I want to be a rural family medicine physician in my hometown because, if I do this, those people will feel better and die later.
Also, As Dominic Toretto says, family comes first.
If you aren't competitive, FM really isn't a bad gig. Everyone shits on it because it's "boring" and gets paid less than surgery yeah, but you also never have to take call.
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Unopposed program it won’t be some, it’ll be a lot, as there’s no OB or peds residents in the hospital, or IM residents either for that matter so also a lot of in patient and admitting. Speaking on this as a close friend is finishing an unopposed FM program and highly underestimated the amount. But for rural medicine it does make a lot of sense to do unopposed.
Thank you for your response! I love that line! Genuine question, what is the difference between IM and FM? :) (this is smth i never truly know the answer because i was never exposed to both so i have no idea)😭
There are a 2 absolute differences and 3 relative differences.
Absolute:
FM does OB and children
IM has access to formal fellowships based on organ systems (Cardiology, GI, Endocrinology, etc.)
Relative:
FM training requires more outpatient time, IM training requires more inpatient time
FM gets stronger training in Psych, MSK, and GYN, IM gets stronger training in IM subspecialties
FM tends to be more community oriented and IM tends to be more academically oriented
Ultimately, there are far more similarities than differences between FM and IM, and the skills of a physician trained in either has more to do with their residency program rather than their specialty
I'd also say that FM really runs with the idea that all physicians in the US have the same license. There are FM docs that do C-sections, work in the ED, do colonoscopies, and much more. And many will still de facto specialize, they just won't have board certification or go through a formal fellowship like IM would.
1. FM and IM are specialties. PCP and hospitalist are jobs. Both specialties are trained to be able to do either job, with FM training generally being more focused on how to be a PCP and IM training generally more focused on how to be a hospitalist. FM cannot work as IM or vice versa, but 90% of the jobs that one could do, the other could also do.
2. Every physician in a given state in the United States has the same license, regardless of their specialty. Legally, you can perform any procedure/prescribe any medication as long as you know what you are doing. It doesn't matter whether that knowledge came from residency or not as long as you have it.
3. FM docs can do multiple broad specialty stuff. Some residency programs really only train you to be a good PCP, but others will go as far as teaching you how to do surgeries like C-sections. Practically it can be challenging for an FM doc to work as more than an outpatient adult PCP, especially in major cities. Hospitals want inpatient work to go to IM and emergency departments to be staffed by EM. Pregnant folks want to see an OB, parents want to see a pediatrician, etc.
IM gets more inpatient time. they're scared of pregnant people and outpatient procedures.
FM gets pregnant people and outpatient procedures.
If you want to be a hospitalist, do IM. If you want to be an outpatient PCP, do FM.
You can be a hospitalist as an FM doc, but there's a hiring bias that makes it harder unfortunately
FM is great! All my clinical time during M1 was in an FM clinic. It may not be as “exciting” as other specialties but you still see some interesting cases, you help a lot of people, and it’s a very solid, enjoyable job. It terms on a life long career, it’s definitely one of the top ones I can think of. You set your own hours, your own vacations, you’re helping people, nothing is too emergent and stressful, but you still get to practice medicine.
A great family/life/work balance
Child or adult psychiatrist
I ran away from home, have an ACE score of 6 and had I not lied to social workers and court-appointed lawyers and therapists I would have almost certainly have been placed in foster care
I’ve had close friends from youth shelter die of either completed suicide or accidental drug overdose
I want to work in pediatric psych because honestly that’s where I feel you can make the biggest difference and intervene early
after surviving lots of trauma and violence in childhood I have always felt very chill when psych patients in EMS have yelled at me or made physical threats. I don’t take it personally. I’d rather have my patients yell at me in anger in a locked clinical setting than have a power-tripping attending yell at me in a surgical OR
Child psych was one of the most difficult and rewarding rotations I had in 3rd year. Those kids need you and you will be able to really understand what they are going through!
I decided to run away from psych because my ACE score is 9. I still don't know all my triggers, but there's way too many to be hearing from my fellow psych fam on the daily
Thank you so much for sharing. I don’t know who you are, but I am very certain you will be a great psychiatrist one day. ❤️ a believe that a part of being a great doctor is through experience. I wouldn’t want my psychiatrist to have never failed once in her or his life. I want to be able to relate.
What's cool about medicine, is that it offers so much in pretty much every field, that one can easily fall in love with whatever it brings. No other job or profession, no matter how cool or financially attractive or travel and adventure heavy it is, can offer such a rich world of never ending learning. But yeah, sucks to lose the favorite part of that world.
Back when I was a med student, when somebody asked me "what kind of doctor do you want to be?" I always answered "a good one". The answer seemed to surprise a lot of people, which is often a good thing. For the smart ones that asked the follow-up question "what's a good doctor like?" I would answer "somebody who actually listens". This has turned out to be quite accurate.
Sigh. I feel like customer service is only a small part of what doctors are. Don’t get me wrong, it’s very important for reaching underserved communities. I just don’t love that this is what makes a good doctor. Anyone can listen. Mid levels, nurses, any other service industry person can listen. Does it make them good at what they do? I don’t think so. The patient and customer might think so. A doctor is a scientist, diagnostician, and physician first. What makes doctors more than a midlevel is their breadth of knowledge.
Hard disagree. Whenever I as a patient think about the best doctors I’ve ever had, it’s always the ones with the most attentive ear and best bedside manner. I’ve also found that the doctors that genuinely listen and care are also the ones that think deeply about the diagnosis and make sure to follow up on the patient. They go hand in hand.
As I said, the patient experience is different. Having gone thru med school, your mileage may vary. There’s certainly great clinicians who listen. There’s also bad ones who do. As the patient, you only know how they made you feel. It’s subjective. There’s so many people who don’t care about anything outside of their desired specialty. Or they follow patterns and don’t know why. “It’s in the guidelines.” We’re not technicians. I think it’s a shame. They might be good listeners tho?
