Choosing a Specialty

My favorite part of my job is teaching. There, I’ve said it. Yeah, it’s cool picking apart diseases and mix-n-matching treatment regimens for the optimal balance of cure and side effect. I love hand-holding people through concepts that are far beyond their educational level and helping patients and families make impossible decisions with uncertain data.

But give me a new third-year medical student who’s been dropped in the middle of the hospital for her First Real Rotation Ever, and I am just in heaven. I love teaching med students.

One of the things I love the most is helping them figure out what flavor of doctor they want to be. Third year is all about sampling it all, and experiencing what actually happens in the various medical specialties. You rotate through Surgery. You rotate through Internal Medicine. You rotate through Family Practice. You rotate through Anaesthesia. You rotate through Psychiatry. In fourth year, you’re supposed to be narrowing it down to your most likely options for residency.

New Physician Jobs Feature Hospital Employment

Primary care physicians remain in high demand, although the majority of job openings are for hospital employees, not in private practice, according to a new survey by Irving, Texas–based national physician search firm Merritt Hawkins.

For the sixth consecutive year, family practice and general internal medicine were the top 2 most-requested physician search assignments. They were followed by hospitalists, psychiatrists, orthopaedic surgeons, emergency medicine physicians, obstetrician/gynecologists, neurologists, general surgeons, and pediatricians.

Reimbursement cuts and declines in elective procedures have reduced the volume of search assignments for radiologists, cardiologists, and anesthesiologists. Those specialists, which were among the most requested searches 4 to 5 years ago, are now ranked 17th, 18th, and 19th.

Catching the ID Bug

In medical school, I was planning to pursue primary care when I landed in an infectious diseases (ID) rotation at the Veterans Affairs hospital in Portland, Oregon. The cardiology rotation I wanted was full, and looking at the elective list I thought, "What the hell, I'll try ID." All too often in my life, serendipity has led to life-changing circumstances. (Sometime I will tell you the story of how I met my wife.)

As a medical student I was amazed by the pathology in ID. A patient with mitral valve endocarditis caused by Staphylococcus aureus required acute valve replacement. A person with Pseudomonas meningitis from urosepsis died. I remember, like it was yesterday, the thin green slime of bacteria and pus covering the patient's brain at autopsy.

As a student, I was also impressed with my attending's breadth and depth of medical knowledge. Unlike my other attendings, who often seemed slightly bored and were going through the motions, the ID doctors were fascinated with medicine. ID doctors, then and now, get excited about a great case. I was hooked. As an intern I did an ID rotation and my addiction was confirmed. ID was the life for me, and I have never looked back. Including my fellowship, I have been an ID physician for 24 years.

Is Ob/Gyne for you?

"Ob/gyn is great because it's some medicine and some surgery," many students say when they choose the field of obstetrics/gynecology. Certainly, this specialty is more than just medicine and surgery, and it is uniquely different from either one, but the statement is fairly accurate. Ob/gyn has a significant surgical component. The rate of cesarean sections for many ob/gyn practices is 30%, and this translates to a reasonable volume of laparotomies. Vaginal deliveries in many instances require cutting, control of blood loss, and tissue reapproximation. If you enjoy surgery and like putting your skills to the test, the obstetrics aspect alone should keep you mostly satisfied.

In addition, there are "operative deliveries," many of which include the use of forceps. Although fewer forceps deliveries are performed as the years go by, forceps are good tools to have when the need arises. In many cases, their use has been supplanted by either the vacuum device or good old-fashioned patience. Of course, there are also the more pure surgical procedures performed by ob/gyn specialists, including myomectomies, hysterectomies, and laparoscopies.

What about the medicine portion of obstetrics and gynecology? Treating classic medical problems such as hypertension and diabetes is a small but important part of obstetric practice. Although most general ob/gyns do not treat nonpregnant women for basic medical conditions, such specialists have become uniquely qualified to treat other types of significant medical issues. Contraception, for instance, can for some patients become a very challenging medical treatment process, and the treatment of menopausal symptoms is routinely an even more difficult endeavor.

Time is Right for Anesthesiology

I don't think there has ever been a better time to be an anesthesiologist. The role of the specialist is evolving, in part through the introduction of new technologies such as video laryngoscopes for airway management. The breadth of subspecialties, from critical care to pain medicine, has similarly mushroomed. As a result, research questions abound. Amazing advances, such as the imaging of nerve blocks and cardiac ultrasounds for noncardiac cases, have come about in the past few years and new developments are on the horizon. And, of course, guiding patients who are fearful about an invasive procedure and taking them safely from induction to recovery is an enormous honor and privilege.

Finding the right specialty will in many ways determine the quality of your life, both at home and in the workplace. Fortunately, within the same specialty -- anesthesiology included -- there are myriad types of roles, including teachers, researchers, quality managers, administrators, and mentors. There are also many different practice settings. That gives you limitless choices and opportunities within a particular field.

Keep in mind that your choice of specialty will be affected by chance events: the resident or attending who mentors you during your rotations; the location of your clerkship, whether it is an inpatient or outpatient experience; the patient population; even the condition of the physical plant where you are trained. For better or worse, these different experiences can transform your desire to enter a particular specialty. It may not be possible, in such a short time span, for you to get an accurate glimpse into all available specialties.

Job Satisfaction in Geriatrics

I am often asked by my patients, medical students, residents, and even my colleagues, "Why did you choose to go into geriatrics?" The answer is not simple. Much like the patients I care for, my reasons for practicing geriatrics are complex and nuanced. They have a great deal to do with my underlying values as a physician. That said, I will do my best to describe why I chose Geriatrics and why medical trainees should consider it as a career path.

The oldest of the US "baby boomers" generation turned 65 on January 1, 2010. Every day for the next 19 years thereafter, another 10,000 baby boomers will turn 65. To put this in perspective, this is the equivalent of a Boeing 747 airplane full of baby boomers turning 65 every hour. By 2030, the country's population of "senior boomers" will double to an estimated 71 million individuals.

The Forsaken Specialty

PhotoCredit: guardian.co.uk

Abstract and Introduction
Introduction

As a medical student I found that most other students thought that psychiatry was not a true profession—the consultants sit and sip tea, talk nonsense, and nobody ever seems to gets better. No blood test confirms what is wrong. No imaging shows the diagnosis. Simply put, ward rounds that consist of sitting in a room and chatting just didn't seem like "real medicine" to most of my peers. Psychiatric patients were people to be mocked, feared ("you were left alone with them?"), or ignored. Revision for objective structured clinical exams and written papers was left to the last minute because it was "only psych."

I don't know why I thought this would be different when I qualified. Perhaps the "doctor" title would equate to being surrounded by those who understand, appreciate, and respect psychiatry? Goes to show that a label does not define how you act.