Why do you pick what you pick?

Pre-Med & Medical School Pre-Med Topics
1

<p>My mind wanders a good bit. I have had a really close relationship with my D and now that I am getting to be pretty useless (as was the plan) my wanderings lead me further afield. D takes the MCAT this summer after her second year of college, after a summer of paid research and the full Kaplan course, and after what she considers sufficient coursework (she's a very good test-taker). </p>

<p>Although I still can't tell you with any certainty what course prereq's are for D's likely schools (AP and dual credit questions), or even what schools will be in play (other than the Texas schools) , and can't tell you what schools are likely to offer her financial help in attending, I seem to have let my mind leapfrog to what type of med school program will best fit her. Traditional, Mixed, PB? </p>

<p>She presently plans on a career in academic medicine, teaching some, doing research, and having some portion of a clinical practice (presently ENT has the nod, used to be Opthalmology, for a short time Plastics, and before that Cardiology- all of which she has shadowed pretty thoroughly). Yeah, I know - naive and horribly optimistic but I wouldn't put it past her to surprise us.</p>

<p>To that end she has announced to all that she will be doing a MD/PhD. and hopes to do one at fully funded MSTP program. Yeah- I know. Naive and horribly optimistic again. There do seem to be some alternatives in that some schools have a halway in between program it appears , a funded research year?</p>

<p>So , since I don't really have a specific question I phrased it this way - Why do you pick what you pick? I mean since it's likely that your favored practice area will change during rotations (if my reading is correct) what are the factors y'all would think need to be considered? Don't avoid the obvious because I'm may not be smart enough to know what's obvious to the rest of y'all. Thanks in advance.</p>

<p>Assume for the sake of the thread she will be a compellling applicant with "very good numbers" , rec's, and EC's (both medical and otherwise).</p>

2

<p>Are you talking about why we pick certain specialties or certain med schools?</p>

3

<p>1) Absolutely correct to assume that things will change once you do rotations during third year - simply for the fact that it happens so frequently. </p>

<p>2) Most people I've talked to have started out thinking in big categories - kids vs adults, procedures vs none, building long term relationships with patients vs only seeing them once or twice. </p>

<p>I think this is a very appropriate initial strategy. If you hate working with kids (or their parents), don't like working with your hands, and want to have extended long term relationships with patients then pediatric surgery is certainly a horrible choice. </p>

<p>The one drawback is that some fields don't fit very well into the framework or at least are pretty surprising as to where it seems they actually fall. For example pediatric orthopedics is actually pretty heavy on the long term relationships - whether for scoliosis or cerebral palsy or even club foot, those kids get seen frequently. Compared to adult ortho, its pretty different in that category.</p>

<p>3) The obvious reason people change so much during third year is because they finally get to see what it's like day to day. One of my good friends has kind of bounced around all third year based on what he just finished up with. He's finally gotten to the point that he's decided Anesthesia because one of the things he dislikes about the medical and surgical teams is the infighting that goes on over who is the primary team. He doesn't like that every team is trying to get away from doing work in these situations, and he sees anesthesia as a place where he'll rarely have to deal with that. That's obviously not his only reason for picking anesthesia, but it's a pretty big one, and its certainly something you'd never know until you get on to the wards.</p>

<p>4) The other thing to consider is lifestyle. That's a big concern for a lot of women, but plenty of men too. I loved my two weeks on peds ortho, but even after only a couple of days, I knew that I wasn't thrilled (to put it mildly) about the prospect of doing an ortho residency. </p>

<p>5) At the tail end of it all, there's minor factors, things that slightly modify how one feels about things. For example, I know I want to do a peds subspecialty, but I'm currently stuck on the decision of whether to do a regular peds residency or a combined med/peds residency. The heart of my reason for even considering med/peds is that many peds subspecialists end up following their patients for many, many years, even into adulthood because many of the adult specialists are not comfortable dealing with they types of illnesses/conditions these patients bring with them. There are several peds cardiology fellowships which are only recruiting med/peds trained residents. This is again something that only comes into play when you've narrowed it down.</p>

<p>there are certainly more things I can go into. I might post some more later.</p>