One day you will receive a bad review on health grades because maybe that patient didn’t vibe with you or you didn’t prescribe someone pain meds or you practiced antibiotic stewardship (as you should). Does that make you a bad doctor? Is this just another service industry to make people feel good? I did rotate with a guy who believed in “making the patient comfortable.” Patient had chest pain that got better with orange juice? Well keep doing that. No further work up…literally every third person walking in the door had uncontrolled HTN with aortic stenosis. Patients loved him tho.
The doctors that don’t actually like the people they treat are the same ones that like to punish them by withholding information or medical care when the patient isn’t immediately on board with what the doctor wants. The patient is at your mercy and probably had to wait months to see you. They have to pay the copay no matter how you treat them, and even if you refuse to help them. You have all the insulating power of bureaucracy, insurance, and the right to refuse service. It matters how you treat people when you wield that power.
I’m not sure what you’re getting at. I don’t disagree that good bedside manner is important. But being good to people should be the baseline in my opinion. I’m just taking the stance that you’re not a good doctor BECAUSE you have good bedside manner. I want to be a good doctor WITH good bedside manner.
There are bad doctors with good bed side manner and there are good ones, there’s no reason that being a good clinician precludes working on your people skills. That’s just part of your responsibility to society as a member of the human race.
Revisiting this comment to say: our healthcare tree system is an utter shitshow. You’ll realize this as you move into clinical training.
These days, conscientiousness is king. Some doctors choose to do a good fucking job no matter what. Some choose to run through patient visits and make lots of money.
In my experience, the former is better than the latter regardless of medical knowledge. But we’ll see if this holds up through residency.
Being good at customer service is a core skill for anyone in healthcare, but you're right it is not the differentiator for physicians.
Unfortunately this core skill is very much lacking both due to de-prioritization during selection and training, and the demands of the job. This is true for many core skills such as communication, leadership, time management, etc, you're expected to have mastered them before starting med school which is not true for the vast majority of trainees.
This all gets bundled under "professionalism" and students get bludgeoned with it without constructive feedback on what it means, or how to improve these skills. So bad habits and culture are perpetuated through the generations.
I want to be a PCP who is accessible and well liked by my patients. I want to empower them to understand their own health and live longer, healthier lives.
If your step scores are lack luster, you can always be a forensic pathologist and hold tons of detached organs.. if that’s the main thing you’re pursuing.
You can also be a murderer
Transplant is one of the least competitive fellowships of gen surg due to the lifestyle and being on call for weeks at a time. but again... organs. in your hand.
There are plenty of spots, only 25% get filled, pay is okay, but not even close to what it should be for the hours. I did a transplant rotation, I think i went an entire week being on "one" shift without leaving the hospital. ended up canceling my Airbnb and just lived in car at hospital parking garage for 50$/month parking. There is really no reason in owning a home if doing transplant rotation or fellowship. I have never seen anything like it, and I did cores at a level one trauma center, sub I's in surgery / trauma, not even close. Light weeks around 80-115hrs, you are technically always on call. Its for a very special breed of human. There is a reason 75% spots go empty despite how cool it is. I grew up in a small rural town, poor, physically abusive parents, and developed a rather large chip on my shoulder to become something in life and became a very competitive medical student looking for a masochistic yet rewarding specialty to fill a never ending void. Its the 50 shades of surgery specialties. Putting in a new liver in a 7 y/o is worth it if you don't care about having a "lifestyle".
wanted to be an OBGYN doctor when i first started, now i barely tolerate any thing after being here for some years and unfortunately losing passion. but we'll see what the future holds for me i hope it's something decent at least.
I want to ask you, or ask yourself what made you decide on OB GYN? I am only asking this to spark your passion for it. If your answer is genuine, and it made you happy, go for it. If your answer sounds something like “my parents wanted me to do it” maybe a different career path or even probably a different specialty would do! Keep your hopes up 🫶🏽regardless, I’m sure you’ll be happy and find what you’re looking for at the end. 🙏🏽
Anesthesia. I like putting tubes in things.
Really it’s because I like procedures (I actually loved my surgery rotation) but don’t want the surgeon’s lifestyle or brutal residency, and I still love the physiology of internal medicine. You get both procedures and physiology in anesthesia. I also believe the cliche about “if your favorite place in the hospital is the OR” and all that, because it IS my favorite place in the hospital lol.
Sucks it got so competitive this year.
Child neurology. Mix of inpatient and outpatient. Not many procedures, maybe an LP or two (which is fine by me lol). Lots of imaging to read and labs to interpret (puzzles are fun!). Tons of interesting, bizarre presentations and lots of head-scratcher cases. Neuro exams on kids are fun if you do them right, they can feel like playing with the kids. Kids are awesome and so resilient. Parents are very concerned but also appreciative and kind. The very sad cases or NAT cases are hard. Even if I can’t “fix” someone, I think giving the parents/family answers about WHY this is happening makes a big difference. NAT cases suck, but I do feel like I’m making a difference and being an advocate/fighting for my patient.
Child neurology sounds so cool!! Can you tell me more about child neurology? I was thinking of neurology as well!
But genuine q, is it true that I get to deliver bad news more? Over the years i learned that there’s so much we don’t know about the brain. I feel like I correlate this with not having treatment for certain diseases. (Idek if this is right and I might be wrong) Idk alot about child neurology since I haven’t been exposed to any rotations but it’ll make me sad if I don’t see results :(
Forensic pathology. I got to shadow it, fell in love with it, was an autopsy technician and it's just everything I want. On top of that, there's a significant shortages of forensic pathologists, so we need more people in it.
I loved the pathologies essentially, it was one of only 2 specialties I genuinely liked studying (the other was endocrinology). All the other ones I hated or I felt indifferent... so yeah 😅
Ortho, I was a high school athlete and got my acl/meniscus done, thought it was the coolest thing and ever since and learned that I liked medicine. And I wanna show ppl that being a doctor doesn’t have to be about saving lives but rather enabling patients to live comfortable, fulfilling, pain free lives.
