Sunday, February 08, 2009

Choosing A Medical Specialty

It seems like in every class, there are two groups of people. The first group seems like they were born with a scalpel or stethoscope in hand, claiming to have known they wanted to be an orthopedic surgeon or pediatric rheumatologist since practically the day they were born. The other group is on the other side of the spectrum: they weren't sure about medical school, weren't sure how to pick their rotations, weren't sure what to specialize in, weren't sure where they were headed in general. This post is for that second group. As Match Day approaches and the 4th years effectively complete medical school, the third years now feel the full weight of the decision on their shoulders. How do I choose a  medical specialty that is right for me? 

When I addressed this issue earlier in the post "How To Choose A Medical Specialty", the image was meant as a facetious commentary on just how hard it is to choose a specialty! The decision is so difficult for some physicians that there are some who have completed a residency, went into practice, only to go back and do a second specialty in something entirely different!

Now, some of that may simply be due to personality, but how does one avoid such a fate?  While it may be cliche, I think the old idea that "Knowledge is power" applies quite well: the more you know about various fields, the more informed a decision you can make. The key is to start early. Don't merely rely on your third year rotations to expose you to everything. Some rotations will be much longer than you would like; some, too short; and some, you won't even experience at all. The latter group is the most worrisome: how can you tell if you would like something like geriatrics if you never rotate in it? If you have even an inkling of interest, it behooves you to either schedule a short elective in a field, or simply shadow a physician in that area on your day off. Now, I realize many of us may not be that self-motivated to take time on our days off to do that, but there really is no substitute for that kind of experience.

Okay, so you took my advice... and are still confused. Now what? Here are a few more resources to consider:

I also highly recommend reading through Iserson's Getting Into a Residency: A Guide for Medical Students. While the book does focus on residency applications, the first half of the book focuses on what you need to do in medical school to prepare for applying, as well as discussing practically *each* medical specialty and what type of applicant is ideal for each one.

Hopefully this post has been helpful in pointing out some resources to use. Have you come across any other resources that you found helpful in choosing your medical specialty?

Updated 2015-12-18


  1. This post was funny and helpful.

  2. I like my field, and ended up in it by process of elimination. I went through all my 3rd year rotations, and learned what I DIDN'T want to do, and that narrowed it down quite a bit.

  3. I think most people fall into one of two categories regarding this decision. Either, they know from like childhood they want to be a, say, pediatric cardiologist. Or, they follow a decision process much like Grumpy, and use a process of elimination to find what they like. Ah, those multiple choice test skills have broad applications, no? =)

  4. No good deed goes unpunished.
    (A.K.A. The good Physician will always be stepped over by everyone else.)

    I entered physician training for several reasons. The intricacies of internal medicine interested me. Because I like to know things, to see patients come in with their complex problems and watch their story play themselves out and come to a conclusion that is satisfying. Because I respected the Physicians I studied under. But it has become increasingly obvious that all is not 'even' in the real world.

    As I embark on my specialist training, I start to wonder whether or not I have made the right decision.

    It is no secret that Physicians will ultimately earn much less than the Surgeon or the Radiologist. And definitely much less than the Anaesthetist. A trade-off for the lack of procedural income? Or more a culmination of goodwill being taken for granted? How often have Physicians been passed over (or not give the same work incentives) at each round of enterprise bargaining? Even the medicare benefits schedule are a starkly obvious sign that society values my clinical acumen much less than other specialties.

    What does the government (and medicare) value more? The follow-up Physician consultation of a patient with multiple medical problems, or an Anaesthetist giving sedation for a CT scan? It seems the latter... And the private insurance rebates show a more of a discrepancy. See ten medical patients in one afternoon, or perform one epidural? Or maybe look after a handful of patients in private hospitals? Have you tried finding a private hospital bed for a medical patient? There's no chance of it - because there's no money in it. Hospitals make more money from an operation, and so they're more likely to have a bed afterwards. Better off filling a bed with a prime-paying Orthopaedic patient than someone with pneumonia.

    Whilst many of us will vouch that life isn't all about money, it's hard to think that a full-time-Physician will earn less than a part-time-Radiologist. And the Radiologist will get to see their family more often, take holidays more often, have more time for the other things in life. I ask myself (at the risk of sounding somewhat obnoxious) if there really are that many 'pluses' of Physicianship compared to other specialties.

    Is it really a 9-to-5 job? Are there public hospital positions available? Is it really less stressful? Is there more respect for a Physician?

    The answers seem to be obvious, but are coloured by our own ideas of what makes us tick, restrained by our moral sensibilities.

    Which leads me to consider my future role in the public or private sector.

    I don't intend to see any private inpatients. It's financially not viable. Why go around seeing patients in hospital beds in *their* rooms, when they can easily come to *my* rooms? I would rather spend time with my children and my family than keep my phone on all night. I would rather hold onto my own dignity than become a post-surgical lacky for the higher-paid surgeons. I firmly believe the newer generation of Physicians will also have the same ideals. If this is anything to go by, there will be an even bigger gap in the medical care of private inpatients.

    I intend to stay in Physicianship because that's what I love. But if asked to evangelise the benefits of Physicianship over every other specialty, my conscience will prevent me from lying. Don't do it.

    Written by an Australian Doctor.

    1. These are soo true... Harsh realities of being a physician in the modern day... Sigh

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