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How Do I Know If I Really Love It?

April 3, 2014

Very interesting question from a med student reader the other day:  How do I choose what specialty to go into?  Her particular decision was worded  differently, but the general idea of the query is the same:  how can I possibly know what it’s going to be like to be this or that kind of doctor?  It’s a great question.  After all, you have to choose during the third year of medical school because of the lengthy match process.  (For those of you who don’t know what the match is, I’ll rant on that another day.)  Plus, once you pick you’re going to spend the next 3-10 years training in that specialty.  It really sucks when after all that you realize you chose wrong.

Some people just know.  “I’ve wanted to be a pediatrician since I was 5, my mom is a pediatrician, my grandfather is a pediatrician, I was Doc McStuffins as a child, I loooooove kids…”  Great.  Awesome.  Those people are lucky, and usually right.  Others have it narrowed down to, at least, adults vs. kids, medicine vs. surgery, out-patient vs. in-patient, etc.  Those people are less lucky, and sometimes right.  For the rest of us, all we have to go on is what we see in the third year of medical school, when real clinical rotations get going.  Remember, I was a nurse before I went to med school.  I was a cardiac nurse.  I wanted to become a cardiologist.  I thought I knew exactly what I was getting into.  I was so wrong.  So, as someone who has chosen wrong more than once in her life, I herewith give you a list of things to consider so you don’t do what I did.

1. DO NOT LET A BAD ROTATION INFLUENCE YOU.  I can’t emphasize this enough.  For a medical student, the experience she has during clinical rotations has more to do with the residents and their treatment of her than anything else.  For example, I had a horrible surgical rotation.  The residents were stressed and thus either mean or dismissive of students, who are generally not useful and can be a significant added burden.  No responsibility or accountability was given to the students, so I could disappear all day and show up for rounds in the evening and nobody would notice or care.  I felt hesitant to ask to scrub in and nobody insisted that I do so.  Med students in that rotation were not valued.  And I could feel that.  On the other hand, in medicine everyone was super nice and let me do stuff and ate lunch with me and generally tolerated my presence.  So I went into medicine, which was a terrible decision.  Please don’t take any of it personally or dismiss a specialty out of hand because some miserable resident was a jerk to you.

2. FIND THE BORING PART.  What is it that the attending in each specialty does repeatedly?  Because I guarantee you there is at least one thing that each doctor in every specialty does over and over every day.  Happiness in a specialty is going to depend in part on how well you tolerate this repetition.  Examples:  Don’t become a pediatrician if you are bored to death treating ear infections.  Even if you love kids.  Don’t become a general surgeon if, after doing three appendectomies you’re ready to shoot yourself if you have to do another.  Even if you love appendices.  There’s a boring part, I guarantee it.  Find it.

3. DON’T MAKE LIFESTYLE YOUR MAIN CRITERIA.  This one is sort of counter to what people are aiming for these days, but I’ll tell you why I say it.  It relates to #2.  If you love the lifestyle of dermatology but can’t stand rashes, even the 9-5 office hours and lack of call will not redeem days filled with rashes.  If you like that anesthesiologists get a lot of vacation time (we do) but can’t stand sitting in the OR all day, no amount of fabulous days at Disney World is going to make up for what you have to do when you’re not on vacation.

4. FORGET #1.  PAY ATTENTION TO HOW YOU FEEL.  By this I mean observe yourself in each rotation.  Are you cold, hungry, and sleepy all the time?  Not a good specialty for you, even if you think you would like it.  You’re bored, don’t waste your time.  Are you on call every other night and can’t wait to get back to it every day?  Better choice.  Does the work induce “flow”?  That is, do you look up at the end of a day and go “That was fast!”?  Good choice.  Don’t find excuses for how you feel if you have your heart set on a specialty.  Just because you thought you would like it doesn’t mean your body and mind aren’t telling you “no way”.

5. BEWARE OF THE NOVELTY FACTOR.  You might think OB is awesome because you’ve never seen a baby born before.  You might find cardiac surgery totally cool because you’ve never seen someone stick a hose in a ventricle.  These things are awesome, but they better be awesome 15 years from now.  Even if you love a specialty, residency will make you practice that specialty so much it won’t be fun anymore.  You have to be able to sustain your passion through that.

Good luck!