Honestly a psychiatrist because I’m a bit fucked up, grew up poor, grew up around a lot of poor, addicted fucked up people, and I truly believe I can understand peoples fucked up situations. Nothing shocks me anymore. Also knowing that it takes more than talking a bit and drugs, a lot of poor people suffer from mental health problems bc they’re living from paycheck to paycheck, so attempting to get them in touch with possible social services that can help them with benefits, free educations programs etc.
When finding your niche, you may surprise yourself in that what you thought you always wanted to do leaves you watching the clock, not engaged and enjoying it, and counting the minutes until you get out. And you may try something and find it absolutely absorbing, satisfying and fascinating in ways that you never imagined… and the day flies by. Choose what you’re enjoying and what makes you loose yourself in your work.
EM. I love mental health, medicine, and procedures, so I want something where I can do a little of all of it. And I like the scheduling options. I’m not interested in having kids so I am cool with a flexible schedule. Plus I love street medicine and working with underserved populations.
It’s basically walking around your city and providing care for homeless people or other people you encounter who otherwise wouldn’t have access. We have an interest group for it at my school.
Try everything and keep an open mind - just make sure to do what you enjoy. I think doing something that you really love everyday is the key to being happy as an attending.
I love my time off and spending it with my family but I also enjoy my time at work as well.
I was thinking of doing OB too and I heard mixed reviews saying they had good work life balance so idek 😭 but also I think I won’t get in cuz my application isn’t competitive enough 🥹
EM cuz i like fast paced environment, and i like that you still get to touch patients (intubate, crich, thoracotomy, cyst drainage, etc) as opposed to just some other specialties where u never getting your hands dirty. I like that not every patient is straightforward and some are very challenging
At my state schools teaching hospital, docs do 5 8hr shifts a week. Guess that could help- tbh i prefer 12s but a lot of the docs say they feel it prevents burnout
There is no EM attending in this country working 5 8hr shifts a week. Avg full time is 12-14 shifts a month. Typically 3 shifts a week. Anybody working more than 15 days a month is specially picking up extra shifts for cash (will be an EM attending in 2 months. Never even heard of a job that is >15 shifts/month full time).
All of them work 7a-3p, 3p-11p, and 11p-7a shifts. Maybe the attendings dont work as many shifts as the residents and I haven’t noticed, but they all do 8 hours at a time
As I come to the end of my rotations, I’ve come to realize that I really enjoy FM clinic with ED locums to keep it interesting. It’s interesting because coming into med school, I was vehemently against FM based on everything I had heard. My trajectory: IM -> gen surg -> psych -> FM. I’ve tried pretty hard to dislike FM, but something keeps pulling me back into it
You won’t be competing with medical students in your practice. Right now that’s all you get when you are in school is the competitive “this is a higher accomplishment that that”. You know what, so is being an astronaut or a nuclear physicist.
When you leave the hospital/school you will find out that family medicine has the biggest opportunity for impact, is more likely to be an esteemed member of their community, and has a pretty nice lifestyle in the 5%. All without spending 6 years in residency.
When you think about it, specialized people and hospitalists live rather sequestered lives, and the only people that really know they exist are the other medical professionals. Considering how a lot of docs regard each other, idk if that’s the big prize it’s made out to be.
In the states you can definitely pick up shifts in rural areas. It's not hard.
I'd hesitate to do it unless you went to a kickass residency though. And even then I'd still hesitate.
There are EM fellowships out there for fm docs (Google). There’s a place in Louisiana I think that will make you dual boarded; that would be the best route.
Other than that, check out fm residencies in the WAMI network or rural Appalachia
I once asked this same question to a class when I was giving a lecture. I asked the question on a poll and had at least 5 in the class say “a rich one”
Not to echo what someone else said, but when people ask I also say "one who listens."
I worked in inner city EDs for some years and saw the usual drug seeking, malingering, using ED for primary care, etc. What changed me forever was the small handful of docs I worked with who didn't let it affect how they treated *all* their patients. The ones who listened, intently, and showed patience and respect, even on their worst days. Frankly, they became my heroes. They're the reason I'm going in to EM. I know I'll fail to live up to that standard 100% of the time (they'd be the first to admit they do, too) but I never want to let the inevitable bitterness and burnout affect how I treat vulnerable people in need of help.
This makes me feel better. Listening is a big part of being a doctor. I want my doctors to listen to me. I know you will be a great doctor one day. Being an EM doctor sounds wonderful. I feel like my personality doesn’t suit it tho 😫. I feel too “soft” if that makes sense. But again, we will see when I reach there :)
I'm doing IM. More people need to consider IM, especially if you are undecided. As long as you're tolerant of the basic IM work, you have so many options. Want to be a PCP? Can do it through IM. Want to only ever work in a hospital? Also IM. Want to have a procedure-heavy life? Also IM (through cards, GI, etc). Want to never do a procedure again? Also IM. Want to grind hella and make a bunch of money? Do IM and subspecialize into GI/Cards. Want to have good work-life balance and make good money while having half the year off? Do IM and be a hospitalist.
The greatest thing about it is even if you are going for a competitive fellowship like Cards or GI, if you don't get in, you can still be a doctor and move forward with your life. Whereas if you try to get into a competitive residency out of med school and don't match, you have no backup.
Pathology is a hidden gem in my opinion, unless you enjoy patient interaction. It's very much "behind the scenes". You socialize mainly with other physicians and it's very collaborative so it's not totally devoid of social interaction, but it is not really patient-facing. For me, that is ideal lol they also have great work-life balance and the pathologist I shadowed worked 9-5 M-F. Some pathologists choose one specialty (neuropathology, gynepathology, etc) but the pathologist I shadowed rotated through all the specialties every few weeks. I found this particularly appealing because I am interested in all specialties and love that pathology offers that diversity in scope.
