How To Choose a Medical Specialty in a Changing Landscapeby Stesha Doku on Jan 2, 2013 • 3:55 pm
Along the path to becoming a physician involves many decisions that will ultimately determine the populations you serve, the context you work in and the relationships you build. Deciding on a medical specialty is considerably difficult — most medical students find that there are many sub-fields they find engaging. Some will find that the flexibility of their personality allows them to enjoy various kinds of work. And still, some will find that they like nothing — and that’s ok too — there are many ways to contribute to medicine post-medical school that don’t require you to be at the bedside.
Don’t let anyone tell you that you have to be a traditional physician — you’re dedicating your time and money, so why should they pick what your job should be?
Here are some approaches to thinking about what specialty may be good for you to pursue, and resources you can check out for more investigation.
1. What kind of daily work do you want to be doing?
A simple enough question that usually translates to people dividing their thoughts into ‘medicine vs surgery’. In many ways that is an accurate way to think about it but given the complexity and overlap of many specialties you can do lots of surgical things in fields that require more medicine based training and vice versa. Examples of fields with medicine training and lots of hands on procedures include interventional radiology, emergency medicine, gastroenterology, cardiology and anesthesia. If procedures scare you, there are many fields that give you non-invasive treatment options: internal medicine’s smorgasbord comes to mind. If you want to be a surgeon but not in the OR all the time, remember that surgeons have lots of clinic (you have to follow-up with your patients!) and can also work in the ICU. If you don’t know what kind of work a field does, get out there and shadow for a week (don’t just do one or two days). It will give you a chance to see the variation in one’s job and what you like. Do this during the first two years of medical school instead of waiting for your clerkship if you’re looking into a highly competitive field. If you like it there may be some preparation you need to do and contacts to establish and exploring it early gives you more time to do so.
2. Are you an introvert or an extrovert?
Check this guide out: Medical Specialty Myers Briggs Personality Types. If you’ve never done a Myers Briggs MBTI test, this is probably a good time to do one officially or do this simplified version. Introvert does not mean you’re shy, it just means you get energized internally or maybe even that too much social interaction can leave you drained. There are many introverts who are the life of the party but they just don’t want to do it every day. They work well by themselves and don’t panic if they have to be in solitude for some time. Be true to that. Consider fields that will give you that space so you don’t burn out. Likewise extroverts who crave social interaction should seek a field that will fulfill them in that way.
3. Who do you want to work with?
Find out if you fit in with the personalities in your field of interest. All fields attract certain types of common personalities because of reasons #1 and #2 BUT if you don’t fit with the people you meet that doesn’t mean you won’t enjoy doing their work. You may actually want to work with people who are different than how you function.The other thing to consider is that medicine is not a solo sport. Consider who your colleagues are going to be outside of your field. For example, anesthesiologists have to work with surgeons, nurses, techs in the operating room but they can also work with internists in the ICU. Consider which kinds of people you have to consult or work side by side with and decide if those interactions excite you.
4. What setting do you want to work in?
Even if you choose the perfect specialty for you, the setting can still make a huge difference. I remember the story from an ICU doc I spent time talking to while I explored my own career options. He recounted a couple he knew who were both ENT surgeons. The husband had decided to go into academics and in his setting he was doing research, teaching and doing a few cases a week. The wife had taken a job at a private practice across the street focusing on only the ear for children. Though they received the same degree and training their jobs were remarkably different after residency training. You can carve your own path within a specialty so remember that if everything doesn’t appeal to you about one of your choices, find a way to practice the part that actually does.
5. Lifestyle/Money Matters
Everyone’s talking about it. And too many docs over the age of 50 are complaining that the younger generations are ‘weak’ for considering that in our decisions. They’re foolish and so are you if you don’t take lifestyle into account. What you want in the next 5 years in terms of your life outside of medicine (and yes you should have a life, happy doctors tend to do their job better) may be different 15 years down the line. Plan in advance. This does not mean you have to know for sure what you want but making room for friends, partners, children, parents or siblings is probably a good thing. Or maybe you want to make sure you can take vacation or run a startup or sleep (!)? Times are changing and while our predecessors spent all their time in the hospital (there were fewer of them to do the job and less technology to help in the process), we don’t have to and we don’t need to. Soon enough our healthcare system will better account for the inefficiencies that have caused these time problems. With work hour restrictions we’re headed in the right direction but some fields are still better than others right now.
6. Tech Matters
This may not matter to many of you as it’s hard to see at this point how some technologies still under development or yet to be discovered will impact your specialty. But there are certainly some fields that are incorporating technology at an unprecedented pace to decrease the risk of our medical interventions, improve patient safety and working conditions. The impact of technology cannot be ignored. For example, while there are still unfortunately many open heart surgeries required, many heart operations are now being done through the skin (percuatenously) which means very different skills are required than your heart surgeons from the past. This means cardiologists, interventional radiologists and cardiac surgeons can all do this job. Look into how your fields of interest are changing and if you like the direction it is headed you can be part of the process.
So what happens at the end of the road if you haven’t decided and are still torn between more than one specialty?
1. Take time off. I won’t be able to tell you what to do with that year — you can figure that out for yourself but some advice: Don’t take time off to do silly research you don’t care about. Take time off to explore the fields you are considering. There are ways to make that productive if you feel some sort of societal pressure to build your resume but really you should be using the time to step back and evaluate your options. In a year’s time you may have a clearer idea.
2. If you’re in the US, you can apply to the match in multiple specialties. Beware, this process is both fun and expensively annoying for one specialty so make sure you are prepared to do twice the effort. Along the interview trail you may discover that the residents, faculty and other applicants in one of those specialties jives much better with you than the other. Being able to envision potential people you would work with and how they can help shape your career path may be what you need to decide what you want for yourself. This will also give you time to delay the decision by several months if you don’t want to take off an entire year.
3. Don’t match. You’re still an MD, just not a practicing one yet. You can enter the match later. Do something good in the mean time.
4. Match in the specialty you believe at the time is best for you. You’ll be surprised as human beings how sometimes we can fall in love with something because of the routine of it. If that’s not the case and you make the wrong decision, You can always change your specialty and do something else. All you lose in the process is a little bit of time. Rather, all you gain is time to confirm that something is absolutely not for you and you can go down another path. But, please don’t stay in a field you don’t like because you’re scared of what others will think or can’t accept the decision was a bad fit for you. Many people change fields. You, your colleagues and your patients will be better off to have a happy doctor that wants to be there. If you weren’t competitive for the specialty you really wanted to go in, try, try again. Maybe gain some experience in some other domain or find ways to build your resume better and get into the field non-traditionally.
Photo Credit: Making Choices by Orangejack