When I Grow Up
Nine months into my M3 year, I still don't know what I wanna be when I grow up. Put into context, I'm fourteen months away from graduating and actually getting an MD. I'm twelve months away from "the match," where I find out what specialty/residency I matched into and where I'm going for the next few years.
In making my M4 schedule, I've been forced to think about what I've truly liked. This has proven to be pretty difficult, since I've liked everything. Having done seven rotations to this point, we basically decide our careers based on these experiences and impressions of ones we've yet to do. I'm not one of those who knew exactly what I wanted to do when I came to med school. I'm jealous of them at this point. I always figured it would kinda come to me along the way. Not so much.
At this point, I can safely say that I probably won't be going into OB/gyne, neurology, psychiatry, pathology, radiology, or dermatology. I'd be pretty competitive in most of those fields, but I just don't see myself doing them. Of the six, I'd be most likely to go into OB/gyne. I'm ambivalent towards neurology and psychiatry. I have zero interest in pathology, radiology, or dermatology. A word about derm. It truly appeals to some people: that'll happen and good for them. It appeals to others because its among the most competitive specialties to match into, it's a decent lifestyle, pays well, and there's an according "prestige factor." Zero appeal on those fronts for me.
Traditionally, the first decision to make is surgical vs. medical. I really liked surgery and could see myself enjoying it. As an attending. Five years of a general surgery residency are not really to my liking though. The thought of five years of 80+ hour weeks and getting zero sleep every third or fourth night isn't all that appealing. Problem is, gen surg is pretty much the gateway to most of the subspecialties: peds surg, cardiothoracic, vascular, trauma, colorectal, transplant, surgical oncology. And for these subspecialties it's another 1-3 years in fellowship. I think not.
There are more lifestyle friendly surgical specialties: otolaryngology, urology, plastics, and ophthalmology. These have a reasonable mix of surgery and medicine and are less intense than gen surg residencies. For these very reasons, they're ridiculously competitive, on the same level as derm. My refusal to be extracurricular (research, volunteering, networking in those fields, etc) is a pretty limiting factor. More importantly, my board scores are slightly to decently below average for these fields. Ortho is another pretty competitive specialty, but it doesn't really interest me all that much, and its residency can be pretty intense.
Sadly, the above thought process puts a lot of things ahead of surgery. And my body of work realistically limits me to general surgery and it's associated fellowships. It was a realization that I had been hoping to avoid.
That leaves the medical half of the equation: internal medicine, pediatrics, family medicine, and their associated subspecialties. I haven't done IM yet, but I could see myself doing any and all of the above fields. Family medicine has turned out to be surprisingly appealing, as it's generalist medicine in the truest sense. Anything can walk through the door, and you've gotta be able to at least recognize what's happening so as to either manage it or refer it out. There's a decent number of minor procedures, a chance to work in urgent care centers, and opportunities to practice obstetrics (becoming rarer with malpractice).
All that love for the medical specialties, but I'm actually in a gray zone with the surgical/medical debate. Top two specialties right now are emergency medicine and, wait for it: anesthesia.
Emergency medicine is something that's always been on my radar. A nice breadth of pathology and patients, potential for lots of procedures, shift work, and all sorts of acuity. The major downers are no continuity of care and (strangely enough) shift work. The shift work is nice as a younger attending, since it's pretty easy to work 36 hour weeks and consider that your work week. The downer is still working 7PM-7AM shifts on a regular basis as a middle aged attending. Most attendings at that age transition over to administrative work, which is something I'm not remotely interested in.
Anesthesia is probably the shocker for those who've kept tabs on me over the years. It gets me involved in the care of different types of surgical patients, it's a medical field where I getto use my brain (vs. surgery). For being in the OR and involved with surgical patients, there's a decent amount of physiology and pathophysiology that has to be applied. There's also a reasonable number of procedures and yes, it pays pretty well.
To add more confusion to the picture, I just finished my family medicine rotation. And I actually thoroughly enjoyed it. I could see myself being a family doc - good breadth of pathology, some minor procedures, continuity of care - just no acuity and the hours aren't set in stone. The other downer is that the training isn't as in-depth as I might like. Not to say that FPs aren't qualified, because they are. I just wouldn't mind having a little more in-depth training, maybe to the tune of a combined med/peds residency. I wouldn't want to lose treating kiddos by doing an internal medicine residency, so I'd be amenable to combining my training with a peds residency. The med/peds idea and whether it moves forward hinges pretty heavily on whether or not I like my internal medicine rotation - which starts tomorrow.
Basically, I there's no field that I *have* to be in. But I know what I don't want to do. And there are a few fields that have either piqued my interest or that I could see myself doing. Which brings me to the current list: emergency medicine, anesthesia, family, med/peds. And as a sign of how unsure and fluid my thoughts are, those last three fields weren't on my radar a month ago.
