The Pre-Med Playbook
The Pre-Med Playbook is the definitive roadmap for the next generation of physicians, hosted by Casey Pearce to deconstruct the pre-med journey from freshman year to the White Coat at NYITCOM at Arkansas State. This series provides a localized, end-to-end perspective on the medical school pipeline, offering direct access to the faculty and students navigating the Arkansas healthcare landscape. By transforming the daunting path to medical school into actionable steps, Casey and his guests provide the structure to turn a dream into a clinical reality at Arkansas State.
The Pre-Med Playbook
A 'Special' Decision: Deciding the Right Medical Specialty for You
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Most people think choosing a medical specialty is a single decision you make near the end of med school. We see it as a long chain of moments: the first patient you connect with, the rotation that surprises you, the mentor who challenges you, and the day you realize you actually want to come back and do this work for decades.
We sit down with Dr. Adam Hurst, an outpatient pediatrician and NYITCOM Arkansas faculty member, and Tate Snider, a graduating medical student heading into emergency medicine. Together, we map the medical school curriculum from the preclinical years (foundations, systems, and learning what “normal” looks like) into the clinical years (rotations, patient care, paperwork, and real-world decision making). If you want a clear overview of how medical training is structured, this is the walkthrough you wish you had earlier.
From there, we get practical about specialty choice: what emergency medicine is really training you to do, why pediatrics involves caring for the whole family unit, and how family medicine and internal medicine differ in patient population, practice scope, and pathways to fellowship. We also talk residency length, board certification, ACGME requirements, and why some fields are more competitive than others, then zoom out to the real-life factors students weigh, call, shift work, geography, and the parts of the job you cannot “buy” with a paycheck.
If you’re pre-med, a med student, or advising someone who is, subscribe, share this with a friend, and leave a review so more future physicians can find it. @Arkansasstatemedianetwork.com.
0:00 Why Specialty Choice Feels Hard
1:05 Tate Snyder Finds His Calling
4:40 Preclinical Years: Building the Foundation
8:12 Clinical Rotations: Learning in Hospitals
12:10 Adam Hurst on Choosing Pediatrics
13:37 What Emergency Medicine Really Trains
16:54 Family vs. Internal Medicine Paths
25:22 Surgery Training Length and Board Exams
33:30 Competitiveness and Lifestyle Advice
41:21 Closing Words: Work Ethic and Community
Why Specialty Choice Feels Hard
SPEAKER_01Welcome to the Pre-Med Playbook Podcast on the Arkansas State Media Network. I'm Casey Pierce with NYIT College of Osteopathic Medicine. The goal of this podcast is to tell prospective medical students about the path to becoming a physician. And today we're going to discuss what that journey looks like from a curriculum standpoint and how physicians choose what specialty they are going to pursue. I'm joined by two guests today. Dr. Adam Hurst is a pediatrician, a faculty member at NYIT Commode State, and student Dr. Tate Snyder. He will soon drop the student part of that name. He'll graduate from our medical school here in a few weeks and begin his residency. So, gentlemen, today we're going to talk about medical specialty that you're choosing, how you came to that discussion. So let's start by telling us what specialty you did choose, what specialty you have that you're about to pursue. And just introduce yourself, tell us a little bit about yourselves. Go ahead, Tate.
SPEAKER_02Yeah. So my name is Tate Snyder. I'm a product of Jonesboro. I've been here for what some would say probably too long, about 23 years, but it's provided me everything that I've needed education-wise. You know, I didn't decide till pretty late to pursue medicine. It was honestly at the end, tail end of my undergraduate career here at Arkansas State University. But I did find a passion through volunteering. I had an awesome experience with Huntsman Cancer Institute. Ended up finding a mentor in oncology. And through that experience, I found a love for medicine. So I came to NYTCOM. You know, specifically for me, you know, I found a love for emergency medicine unexpectedly, kind of like my love for medicine. Mr. Fruit, you know this. You've heard my story plenty of times. Um, you know, I like to say my application was geared towards internal medicine. I had this plan, I was going to pursue internal medicine. Um, and then within a month of applications being due, I actually switched up. Uh, you know, for me, uh, I found that emergency medicine was a place where
Tate Snyder Finds His Calling
SPEAKER_02I had a unique opportunity to take my perspective and a lot of the life experiences that I had with my own dad uh and been able to apply them to the work and the patient relationships I had. And uh I really didn't find that anywhere else uh in any other specialty I was looking for. Uh it was incredibly powerful for me. The the work that I was doing means something. And then the teamwork in the emergency room was uh something that really stood out for me.
SPEAKER_01Awesome. Well, we'll get into a little bit deeper into your story in a bit. But Dr. Hurst, you're a pediatrician. Uh um obviously you have four kids, so you you must like kids a lot. I assume that goes a lot into that decision.
SPEAKER_00It doesn't have to, but it definitely helps. Um and because I'm a pediatrician, I am feel like I'm a more confident parent, but every day's a little different too. So, but uh my name is Adam Hurst. Uh, I'm a general outpatient pediatrician. And so thinking, especially that, hey, I see outpatient um people. So not if you're hospitalized, not in a hospital system, in an outpatient clinic on a day-to-day basis, um, but general pediatrics too. So um, really from birth until 18 years is my common. Um, some pediatrics um will go until 21 or 25, just kind of depends. But um seeing kids, so um pediatric problems, pediatric conditions. Um, but I get to see the family. So I say kids, but I'm seeing the parents, I'm seeing the siblings, I'm seeing the grandparents. Um, and so you're seeing the whole family unit too.
