Choosing a Specialty As a SheMD

Then newly-minted INTERN Dr. Grace Oliver joins us on the blog to provide practical advice on HOW to organize your thoughts when approaching the This is the SINGLE HARDEST decision that you will make in medical school- What do you want to spend THE REST OF YOUR LIFE doing?

This article is not intended to tell you what you SHOULD pick for your medical specialty; here at SheMD we’re all about supporting you in choosing your own adventure. Neither is it meant to reduce this decision into finding which pithy stereotype you most fit into, like this flowchart meme:

📷

Rather, this article is to give you some guidance on how to approach your clinical rotations with the goal of figuring out which medical specialty will bring you the happiest, most fulfilling career in medicine. This is my advice as someone who has recently done this and made a choice of specialty, rather than as someone looking back on my career with some experience behind me. For that type of reflection, check out the SheMD “Why {Specialty}?” series. The world is your oyster, but let’s narrow it down a little, for practicality’s sake.

First: take a deep breath. It’s totally fine if you aren’t completely certain what your specialty is. It’s totally fine if you thought you knew, but now you’re doubting that. It’s totally fine if you have ABSOLUTELY NO IDEA right now what you want your medical specialty to be. Yes, even if your roommate has been dead set on cardiothoracic surgery since you guys started Organic Chemistry back in undergrad; don’t worry about that right now. You have time to decide, you have time for this article, and you have time for a whole year of amazing clerkships to try-before-you-buy. In a way, it’s fun to not have already decided—the adventure of making this choice still lies ahead of you!

(PC: Angel Cano Idáñez, via Pexels.com)

Laying the Foundation

Before you even step foot in the hospital again, take an inventory of what specialties you have been DIRECTLY exposed to up to this point: shadowing, clinical preceptorships or internships, rotations you may have already started, even tagging along for weekend rounds with your parent growing up, whatever. Next, to everything you have heard a lot about, or have some indirect exposure to. Delete everything that came off of a TV drama, a meme, or any smack talk about another specialty you’ve overheard; a surgical residency isn’t going to look like Grey’s Anatomy, being an anesthesiologist won’t give you a drug problem, and matching into dermatology won’t instantly make all your acne disappear. Sorry, I don’t make the rules. Finally, stare dreamily at the ceiling and reminisce about which pathologies and physiologic systems were most fascinating to you in your didactic courses. Now look at these three lists and try to find some common features between your exposure and what you have found intellectually stimulating.

For example: I did some cardiology shadowing in high school and college, a clinical internship in college at a children’s hospital, and spent a lot of time my M1 and M2 years volunteering at a free primary care clinic for local underserved populations. My favorite didactic subjects were behavioral health and reproductive physiology/endocrinology. See any connections in there? I didn’t at first. This exercise is just to build a foundation before you start asking yourself a lot of important, reflective questions on rotations.

Approaching Rotations to Figure Out What You Want to Do With Your Life

When I started medical school, I hadn’t really gotten any farther than wanting to be “a doctor.” Between my volunteering at the free clinic and noticing a pattern in my favorite didactic subjects, I was thinking ObGyn by the time I started my M3 clerkships because I knew I wanted to emphasize women’s health. I had my ObGyn rotation first, and was quite upset when the heavens didn’t open up to a choir of singing angels congratulating me on making the perfect choice. It was back to the drawing board for me. The rest of this article is basically a compilation of the advice I would have for any M3, as well as advice I was given regarding picking a medical specialty.

1. It is normal to change your mind.

Medical students and trainees (and hey, all humans) often have trouble admitting when they are unsure about what they’re doing. In my experience, we are especially scared of looking like we don’t know what specialty to go into. Perhaps we fear we’d look like we aren’t passionate about medicine if we were able to change our mind about a specialty? Most of us do change our mind at some point, and it’s ok no matter what as long as you’re making the right decision for yourself and your happiness, and not for what other people might think or say.

Give yourself permission now to always choose your career moves for yourself, and you will always come out on top! Your commitment to ENT is not lesser because you thought about going into anesthesia at first. In fact, questioning and pondering and growing should make you feel more confident that you’re making the right choice. It doesn’t need to be an identity crisis or a bad thing to grow into something you didn’t expect! You deserve happiness, no matter which path you take to get there or how the destination looks.

2. “Oh well I already know I’m not interested in that.” Ok, but why though?

If you find yourself dreading a particular rotation or already excluding a particular specialty from your list of options, ask yourself why you feel that way prior to even doing the rotation. Are you worried about the work hours? Did you hear that NBME is particularly brutal? Do you think there’s no way you’d ever enjoy that work?

One thing I want to address in particular is negative stereotypes about various specialties, often propagated by people from other specialties and it seeps down into the culture of the trainees and even the pre-clinical medical students. For example: at my institution there is the stereotype that any students who choose to go into psychiatry or family medicine are only doing so because their Step 1 scores were too low for anything else. These stereotypes were so pervasive that I wouldn’t even consider family medicine at first, because I was taught that only bad students go into that out of lack of other—presumably better—options, and because I feared my peers would think I was unintelligent if I expressed interest.

