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How to Think About Choosing a Residency & Specialty

How to Think About Choosing a Residency & Specialty

Session 26

There are many things to think about when you are deciding your future career. In this episode, we discuss how you should start that process.

The goal of this podcast is to speak to specialists from every field, both community and academic. But I want to rewind a little bit and talk about the whole process of just thinking about these specialties and the questions you should be asking yourself, and what you should be thinking about as you’re going on this journey so that as you listen to these interviews, you will have a better sense of what you’re thinking about and your goals in career and life in general.

Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[02:10] Keep an Open Mind

A large percentage of premeds that go into medical school know what they want to do. But keep in mind that most medical students change their minds. They may get in a specific field after exposure and research but as they get more involved in the field through rotations and doing a lot more clinical work as a medical student, they realize it’s not for them.

So realize that your preference can change. Don’t hold onto your convictions of wanting to be a certain specialty. Let go a little bit of that and keep an open mind as you are going through this process.

A large percentage of students go into medical school thinking they know what specialty they want to do, but most of them end up changing their minds.Click To Tweet

[03:38] Academic/Community, Urban/Rural Settings

Understand that what you see as a medical student is typically urban, academic medicine. For DO students, that’s not always the case. Most DO schools are not associated with large academic medical centers. You have to go around to different hospitals. Some are academic while others are more community-based or more in the suburbs or more rural, wherever the hospitals are that you rotate at based on the schools you go to.

In your elective rotations, try to mix up academic and community settings to give yourself an idea of what you want for yourself. Click To Tweet

Understand that what you see day in and day out as you’re a student doing your rotations and doing your preceptorships and your pre-clinical years, the medicine you’re likely seeing is not how the majority of medicine is practiced.

So when you’re out shadowing a cardiologist in a large urban, academic medical center, the life of that cardiologist could be 180 degrees different than a community-based cardiologist or a rural-based community cardiologist.

Figuring Out if You Want to Practice in an Urban or Rural Setting

As you’re setting up rotations for your sub-internships and getting more involved in some of these electives (cardiology is not the best because it’s a fellowship you do after medicine), try to mix up academic and community settings to give yourself an idea of what you want for yourself. Do you see yourself as an academic person? Do you want to be around residents and medical students? Or do you just want to work as a physician and practice?

Do you enjoy teaching? Do you enjoy doing research? Research is usually big in the academic world. You can do plenty of research in the community too but in the academic world, research is more mandatory.

Do you want to be around residents and medical students? Or do you just want to work as a physician and practice in the community?Click To Tweet

Or do you want to have a hybrid setup? We talked to Dr. Topf back in Episode 16. His is more of a community-based nephrologist but is also involved in academics and running a fellowship program for nephrology. So you can have a little bit of the best of both worlds.

Start thinking about those settings. Start thinking about where you want to go to residency. Have those ideas in mind regardless of the specialty.

[07:00] Medical Specialties for Introverts vs Specialties for Extroverts

Think about what kind of person are you? Are you an introvert or an extrovert? I, myself, am an introvert by nature. When I go out and interact with people and when I used to interact with patients all day before medical school and during medical school, when I was interacting with clients all day while I was a personal trainer, I would be completely drained at the end of the day.

Working with people drains me. Even being at conferences drains me. If I would have taken that into account and it was significant enough that at the end of the day, I was completely wrecked and couldn’t do anything, maybe I would think about a specialty that is a little bit patient-focused. If that’s the type of person you are, think about it.

“Faking It Till You Make It” as an Introvert in Medicine

There’s also that opportunity to fake it till you make it. I put on a big smile on my face during work and at conferences and just deal with it then at the end of the day, I get tired and would need lots of alone time. I need to be by myself to recharge my batteries.

Or you may be the type of person that recharges being around other people. If you’re a people-person, look into those fields that are more people-heavy like psychiatry or some of the general primary care specialties.

The classic medical specialties for introverts would definitely include radiology and pathology.Click To Tweet

For the introverts, when you try to get away from people, possible specialties include radiology or pathology. We did an interview with Dr. Judy Melinek back in episode 24. She is a forensic pathologist and she interacts with the deceased’s family members whom she calls patients. So she’s still interacting with people as a forensic pathologist.

[09:30] Stressful Situations

Think about what kind of stressful situations you like to be in. Are you ready for anything at any notice and life and limb and death in your hands? Maybe the emergency department is right for you. I personally liked the emergency department but not the sort of intensity. For me, I wouldn’t want to work in that sort of stress.

I originally wanted to be an orthopedic surgeon. Complications happen in the operating room and you need to be able to handle that. But you’re already in a controlled environment.

Hopefully, you’re thinking through these situations as you’re going through it. You’re always thinking three steps ahead. In the emergency department, anything can come in at any time so you always need to be prepared and really be able to handle that.

In the emergency department, anything can come in at any time so you always need to be prepared and really be able to handle that.Click To Tweet

[10:38] Length of Training and Variety

A couple of silly questions I don’t think are valuable in asking is what time frame do you have or how long do you want to train? Neurosurgery is seven years versus pediatrics which is three years. But if you really want to be a neurosurgeon and you settle for pediatrics due to the length of training, you’re making a huge mistake.