SPEAKER_01Yeah, that's one thing about pediat pediatrics. You always have more than one patient because the parents, the grandparents that are in that room, the caregiver, whoever has brought them, you've got to be able to speak to that child to explain to them what you're doing, but also to the mom or dad or whoever uh exactly what's going on with them as well.
SPEAKER_00Yeah. And I mean, it's really like you get two relationships at least to um in that kind of connection. You have your relationship with your patient, and it's the kid. And they might be six months or nine months or a five or six-year-old. Um, or, but you also then get a whole different relationship with the parent. And honestly, sometimes that's more beneficial than um the relationship with the patient of how I can impact and and guide young parents, or they can guide me and tell me things that I don't know and help me learn um about my own parenting skills, what are how I pursue pediatrics and just learning from other parents.
SPEAKER_01Awesome. Well, we we've heard the destination. Now let's talk a little bit about the journey. So traditionally, you graduate from high school, you earn an undergraduate degree, you go to medical for school for four years, then you go to residency. Now, those four years of medical school where uh you currently are wrapping up that all uh physicians go through, those are pretty much the same, regardless of what type of doctor, family medicine, internal medicine, OBGY and surgery. Is that right?
SPEAKER_00Yeah. Overall, the pre-curriculum, so the prerequisites are needed. There's a certain set, but then depending on what your undergraduate program is, hey, maybe the additional courses that changes too that you have to have certain amounts of chemistry and basic biology and some structure. But then there's going to be other courses that you can get. Um, some undergraduate programs will have a pre-med course, some of them will have a pre pre-med curriculum, some don't. Um, and then a lot of students still come just on a different pathway too. And they got the prerequisites, but they majored in something completely different.
SPEAKER_01Yeah, I share that story all the time. Our dean, Dr. Shane Spites, has a business degree and then took a little bit of extra coursework before he got to the medical school. Okay, so years one and two of medical school, we call those preclinical years. What happens in those two years? Tate's pressure too.
SPEAKER_02It's like you can have fun with that one. So uh, you know, first year you're focusing on your foundations, and how I like to describe it is pretty much it's a glorified version of your pre-medical tract and undergrad if you went that route. Uh so you're gonna cover uh topics such as genetics, biochem, organic chemistry, a little bit of physics, different things like that. Um, and it's honestly fast-tracked. Um, so you know it's you've seen the information, um,
Adam Hurst On Choosing Pediatrics
SPEAKER_02but you're applying it in a way that you've never necessarily done it before, which is incredibly unique. Um, I enjoyed my first year, and I think it sets up really well to move into the second year. Um, and then the second year, depending on what school that you go to at NYITCOM, you start introducing systems. So you'll do cardiology, gastroenterology, uh, endocrinology, kind of what we talked about earlier. Um, and what you're trying to do is you're trying to take the concepts that you learned that first year and apply them to the human body and exactly how those things work uh in regards to your patients. Um, it is tough to kind of make that transition. Um, you know, I I had the opportunity, I did very well uh my first and second year. Um, but I do remember there being a learning curve with that, um, and especially the way that you study and the resources that you use, but uh uh two great years and really set the foundation for going into your third and fourth.
SPEAKER_01Yeah. So you're building a base of that knowledge that it's these are the things that happen in the body, but you get all the way down to the the root level of what's going on at the cellular level to understand why is that accurate?
SPEAKER_00Yeah. And I mean, Tate said it great. It's like that foundation. Like you really are, you have to learn the normal. Um, and then that first year and the first kind of aspect of things, what's the normal DNA? What's the normal cell? What's the normal metabolism? What's the normal, then how does that integrate into the heart? And then what's the normal system? And so you learn all these normal things about the human body and how it's all interconnected on both a big level and then a microscopic level, um, a DNA level. So, I mean, you're getting down to the minute detail. And that's where first year I struggle because that minute detail is not my best uh characteristic. But thankfully, some very smart people um helped me get there and learning that foundation. But then once you have that foundation, you build on it. Hey, what's the abnormal? How does what happens to your heart affect what happens to your lung? How does what your brain is doing tell your muscles things differently and how all how it's all interconnected? Um, and so you start to build off of that foundation as second year comes along, and then you keep adding that, and then you put it into a personal clinical scenario. Yep.
SPEAKER_01So years one and two happen in a lab, in a classroom, kind of in an academic setting. And then years three and four, we call them clinical. So that's when, okay, you've taken that base knowledge, how to apply it to the body, then you get to go actually see patients with the doctor and learn.
SPEAKER_02Yeah. Um, and I love what Dr. Hirsch said, like knowing what normal is. I think we oftentimes forget that. And when you get into that third and fourth year, you need to be able to differentiate is this sick or not sick? And it kind of goes back to those basic principles of normal versus not normal and those pathophysiology, the actual disease process. Um, you know, my third and fourth year was fantastic. Uh, I spend my time in Memphis, Tennessee, uh, with an incredibly unique patient population. And what you'll learn when you do go out on your rotations in that third and fourth year is, you know, wherever you go, you're gonna see a different set of presenting symptoms, diseases, uh, social determinants of health, many different things that uh will kind of influence the way you practice. But uh third year was incredibly unique, and uh, it's really the time for you to bridge that gap between your preclinicals and and the future doctor that you do want to be.
