The Physician Philosopher (TPP) Takeaways:
- Biggest branch point in deciding: Procedural versus non-procedural. After that it gets more difficult!
- Love the good aspects of the specialty you choose, and put up with the bad aspects. (If you haven’t found the bad aspects, dig deeper)
- Don’t look to the residents to choose if a specialty will fit. Residency is a finite amount of time. Look at the attending physicians.
- Lifestyle matters. It’s not the only consideration (and not even the most important). But it is part of the decision.
Love the Good, Put up with the Bad
I recently found my personal statement for medical school applications, and reminded myself that when I started this journey I wanted to straighten children… I mean be an orthopedic (ever thought about what this word meant: ortho-pedic) surgeon. At some point during medical school I also thought about emergency medicine, pediatrics, and even ENT. I ultimately decided that the best fit for me was anesthesiology.
How did I come to this conclusion? I am glad that you asked.
The first branch point is really the following: Do you like using your hands (doing procedures) or not.
I always tell students I work with the following: You have to LOVE the good aspects about your chosen specialty and be able to PUT UP with the negative aspects.
What do I mean by that? Well, if you choose emergency medicine you have to love procedures, enjoy shift work, and be able to quickly diagnose a presenting patient. You also have to be okay with getting “Monday-morning quarterbacked” by every consulting physician to whom you speak.
You can set this line of logic up with any specialty, because the truth is that there are pro’s and con’s to Every. Single. Specialty.
For example, I chose anesthesiology because I love quick procedures, seeing immediate effects of my treatment, and being the expert in the hospital when it comes to airway management, running codes, and resuscitation. Simply put, if your patient is crashing you want an anesthesiologist around. I also realized I had to put up with the political discussions involved in anesthesia (lets keep it friendly!), being limited in my interactions with patients, and patients not recognizing me after the fact or maybe even realizing I am a physician (trust me…it happens…a lot).
Life Style Matters, Too.
Whether you like it or not, you also have to consider life-style. Do you like shift work? Do you hate it? Do you like working in clinic? Do you plan on having a large or active family? Is your spouse (if serious) also in medicine?
These are all difficult questions to answer. My best advice to you when thinking on these is to look at the ATTENDING physicians of the specialty you are considering and see if their life matches what your expectations might be.
The most common mistake I see medical students make is looking at the RESIDENT to determine if they’d like that specialty. Residency only lasts but a minuscule amount of your career. Better to make decisions based on what the vast majority of your career will be like (i.e. look at the attendings).
Another major lifestyle consideration is your debt to potential future income ratio. If your annual income is half of your anticipated debt at the end of residency, you may need to think long and hard about whether that is really the right specialty for you. For example, if you anticipate earning $150,000 per year (~$8000 post tax dollars per month) and your anticipated debt is $300,000. At 6.8% interest, you will pay a little less than $2000 per month (25% of your take home pay) for 30 years before paying that off.
Now don’t fret, those numbers are worst case!! You’ll likely make more money as you advance. Also, I am a big proponent of either doing PSLF (Public Service Loan Forgiveness) or refinancing your loans to get that interest rate to a more manageable level.
My point is that lifestyle and income aren’t the only consideration, but they are certainly part of the conversation.
What do you think? How did you choose your specialty? Does lifestyle matter?