The Pressure of Choosing a Specialty

Emily Kahoud


March 05, 2019

Whether you're in an allopathic or an osteopathic medical program, choosing a specialty often falls toward extremes: Either it's as clear as day and hits you with unquestionable clarity or it's a greater struggle than med school itself.

An article in The Pan African Medical Journal observes, "While the career-choice stage of a student's life was expected to be filled with enthusiasm and optimism, it was instead found to be one of the most critical and stressful times due to the complex, dynamic and multifactorial nature of the decision-making process." The authors go on to describe the stats of how many students change their preferred residency specialty prior to completion of medical school. According to an Association of American Medical Colleges report, 56% make a switch. Whether this is for better or worse is unknown. We do know that a significant number of residents and physicians change specialties to unrelated fields.

Specialty Choice and Burnout

Unfortunately, many medical students make these critical life-changing decisions under increasingly pressured circumstances. They worry about the debts that are unmercifully accruing with compounded interest, at sometimes exorbitant rates. Some may feel pressured by the expectations of their parents, who may have spent a lifetime of toiling to build a practice and a namesake that their child can someday inherit. Still others are motivated by prestige and cannot live with themselves if they "settle" for less than the very best that they can possibly achieve. These are all potentially regretful reasons.

With physician burnout and suicide reaching alarmingly high rates, we have to ask what role this critical decision plays. This burnout has been described by some as a "global public health crisis," yet it remains the elephant in the exam room at most medical institutions.

According to Pamela Wible, MD, author of Why 'Happy' Doctors Die by Suicide, a disturbing trend has emerged. "When accounting for numbers of active physicians per specialty, anesthesiologists are more than twice as likely to die by suicide than any other physician. Surgeons are number two, then emergency medicine physicians, obstetrician/gynecologists, and psychiatrists." Interesting to note is that the specialties on polar ends of the board score spectrum seem to be the ones with the highest risk for physician suicide.

We can only hypothesize what this means.


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