Conflict

I am having a lot of inner turmoil these days. I was (smartly) advised to blog about these feelings so I can look back on them one day and (hopefully) be reassured that I thought out my situation well and made the right choice. Long post ahead, be warned.

1. My 4th year schedule is due on the 25th of this month. This is VERY soon. In order to fill this out, I need to have picked a specialty pretty definitively. At this point, I am deciding between Pediatrics, Psychiatry, and Emergency (ED). The problem I am having with this is threefold:
A. I do not have my ED experience until my elective in March. On paper, I think it sounds great (predictable hours, no being on call, shift work, easy to do part-time, exciting, no need to stay late or follow up on patients). In practice, I've got nothin to go off of, and won't until March. This doesn't help me when a decision must be made in about a week.
B. I am on Psych right now, and I am having a mini conflict about it. I went into this year with Psych at the top of my list. Now, after one week of child psych and 3 days of inpatient adult psych, I am not sure how much I like it. I knew the thing that would draw me to Psych was the theraputic part; I did not want to be a "medication manager" and ignore the patient's psyche. All I have seen is medication management. This may be the environment that I am in, but I'm not convinced that it is. I also feel like it is incredible subjective; one patient may be diagnosed OCD by one doctor and ADHD by another and be put on completely different meds even if the diagnosis was agreed on. I do not know how I would ever know that I was doing a good job or was doing it right. Also, EVERYONE gets diagnosed with something. Obviously they are at a psychiatrist because it is causing them distress, but it is discouraging. Lastly, most of these patients will not really get better, and it can be a lot of trying to convince someone to change something about themselves that they do not think is a problem. In short, like banging your head against a wall while trying to convince it that it is really a pillow. This was a long rant about Psych, but I am frustrated by these feeling because I really thought I would love it and while I like parts of it, I do not think I love it.
C. I got the score back from the Peds exam I took in December...not too hot. I passed, no problem, but it was actually worse than my Internal Medicine score, which is VERY surprising. I know one exam is not everything, but it is very discouraging...how can I believe that Peds is the right choice for me if I do poorly on it? Based on the above two worries, it would be logical to put my stock in Peds, schedule my 4th year for that, and just be done with it. I know it makes me really happy, I know that I miss being around the kiddos, I know that there are a lot of other positives about it, but this exam thing is seriously throwing me off. I should wait until I get my clinical evaluation from my supervisors back and see what that said (since what I actually do with the kids counts way more than some silly test), but unfortunately it will probably be months before I get that back. Again, not helpful when my schedule is due in a week.

2. Apart from not knowing what I want to do, I am having problems with the logistical aspects of the scheduling. There is a lot of strategy involved. For example, if I am interested in doing a Peds residency at a particular hospital, it is advised that I do a "sub-internship" there during Nov, Dec, or Jan. A "sub-i" is where I will act like an intern (interns are in their first year of residency) so that the program can evaluate me and decide if they would want me to be an intern/resident with them. It is basically an audition. So I need to be strategic about when I do my sub-i, and I also need to decide how many hospitals I want to try to do it at as well as at which hospitals. So not only do I need some idea of WHAT I want to do, but WHERE I want to do it at. How in the WORLD am I supposed to know this?!? How am I supposed to know which programs are good and which are not and which are too good for me to ever get into? How am I supposed to know even what CITY I want to live in if I haven't even ever been there? Apart from the strategy is scheduling sub-i's, there is also leaving time to interview, scheduling easier/more flexible rotations during interview season, choosing what other rotations I want to do, trying to find a research project/mentor, etc.

3. I am coming up on Step 2 of my licensing exams. Now, it feels like I just took Step 1 (which I did, last June), and I am DREADING going through that studying process again (the schedule is much the same...multiple weeks straight of studying 10+hours per day). Step 2 is divided into two parts: Clinical Knowledge (CK)- the multiple choice exam, and Clinical Skills (CS)- the practical part. There is strategy about how and when you take these exams as well. I think I have decided to take them both in the same month, which I hope goes well...just get them over with. There is a lot of scheduling involved, as CS is only offered in 5 cities and I have to travel to take it, and I need to schedule time off from rotations to study for CK. I do not want to study again and do poorly or only as well as I did on Step 1. To help me with my residency applications, I need to do better on Step 2 (particularly CK), and I'm scared that I can't do any better than I did on Step 1.

Clearly I have a lot on my plate right now and trying to stay organized and on top of the rotation I'm currently on while trying to figure out the rest of my life is very, very taxing. I have made probably 25 lists in the past week of things I need to do, people I need to email/call, things I need to study, things I need to check on for my patients, etc. I guess I have learned that about myself...when I get stressed, I write lists. It is a little pathologic (I'm probably looking at it like that because I'm on Psych!), but I don't know how else to feel like I have any handle on everything that is going on.

This has been long enough. There is more, I'm sure, but that is all for now.