choose the specialty you love

[q-school]

we seem to offer that advice to a lot of medical students.

as i think about it, i'm not sure whether it is as clear cut as that.

let's say that there are some bad jobs within your favorite specialty and you may find yourself in one of them due to changes in reimbursement or practice changes or departures or whatever.  let's also propose that your own needs and priorities change over the course of your career at least a couple times.  kids priorities may take precedence over professional goals.  you may find that you don't even love your specialty after few years of practice.  you may find that you hate call more than you love the days.   or the procedure/surgery that you love to do, you only get to do one day per week.

some specialties clearly are more schedule flexible than others.  some have relative geographic freedom.

if we look back and ponder whether we had wound up in specialty 1,2,or 3, would it have made a difference?  another alternative is to weight more heavily what you think your priorities are rather than something you love?   even if you loved 1 and moderately enjoyed 3, if 3 had more money or more ability to give you shift work to balance your schedule, is it highly likely or improbable that 3 might make you net happier?  is your ultimate happiness more a reflection of your own inner satisfaction than your actual job situation?

for those more gray haired, as the financial nest eggs are completed, do you find you love your job differently?

 

 

[Hatton]

I think it is natural to change your perspective as you age.  Everyone hates call.  It certainly intensifies with age.  I think age enables you to simply ignore certain changes you disagree with because you know you will not be working forever.  No one can be certain if they would be happier if they had chosen door #1 instead of door #2.  I was asked if I wanted to change into RadOnc as a second year resident in OB.  I might have more money now if I had done that I am not sure because I have done well with OB/GYN.  I think I would of worked fewer nights and had less malpractice concerns. Would I be happier now?  No way to know.

 

 

 

 

[Dr. Mom]

Loving a job was not ever in my thought process.  Our jobs allowed us the life we love, so we appreciate them very much.  I did start in OB and switched to Peds after my internship when I realized I had chosen poorly.  My husband and I have changed jobs several times over the years.  I counsel my kids to choose the lifestyle they want and pick a job that fits into it.  We make enough money that it has not ever been the driver in decision making.

[jsr52]

Agree with Dr. Mom that loving your job doesn't have to be a priority. I think it's a perc. I personally love my job right now, but I think it's more important to run from any job you loathe

[Miss Bonnie MD]

q-school wrote:

 

if we look back and ponder whether we had wound up in specialty 1,2,or 3, would it have made a difference?  another alternative is to weight more heavily what you think your priorities are rather than something you love?   even if you loved 1 and moderately enjoyed 3, if 3 had more money or more ability to give you shift work to balance your schedule, is it highly likely or improbable that 3 might make you net happier?  is your ultimate happiness more a reflection of your own inner satisfaction than your actual job situation?

for those more gray haired, as the financial nest eggs are completed, do you find you love your job differently?

 

 

Click to expand...

I cannot imagine not doing derm. I didn't match the first time I applied and many ppl told me - just do IM or Rads. I was not looking for a purely lifestyle specialty but that is a great part of derm. I def would not have been happy in any other ROAD field.

I know not everyone feels strongly about what they ended up choosing, but some of us do.

[Zaphod]

I think its pretty dumb in reality. One of the most obvious points being that you will never have enough time to see on a real, day to day basis and with the appropriate amount of responsibility to fully assess any field. Also being young blinds you to a lot of things that will be far more important as you age. The physical nature of the job and how injuries/time may make that far less appealing or impossible, call load (say young, energetic, no family), how versatile practice settings are given above, etc...ego/status is also a lot more important when younger.

The truth is you change a lot over the years and what you loved and valued, changes as well. Almost impossible to foresee in its entirety. I tried to think of many of these things and while certain secular, policy, structural, and fundamental things were correct, I overlooked the physical, status, and lots of things I didnt know would be so important to me now.

What I find really interesting now is that I am pretty sure that there are at least 5 different specialties I would probably enjoy equally, and several more that would also be just as rewarding. The older I get the more interesting anything else is. Institutions and reality do have a vested interest in us just focusing on the one since thats realistically all you can do, but doubt its real at all.

