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The Shortlist – Year Three

At the end of my first year of medical, I made a shortlist (year 1) of specialties I was considering. At the end of second year, I made another list (year 2) of specialties I was thinking of doing. Now, after finishing my third year and more importantly the clerkship year, I will present my thoughts on what my current specialty choices will be. There are some specialties I have gained a greater appreciation for while others that have fallen on my list. Here are my top picks, bottom picks, and some hidden gems.

Top 5

  1. Internal Medicine
    This topped the list in first and second year, and I really enjoyed my medicine rotation despite how crazy/busy it was at times (a good sign?). I’m interested in the wide variety of practice, the different subspecialties and diversity of patients. I am about 70% certain I will rank it as my first choice for the upcoming Carms application.
  2. Family Medicine
    Primary care has definitely jumped up quite a bit since the beginning of medical school. I never thought I would enjoy it as much as I do. I like clinics, having your own patients, continuity of care, preventative medicine and being the primary care giver. It’s an incredibly challenging field; you have to know everything about everything, and it’s definitely under appreciated. But you can tailor your practice or schedule to whatever is flexible for you. You’ll never be worried about finding a job. I am most likely going to apply to both Internal Med and Family Med, I know I’ll be happy with doing either.
  3. Emergency Medicine
    Fast pace, high acuity, ability to make a difference quickly. What’s not like about the ER? I’m more open to the shift-work schedule now, still not liking the lack of continuity, but I’ve seen some docs have clinics to follow up patients they see in the ER too. If I was to do ER, I would probably go through the FM 2+1 route though.
  4. Psychiatry
    Big mover. In first year, this was on my bottom 5 and now it’s moved to the top 5. This year, I enjoyed my psych rotation and gained a much better understanding of mental health. I may have also had some preceptor bias, but who doesn’t?
  5. ??? – Couldn’t think of what to put here. The rest were either specialties I really didn’t like, or ones I didn’t care too much about. But it would probably one where I would talk to patients.

Bottom 5

  1. Obs/Gyn – Definitely returned to the bottom 5 this year. Just way too much estrogen (the patients and the colleagues) for me. And the vaginal bleeding… oh make it stop!
  2. Radiology – In first year, I seriously considered doing radiology. I did several electives and shadowed quite a bit. I know now it was never meant for me. I was attracted mainly to interventional radiology, a small subsection of radiology. But I don’t think I could ever do the bread and butter of sitting in a dark room, staring at a screen and interpreting films all day.
  3. Pediatrics – I like kids, but perhaps they didn’t like me? I realized quickly I don’t handle crying babies and crying parents too well.
  4. Pathology – They’re very good at using the microscope… not for me.
  5. General Surgery – I actually liked the surgeries themselves and got to home my technical skills. The interventions they do are fascinating and there is satisfaction from fixing things. But the grueling residency + lifestyle afterwards, combined with a hierarchical ladder and the “surgical culture” ruled it out for me. And I only found it like this for general surgery… I had better experiences with subspecialty surgeries.

Hidden Gems

  1. Anesthesia – Great lifestyle, interesting medicine, lots of procedures. If only I didn’t enjoy talking to patients as much… definitely recommend checking it out if you don’t know what it’s about.
  2. Plastic Surgery / Urology / ENT / Ophtho – Subspecialty surgeries have it pretty good. Less grueling hours, interesting cases, cool toys, good mix of clinics and surgeries. If you’re interested in surgery, I would highly recommend you check out some of these subspecialty surgeries first! There’s a reason why they are so competitive.
  3. Dermatology – Even though I still think the majority of their practice is just prescribing steroid creams, this year I got to see more of what dermatologists do. From small procedures to cosmetics to cancers, dermatology is actually a pretty neat specialty. Lots of medicine to learn and a great variety of things to see (it’s not just acne!). If it wasn’t its only specialty and was still in Internal Medicine, like the old days, I might have considered it more, but now-a-days it’s crazy how competitive it is to get into it.

That’s it for now. I’ll post about my clerkship year and my thoughts about my different rotations next!

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  1. Hello
    Hello August 3, 2011

    When do you apply for CaRMS? Is it before, at the beginning of, in the middle of, at the end of, or after fourth year?

    What about schools such as Calgary and McMaster? When do they apply?


    • medaholic
      medaholic August 3, 2011

      You apply for Carms during your 4th year, for schools like McMaster and Calgary it would be their last year (3rd)

  2. Joshua
    Joshua August 3, 2011

    I don’t start clerkship until end of this month, but my current list would be almost identical to what you’ve posted here!

  3. Josh
    Josh August 3, 2011

    I’m still mulling (perhaps I should finally post something again). But as it stands it’s something like Gen Surg, IM, or (maybe) Anesthesia. I liked family a lot, but not so much emerg – it’s like endless clinics in a more stressful, less thorough environment lacking in any of the more interesting follow-up or definitive management.

    It’s interesting to note how important the “team” or “preceptor effect” comes into play in these situations. Gen Surg was one of my more collegial rotations and I really enjoyed consults and the kinds of management decisions that come up. On the other hand, I really wish I’d been considering/preparing re: Anesthesia a long time ago, but that window may be closing already. And I do like talking to patients…

  4. Spencer
    Spencer August 6, 2011

    For the Carms application, do you pick 2 or 3 specialties?
    As well, I hear that neuro and cardiac surg has lots of job shortages. Is this the case for orthopedics, general, and all the subspecialty surgeries?

    • medaholic
      medaholic August 7, 2011

      Varies between different surgeries and locations. Hard to say, job market tends to change a lot by the time you’re done.

  5. m
    m August 6, 2011

    Just curious, are medical students guaranteed to get at least one (whether they like it or not) residency spot after graduating? If there isn’t, do they do something like a Victory lap?

    • medaholic
      medaholic August 7, 2011

      There’s no guarantee

      • m
        m August 7, 2011

        Stay behind a year then?

        • George
          George August 19, 2011

          if you only rank really competitive specialties (only rads/derm/plastics, etc…) and don’t back up, then you risk going unmatched for iteration R-1. at that point, you could try to match into R-2 (this is where usually IMGs match into) but spots are very limited – most common is matching to family or maybe internal or paeds in R-2.

          you could take a year off though. I know someone who did a master’s during the year off, got some stuff turned around really quick (posters, abstracts, author on a few papers) in plastics, and then matched the plastics the next round of CaRMS. it’s dangerous though because the same program directors are interviewing you and they’ll remember you from last year…

  6. Ideas about potential specialties at day zero « Paradocs
    Ideas about potential specialties at day zero « Paradocs August 24, 2011

    […] a couple similar posts about top and bottom five specialties from Medaholic (year one, year two and year three) and Idiopathic Thoughts.  Thanks for the inspiration and thoughts guys! Advertisement […]

  7. Now I think I have to make my list too. I’m still at my 2nd year in med school though but all that’s in my head is going to General Surgery and I haven’t figured out any back up specialties. Is Internal Med any good? or is it one of the many specialties that a lot are going in to after graduating?

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