Don’t settle on something or don’t avoid something just because the training is going to be longer than you hope for. It may seem a long time at the beginning of your career, but it’s actually not a lot when you look back at it. So don’t use this as your criteria for deciding what specialties you’re looking at.

Don't avoid a medical specialty just because the training is going to be longer than you hoped for. Click To Tweet

How Much Variety Do You Need in Your Medical Specialty?

Another question you should ask yourself is do you need a lot of variety? Maybe the emergency room is good for you. I interviewed an emergency medicine physician back in episode 02 and he said the majority of the day is spent dealing with a lot of the same stuff over and over again. All the other stuff is just a small percentage of what you see.

Everything you do as a physician will get monotonous so you need to really love the monotony. Don’t go into emergency medicine because you want to treat gunshot wounds all day long because that’s not what your career is going to be like. You have to like all of the other stuff.

Don't go into emergency medicine to treat gunshot wounds all day because that's not what your career is going to be like.Click To Tweet

[12:50] Should You Choose a Specialty with Less Blood and Guts?

How much you can handle blood and guts and how squeamish are you is a silly question. As we’ve heard from Dr. Melinek, again back in Episode 24, as a forensic pathologist, she deals with a lot of nastiness. With crime scenes and accident scenes and everything else, you’re dealing with squished heads and blown up bodies. She said you just get used to it and get desensitized to it. It’s something that happens all the time with your training.

Right now as a premed or medical student, don’t think that you don’t like blood and guts because as you progress through your training, you will become more and more accustomed to blood and guts. Maybe you’re different, but for now, put that aside.

[13:55] “I Am Not Good with My Hands!”

Surgical skills can be taught, so don’t worry about that. If you feel you don’t have that much manual dexterity, a lot of that stuff can be taught. Don’t write off surgery just because you don’t have the manual dexterity. Practice and get better. There’s still lots of time.

Don't write off surgery just because you don't have the manual dexterity. Practice and get better. Click To Tweet

[14:35] Medicine or Surgery?

When you’re starting down this path and you’re getting into the weeds and thinking what you’re interested in, there’s this huge divide. You have medicine and surgery. Medicine is going to be pediatrics, neurology, radiology, and internal medicine docs and a lot of those subspecialties. You’re going to deal with a lot of the bread and butter.

To get started, go to the AAMC Careers in Medicine website to check out a huge list of medical specialties and what is available for you. This is where you start looking as far as what’s out there.

On the other hand, F.A.C.S. (Fellow of the American College of Surgeons) recognizes fourteen surgical specialties. But surgery is surgery. Do you like the O.R. or not? Again, do not think about it as whether you like blood and guts or you get queasy around it because this is stuff you will get used to over time. Don’t worry about it from that perspective.

Personality-wise, the O.R. is a little bit different. The environment is different as well as the pace. Do you like that sort of environment? You don’t know until you get in there.

Medical Specialties That Are a Mix of Medicine and Surgery

There are four specialties typically named that are a great mix of medicine and surgery. We had this in last week’s episode with urology (Episode 25). Urology, ophthalmology, ENT, and OB/GYN are considered really good mixed specialties that have medicine and surgery. So if you find yourself stuck in the middle of wanting to be in the O.R. but wanting to do a lot of medicine as well, take a look at those.

Do you like procedures? Dermatology is huge with procedures.  I’ve talked with Dr. Chris Sahler back in Episode 13 about Physical Medicine & Rehabilitation and how there’s a lot of procedures in that specialty. Are you interested in working with your hands and doing that sort of thing but don’t really want to be in the operating room?

There’s a great ScutMonkey Comics by the blog site The Underwear Drawer that presents The 12 Medical Specialty Stereotypes, which I think are pretty spot on and funny. Take a look at it, too, as well as a couple of fun algorithm charts out there or a flowchart of how to choose your medical specialty. Just Google “medical specialty flowchart” and you will find lots of them.

[18:37] Final Words on Choosing Your Specialty

Something you don’t want to look at when it comes to choosing a career is income. It should be last on your list as far as what you’re hoping to do in the future. Don’t look at potential income as you won’t be happy. You may get lucky but more than likely, you won’t be happy if you’re in it for the money which is the wrong reason.

You won't be happy if you choose your medical specialty based on money.Click To Tweet

Don’t think, either, that just because you’re choosing a certain specialty in an academic setting, you’re stuck there for the rest of your life. Once you have your specialty, you can go move to a community hospital.

Most Specialties Require the Same Traits

So these are the things I want you to think about just to get you in that mindset of what you should be thinking about when you’re listening to these physicians talk about their specialties. I ask these doctors what traits do they think are good for this particular specialty, and when you listen to those, they are very much always the same.

Nephrologists seemed to be the odd men out with one specific thing that you have have to love the attention to detail to be a nephrologist. But everybody else says you have to work hard and you have to want to help people, be a lifelong learner, and all those generic things.

If you have something else that you want to add to this list to help choose a specialty, shoot me an email at [email protected].

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