 

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6 Comments
  1. johnbennett70 permalink

    Oh, to harken back to those rotation days! still being excited about first starting to practice medicine, examine patients, ordering labs, looking at x-rays, getting yelled at by attendings!
    And I still remember the residents that were good to me, and were bad to me. In between treatment not so much.
    Yes, you have to follow your passion. Follow what you really really like to do. Hang around with the residents, because they probably share the same passion of what you like. And, of course, you have to like the work. I loved orthopedics, so I made a stab at it. But in ortho residency, I found that my favorite part with ortho ER. So I went into ER full time, and loved the variety of cases, and, of course, maintained my love of Ortho ER. You know how they say in the movie, “I love the smell of napalm in the mornging?” I love the “clunk” sound of a reduced shoulder or ankle. That is my napalm without the human devastation. Or turning a COPD around, that will not now have to be intubated.

    jb md

  2. Ashers permalink

    Thanks so much for this! I too am a med student who is trying to figure out what I really enjoy. So far I like anesthesiology and internal medicine (and with hopefully a subspecialty in either cardiology or hematology/oncology – even though I realize the latter is totally different like it has no procedures but I really loved the physicians and patients and the entire “culture” or “personality” of medical oncology, and cancer is actually fascinating to me).

    Could I please ask you though, if you don’t mind saying, as someone who thought she wanted to be a cardiologist too, why did you choose anesthesiology over cardiology? I really love anesthesiology, and in fact I’m doing a small research project in it now with a nice anesthesiologist (which could be relevant to both anesthesiology and cardiology), and I love the OR, and also the day to day stuff of anesthesiologist (though still working on trying to intubate well, which I’m hopeless at, but the anesthesiologists are so nice and friendly and patient!), etc. And I like cardiology too but it just seems they are constantly working. But maybe they just love what they do too and don’t mind the crazy hours and call and all.

    Sorry I’m rambling! But basically I was just wondering, if you feel passionate about or like multiple fields equally (i.e. anesthesiology, cardiology, heme/onc), and otherwise #s 1-5 seem to fit well with multiple specialties more or less equally, how would you decide? Cool thanks! 🙂

    • I think what you feel is passionate about medicine in general. Which is great. Find the boring parts. I’m telling you. It sounds cynical but those are the things that are going to sap your passion over time. Good luck

  3. Bettercareelsewhere permalink

    What about dumping a 3rd year or 4th year of a bachelors’ degree and using it for another rotation year?

    #2 you forgot if you don’t want to do STUPID things, like be a hamster on a wheel, don’t go into medicine in the first place. Meaning typing at a computer, phone calls and emails you don’t get paid for, if you can’t do that for FOURTY years, do NOT go into medicine. No patient care of any kind.

    #3 you missed – and don’t make $$$ your main criteria either. If you want to jawjack with patients all day, want easy things to fix like sprains, colds or the flu, repetative work is fine, don’t go into trauma surgery because the money is better.

    #4 “Are you cold, hungry, and sleepy all the time?” It must mean you are doing surgery, so either you get used to it or pick something else.

  4. gasdude permalink

    I’m a med student. I love anesthesiology, I’ve done more than one rotation in it, I don’t mind the boring parts, and I’m even doing some research in it (involving BIS monitoring). But I’m really afraid of its future, and some anesthesiologists have told me not to enter anesthesiology if I can imagine myself doing anything else. I also saw this article which frightens me. And I’m especially frightened of loss of autonomy, with surgeons, hospitals, AMCs, etc. gaining more and more control over what I have to do or not do, etc. My simple question please, it seems most of this is mainly in private practice, can I be an academic anesthesiologist and hopefully avoid most of this, so I can still have a good career in anesthesiology? Thanks!

    • gasdude – thanks for reading! The short answer is that there will always be physician anesthesiologists. As long as the ASA is in Washington, anesthesia is alive and well. There just won’t be as many of them. I think I wrote a post some months ago about how the evolution of anesthesia should go, because it will have to evolve. I think CRNA’s and others will take an increasing amount of the basic work, and the board-certified anesthesiologist is going to be the true expert, the consultant, the guy who does the hard stuff, the guy who comes in when things go south. And actually, that’s what you want. You want to be the person that everyone looks to and says “Oh, thank god. The doctor is here”, not just “go get anesthesia.” I also think academics will be physician-led forever. If you want to teach and do research, there will always be work. If you love it, go for it!

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