At this point my second year of medical school and with clinics on the horizon I feel like I need to start turning ideas over in my head a little more frequently. I have to agree with people that it's never too early to start thinking about what you'd like to do, because your first year of medical school goes by so quickly, and we're already in September.
Everything is really hazy when it comes to something I'm super passionate about. Head and neck surgery seems thrilling and I loved learning the anatomy and idea of diverse fellowships like oncology, trauma, and reconstruction.
I figure that if you want a surgical field, you have to really love the anatomy and maybe even dream/daydream about it a little bit. Pediatric surgery seems fascinating and I have a little shadowing experience in it: I like the idea of correcting congenital defects and while I probably wouldn't see my patient grow up, I think I'd be happy knowing I made a difference. The 5 year general surgery residency on adults and then applying for a 2 year pediatric surgery fellowship seems like such a long time, but again, this one of those things where you do some deep soul-searching. Remember that surgery is one of the few fields where you can look at an X-ray and say "let's fix that," and then see your patient go home with a problem solved.
Cardiology seems amazing for the variety in the sense you can specialize in EP, invasive procedures or focus on nuclear imaging. If you're interested in a right-then-and-there specialty with long-term patient care, think about this. I don't know how the hours vary compared to surgery and I don't want to speculate, but this field is notorious for call.
Oncology appeals to me because research is booming, with the advent of small molecule therapy and advances in radiation oncology. Also, you can be a long-term counselor and teacher and figure of support for your patients and their families who are going through a dark time. A lot of oncology is outpatient. There are some parallels to treating infections in the sense that a lot of cancers can resist chemotherapy, and not everyone responds to treatment. In addition to cancer, you'll be seeing infectious diseases not common in the everyday patient, because of immune suppressing regimens. I don't know if the oncologist manages those infections or ID does. I'll have a better idea when clinics start and update this.
Critical care seems interesting for the acuity and I imagine it has to be really rewarding getting a patient out of the ICU and back home. However, a lot of patients don't make it out, and I've heard figures as high as 50% (though I don't know if that's the norm or anything). Putting in lines seems exciting, but I'll probably wait until after my rotation really get the dynamics of the ICU and how much of a fit it would be for me. Shift work is a plus, but multi-organ failure being commonplace is very hard on the patient, the family, and the care team.
EM for a lot of the same reasons.
The thing is, go into what you love, and not for the money, because I'm pretty sure the government is going to mess with what you earn. I've seen some SDN posts and read some articles about how specialists income has been decreased or how there's less reimbursement for some procedures and how Medicare handles a lot of dialysis (and that the reimbursement isn't that great).
So go for what you love, the money will follow. And don't worry about prestige, because I've seriously seen so many SDN posts asking what the most prestigious fields are, and really, what truly truly matters is how good you are at your job.
Everyone will respect you if you have great interpersonal skills, have a thick skin, have a strong work ethic, are a great physician, and go above and beyond in your service to your team and patients. Besides, why care so much about what other people think about "how good" your career is? You chose it because you love it, and that trumps everything.
Miscellaneous:
As of right now (from AMA's FREIDA) there are more programs in orthopedics than in ENT, kind of crazy right? I really debate if I have a better chance at matching into an IM subspecialty than I do applying for an ENT residency. Time will tell though. Good luck everyone!
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