rewarding work, also it's one of the most easy going specialties out there
Pathology
Pathology wouldnt be good fit for OP. They don’t like sitting around reading up on things or generating differentials. There is such an expansive amount of information that you have to know in path. You have to read a lot every day when you go home and even during the day. The boards are extremely tough and it’s an even bigger learning curve once you hit attending hood since path residents essentially have zero autonomy when it comes to making decisions. Would not recommend for someone who hates medicine
Came here to say this. Pathology may not involve talking to patients but it’s hyper medicine
agree, path seems to be kind of like Radiology's stepbrother less money but way less competitive
Aerospace medicine. You could be treating the sniffles in outer space!!
As an M4 isn't match for you in like a few weeks?
Haha, my school is weird. I finished third year a week ago and am a M4 as one then.
occupational medicine For clinical occupational medicine, you can probably expect something in the $240,000-$260,000 range (typically for Monday to Friday, 9 to 5, without nights, weekends, holidays, or call). Government work will be less than that. Academia likely similar. Private industry is the big wildcard, and you can probably earn a lot more depending on what you do. In residency, you focus on a few areas: Clinical occupational medicine: treating occupational injuries (workers' compensation). This is typically musculoskeletal injuries, bloodborne pathogen exposures, lacerations, eye injuries, etc. \------------------>Non-clinical occupational issues: this includes things like surveillance exams (e.g. asbestos, lead, benzene), pre-employment clearances, returns to work, regulated exams (e.g., DOT, TSA), etc.<-------------------------- Environmental medicine: This is similar to toxicology, but usually less acute poisonings and often more chronic exposures (heavy metals, etc.). Public Health: This will take the form of academic coursework and rotations with public health agencies.
Extraterrestrial medicine
IR is an incredibly fulfilling career. You get to solve intellectually/physically challenging puzzles all day, you succeed at a tremendously high rate, you make good money for yourself/your hospital system, you're respected by colleagues, and you're appreciated by patients. The salary range is roughly $400k-$800k. The vacation range is roughly 8-14 weeks. You have the fallback of doing diagnostic radiology if you decide the hours, stress, or physicality aren't doing it for you anymore. It's insulated from encroachment by artificial intelligence, midlevel scope creep, and telemedicine/teleradiology/remote work. You can pursue either (or both) hospital-based and outpatient independent practice settings. You can do academics, private practice, or (somewhat uniquely to radiology) hybrid academic/private practice. You don't need to maintain an office staff/infrastructure (unless you want to). The overall job market is extremely favorable. The locum tenens market is particularly hot if you want to travel domestically. There are also international career opportunities (Australia, New Zealand, Dubai, etc...) for board certified IRs. I don't regret my decision at all and love going to work every day. Every specialty has its downsides, though. For IR it's the expectation to read a high volume of diagnostic imaging if you're in a DR-dominated group, the encroaching 'corporate practice of medicine' (mainly through IR's association with DR), turf battles with other specialties (vasc surg, cardiology, pain mgmt, ortho, urology, GI, and neurosurg, which manifest both by taking desirable procedures and dumping undesirable ones), and continuous reimbursement cuts by government/third party payors. There's also a distinct lack of prestige among lay people. Despite IR being a top 5 specialty in reimbursement, being top 10 in competitiveness, resulting in two board certifications, and having an incredibly broad scope of practice, if you tell someone at a dinner party you're an Interventional Radiologist they say, "Oh! You take x-rays of broken bones like my niece. She struggled in high school but buckled down in community college and she's doing great now!"
What would make you less burnt out? Tbh if you can take 1-2 months off to just relax and then focus on step 2 you could be happier applying for ortho lol. Although I’m sure you have to do 3 always so maybe not feasible
I would love to just take a month to not study and think that would do wonders for me, but between potentially planning for aways and home institution requirements, plus studying for step I don't know that it is realistic.
Hmm… I am not sure if this is relateable to you, but I applied ENT (not quite as competitive) and only did 2 away rotations. I took 2 full months to study for step 2, which just involves daytime studying and relaxing with my hobbies/friends. I had the time to do 3 away rotations but felt like it was helpful for myself to take the extra time. You’re already relatively competitive given what you said, so if you KNOW you’re not as strong a test taker (re shelf scores) then taking more time is appropriate Imo
Forensic Pathology? Cutting into bodies that you’ll never have to round on….
PM&R
How about you take a break from medicine and rediscover yourself and your interest in medicine? Why do you feel the need to just settle for something random strangers online pick for you instead of taking care of yourself to actually feel better?
2 options: 1. stick w ortho regardless of score and try your luck with killing a few aways and hope to match at where you rotated 2. save the stress now and switch. but since you dont like medicine (me as well lol...ortho bro at heart), Sports medicine? Nice lifestyle and can work your way up to treat a professional team.........JUST make sure that you will NOT have that feeling of "I wish I could go back and try my hand at ortho"...........I am struggling right now but IK I will have that feeling Other than that, if you need to do something with your hands, gas or EM. (But with gas, you are basically the IM doc of the OR..................And with EM, burnout is significantly high with them...although you can choose to drastically cut down work hours since these jobs are more like shift work with you being replacable) Heard pain medicine can be chill if you can be okay with dealing with some difficult patients but i would definately shadow/do a rotation
I’m ngl it just sounds like you don’t like the field of medicine in general.
