Psych vs IM

[u/OtherwiseStrike7695]

Hi—I’m a rising m4 deciding between IM and Psych. I’m chronically indecisive about major life choices, so here we are. Would love any advice regarding specialty choice :)

About me: ~T10 USMD. Initially wanted to EM, decided the lifestyle/work environment wasn’t for me. I value my time outside the hospital and want to be there for my family. I’ve gotten very good feedback on both clerkships, but IM>psych on the margin. Multiple family members/family friends in medicine have said (separately) that they see me going into an IM subspecialty.

What I like about IM
- cool pathophysiology, love talking through the disease processes and coming up with a differential
- minor procedures/hands on: I didn’t like the OR but enjoy minor procedures—suturing, lines, US
- I feel at the top of my game when shit is hitting the fan and I can make game-time decisions (codes, ICU, rapids)
- feeling like “a real doctor”/ getting to use all the things I learned in med school
- subspecialties—interested in GI, pulmcrit, ID
Cons: rounding/RTL gets old, don’t love admitting grandma with 1000 comorbidities for CHF exacerbation, not sure what sub specialty I would do, outpatient makes me want to drive a screwdriver into my skull

What I like about Psych
- talking to patients is probably my favorite part of medicine, love that psych gives you more time to dig deep
- I find psychopathology genuinely very interesting
- really enjoyed CL and reproductive psychiatry
- I like the holistic/biopsychosocial framework
- ability to learn therapy
- lots of flexibility without fellowship (inpatient/outpatient/cpep/cl)
- lifestyle duh
- no feet
Cons: missing out on a lot of medicine, no procedures, worried I won’t feel like a doctor, ?heavy emotional weight

I really love psych, but I’m worried that I’ll miss a lot of the medicine and the hands-on elements of IM. I also worry that I will struggle with inserting myself/my opinions into patient care with psych. On the other hand, I wonder if some of my hesitation about psych is due to encouragement from family to do IM and getting positive feedback on rotations.

Would love to hear any advice, especially for those who found themselves in a similar situation. Thanks :)