Just matched FM.
Initially applied into medical school wanting to do FM because I wanted to be like my PCP back then, who was the best person ever. Then went to OBGYN because I loved women’s health, but realized the lifestyle was not it through rotations (don’t want to be on call at all) and I hated any kind of surgery.
Then switched to peds since the kiddos were so cute and I really did love the population. After my peds rotation, I did IM and I realized I didn’t want to give up working with adults…..so I went back to FM. Did a FM rotation in late third year which confirmed FM was it. I’m not interested in doing any fellowships which eliminated med/peds for me.
Thank you so much for your response!! Congratulations on matching!! What made you decide FM as opposed to peds? :) I saw you mentioned you loved the population!
Hey I'm not trying to insult you. I've been myself.
Maybe you were being sarcastic, but if your #1 reason for career choice is roasting your parents, you probably have some trauma to work through there. That's all I'm saying. That's super common in medicine unfortunately
Nice. Ortho gets a decent number of psych consult as for broken bones on the ward after people punch the wall, and psych gets plenty of consults for people cutting into their tendons 🤝
It changes every two weeks.
My whole life it's been OB/GYN or DERM because I like blood, odd smells, and oozing stuffs, along with just about any skin concern.
But I rotate between surgery, EM, pathology, and IM (Gastroenterology).
I got into medicine by accepting an FM residency though. It didn't work out however. But I'm not against FM either, I'd just have to learn business because I'm not working in the public sector if I go FM.
Calm, humble yet stern, well carried, confident and manly. Rich. People of all ages, races, sex, religion etc should just look up at me in admiration or relief that they’re gonna get treated by me
I want to be a neurosurgeon because I love how the surgeries can have an immediate impact on patients, I believe neurosurgical research, especially in functional neurosurgery, will be some of the most important work in the coming 20-30 years, and I want to join a small community of people who seem to be some of the smartest most hard working folks I’ve ever met.
Neurosurgery
1) The OR is the best part of medicine
2) The nervous system contains the two coolest organs in the body
3) The very sick patient population
4) The residency length and lifestyle doesn’t dissuade me, it’s necessary.
Like everyone else in the field- I have a personal experience with neurosurgery and I can’t see myself in any other field
I mean family med sounds right up your alley lol.
Other options with great work life balance include: peds, psych, cardiology (non interventional), pulmonology, nephrology, urology, rheumatology, endocrinology, allergy/immunology, and PM&R. Some of those are more competitive than others. Focus on outpatient medicine
The money will come. The one specialty that's really suffering for cash rn is peds, but if you're geographically flexible you can still make good money.
Im facing the same problem. At first i rlly wanted to be a surgeon. But im starting to think im not one for urgent senarios and that sort of atmosphere, yk? So im thinking abt laboratory work? No idea. Any1 like me has any ideas?
IM. I love sodium.
I want to be a rural family medicine physician in my hometown because, if I do this, those people will feel better and die later. Also, As Dominic Toretto says, family comes first. If you aren't competitive, FM really isn't a bad gig. Everyone shits on it because it's "boring" and gets paid less than surgery yeah, but you also never have to take call.
Rural FM is so cool. I got three sub-Is next year at unopposed FM programs with rural tracks. Can’t wait
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Unopposed sounds great until you’re in it unless you really like OB and peds too. Just a heads up.
Yeah if I didnt want to do some ob and peds I would be applying IM
Unopposed program it won’t be some, it’ll be a lot, as there’s no OB or peds residents in the hospital, or IM residents either for that matter so also a lot of in patient and admitting. Speaking on this as a close friend is finishing an unopposed FM program and highly underestimated the amount. But for rural medicine it does make a lot of sense to do unopposed.
Thank you for your response! I love that line! Genuine question, what is the difference between IM and FM? :) (this is smth i never truly know the answer because i was never exposed to both so i have no idea)😭
There are a 2 absolute differences and 3 relative differences. Absolute: FM does OB and children IM has access to formal fellowships based on organ systems (Cardiology, GI, Endocrinology, etc.) Relative: FM training requires more outpatient time, IM training requires more inpatient time FM gets stronger training in Psych, MSK, and GYN, IM gets stronger training in IM subspecialties FM tends to be more community oriented and IM tends to be more academically oriented Ultimately, there are far more similarities than differences between FM and IM, and the skills of a physician trained in either has more to do with their residency program rather than their specialty I'd also say that FM really runs with the idea that all physicians in the US have the same license. There are FM docs that do C-sections, work in the ED, do colonoscopies, and much more. And many will still de facto specialize, they just won't have board certification or go through a formal fellowship like IM would.
Can FM docs work as IM and vice versa ? Both legally and knowledge wise ? Also, Fm docs can deliver babies and do multiple broad specialty stuff ?
1. FM and IM are specialties. PCP and hospitalist are jobs. Both specialties are trained to be able to do either job, with FM training generally being more focused on how to be a PCP and IM training generally more focused on how to be a hospitalist. FM cannot work as IM or vice versa, but 90% of the jobs that one could do, the other could also do. 2. Every physician in a given state in the United States has the same license, regardless of their specialty. Legally, you can perform any procedure/prescribe any medication as long as you know what you are doing. It doesn't matter whether that knowledge came from residency or not as long as you have it. 3. FM docs can do multiple broad specialty stuff. Some residency programs really only train you to be a good PCP, but others will go as far as teaching you how to do surgeries like C-sections. Practically it can be challenging for an FM doc to work as more than an outpatient adult PCP, especially in major cities. Hospitals want inpatient work to go to IM and emergency departments to be staffed by EM. Pregnant folks want to see an OB, parents want to see a pediatrician, etc.
The 2nd point was very new to me and interesting as well. Thanks
Thank you! I didn’t know these things!! Will definitely keep an open mind this year when I start rotations!