SPEAKER_01So just to go very layman's terms, we say clinical rotations, that means you're following a physician around, basically seeing patients with them and learning from them. Is that accurate?
SPEAKER_00Yeah. And so the hope is during your clinical rotations, you are put into a very specific
Preclinical Years Building The Foundation
SPEAKER_00kind of focus. And the goal for most medical programs, that third year, you're gonna get the general aspects. You're gonna do family medicine, you're gonna do internal medicine, you're gonna do pediatrics, you're gonna do a version of a surgery, a general surgery. So you're gonna see very generalized, the full spectrum of things. Um, and that you're seeing the day-to-day. You're seeing the patients, you're seeing the paperwork, the labs, the follow-up, you're seeing everything about that clinical scenario and getting to help kind of process and put that piece together. I learned all these things. And so now how does it actually look like in the real world?
SPEAKER_01Yeah. And then from the standpoint of what we're talking about today, you're seeing all these different specialties, you're getting to see what that physician does, how they practice in accordance with their focus. And I'm sure that's pretty impactful on I really like this rotation. I didn't maybe like this one as much. So this is kind of where I'm gonna lean to.
SPEAKER_02Is that right? I I would definitely agree with that. Uh, there were plenty of rotations where I may have not necessarily enjoyed um the work, um, but I knew that I was gonna show up and work hard and use those concepts to better me in the position that I wanted to be. The, you know, when I go to the emergency room, I know that I'm gonna have to have principles of being, you know, an OBGYN or with pediatrics or with internal medicine, the people that I send some patients to uh from the emergency room, I know that I need to have those concepts and those uh those clinical understandings to be the best version of the emergency doctor I can be.
SPEAKER_01Yeah, like for example, you will see pregnant women come into the emergency room. So if you don't have that background in OBGYN, it's gonna hamper your ability to help that woman.
SPEAKER_00And so much of like we talk about like a first and second-year med student, and then third year is your clerkship and clinical experience. But clinical experiences, they start, I mean, in undergraduate degree, they start in high school, they start just in life of hey, understanding and what your background is and what medical experience have you had in terms of a job or exposure or just your family members being sick and what the impact that has on kind of that future outlook. Um, because you're getting those perspectives. And you might not reflect on that until you're in medical school, though. And so you just think back and had some of those experiences that you've had. I always feel like, man, in 30 or the clerkships that I didn't enjoy as much. Um the residents attending, hey, you might not ever use this again, but someone might ask you it. And like, I'm not gonna know everything, but to have a comfort um when that does come up and to understand, hey, what a patient goes through when they do go to surgery, to have an understanding of what's happening to their family. It might not be my specialty, but uh really help me relate to my patient the best is to know all the aspects of medicine that I can and to continue to learn. And I mean, I feel like that's why we both pursue medicine is just that lifelong learning, continuing to learn and grow our knowledge and um grow our understanding of how the body is impacted. Yeah.
SPEAKER_01So Tate, you mentioned that you kind of made a change late in your career. Dr. Hurst, did you always know you want to be a pediatrician?
SPEAKER_00I didn't make that decision probably till third year of medical school. But then if I think back to it, I was meant to be a pediatrician. My disposition, my demeanor, everything, everything I did, it makes a whole lot of sense. And I'm a pediatrician. Um, I always did like summer camps and volunteering and uh vacation Bible schools and working with kids. Um, and so I think it was like, oh yeah, kids were always gonna be a part of the picture. Um, once I got into really those like clerkship rotations, though, that's when I figured out, hey, I still really love kids and relating to the parents and working with kids. And then I found some things I didn't really love as much. And I don't think I ever really contemplated surgical. Um, and but then I had to think about, hey, well, what is my patient population that I really want to serve? Like what gives me the most joy? What gives me the most like benefit for my day-to-day? And it was the kids, it was the parents. Um, it wasn't as much the geriatric population and um an OB, I like going to the baby. I didn't like the mom as much. Yeah, and but I still learn all those principles. And so then it was like, oh, yeah, it's gonna be kids, and it's only gonna be kids. That sounds awesome. I can't wait.
SPEAKER_01And so Tate wanted to talk about emergency medicine. So we kind of think of, you know, if I'm at a car wreck, if I if I break a bone, one of my kids unfortunately experiences that. Not that I'm speaking from personal experience, but um, those are the kinds of things that we think I go to the emergency room for. But what specific training are are those things and what else are you training to be able to take care of?
SPEAKER_02Yeah, I I think the overall premise of the emergency room, you know, is to stabilize an unexpected event that happened in somebody's life, whether that's incredibly traumatic, a car crash, uh, somebody fell all the way to somebody gets a kidney stone, somebody has pancreatitis. Um, but I feel like it's your job as a clinician in the emergency room to stabilize that situation, whatever picture that looks like. First off, you have to deduce what's going on. You have to say, okay, you have to rely on your physical exam, how they're presenting, uh, the actual history of what they're going through, um, be able to identify what's going on and then treat it. Um, I think a large part is figuring out where they need to be. Should they go home? Should they be admitted to the hospital? How soon do they need to follow up with their primary care physician? Um, all those things are, I mean, honestly, almost every single patient interaction that you have in the emergency room. Um, I the training um for me and what I've just experienced in my third and fourth year, um, it's been incredibly gratifying. Um, for me, um, what I took away from it was I was having really, really powerful patient interactions. And I think with how my personality is, um, you know, I like to talk to people, I like to kind of figure out what's going on. And also, too, kind of what I mentioned with my perspective and my life experience with my own family. Um, I left each and every day um wanting to know more and wanting to go back. And I figured that that was probably the place that I needed to be for the next 50 years.
