As all physicians know, most of us change our specialty at least 2-3 times during medical school. It’s terrifying and exciting to take the leap and commit. Submit your application into the match and gamble your life like Wheel of Fortune!
Perhaps you’re lucky enough to land an exciting rotation with an attending that likes students. Before you know it, you’re intubating patients as a med student and smugly convinced emergency medicine or surgery is for you…until you work the trauma service, overnight, with no senior coverage. Your patient is hypoxic, but your attending is resuscitating a gunshot wound next door, and it’s all you. You pronounce a few people dead and maybe realize this isn’t for me.
You enjoy the rush of delivering babies and caring for expecting mothers, until you rotate through the Suboxone clinic and spend a week in the withdrawal NICU unit. You then switch to Pediatrics, because healthy children make you smile and they’re kind…until the politics of Pediatrics and Medicaid slap you in the face, as do the parents. Repeatedly.
The introverts gravitate toward non-direct patient care jobs, like Radiology…until you find yourself photophobic from sitting in a dark room for 8-10 hours and people start calling you the raccoon. Maybe Pathology or Genetics for the research inclined, until you realize how dubious and competitive it is to write and receive grants. You find yourself missing patients.
Resuscitating and investigating in the ICU thrill you, until the hospital has ignored your third request to replace the 30-year-old ventilators because the CEO would rather spend that money on Super Bowl ads. So, you move down the unit to become a Hospitalist on the floor. You have no nursing staff, 20 patients waiting in the ER to admit, no available beds, the hospital has you on probation for not submitting your notes on time, and the mid-level in the ED calls you every 30 minutes because they’re a mid-level.
Things to deeply consider before choosing a medical specialty
- Experience the day in and day out of the job. David Foster Wallace wrote a beautiful graduation essay on this topic called This is Water. I highly recommend you read this before you choose a specialty.
Attendings try to show you the best cases with the most interesting patients. This is out of nostalgia. They remember how excitement used to lurk behind every patient, before the reality of the system rested on their shoulders. Put this aside for a minute. See the mundane, banal patients. Try to get a taste for their true schedule – don’t leave when they dismiss you. Stay and work their full shifts. Chart and document as painstakingly as your attending.
- Ask seasoned doctors how hospital systems and politics will change your desired specialty. Insurance and hospitals completely changed inpatient care in the last 10 years. Many surgeons retired early. Pediatrics and Family Medicine have largely been replaced by less expensive mid-levels. Artificial intelligence will augment and likely replace much of radiology and pathology. As a physician, you do not have the luxury of checking out of politics, as they control now what you can and cannot do.
- Ask older doctors if they are happy. I initially began residency training in Emergency Medicine. I loved it for the first year but later realized I made a terrible mistake. In general, half of my attendings were utterly miserable. In their defense, the ER has changed for the worse in the last 10 years. You can absolutely trust that if none of your attendings are happy, you won’t be, either.
- Be extremely honest with yourself about your schedule. Some specialties offer better work/life balance, like Ophthalmology and Dermatology, while in others you will work a minimum of 80 hours/week. Take some time to seriously contemplate your family goals. Do you want to be home with your children, travel, or invest in hobbies? You may enjoy working 100-hour weeks now, but I can promise that after 15-20 years of working the day-in, day-out, you may change your mind.
Medicine remains the hardest, most rewarding, highest calling you can aspire to in this life. Your patients will drive you into existential crises some days and into euphoric elation on others. Balancing your enjoyment in a specialty with the reality of the job, politics, and current system failures in that area will save you a world of pain.
My last bit of advice: Everything you know about medicine will be wrong in five years. Every 10 years, your specialty will be radically different, due to biotech, big pharma, and politics. It’s ok to change specialties a few years in – you’re allowed to make changes. This isn’t Harry Potter and the sorting hat. Enjoy the ride and be good to your students. The future of healthcare remains unknown.
Perhaps when I’m 80, we will live on Mars, consult AI computers, and not see doctors at all.
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**Editor’s Note: For more articles on choosing a medical specialty, visit our medical specialty page.
