Several months ago, I posted Alfred Padilla’s Venn Diagram as a fool-proof means for medical students to decide upon a specialty. I remember how difficult for me to decide upon a specialty–it took me years. It’s been yet another match day cycle and graduation year with newly annointed M.D.’s. Despite the joyous faces of the new grads, I can’t stop wondering how many of us actually made informed decisions in our careers. Given the structure of most medical schools, the majority of our decisions are based on limited exposure to a field. Some medical schools condense the preclinical curriculum to one year (Duke) or 18 months (Baylor), but the majority of them remain at two years.

Two years of textbook education is absolutely unnecessary for medicine. We need early exposure to the hospital with a breadth of specialists. Many of us have no exposure to the surgical subspecialities (urology, otolaryngology, ophthalmology, orthopedics, neurosurgery,anesthesiology) or even medical subspecialties (dermatology, cardiology…etc) before we decide on 4th year electives. The even more obscure fields are shunned (nuclear medicine, rehab, radiation oncology).

If we receive so little exposure to these fields, how do we ultimately decide on them? My theory is that we already have preconceived notions of the field long before medical school. Some of us worked on medical projects in college, and simply decided to pursue a career in that field.

“Chuck wanted to be a neurosurgeon when he applied for medical school because he liked brains.”

“Tony wanted to be a doctor, but he didn’t like to work hard. He chose specialties that he thought had a good lifestyle and/or residency.” Ophthalmology? He’ll be in for a BIG surprise. Dermatology? Tony never knew that dermatology clinic had 40 patients a day (vs 10 for his internal medicine counterparts).

Tony may end up being a miserable doctor. If he had known about Rehabilitation medicine, he may have chosen it. This is an extreme example, but the consequence of choosing a specialty unsuited to you can be disastrous. If Chuck hated neurosurgery after 6 months into residency, he still has 6.5 years to go. He could quit, and his department will hate him forever because now they will have to find a replacement.

The solution? It’s already in the works. Many medical schools like UCSF have preceptorships during the preclinical years to expose students to professional offices. For those of you without formal preceptorships, you can always contact community physicians for help. Your dean’s office will likely have a list of alumni in the area who may be interested in having a student around. Use your hospital. Volunteer for transplant surgery trips. You will be pleasantly surprised what you find.

For those of you who are too lazy or meek to seek (bad pun) out your career path, you can still use my Venn diagram. It is amazing.

medicine humor, medicine