SPEAKER_01Yeah, that that sounds like that would play into that pretty strongly. So, Dr. Hurst, you have a little bit of an interesting perspective on specialties. Uh, you're married to a dermatologist, your favorite person in the world, is the skin that got me here. If it wasn't for her, I wouldn't be here. Uh and and your dad is a well-respected family medicine physician in Jonesboro. So, considering that experience, uh did that impact your decision or I mean your pers your general perspective on medicine at all, be having those two close relationships that do things that are a little bit different than what you focused on.
SPEAKER_00Well, and I think he really wanted me to be family med medicine, your dad's family practice, like uh, but I think I could see it and I saw a day today and saw everything that he did. And I think I got a great, I don't know, early introduction to what that all the parts that it entailed. Um, but then it is even more intriguing to think back to of like third and fourth year for me and my wife. Um, we got married in third year, and so just all the dynamics of, hey, well, why do you like this one? Why do you not like this? I'm like, what about this? And just how that played with each other to be able to talk through specialty approaches versus generalized medicine, um, kids versus adults,
Clinical Rotations Learning In Hospitals
SPEAKER_00inpatient versus outpatient, so many different approaches. Um, and we had such a different take on um and but there's so many things that you balance into it all. I think you said it though, right? You'll find what makes you happy and where you can see yourself going back to every single day. And when it really boils down to it, like that's what it comes down to is hey, this is awesome. And I I could do this every day, and it's always going to be variable and each day's a little different. But hey, what can you do every single day? Yeah.
SPEAKER_01I want to talk specifically about some of the other specialties. You've talked about pediatrics in general, in general, we've talked about the types of patients you see and prepare for in the emergency room. You know, Dr. Spitz, our dean, is a family medicine physician, and I've heard him say, if you like every specialty, then welcome to family medicine because you get to do a little bit of everything. Is that how you guys would describe that?
SPEAKER_00I can see his approach to that one. I mean, I think to be family is everything. Like you're seeing, you really are able to see, and you might not choose to, but you're gonna see birth all the way up until the um until geriatrics, until they're um elderly people. And so you're thinking, hey, I get to see all the spectrums of medicine. Um, commonly family medicine, it's still inpatient or outpatient. Um, but it's changed so much. Family medicine back when my dad was kind of when I was a younger kid, I've been in Jonesboro longer than uh, but family medicine used to be both inpatient and outpatient. And now commonly, hey, you do hospitalist care and you're an inpatient family medicine provider, or maybe you only see people in an outpatient setting. Or maybe you've decided, hey, I don't want to do OB with family medicine. So I'm gonna not focus on that. But you have so many avenues that you can go down with family medicine. And so where your area of interest is, what you're what gives you excitement, or where are you smartest in? Like what can you really pour into and and have that area of uh excellence and um knowledge?
SPEAKER_01So I want to step back. You said outpatient and inpatient. So the the model of both would be I'm sick, I go to my doctor and see them in a clinic. They say, okay, I need to put you in the hospital, I need to admit you. And then instead of passing me off to another physician, then when I finish my work or before I get to my clinic, I go to the hospital and take care of my patients that are in there. Is that accurate? So I visit my patients that are admitted into the hospital and um plan their treatment and oversee uh how we're gonna get them better to get them out. Is that accurate?
SPEAKER_00Yeah. And that's and that was a it's a common approach. Some hospital systems or some kind of group practices will still go that way of that, hey, this is my patient. I'm gonna see them whether they're in a hospital and having to stay overnight for a reason, or whether they're an outpatient. I'm gonna see them in my clinic. Or maybe it's my group, maybe it's my partners that I work with that know my patients and I know how they practice. So that way um it's similar medicine and similar um types of medicine and styles. Um, versus for myself right now, I only see outpatient. So if you I have to admit a child to the hospital or if they're born as a new baby in the hospital, I won't see them there. I won't see them until they get discharged from the hospital. And so I think from a family perspective, that's a little harder. You get more people involved, different opinions, different approaches. Um, but it's also a different approach to hey, what's the day-to-day for the job? Um, and what that physician's doing each day.
SPEAKER_01So Tate, you got pretty far down the road towards pursuing internal medicine. Tell us specifically what is internal medicine? Uh how would you get it? Yeah, that's a big problem.
SPEAKER_00Whoa. Glad he got that question.
SPEAKER_01Well, but there's a little bit of a different focus. I mean, it's a primary care uh specialty, but there's a little bit different focus with internal as opposed to family. Is that accurate?
SPEAKER_02I think they share a lot of similarities. Um, you know, you still kind of have that inpatient, outpatient component to it. Uh, you know, in the residency programs I get to work with in internal medicine, you know, a lot of those residents would make the decision do I want to primarily focus on being a hospitalist on the inpatient side or do I want to move to the clinic? Um, but for me, kind of internal medicine as a whole, I think how some people will describe it is it's like uh the show house, right? Um, so it's kind of like you're deducing these problems as these patients are coming into the hospital. Um, you know, you sometimes will get a pretty large problem list. You have the acute reason while they're there, um, but you also have a lot of different things that you haven't managed uh medicine-wise. So the person could come in with uh an acute exacerbation from uh COPD.
