How Should I Handle Negative Comments About My Specialty?

Geoffrey A. Talmon, MD

Disclosures

November 17, 2011

Question

On my new rotation, my attending keeps making disparaging remarks about my specialty. How should I respond?

Response from Geoffrey A. Talmon, MD
Assistant Professor, Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska

It was inevitable for me on every clinical rotation. I would get some reaction, usually negative, from my attending physicians or senior residents when I mentioned that I was considering pathology as my specialty. At best, the person would roll his or her eyes or make some crack about how I was not interested in talking to living people.

Sometimes I also noticed that the performance bar seemed to drop; I was no longer asked to help with procedures or given certain tasks. The typical explanation: "You don't have to worry about helping out with inserting that central line because you would never have to do it for real."

Almost every specialty seems to elicit preconceptions, ranging from personality type to duty hours, salary, work ethic, and perceived intelligence or skill level. From the family physician to psychiatrist, everyone receives input on his or her career choice at some point.

While these stereotypes serve as jokes among practicing physicians, they can be difficult for medical students, especially when they come from evaluators or individuals who may write letters of recommendation.

The comments can also be problematic for students who are still unsure of their residency choice. For example, a medical student friend of mine was trying to decide between pathology and internal medicine, and one reason why she began a residency in the latter was that her father (also a physician) said her "people skills were too good" for pathology and that she belonged in clinic. After 2 unhappy years, she transferred into a pathology residency and found it to be one of the best decisions of her career.

How, then, should medical students handle negative or disparaging remarks about their chosen specialty?

First, consider the source. Many remarks of a stereotypical nature can be attributed to the lack of empiric information or isolated negative experiences that the person may have had with a few individuals.

In addition, consider your source's perspective. For example, if a general surgeon comments on pathologists' work hours, consider what specialty she is using for comparison. Is the comment that all gastroenterologists make too much money based on data? Did your internal medicine attending call radiologists "lazy" because he or she had negative experiences with 1 or 2 people in that department? Remember that physicians are human. They have the same tendencies to develop preconceptions as the next person.

More important, do not give isolated comments from a small number of individuals (no matter who they are) significant weight in your decision. Choose your specialty after doing thorough research and introspection. In particular, research what you have heard. Are the statements based on accurate information? Do other staff or residents in other departments share the same perception?

It is also important to think about why you initially considered the field. Perhaps you liked the type of cases or patients you've encountered, or you can see long-term satisfaction from the career. These factors should trump sporadic negative comments that you receive.

Responding to these remarks while on service as a medical student is complicated. It might be safest to ignore them. When I was a medical student I often found that there was little to gain from trying to sway a senior surgeon's view on pathologists. Others, including some of my colleagues, have felt the need to respond to negative comments about our specialty. If you choose to respond, ask why the person has that opinion. On several occasions, I found that the attending would admit that the comment was a gross overgeneralization or was inappropriate.

Do not actively debate the inaccuracies of your supervisor's position while in the operating room or with the entire team present.

It's best to speak up when you feel that your education on a rotation is being negatively affected. In the instance when I was not getting to assist with procedures, I found a quiet moment with the chief resident and mentioned that I wanted to get as much experience as possible. A productive conversation ensued and the situation markedly improved. You might also talk to the rotation director or dean if you still feel that you are not being treated equitably.

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