Steven Tsoraides MD/ September 2, 2019/ Medical Students

Medical Students often struggle finding their path. Life in a clinic or life in an operating room? Pay off debt quickly fixing bones or slowly treating runny noses? Once you choose, you choose for life.

It’s not uncommon to come across a personal statement where an applicant confesses,
” . . . I remember seeing the light behind the doctor as I exited the womb, and I knew from that moment, I wanted to be an obstetrician.”

Well, maybe not exactly like that, but many young physicians know from early on that their path is one towards a particular field. We can draw a number of stereotypes of the ones that go into orthopedic surgery vs. the ones that are drawn to psychology, but in the end, you are the one who must choose your path.

You’ll likely often see me refer to the Greeks and their wisdom. I can’t think of a more relevant reference than that inscribed at the Temple of Delphi,

“Gnothi Seauton” or “Know Thyself”

The most important part of choosing a field is knowing yourself and staying true to that. You need guidance from others, but the decision is yours. Ultimately, the choice of a particular field is one of the most important decisions you will make as a doctor, and it’s made before you ever swear an oath or actually work as a doctor in that field. What you make, how much you work, the setting you work in, and ultimately your job fulfillment will all be determined after only 2 years of studying outside of a hospital, a 3rd year of shadowing a few select doctors, and finalized in that wondrous 4th year of medical school.

So how do you know? Well, if you know, you know. Hopefully those who are confident in their choice have had a chance to test drive their field at some point early in the third year of medical school. But what about the “off the beaten path” fields like radiation oncology or interventional radiology that are not routinely part of core clerkships? How do you know even if you know you know, you know?

Here are some things to consider if you are still unsure of what you want to be when you grow up.

  1. Rotate early. If you are leaning in a direction or two, be sure to seek out those rotations early in M3, or whatever your school calls the first clinical year. Perhaps you may want to knock out another field as your “first” rotation so you can work out some kinks and get used to being part of the clinical team as you transition from M2 to M3. Many schools are offering earlier and earlier clinical exposure to help with this. Some have also gone away from the standard M1-4 structure and terminology. No matter how your school is structured, try to experience your field of interest prior to the winter holidays so you can have time to either prepare yourself for that field or start thinking about a backup. If your school doesn’t offer a particular field in M3, seek it out prior to September/October of your M4 year. Remember, applications open to the programs for many, but not all residencies in mid September. If you are going into an early match field, you need to know this well in advance.
  2. Find a Mentor. You didn’t think you’d visit a site called TheDocMentor.com without mention of mentors did you? One benefit of rotating early is that you also get more time to pick the brain of the one you hope to emulate. Often mentors and mentees gravitate toward each other. Rarely are they appointed with lasting success. If you are in a field and fail to find a mentor, that could indicate you may not be in the right place, but that isn’t always the case. Doctors are not always the best communicators and some have outright odd social interactions. Don’t get discouraged if you don’t land a mentor right away. Schedule appointments with the clerkship director and program director and they should be able to point you in the right direction.
  3. Go to a Conference in that Field. This is probably underutilized by students as time and money are limited. Medical conferences are the best environment to see what is exciting doctors in a field at any given time. They are also great venues to see doctors socializing with their colleagues outside of the hospital. You are more likely to see smiles on doctors faces in these settings. If you go to a conference and everyone is unhappy, that may be a red flag for you in that field.
  4. Read the Journals in that Field. Much like going to a conference, thumbing, or swiping, through a leading journal in that field will give you a preview of what is important to those doctors. You should get a spark of interest in these topics. If you don’t, what will motivate you to keep going once you are in the field?
  5. Ask Yourself what Environment you want to Work in. I still remember Dr. Rick Pearl laying it out for us during our M3 rotation in surgery. He made it seem very easy as he claimed, “Being a surgeon isn’t just what I do, it’s who I am.” You have to decide first, he continued, if you want do procedures or not. This weeds out a lot of fields traditionally, although the lines are blurred as technology and training evolve. Internal Medicine training can lead you on a path into the clinic, or into a procedure suite (think cardiology, pulmonology, gastroenterology). But still, this is a good starting point. Then think about if you like being in a clinic setting or in a hospital setting. Primary care doctors now rarely set foot in the hospital and hospitalists rarely see patients in the ambulatory setting. Many doctors still cover both arenas, such as surgeons, gastroenterologists, and cardiologists. Another fork in the road can be taken if you hone in on an organ system or disease set that excites you. Hate guts? Don’t choose general surgery. Love brains? Neurology or Neurosurgery perhaps. Consider also the opportunity to engage technology and how much you want to incorporate that into your work.
  6. Ask Yourself how much You Like People? This may seem stupid. All doctors go to medical school because they want to help PEOPLE, but some doctors don’t really like INTERACTING with PEOPLE. Figure out how much you really like socializing with or interviewing others. If you are more of an introvert, then maybe life behind a viewing screen reviewing images or over a microscope will suit you better. It’s ok to be honest with yourself and admit you prefer not to deal with people in a high volume every day. Remember also that children are more than just little people. How many lollypops are you prepared to fork out in 30+ years of practice?

One thing you SHOULD NOT DO yet is let lifestyle considerations make your decision. You have already chosen to be a doctor. That puts you at a certain commitment level and amount of sacrifice in life. You will have less time with your family than your friends in business and IT no matter what field you choose. You will spend most of your awake life at work. You NEED TO BE HAPPY AT WORK to be happy away from work. Yes, that’s right. YOU NEED TO BE HAPPY AT WORK. Let your passion guide your decision and BE SELFISH in choosing a field. Even if you’re married or committed, this is your choice. Your marriage will fail if you spend prolonged time resenting your spouse for your poor decision.

Only after you have chosen your field should you consider how that will affect your wellbeing and lifestyle. Indeed, you MUST consider how it will affect your wellbeing. In the modern era of healthcare, you will see that there are many ways to make it work. Shift work is more and more common. Larger groups allow for more cross coverage. Locums work adds another way to control your life style. I would say there are few exceptions to being able to follow your passion and balance your wellbeing. Demanding surgical fields such as Neurosurgery, for example, may make this rather challenging, but remember, you are not an animal or a slave. You will be able to choose the terms of your employment. You may find your income will be the factor that has to give, however, if you are adamant about a certain lifestyle within a particular field.

This is just a start. There may be more or less questions you need to answer in order to choose wisely. Often it just feels right when you walk in those shoes on a clerkship or rotation. On the other hand, some students don’t know until well into interview season. Trying to apply to multiple fields can be tricky, but has been done. It’s best to think things through well in advance and avoid putting your future at the hands of fate. While you may be happy in a number of fields, you’ll be happiest if you can find a field you are passionate about.

And if you still can’t decide, remember the leading factor in making a good choice, time and time again, is having a good mentor.

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