u/franksblond

M4 here trying to decide on specialties, and rheum is currently at the top of my list (along with pathology)

I really like the pathophys of rheum; it was my favorite subject during pre-clinicals and I always find myself interested when I encounter patients on other services with possible rheumatologic conditions. I also like that the physical exam still seems to play an important role. From my experience on my rheum elective, the patients (at least in the outpatient setting) seemed relatively healthy overall and genuinely appreciative of their rheumatologist which is something I care about.

That said, I do have a few concerns. I often hear people describe rheum patients as difficult or annoying to deal with. However, I’ve encountered far more challenging patients on general medicine wards than I did during my rheum rotation. I’ve also heard that compensation can be relatively low and I can be expected to make about the samej or even less than a PCP and hospitalist, which makes some people question whether the additional years of fellowship are worth it. For any rheum attendings reading this, has that been a concern in your experience?

Finally, I remember seeing survey results showing rheum among the less happy specialties, with some suggesting it’s because of the burden of managing chronic disease. However, all of the rheumatology attendings I’ve worked with seemed genuinely happy and chill so I’m curious where that discrepancy comes from.

Hi! Just started MS4 and still trying to decide what specialty to apply to this year. I have been between pathology and internal medicine (for an outpatient fellowship like allergy or rheum) since the beginning of med school. I’ve come to realize that I’m probably a better fit for path vs IM (introvert, prefer focusing on making diagnoses rather than dealing with social issues, would rather talk to other physicians instead of patients). For the most part, I have liked talking to patients during my rotations which is why I thought I should just stick with IM, but I’ve realized that I only like it when I’m not in a rush and when patients are nice. So, I know my experiences will likely be much different as a physician vs a medical student and can see my self getting burned out. Plus, I don’t enjoy hospital medicine, and outpatient can be draining too, so I’m not sure I’m a good fit for IM/fellowship. I did a path elective in M3 and liked it. I will be doing a path Sub-I before applications are due. If I did path, I would be most interested in heme, gi, or derm path. I would also be interested in teaching medical students or residents in the future.

Work-life balance is the most important for me, and sometimes wonder why I chose medicine in the first place. I don’t want medicine to feel like my whole life. I would rather be able to come home from work and be done with it instead of having to deal with notes/ inbox messages.

I think all of this aligns much more with Path. The only thing that worries me is job market. I would like to be able to have more control over what city/state I live, which is why I was considering IM over path. However, i know that there isn’t really a perfect specialty and I may have to sacrifice one thing for another.

I wanted advice about what I should be thinking about when choosing a specialty. Specifically, some things I wanted to know from path attendings are:

- Pros and cons of path

- Do you have any regrets/ wish you chose another specialty?

-How did you know path was for you

-Things I should think about before choosing path

Sorry for the long post but thank you all so much :)