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Specialty Choice Advice for MS3

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  • #16
    Keep an open mind during 3rd year and pick what you love doing the most. Start by deciding if it’s going to be surgical or not, but I wouldn’t rule out surgery until you actually rotate through it.

    You’ll make more $$$ doing what you love for longer versus feeling like you want to FIRE every day.

    You’re fortunate to be able to choose any field. REI’s work weekends (US for stim cycles) and the patients are demanding (they are paying $30k+ per cycle after all). If you don’t love it, you will burn out.

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    • #17
      Originally posted by GlassPusher View Post
      Do not do path unless you want roll the dice for a good income; most path gigs are academic or corporate or require stumbling upon a gem in the middle-of-nowhere/rural.
      hours are good, call is zero, weekends are free, pay is livable but often mostly siphoned off by academic dept, hospital, or benevolent physician employers (derm, urology, gastro) that pay you "well" for the privilege of financing their 7 figure income.
      This is solid, realistic advice on the downsides of path. The big 3 above seem to think de facto kickbacks are ok. If one can live with that or find a nice practice set up, it's a solid job .

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      • #18
        Welcome op.

        As others pointed out....what factors led to burnout. Identify those and use those as your guideposts.

        Also enter a field you enjoy. twenty years in the wrong field is just asking for it. A trauma surgeon here will poke their eyes out before primary care and likewise vise versa...yet we all are clinicians and most likely financially doing just fine and good with our chosen lifestyle.

        Do what you love first then figure out the financials that that career affords. That's a key to burnout avoidance imho.

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        • #19
          Originally posted by ObgynMD View Post
          Keep an open mind during 3rd year and pick what you love doing the most. Start by deciding if it’s going to be surgical or not, but I wouldn’t rule out surgery until you actually rotate through it.
          Exactly. During my first year of psych rotation 3rd year they asked what we planned to specialize in. My reply: "definitely not surgery or psych"... I ended up being an eye surgeon. So, try a bunch of things and then figure out how to make your lifestyle fit into whatever you like most.

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          • #20
            The problem with the whole “pick what you love” mantra is that you may love the small slice of the specialty you are exposed to during your med school rotation but not really love the specialty. E.g. there was one rotation in medical school where I loved the team i was on. And liked the work ok, but i really loved the people i was working with. I went into intern year planning on doing that specialty…worked with other teams in the same specialty and realized it wasn’t for me after all. Luckily I also started internship knowing i wanted to be a flight surgeon in between internship and residency so was able to take that time and reassess and figure out what I really wanted. So basically i think it’s a difficult choice and i don’t think you can make it by reading or asking for advice on a forum. Talk to as many doctors in as many different settings as you can and get as involved in your rotations as you possibly can. If something sounds appealing and isn’t a core rotation find a way to check it out. I personally don’t think the U.S. medical system gives you adequate time to make a great decision unless you are one of those people who just know from the start.

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            • #21
              Totally agree third year is more a rule out year than.
              I have to be xx area.

              Don't have to commit to a spefific large area really until interview season. Your can take broad electives and still be fine in fourth year.

              I was surgery until I hit my end of third year clinicals and switched to a gi/cards regimen. Then during second year decided that wasn't for me and went to primary care.

              ​​​​​​Things change with exposure and fine tuning happens. Not unusual to see 1-2 residents each year completely change too

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              • #22
                Originally posted by StarTrekDoc View Post
                Totally agree third year is more a rule out year than.
                I have to be xx area.
                I was about to post the same thing. No one can predict compensation in 10 years time. Things can change and change back again.

                You are looking for high compensation, great life style, fulfilling work and also reasonable easy field to get into. That is asking for utopia. Choose 2 of them. Most have lifestyle or compensation and derm might be the exception that is slowly going away from having both.

                Pick low compensation ( pediatrics, some IM subspec, FP) and high(er) stress ( trauma, neurosurg, ortho) and put it aside.

                Then choose one among the remaining that you like and can get into and try for it.