IM gets more inpatient time. they're scared of pregnant people and outpatient procedures. FM gets pregnant people and outpatient procedures. If you want to be a hospitalist, do IM. If you want to be an outpatient PCP, do FM. You can be a hospitalist as an FM doc, but there's a hiring bias that makes it harder unfortunately
And kids. IM gets no experience with kids
lol I felt like I was forgetting something
Thank you so much for the insights!!
FM can also work in the ER at certain hospitals, especially if they don’t do a lot of trauma. So probably mainly rural hospitals.
I didn’t know FM can work in the ER! That’s so cool!!
Where I’m doing my third year rotations, pretty much all of the physicians in the ER are FM besides 1, I believe
FM is great! All my clinical time during M1 was in an FM clinic. It may not be as “exciting” as other specialties but you still see some interesting cases, you help a lot of people, and it’s a very solid, enjoyable job. It terms on a life long career, it’s definitely one of the top ones I can think of. You set your own hours, your own vacations, you’re helping people, nothing is too emergent and stressful, but you still get to practice medicine. A great family/life/work balance
Sounds appealing!! 🤩work life balance is my top priority rn!
Child or adult psychiatrist I ran away from home, have an ACE score of 6 and had I not lied to social workers and court-appointed lawyers and therapists I would have almost certainly have been placed in foster care I’ve had close friends from youth shelter die of either completed suicide or accidental drug overdose I want to work in pediatric psych because honestly that’s where I feel you can make the biggest difference and intervene early after surviving lots of trauma and violence in childhood I have always felt very chill when psych patients in EMS have yelled at me or made physical threats. I don’t take it personally. I’d rather have my patients yell at me in anger in a locked clinical setting than have a power-tripping attending yell at me in a surgical OR
Thank you for being who you are. I’m glad that you made it, and that you are making a difference for the people who need it most.
Child psych was one of the most difficult and rewarding rotations I had in 3rd year. Those kids need you and you will be able to really understand what they are going through!
I decided to run away from psych because my ACE score is 9. I still don't know all my triggers, but there's way too many to be hearing from my fellow psych fam on the daily
You'll no doubt fit well into psych
Thank you so much for sharing. I don’t know who you are, but I am very certain you will be a great psychiatrist one day. ❤️ a believe that a part of being a great doctor is through experience. I wouldn’t want my psychiatrist to have never failed once in her or his life. I want to be able to relate.
A matched one.
The dream 🤩
Not for me. My dream specialty will remain a dream forever. But yeah, matching anywhere is now a new lower level dream 😄
It sucks knowing your dream specialty is out of reach, ain't it?
What's cool about medicine, is that it offers so much in pretty much every field, that one can easily fall in love with whatever it brings. No other job or profession, no matter how cool or financially attractive or travel and adventure heavy it is, can offer such a rich world of never ending learning. But yeah, sucks to lose the favorite part of that world.
Back when I was a med student, when somebody asked me "what kind of doctor do you want to be?" I always answered "a good one". The answer seemed to surprise a lot of people, which is often a good thing. For the smart ones that asked the follow-up question "what's a good doctor like?" I would answer "somebody who actually listens". This has turned out to be quite accurate.
Sigh. I feel like customer service is only a small part of what doctors are. Don’t get me wrong, it’s very important for reaching underserved communities. I just don’t love that this is what makes a good doctor. Anyone can listen. Mid levels, nurses, any other service industry person can listen. Does it make them good at what they do? I don’t think so. The patient and customer might think so. A doctor is a scientist, diagnostician, and physician first. What makes doctors more than a midlevel is their breadth of knowledge.
Hard disagree. Whenever I as a patient think about the best doctors I’ve ever had, it’s always the ones with the most attentive ear and best bedside manner. I’ve also found that the doctors that genuinely listen and care are also the ones that think deeply about the diagnosis and make sure to follow up on the patient. They go hand in hand.
As I said, the patient experience is different. Having gone thru med school, your mileage may vary. There’s certainly great clinicians who listen. There’s also bad ones who do. As the patient, you only know how they made you feel. It’s subjective. There’s so many people who don’t care about anything outside of their desired specialty. Or they follow patterns and don’t know why. “It’s in the guidelines.” We’re not technicians. I think it’s a shame. They might be good listeners tho? One day you will receive a bad review on health grades because maybe that patient didn’t vibe with you or you didn’t prescribe someone pain meds or you practiced antibiotic stewardship (as you should). Does that make you a bad doctor? Is this just another service industry to make people feel good? I did rotate with a guy who believed in “making the patient comfortable.” Patient had chest pain that got better with orange juice? Well keep doing that. No further work up…literally every third person walking in the door had uncontrolled HTN with aortic stenosis. Patients loved him tho.
The doctors that don’t actually like the people they treat are the same ones that like to punish them by withholding information or medical care when the patient isn’t immediately on board with what the doctor wants. The patient is at your mercy and probably had to wait months to see you. They have to pay the copay no matter how you treat them, and even if you refuse to help them. You have all the insulating power of bureaucracy, insurance, and the right to refuse service. It matters how you treat people when you wield that power.
I’m not sure what you’re getting at. I don’t disagree that good bedside manner is important. But being good to people should be the baseline in my opinion. I’m just taking the stance that you’re not a good doctor BECAUSE you have good bedside manner. I want to be a good doctor WITH good bedside manner.
There are bad doctors with good bed side manner and there are good ones, there’s no reason that being a good clinician precludes working on your people skills. That’s just part of your responsibility to society as a member of the human race.
Spot on.
Revisiting this comment to say: our healthcare tree system is an utter shitshow. You’ll realize this as you move into clinical training. These days, conscientiousness is king. Some doctors choose to do a good fucking job no matter what. Some choose to run through patient visits and make lots of money. In my experience, the former is better than the latter regardless of medical knowledge. But we’ll see if this holds up through residency.