SPEAKER_01Um where Okay, you English police. Yeah.
SPEAKER_02So basically, let's say uh, you know, this person has horrible lung disease and they get pneumonia um and they need oxygen. Um, they're probably gonna have to come into the hospital and receive different things like antibiotics, oxygen, uh, maybe some steroids to open up their airways. Um, and when you bring them into the hospital, you're not only having to manage those problems with uh with those particular medications and treatments, um, but you may have, they may have an underlying kidney disease that they have to manage. They have to manage one thing that I uh will never forget was the creatinine levels of the kidneys, uh giving fluids. Do I give fluids or do I not? But internal medicine is honestly, um, it's for the people who really love to add a flair to how they practice medicine. Um, it's there's no perfect way to practice medicine. I think internal medicine is a perfect way of seeing that. So, what do you mean by a flair? Um, you know, there's different clinical guidelines for different diseases. And what that means is there's different ways to treat. There are standardized ways in gold treatment, um, but there are alternatives. And some doctors, um, you know, you do have the privilege of practicing other ways than how a traditional doctor would. Um, and I think internal medicine is one of the areas where you really can add that, like I said, flair um to how you practice. Obviously, you still have to be part of the gold standard and standard of care.
SPEAKER_00Well, and the style. Style. What is my style? You um, why do I pick this type of antibiotic versus this type of antibiotic? Yeah. Um, I'm gonna focus on this versus doing that. I'm going to allow your outpatient provider, your general practitioner to help make sure you follow up your appropriate scans for your age to screen things or um or the opposite. Hey, I care that you haven't had this done yet. I'm going to go ahead and do this because that's my style. And that's what I'm going to focus on. And like internal medicine, internal medicine is only adults. And commonly, um, it does not have the obstetrics and gynecology. Um, so that's like a difference from family medicine. Family medicine does kids, obi gone, so obstetrics, gynecology, and kind of internal medicine. Um, internal medicine is really just adult care. And how commonly that you think adult care, it's everything. And it's the human body and all of the components, whether they have 15 medical problems or zero medical problems. Um, and I think you said hospitalist, and that's where a lot of internal medicine will stick to a hospital in seeing you as an inpatient. Something has
What Emergency Medicine Really Trains
SPEAKER_00happened to your body, you're sick, and I'm seeing you in the hospital when you're ill. Um, or if they use internal medicine to continue to build that foundation on adult medicine and the adult body and the issues that happen, and then I'm gonna specialize. I'm gonna take that internal medicine kind of second tier of foundation that I've gotten now. And now I'm gonna learn more cardiology, or I'm gonna learn more endocrinology and what that next kind of fellowship, that next level of learning is. But you can't get there unless you have that strong internal medicine approach. Good. Unless you have that huge base knowledge to then build off of and be an expert in that area.
SPEAKER_02Yeah. And for me, when I was, you know, had the idea that I wanted to fully pursue internal medicine, I had a passion for oncology. And that stemmed from my mentor, Dr. Collins, who's a radiation oncologist. Um, so I knew good and well that, you know, I was gonna need a solid foundation of internal medicine as well as a solid uh fellowship if that was something that I wanted to pursue. And at the time I did.
SPEAKER_01Yeah. So a lot of internal medicine physicians, they okay, four years of undergrad, four years of medical school, three years of internal medicine, and then another two, three, four, five, six of whatever that specialty is, because our cardiologists, our nephrologists, our physicians that focus on a system of the body. So the heart, the lungs, the uh infectious disease, the kidneys, um, the uh gastroentology, our digestive system basically. Um, then you're gonna spend a few more years, specifically, as you guys are saying, diving even deeper on that specific body system. Is that right?
SPEAKER_00Yeah, that's a common approach. And so my kids, so I got four kiddos. Uh my oldest is in fourth grade right now, and she's I'm gonna be this kind of type of doctor. So, hi, Margaret. Well, that you still got a lot of school left. And we started adding up the years, and she's like, You go to school for that long? And you're like, Yes, ma'am, that's correct. Uh, we do, we do. Um, it does. So you're four years of undergraduate and then four years of medical school. And then depending on then what field you go into, whether it's internal medicine, family medicine, pediatrics, maybe that's only three years. But then if I want to be a um cardiologist, I might do three more years. And then if I want to be an electrophysiologist in cardiology, I might do another one or two years to continue to hone that skill. And you're practicing during all those times. You're seeing patients, you're learning, you're doing things, but you're given kind of guidance, you're given supervision, you're given that ability to continue to learn um and grow and be that expert.
SPEAKER_01Yeah. And, you know, we've talked about the the primary care um physicians that, you know, some would argue emergency medicine. I mean, it is a frontline specially, but family medicine, intro medicine, pediatrics. Now, a few, let's talk about surgeons and OBGYNs. A lot of people don't realize that OBGYN is a surgical field. OBGYNs do a lot of surgery, don't they?
