“I’ve always known that I wanted to be a __________” and other self-fulfilling prophecies

This is a post about thinking (read: freaking out) about choosing a medical specialty.

Before starting: yes, I am fully aware that no one needs to choose a medical specialty during first or second year. And yes, I know that many older students/residents will write this off as simply gunner or fanciful or both.

But I can’t help but think that the majority of first year students do spend time thinking about this topic, and moreover could benefit immensely if they happen to guess correctly their medical specialty of interest, or at least, the ballpark of medical specialties they would enjoy.

The benefits are self-evident:

1. we have more time to think about specialties, shadow, meet more people, ask more overly direct questions to physicians during lunch talks before slinking off into the background (the book “The Ultimate Guide to Choosing a Medical Specialty” is very good too);

2. we have more time to prepare our extracurricular portfolios (even though people will swear again and again that “it doesn’t matter” and “they just want to see leadership/involvement/work ethic,” obviously the people interviewing you will be more interested in any work or research you’ve done in their field);

3. we get procrastinate studying renal physiology by agonizing over personality tests online that TELL YOU YOUR FUTURE! (here and here).

The medical specialty selectors (I’m partial to the SDN one for the ease of use) may in fact be very insightful, although their methodology is vague (“I have a 70% match with surgeons? Does that mean I will be 30% unhappy???” Cue me exploding in a pouf of bad statistics and pessimism).

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4 Things about the beginning

The first few weeks of med school have been sort of busy (kind of a lie, but I’ll go into that later), although that’s not really the reason why not to blog. Mostly the reason is that as much as I’m a go-with-your intuition kind of writer (you’re never going to see as many data/citations as with C), new situations means that I’m often vacillating as to how I feel or think. Here are just some thoughts:

  1. Med school is like being premed with a sick twist: the pass/fail (at C and my schools) makes it, in my opinion, a different playing field. On one hand, it means that other things are much more important: research for example. On the other hand, we still need to do well on Step 1. I’ve been a little surprised that many people (maybe me included? I’m not sure) have a really hard time adapting to this. By all reasoning, we should be a little more lax in our study schedules as not everything we are supposed to know for tests will be high yield for Step 1. Moreover, we’re not likely to retain all this anyways. And yet people are very very unnerved by not knowing everything – not feeling like they’re going to ace the test or at least do above the mean. (I was never the type to review lecture notes after class during college, and was really surprised that such people actually exist! Figures I would meet them in med school though.) The game has changed, and I have been trying to adjust to that why I’m writing this now rather than studying for my biochem final on Friday. But that has only made me more anxious about finding a lab (see 2 and 3).
  2.  I have a lot of free time. First year in my program gives us tons of free time. Some people choose to spend all that time studying. I am currently spending it being anxious (see 3), hyper-energetic (went out more and harder than I had ever gone in my life in the first 3 weeks of med school – bars/clubs every day of the week for 1.5 weeks straight), or just bored (watching TV shows every day), frantically setting up opportunities to shadow. Perhaps this excess of free time will stop, come anatomy and when I join a lab.
  3. Thinking about residency makes me bat-shit crazy anxious. As I’ve only in the last couple of month decided I am much more interested in surgery and subsurgical specialties than I had thought, this has made me sad about how damn hard it is to match into good residency programs. People make it sound like a fifth year is necessary for competitive specialties and that makes C and me sad because it means more time apart, and maybe not matching in the same year. Also, 2 of the specialties I am a bit interested in are early-match and so that would mean no couple’s matching. Given that C and I are very research oriented, I’ve had to think about this a lot as I feel some pressure to choose a specialty now to start research in it. I will probably look back on this and laugh my ass off in third year when I do a 180* and choose something totally different.
  4. It has been interesting to go to a different school than C. In some ways it has been a little lonely but in many other ways it has been very, very exciting and positive. Other than the getting used to not having a “family unit” to retreat to every day, it has been wonderful because we can do similar things at two different institutions and talk about them. We can be involved in the same extracurricular groups at two different schools, for example. However, this experience has also so far reverted me back to freshman year of college – looking up at C and wondering how I will keep up. He’s always so ahead of the game at the start, and I feel like I’m always scrambling to keep up: in terms of deciding on a field that I’m interested in, getting involved with extracurriculars, etc. But that’s just in his personality to be excited about the future. I suppose that is how he has always made me a better student.


Top reputation residencies by specialty

I noticed most hits this blog are to previous posts about admissions or residency. The following is a relevant re-post from SDN. The list is biased towards academic programs. It is assembled from a large number of anonymous posts online in specialty forums on SDN, orthogate, uncleharvey, urologymatch, otolaryngologyresidencyapplicants.yuku, as well as the Ophthalmology Times survey of program directors. The higher on the list a program is, the more I felt there was a consensus or really strong opinions. It provides only a rough ranking.

Disclaimers: These are not based on objective data. They are based on the opinions people with no specific qualifications other than participating in specialty forums. These are not my opinions. I have no qualifications to talk about this beyond aggregating the opinions of others. If you feel your favorite program was unjustly left out, you should take your rage to specialty forums and leave civilized comments here. The quality of programs can change over time. These residencies may not fit your interests and other very important considerations in making a rank list (location, significant other, malignancy, community/clinical/research focus, etc.).

Hopkins, MGH, UCSF
BWH, Stanford, Columbia, Duke
And many others (Penn, Wash U, Michigan, U Washington, UAB, Mayo, Cornell, Wake Forest, UCLA, UVA, Wisconsin)

Penn, UCSF, NYU; Harvard, Stanford
Yale, Columbia, Michigan
Mayo, Miami, Emory

Emergency Medicine
Methodist/Indiana, Cincinnati, Denver, Hennepin, Carolinas, Pitt, Highland
Chrisitiana, Vanderbilt, UCLA-Harbor, Cook County, Emory, Harvard/BWH
??? USC-LAC, King’s County, Maricopa, UNM, U of A, U of M, UCSD

More after the jump…

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