This year, the National Resident Matching Program provided matching services to more than 42,000 applicants. A medical student’s choice of specialty is one of the most important decisions they will ever make. But deciding which medical specialty to enter can be difficult. The majority of medical students are indecisive about their intended area of practice. Over the course of medical school, only a quarter (26.1 percent) of medical students who graduated in 2020 indicated the same specialty preference as they had when they began medical school.
Increasingly, U.S. medical students are choosing specialty and subspecialty practice rather than primary care, perhaps because certain specialties are constantly evolving and hold more interest than primary care practice. Boredom in a physician’s specialty is a consistent factor resulting in burnout and career choice regret. In fact, once in practice, nearly 1 in 5 physicians change their specialties to unrelated fields. Many others, however, feel trapped and unfulfilled and are left singing the blues, much like the tune BB King famously crooned: “The Thrill is Gone.”
The results of the 2022 Match speak to the attractiveness – and strength – of specialty practice compared with primary care practice. The most competitive specialties were emergency medicine, pediatrics, interventional radiology, otolaryngology, physical medicine & rehabilitation, diagnostic radiology and various surgical subspecialties. On the other hand, the percentage of primary care positions filled by U.S. seniors in 2022 declined 0.7 percent from 2021.
Career choice regret has been studied by numerous researchers, and the reasons for feeling regretful are a mixed bag of personal preferences, organizational fit, and unique characteristics of the work intrinsic to certain specialties. The truth is, physician regret is seen in all specialties as well as in primary care. It may be slightly higher in primary care because specialists are generally better compensated, and their focus is usually restricted to a specific problem or patient complaint. In contrast, primary care physicians have a wider scope of practice. They must deal with many different problems, and not all physicians thrive on doing comprehensive exams for patients with multiple problems and comorbidities.
Yet, for some physicians, primary care has more versatility than specialty practice. Family medicine physicians, for example, can practice urgent care, traditional family medicine, women’s health, pediatrics, integrative medicine, addiction medicine or hospitalist and palliative care. So, in some ways, regret could be less for physicians who choose primary care practice because of the ability for family and internal medicine physicians to pivot.
Regardless, it should be evident that remorse over choosing a particular specialty is entirely different from remorse related to choosing medicine as a profession. Career choice regret is typically defined as whether doctors would choose to become physicians again if they were able to revisit their career choices. According to a study published in JAMA in 2018, 502 (14.1 percent) of 3751 resident physicians said they would not choose to become doctors again. When it came to the choice of their actual specialty, 253 (7.1 percent) indicated they would “definitely not” or “probably not” choose the same specialty if given another opportunity.
Could it be that staying in medicine, as opposed to switching specialties, is the more critical decision of the two? Perhaps physicians who are content with medicine as their chosen profession show the least amount of regret as long as they are able to traverse the system as their interests dictate. Physicians must keep in mind that they have a multitude of options about how they work and on what terms they practice, in part because their core generalist education extends their reach and job flexibility.
I experienced regret during my residency – not for choosing to be a physician – but for the career path I chose as a practicing psychiatrist. I lost interest in seeing patients as my residency progressed, and by the time I was five years into academic practice, I knew it was time to bail and find another calling. My focus had changed from one-on-one patient care to population health. I changed jobs to work for a health insurance company in the newly emerging areas of quality assurance and utilization management. Eventually, I worked beyond the boundaries of mental health and supplemented my medical degree with a business degree.
When I became jaded working in the health insurance industry, I started a career in the pharmaceutical industry, working initially as a medical liaison and later in R&D and Medical Affairs. I had always had a strong interest in pharmacology and the neural mechanisms underlying behavior – after all, I came of age in the 1970s. And wouldn’t you know it, the rave in psychiatry today is the repurposing of psychedelics as therapeutic agents to treat a wide variety of disorders including depression and PTSD.
Currently, I am writing the final chapter of my career as a consultant, free to pick and choose projects that appeal to me. My current work cuts across clinical-supervisory responsibilities, pharmaceutical specialty services, publishing peer review and medical communications. Still, the thread that ties all these activities together is the profession of medicine; I could not conceive of an equally rewarding career in another field. Paraphrasing Pete Townshend of The Who, I’ve gone mobile to sustain my attraction to medicine and satisfy my whims.
My travels are not meant to be a paradigm for overcoming career regret. Rather, it simply points out that job mobility may be an antidote for an initially wrong choice of a specialty and that leaving the medical profession may be an unnecessarily drastic move. Medicine offers many fulfilling, meaningful and lucrative opportunities to practice – or not. In addition to changing specialties, consider locum tenens work and working in industry or other non-clinical jobs.
If you have career remorse, think hard about the myriad opportunities within the medical field before calling it quits. Only then can you truly say you’ve left with “No Regrets” (think Tom Rush).
Arthur Lazarus is a psychiatrist.
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