Tuesday, January 18, 2011
At what point should medical students select their specialty?
I changed my mind after two years of residency from one specialty to another. It is difficult for medical students to have a solid basis for long term career specialty selection. Realistically, as medical students, we spend 1-2 months "testing" various specialties. I would say that probably the most influential factor in a medical student's selection for a specialty is the clinical rotation and the attending at that time. If the attending is a mentor and role model that for whatever reason appeals to the student, then that student is more likely to enjoy the rotation and select that career. Good or bad, that is the reality. Do Attending physicians have any idea of the impact they have on shaping a career choice. I remember doing a urology rotation, for example, the surgical attending in the OR was so abusive, that I was compeletly turned off to that as a career choice. Right or wrong, that is how it happens, it is organic and often times subconscious, but it is an interesting variable that often times is overlooked. The career selection process needs to be re-focused and perhaps made a part of the education curricula.
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5 comments:
As a current medical student, I can attest that the selection process often has to begin even before the rotations. Since competitive specialties reward research output in their own field, students must choose research projects in part based on their specialty choice, and well before they get the brief tour of the hospital in years 3-4.
Peter,
It is a good point but difficult practically with current curricula demands. It is probably more realistic for medical schools to put forth some required course, perhaps even at night,before end of 3rd year, to teach and inform students regarding all the implications of their career choice , ie residency choice to put all issues in front of them including as we mentioned lifestyle, income, practice demands, group practice, hospital based practice, etc etc. So many of my physician colleagues late in their career say to me they would have done something different had they known what practice was like in the real world.
Yes, certainly. In addition, at least at my school, rotations are exclusively at the hospital, so students have little opportunity to explore the private-practice side of things.
But given the system we have, do you have any advice on how to figure out a specialty with both eyes open?
Unfortunately, it is a conundrum as you need to experience the specialty and then you need to experience it in private practice and you need to be able to have an understanding of what life is like in private practice. It sounds like your exposure to this may be limited. Given the current constraints of the existing system, I would recommend that you do your "research". The Internet will provide the answers you need such as expected income for a given specialty, expected hours and workload, and whether or not you will be working for a hospital, group practice, or solo practice in that particular specialty. Maybe call a few docs in private practice to ask them what life is really like. Hope that helps and read my book, that will help if you decide to go into private practice.
I think you make a very good point regarding the mentor as being a significant influential role in a medical student's career choice. As a current surgical resident, I remember when I was a medical student having to really separate my interests from the actual clinical rotation. I even remember considering Psychiatry at one point not because of my interest in it, but because of the receptiveness of the attending/mentor at the time.
In regards to the private practice thread, it is true that in medical school we learn nothing about the nuances of private practice. As you may remember, we don't learn much more during residency either, unless you actively pursue it. Seeing myself ultimately in private practice, I agree with your statement in that previous knowledge of what the private practice world is like out there in different specialties may factor into the career decision. It is unfortunate, as Peter mentioned above, because most of the rotations are in fact hospital-based and medical students thus receive a certain biased view of the practice of medicine.
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