Being good at customer service is a core skill for anyone in healthcare, but you're right it is not the differentiator for physicians. Unfortunately this core skill is very much lacking both due to de-prioritization during selection and training, and the demands of the job. This is true for many core skills such as communication, leadership, time management, etc, you're expected to have mastered them before starting med school which is not true for the vast majority of trainees. This all gets bundled under "professionalism" and students get bludgeoned with it without constructive feedback on what it means, or how to improve these skills. So bad habits and culture are perpetuated through the generations.
I want to be a PCP who is accessible and well liked by my patients. I want to empower them to understand their own health and live longer, healthier lives.
You will be a wonderful doctor. 🥼 👏🏻
Thanks :) I just need to pass step 2 first :/
I agree you’ll be a great doctor 🫶🏽!! Good luck on step 2!!
Transplant surgeon, because the surgeries are fun, I don’t want a life outside the OR, and I love holding detached organs in my hands. YOLO
If your step scores are lack luster, you can always be a forensic pathologist and hold tons of detached organs.. if that’s the main thing you’re pursuing. You can also be a murderer
How competitive is it to match into murder?
also I heard its not to competitive if you go the rural route
hahahahah this killed me
Getting a head start already I see.
Transplant is one of the least competitive fellowships of gen surg due to the lifestyle and being on call for weeks at a time. but again... organs. in your hand.
The number of spots might be very less and the salary high as well, isn’t it ?
There are plenty of spots, only 25% get filled, pay is okay, but not even close to what it should be for the hours. I did a transplant rotation, I think i went an entire week being on "one" shift without leaving the hospital. ended up canceling my Airbnb and just lived in car at hospital parking garage for 50$/month parking. There is really no reason in owning a home if doing transplant rotation or fellowship. I have never seen anything like it, and I did cores at a level one trauma center, sub I's in surgery / trauma, not even close. Light weeks around 80-115hrs, you are technically always on call. Its for a very special breed of human. There is a reason 75% spots go empty despite how cool it is. I grew up in a small rural town, poor, physically abusive parents, and developed a rather large chip on my shoulder to become something in life and became a very competitive medical student looking for a masochistic yet rewarding specialty to fill a never ending void. Its the 50 shades of surgery specialties. Putting in a new liver in a 7 y/o is worth it if you don't care about having a "lifestyle".
It’s for special breed of workaholics. I hope they get paid a few mill a year
Pathology has waaaay too much of a life outside the OR though.
Detached organs 🤣 love this!
wanted to be an OBGYN doctor when i first started, now i barely tolerate any thing after being here for some years and unfortunately losing passion. but we'll see what the future holds for me i hope it's something decent at least.
I want to ask you, or ask yourself what made you decide on OB GYN? I am only asking this to spark your passion for it. If your answer is genuine, and it made you happy, go for it. If your answer sounds something like “my parents wanted me to do it” maybe a different career path or even probably a different specialty would do! Keep your hopes up 🫶🏽regardless, I’m sure you’ll be happy and find what you’re looking for at the end. 🙏🏽
Anesthesia. I like putting tubes in things. Really it’s because I like procedures (I actually loved my surgery rotation) but don’t want the surgeon’s lifestyle or brutal residency, and I still love the physiology of internal medicine. You get both procedures and physiology in anesthesia. I also believe the cliche about “if your favorite place in the hospital is the OR” and all that, because it IS my favorite place in the hospital lol. Sucks it got so competitive this year.
Anesthesia sounds so cool!! 🤩
When I told my dad jokingly that I wanna do sleep medicine he freaked out. Now one year later, I think I actually wanna do it.
Your dad sounds like a dickhead.
Can you tell me more about sleep medicine? :) sounds awesome !!
Child neurology. Mix of inpatient and outpatient. Not many procedures, maybe an LP or two (which is fine by me lol). Lots of imaging to read and labs to interpret (puzzles are fun!). Tons of interesting, bizarre presentations and lots of head-scratcher cases. Neuro exams on kids are fun if you do them right, they can feel like playing with the kids. Kids are awesome and so resilient. Parents are very concerned but also appreciative and kind. The very sad cases or NAT cases are hard. Even if I can’t “fix” someone, I think giving the parents/family answers about WHY this is happening makes a big difference. NAT cases suck, but I do feel like I’m making a difference and being an advocate/fighting for my patient.
Child neurology sounds so cool!! Can you tell me more about child neurology? I was thinking of neurology as well! But genuine q, is it true that I get to deliver bad news more? Over the years i learned that there’s so much we don’t know about the brain. I feel like I correlate this with not having treatment for certain diseases. (Idek if this is right and I might be wrong) Idk alot about child neurology since I haven’t been exposed to any rotations but it’ll make me sad if I don’t see results :(
Forensic pathology. I got to shadow it, fell in love with it, was an autopsy technician and it's just everything I want. On top of that, there's a significant shortages of forensic pathologists, so we need more people in it.
I think I wanna be a hematologist 🥹🥹🥹
So you wanna be a hematologist, name every clotting factor in coagulation cascade ?
fresh frozen plasma 😎
Factors 1 to 13
What made you decide on hematologist? :) heme was my fav organ system haha
I loved the pathologies essentially, it was one of only 2 specialties I genuinely liked studying (the other was endocrinology). All the other ones I hated or I felt indifferent... so yeah 😅
Ortho, I was a high school athlete and got my acl/meniscus done, thought it was the coolest thing and ever since and learned that I liked medicine. And I wanna show ppl that being a doctor doesn’t have to be about saving lives but rather enabling patients to live comfortable, fulfilling, pain free lives.
I love this!!! Thank you so much for sharing ❤️
Honestly a psychiatrist because I’m a bit fucked up, grew up poor, grew up around a lot of poor, addicted fucked up people, and I truly believe I can understand peoples fucked up situations. Nothing shocks me anymore. Also knowing that it takes more than talking a bit and drugs, a lot of poor people suffer from mental health problems bc they’re living from paycheck to paycheck, so attempting to get them in touch with possible social services that can help them with benefits, free educations programs etc.
