4 bad reasons why medical students choose a specialty

4 bad reasons why medical students choose a specialty

“I love the hours.”
“I want to be just like Dr. Smith. He has a sweet practice.”
“I want to make a ton of money.”

These are some bad reasons why medical students choose a specialty. Most medical students decide what specialty to pursue when they are in their mid to late 20s. While we all think we are pretty wise and informed by that time, often we are fairly immature in our thinking and don’t fully consider the “big picture” when deciding what we are going to do for the remainder of our lives and careers. Medical students can also be in a proverbial ‘bubble” during medical school, busy studying and spending long hours in the hospital, with little time outside of the “medical world.”

This, too, can lead to a warped perspective that doesn’t involve the “real world” or consideration of what life might be like after training. In deciding on a specialty, do not base your decision on “bad reasons,” which include more than those above:

1. You want to make a lot of money. Maybe you also want to join a field with “status.” Most medical students have loans and therefore have a practical reason for a high-paying specialty choice. However, as you have likely heard before, money alone won’t make you happy. You will be practicing your specialty for the rest of your life and even if you decide to become a plastic surgeon because of the big bucks often associated with the practice, if you don’t enjoy the types of procedures and patients it entails, you might be miserable despite your big bank account. I had one student who was eager to have a big home, take fancy vacations, and generally live a life of luxury. After doing his research and seeing all of the glossy ads in local magazines for cosmetic surgeons, he realized this would be a great choice to reach his goals. He shadowed a community doctor who had a thriving cosmetics practice and performed many cosmetic surgeries, botox, and other “beauty enhancements.” After shadowing this doctor for a week, the student decided he would not enjoy caring for this patient population. However, he reasoned that he could ‘deal’ with it if he was making a lot of money since he could spend his leisure time as he wished. However, after considering that most of his waking hours would be spent in the operating room or the office, he realized that perhaps he should consider another specialty.

By the same token, many medical school students are, by nature, very competitive and want to join a specialty that has a “wow factor.” They are concerned – will people be impressed when they hear what I do? Will I be saving lives? Status alone won’t carry you through a long career. You must, at a very basic level, enjoy the work you do. Also, as you mature, your values may change. In your late 20s, spending long hours in the hospital may seem glamorous and appealing, but as you get older and have family and other responsibilities you may not want to work as intensely as some specialties demand.. Keep in mind that stereotypical heroic specialties such as neurosurgery, emergency medicine, trauma surgery, and oncology often require a tremendous amount of emotional stamina, leaving little for your personal life.

2. You love the hours and want a specialty that is “easy.” Many students choose a specialty thought to have ‘easy hours.’ The fields that come to mind are the E-ROAD specialties – emergency medicine (EM), radiology, ophthalmology, anesthesiology, and dermatology. The hours related to these specialties often aren’t that “easy, however.” Anesthesiologists, for example, routinely wake up at about 5 AM because operating rooms open early. Even though full-time emergency physicians put in about 35 – 40 hours per week, they work odd hours – evenings, nights, and weekends. Emergency physicians often spend their “off time” recuperating or “bouncing back” from late shifts. Odd hours can take a toll in the long term, something that’s difficult to understand when you are young. One student, who was always a night owl, considered a career in EM, figuring that she could “handle” the circadian rhythm disturbances. But, after doing her EM rotation, she saw how wiped out some of the attending physicians were and decided this would not be the best long term choice for her overall health and well being.

3. You were impressed by someone in a particular specialty, and you want to be just like that person. You are on your surgery rotation and you meet a person who represents the type of physician you want to be in the future. She is swift in the OR and deals with unexpected complications with aplomb. Yet she is also kind, compassionate, and deeply invested in her patients and their outcomes. She is also a real team player who treats everyone on her team with warmth and support. You want to be like her when you grow up so you decide to meet with her to discuss the idea of becoming a surgeon. At that meeting, she tells you that working in academic medicine has many demands. She must publish, participate in hospital committees, teach, do research, and attend grand rounds even when not presenting. You tell her that all you hope to do is practice community medicine so she suggests you gain exposure to the field of surgery “in the community.” During your winter break, you shadow a community surgeon. The work doesn’t seem nearly as exciting as the work in an academic setting. The surgeon has busy, but lonely, days filled with OR time, outpatient visits, and administrative work. Confused, you consider what other specialties might interest you.

During medical school, most of the people you meet and your clinical rotations will take place in academic hospital settings. Yet the majority of medical school graduates will not practice in these arenas; most will practice in community settings. The reality is that specialties are practiced very differently in different settings, and many students select a specialty based on their understanding of how it is practiced only in an academic medical setting. It is important, when you meet ‘the doctor you hope to become,’therefore, to be sure to really talk to her, find out exactly what her career entails, and “test out” your specialty in those settings in which you are most likely to practice.

4. You don’t really want to practice the specialty you are choosing or you plan to practice for only a short time. I sometimes hear students say, “Well, I don’t really want to practice that specialty. My goal is to get out of clinical medicine or just practice one part of the specialty.” For example, some students think if they pursue EM, they can graduate and just work day or urgent care shifts. Or, someone may pursue a residency in several disciplines with the intent of gaining clinical experience and then “going into industry.” Others may choose a specialty that would make them a good candidate to become talk show hosts. While some people are successful when pursuing careers that are tangentially or barely related to medicine, most are not. If you know as a premedical or medical student that you really don’t want to practice medicine, perhaps you should give your medical school seat to someone else and consider what other careers might be more fulfilling.

