5 questions to ask before choosing your specialty.

It’s residency interview season for fourth year medical students. However, I’m writing this for the first, second, and third year medical students who are still undecided on which specialty they’re going to choose. The focus is going to be on introspection.

Physician burnout is real. The cause is multifactorial, but I personally believe that a significant factor is not fully knowing what you’re getting into when deciding on a specialty.

As a third year medical student, sometimes you get caught up in the moment and focus more on the pros than the cons, or subconsciously try to not think of any cons. When it comes to burnout, a common theme that I read about and hear from colleagues is feeling trapped.

The culture of medicine is one that tries to get its physicians to put the hospital and patients ahead of themselves. If you add in copious student loans and limited time for relationships (family and friends) and hobbies, then who’s still surprised that physicians are feeling trapped and becoming burned out? The goal should be to find balance.

This is why I think all medical students should ask themselves the following five questions before choosing their specialty. 

1. Do I enjoy working with my hands?

An important part of preventing burnout is liking what you do. If you like doing procedures and using your hands, then this is an easy fork in the road for narrowing down your choices.

The follow up question to this is whether or not those procedures you like are complex (eg. surgery or endovascular procedures) or “simple” (eg. ultrasound-guided procedures, “scoping”). The answer to this question is important because more complex procedures require more training, and complications from these procedures can consume much of your day.

Examples of specialties that regularly perform “simple” procedures are anesthesiology, emergency medicine, gastroenterology, pulmonology and critical care medicine.

My answer to this question was yes. I narrowed down my choices to a final two: anesthesiology and general surgery (with the intent of doing a vascular surgery fellowship). I’m so glad I chose anesthesiology and I’ll break down my decision at the end.

2. Do I want to have longitudinal relationships with my patients?

The crux of this question is whether or not you want to have office hours in clinic. Some people have the desire to establish and maintain long-term physician-patient relationships. Other people do not.

My first rotation as a third year medical student was family medicine. I enjoyed meeting and getting to know patients, but my greater desire is for patients to get (or feel) better…faster. I just couldn’t see myself in a longitudinal setting where patient improvement relied on so many variables. Also, there’s lots of charting and phone calls that come with clinic.

3. How much of my work will I take home?

Work will inevitably follow you home with some regularity. This question forces you to look ahead and imagine how you want your personal life to be.

I firmly believe that work should be separated from home. I would rather stay an extra hour or two at work to finish something up than to be at home and not be mentally there for my wife and kids. Sometimes it’s unavoidable, but I will do the work after the kids are asleep. I don’t want them to grow up and only remember me working on a presentation or progress note.

An extreme example is one of my colleagues in Florida. She is an Ob/Gyn physician, and she feels guilty when she takes a week off for vacation. She feels this way because she spends 30+ weeks establishing a rapport during a woman’s pregnancy. If the patient goes into labor during her week of vacation and she’s not there for the delivery (or Cesarean section if needed), then both she and her patient are upset about it.

Then there’s being on call. It doesn’t matter if it’s home call or in-house call, you’re still limited in what you can do in your personal life. As a pharmacist, I can remember calling numerous physicians at home about their patients. As a physician, I see surgeons and other proceduralists coming in to the hospital from their kids’ sporting events, birthday parties, etc.

This is part of the job, but you have to know how much you’re willing to take.

4. How many more years am I willing to give up?

Four years for undergrad. Four more years for medical school. Most people are in their mid-20s by this point. Us nontraditional medical students are in our 30s or older. Our non-medical friends and family are well into the prime of life and we are still in training. How many more years are you willing to give up?

There’s a reason some specialties have high burn out rates. Not only does residency and fellowship consume a large percentage of daily time, but it does so for a long duration.

Neurosurgery7 years
Otolaryngology5 years
Cardiothoracic surgery7-9 years
Vascular surgery7-9 years
General surgery5-7 years
Orthopedic surgery5 years
Sports medicine surgery6 years
Interventional cardiology7-8 years
Cardiac electrophysiology 8-9 years

5. What are my other life goals?

When you’re choosing your specialty, it’s important not to forget who you are today and who you want to be in the future. 

Do you have other aspirations? Is medicine a springboard to something later in life? Any new hobbies you want to try “when you have the time?”

If you’re single, then today that intense specialty seems like it’d be fine, but what about 10-15 years from now? Do you want to be married? Do you want to have kids? How “there” do you want to be for your kids?

Remember that, even though being a physician is an honor, it is still just a job and it does not have to define you.

What was I thinking?

As you know, I ultimately decided on anesthesiology and I have zero regrets. I love physiology and pharmacology, and every time I get a patient safely through surgery verifies that knowledge. I love that there’s so many different ways to get patients safely through surgery. I love that I get to care for people in such a vulnerable state. I love ultrasound guided procedures, especially nerve blocks.

But I love my wife and kids more. I love that work follows me home minimally. I love sharing my love of playing musical instruments with my kids. I love that I am there for every recital. I love that we do fun runs and 5Ks together as a family. I love movie night. I love game night.

I chose balance between my career and personal life.

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