I've missed the boat by a few weeks, but the 4th years were all busy in the hospital getting their CaRMS applications in. Very excited for them, especially the many excellent students I've worked with in clerkship. I'm particularly thankful to the elective student who was with me on my first week, they were an enormous help in getting adjusted to all things clerkship - while I hope everyone gets a residency they'll enjoy, I have to send extra good vibes to this person.
Ok, enough about other people! Me time! Ok not really, I'm really excited for the 4th years I know going through CaRMS, just couldn't think of a better segue.
I've been giving a lot of thought to my career in the short- and long-term given what I've learned from my time in clerkship. As I'm basically a single year from my CaRMS applications and specialty choice is a fairly important part determining my career direction, I've been narrowing down my options pretty quickly.
I'm finishing up my Pediatrics rotation now. I wanted it early because it was essentially at the top of my specialty list when clerkship started. It has a lot of practice options, there's a fairly holistic approach, people who work in Peds are generally good-spirited, and I really like working with kids. I had a good rotation, minus the traditional Peds rotation illnesses. My residents have been great, the kids were awesome to work with, the medicine was interesting. Yet, Peds is no longer my #1 choice.
As much as I liked Peds, I didn't love it either, and it comes with some downsides. Still not big on inpatient medicine, which is a huge part of Peds residency (consultants have some choice on this). The hours, while not nearly as bad as OBGYN, are still fairly long, with frequent overnight calls (that also gets better once becoming a consultant). The job market is pretty tight for Peds specialists, and I'd have to move a lot to pursue subspecialty training, likely to places I don't particularly want to go. I liked Peds ER, and that was definitely something I was thinking about beforehand, but I don't know for how long I'd be able to handle true shift work. It's not terrible now, but I don't think I'd be comfortable with the chaotic schedule in 10-15 years. If I could get regular shifts week-to-week that'd be one thing, but it's just a very messy arrangement. That pretty much leaves Community Pediatrics, which was also something pretty high on my list. It hits many of my preferences and has a decent job market.
The other specialty I'm considering is Family Medicine. While it's not the only difference, the main contrast between FM and Community Peds is simply patient population. One deals with all ages, the other is kids only. I like working with kids. I also like working with adults, including the elderly. Do I like working with kids more? Maybe. Not totally sure. But I know the difference isn't substantial, if one exists at all. It's pretty much a wash to me in terms of final working conditions.
So it comes back to residency. 2 years vs 4 years. Primarily outpatient vs primarily inpatient. Non-competitive vs competitive entry. Variety of locations vs only major centres.
A common refrain I hear from staff and residents is that you shouldn't avoid a specialty you like because the residency sucks. I appreciate the logic - no point being miserable for decades of your life in a less-than-ideal specialty to save yourself a bit of pain in the early years, and some sacrifices early on can lead to long-term gain.
But that only makes sense if there is a big difference in long-term payoff between specialties under consideration. For me, there doesn't seem to be one. Just as importantly, the next few years really matter to me - it's when I'd like to get married, buy a house, have kids. Trying to accomplish these life goals while in a time-intensive residency - or delaying them in order to finish residency - isn't a trade-off that seems worth it given the minimal differences in factors that matter to me between FM and Community Peds.
This is my long-winded way of saying I'm gunning for FM now. I don't have too many other question marks about other specialties - I either know I don't like them, or there's no compelling reason to prefer them over FM or Peds. Maybe I'll discover I hate FM when I rotate on it, but I've had decent exposure to the field so far and have generally enjoyed it, so I'm hopeful I won't be unpleasantly surprised. I'm a year away from having to make the final choice, but for the first time, it feels like I'm finally settling on a concrete option. That in itself is a huge stress reliever during the otherwise stressful time that is clerkship.
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