[Zaphod]

Miss Bonnie MD wrote:

q-school wrote:

 

if we look back and ponder whether we had wound up in specialty 1,2,or 3, would it have made a difference?  another alternative is to weight more heavily what you think your priorities are rather than something you love?   even if you loved 1 and moderately enjoyed 3, if 3 had more money or more ability to give you shift work to balance your schedule, is it highly likely or improbable that 3 might make you net happier?  is your ultimate happiness more a reflection of your own inner satisfaction than your actual job situation?

for those more gray haired, as the financial nest eggs are completed, do you find you love your job differently?

 

 

Click to expand…

I cannot imagine not doing derm. I didn’t match the first time I applied and many ppl told me – just do IM or Rads. I was not looking for a purely lifestyle specialty but that is a great part of derm. I def would not have been happy in any other ROAD field.

I know not everyone feels strongly about what they ended up choosing, but some of us do.

Click to expand...

The human bias machine is strong though. You would have eventually found things you liked in your new venture, found things to dislike in derm, and then over time told yourself it was the best thing to have happened, felt happy and maybe even lucky.

Hard to find stories in the opposite direction where people know for sure some quirk of life fork in the road was obviously terrible.

[Hatton]

I will say that OB is a hard lifestyle.  It does offer you a chance to feel at the end of a career that you made a difference for some people.

[q-school]

It remains a curiosity to me why nurse practitioner and PA can just change specialty almost on a whim and that's okay. It seems to me that there would be significant liability risks, but admittedly am ill informed and someday may be jealous of their flexibility in that area. For now I still really love my specialty and enjoy it a lot. If I had to live life over I would definitely be vagabond.

[PhysicianOnFIRE]

You absolutely should factor in how you enjoy the workday, but that's just one piece of the puzzle. If you don't like the workday, you can rule that specialty out.

I thought I might like surgery and working with my hands, but it turns out I didn't like being scrubbed in for any extended period of time.

I thought I would like radiology with all the cool technology, but it turns out I don't enjoy staring at scan after scan after scan.

Anesthesia ended up being the best fit, and I now do procedures with my hands under ultrasound guidance (peripheral nerve blocks and the occasional central line).

I did consider all aspects of the job beyond the workday, too, including pay, job portability, lifestyle, and the general happiness of the doctors I met within the different specialties.

[q-school]

PhysicianOnFIRE wrote:

You absolutely should factor in how you enjoy the workday, but that’s just one piece of the puzzle. If you don’t like the workday, you can rule that specialty out.

I thought I might like surgery and working with my hands, but it turns out I didn’t like being scrubbed in for any extended period of time.

I thought I would like radiology with all the cool technology, but it turns out I don’t enjoy staring at scan after scan after scan.

Anesthesia ended up being the best fit, and I now do procedures with my hands under ultrasound guidance (peripheral nerve blocks and the occasional central line).

I did consider all aspects of the job beyond the workday, too, including pay, job portability, lifestyle, and the general happiness of the doctors I met within the different specialties.

Click to expand...

agree, but I am struck by how much of that may be chance-how happy the people you meet are.  what if someone was on vacation the month you did the rotation that might have swayed you one way or the other?  there sometimes is no exposure to rad onc or occupational medicine or some other specialties depending on your medical school.  and on a bigger scale, I remember when anesthesia was wide open and if you didn't match you could find an opening in many fantastic anesthesia programs.   I remember the anesthesiologists at that time were worried about the future.  turns out needlessly, but I am sure some fantastic medical students might have been turned off due to inaccurate predictions about the future.  maybe I might have been one of them!

 

 

[VagabondMD]

q-school wrote:

It remains a curiosity to me why nurse practitioner and PA can just change specialty almost on a whim and that’s okay. It seems to me that there would be significant liability risks, but admittedly am ill informed and someday may be jealous of their flexibility in that area. For now I still really love my specialty and enjoy it a lot. If I had to live life over I would definitely be vagabond.

