18- How to Choose a Medical Specialty?

I Want to Be a Doctor

Welcome to the I want to be a doctor podcast where insider information about what it takes to become a physician is available for anyone. I'm Dr. Robin Dickinson, a board-certified family physician and I will give honest answers to your questions. Today's question is from a 3rd year medical who asks: Help! Everyone on my rotations keeps asking me what I'm going into and I DON'T KNOW! How do I choose a specialty?!

How Do I Choose a Medical Specialty?

Well I wish I could give you a simple answer. Take this test, sort yourself into the correct Hogwarts house, hold this thing in your hand and it will turn the color of...

But no, I'm going to start by saying there's no wrong answer but there's no right answer. Kind of like there's no perfect person to marry, whoever it is will have bad days and drive you crazy and sometimes you'll stay with them only because you trust they'll come back into their right mind someday, no specialty is going to be a perfect fit. If you are totally in love with a specialty, that's no different than someone in the infatuation stage of a relationship. It's not going to last. Remember that a lot of arranged marriages work out really well, often even better than marrying for love.

And really, it's more like buying a house than getting married. No one buys the perfect house. Maybe you love the location but hate the avocado green bathrooms. Maybe it has enough bedrooms but the kitchen is tiny. But you find something that's good enough and you live there for decades and you end up really loving the house but eventually moving into a nice retirement place in another state.

Specialties are the same. There are good and bad about each. You'll spend decades there. And then you'll retire and do something else with your time.

So now that we've got some realistic expectations about finding a specialty, let's talk about the actual decision.
How to Choose a Medical Specialty, Funny

There's a humorous flowchart out there to help you decide your specialty. If I can find it, I'll put a link in the show notes. (I found it, that's the link.) It starts with a simple problem. Do you like everything or nothing? If you truly have no idea what you want to do, that's a reasonably good place to start.

I liked every rotation for about two weeks and then I'd hate it. Another gallbladder?! Another well child check?! Another diabetic check?! Another... whatever. Every specialty seemed to be the same thing over and over. Because it is. Except family medicine.

I loved the totally random nature of family medicine. I never knew what we'd do next. A joint injection? Patient counseling around bipolar? A child who broke off a colored pencil tip in their ear? While there are certainly things I don't like about it, nothing else suited my personality. I couldn't understand how anyone could ever do the same thing for more than a few weeks.
Story About Choosing a Medical Specialty

But on my radiology rotation during residency, I got a little taste of the difference. I spent as much time as I could with a younger radiologist who told lots of stories to go with what we were looking at... again, that's my personality. I love stories.

One day he told me about how he chose his specialty. He was rotating with a family doctor who did everything, a pillar of that community. The family doctor saw everyone and they were in the office, at the high school football game sidelines, admitting patients to the hospital. It sounded wonderful to me. And then one day they went into the radiology reading room. Now radiology reading rooms are really unique places. They are dark and quiet and warm. The radiologists spend hours in little cubbies looking at images and quietly murmuring their dictations describing their findings. So the family doctor took him into the radiology reading room to ask a radiologist to look at something for them and discuss the case. As they walked back out into the light and bustle of the hospital, the family doctor said, "I can't believe they spend all day sitting in there in the dark." And he [the future radiologist] thought, "I can't believe they spend all day sitting in there in the dark."

And that's what you've got to figure out. What makes you think, "I can't believe they do that!" And what makes you think, "I can't believe they do that!" Cross off everything in the first group and if there's anything in the second group, consider it first.

Journaling to Choose a Medical Specialty

If not, don't worry! There's more. So much more. I'm going to ask you a bunch of questions. You can copy them off the show notes
Questions to Ask When Choosing a Medical Specialty

What's your personality? Have you had one intense hobby for a decade now? Do you have six unrelated hobbies? Did you resent having to take any classes outside your major in college? Did you double major in subjects that were on the opposite end of campus? Do you prefer to work on just one project all day? Or do you like to switch between activities frequently? Do you like being part of a team? Do you prefer working alone? Do you like writing really detailed notes or would prefer to just leave that to someone else and DO SOMETHING?

