Id like to weigh in on this. I’m a third year student (yes I know that my name has MD in it) and I’ve had to put a lot of thought into what specialty I am going to apply for. In the last year I have become quite addicted to triathlon, and currently compete in the 70.3 range. I have had a lot of people tell me that I should make my decision based only on what I will enjoy doing, but I don’t think that that is the best way to approach it. I think that you have to look at every aspect of your life and how happy you will be overall. For instance, lets say you are interested in critical care medicine so you are choosing between trauma surgery and pulmonary critical care, but you actually see yourself being a little happier in trauma and would make more money. But you cant compare those two specialties in isolation. You have to incorporate every aspect of what your life will be. I would look at that decision as trauma + more money vs critical care and triathlons, and I would see myself actually more happy in general with the latter. I hope that makes sense.
The best time in my life so far for training was second year medical school. I was secure enough in my academics that the yin-yang of studying and training worked out really well. I did IMs 3-5 and a bunch of shorter stuff and I graduated in the top 10th of my class so it worked for me.
The worst time for training- internship or in current terms PGY-1. I’m living in paradise for training and racing, belong to a ‘company’ that requires twice a year physical fitness tests(luckily with rather low standards) and am in probably almost my worst shape ever short of the post op period after each of my knee surgeries and this may be worst because it’s longer and sleep is something I day dream about. I’m constantly exhausted and question at least once a day why I didn’t just become a cop like was my second choice. On the other hand when I’m working in the location that drew me to this specialty, I work long days and absolutely love the medicine.
I’m a pediatric resident in a town where the peds residents work longer hours than the surgery residents do in both programs.(We peds types do rotations at each others programs so we interact enough to talk about this stuff.) Near as we can figure the reason is the number of slots we have to cover on call with the limited number of residents- ward, PICU, newborn service, NICU. We routinely violate the 80 hour work week although I just don’t track it and therefore fudge by omission.
Other than the ‘paperwork’-we use the worst EMR on the planet for our outpatient charts- I like what I’m doing while I’m doing it most days. I did choose this specialty with the plan of doing fellowship though. I’m a resident in a primary care specialty who has no intention of doing long term primary care short of the occasional trip to the sand box. I love the NICU- I like the patients and most of their families, the procedures, the science and the research questions. I actually do like my ‘employer’ too in spite of my split personality about it first Saturday in Dec every year.(Alumnus of one, work for the other). Residency wise things should somewhat improve as an upper but part of the demands will be self induced as my research project(s) will take time too. My total post grad training will be 6 years as all fellowships in peds are 3 years.
Triathlon wise- I’ve done some sort of race all but one month. July- OWS, Aug- Xterra tri, Sept- tri, Oct- post call did an afternoon 5kish trail run, Nov- 10K, Dec- trail half marathon(missed the marathon a week later due to call in my happy place), Jan- off month, Feb- 10K, 13Kish, triathlon. Upcoming in Mar- run-swim biathlon, crit, and triathlon. Race schedules are dependent on call/work schedule as we work 24 days out of every 28 day block. Most blocks that means 1 Sat off, 1 Sun off, and 1 Sat/Sun combo off with the other weekend being straight through. I’m taking my first vacation week soon and it will involve much time on the bike and then some quality Step 3 prep time beach style:)
I would pick a specialty with good income potential and lots of time and scheduling flexibility. The actual employment situation may be more important. It’s probably better to be a solo, self-employed physician. Less, or no hospital work, limit night and E.R. coverage. Some suggestions: dermatology, rheumatology, physiatry, psychiatry. Office based family medicine or internal medicine but income can be low.
Is it too late to switch to DENTISTRY?
Ahhhh…Simple. Gastro. Highest current reimbursement. Rhumo is taking it on the chin at times with slow or no pay Medic (are - aid).
But at the end of the day…what is your match? If you dont match into what you want it is all for not eh?
Oh, and no hospital work for indies? Right until one of your patients is inpatient.
This is a good thread.
