October 5, 2015
Thinking about Medical Specialties
Time for another medical post for my med school followers! Current fourth years applying for residency now will know that it's October - Dean's Letters are out and applications (should) have been submitted, and now it's time to wait and get interview invites! While I was applying for residency last year one of the questions that came up quite a bit was how I decided on a specialty. (I decided on dermatology, by the way, and am doing my preliminary year in medicine right now and will start my dermatology part of training in July - there are lots of specialities that require a "prelim" or transitional year like ophthalmology, radiology, anesthesia, etc).
I'll save how I decided on dermatology specifically for another post, but today we'll talk more about how to figure out what might be right for you. I will first say that deciding on a specialty is a very personal choice and everyone will have a different answer as to why they chose their given speciality. The path to figuring out what you like is a long one, and it really is best to wait until at least third year to really try and make up your mind as to what you should actually apply in. When I first came to medical school I thought I'd do Ob/Gyn - I had worked at a women's health clinic for underserved women throughout undergrad and loved it - but by the time I did my Ob/Gyn rotation third year... well let's just say my experience changed my mind! There is of course nothing wrong with knowing early on, just make sure to keep your mind open to everything you think you don't like, and to keep a critical eye when it comes to what it is you think you do like. Does that make sense? Of course with that said, there are definitely things you can start doing in the pre-clinical years to help you figure out in a broader sense the parts of medicine that may be most fitting for you!
A few questions you can ask yourself during first and second year - do you prefer memorizing anatomy and visualizing where things are in the body or working through physiology problems and thinking about how organ systems work? Do you like basic science or histology, or do you never want to get near a microscope again? Do you like radiologic images and trying to find the pathology on film?
If you really like anatomy, do you prefer a more passive or active role in exploring it? If active, you might really like surgery - anatomy is at the forefront of surgery and you will know every muscle, artery, nerve, etc. of whatever system in the body it is that you focus on! If you prefer a more passive role in exploring anatomy, you might really like radiology - radiologists are the other physicians who really know every single vessel and can manipulate images in their mind to put together an anatomical picture of patients that really is amazing.
If you like organ systems and physiology you might really enjoy medicine or critical care, or even anesthesia (especially if you like pharmacology). In these fields you're constantly thinking about feedback loops, electrolyte abnormalities, etc. Do you really enjoy the physical exam and what it tells you about a patient? Neurology takes the physical exam very seriously. Do you hate the physical exam and care more about what the patient is telling you? Psychiatry could be better suited to you. Do you like acute problems with quick solutions (emergency med) or chronic problems with longer solutions (primary care). Kids, women, older folks? These are all things to keep in mind when you think about what you might want to do.
At the end of the day, it comes down to the kinds of problems you like solving and the types of patients you want to treat. One of the residents I worked with gave me some advice I hadn't thought of before - "what is the most boring, bread and butter stuff that a doc in that specialty does? What are they guaranteed to be doing in their practice every single day when there aren't the exciting or rare cases? If you're satisfied doing that, you may have found your specialty." He was of course trying to convince me to go into OB, since their "boring, everyday" is delivering babies. Pretty cool, but not for me. But the advice is something good to think about for every field! If you're not sure of what the basic things are in a field, ask someone who practices in it!
Something you should not make your decision based on? The money. For any of us who come from upbringings where money was very scarce, the last thing you want to hear is someone telling you it's not all about the money. I think what we really care about though when it comes to money is stability. And whatever specialty you choose, as a physician you will be making enough to not have to worry if you will afford rent next month.
This early on (ie in the preclinical years) the most important thing is to do well in classes and Step 1 so you don't close any doors for yourself should you like something more competitive. And most of all just keep an open mind! You will gain something from each of your clinical rotations, whether you go into neurosurgery or pediatrics, so try to enjoy all of them! And listen to your heart - listen to what makes you excited and happy again! I was on "easy" rotations where the hours were short, but what we did during those hours was so boring (to me) that the day literally dragged, and getting out of bed every morning was tough! On the flip side, there were rotations where I never saw the sun, but I enjoyed what I was doing so much and had such great teams that I loved going to the hospital! Don't dismiss that feeling.
Figure 1 app. This is a new app that's sort of like Instagram for medical providers. Users can anonymously share photos of medical conditions - either a rash, a picture from surgery, even an interesting EKG or blood smear - and get feedback on differential and treatment! It's not always 100% correct (it's random people commenting) but it's really fun to just see so much different pathology. Pay attention to the cases you're drawn to - maybe you're like me and love seeing a rare rash, or you love all the orthopedic cases, or the rare infectious disease presentations from third world countries! Just check it out!
Once you get to the clinical years, try and ask attendings what they like about their jobs and how they've set up their practice (do they work mostly in the hospital, a mix of clinic and hospital, private practice, or mostly research and teaching, the different set ups will surprise you)! It's obviously great to talk to residents who have chosen that field as well, but try not to dragged by them if they happen to be a little less than optimistic. The years of training are some of the hardest and you have the least control of what you actually do during the day, so sometimes residents aren't always the happiest. Don't always let that get you down! But on the flip side, if every resident is miserable, that's something that's hard to ignore (and you probably shouldn't)!
I hope some of my rambling can help as you think about what kind of specialty you might want to practice. As always leave questions or suggestions for posts in the comments section!!