So how should you decide on a field to pursue? Whatever your reasons for choosing a specialty, you need to fundamentally enjoy its subject matter, the disease processes, the type of practice, and the patients for whom you will be caring. Ideally, you also want a career that will have longevity.

In making a decision, it is essential that you view your life in the future. Fast forward 20 years. Where do you want to be? How do you hope to be practicing? Find role models who are older than you. Ask them what they like or don’t like about their specialties. Would they make a different choice now that they have a more mature perspective? Many people who practice primary care have great lifestyles and can also practice for a long time because the practice is not the most physically or emotionally rigorous. In general, outpatient medical practice and specialties, which some medical students consider “boring” since they lack the “excitement” of others, allow doctors to work for a long time.

To achieve the same goal, many doctors try to leave the “intense part of their specialty for something less vigorous; for example, orthopedic surgeons may practice solely outpatient sports medicine, and ob/gyns sometimes leave the OR to practice only outpatient gynecology. Emergency physicians may transition from main emergency department work to outpatient urgent care. In deciding on a specialty, do your research, explore how your desired specialty is practiced in many settings and, most of all, be honest with yourself.

Jessica Freedman is founder of MedEdits, also on Facebook and Twitter.  

Image credit: Shutterstock.com

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  • http://www.facebook.com/shirie.leng Shirie Leng

    There are two essential problems with medical education as I see it. The first is that the skills that get you INTO medical school are not the skills you will need to actually BE a doctor. The high-achieving student with “A”s in biochemistry does not necessarily translate into a caring physician. The process of getting into medical school and though tends to weed out people with a more balanced approach to life.
    The second problem is that medical students are young. The amount of comittment and time involved in training require a decision about a future 8-10 years down the road that a young person just can’t make. Few 20-year-olds have the personal insight to see past the bells and whistles to what would really make them happy.

    • http://www.facebook.com/beau.ellenbecker Beau Ellenbecker

      Few medical students are 20. Most are 25-27 when deciding on a specialty (which they can still change over the next 1-3 years without to much hassle). That is actually quite a bit older than most other young people deciding on their profession

    • medicalstudent

      “The process of getting into medical school and through tends to weed out people with a more balanced approach to life.”

      This isn’t really true. I may still be just a med student, but I’ve served on the admissions committee, interviewing potential students, and I also have many friends at other medical schools who are involved in admissions. The admissions process initially is designed to weed out people who we don’t think can withstand the academic rigor of med school — by the time someone makes it to the interview stage, we’ve already decided that they’re academically capable. It’s during the interview process where we select for the “balanced” individuals rather than sheer academicians. So, it’s not a mutually exclusive thing where you have to be an “A” student, at the cost of everything else, in order to get into med school. It’s so competitive these days that you HAVE to be an “A” student PLUS be “balanced” (ie. have a lot of diversity, be involved in things not related to academics, etc). The days of admitting type A students who are only good at science and nothing else is long, long, long gone and you’re kidding yourself if you think otherwise.

      The thing about med school and residency is that they take away a significant amount of free time. The first two years of med school aren’t as bad, in that your hours are still under your control. Once you hit the clinical years and beyond, however, you lose all control of your hours. I’m routinely in the hospital anywhere from 60 to 80+ hours per week and the schedule changes on a weekly basis, so I don’t know beforehand what my schedule a month from now is going to be like. Not only that, once I get home, a good chunk of my time is spend on reading up on patients, studying for shelf exams, doing practice UWorld questions, etc. Medical school is rigorous. The definitely cuts into the “balanced” life I used to have. The process of getting into med school though, not so much.

      I also think you severely underestimate the insight and maturity of medical students. Yes, some of them are young (though the avg. age of matriculation is a little over 24 yrs old these days — definitely not 20, like you suggest), but it’s quickly beaten into everyone’s heads how they’re held to a higher standard, whether they like it or not. We understand the current healthcare climate, we see what issues are currently influencing medicine. I would argue that my med school classmates, as a whole, are far, far more mature than my friends from college who are currently engineers, grad students, etc (ie. already in the real world, making money, starting families, buying houses, etc). We’re not blindly making decisions on the fly without considering the consequences. To get into those ROAD specialties takes years of planning and sacrifice (try matching into radiation oncology without a research publication or two, having AOA honors, etc). So even for students who are impressed by the “bells and whistles” of those highly competitive fields, they probably spent years finalizing their decision.

  • Dr reconstructive

    By the way most board certified plastic surgeons are smack in the middle of physician compensation.

    Anesthesia radiology orthopedics do far better per hour worked

    We need to have physicians stop copying the TV perpetuated falsehood.

    True there are a few. Just like ortho has a few making huge amounts.

    But our national average is 350 a year after 7 years of surgical residency building a practice lots of call and running a business. And a shorter window to do it. Our practices drop off in our 50s too

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