Daniel J. Egan, MD

Disclosures

September 20, 2006

Question

I realize that the specialty I choose will largely define my medical career, but there are so many things to consider. How do I decide which specialty will suit me best?

Response from Daniel J. Egan, MD

Daniel J. Egan, MD 
Attending Physician, Emergency Medicine Department, St. Vincent's Hospital, New York Medical College, New York, NY

There is something very strange about medical training. Early on, students are forced to make decisions about their future on the basis of relatively minimal information. How should you make this decision? For me, the choice was easy; I had always dreamed of being an emergency physician. But my decision was also based on real-life experience, and I think that is the key element in reaching your decision.

Once you reach your third year of medical school, you really begin to practice clinical medicine. You are given a responsibility that is uniquely different from the shadowing experiences you have had during the preclinical years. Every 4-8 weeks, you rotate to a new specialty and learn the subject matter in great detail. During this time, you likely will be trying to impress your residents and attendings, and you will be studying hard so that you can do well on the shelf exam. You also need to pay attention to the subtleties of each specialty to see if it may be a good fit for you.

Medical students base a lot of their decision on their clerkship experiences. However, most practicing physicians will tell you that what happens during your medical school rotation is quite different from everyday life in that specialty. For example, in the world of internal medicine, many practitioners spend most of their time in the outpatient setting, forming long-term relationships with their patients. For a surgeon, not every day is spent in the operating room as it is when you are the student. In obstetrics, the labor floor and postpartum evaluations are only a small part of the practice. It is clear that what you see as a student will help you understand what it will be like as a resident in that specialty. But one could argue that even residency may not perfectly emulate a long-term career in that specialty.

As you try to decide, I recommend going back to the preclinical years and thinking about role models you may have encountered. Call those people up and ask them if you can spend time with them in their practice. Perhaps there is a subject matter that grabbed your interest and you can find a clinician in that field. As you go through your clinical rotations, identify mentors who may be able to show you what life is like outside the hospital as a physician in that specialty. Also, pay attention to the consultants you encounter. Maybe radiation oncology is something you would love, but your only chance to see what they do was when they consulted on your medicine patient with newly diagnosed spinal metastases. In my opinion, there are many options available but our medical education exposes us to so few.

The difficult part for physicians is that when we choose a specialty, we are locked into that field for the rest of our careers, unless we choose to pursue additional training in another field. Unlike nurses or physician assistants, who can change career paths, we are somewhat committed to one area of medicine for the long haul. Obviously, this needs to be a specialty you love. The content of the medicine must excite you. You need to try to find an area in which reading about a topic or treating a patient with a particular disease makes you crave more. Perhaps your interests are limited to the nervous system, for instance. Or, perhaps you have enjoyed all of your clinical rotations and want a field that can incorporate all of them, like family practice or emergency medicine. Or perhaps your clinical years showed you that interacting with patients on an everyday basis is not something you desire, so you might consider radiology or pathology. In addition, many would argue that certain specialties have personalities that are drawn to them. Look at the residents during your clinical rotations and see if they are people with whom you could see yourself spending several years in training.

Finally, ask questions. Ask questions not only about the specialty itself but about life outside of work. People love to talk about their own specialty, and frankly, many people in medicine just love to talk about their own work in general. Try to get a sense of what life is like once residency is over. Residents have a unique perspective on things that may be somewhat limited to the lifestyle they experience during training. These are important issues to understand, as you will spend several years of your life in that role, but the rest of your life involves many more years after residency training.

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