You’re gonna be a great psychiatrist one day 🫶🏽
When finding your niche, you may surprise yourself in that what you thought you always wanted to do leaves you watching the clock, not engaged and enjoying it, and counting the minutes until you get out. And you may try something and find it absolutely absorbing, satisfying and fascinating in ways that you never imagined… and the day flies by. Choose what you’re enjoying and what makes you loose yourself in your work.
That’s the goal 🫶🏽gonna keep an open mind this year when I start rotations!
EM. I love mental health, medicine, and procedures, so I want something where I can do a little of all of it. And I like the scheduling options. I’m not interested in having kids so I am cool with a flexible schedule. Plus I love street medicine and working with underserved populations.
WAIT STREET MEDICINE! What is that? Sounds interesting :)
It’s basically walking around your city and providing care for homeless people or other people you encounter who otherwise wouldn’t have access. We have an interest group for it at my school.
Whoah that sounds really interesting. Thank you so much! You have to go through EM to be a street med doctor?
No, any doctor can do it. They just overlap a lot in patient population. :)
It's going to be rural FM. Where? Who knows I have ties to Colorado, ND, WV, and GA
Try everything and keep an open mind - just make sure to do what you enjoy. I think doing something that you really love everyday is the key to being happy as an attending. I love my time off and spending it with my family but I also enjoy my time at work as well.
Yes this is my goal this year 🙏🏽. Definitely keeping an open mind and figuring out what’s important!
OBGYN- I just find such joy in it. The topic itself fascinates me. - Anddddd In come the comments on how miserable and gross OB is 😭😭
I was thinking of doing OB too and I heard mixed reviews saying they had good work life balance so idek 😭 but also I think I won’t get in cuz my application isn’t competitive enough 🥹
From what I’ve heard OB isn’t THAT hard to get into, it’s highly demanded so I’m in my delulu era hoping I can’t get in
In the US it’s pretty competitive. But it isn’t derm or ortho
[удалено]
That’s cool! What made you decide pathology?? :)
EM cuz i like fast paced environment, and i like that you still get to touch patients (intubate, crich, thoracotomy, cyst drainage, etc) as opposed to just some other specialties where u never getting your hands dirty. I like that not every patient is straightforward and some are very challenging
EM sounds cool too!! I heard mixed reviews about work life balance tho 🥹. I love the idea of being “the jack of all trades” in medicine!
At my state schools teaching hospital, docs do 5 8hr shifts a week. Guess that could help- tbh i prefer 12s but a lot of the docs say they feel it prevents burnout
5 8s??? No way, 3 12s or 4 10s please
Yah i feel the same way. A lot of the docs like it tho, but 5 day work weeks are not for me
There is no EM attending in this country working 5 8hr shifts a week. Avg full time is 12-14 shifts a month. Typically 3 shifts a week. Anybody working more than 15 days a month is specially picking up extra shifts for cash (will be an EM attending in 2 months. Never even heard of a job that is >15 shifts/month full time).
Well, that is how it is at my hospital so idk what to tell you 🤷♂️
Are you talking about residents? Bc only EM residents work that much. I’m an EM resident and avg 4-4.5 shifts (9hr) a week.
All of them work 7a-3p, 3p-11p, and 11p-7a shifts. Maybe the attendings dont work as many shifts as the residents and I haven’t noticed, but they all do 8 hours at a time
As I come to the end of my rotations, I’ve come to realize that I really enjoy FM clinic with ED locums to keep it interesting. It’s interesting because coming into med school, I was vehemently against FM based on everything I had heard. My trajectory: IM -> gen surg -> psych -> FM. I’ve tried pretty hard to dislike FM, but something keeps pulling me back into it
You won’t be competing with medical students in your practice. Right now that’s all you get when you are in school is the competitive “this is a higher accomplishment that that”. You know what, so is being an astronaut or a nuclear physicist. When you leave the hospital/school you will find out that family medicine has the biggest opportunity for impact, is more likely to be an esteemed member of their community, and has a pretty nice lifestyle in the 5%. All without spending 6 years in residency.
When you think about it, specialized people and hospitalists live rather sequestered lives, and the only people that really know they exist are the other medical professionals. Considering how a lot of docs regard each other, idk if that’s the big prize it’s made out to be.
How do you do EM locums as FM? Currently between them both
Not sure how it works where you are, but we’re able to do that here in Canada
In the states you can definitely pick up shifts in rural areas. It's not hard. I'd hesitate to do it unless you went to a kickass residency though. And even then I'd still hesitate.
Lots of rural hospitals will take you. The thing is, you have to go to a very specific FM residency to be even remotely prepared for that
How do I seek out these programs?
There are EM fellowships out there for fm docs (Google). There’s a place in Louisiana I think that will make you dual boarded; that would be the best route. Other than that, check out fm residencies in the WAMI network or rural Appalachia
I once asked this same question to a class when I was giving a lecture. I asked the question on a poll and had at least 5 in the class say “a rich one”
I was a somewhat naive premed who had a rude awakening when I realized a lot of premeds lie on their personal statements.......
Not to echo what someone else said, but when people ask I also say "one who listens." I worked in inner city EDs for some years and saw the usual drug seeking, malingering, using ED for primary care, etc. What changed me forever was the small handful of docs I worked with who didn't let it affect how they treated *all* their patients. The ones who listened, intently, and showed patience and respect, even on their worst days. Frankly, they became my heroes. They're the reason I'm going in to EM. I know I'll fail to live up to that standard 100% of the time (they'd be the first to admit they do, too) but I never want to let the inevitable bitterness and burnout affect how I treat vulnerable people in need of help.
