Choosing a Medical Specialty- Things to keep in Mind

By Dr Prem Aggarwal

As far as I remember even in my childhood I always wanted to be a doctor. At that time in 1970's becoming a doctor was an idea of helping people, learning more about human beings brings someone respect and honor in the society and a career which also earns you enough to pay your bills. Becoming a lawyer was a far distinct choice and becoming a police officer through administration competition was a difficult option. I always hated accounts where I have to deals with files and continuing with business restricting yourself with money and office did not seem as exciting.

But when I went to medical school, the next question - which specialty I have to choose never came to my mind till I nearly completed my MD Internal Medicine and I was ready to jump in private practice and opting for business as my final choice which, ironically was no choice to me at initiation of my career.

Nobody asked me at that time, what specialty you want to choose. Even now when the question is most frequently asked now the answer seems frequently not known. The mystery is similar to the question you asked a newlywed that how many children you want to have and what you want them to become. At a time when they just married there are too many challenges in front of them like that of finding a house, getting a job, settling in new environment rather than this the most important question you have asked. Similarly for a medical student learning anatomy, histology, biochemistry, microbiology and all other absolutely unknown courses for their exams, practical's is such a challenge that decision of selecting a specialty always takes a backseat .

For a young medical graduate, there are countless fascinating careers which are available to choose. Every arena of medical practice- from pediatrics to geriatrics, surgery to cosmetic surgery, obstetrics to infertility, laboratory to nuclear scanning and within these specialties, there are options. One can become a practitioner, researcher, teacher or a self employed investor. While during graduation, one is definitely exposed to most of these options but still you may have to ( or even should) wait for more exposure to various other specialties and super specialties to reach a final conclusion. It's important to remember- when you choose a specialty or one methodology of practicing that specialty you are shutting down doors to others if you want to exel.

Peer Pressure

At this stage, many odd decisions are made by the compulsive influences exerted by peers. One becomes a doctor or chooses a specialty because most of his classmates want to become doctors or choose that specialty. Our peers would talk about the various competitive exams whole day forcing our own competitive mind to excel and surpass them in what they want to do.

Role of Mentor

Sometimes you ask your mentor for advice and you should be prepared that even that may not be the best for you. If you asked Sachin Tendulkar about a career, he will advise you to become a top cricketer, if you asked Sania Mirza she will suggest tennis as great career and if you asked Sushil Kumar he will advice you wrestling. But you are not either of them, and hence the career excelled by him/her may not best for you because of different circumstances, opportunity, preferences and time lines.

You must always remember that having entered in medicine you are definitely likely to become a doctor (because very few drop out or fail) and then deciding your specialty is absolutely your domain. In many rare circumstances, a student wants to become cardiologist because he has seen a doctor saving his kin's life. However, this indeed is a rarity, as most of medical student not have a clue what specialty and why they want to choose.

Many times you are influenced by a teacher – say for example during a posting of psychiatry. You see an exemplary teacher is interacting patiently with a patient but may find later after choosing that particular specialty, you may not be comfortable surrounded by mentally ill patients and your teacher insight is not there with you

So what really matters, then, is what is there in your heart . It cannot be a spontaneous decision -it has to be a reasoned, informed decision; taken after consideration what you shall continue to like enjoy with additive influence of lifestyle, location, compensation, talent, temperament, opportunity and any other which you deem fit in your imagination.

Many of the physicians, including women having families, want to work for well defined hours which is rarity in clinical working. Hence they choose pathology, microbiology, radiology or other fix time specialties. Many a times, doctors decide to do only OPD's and consultation - so dermatology, psychiatry and geriatrics have got less in door patient burden. A person who is choosing interventional cardiology, critical care, emergency medicine, obstetrics and gynecology chooses challenges over choice of time and working comforts.

A person who is choosing a signs which involves equipment may already starts thinking about the city and group of services have to join. He and his wife want to start a family life and plans to spent lot of time which children, he also have to look into choice of city and group of services he wants to join.

Here are 5 important things one should consider while choosing their specialty

Location:-

It is important for you to decide first , whether you plan to learns and practice in a big city, small city or a country side. You want to live in a small city or you want to enjoy a farm house life in a country side. Don't embark upon a super- specialties such as cancer, endocrinology or even cosmetic surgery if you think you are not going to find institutions to support your services. If you want a freedom to practice anywhere then family medicine, internal medicine, Obstetrics & gynecology, pediatrics and MD Medicine are indeed more practical choices.

Compensation:-

Money is matters of importance. The current paying system preferentially rewards the volume and the procedure and the revenue earned out of it. Working harder for longer hours and doing more costly procedures generally result in higher income. The absolute numbers of Rupees earned by the institution or individual per patient will defer initially patient to patient.

Specialities differ in their kind of work and hence also in compensation. Psychiatrist earns money after doing a one hour consultation and counseling in OPD where an surgeon may earn more more by doing a 30 minutes procedure. While selecting a specialty, you always have to consider and estimate your compensation.

At this point, Kindly note the compensation may change by the time you become eligible for the same because of excess availability of physicians of the same specialty or development of more center making the job prospective low.

Temperament:-

Some medical students love children so they what to do pediatrics, some students enjoy solving the diagnostic puzzle desires decide become physicians, some desire to help people to remain more beautiful opt for cosmetology. Surgical specialty and critical care requires a unique aggression of learning the skills.Technology attracts you to newer branches of diagnosis, special writing skills encourages you to research and publishing. Some love teaching become faculty at medical colleges. Thus it is always better to study own temperament to help you deciding you particular specialty.

Talent:-

You must pay attention to this while rotating through your intervention or your subject, you must keep identifying a special talent within yourself for a particular skill. Some people are extremely good suturing, tying knots leading them to prefer surgical specialities. While the process of MBBS, if you realize having special talent or a "knack" in a particular field which others do not- make a right mov toe go with the gift.

Avoid burn out:-

Fifty percent and more out of physicians get into burn out. I don't want you to burn out. It is also true that the people who love their work do not burn out. Look into your "calling", if you are following your calling, you will never burn out. If you take the right decision even at late moment, you avoid this deadly happening.

Last but not the least remember

Once you have entered in medical school there are very high chances that you complete your education you will become a doctor.During the whole education cycle you will be exposed through a number of specialties and sub specialties.

Always identify the one you like the most which suits temperament, your calling from within and future expectation of your lifestyle and expected compensation.

Keep looking for if your calling, a gift for some skills. Lookout for your mentor, teacher and competition- take their advice. But also keep in mind that more often than not it may not be the same which you want to be in life. You cannot be fitted into somebody else shoes and meet the expectation. Remember, you have to find a right size shoes for your feet, so you can enjoy working.

The author is the Editor of Speciality Medical Dialogues and is currently pursuing his PhD in Cardiology at the age of 60.