Where do you feel comfortable in your own skin? I loved working in a hospital but it was like a drug for me. It made me so overstimulated that I couldn't sleep or focus or enjoy any of my hobbies. I just didn't feel like me. But working in an outpatient setting suited me. I still got the thrill of caring for complex patients and really making a difference but I could leave it at work and enjoy my life at home.

What kind of patients do you enjoy caring for and what makes you want to run away screaming? And where are you likely to find those sorts of patients? Do you prefer to spend as long as possible talking with a patient or would you rather keep it brief?

What kind of colleagues do you enjoy? Do you want to work in an academic setting? Are you hoping to live in a rural area? A big city? What kind of jobs are possible there? An endocrinologist would have a very hard time supporting themself on the eastern plains of Colorado in a town of 300.

Do you want to be the one and only that people count on? I wanted that when I was younger but over time I wanted to be able to take time off without it bothering anyone. My life goal is to be able to batch my work enough that I can take a couple weeks off and not have anything waiting for me when I come back. As a physician you can work your shift, like a hospitalist or ER physician or you can have your own patients. If you have your own patients then usually all the work will be piling up while you're gone and you'll be working like crazy when you get back. Unless you find a practice that has come up with a better plan, which will hopefully be more common by the time you're through residency.

What do you want your day to be like 10 or 15 years from now? Do you want to be home for supper with your family? Do you want to sleep in your own bed? Do you want to be on rotating call? Do you want to choose your own schedule or do you want to negotiate it with a group? Will you be in the military? Are you interested in working for Indian Health Services or the prison system? Do you want to travel? Have a hobby farm? Try working through an actual day in your potential specialty and how that will work out with your other life goals.

Everything has a trade off. Ophthalmologists have a great lifestyle. And they do surgery on people's eyes all day. I don't know many ophthalmologists who actually have a passionate interest in eyes. Sure, they enjoy the really careful surgeries and understand what a huge difference they make in people's lives. But mostly they seem to enjoy their lives outside of work.
Stereotypes of Different Medical Specialties

While the stereotypes of various specialties aren't entirely true, they are very revealing. If the stereotype is that they are ridiculously detail-oriented then you probably don't want to go into that specialty if details drive you crazy.

I know several physicians who switched specialty in the middle of residency and that's okay too. But hopefully if you're true to yourself and what you like, you'll figure it out sooner. I know someone who went into family medicine but discovered during residency that they didn't actually like touching patients and changed to psychiatry. Paying attention to how they felt about touching patients in medical school could have helped them make that decision from the beginning.
How to Make a Big Decision

There are several ways people double check their choice. One is to put several top options on pieces of paper, fold them up, and randomly grab one and open it. See how you feel. Does your heart sink or leap?

Another is to write out a decision grid. Fold, crease, then open a paper hamburger and then hot dog (long ways then wide ways) to make four spaces. One is pros if you do, one is pros if you don't, then cons if you do and cons if you don't. Dump everything out on that paper. Cross out any cognitive distortions. See what's left.

And of course, doing a sub internship in the specialty can help if it's a hospital based specialty.

Ultimately, the choice isn't simple and it isn't absolute. Many people aren't 100% sure but they find something that works for them. You'll find something that works for you, too.

That's it for today. Subscribe, share with your friends and mentors; and remember to live the life that is right for you with your personality interests and values.

Please send your questions to me at [e-mail]. That's podcast at d-o-c Robin like the bird school dot com.

Show notes are available on the podcast website linked below.

This episode was sponsored by Dr. Robin's School, the first premedical curriculum for kids, and recorded and produced in beautiful, downtown Englewood, Colorado.

https://podcasts.bcast.fm/i-want-to-be-a-doctor