Did not realize there were so many other Drs on ST…although I havent been lurking as much lately. I am a Navy Colon and Rectal Surgeon and I work normally in a teaching hospital (Currrently deployed to a hot place with alot of sand/dust). The 80 hour work week and night float has changed everything. When I started training (for surgery) no one left intill all the work was done, if your patient was getting worse you did not even think about leaving if one of your post ops came in and needed a take back you would come in and be pissed if no one called you back in off vacation. This is no longer the way it is…I see a lot of clock watching and turning over really sick patients to junior residents. The training is different…I think Surgeons mature at a slower rate because of the changes but I like to think/hope that they reach the same place at the end of there training. I think the patient ownership and bond is not as strong as it was…but I wonder if we will make for better adjusted and happy physicians with a lower divorce and substance abuse rate. With incomes down one of the ways to attract people to these strenous professions is to make them easier… But I worry about the quality of our future.
Anyway, the way to choose a specialty is to choose something that you like to do. I like to do colonoscopes and operate on Colons and the Anus and I have more flexability in my schedule then most general surgeons. However there are a ton of different types of practices out there (academic, VA, fee for service, millitary etc…)that you can fit Iron distance tris around and I think most Surgeons can find the time to do sprints.
Earlier, someone posted about smaller town practices being more demanding of your time. This is not always the case. I met a cardiologist this past summer who suprised me when he told me how great his practice and life are. When I was doing general surgery residency in Atlanta, the cardiologists were always at the hospital late at night with us GS guys. I believed they all worked as hard as the surgery residents. This friend of mine said Big City cardiologist usually cover multiple hospitals and there is a lot more competition. This keeps them all over the place and super sensitive to their referring docs “needs”. In his small town, he has one hospital and (I believe, no competition). He gets to work at 8AM or so and says he is sometimes done by 4PM. Call is not bad either. I thought “damn, I’m an ophthalmologist (vitreoretinal surgeon) and this guy has better hours than I do”.
The point is, you choose where your interest settle and then seek out the life you want in practice. Some specialties with a bad rep for long hours (ie, cardiology) can suprise you with their diversity of practice situations.
Also, with you being a 2nd yr student, a lot can change between now and match time. Keep racing and study hard
Another ED doc here. I’ve been in practice > 10 years. As others have noted, you get a lot of free time. But you can’t always control your schedule. Everyone in your group wants time off too. So there’s a lot of compromise involved in scheduling. It’s REALLY tough to get hooked up with regular training parters because most triathletes aren’t flexible enough to tailor their lives to your scheduling needs.
You work a lot of evenings, nights, and weekends. It makes it tough to get together with family/friends. Since most normal people are off during those times. In addition, if you work 5p-1a, are you really going to get up at 5am for your group ride or master’s swimming. After 10+ years, it gets old and hard to do.
Burnout is pervasive in the speciality. I disagree with Frank that people who choose EM for the wrong reasons get burned out. How do I deal with burnout issues? I don’t work full time. I make less salary than others, but I learned how to save/invest 15 years ago and do it extremely well. I also live within my means so I’m not forced to work more to afford my lifestyle. Working part-time isn’t always a great answer because a lot of groups don’t take you as seriously. So you also need to learn how to negotiate and advocate for yourself so you can still be professionally and finacially successful.
Somehow ran across this thread while looking to buy some used locking powercranks. I, like you are an anesthesia MD and it happens rarely but just last week, when you don’t expect it. 40 y/o athletic guy for a routine lap chole, wife didn’t even come to the hospital b/c of chip shot nature of surg. Very experienced surgeon sticks the trocar in the VC, retroperitonial so no frank blood, but calls from crna re brady and trouble with bp cuff, then profound ST changes, and then the ominus disappearing CO2 from the capnography, with a decent albeit ugly rythym. Within 2 min. timespan this guy tried to exanguinate. Good ending to the story, but difficult call to open an apparently normal abd., and admit a complication. Lots of tight sphincters for a few minutes. Any used locking PCs for sale?? Good luck all
Another ED doc here. I’ve been in practice > 10 years. As others have noted, you get a lot of free time. But you can’t always control your schedule. Everyone in your group wants time off too. So there’s a lot of compromise involved in scheduling. It’s REALLY tough to get hooked up with regular training parters because most triathletes aren’t flexible enough to tailor their lives to your scheduling needs.
