Choosing My Specialty

I have wanted to be a pediatrician since before I started medical school. I was the first to sign up to join the Pediatric Interest Group during orientation week, and had volunteered to be the society’s president by the start of my second year. I found a research project in juvenile medulloblastomas and traveled to San Francisco to present my findings at the American Academy of Pediatrics. When I heard pediatric residents at the local children’s hospital were planning on setting up a children’s clinic just across the border in Tijuana, Mexico, I corralled several likeminded classmates and together won a grant to run a youth nutrition class at the site. Pretty soon, I came to be known among my classmates as ‘the pediatrics guy’. A friend even gave me an old pediatric stethoscope that belonged to his veterinarian father—apparently they are the ideal size for auscultating cat hearts.

It just made sense for me to pursue a career in pediatrics. I have always felt comfortable interacting with children and adolescents. Before medical school, I was drawn to volunteer opportunities that allowed me to work with these populations, first at a summer camp for kids with muscular dystrophy, later at an elementary school gardening class, eventually at a children’s hospice. As a student of political science in college, I had always grappled with difficult moral questions posed by my professors. But with children it was simple: kids are special and should be protected, nurtured and helped, no matter the cost. This simple logic was, for me, a comfort.

So when I began my third year of medical school, the year when students finally depart from lecture halls to flex their clinical muscles on the wards, I was impatient to begin my pediatric rotation. However, I intentionally scheduled it near the end of the year, after medicine, surgery and neurology. This would, I figured, give me a chance to build some skills as a medical student, and allow me to shine on my pediatric rotation.

I began rotating at the children’s hospital in December, and immediately felt something was wrong. While I still enjoyed being around kids and I remained passionate about helping them heal, I found myself dragging my feet to work each day. Morning rounds seemed to stretch on for hours and I caught myself dozing off against a wall on more than one occasion. Perhaps worst of all, I struggled to find any residents I could really bond with. I had been told repeatedly that choosing my specialty would be easy when I found ‘my people’, the tribe with whom I felt most confident facing down the daily toil of the hospital. The residents I worked with at the children’s hospital were kind and enthusiastic, but their goals didn’t seem to align with my own. I never felt comfortable in my own skin as we sat chatting together in the work room.

What was happening? I loved kids. Pediatrics was supposed to my calling. This was supposed to be my chance to shine, and yet every day was a struggle to remain enthusiastic and buoyant. I redoubled my efforts, staying late with the kids who had inspired me in the first place to pursue pediatrics, waking up early to study my patients’ charts so I could appear knowledgeable on rounds. My hard work paid off, and I scored well on the rotation. But after 2 months on the pediatric wards I left feeling more uncertain about my future than ever.

My next 3^rd year rotation was obstetrics and gynecology, and I was already dreading it. I had heard the horror stories from classmates, of waking up at 3 am to round and being shouted at by overworked residents. I was already exhausted from the hard work I had put into my pediatrics rotation, and told myself all I had to do was survive.

Instead, I thrived. Delivering a baby is one of the iconic moments of medical school. For many it is a rite of passage, but for me it became an addiction. Every minute on my OBGYN rotation was spent in bustling activity, reading fetal heart tracings, rushing to the OR for crash c-sections and comforting anxious mothers-to-be. The residents were just as tired and overworked as I had been expecting, but rushed about always with the smiling, unflagging enthusiasm of a person whose job it is to ferry children into the world. When I expressed a modicum of interest in the subject, they were enthusiastic to teach, handing me more and more responsibility with every new skill I learned. I felt just as drawn to the welfare of these women as I had to children, whether my team was fending off preeclampsia or inserting a pelvic sling or counseling a patient on contraceptives. The first time I caught a baby by myself, clamping the cord and handing her up to a smiling mother, my fate was sealed. The supervising resident slapped me on the back and congratulated me on a job well done. I had found my tribe.

When it comes time to picking your specialty, attendings and upperclassmen alike will dispense limitless pearls of wisdom in an effort to make your choice easier: Do something where even the bread-and-butter tasks excite you. Pursue a residency where time passes without you even realizing. You’ll know it’s your specialty when you pass their team on the wards and wish you were rounding with them. Be around people you wouldn’t mind sharing a beer with.

I was fortunate that OBGYN fulfilled most of these criteria for me, but the case may not be same for everyone. Some may finish 3^rd year without a clue about the future they wish to follow, either because they are overwhelmed with options or because they never really found anything that resonated with them. All hope is not lost, however; everyone always has the option to kick the can a little further down the road by pursuing a residency in internal medicine or general pediatrics and delaying the decision to sub-specialize for a few years.

Rotating in medical school is usually a poor simulation of what it is truly like to be a resident in that specialty. This is especially true for surgery, where medical students can expect to spend the majority of their time retracting, clipping thread or, if they’re lucky, sewing shut simple incisions. I learned to pay more attention to the moods, behaviors and personalities of my residents than to my day-to-day tasks as a 3^rd year medical student; their experiences gave me a more realistic impression of each specialty than my own. I learned too that most determinants of my happiness while rotating were determined by factors out of my control: the burden of my team’s patient load, the willingness of my residents to teach, the collaborative qualities of my fellow medical students. The one factor you can control is the enthusiasm and positive attitude you bring to work each day, despite these obstacles.

Picking my chosen specialty so late in the game has been a little scary. I am now at the beginning of my 4^th year and in the middle of my OBGYN sub-internship, the special 4^th year elective rotation where students are assigned the same responsibilities as a first-year resident. Medical school is structured in such a way that students have only a short few months after clinical rotations and before residency application to make this crucial decision.

Fortunately, I leave work each day feeling just as bowled-over and inspired as I did that first time I saw a delivery.

As you begin your 3^rd year, put your trust in the same process of trial and error that has inspired physicians to follow their calling for decades. Allow yourself to imagine life as a resident in any one of these fields, and try not to make your mind up before you have experienced everything. And if you are one of the lucky ones who began this process with a clear idea of the direction you wanted your career to head, be open to change. All it took for me to realize my future was the miracle of birth; hopefully your cue will be a little more subtle.