SPEAKER_00And especially from a gynecology approach, um, and just procedures and so much when medical students have been like, hey, how do you pick this versus that? Do you want to do something surgical or do you want to do something non-surgical? I think that's a really basic approach to kind of come into it. But do I want to have the hands-on in an OR doing procedures all the time? Um, and you're not there 24 hours a day. No one, no one is. Um, but hey, is that something you want to do day in, day out? Is procedures, um, search that surgical approach to things. And if you're like, uh, that I don't, I don't like that. I maybe I want to have more of that communication or I want to do a different style of medicine or I want to focus on a different disease pathology. Hey, I'm not gonna do surgery. And so, but oh my goodness, do we need surgeons? I'm so thankful that we got surgeons and neurosurgeons and obigon, because it's not what I wanted to do, but we have to have those. And so we need those interests.
SPEAKER_01What would be some things like your colleagues, your friends? I mean, obviously, you guys have these conversations about why did you choose this specialty? What are some things that they would say, why they maybe chose a surgical specialty or an anesthesiology, uh, physical medicine and rehabilitation, one of those. Any any thoughts?
SPEAKER_00A lot of the surgeons and where technology has gone too, so much of it's robotic, urology, general surgery, but laparoscopic procedures. The technology is awesome. I mean, you're playing a video game and like, but you're doing that on a human body to take out cancer, to take out abnormalities, uh, to fix infectious things. It's so cool. Um, I couldn't do it every day. orthopedics, like you're you're putting the bones, the joints, you're using devices to aid people so they can walk again, so they don't have ailments. Um, you're putting these things back together and you're seeing that on a very hands-on visual approach. And that's that's cool. Um, however, you're standing at a table and you got a mask on, and and the patient interaction is just different because hey, I want to go to my next case. That's how I'm doing my the best that I can. Um, but they still have great bedside manner. They still make such an impact on their patient by what they're talking to their patient about and how they're expressing news to the family. Um, but it's just a different I don't know, path. But I feel like a lot of the friends that I know that did surgeons, it's because they like those details. They like the procedure, they like doing that. Um, I didn't love the procedures. Nope. I'm good. I got a few procedures under my belt, and I'm good with those.
SPEAKER_01Uh well, I think it's interesting. I had an experience with a general surgeon with a family member, and you think the surgeon comes in, they operate, they they fix what they do, and then they're on. But in this situation, we had follow-ups with that um surgeon because their perspective on what they were fixing and why they were fixing it, he was able to explain that to us very well. And I think that's sometimes what we forget. There is that um clinic outpatient responsibility of a surgeon, too.
SPEAKER_00Yeah. And I mean, like, and you could argue that's more important than the actual surgery. Yeah. Hey, was surgery indicated? Did I just do a screen and and a consultation before you went to the OR and had a huge procedure done with a lot of risks? Um, is that the correct thing for you and you as a person right now? Or even after the fact, making sure you understand, hey, what comes next? What do you have to worry about as you get older? How do we fix this? Or hey, this is where I need you to go to after me. Um, but so much of that patient communication, the patient relationship, I think it's hard to think, oh, it's so different for a surgeon or an ER doctor, you never see him again. You might know, but the impact you can have as a physician on your patient is huge and whatever threshold. Um, and that's something that I think the hope is we all take very seriously as physicians.
SPEAKER_01So you'll do a three-year emergency program. Is that right? And Adam, Dr. Hurst, you did a a three-year general pediatrics residency, and then you were and you will be at a place where you can go practice on your own. Uh, your wife, I believe, dermatology is five years. Four. Four. Okay. So um, but OBGYN is four. The surgical specialties are five plus. Why are some residencies longer than others?
SPEAKER_00So, some of it is kind of the setup of what the systems um are in place for you to still learn and have that foundation. Um, so for like dermatology, anesthesiology, you spend a year just doing general care. You do kind of a transition year or an internal medicine year of again, just building that foundation of, hey, in a hospital, this is what your patients go through. Hey, the human body, this is everything when they get sick,
Family Vs Internal Medicine Paths
SPEAKER_00how to balance those things, how to treat them, how to do that as a physician. Because while a third and fourth year on a clinical rotation, you get to do some things when it's your choice and your decision and you're making those calls, like it's just a different approach. And so um, you spend a year, hey, or two years in surgery, hey, learning that everyday medicine. And then you go into that specialty of, hey, I'm gonna do only the skin. So let's just talk skin. I'm gonna spend a lot of years being in becoming an expert in the skin or becoming an expert in how to use anesthesia or pain medicine. Um, and so it just kind of depends on every approach. I think a lot of that's because of kind of the the licensing bodies, whether it's um the obstetric synacology licensing bodies, dermatology, general surgery, neurosurgery, all these bodies have kind of come together and said, Hey, this is what we need to do for you to be an expert. And so for you to be comfortable treating not just your patients, but treating patients, um, for you to be able to be board certified. And so at the end of your residency training, you get to take a board certification. And there's a lot of testing, but that's one of the big tests. Um, and it never ends. You do recertifications or you have to do oral boards and you learn all that stuff as time goes on. The testing, it'll always get there. And the hope is your residency program, your medical school, your undergraduate program prepare you for tests because it's nonstop tests. And take note is that one, it's always changing too. Hey, this year it's fewer numbers. This next year it's maybe more. Maybe it's gonna be this style. Um, you don't play to the test. You learn the foundation, you learn the knowledge, and then figure out how to apply it to a question, how to apply it to your patient.
