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.
It’s a tough process, full of uncertainty and soul-searching and fears about locking into the wrong option.

It can be overwhelming. The choices are practically endless. And there’s not all that much guidance out there to tell you how to narrow down your options for the best possible outcome for YOU.

So here are a few things I tell my students to keep in mind when they’re doing their rotations, and so far they seem to think it’s helpful.

1) The best choice of medical specialty will be something you enjoy AND something you are good at. Most people drop out the second condition. But think hard about this: If you pick something you enjoy but that you are no good at, it will be a disservice to your patients. If you pick something you’re good at but that you don’t enjoy, it will be a disservice to you. Look for something that will satisfy BOTH conditions, and you’ll be set.

2) Pay attention to what you DON’T want to do. If you hate Pediatrics or you couldn’t stand General Surgery, THAT’S A GOOD THING! Negative experiences provide you with good, solid information about the kinds of work you want to avoid, and why. It’s especially helpful if you’re overwhelmed with the typical too-many-options brainfreeze. Discarding the rotations you hate will cut out some of the noise from the data, and then it may be easier to see your eventual specialty stand out from the fewer options that are left.

3) It’s okay to take lifestyle into account. As a matter of fact, you should. You want nights and weekends to yourself? Go into Dermatology. You want a lot of money? Look at some of the surgical sub-specialties like Plastics. You’re all right with staying at work late to stabilize a patient? Think about something like Internal Medicine. Want shift work with solid start and finish times? How about Emergency Medicine? Take your personal preferences into account when picking what to do, because if you pick a lifestyle that won’t work for you, you’ll burn out.

4) Confusion is a GOOD thing, even if it’s getting close to the time where you have to commit yourself to an option! How can I possibly say that? What if the deadline for applications is right around the corner, and you STILL don’t know what you’re going to pick? Think about it this way. If you hated OB/GYN, that’s not going to be an uncertain thing; you will feel no confusion about it. Confusion means you have a bunch of options to pick from, and YOU THINK THEY’RE EQUALLY GOOD. That takes the pressure off, because no matter which one you pick, you’ll be satisfied with the result. (Unless you didn’t like any of them at all, in which case you may have a considerable amount of soul-searching left to do.) Don’t get scared if you’re still confused; you’ll land on your feet somewhere, and someday you’ll look back and realize that you made the right choice. No matter which one you pick.

5) Pick for yourself. I don’t care if your father wants you to be an orthopedic surgeon. I don’t care if your mother has been grooming you your entire life to take over her Neurology practice. This is your life and you have to be satisfied with your job.

6) Pick for your community. As a doctor you have a responsibility to serve society. Pick something that’s needed, something that will contribute a valuable service to the community you live in.

7) Pick for the future. Specialties are not static. While you’re always going to need generalists, it’s important to realize that there are a lot of forces pushing and pulling at the medical specialties. Some specialties have only a limited pool of patients, but a lot of doctors who want to go into that field. You may graduate med school to find that your chosen specialty has a LOT of competition, both for residency positions and eventually even for patients. Family Practice doctors are in trouble these days due to the pressures of reimbursement patterns and the advent of physicians’ assistants and nurse practitioners who can provide similar services but aren’t paid as much. As the space program shuts down, Aerospace Medicine is probably going to focus more and more on airline pilots and suchlike. It’s important to recognize where your chosen specialty fits into the grand pattern of things. It’s important to look to the future. So keep your eyes and ears open. Read the news and keep up on health policy trends. Listen to what people say about their doctors. Watch how different kinds of doctors are portrayed on TV and in movies. Use every resource at your disposal to try and predict what will happen five, ten, or twenty years from now. Plan ahead; this will be your specialty for life. And it’s easier to roll with the punches if you know what direction they’re coming from.

8) When in doubt, leave your options as open as possible. What if the application deadline is RIGHT NOW, and you still have no clue what you want to do? PANIC! PANIC! No, actually…please don’t. Okay, it’s a tough place to be. At this point, you’re going to want to pick something that gives you the most flexibility. Internal Medicine and General Surgery can be good options. They both have tons of sub-specialties that you can sample throughout residency, and either one of them will allow you to fine-tune a career for yourself out of the available options.

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