My reluctance to change specialty from ObGyn to family medicine came from a place of insecurity and misinformation. I obviously worked through it, but it’s terrible how much time in medicine we spend talking trash about other specialists. These stereotypes can be negative like those I already mentioned, or face-value “positive” like the cliché that students going into emergency medicine are super fit, or that future surgeons are the smartest people in the room. Whether they describe a traditionally positive or negative trait, stereotypes are harmful to the people they’re about and they aren’t worth our time in medicine.

Ahem, I will dismount my soapbox now.

Ideally, you’d be able to show up bright-eyed and bushy-tailed to every rotation, ready to work and learn even if it may not be what you think you want to specialize in. The odds that it has LITERALLY nothing useful to teach you are pretty slim if you keep an eye out. So do your best to keep an open mind, or at least a learner’s mind when you start rotations.

I’m not saying you can’t be bummed out about workload. There’s a lot of pressure to never complain and to grin and bear it in medicine, but I’m going to rebel against the hidden curriculum for a second and say it’s ok to hate getting up at 4 AM. I do, and it will only be for my chosen specialty that I’d ever consider going through stuff like that. That’s what this article is for: to help you find the thing that you won’t hate for making you get up, even at 4 AM!

3. What is the thing left on your mind at the end of a day on this rotation?

There are annoying aspects to the clinical years of medical school, and sometimes they’re just the nature of the beast rather than something specific to a specialty. Try to separate these out, and focus on seeing if there are elements of care you are left wishing you could be the one to provide. What questions about each patient case are left on your mind when you leave? What did you wish you had more time to spend on?

For example: the biggest red flag to me when I was on my ObGyn rotation is that I would get frustrated when a patient would come for her pap smear and mention being depressed or feeling bad on her blood pressure medication, and we would have to just send her back to her primary care physician. I realized that I wanted to be that “catch-all” person dealing with a little bit of everything to treat the whole patient, and that’s why I chose family medicine.

4. Think about your favorite patient experiences. What made them so awesome?

As the flip side to #3: think of your favorite things and why you enjoyed them so much. Did you notice something subtle on physical exam that helped your team clinch a rare diagnosis? Did your one-handed knot make your attending weep with joy? For me, the themes of my all-time patient encounters were advocacy, emotional support, and teaching. While these are actions that any physician can do, I noticed I enjoyed them even more in the context of primary care—especially at the free clinic. Every element of your favorite interactions will bring you valuable information on what specialty would be a good fit for you, about what type of practice setting you might like best, etc., if you take the time to check in with yourself about why you had the emotional response that you did.

This is important because this career needs to keep you occupied for decades; if your balance of the experiences that sustain you is too much smaller than the experiences that annoy you, you’re going to lose passion. If you know what made it so awesome, you can replicate it and improve that balance by making it your job to get to be in that environment EVERY DAY! Does it feel real yet?

5. Narrowing down: like Plinko, but for your future.

You may find after careful reflection that you, in fact, love more than one specialty. Or, you may realize that training from multiple different specialties may bring you to your ideal practice. Honestly: what a good problem to have! You have multiple things that would make you happy! You can of course apply to multiple specialties for the NRMP Match, but you’ll still have to rank the programs in the end. So now, let’s talk about narrowing it down.

This part is basically a “Pros” list/values table hybrid (see my example below). What does each specialty have that the other one doesn’t have, both positive and negative? How important are those things to you relative to one another? Is there something you absolutely can’t live without that is only true of one specialty?

For this part, be sure that you’ve spent time shadowing or doing a clerkship in these specialties, as well as talking to people who specialized in each (or reading their perspectives, like in the SheMD “Why {Specialty}?” series), to be sure you’re making as informed a decision as possible.

Family medicine, psychiatry, and obstetrics and gynecology were my top three choices for specialties. I ultimately went with family medicine because I valued the benefits that were exclusive to that field more than those that were unique to the other fields, especially once I added in the “Cons” list.

Let’s Go!

Choosing a medical specialty can be a nerve-wracking decision. At first I felt like I had failed somehow when I realized ObGyn wasn’t actually what I wanted for my career in medicine. A friend of mine kept it a secret for months that they had changed their mind about the specialty they had talked about pursuing for years. Several classmates applied to multiple specialties in this year’s Match. In the end, all of us got what we most wanted.

My goal with this article is to promote self-reflection in particular areas that should hopefully be helpful no matter which specialties you consider as you go through your clinical rotations. The bottom line is there is no magical formula to arriving at this important decision quickly, effortlessly, or even on the first attempt. But it’s worth doing the work to figure out what is the most fulfilling specialty for you, because you deserve to have that awesome career you’ve been working so hard for all this time. Let’s go!

#DearMedStudent

#WhySpecialty

#ChoosingASpecialty

#SheMD