Thursday, June 17, 2010

Factors To Consider When Choosing A Medical Specialty

I see many students entering their 3rd and 4th year of medical school with a seemingly daunting question hanging over their heads -- "How do I decide on the specialty that's right for me?"

On the surface of it, the question should not seem that difficult. Just choose the specialty that you enjoy the most! Right? Well, in the past, it may have been that way, but these days things are much more complicated.

In the days of the past, when people like my father were entering medicine, there seemed to be an overall superlative sense of dedication to the profession. People at that time largely entered medicine knowing that it was more than a job - it was who they were. They recognized that they would continually forego a lot of life's flexibilities in order to be there for their patients and their practices.

In those days, residency training had no "80-hour" work restriction, and young residents literally lived at the hospital. And when they would eventually complete their residency, they would classically go into a single practice by themselves and literally be on-call for their patients 24 hours a day, 7 days a week.

My father is one of those individuals. He has been in ObGYN single private practice for 30 years, and has taken all of his own call for that entire time.

Slowly over the last twenty years; however, things have started to change. Something called "lifestyle" started creeping into the mix. In the 80s and 90s, some of the physicians coming into practice would still choose a specialty based largely on what they enjoyed the most, but they would also then choose a practice modality that would allow them to have a better lifestyle. They entered group-practices and hospital-based practices. This allowed more time for family and friends, relaxation, and pursuit of things outside of medicine.

And now most recently, I have noticed a trend further toward this direction. Medical students today have such a concern for lifestyle autonomy that they are now starting to choose medical specialties that would allow them to first and foremost achieve a lifestyle outside of medicine that they desire!

In our culture, the freedom to have full discretion over one's time appears to be one of the single most important factors that affect what specialty someone chooses.

Take my specialty, for example. Neurosurgery is a field of high stakes and long hours. Our surgeries with special skull-based approaches can last as long as 17 hours. The core neurosurgical residency is 7 years. Many go on to obtain a fellowship, which is an additional year. When my father heard that I was entering neurosurgery residency, he told me, "Wow, seven years is a lifetime." He's right -- it’s definitely is a long haul!

Unfortunately, I do not see a lot of students opting-in for this type of rigorous training. Time and time again, I have had students contact me when they are eager 1st year med students, wanting to know what they can do to get into neurosurgery, only to have them change their minds when they are in their 3rd and 4th years of medical school. When I ask them to tell me why they've changed, the answer is always some version of the same thing. They love neurosurgery, but resist entering the field out of concern of for the free time that they won't have.

Now let's pause for a moment and recognize an important fact -- lifestyle IS important, and having freedom and ample discretion over one's time is definitely a key part of life happiness.

Yet the worry is that the best and brightest individuals who should be entering rigorous fields, such as neurosurgery, ENT, or cardiothoracic surgery, are leaving to enter other fields that require less time and less training. Over time, this may be something that the overall medical community can ill afford.

Just this past year, key medical students of whom I had full confidence would be well dispositioned for the field of neurosurgery ended up changing course in the last moment to choose another specialty. What did they choose? Radiology. Nothing's wrong with radiology as a medical specialty, but they chose it largely because it offered better a better lifestyle, fewer years of training, and less hours invested a week.

I'll admit it. During the last 6 years, I've noticed that life has continued without me. My parents have gotten older, my sisters are both married, and I have new nieces, and cousin, many of whom I have yet to meet. But I'm willing to forego all of this for the training that neurosurgery provides. In the end, I'll be able to provide a valuable service to individuals who are in dire need of my help. That is a wonderful feeling, and a legitimate calling.

We all have one life to live, and it is important to choose the right specialty. All of us who are physicians, or aspiring physicians are doing this largely because we have a sense of dedication and responsibility to be a positive impact on others in our community. Young physicians-in-training would do well to remember that residency training does not last forever, and when it is done, you can still reconcile your lifestyle aspirations with your chosen specialty by choosing the practice paradigm that's right for you.

1 comment:

Marianne DiNapoli said...

Great post! I also think that fields with extra long residencies and crazy hours can be especially hard for med students who are planning on becoming parents during that time.