The question we all know is coming

I am halfway through my third year of medical school and so far, I absolutely love it. I feel one thousand times more like a doctor than I did six months ago, and I’ve learned more in these six months that I had in the six years prior. And I’m not just saying that – third year is high yield beyond belief.

By this point, we’ve all answered the golden question hundreds of times. Everybody asks it – family, friends, doctors, patients, strangers on the street – they ask in all types of ways, but it’s always the same underlying inquiry: “What are you thinking of doing after med school? What specialty are you going into? Have you thought about what kind of doctor you want to be? So, David, have you given any thought to what you might actually want to do with your life?”

As a first year student, I would answer this pressing question with whatever I felt like in the moment – cardiothoracic surgery one day and dermatology the next. If I had just read an article about ICU medicine, “pulm crit care” would roll right off the tongue. For most of my first two years, these words were sexy-sounding ideas that would light up people’s eyes and had no base in reality: “Wow, David, you’re going to be a plastic surgeon!?” Which was my cue to say, “Yep, absolutely, it’s a done deal.”

Even at the beginning of third year, the pressure to choose still felt fairly low. We finished Step 1 boards, which felt like a two ton elephant leaping off the shoulders, and for at least a month nothing really mattered because we felt so accomplished by finishing that beast of an exam. Then as we prepared to start our rotations, the message was clear: “just enjoy the year!” everyone said. “People often change their minds third year anyway, so don’t worry about it.”

Oh, but be sure to know for sure what you want to do by February so you can choose your fourth year rotations! And obviously get in touch with the departments of the specialties you’re interested in so they get to know you. And don’t forget about letters of recommendation!

A central and confusing aspect of choosing a specialty is reaching out for advice. Naturally, advice seeking is generally directed toward older and wiser physicians. Attending and resident physicians are the people with the experience and the futuristic understanding of the actual life choice you’re making, so it seems they would be a great help, and sometimes they are. I have received some great advice along the way, and most of that advice involves a discussion where we meld what I enjoy about medicine with what specific specialty choices offer. An exploration of the specialty itself can only scratch the surface – it’s your interaction with the job that makes it work or not work for you.

One problem with advice seeking is every single doctor is biased.  This often leads to one of three answers. The first is the “don’t do what I do” response. You hear this a lot from surgeons. “Surgery is the best,” they say, “but absolutely do not do it.” The second approach is the deep understanding of the process, which results in a response such as, “you’ll be good at anything you choose” or “only you can really make the decision for yourself, I can’t tell you what specialty to choose.” Finally, and you get this response from residents a lot, is the convincing diatribe about why their specialty is clearly the best. Without bashing other doctors, nearly every physician in the hospital can give reasons why their specialty actually makes the most sense to do. This is not surprising because they are describing their own thought process when they were third year medical students, and obviously they picked what they are now doing.

The trouble comes with the fact that everything is exciting, and with half of the third year clerkships under our belts and half to go, we have to start making real decisions about what we want to do with our lives. A lot of specialties are absent from the third year curriculum, so interest in these at this point is purely theoretical, unless you’ve taken initiative to explore these options beforehand.

The advice I’d give to current first and second years (and pre-meds) even though no one asked me for advice is to start exploring now. Go check out anesthesiology and emergency medicine. Shadow an ENT for the day or visit a sports medicine clinic for an afternoon. These are experiences that seem like extra work early on, but for many of us, nothing magical is going to happen that will allow us to make that final choice. It’s going to be a collection of experiences, a unique interaction with a patient, a team mentality that exists only in certain departments of the hospital, a realization that this is where I belong because I’ve seen a lot and this is what feels the best.

At the same time, I do trust the process, and think that exploring medicine early on is difficult because at that point you really don’t know much medicine (and therefore you’re just confused all the time). Med school is like this crazy puzzle. When you’re halfway through it feels like you haven’t made any progress, but then all of a sudden it starts coming together. You start to get it. We have to trust that the puzzle will come together, and whether the picture on that puzzle is a scalpel or a pediatric stethoscope or a central line kit, we have to go with our gut and do what feels right, knowing there are a lot of good options out there and that there is probably more than one that will work out just fine. But be sure to make the right choice.

3 responses to “The question we all know is coming

  1. As an MS1, I really appreciate this article. Thanks for the well written and very informative piece and best wishes to you.

  2. Beautifully put, David.

    We are hopefully putting the final touches on a “Medical Specialty Speed Dating” evening in mid-Feb, to allow students to ask alumni and community physicians what it is like to spend a career in any one of over twenty specialties.

    Look out for more announcements later this week!

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