SPEAKER_02But that's that's my thought on yeah, and like emergency medicine, for instance, their uh a large talking point during my interview season was um the overseeing body want to maybe transition to a four-year uh curriculum moving forward. Well, and some emergency programs in the Northeast are four years. Yeah, yeah, some are. Uh, I I had the opportunity to interview with one. Um, you know, their curriculum is just different. Um, and a lot of these programs or all these programs, they have to meet ACGME requirements. Basically, uh a checklist for saying this person's ready to go out into the field and to practice medicine on their own. Um, you know, I it definitely differs by specialty. Um, you know, kind of going back to the surgical, non-surgical. Um, the people who are doing the surgeries are gonna need to see a lot more surgeries before, you know, they're primed and ready to go out into the real world. Um, and so their requirements will probably look a lot different than mine, even though uh we do have a lot of procedures in emergency medicine. Yeah.
SPEAKER_01We want the people, not that everything's important, but the people that are operating on our brains and our spines have to have to get a little bit extra practice. Right. So um, why are some specialties more competitive than others? I know that there's that that's probably an hour-long podcast in and of itself, but we we do know that um, for one, there are more we need more family medicine physicians because everybody needs a primary care physician uh and internal medicine. Um I'm fortunate that I've never had a surgery in my life. Fortunately, I've never needed a surgeon. So uh it is it, it's partial, I know it's partially a numbers game, but let's just talk through that. Like the competitiveness and um being, I don't know if self-aware is the right term, but coming to grips with also not I don't even know if grips is the right word, but becoming okay, this is also what's within my wheelhouse, what's attainable for me. Is that part of the conversation?
SPEAKER_02Oh, definitely. Um kind of like what you were saying with you know, the match, what you go through to actually match into a residency program at the end of your medical school experience. Like they'll put out uh what's called match statistics, which is a huge PDF of this is how many uh opportunities were available to students wanting to go into this particular field, this is how many match, this is how many were not open. Um, kind of what you were saying. Um, there's different seats for different specialties. So for instance, number of seats, number of seats open to those applicants. So for like uh primary care and emergency medicine, like you're gonna have more seats in comparison to general surgery, orthopedic surgery, and radiation oncology. Radiation oncology has, I want to say almost like low double digits, 10 to 15 seats normally on a national basis, which is really tough to match. Um, but kind of going back to what you were saying about like understand, like it's really important to assess your level of competitiveness. Um, you are gonna be in a predicament at the end of your medical school career when you're applying for things and uh you didn't do that. And when you apply to certain specialties, um, whether it's like surgery or orthopedics or uh emergency internal medicine, um, because different programs want emphasize different things.
SPEAKER_00So and I mean the competition, it's competition in anything. And if you just now you're getting into hey, the business of medicine and the the business approach of hey, what makes me a better applicant for this job than somebody else? Yeah. Um and having to look at you personally, but you still have to figure out like, what do I want to do? Like what what field do I want to pursue in the business of medicine? And so what do I want to do every single day? And can I do that? Am I am I ready for that? Am I uh is this appropriate for me? Um, but the competition is tricky because then it's the business. Hey, what what are your hours? Do you have to take call? Are you gonna work weekends? What's my reimbursement? Um well, how how much malpractice do I need? Um, how much vacation do I get? Um, is it good for a family? Is it good to travel? Is it something I can live in a big city with? Is it a rural area and something in a smaller community? Uh so you really start to then look at really the fine details of that true kind of business that you're trying to get yourself into.
SPEAKER_01Yeah, well, and I was gonna ask the next question. You know, you can Google salary by specialty, average salaries, and sometimes that's going to play a role. But I think uh, Dr. Hirsch, you answered that question in of itself. Yes, compensation is the how much is in your paycheck, but it also represents lifestyle, and there's things you can't buy. So I want you guys both to just throw that around. Like what I assume you would both give the advice of never choose a specialty based on solely on money. Uh that's probably good life advice outside of money, uh-huh or outside of medicine, rather. But let's get into that a little bit. What what some of those benefit factors should weigh, should and shouldn't weigh into your decision
Surgery Training Length And Board Exams
SPEAKER_01to what specialty to pursue?
SPEAKER_00And even within that specialty, do you do inpatient? Do you do outpatient? Yeah. So when you start to really get in figure out what that job is gonna be, um, because even in pediatrics, hey, do I want to do something where I'm a hospitalist and I work a week on and I have a week off? Or do I want to do something where I work seven days out of the week all the time? Uh or no, I don't like any of that. Or I like doing overnight. Um you should never pick it because of the financial benefit from it. Um, if that's why you're gonna pursue it, there's a chance that that comes down and it it stings because you're not compensated appropriately, or you don't work hard enough to get the financial reward, or um, just something changes in life. I think the the bummer of it all is the competition, the competitive fields are are fun. Um, they have great compensation overall an okay work-life balance. Um, and so they have more people going into them. The fields that we need um more bodies in are the general practice ones, but usually those are not at the same compensation level. And so it does kind of come down to, hey, well, I can work a similar amount and make more money if I pursue this field, and I'm good at that and I like it. I can do that. Well, that's what I should do. Um, and you're not wrong, like that's awesome, good, that's great. Um, but we still need people everywhere. Right. Um, and so it's figuring out just kind of that balance, and that's not on you as a person to figure out. Like you figure out what you want to do every single day. Um, I think we as a medical community get to help figure that one out. Hey, what do we need in this area? How do we support that? Like, how do we get you to do those things? Um, and whether it's work-life balance, whether it's other kind of benefits, um, because it's not just about the the money, but it you have to think about it because that's your job, that's your career. Like, that's what you're going into to have a family, to have an ability to do things, um, to be able to retire at some point in age and not work.