Click to expand...

LOL!

The graduating medical student is making a life-defining decision, with minimal and biased information, in a world where things are always changing, and the person is changing, too. It is odd, but even though I am somewhat dissatisfied with what I do today, if I had to go back in time to my fourth year in medical school, I would probably pick the same field (and later, the same fellowship).

I really loved residency and appreciate the great, lifelong friends that were made in training. I enjoyed the work earlier in my career, am grateful for the friends made along the way, parlayed the clinical career into interesting administrative roles and consulting side gigs, have been paid very well over the years, and am now in a position where I can walk away at any time at age 52. Not too shabby!

Then again, maybe had I been in GI, or ENT, or ophthalmology, or something else, I might have felt the same. Maybe I would now love the job or despise it and been out for five years. Who knows?

I remember going through the third year clerkships and rationalizing that I could see myself in any of the fields. We adapt to the choices we make and the conditions therein. There are no "do overs". Stephen Stills said, "Love the one you're with," and it probably applies, too, to the medical career.

[Kamban]

q-school wrote:

for those more gray haired, as the financial nest eggs are completed, do you find you love your job differently?

Click to expand...

Good that you had qualified as 'more grey haired" since my first one turned up on my scalp at age 27  . Soon it was salt and pepper hair and now it is all salt with very little pepper. For some reason the African American patients love the hair yet my Asian friends want me to dye it black. Back to the topic..

I would not say choosing the specialty you love. I would recommend not taking up the specialty you dislike or hate, whatever be the money you can get from it.

At the end of med school or residency ( for those going to fellowships) there is no magic mirror that can tell you what the work schedule and income will be there for that field 5, 10 or 20 years down. A few cuts in reimbursements over a few years by medicare and big insurers can make a lucrative field not so attractive. And if you had disliked that field at the beginning , now you will positively hate it.

We can easily adapt into any field as long we are somewhat interested in it and the work schedule is tolerant and the pay is decent. And if you save early and regularly and have FI then you can customize your work to your liking and still be happy.

[PhysicianOnFIRE]

q-school wrote:

I remember when anesthesia was wide open and if you didn’t match you could find an opening in many fantastic anesthesia programs. I remember the anesthesiologists at that time were worried about the future. turns out needlessly, but I am sure some fantastic medical students might have been turned off due to inaccurate predictions about the future.

Click to expand...

That was about 10 years before I finished residency, and the perceived glut of anesthesiologists probably helped me. Fewer anesthesiologists were minted in the late 1990s, and demand and salaries had risen substantially by the time I finished in 2006.

[StarTrekDoc]

What are your goals in life and consider success?  Silly having to say it, but people take the eye off that ball and get lost in the weeds.

Another Phrase for High Achievers -- Work-Life balance

Some other fields tend not to struggle as with this as pursue your love is priority -- eg starving artists.   While others with money goal priority --i'd argue medicine is a poor ROI for amount work:income rewards.  -- hence job dissatisfaction /burnout happens a lot of very intelligent people who make the wrong choices for the wrong reasons.

A job is a job unique to that situation.  We can talk broad strokes of a field, but inside each field the job demands and experiences vary greatly ---BUT the subject matter itself doesn't change.  I love my derm colleagues, but for me to look at skin all day long -- no thanks.   Also a total techie but to stare at a rads monitor all day???  no thanks.  Subject matter is the basis -- choosing the right job that fits the work/life balance is the second and very important step.    eg:  I'm in Internal medicine; but much prefer the continuity of outpatient care over urgent/inpatient care.   Same subject matter -- different exposures in timing and scenarios of disease process ----  I also agree that this scenario perspective can and often changes over time -- people say hospitalists is a 'young persons job' which certainly can ring true for many when optics are broadened to work/life balance of families with kids.

I'd probably make the same good and bad decisions again if there was a redo.  If I bring my cumulative experiences to redo -- I'd make different choices but would not be where I am now either as the path would be changed and who knows for the better or worse.