4

<p>norcalguy, both. Like I said , I don't even know the questions. ;) Those of y'all who are selecting what med schools to apply to/attend have to be doing some "sort". Other than Texas for my Texas D (for what I assume are obvious reasons) , what are some other things you would look at? And why? I mean it seems silly to base your decision on a specialty or match results for that specialty if you have zero idea of what that specialty will really be. And once you got in, did you consider the 5 year programs? if yes-why? If no- why not? And then finally, what really pulls somebody to a specialty? brm's post gives me some ideas of initial sorts that can help limit areas, but how do you set yourself up to where you can best take advantage of those opps? Is that something you should try to do when selecting schools to apply to? Or do you just apply where you think you'll be able to afford and get in? </p>

<p>Just more of a free floating set of questions- like this one : assuming you are where you are as part of a "plan" you made (ex. traditional lecture based, no patient contact till later, primary care emphasised , no research year, no MD/PhD., no academic medicine, great plastics and opthamology matches) how did you decide on that plan? What did you consider? What did you reject as criteria?</p>

<p>Another example, D and I have discussed PBL and lecture and she says she could do either. Pass/fail or traditional grades- again, she doesn't seem to feel that strongly about it. Feels she can grow where planted. I don't think she cares too much about where she is, either instruction type, grading, or geographically. All 3 are of less importance to her than they would be to me, for example.</p>

5

<p>I can't speak for picking specialities since I'm a premed myself.</p>

<p>As for med school, if she's planning on MD/PhD, her choices of where to apply will be easy: there are only around 35 MSTP schools. Most MD/PhD applicants will apply to most of the MSTP schools. Since your daughter is a strong applicant, I'm sure she'll apply to most of the big names (if you think about it, a Top 20 school could be in the bottom half of the MSTP schools) since, for academia, the prestige of your school is relative important.</p>

<p>As a non-MD/PhD applicant, I mainly used the MSAR to narrow down my choices. There are only 125 or so MD schools to begin with. If you simply use two factors to narrow down schools:
1. MCAT/GPA
2. Location</p>

<p>You actually end up with relative few schools left. That's why 1/3 of all MD applicants apply to Drexel and 1/6 of all MD applicants apply to Northwestern...there simply aren't that many private med schools in urban areas to apply to. My own personal list was top-heavy since I want a research-oriented school. I ended up with around 26 schools or so that I applied to. </p>

<p>I use things like happiness of the students, PBL vs. traditional, etc. to make final decisions on where to matriculate. Most med school applicants will get accepted to 0-2 schools so there's really no need to limit yourself before you get the acceptance decisions.</p>

6

<p>Curm -- sent you a PM talking about school selection.</p>

7

<p>


</p>

<p>Oh, joy. Oh, rapture. Something to look forward to.</p>

8

<p>As far as the choosing where to apply - my first consideration was "where am I most likely to get in?" So I spent a lot of time looking at average MCAT and GPA. </p>

<p>Seriously, everything else was a distant, distant, distant second in regards to selecting schools. Like NCG, location was probably my #2 consideration. </p>

<p>I think in the end, the educational method doesn't matter, and given the results on USMLE Steps 1 and 2, and in the Match, the data seems to support that. Personal preference might push you slightly one way or the other, but I think that should only be a consideration AFTER you've been accepted to two schools with different options.</p>

9

<p>Back to specialty choice, the following rundown is something my peds clerkship director went through with us as one way to look at things that will influence specialty choice. It's by far the most cohesive advice I've gotten from any attending about specialty choice - since most of them say lame things like "find what you love and then do that". The four categories are fame, fortune, lifestyle and brain candy.</p>

<p>FAME - Do you want to be that doctor who shows up at a cocktail party and everyone knows who you are? We're not talking Dr. Gupta/CNN fame, but a variety of factors like the wow factor, or the respect within your field, or the respect other doctors/persons in your community give you. For example, neurosurgeons certainly garner that WOW factor when they meet someone. Other people want the notoriety from their patients and that's it. A General Pediatrician isn't likely to get the same response as the Neurosurgeon when they walk into a room, but may very well be more beloved by their patients and their parents. Other people want to be well respected in their community, really be seen as a pillar - these people might prefer to end up in a small town and be THE DOCTOR in town. Other people might want to be in a larger city, but want other doctors to say "when Dr. X speaks, pay attention" these might be your med school faculty who are focused on general areas of medicine.</p>

<p>FORTUNE - I don't think I need to explain this, but keep in mind your financial goals. No doctor is going to have trouble paying the electric bill. But some people want a Mini Cooper, others a Lexus, and some want the Lamborghini. Some people must have a vacation home. So pay does matter in keeping you happy if you have certain financial expectations.</p>

