You want to do WHAT for a living?

As the end of the third year of medical school approaches, students have to decide what they want to be when they grow up. I’ve known since high school that I wanted to be a doctor, and since college that I wanted to be a surgeon. What I hadn’t anticipated was having to choose between all of the different exciting kinds of surgery. Every 5-year-old wants to be a doctor and a movie star and an astronaut before they become President, and I think every first-year medical student wants to be a medical doctor and a surgeon and a subspecialist and an emergency doctor. Most of us came to medical school with an idea of what modern medical care is really like, but I think that in the backs of our minds we are all still holding on to an image of the old country doctor; the man who will deliver your baby, then take out your appendix and amputate your arm when it gets run over by a tractor.

The Country Doctor – a famous image of the old-time rural physician

Sometime in the third year, it starts to sink in that you have to choose – you have to pick one specialty and give up all the others. Even a “generalist” doesn’t do everything. Most family physicians don’t deliver babies, and they don’t do surgery. You try to figure out what work you like the best, whether you can tolerate the hours, and whether you like the people. You read, you talk to people, you scrutinize your USMLE scores and your transcripts, you agonize.

In the end, though, most people seem to choose based on the people they feel like they “fit” with. Each specialty has its own distinct personality, and no matter how much you like the work, you’re not going to be happy if you hate your co-workers. It’s been done to death, but I present to you, my thoughts on the medical specialties:

Internal medicine: Lots of talking and thinking about things. Rounds take forever because there is so much talking and thinking going on. After rounds you are rewarded with the opportunity to do paperwork. You spend a lot of time figuring out the best combination of medications to avoid side effects/save money/make sure your illiterate patient will understand which ones to take when. You are probably either blindingly brilliant or… not.

Family medicine: You still think you are going to be the rural family doctor in the paintings.

Emergency medicine: Extreme sports/outdoors junkies who will talk my ear off about mountain biking/kite surfing/backpacking the himalayas. You don’t mind working at 2am because you would have been up all night anyway waxing your surfboards or sharpening your walking sticks or something.

General surgery: Very detail-oriented, you like to practice something over an over again until you can do it perfectly. You will crush anyone who interferes with this mission. You are intense and driven and expect everyone else to feel the same way.

Obstetrics and Gynecology: Like general surgery but with more women, so there is always chocolate in the office somewhere. You enjoy variety and are willing to work at 2am, but you prefer to spend your weekends with your family. You are probably married +/- kids by the time you finish residency. If you are a girl, note that it is ok to wear skirts/dresses/makeup. If you are a guy, half of your patients will ask for a female doc and the other half will quietly wonder why you chose this specialty.

Pediatrics: You love giving advice, even though you know no one is listening. You desperately want the kids to think you’re cool, even though it means you are a 30-year-old wearing a bowtie.

Which one did I choose? I’ll get to that next time!

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