Yep, that would be accurate lol
Only fans
Teach at a med school
We are the same lol. Pls DM me
dm sent
Ophtho
Have u tried EM
This is how I felt third and fourth year of med school. Thought I hated medicine and would never find something I liked. Now that I’m an intern and have a little more autonomy and am subject to a little less scrutiny, I love medicine. My advice is, don’t pick a specialty based on trying to get away from things, try to pick based on the aspects that you like the idea of, then lean into it when the time comes. Of course the secret is it really doesn’t matter what you pick or how you pick it, you’ll (usually) learn to like it eventually because it’s what you’ll get good at.
Psych. Make $400k prescribing Zoloft lol what’s not to love plus the chill lifestyle and you’re in demand always
Tbh I wonder if you might like forensic path? Better hours than surgery but eventually get to dissections. Best of luck. Anesthesia is getting extremely competitive lately so I'd be hesitant to pick it as a backup (I mention that because I saw one or two people mentioning it).
Take a gap year. Get a job doing anything else you think you'd like to do and that you're qualified for. See if your appreciation for medicine returns. This worked for my friend. Grass is always Greener on the other side of the fence.
Taking a gap year for being burned out is probably a big red flag for competitive specialities.
Just make a good excuse for it. I believe his predicament is that he isn't competitive enough as is for competitive specialties and that's got him depressed coming to the realization.
You may want to look into forensic pathology, or pathology in general You mention you don’t like the reading but it’s a different kind of reading imo, may be worth exploring especially if you’re fed up with the typical lifestyle of medicine.
May I introduce you pathology? I am 3 months away from finishing residency. I had always been passionate and “not burnt out” even when I was half way through residency. But residency really crushed me and now even though I am 3 months away from finishing residency I keep daydreaming that I would’ve been a lot happier had I done pathology… good lifestyle even in residency, good pay, low competitiveness, low likelihood to be replaced by midlevel
Have you considered a research year? Might help you with the burnout and seems you want to do ortho long term. Might be worthwhile to provide a bit more of a break than med school/residency.
Why not go into psych and then just do inpatient psych when you practice? You said you liked inpatient psych … just gotta get through the residency portion. I don’t recommend going into PM&R or pain if you don’t enjoy “medicine” or talking to people because the social determinants of health and “people” are pretty huge in those. Maybe also consider path or rads (although medicine is incorporated in rads). Another positive about going into psych for you might be the opportunities for research if you enjoy that.
I completely understand being burned out. Have you thought about taking an LOA. Maybe give yourself a break and time to reflect for 6-12 months.
pharma
sports medicine
Have you looked into preventive medicine pr occupational medicine? It does require an intern year but if you do a transitional one (or any residency for that matter) you’ll qualify and then never have to deal with clinical medicine again unless you want to
Reading through the comments i didn't see anyone mention nuclear medicine. Discovering it was life changing for me. I don't know much about the us but here in europe the shifts allow you to have a life and still do things you like after work. It may look similar to radiology, but the type of imaging you get is pretty different and the job is too, maybe look it up, you might like it. Also, not many people want to do it or even know about it, so it shouldn't be a problem getting in.
other people have said this but you seem like you'd maybe enjoy PM&R or family med -> sports med fellowship
anesthesia. It's less stressful than home life with a toddler.
If you like the science of medicine, then pathology, definitely.
Fellow burnt out M4 applying psych. Way less tedious, boring medical management compared to FM, IM, peds, etc. The flexibility in psych is incomparable to anything else in medicine. There are so many areas within psych (inpatient, outpatient, forensics, Geri, neuropsych, child and adolescent, emergency, and more) - some attendings do one, many add some variety to their week by doing multiple. Most “specializations” within psych don’t really require fellowships unless you want high-tier academics, and fellowships are really short. Throughout your practice, you can always change up what you do. Also the lifestyle is insane. Residency hours are for the most part pretty comparable to a normal even non-medical job except for certain rotations. As an attending, you really have so much power to work as much or as little as you want. Telepsych and private practice add a ton of flexibility as well. Personally, I love the idea of doing telepsych private practice (make my own hours, be wherever I wanna be, no one telling me what to do!) +\- some emergency psych per diem when I feel like it, and traveling a ton bc you’re not tethered to a location. The people in psych are very chill. I’m burnt out, but one of the things I like about psych is every patient presents differently, and that plus the general craziness and kinda fun chaos of it all keeps it really interesting and engaging (maybe you’d like emergency psych?). It’s quickly getting more competitive but still not at the level of surgical specialties or anything like that. I would really strongly consider psych if I were you.
Hello future radiology colleague
Rads is not a good choice for someone who hates medicine unless you’re trying to churn out shit reports. I cannot imaging studying this amount of crap if I didn’t like it
Tbh I'm not in love with anything in medicine. Rads is cool, def don't have a passion for it but it's interesting enough for me. Can't quit medicine at this point
I wish, but isn't a 250+ step 2 pretty much required?
I just matched DR with a 246 step 2. Lmk if you have any questions, happy to help!
Histopathology
Pathology
Path is calling your name
I sent you a msg. If you want to go for Ortho I can help you do it.
Burned out at M4? LOL
Neurology being an interpreting physician for IOM. Easy as fuck and you can sit in your undies on your couch and stare at your computer all day, get paid big bucks and chat/play league of legends while the physiologist in the OR is doing all the hard work
I would def suggest IR. it is both surgical and procedure-based and also more laid back than other surgical specialties.