How to Pick a Specialty in Medical School

I couldn’t be happier and more grateful to have recently matched into the medical specialty of my dreams. My first memory of deciding I wanted to be a cardiothoracic surgeon took place in the fifth grade, when I was introducing myself to our substitute teacher. Since then, clinical exposure, mentorship, and a high degree of stubbornness have helped nurture this childhood dream. After a lot of reflection leading up to and during the residency application process, I’ve determined what I believe to be the three most important factors that should drive a medical student’s decision to pick a specialty.

After speaking to many colleagues and mentees as they’ve also deliberated this decision, I’ve found that some may discount a specialty like surgery because of stereotypes, isolated negative experiences, a bad grade, or workplace dynamics. Some count themselves out before they even count themselves in, and I venture that this may be especially true for women on the fence about surgical fields. As someone who becomes deeply invested in others, I consider it a huge loss when a mentee or friend cites surgery not being a good fit because of “the culture.” What experiences truly led them to think this?

Of course, there are many caveats and personal circumstances to weigh. As mentors, it’s important to offer constructive points for reflection, but ultimately to offer our full support at the end of the day. We must not project judgment once mentees make their final decisions. Mentors should also strive not to outwardly disparage other specialties, especially in the presence of learners, when in medical school we develop our first impressions of these same specialties and look to others in our immediate proximity as role models.

Without further delay, here are my 3 P’s for picking a specialty in medical school.

1. Patients

We all decide to go to medical school to help take care of patients when they are sick. Picking a specialty should first depend on with which patients you most enjoy working and helping. Adults, children, families, or all of the above? Are the patients fairly healthy or very sick? The moments in which you have helped your patients heal, cope, and live better lives will serve as your motivation and fuel in the darkest of times, when bad outcomes and exhaustion will inevitably weigh you down and test your resilience.

I deeply enjoy spending my time with adult cardiothoracic surgical patients. They may be high- or low-acuity in their presenting disease states. Often they are older and comorbid, but this is not always the case. They are uniquely vulnerable after surgery, and I feel very comfortable aiding them in what is often a long recovery process.

2. Practices

Each medical specialty applies knowledge and innovates differently. In an oversimplified sense, one question you can ask yourself is, are you more technically oriented or more cerebral? Although each specialty has both technical and cerebral components within the line of work, time spent developing and practicing either skillset varies considerably over the years in training and beyond. For instance, surgeons strive to hone dexterity and rehearse operations each day, while internists engage in intellectual discussion of differential diagnosis and coordinate patient care from a broader perspective. Consider also the frequency and nature of emergencies in a medical specialty, as well as your individual comfort and desire with being called to take care of tasks for a patient.

The days of cardiothoracic surgeons start very early with managing sick patients in the hospital, followed by hours operating in a very technically demanding and high-risk environment. The week could also consist of preoperative appointments with patients in the clinic or responding to surgical consults from other physicians.

3. Partners

Medicine is interdisciplinary, and each physician interacts with a multitude of other providers and support staff. With this final point, it’s important to consider the categories of people with whom you will be working, rather than any individual personality or specific group. Do you like spending most of your day seeing patients by yourself, or would you like to work directly side-by-side your colleagues? Will you have support from other ancillary staff? Do your specialty’s colleagues share your values for handling the demands of patient care specific to the specialty? Will the types of workplace relationships essential to succeeding in the specialty be professionally and personally fulfilling? Each practice has more experienced and newer individuals, some with bigger personalities and others more open to teaching and engaging learners. Students should consider the larger network of interconnected relationships in a specialty, rather than the characteristics of one or a few people who merely serve as isolated examples, negative or positive. Nonetheless, students and educators should keep both of these sayings in mind: “one bad apple can spoil the bunch,” and “it’s too good to be true.”

In my chosen specialty, cardiothoracic surgeons work with a large intensive care unit team to take care of hospitalized patients, as well as a large operating room team to manage different aspects of surgery, including anesthesia and perfusion. We rely on a multitude of advanced practice providers and other vital staff to assist in daily patient care tasks. This large team is an essential reason for why I picked cardiothoracic surgery!

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