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                • #23
                  Originally posted by Anne View Post
                  The problem with the whole “pick what you love” mantra is that you may love the small slice of the specialty you are exposed to during your med school rotation but not really love the specialty. E.g. there was one rotation in medical school where I loved the team i was on. And liked the work ok, but i really loved the people i was working with. I went into intern year planning on doing that specialty…worked with other teams in the same specialty and realized it wasn’t for me after all. Luckily I also started internship knowing i wanted to be a flight surgeon in between internship and residency so was able to take that time and reassess and figure out what I really wanted. So basically i think it’s a difficult choice and i don’t think you can make it by reading or asking for advice on a forum. Talk to as many doctors in as many different settings as you can and get as involved in your rotations as you possibly can. If something sounds appealing and isn’t a core rotation find a way to check it out. I personally don’t think the U.S. medical system gives you adequate time to make a great decision unless you are one of those people who just know from the start.
                  Anne is correct as usual.

                  Psych residency is pretty chill after intern year. If I didn't occasionally find psych interesting, I think derm has to be top of the lifestyle/$$ pyramid. Being on call and working weekends sucks, increasingly over time. I think I would have liked path somewhat ironically I suppose. Definitely not REI, would be rewarding at times but not a lifestyle specialty I think. Despite cash paying folks not close to the derm income realm I think

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                  • #24
                    Psych residency at least where I'm at is very chill. Without moonlighting, I work about 25-30 hours a week, with hardly any stress. I went home today at noon. 1st and 2nd year were busier, but still a breeze compared to medicine and surgical residents.

                    Starting to look at job offers and there's plenty of 250k+ jobs that are bankers hours, no or minimal call. Other specialties obviously make more but I think psych is pretty good in terms of hours and stress.

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                    • #25
                      There’s a HUGE difference in residency work loads among specialties. Another vote for derm here. Derm you’ll work essentially business hours for 3-4 years during residency with occasional very light call. If your scores and grades are good enough you can hopefully find a pretty cushy TY year rather than be a IM or surg intern somewhere. If you start networking/get your name on a few things you won’t have to take a research year. I wouldn’t skip a year just to match if your step 1 is >99%ile. I don’t know what rads residency lifestyle is like. For non traditional students, I think work/life balance during residency itself should not be overlooked. As you stated, being available to family during that time is important.

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                      • #26
                        Originally posted by FreshPaint View Post
                        Psych residency at least where I'm at is very chill. Without moonlighting, I work about 25-30 hours a week, with hardly any stress. I went home today at noon. 1st and 2nd year were busier, but still a breeze compared to medicine and surgical residents.

                        Starting to look at job offers and there's plenty of 250k+ jobs that are bankers hours, no or minimal call. Other specialties obviously make more but I think psych is pretty good in terms of hours and stress.
                        You expect to be well trained working 25h/week?

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                        • #27
                          Originally posted by VentAlarm View Post

                          You expect to be well trained working 25h/week?
                          Nope. But my residency didactics and mentorship are minimal to nil. Most attendings at my program are lazy and hide behind residents to avoid work, and place blame on them if something goes wrong. One attending on inpatient weekend call signed all the notes but nurses told me he didn't even show up to see the patients.

                          So I moonlight a ton at a state hospital with very sick patients, read a lot, and lean heavily on some mentors I've gotten to know there.

                          I'm not sure if this is common in psychiatry or specific to my program. We've graduated some residents recently that are truly horrific in terms of knowledge and ethics.

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                          • #28
                            Originally posted by FreshPaint View Post

                            Nope. But my residency didactics and mentorship are minimal to nil. Most attendings at my program are lazy and hide behind residents to avoid work, and place blame on them if something goes wrong. One attending on inpatient weekend call signed all the notes but nurses told me he didn't even show up to see the patients.

                            So I moonlight a ton at a state hospital with very sick patients, read a lot, and lean heavily on some mentors I've gotten to know there.

                            I'm not sure if this is common in psychiatry or specific to my program. We've graduated some residents recently that are truly horrific in terms of knowledge and ethics.
                            That sounds like a program that shouldn’t be a program.

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                            • #29
                              My question is, what field would you advise an MS3 to go into if that student cared most about having a good lifestyle, higher compensation and fulfilling work?

                              My response would be to pick something you actually like to do. You never know what changes are happening in the medical field over the future. Picking a field because you think it will be good but dont really love it will definitely lead to burn out. I could not imagine looking at films all day, and I am glad there are those which love to do it. But choosing it because it seems easy and that you are going to make a lot is not logical. I cant speak for a Radiology or Optho, but I bet most of them think they work pretty hard.

                              I chose IM , which turned into out patient IM over the years. In the last 20 years , I have not worked a night , weekend or holiday. My w2 income last year was 550,000, not including consulting and other interests. Medicine is what you make of it. I feel my income is a good trade off , for having enough family and free time.

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