<p>LIFESTYLE - Another self explanatory one. If you want 9:30am to 4:30 pm clinic hours with no call, there are some things you simply CANNOT be. Other people love being called into the OR at 3am.</p>

<p>BRAIN CANDY - do you like knowing a little about a lot of things, finding out your limitations and then passing patients along to someone who knows more? Or would you rather know everything about one little part of the body? Can you handle the complex problems where it's never really clear what's going on, the sort of case where you entertain the patient while nature cures the disease? Or does uncertainty drive you crazy? Some people love finding that one little detail that clinches a diagnosis, while other people are much more comfortable with not having it all make sense, especially if it's not going to change the treatment. The other consideration is that some people really enjoy coming in as a consultant to deal with only one problem and then leaving the rest of the patient to others. Doctors who would enjoy being hospitalists will find much more happiness from having to balance all the problems, handle the differing recommendations from the consultants and making sure the loose ends are taken care of. Even further, some types of doctors - diagnostic radiologists and pathologists for instance - prefer to be purely consultants, just giving information to the primary teams and not doing anything more than that.</p>

10

<p>I think in the end, the educational method doesn't matter ........Personal preference might push you slightly one way or the other, but I think that should only be a consideration AFTER you've been accepted to two schools with different options.</p>

<p>Thanks, that makes sense.</p>

<p>And I will send D your Fame, Fortune Lifestyle, Brain Candy matrix. ;) That'll get her thinking in the right direction. </p>

<p>brm, did you give any of those things consideration in your school choice? I think you knew you were "destined" for primary care, correct? Did that play a role in your app process or just in your acceptance process? Or if I remember correctly, you only applied to a couple of schools, right? I guess you pretty much knew beforehand.</p>

<p>I just know some schools actively court and have in their mission statement the "education of primary care physicians".</p>

11

<p>Choosing a specialty is a mix of rational and irrational processes. During rotations most students will form opinions along the lines of "I could do that" or "No way, would I ever do that" for most specialties. Often, an particularly interesting clinician will influence or even advocate a specialty choice.</p>

<p>Specialty features to consider include:
clinic based or not
episode based or long term relationship with patient
identification as the patient's Doctor (vs. nameless consultant)
ability to deal with stress
ability to make decisions with incomplete information
ability to work with other physicians
manual dexterity
tolerance of interuptions
call intensity</p>

<p>UVA has a Java applet which suggests specialties at Medical</a> Specialty Aptitude Test. Some of the 130 questions are redundant, but the approach suggests what questions might be useful to consider.</p>

12

<p>I'm not destined for primary care at all. At the moment, my first choice is Peds Pulm, then Peds Cardio, and just recently Peds Critical Care is making a run into my top three. GI is kind of falling off at the moment. While going into peds or med/peds would place me in USNWR "% entering primary care" in their ranking metric, I have no intention of being a general pediatrician (though, if I could get someone to pay to do well baby checks on 4 to 6 month olds all day, I'd probably take it - I could definitely be happy doing that all the time).</p>

<p>I made the mistake of only applying to 7 schools, not realizing at the time that applying to many more was so common. </p>

<p>Many state schools do actively pursue the education of PCP's. After dating another medical student who went to a different medical school, and in talking with other students elsewhere, the biggest way they do this is simply to make their PCP clerkships a priority. For example, my school has 8 weeks of family medicine and we're required to go to a rural town to do it (which is certainly different than my ex who stayed in our large city for her family med month). Lots of other schools have only 4 weeks of family (or none). But they also require their third years to do 4 or 6 weeks in Neurology or Emergency Med which we don't get. Also our internal medicine clerkship is 12 weeks long - which is 4 weeks longer than any other place I've heard of. But in order to manage that, we only have 6 weeks of psych and 6 weeks of OB/GYN. At least for me, it's never felt like there's been overt pressure to go into a Primary care field, but you can see how the structure is set up to give extensive exposure. I imagine that at schools more heavily concerned with research there are similar "facts of life" sorts of setups to get students involved.</p>

13

<p>Internal medicine here is 12 weeks also; we do have a neurology requirement and no primary care/family practice requirement. Psych is four, ob/gyn is six.</p>

14

<p>All very interesting. More to contemplate when the mind gets to rattling around.</p>