SPEAKER_01Well, and you've made a financial investment because medical school's not cheap. So that has to play a role there too. Take just your general thoughts on yeah.
SPEAKER_02For me, um, you know, when I was deciding on a career path, like I said, it was incredibly unexpected and very far from what I had originally planned to do. But um, when I ultimately made my decision, I just wanted to keep it simple because I feel like when I keep it simple, my best decisions are made. But um, I I just want to do what made me happy. Um and I knew everything else was going to kind of fall in place, whether that was the paycheck, uh, whether it was the lifestyle. Um, I think that was really important for my wife and I, knowing that I could have a career in something that will support my family and that we would make it work regardless. Uh, you know, I do love the aspect of, you know, when I'm on, I'm off, I'm on, and when I'm off, I'm off with the medicine shift work. Shift work. Yeah.
SPEAKER_01So you were, you know, like uh Dr. Hirsch, you mentioned call, like you go to the hospital, you work, you check out, and you go home. Whereas other specialties, you can kind of be called on all the time to help. Is that what you're getting?
SPEAKER_02Yeah, yeah. And and the reason I love that is because, you know, for me mentally, like I can check in and then I can check out. And when I'm in, I'm in, I can give 120% effort and I can focus and everything's good, and I know I'm gonna be within this parameter. Now, obviously, the hours can fluctuate, and if something comes in at the very tail end of your shift, you may have to stay a little bit longer. But um, the idea of that was uh incredibly enticing for me.
SPEAKER_00So that plays into that entire factor. So and then, and that's where you get to of like, what am I gonna do? Like, what kind of doctor am I gonna be? And like that's the conversation of like, how do I pick my specialty? You'll figure it out. You you get a you build that foundation, you get that comfort of knowing the normal. You understand, hey, these are the abnormal things that come up. This is what my patient's like demographics could be. Um, this is the community that I could work in. This is the need. I want to live here, and this is what we need. Like I can I can work and really provide this awesome service um by learning more about this and pursuing this field. Um, we all have different kinds of calls and and ways to serve as a physician. And so it's really figuring that out about yourself. Yeah. And that's any walk of life, right? Yeah. But that just takes time. Yeah. I think the most important thing is to ask, ask questions, prepare yourself, like uh, especially from an undergraduate approach, like have that mentor undergraduate, talk to medical students, look into the programs, talk to upperclassmen that are pursuing it right then. Um, ask financial questions. I feel like if I could really go back to med school, it's like, oh man, I probably should have done this and this and this. Like, if you really think about some of these things that currently are talked about, that's awesome. Um, but kind of asking questions and asking your mentors, hey, what did you mess up with? Because no one, no one was perfect with it. Um,
Competitiveness Lifestyle Advice And Closing
SPEAKER_00what would you have done differently? Would you have done this? And so just asking good questions, being informed. Um, but we all have such different approaches. The biggest thing is just learning that about yourself um and taking it one step at a time. Yeah.
SPEAKER_01Tate, my last, my last question here was just some general advice for students that are thinking about medicine to to think about as they're taking each step along the way. And I think Dr. Hirsch just answered it, but I want to give you the last word there.
SPEAKER_02Yeah, well, I love what Dr. uh Hirsch just said. Um, you know, asking questions, that's that's huge. And, you know, I think the great part about medicine is people pretty openly share with you their experiences, the things that went well, the things that didn't, the things that maybe uh can improve the next generation's applications and go into medical school. Um, I think for me, I'm always reminded, like, I'm not the smartest person in the room, but I will work the hardest. And I think medical school, I will always say this, I stand by it is 90% work ethic and I think 10% intelligence. Um, I think if you want to be here, um, then you can easily do it. Um, I think you can make it happen. Um, don't get distraught by you know seeing people with crazy board scores from what they say. Um, you know, shoot your shot, I feel like is the best way to say it. And if you work hard, things will normally work out. Awesome.
SPEAKER_00Well, this is good. I'd say I know I'm not the smartest person in the room, too. My dad would say the same thing. Um, you find the smartest person in the room and you marry them. Yes. So yeah, I did it. Got me through med school. But befriend them. Um, I my undergraduate, I went to Washtaw Babbage University, our group of like 10 people, we were in med pre-med together. We all went to the same med school. We went through medical school the same. Like, get a get a group, have people to to learn with, to grow with, to ask questions from. Find that smart person, let them teach you some of the details. Yeah, um, let your work ethic rub off on them. Um, but like find those people and and find that group to kind of push you and help you be. And that's a life thing too. And that's undergraduate and all the things, but I think having those connections, finding that community um to help you like kind of really push yourself and to learn um is huge. But yeah, uh-huh, yeah.
SPEAKER_01Marry that person. So thanks, Valerie. Great, great advice. Well, guys, this has been an awesome conversation. Thank you guys for having it. Thank you guys for joining us. Thanks everybody for listening in. We hope you've enjoyed it. If you'd like to learn more about our medical school, you can visit us online at nyit.edu slash Arkansas, our social media channels. If you'd like to see day to day some of the things that are happening in and through our medical school, you can find us at at NYIT com A R, like New York Institute of Technology, College of Osteopathic Medicine, Arkansas. What a mouthful. But we hope you've enjoyed our conversation today. Thanks for joining us. We'll see you next time.