Let's say I go through my third year and I realize I want to do a different competitive specialty. How would that play out?

[CuriousMDStudent]

Context: I am an MS2 at a T15 medical school. I have been working towards ortho since day 1 because I found it interesting. I have 4 pubs submitted and am still working on a project that I will be first author on but should be done by the beginning of my third year. I am in good academic standing so far.

A lot of my MS3/MS4 mentors were also set on ortho since day 1 but tell me that I should be cautious of this as many decided to switch to a different specialty after their surgery rotation, citing lifestyle to be a reason. Usually, they switch to PMR or Psych or etc which makes sense and seems like an easy switch as they pushed themselves hard to get into ortho and were strong residency candidates for other specialties

However, I want to pose a hypothetical situation. Let's say I honored all of my rotations and got a competitive STEP score for any specialty. Is it possible for me to match into a hypothetical competitive specialty like dermatology? If so, I assume I would need to take a research year? How would that even look? Would I be sitting in my apartment doing research for a year? How would I be paid?

I cite dermatology because it is the most competitive lifestyle specialty and lifestyle seems to be a reason a lot of people drop out of surgical specialties and I think it would give me a good idea of what to expect. I assume for other specialties like PMR or ER it is simply a switch. However, for competitive ones like optho, rads, anesth, and derm, would I need a gap year. How does it work?

A lot of my attendings in competitive fields say they literally made a last minute decision on their field at the end of third year and never were set on anything until the end of all of their rotations. However, I wonder if that advice is outdated. I do plan to go into each one and really enjoy/learn from them.

I am making this post because I think it would be stupid of me to ignore the possibility that I will go into my surgical clerkship and realize I do not like it. I think I like surgery to be honest as I like procedural stuff, I like the OR but I also really like the clinic and patient care. So I chose ortho because it seems like a good mix of OR and clinic which is important to me. However, many people warn me that they felt similarly until they had to wake up daily at 4 AM and were sleep deprived and exhausted from all the work. If I realize the surgical life is not for me, I am curious what my options are and how I would go about achieving them.

tl;dr: If I were to switch from ortho to a competitive specialty, what would the path look like hypothetically if I had strong stats and decent research in ortho? Finally, I ask that if possible please don't roast me for my naiive questions. Like many on here I don't have anyone in my family or close to my family who are in medicine so I feel that I am flying blind a lot and so I come here to get advice. I appreciate all of the advice people have given so far to me on here.

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[ACSurgeon]

If derm is the competitive specialty you might want to pursue, try to shadow in it and have an elective early third year. You can even get some research going just to explore your interest in the field.

If you have multiple competitive fields Abd you won’t know until end of 3rd year which one you want, then you’ll have to do research.

If you decide to take a research year, you should try to find a paid research position through your school or one of the National programs.

 

[Chelsea FC]

You do what most late deciders do when they realize they want a competitive specialty. They take a research year to network and build up their app. Also give you tons of time to ace step2.

 

[Maximus2020]

I was in your same shoes. Ortho-bound til February (late 3rd year) at the surgical rotation. Hated it, despised the people, had to peace out.

Choosing a ROAD specialty is the best decision you will ever make in your life (outside of investing in Shiba Inu)

I took no gap year but had 10+ pubs and great scores etc. You mentioned 4 submitted - nothing matters unless actually published so keep raking in the number of papers. More the merrier. Do your surgery rotation early. If you switch paths, do an elective and 1-2 papers in that new area and get a LOR from your PI and a clinical attg in that new area. You'll be fine.

Taking a gap year is a huge decision. Consider that a year lost of attending salary. I also just worry on the political climate that physician salaries will continue to decrease over time so the faster you get out and start making money, the better.

Happy to chat more if any other Qs.

 

[TelemarketingEnigma]

ortho > derm (or ophtho, uro, etc) is going to be a lot harder than ortho > gen surg, or something else. Also depends strongly how flexible your school is about scheduling, and how much you care about prestige.

One of my close friends completely changed course from IM to Gen Surg at the end of our 3rd year, I wanna say around april? We'd set up our 4th year schedules and everything long before that, but our surgery clerkship director and various deans really supported them in getting their whole schedule rearranged so they had all the surgery rotations they needed to get letters etc. they already had some ECs that weren't directly gen surg but related enough, and I think had a couple case reports thrown their way so they could try to publish. They are doing pretty well so far with interviews.

If your school isn't flexible about scheduling, or you need to do away rotations, things could be a bit trickier.