Deciding to do medicine with a view to life as a doctor seems a pretty definitive career choice. That is, until you pose the question to yourself: “Well, what type of doctor do I actually want to be?” becomes the source of many a sleepless night and mini-existential crisis, especially around exam time with its associated emotional lability. Furthermore, this is a decision not made in isolation. Under the burden of advice from friends and family members, the medical student often begins to suspect that they are not alone in spending considerable time weighing the many specialties.
While most counsel is well-intentioned, the incessant extolment of say, geriatrics by a Parkinsonian grand-aunt can become particularly wearying. Sure, diversity of opinion is healthy in the making of any major life decision. However, it would seem as though the odd prescription is not enough for some people.
So, what’s to be considered when choosing a specialty? I refer to “choice” but this is rather presumptive; preference is perhaps more apt given the reality – anywhere up to two-thirds of a class will become GPs (whether they wanted to or not), a statistic that drew audible breath from this particular crop of students, among whom dreams of sexy, city-based hospital consultancy posts were rampant. With that disclaimer in place, what then are the factors that influence “choice”?
In this regard, money and prestige are like tectonic plates; unseen and largely unspoken of, however their influence is undeniable. There is a hierarchy of esteem that permeates hospital-based medicine to which the medical student is subjected to from an early stage. Placed firmly at the foot of the ladder, it rapidly becomes apparent that choice of specialty is a guaranteed way to drag oneself up a few rungs, if that is what one aspires for. A counter-balance to the allure of wealth and status may be described rather ambiguously as “work-life balance”; a catch-all encompassing everything from personal preference and pragmatism to failure, excuses and justification. This is (probably) the most important factor, and really reflects an attempt to qualify the actual day-to-day reality associated with a given specialty.
Sorting through the pros and cons of the ever multiplying and narrowing specialties (each with their own sub- and super-sub-specialisations) can be more tedious than study itself. Even with the assistance of a simple money/prestige/work-life balance framework, it’s difficult to formulate accurate comparisons when relying on rather suspect information. Hearsay, the opinions of peers and, in particular, laughable stereotypes go something like this. Psychiatrists are madmen or women with the keys. Orthopaedics is a marriage of blood, bone, carpentry and testosterone, while Derma is succintly put as a “holiday”. These are really not an appropriate basis for making such an important decision.
Relevant resources, online or otherwise, are pretty much non-existent and information evenings with guest-speakers representing more than one specialty seem to inevitably descend into tribal grand-standing – that vascular surgery is more demanding than its colorectal counterpart because “shit doesn’t clot at two in the morning” scored particularly highly one memorable night (expect an increased number of applications to that specialty’s training scheme in about five years time). In fact, accurate and objective information on what is a surprisingly emotive subject is agonisingly hard to come by for medical students, even raising the topic on the wards carries with it an inherent health warning – just one stray comment can eviscerate your carefully arranged perceptions (such as they are).
And woe betides the student brave enough to declare their preferred specialty;
Radiation oncology; “Do you like burning people?”
Pathology; “Shame, you would’ve made an alright doctor”.
Surgery, in general; “Alas, your children hardly knew ye” or “You can hardly tie shoelaces”.
Radiology; “Why can’t you watch TV at home?”
Plastic surgery; “Dream on”.
These are but some examples of the kind of encouragement the “decided” student can expect, and, to be honest, no answer to “what specialty do you want to do?” will grant immunity. “I don’t know yet” rapidly becomes a stock favourite, or one can simply state any specialty they have yet to hear a joke about. At this stage, it’s almost too bewildering to even think about. A doctor is a doctor right? I’m sure that at some point, I’ll happen across a specialty (the One) that’ll be just right – and hopefully attainable. Or I’ll be in Australia on the beach, lying in the sun with wads of cash and working so few hours that it really doesn’t matter what I am.