Agonizing between two specialties? Some thoughts on choosing.

When I was a medical student, I had a really hard time choosing my specialty. I loved everything! I’ve talked to a number of medical students lately who were having the same trouble. After a recent advising meeting with a student, I thought it might be helpful to share some of those thoughts here. Consider these questions a way to guide your own reflections on choosing the right career path.

How many choices are you torn between?

Most students that I have talked to (myself included), find themselves torn between two specialties. If you are choosing between three specialties, the other advice that I will offer should still be useful to you. If you really can’t make up your mind at all, and are choosing between four or more specialties… Well, then I’ve got nothing. 

Are you a thinker or a doer?

I don’t mean to say that you can’t be both, but the real question is, which do you enjoy more? Given a choice between rounding all day, and rounding for 5 minutes then operating all day, which would you rather do? Or would you rather do both? When you are on an internal medicine rotation, do you find yourself itching to get back to the operating room and DO something? Or do you really enjoy the debate and discussion? When you were on your general surgery rotation doing hernia repairs and lap choles, did you love working with your hands, or did you feel like a car mechanic just fixing widgets all day?


For the doers  – Do you want to be really, really good at doing one thing, or do you want to do lots of different things?

It’s no secret that surgery is becoming increasingly specialized. This is more pronounced in some surgical specialties than others. For example: I hear that in orthopedics, there is increasing pressure to subspecialize (officially or unofficially), to be a total knee guy or a total hip guy – to be really, really good at one surgery. In general surgery, that pressure is less pronounced – most general surgeons do a smattering of things, including lap choles, appendectomies, breast biopsies, pilonidal cyst excisions, and hernia repairs. Which of these would you prefer? Neither is better than the other, just different!

If you are having trouble deciding, think about this: what are your hobbies? Do you spend all of your free time on the same hobby, which you take really seriously, or do you have a number of different and seemingly unrelated hobbies? Do you absolutely live for soccer, and like to spend all day playing and watching games? Or do you like to spend an hour gardening, then go for a jog, then read for an hour, then cook dinner, then do some knitting?

If you like to do lots of different things, consider OB/GYN or emergency medicine. If you like to do one thing, consider orthopedics, plastics, cardiothoracic surgery.

ENT is a bit of a middle ground – some variety and the opportunity to do medicine and surgery, but not as much variety as OB/GYN or EM.

General surgery also falls somewhere in the middle. Gen Surg admits their own patients, but they often get referrals to perform specific procedures a la “take this guy’s gallbladder out,” rather than an evaluate and treat referral such as an OB/GYN or an ENT might get for, say, irregular periods or vertigo. Most of the evaluation is done by someone else.

For the thinkers – Would you rather…

Ok, bear with me here, since I’m definitely one of the people who started getting “OR withdrawal” after back to back nonsurgical rotations, but here’s my best shot.

Would you rather…

…be a jack of all trades, or an expert in one? (family medicine vs internal medicine/peds/psych) to parents, or talk to the elderly? (peds vs internal medicine)

…talk to patients about their past traumas and current anxieties, or talk to them about their lab results and the complications of diabetes? (psych vs internal medicine)


Has that helped at all? I hope so!

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