Decision Time (Eventually)

I have thoroughly enjoyed this last weekend. My wife is here full time now, sort of, and after taking the exam on Friday there wasn’t much to study over the weekend. We did tackle a disgusting project, however. My office/study area had blue wallpaper that was poorly applied, and so it was peeling all over the place. We peeled it off, only to find more wallpaper underneath. And so we kept scraping and peeling wallpaper, and kept finding more disgusting layers underneath. The last layer was an especially ugly floral print that was probably put up when the house was built 60 years ago. Here’s a picture to demonstrate some of the ridiculous patterns we discovered.

Photo: Five layers and six decades of style later, we have finally reached the last layer of wallpaper.

Over the weekend and during the aforementioned wallpaper scraping, I was giving some thought to the future. Who will win in the first week of the NFL? When, as my sister asked me, will my wife and I go back home to visit? Have I forgotten to do anything before class next week? When can I eat at Chick-fil-a again? (Monday, actually. They are giving away free breakfast all week next week. True story)

One of the more serious things I have been thinking about is choosing a specialty. Asking someone’s potential specialty in medical school is like asking about someone’s major in college. It’s an easy question to ask because it’s a task we share in common. Also, while everyone thinks they know what they want to do as a freshman, most people inevitably change their minds, sometimes several times. Also, we don’t exactly get to pick and choose due to Step 1 and the match. Regardless, it’s something that’s been on my mind. I have jokingly seen this graphic several places now:

And so I am writing this initial post as a baseline. I want to look back in four years, as I start residency (that should frighten you, knowing that I will treat actual patients and prescribe things in just four years). I want to be able to look back at my past self, read what I thought my plans were, and then laugh at my past self. For tagging purposes and organization, I have invented a scoring system for each specialty, which I shall call the HLAITDTFTROMLH score (How Likely Am I To Do This For The Rest Of My Life?) The scale is either 1-10, with 1 being never ever, and 10 being pretty sure. Ready? Here we go.

Radiology: 1ish. Despite being afraid of the dark (see chart above), I can be reasonably certain that I would go insane as a radiologist. My reasons for getting into medicine had a lot to do with patients and not so much to do with imaging. While the hours, pay, and lifestyle seem fairly nice, I would probably slowly trade in my sanity until someone invents a robot to read images and I get fired.

Pathology: 1ish. I draw on four years of bouncing my legs and tapping my toes, impatiently waiting to get out of ______ lab during undergrad for this rating. I do not enjoy bench work, and probably never will. This specialty is so unappealing to me I almost forgot to include it on the list.

Pediatrics: 2ish. While I can’t rule this out completely, it’s not high on the list right now. It’s not that I don’t dislike kids (SO many negatives in that sentence), it’s the parents I couldn’t handle. Just kidding!! Anyways, I have a very hard time seeing myself in any pediatrics field, even when I try really hard to imagine myself wearing a bow tie (just kidding again…sort of)

Internal Medicine/ General Surgery: 3ish. This is more of a practical decision. I would go do IM if I decided to go into primary care. I would not do general surgery, simply because it seems terrible in every way. Realistically, I think I have a good enough chance at getting into a sub-specialty, which is more appealing in many ways that IM/Surg. We’ll see.

Emergency Medicine: 5-6 or so. I trained as an EMT during undergrad, spending significant time on the ambulance and in the ER, and it was definitely a rush. I see definite benefits in shift work, pay, and salary (lifestyle stuff, I suppose), but there are serious downsides in the high burnout rate, night shift work, and no real patient follow up.

Sports Medicine 6.5. I have attended two sports medicine meetings so far, and have found them very helpful. I would enjoy working with high school/college athletes, professionals, and weekend warriors. There are lots of opportunities for operative/non-operative practices, as well as academic/private practices. Very interesting.

Ortho/Surgical Subspecialty: 8. This is a broad field, but there are tons of options here. The idea of surgical care is appealing to me because it gives me the chance to fix a tangible problem. I’m a problem solver by nature, and the idea of direct intervention is VERY appealing to me. I like the idea of “fixing” something. One downside I see to IM is treating patients with chronic conditions, adjusting medications, etc.

Orthopedics is high on the list due to a doctor I shadowed during undergrad. He worked hard, but had fun and had a better lifestyle than other surgeons I shadowed. This would also give me the ability to treat some of that athlete/adolescent population from sports med (as well as geriatrics). This is a specialty that seems worth a 5-6 year residency.

There are some other fields I will be learning more about in the coming weeks. For example, I became interested in plastic surgery after reading a book about Harold Gillies, one of the pioneers of plastic surgery. Oncology is a double edged sword. On one hand, if I went in to oncology I would likely be part of a revolution in cancer treatment and care. On the other hand, it would be a difficult field, and one where my patients would frequently lose their battles against cancer.

That’s where I am at right now. The decision will partially make itself. At the end of my second year, I will take Step 1. If my score isn’t high enough, I can go ahead and rule out the really competitive specialties. Should I match into ortho, for example, I will probably find some niche that I particularly enjoy and pursue that. I can’t know that now. For the next two years my best course of action is to get good grades on my tests and go to free lunches to learn as much as I can, so that when the time comes to make a decision I’m not limited by poor scores or by a lack of knowledge about my options. Plus….free lunch 🙂

Thanks for reading!


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