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MS3 trying to decide on area of specialty

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  • MS3 trying to decide on area of specialty

    Hello all,

    Long time reader, first time poster. I am a current MS3 trying to decide on specialty choice. I worked as an MA in ophthalmology during college and enjoyed that, but told myself I would keep my options open throughout med school. I recently shadowed in dermatology, including both general and Mohs surgery, and really enjoyed that as well. There really hasn't been a rotation that I've hated so far, although I'm only halfway through my third year. I also enjoy some of the surgical fields (i.e. my rotation in general and orthopedics), but length of training and work-life balance are a concern there.

    I had always been told "you have plenty of time to decide" and "you will fall in love with something during your third year", but I feel like the crunch is on to make a decision soon, and honestly nothing has jumped out at me to the point where I thought to myself "this is what I have to do for the rest of my life". I feel like I am a fairly versatile person and could be happy in multiple fields.

    I was hoping to get some advice on how to make the decision on specialty choice. I am the first one in my family to go to medical school, and as such feel somewhat on my own when making this decision. Any advice you could provide to help with this decision would be greatly appreciated.


  • #2
    You can never go wrong picking derm


    • #3
      How's your step 3 score? Start by deciding surgery or medicine or other (ER, OB, ROAD). Once you make that decision, it will be easier. People say someone who likes everything should go into family medicine. The main problem people have is liking nothing. Sounds like you just haven't landed on the thing that you really truly enjoy. Keep seeking out diverse experiences. You still have time. The crunch is not on until the beginning of 4th year. What are your hobbies? What do you like to do outside the hospital? Do you have a family or plan to start one in residency?


      • #4
        Derm is one of the few (probably only) “lifestyle” high paying specialties out there. I’m a radiologist. It nearly fits the bill hours and vacation wise. But, we have to work soul crushing, high volume weekends and a few holidays. This is the case in both academics and private practice. But, in some academic programs, residents and fellows do most of the acute work, while the attendings sign off the cases.

        The specialty is very fun and intellectually stimulating. It’s a nerds dream having high resolution $30k monitors, fancy imaging modalities/protocols and other techy stuff at your disposal. Compared to other specialties, rads have one of the highest percentage of time spent doing pure patient care stuff and minimal social work, charting stuff.

        Just wanted to throw the specialty out there since it isn’t a required rotation for a lot of med programs. Unfortunately, it’s difficult to learn what a radiologist does as a medical student. It matches many personalities as there are options to be procedure heavy or procedure minimal to none.

        Since this is a finance forum, the specialty remains top 5 pay wise with somewhat accurate 500k non academic median salary. Vacation remains the highest to my understanding.


        • #5
          If you can be happy doing derm you should definitely do derm.


          Other specialty selection bits of wisdom:

          1) Find something you like and just go for it, you'll never know for sure until you do it but very few docs spend their careers saying "I wish I had done X field instead"

          2) Always remember the things that matter to everyone: nights, weekends, holidays, work stress, high pay. Derm is very favorable on all of those. No one (or I should say very few people) wants to work on weekends or overnight, it's a bug not a feature. Money also matters. When you're a medical student you don't think that the difference between $200k and $500k is that big of a deal but it is a massively huge deal.

          3) Good friend of mine who is a longstanding PD always says "never go into a field expecting to change it, it will change you instead."

          4) Ignore med student chatter and stereotyping ("I like IM but I hate rounding." "Anesthesia is boring." "All OBs are miserable.") Talk to attendings about their lives not fellow students about their barely informed opinions.


          • #6
            Have said it before and will say it again: only go into surgery (general or speciality) if you can't imagine doing anything else.

            If you enjoyed derm and have the grades and scores to get in - I can't imagine you would regret it.  I don't know anyone who regrets derm.


            Edited to add: the crunch isn't on, yet.  Applications are a year away.  And, no one tells you this in med school, but lots of people switch fields after a year in residency, or even after an entire residency. Obviously you would rather save yourself that trouble by being happy with the first field you choose, but just keep in mind that you will still have options down the road.


            • #7
              Please focus on something you like and don't listen to the nay-sayers.

              I was always told I could NEVER do OB part time, I only did OB full time for about 4 months, until I had my own twins and went back part-time, never looked back.

              You can make the situation you want... listen to the energy you get when on the rotation... any rotation where you had a skip in your step?



              • #8
                If your scores are good enough to be competitive in derm I'd totally go for that, really cant be beat in almost anything.

                I cant believe people are saying you have so much time, this is especially untrue depending on what your rotation schedule is and doubly so depending on the competitiveness of the specialty.

                Im sure most people feel the same, and its true, you could be happy in several different fields. Honestly, if we just randomly assigned people and wages/lifestyle werent much of a thing you'd still probably have mostly happy docs out there. Theres plenty in any specialty to keep you busy.


                • #9
                  Since the opinion about Dermatology is relatively positive, the one aspect to consider is that certain outpatient specialties have really high volumes (as @GoBlueMD points out). You'll be able to see that when you rotate with them.  The volume does go down slightly if you become a Moh's surgeon for logical reasons.

                  There are also other potentially lifestyle friendly fields including anesthesia, rad onc, psych, and PM&R.


                  • #10
                    Grades, scores, and research will dictate this decision a lot.

                    Don’t forget about path. Rotating as a student can be like watching a friend play a video game. That bored me as a kid, but apparently that’s a profitable side gig now.

                    It has pros and cons like any field. The hardcore academic types can be pretty unbearable about their unfounded views of private practice, but there can be some sweet gigs out there. Not as competitive as others you listed but definitely a lifestyle gig. If you’re considering radiology, it’s worth spending some time in the lab.


                    • #11
                      Can never go wrong with derm — good luck!

                      Number 2 for me would be ortho..


                      • #12
                        Reply back with some board scores and other practical info and we can make better suggestions.


                        • #13
                          Sorry to piggyback, medstudent. I'm also an ms3 debating a few specialties. I was deadset on rad onc before med school. My step 1 is in the 250s and I have numerous rad onc publications. Honors in all my rotations. I have enjoyed most of my third year. My favorite rotation so far has been psych. I also enjoyed gen surg and ent. At this point, I am considering rad onc and psych.

                          As far as I can tell, the biggest differences between these two specialties besides scope of practice is salary and flexibility. Salary is greater in rad onc while psych has greater need/flexibility.

                          Logistics - my wife is willing to relocate with me as I continue training. No kids. We plan to have first child (possibly two) while in residency. Family is in desirable part of California. It would be nice to live close to my family in the future. Loans are not a concern. I would prefer private practice. I have simple tastes and my wife is frugal as well.

                          I could see myself being the oncologist or the psychiatrist. I like the idea of psych but feel like I am giving up something great with rad onc. Any advice?

                          P.S. I sometimes think I could make an excellent dermatologist lol.


                          • #14
                            Your scores and overall application will dictate some of this. As far as lifestyle goes, dermatology can't be beat. I think I've seen one in the ED, but it was during the day and I'm fairly sure they were new and just looking for an exit.


                            • #15
                              I have no insight on rad onc. Psych can be a great lifestyle and there’s also potential to make great money if you’ve been reading some posts on here. Have you even done your rad onc rotation yet?