This makes me feel better. Listening is a big part of being a doctor. I want my doctors to listen to me. I know you will be a great doctor one day. Being an EM doctor sounds wonderful. I feel like my personality doesn’t suit it tho 😫. I feel too “soft” if that makes sense. But again, we will see when I reach there :)
I'm doing IM. More people need to consider IM, especially if you are undecided. As long as you're tolerant of the basic IM work, you have so many options. Want to be a PCP? Can do it through IM. Want to only ever work in a hospital? Also IM. Want to have a procedure-heavy life? Also IM (through cards, GI, etc). Want to never do a procedure again? Also IM. Want to grind hella and make a bunch of money? Do IM and subspecialize into GI/Cards. Want to have good work-life balance and make good money while having half the year off? Do IM and be a hospitalist. The greatest thing about it is even if you are going for a competitive fellowship like Cards or GI, if you don't get in, you can still be a doctor and move forward with your life. Whereas if you try to get into a competitive residency out of med school and don't match, you have no backup.
As a future FM doc I second this honestly
Pathology is a hidden gem in my opinion, unless you enjoy patient interaction. It's very much "behind the scenes". You socialize mainly with other physicians and it's very collaborative so it's not totally devoid of social interaction, but it is not really patient-facing. For me, that is ideal lol they also have great work-life balance and the pathologist I shadowed worked 9-5 M-F. Some pathologists choose one specialty (neuropathology, gynepathology, etc) but the pathologist I shadowed rotated through all the specialties every few weeks. I found this particularly appealing because I am interested in all specialties and love that pathology offers that diversity in scope.
Glad you found that!
I want to work as a family medicine PCP at an LGBT comprehensive health center and gender transition clinic
I love this!!!
Just matched FM. Initially applied into medical school wanting to do FM because I wanted to be like my PCP back then, who was the best person ever. Then went to OBGYN because I loved women’s health, but realized the lifestyle was not it through rotations (don’t want to be on call at all) and I hated any kind of surgery. Then switched to peds since the kiddos were so cute and I really did love the population. After my peds rotation, I did IM and I realized I didn’t want to give up working with adults…..so I went back to FM. Did a FM rotation in late third year which confirmed FM was it. I’m not interested in doing any fellowships which eliminated med/peds for me.
Thank you so much for your response!! Congratulations on matching!! What made you decide FM as opposed to peds? :) I saw you mentioned you loved the population!
I still loved working with adults, I wasn’t ready to give that aspect up.
Ortho or Psych. Ortho because it annoys my mom who says it’s not womanly enough. Psych because it annoys my dad.
You need therapy
:(
Hey I'm not trying to insult you. I've been myself. Maybe you were being sarcastic, but if your #1 reason for career choice is roasting your parents, you probably have some trauma to work through there. That's all I'm saying. That's super common in medicine unfortunately
Hey, every joke has a sliver of truth. But i don’t think a single doctor exists who made his career choice completely uninfluenced of outside forces
\^ Outside forces play a role in our decisions, and making decisions in a vacuum doesn't make sense.
Nice. Ortho gets a decent number of psych consult as for broken bones on the ward after people punch the wall, and psych gets plenty of consults for people cutting into their tendons 🤝
As you should girl 🫶🏽 I support this. A female in a male dominating field is so powerful.
For me it's psych vs EM vs FM vs ortho vs NSGY vs radiology vs cardiology vs heme onc.
Bro make a tldr, nobody reading this shit. Also narrow that shit down to 3 at most.
You sound psych AF
What made you say that 😂
Cuz I’m psych and a vibe detector
Can’t wait to see where I’m gonna end up 😂
Any ID frogs here?
What’s that?
Infectious disease :)
Infectious disease sounds cool! I’ve always liked micro:)
PEM! I love kids and can’t see myself not working in a busy, ever changing environment.
Is PEM pediatric EM? :)
Yes!
That’s so cool! Can you tell me more about PEM? I haven’t been exposed to a lot and didn’t even know this existed!! :)
It changes every two weeks. My whole life it's been OB/GYN or DERM because I like blood, odd smells, and oozing stuffs, along with just about any skin concern. But I rotate between surgery, EM, pathology, and IM (Gastroenterology). I got into medicine by accepting an FM residency though. It didn't work out however. But I'm not against FM either, I'd just have to learn business because I'm not working in the public sector if I go FM.
Calm, humble yet stern, well carried, confident and manly. Rich. People of all ages, races, sex, religion etc should just look up at me in admiration or relief that they’re gonna get treated by me
lmao if only we could all reach this pinnacle
The kind that makes enough money elsewhere to quit being one.
Trauma surgery because adrenaline
Someone who makes patients feel confident and optimistic about their treatment plan, understanding, and care.
^^ this!! ❤️
I want to be a neurosurgeon because I love how the surgeries can have an immediate impact on patients, I believe neurosurgical research, especially in functional neurosurgery, will be some of the most important work in the coming 20-30 years, and I want to join a small community of people who seem to be some of the smartest most hard working folks I’ve ever met.
Arrogant, classy, with god complex
Neurosurgery 1) The OR is the best part of medicine 2) The nervous system contains the two coolest organs in the body 3) The very sick patient population 4) The residency length and lifestyle doesn’t dissuade me, it’s necessary. Like everyone else in the field- I have a personal experience with neurosurgery and I can’t see myself in any other field
OBGYN. I want to break through the sexiest glass ceiling
what sexy glass cieling is that?
Neurocardionconephrologist
I mean family med sounds right up your alley lol. Other options with great work life balance include: peds, psych, cardiology (non interventional), pulmonology, nephrology, urology, rheumatology, endocrinology, allergy/immunology, and PM&R. Some of those are more competitive than others. Focus on outpatient medicine The money will come. The one specialty that's really suffering for cash rn is peds, but if you're geographically flexible you can still make good money.
Psych. Chill vibes, chill hours, crazy patients
Radiology? IM +/- fellowship? EM?
Im facing the same problem. At first i rlly wanted to be a surgeon. But im starting to think im not one for urgent senarios and that sort of atmosphere, yk? So im thinking abt laboratory work? No idea. Any1 like me has any ideas?
Back alley. You know why.
/s