What I think about when I think about specialty selection

Dear Readers – I emphatically welcome your feedback for this post, particularly those of you who have been through the match, residency and beyond, but all insight is welcome.

As for me, as the sidebar and my previous posts might indicate, I’m actively working to narrow down my specialty choices. I’m taking an elective in neurosurgery and I’m actively swooping in on as many surgical oncology cases as I can (read: 2 so far) at the kind invitation of one of our surgeons. I thought I’d organize some of my thinking about specialty into things that I think about – and things that I try to avoid thinking about.

There are some things that I know about myself that inform these thoughts. I want to be in academic medicine (love teaching and I enjoy research, would rather be salaried than paid by productivity, even if I take a pay cut). I get bored easily and need severe challenges – difficult cases, sick and complicated patients. I love medicine and thinking about medical problems, but I also love surgery and operating. The OR to me is like a giant video game – you learn the rules, you test yourself, you accomplish goals and at the end of the day you know that you DID something. That feeling is remarkably satisfying. I want to have a family – BUT I know that I need to be tested by my work. I wouldn’t be a good father if I was bored all day.

So what do I think about when I think about choosing a specialty?

1. What does the doing of each specialty entail? What are the operative tasks of the surgeon – what are the cognitive tasks of the medicine doctor? Do I enjoy doing those tasks? This is a REALLY HARD question to answer, especially in surgery, because 99% of what you get to do is watch. But I always try to put myself in the shoes of the attending.

2. What are the highs and lows of each specialty? Sure that week or two on service might suck – but how much does it suck, and why?

3. What do the residents and attendings say that they value/enjoy in their specialty? Do those values jive with what I value – or do they conflict, or are they irrelevant. You’d be amazed at how many supposedly hardworking folks have different priorities / are lazy.

4. Do the attendings lead a professional life that I want to emulate? Are they coming in at 5 am and leaving at 9 pm, even into their 60’s? If so, why?

5. Where are there moments that make you feel like you’ve come alive – where you recapture a childish sense of wonder? I know that these moments are fleeting, and that they fade, but man – how sad would it be to never take the chance at all?

6. Are the residents lazy when they get real work to do? Are they tired? Or are they enthused and psyched? Yes, there is a tremendous amount of variability in this – but specialites with lazy residents would be a bad fit for me.

Finally, there are some things that  I try to avoid thinking about when I think about choosing a specialty.

1. Will I make money?

2. Do I like the residents/attendings?

3. Do I look/sound/act like the residents/attendings?

4. Is the specialty prestigious (inside and outside the hospital hierarchy / medical community)?

So where does this all leave me in my debate between Neurological Surgery, Surgical Oncology and IM – Cardiology? Frankly, it mostly boils down to which procedures I’d like doing the most. Right now I’m trying to figure out where I would like to *do* crani’s for tumors, or aneurysm cases, or craniosynostosis repairs. It’s quite hard to figure this out – but I’ve gotta say that spending hours with a bipolar and a suction staring into a hole in someone’s cortex doesn’t really seem like that much fun. Not nearly as much fun as a big complicated liver case, or even the craniosynostosis repair. I don’t really like operating in tiny fields as a student (hence my aversion to ENT surgery) but I wondered whether the cool factor, or the endovascular factor, or the fact that I won’t be a student for the rest of my life would sway me.

So far, I don’t know, but fortunately I have another week of neurosurgery to figure it out.



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One Response to What I think about when I think about specialty selection

  1. I start neurosurgery next week. In Australia, they do a lot of spinal surgery (laminectomies etc) which doesn’t interest me much.

    I’ve been thinking about this sort of thing lately as well. I know that my perception of each specialty tends to depend more than it ought on the personalities of the people I’ve worked with.

    For me personally, I worry about the surgical training workload even though I’m not sure I’ll have kids (and in my situation, I’d be picking one or the other of the two – doing both wouldn’t work for me). I also worry about whether I’d get bored of doing the same thing over and over again.

    I’ll be interested to see how your decision making process goes – I’m lucky that in Australia, we don’t have to decide until after our intern year at earliest!

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