By Katrina Harler, MS I
As a child, I frequently returned home from my small-town adventures with a bundle of “flowers” for my mom. Most of them were more of a weed than a show-stopping bloom, and very few were without flaws, but my mother appreciated them nonetheless.
I often became frustrated that I could not find a perfect dandelion: one that had all its leaves, with a sturdy stem, and bright yellow petals. How, in the vast fields of my rural hometown, was there not one perfect dandelion? Even as I grew older and moved from wild weeds to colorful bouquets from the local florist, I was too picky. I wanted every flower in the bunch to be perfect, but that wasn’t possible. Even in their imperfection, though, the blossoms were all beautiful.
Choosing a specialty feels a lot like finding flowers for my mother. There is a seemingly infinite array of options, all of them unique and interesting in their own way. And yet, for many medical students, there is rarely a perfect option.
During medical school orientation week, our school shared a statistic from the Association of American Medical Colleges: “Only 25% of medical students keep the specialty they planned for when entering medical school.” I assume the goal of sharing this was to encourage students to keep an open mind. However, there were several different reactions. To the students who already had one specialty in mind, this number may have been frightening. For others who had not begun the process of considering specialties, this statistic was more interesting than concerning.
Then there were students who fell somewhere in between: those of us who had not yet decided on a single specialty but had a few in mind. For us, this statement was a reminder of the vast number of things to consider when narrowing our options to one final choice.
There is a systematic way to narrow down the options. Many of us have heard that the first choice is deciding between surgery and medicine. Then, if we select medicine, we choose between inpatient or clinic. But there is so much more to this decision than this simple, flowchart method. Once we narrow down our choices a bit, we begin to consider the more detailed questions such as patient population, organ system, salary, lifestyle, geographic flexibility, competitiveness, and an ever-unraveling spool of other factors.
As we work through the nitty gritty aspects of each of our options, we notice how difficult it is to find something that matches our idea of a “perfect specialty.” The most interesting may have a difficult lifestyle. The more specialized options have longer, less flexible residencies. Despite the seemingly endless number of specialties, subspecialties, and fellowships, every one of them has its own collection of pros and cons, just like the flowers that have vibrant petals but weak stems, or a sweet scent but bruised leaves.
My question to those who have been through the process is this: how did you choose a specialty? Like the choice itself, this question is deceptively simple. What I really want to know is, which factors were most important to you? Which were you willing to sacrifice, and why? For someone who already has the pros and cons listed out for my top two choices, how do I go about deciding what is most important? How much did the stereotypical personality of the specialty matter?
As I’ve talked to more physicians, mentors, and coaches, I have learned that many have chosen their specialty because it simply felt right. They went into clerkships with their top few choices and realized they simply fit in better in one of them than they did in the other. Feeling a sense of belonging is a good thing, of course, but to what extent should the general personality of a specialty matter?
What if those generalizations are negative? For example, I was once told by a physician I worked with that I was too nice to be a surgeon. I believe this stereotype has dissipated drastically since then, but I still consider his remark from time to time. Similarly, I know of many others who have been warned away from specialties due to their ideal family life being seemingly incompatible with their specialty interests. To what extent are these stereotypes true? To what extent should medical students consider them when weighing pros and cons?
My final question is this: How do you make such a massive choice in such a short amount of time? While selecting flowers can take as long (or as short) as you choose, picking a specialty has a recommended deadline. As a child, I could spend hours exploring, checking every blossom to find the best one. In medical school, there is simply not enough time to experience each specialty, subspecialty, and fellowship to its full extent. In the vast field filled with dozens of beautiful, imperfect specialties, at what point do you claim the flower you’re holding as the best? How do you reconcile with the knowledge that not every option could possibly be explored to the same degree?
Ultimately, I know what I want to be. I want to be a physician, but I don’t want to just be a physician. I want to be an animal lover, a lifelong volunteer, a sister, daughter, and maybe even a mother. I want to be a reader, a writer, a musician, a creative. Many of these things are things I already am, things I do not want to lose. My goal is to find a specialty that fits with the life I want to build, rather than build my life around a specialty.
So, I ask again:
How…
Why…
When…
did you choose a specialty?
Top photo: Katrina Harler picks flowers for her mother. Click here to send your thoughts to Katrina on how to pick a specialty.
