When deciding on a specialty, we often think about clinical interests, the bread-and-butter, and lifestyle. But there are several more often overlooked qualities that make up an important component in your long term happiness and career satisfaction. Here is what you shouldn’t overlook when considering a specialty as a medical student and future physician.
First, you don’t need to know what specialty you’re going into until the second half of medical school. I thought I wanted to be a pediatric gastroenterologist throughout college, but I didn’t have any experience shadowing one. I was just a gastroenterology patient myself, having been diagnosed with Crohn’s colitis at the age of 18. During the summer after my first year of medical school, I finally got exposure to the field from a provider perspective through clinical research in pediatric endoscopy. At that point, I quickly realized it wasn’t for me. Luckily, I had an inkling that surgery would be a better fit, but I never stepped foot in the operating room until my third year, when I quickly fell in love with plastic surgery.
That being said, it would be strange to work tirelessly through your premed and medical school years, wanting to become a doctor, without some idea of the type of physician you’re aspiring to be. After all, the life of a neurosurgeon is much different than the life of a family medicine physician, and it’s unlikely that both are equally appealing to you.
In my previous post on How to Choose a Specialty, we touched on key areas you should focus on. By reading that post in conjunction with this, you’ll have a comprehensive understanding of the various factors you should consider.
1 | Timeline in Training
When you’re young, you feel like you’ll live forever. I knew medicine was going to be a long grind with delayed gratification, but I wasn’t afraid of hard work. I had already grinded hard for 4 years of college without issue, so what’s another 4 years of medical school plus 3-7 years of residency?
If you’ve ever run a marathon or rode a century on your bike, you understand the first half isn’t really an issue. It’s in the second half that you’re truly tested. The same thing applies here with medical training. No matter how much I or any other physician tells you how rigorous medical training will be, you won’t truly understand it until you get there. Some thrive in it and welcome the challenge. Others prefer to have a semblance of a life, and that’s totally ok.
At the beginning of medical school, you and your classmates will be wide-eyed and hopeful, eagerly awaiting what lays ahead. But after a few years of slogging away, the importance of lifestyle and more manageable training will become front and center. Your friend who was all about orthopedic surgery first year may be applying to family medicine or anesthesia instead. And there’s no shame in that.
After medical school, your training isn’t over. The shortest residencies are 3 years in duration, including internal medicine and pediatrics. Many are 4 years, such as emergency medicine and anesthesiology. Surgical specialties are usually longer, with orthopedic surgery, urology, and general surgery at 5 years. The longest in duration are plastic surgery at 6 and neurosurgery at 7.
Some other fields require a fellowship. For example, gastroenterology and cardiology tack on 3 years of fellowship training after completing 3 years of internal medicine residency, for a total of 6 years of additional training after medical school. If you want to subspecialize surgically, there’s usually a 1 or 2-year fellowship tacked onto the end of your already lengthy surgical training.
Sit down and do the math. If you imagine yourself having kids and a family by the time you’re 30, but you also want to be a neurosurgeon subspecializing in neuro-oncology requiring a 2-year fellowship, the earliest you’ll be done is 33. That is, assuming you graduate college at 22 and go straight to medical school without taking any time off. If you’re like the average medical school matriculant and start medical school at the age of 24, after taking a year or two off from college, you’ll be 35. And to match into something competitive like neurosurgery, many medical students also take a research year to make their application more competitive for residency, which brings us to 36.
You may be the type of person whom that doesn’t phase, and that’s great. You probably have an excellent work ethic and don’t mind delayed gratification. But most people don’t like the idea of being in rigorous training until their mid 30’s, especially while their friends and peers are happily living their lives.
2 | Rigor in Training
Tying in with the timeline in training is how rigorous your specialty will be — both during medical school and in residency. If you want to get into dermatology or plastic surgery, by far the two most competitive specialties, you’ll have to work harder than your classmates in medical school and truly excel, performing at the top of your class to be a serious candidate.
And while in residency, understand that most surgical specialties will be incredibly challenging and rigorous, often pushing 80 or more hours per week. It’s not uncommon for surgical specialties to violate the 80-hour workweek restrictions mandated by the ACGME. Non-surgical specialties are less likely to push you to this extreme, and if they do, it’s usually for much shorter bouts — maybe 1 or 2 months in a year.
If you choose something like anesthesiology, on the other hand, you can expect to work 50-60 hours during your residency. Or if you go with family medicine, 9-5 hours are more the norm, even in residency.
Keep in mind that your hours as an attending, after finishing residency, are also highly variable, with surgeons working longer hours on average.
3 | Dynamic with People (Patients & Providers)
It’s human nature to care about how people treat you – do patients respect you or resent you? How about your colleagues? For each person, this can vary in importance, and for each specialty, you’ll find this highly variable as well.
For example, if you work in the emergency department, you’ll come across hostile patients more frequently than the average pediatrician. But if you don’t like crying kids, pediatrics probably isn’t for you anyway. As an aesthetic plastic surgeon, you’ll likely come across your fair share of entitled and difficult patients who are impossible to please.
Maybe anesthesiology is a better fit, as you’ll be putting patients to sleep and won’t have to deal with much of that. But as an anesthesiologist, you’ll be second in command in the operating room, as it’s the surgeon’s domain. Surgeons and anesthesiologists are working on the same team as colleagues, but anesthesiologists sometimes find themselves on the receiving end of a surgeon’s bad day. You don’t see it the other way around.
There are some secondary and tertiary considerations to also keep in mind.
How is your specialty practice affected by the economy and national healthcare changes? For example, aesthetic plastic surgery won’t thrive during large downturns in the economy, as most people have less discretionary spending and are unable to justify cosmetic procedures. However, if reimbursement through insurance decreases, reconstructive plastic surgeons can always fall back to an aesthetic cash-based practice and be relatively unaffected.
On the other hand, an emergency medicine physician’s work is relatively unchanged, regardless of what’s going on in the economy. People have emergencies and need medical treatment whether bull or bear market. But if reimbursement changes, there isn’t much that they can do about it.
And while this shouldn’t be a focus, particularly this early in your career, consider what type of practice you’re drawn to. For some specialties, private practice is becoming less feasible, and working as an employee at a larger hospital or medical group is more common.
If you’re unsure what type of doctor you want to be, that’s totally normal, but now is the time to give this some thought. The earlier you have clarity, the better. Shadowing physicians is less feasible now with the state of the world. In the meantime, check out our So You Want to Be series, where we highlight individual specialties within medicine, doing a deep dive to help you determine if it would be a good fit for you.
And regardless of what you choose, it always benefits you to keep your options open, in case you decide to pursue something competitive like orthopedic surgery. At Med School Insiders, we specialize in helping students maximize their potential and be the most competitive candidates possible.
Thank you all so much for reading! Much love, and be on the lookout for future So You Want to Be posts.