You work a lot of evenings, nights, and weekends. It makes it tough to get together with family/friends. Since most normal people are off during those times. In addition, if you work 5p-1a, are you really going to get up at 5am for your group ride or master’s swimming. After 10+ years, it gets old and hard to do.
Burnout is pervasive in the speciality. I disagree with Frank that people who choose EM for the wrong reasons get burned out. How do I deal with burnout issues? I don’t work full time. I make less salary than others, but I learned how to save/invest 15 years ago and do it extremely well. I also live within my means so I’m not forced to work more to afford my lifestyle. Working part-time isn’t always a great answer because a lot of groups don’t take you as seriously. So you also need to learn how to negotiate and advocate for yourself so you can still be professionally and finacially successful.
I didn’t say that those who chose their specialty for the right reasons cannot burn out but I suspect that those who chose it for the wrong reasons burn out a lot more frequently. It is easier to rejuvinate the system when one enjoys going to work than when one dreads going to work
I am a physician.
I have cranked out 15+ hr training weeks for the better part of two decades and am FOP in tri for my AG.
I do enjoy endurance athletics, but do you know what I attribute my athletic “success” to? Luck.
I (you) are just one car/bike wreck, blown ligament/tendon, autoimmune disease, tumor, etc. from not being able to enjoy, or even do, triathlons. I have just been flat lucky up to now.
My point? At this stage of your life, your focus should be on the things that will optimize your medical career- learning medicine, learning what kind of medicine fits your personality and strengths, and learning what part of medicine you are really passionate about. If your choice of specialty is based on the aforementioned criteria and it still allows a triathlon lifestyle- great! But if you suddenly couldn’t do tri (bad luck) you would still have 99% of what I currently have. Namely a career that is valuable to society (helping humanity) and valuable to your family (your income.)
Your brain/cognitive talent is your most important asset and is much less likely to be put out of commission by “bad luck”.
Well, a recent study by ACEP showed that 31% of EP’s are showing signs of burnout. That means that either there’s a lot wrong with people choosing the speciality or there’s a lot wrong with the circumstances in which EP’s are forced to practice. Having been in the trenches for over a decade, I can say it’s the latter. I agree that the system is better off if people enjoy going to work. But the system is broken when the average EP, who works full time, only works 30 hours a week and still has a 30% chance of burnout in 10 years.
I would still agree with Frank … medicine is very stressful and I think lots of physicians deal with much greater stress than ER docs. When you enjoy your work and accept that it is your lifes work that all becomes easier to deal with. When you’d rather make your triathlon club ride … well, different game then. From my point of view, ER is one of the easiest medical jobs and that doesn’t mean I don’t have great respect for many of my colleagues who really are committed well trained docs. I just think a lot of uncommitted souls end up as ER docs because they want a job without commitment and decent pay … interestingly, a lot of them don’t seem to have long careers and a lot seem to move on to other jobs. If ACEP says 31% burn out … lots of definition issues there … but I would suspect Franks thoughts ring true.
Dave
I’m an MS1, and am looking for some advice about how to be competitive for a residency in surgery (beyond grades, USMLE, and letters.) I’ve heard mixed things from advisors and professors here, and was looking for some feedback from those who have gone through the process - specifically things I should be thinking about pursuing this summer. I appreciate it.
I’m an MS1, and am looking for some advice about how to be competitive for a residency in surgery (beyond grades, USMLE, and letters.) I’ve heard mixed things from advisors and professors here, and was looking for some feedback from those who have gone through the process - specifically things I should be thinking about pursuing this summer. I appreciate it.
Have a passion but, better yet, have a knack for it, and you will have no trouble getting a great residency. Residents are chosen during internship, not medical school.
Best advice I can give you as an MSI is don’t worry about it. Learn as much as you can about everything and you will find your passion. If you ignore all other aspects of medicine because you want to be a “surgeon” I predict you will be an average to below average surgenon. The best surgeons are those who know when NOT to operate.
I actually disagree somewhat with the advice from the above post. While it is true that a genuinely interested, hardworking, and talented individual will have no problem getting a good residency, there are real advantages to be gained by planning ahead.
My advice, coming from the field of radiology, and a very competitive West Coast residency with way more applicants than we can even consider-
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Decide as early as possible what your field of interest is, and get involved as soon as possible. The better you know the faculty, the better chance you will have of giving them time to know your talents well and thus recommend you down the road.
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Prepare to do well on USMLE step 1. You don’t have to crush it, but you should be well above average for competitive specialties. Anyone who tells you otherwise is not telling you the truth. However, know that a stellar score means little - a 260+ will get similar weight as a 235. I don’t know anybody who got into a residency solely on the strength of a great USMLE score, but I do know a lot of folks who got in highly competitive programs with reasonble scores. 240+ is actually the norm around here, especially if you are asian (see below).
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if you plan on going into a competitive specialty, prepare to spend both summers involved in research relevant to the field, with the goal of attending a conference. This will allow you to interface with faculty, who can then write very strong recommendations for you. This will greatly increase your chances of matching in a competitive specialty, even moreso than good scores and evaluations.
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A balanced resume is still crucially important. For competitive residencies, you need to bring strong academic numbers, but also demonstrate that you will be a personable, collegial team member. Selfish behavior will be the kiss of death regardless of your resume.
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Geography counts a LOT for residency. Anything in Southern CA is far more difficult than anything in the Midwest.
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Unfortunately, there are vastly different standards for “disprivileged minorities” versus others. Being an asian male is the worst category to be in, as they are over-represented in most fields. Be wary of advice given to you if their fundamental situation is different from yours.
I know I sound like a pessimist, but I actually am not - this is reality. Medical education and the selection process of residency and beyond is one of the most rigorous and competitive things you can engage in, and it is naive to think that you will maximize your chances without careful planning and preparation.
I appreciate the advice. I’m an older student to begin with and in fact am quite sure I know exactly what field I’d like to pursue. In fact, I applied to school with that upfront attitude and to tell you the truth it helped me narrow down my choices as many schools didn’t seem to think I had the ability to be so decisive. I disagree, but hey, Im in and going for it so I got past that part.
It’s interesting you mention research, and I’ll certainly look into that and start making arrangements. Is there anything else you would suggest?
rhane, I think it depends heavily on your selected field. Certainly, you should carefully cultivate the relationships with staff at your present med school in your chosen specialty, for their advice/contacts/letters of reference. The importance of research really varies by specialty and residency program (sub-specialty or highly academic centers absolutely require it). I’m going to agree that geography is important only in so far as you can start picking out places you’d like to be for res to do away rotations and make contacts. The statement about the midwest really makes me smile, and I’m not from Mayo, Cleveland Clin, or several places in Chicago - gotta love that SoCal attitude. I interviewed for post-res fellowship at several SoCal programs, no more competitive - if you’re shopping top tier programs, it’s the quality that counts first and foremost. Good luck.
I actually disagree somewhat with the advice from the above post. While it is true that a genuinely interested, hardworking, and talented individual will have no problem getting a good residency, there are real advantages to be gained by planning ahead.
My advice, coming from the field of radiology, and a very competitive West Coast residency with way more applicants than we can even consider-
-
Decide as early as possible what your field of interest is, and get involved as soon as possible. The better you know the faculty, the better chance you will have of giving them time to know your talents well and thus recommend you down the road.
-
Prepare to do well on USMLE step 1. You don’t have to crush it, but you should be well above average for competitive specialties. Anyone who tells you otherwise is not telling you the truth. However, know that a stellar score means little - a 260+ will get similar weight as a 235. I don’t know anybody who got into a residency solely on the strength of a great USMLE score, but I do know a lot of folks who got in highly competitive programs with reasonble scores. 240+ is actually the norm around here, especially if you are asian (see below).
-
if you plan on going into a competitive specialty, prepare to spend both summers involved in research relevant to the field, with the goal of attending a conference. This will allow you to interface with faculty, who can then write very strong recommendations for you. This will greatly increase your chances of matching in a competitive specialty, even moreso than good scores and evaluations.
-
A balanced resume is still crucially important. For competitive residencies, you need to bring strong academic numbers, but also demonstrate that you will be a personable, collegial team member. Selfish behavior will be the kiss of death regardless of your resume.
-
Geography counts a LOT for residency. Anything in Southern CA is far more difficult than anything in the Midwest.
-
Unfortunately, there are vastly different standards for “disprivileged minorities” versus others. Being an asian male is the worst category to be in, as they are over-represented in most fields. Be wary of advice given to you if their fundamental situation is different from yours.
I know I sound like a pessimist, but I actually am not - this is reality. Medical education and the selection process of residency and beyond is one of the most rigorous and competitive things you can engage in, and it is naive to think that you will maximize your chances without careful planning and preparation.
I agree with your assessment except I just can’t possibly imagine someone knowing what they will really want to do with the experience of an MS1 so should they be starting the planning of their career here. I always found those obsessed with becoming surgeons from the get-go (and bored with every other aspect of medicine) pretty much jerks and was never impressed with how any of them turned out. Ones goal, IMHO, should be to become the best physician one can and not worry so much about which residency one gets into. One of the best anesthesiology residency’s in country by way of reputation had some of the laziest jerks in it I ever met (we shared some rotations with them at my residency as mine was “affiliated” with theirs and with, also, another major medical school). I remember one of their residents “bragging” to me that he had not cracked a single book all that year. My residency, which had a zero reputation (it was in the military) was a great program. We had the second highest scores, on average, in the country the year I graduated, as I remember and had been in the top 10% for 5 years (of course, the Navy closed the hospital and the program a few years later).
Reputations are not all they are touted to be. How many patients care where their doctor went to school, let alone where they did their residency? They either like you and trust you or they don’t. Every program has strengths and every program has weaknesses. Put your efforts into finding what you really enjoy doing intellectually and then becoming the best you can become with what is available to you and you will turn out ok regardless of the program you end up with.
I appreciate the advice. I’m an older student to begin with and in fact am quite sure I know exactly what field I’d like to pursue. In fact, I applied to school with that upfront attitude and to tell you the truth it helped me narrow down my choices as many schools didn’t seem to think I had the ability to be so decisive. I disagree, but hey, Im in and going for it so I got past that part.
It’s interesting you mention research, and I’ll certainly look into that and start making arrangements. Is there anything else you would suggest?
I will say this, if you are an older student and have experience other than just going to school then I say good for you. I was an older student and about 10% of my class were older with the oldest being a female in her mid 40’s and a man in his late thirties with about 8 kids. In my opinion, people like you make the best doctors, because you have real life experience. People who have no experience other than school sometimes just cannot relate to patients. If I were the dean of a medical schooland could set the admission requirements I would not accept anyone directly out of college. I would make them all have a year or two of real work experience before starting medical studies. Of course, I am not in charge of setting admissions standards at any school so that will never happen.
Residents are chosen during internship, not medical school.
Frank, it’s 2009, things don’t work like this anymore. One applies to categorical residency programs as a medical student, even if they require a transitional or prelim intern year.
Write an interesting personal statement! I read dozens and dozens of the damn things every eyar, and most of them make me either want to throw up or kill myself.
Don’t use your Grandmother’s death wish as an example, or have a ‘Road to Damascus’ moment while at the bedside of a terminally ill relative- we’ve heard them all before and they are boring and naseating. Don’t say ‘I want to help people’- of course you do- that goes without saying.
Wht to write? that I can’t really tell you, but I know it when I see it. A little bit different, a touch of humor, be honest.
Read a ton of them, most of them are wonderful examples of how to send the interview panel to sleep or rushing for the bucket. By reading a bunch of them youll see what not to write and how just not to be yet another boring intelligent person, albeit one who checks all the boxes.