Picking a specialty – “what is the next hot field”

2 Feb
2010

Last night I had a very interesting conversation with some 3rd year medical students.  We talked about intern applications, scheduling the 4th year and choosing a specialty.  One of the students wants radiology and is not concerned about the 20% decrease in payment that radiologists are getting from Medicare.  Another student asked me to predict what the next "chic" specialty will be.

The fact that the question was asked and that the other students were interested in my thoughts discourages me.  I know that students have championed the ROAD – radiology, orthopedics, anesthesiology and dermatology – and this has bothered me greatly.  Some students should do these specialties, but too many are picking a specialty just because it is chic and felt to be financially lucrative.

As a 60-year-old physician, who has done well financially (but could have done much better financially), I find this subject and concept distasteful.  I chose internal medicine for the right reasons – it fits my personality and my aptitudes.  35 years after medical school graduation I still love internal medicine.  I still love making rounds.  I still enjoy patients and the goal of trying to provide them with the highest quality care.

I do not think I would have remained this happy if I had gone down the ROAD.  The ROAD does not fit me.

I urge medical students to pick a specialty for the right reasons – their personality, their aptitudes and whether doing the job of that specialty will increase their happiness.

I wish that money did not matter.  I wish that primary care had better pay and better working conditions.

I cannot answer the question of what the next hot field is, and I do not really care. 

Related posts:

  1. Health care reform should address student debt
  2. Is medicine worth it?
  3. Work hours – medical student perspective
  4. Why the 4th year is worthwhile
  5. More on personality and medical school success

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8 Responses to Picking a specialty – “what is the next hot field”

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Alex K

February 2nd, 2010 at 3:25 pm

“Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community.”
Rudolph Virchow
I would add another "right reason" to your list: what the community needs.  As a 4th year medical student, I have seen virtually all of my classmates choose their specialties for all the wrong reasons, with little attention paid to what we need as a society.  All the idealism of 1st year is gone for most of them.  I'm not sure how to get medical students to understand the quote above, but, for me, it's one of the major problems with medical education as I see it.  

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PeterW

February 2nd, 2010 at 3:37 pm

It is quite possible however that there are a number of students who are ambivalent between several specialties.  In that case it would make sense to predict the long-term trajectories of those specialties – something that matters a lot more for someone in his 20s than someone in his 60s.

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Michael Kirsch

February 2nd, 2010 at 10:14 pm

Of course, you are correct and I admire your idealism.  Medical students today, however, are colliding with the hard realities of an uncertain future in our profession.  I am certain that the health care reform legislation that nearly made it, would affect the career choices of many doctors-to-be.  I wish I could say that a love for a medical specialty would be enough to sustain a satisfying career,  but who can say? 

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Anon

February 2nd, 2010 at 11:45 pm

Everyone seems to forget one minor detail – if you're good at your job, you'll make a living.  People's illnesses are not affected by the economy or the stock market.  Learn your field well and you will make enough to thrive (even with large student loans).  Other fields aren't always like that.

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amy

February 3rd, 2010 at 10:08 am

Dear Anon, in a free market this is true but medicine is not a free market. Most patients don't come to you just because you are good, they come because you are "in network".

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Jennifer S.

February 3rd, 2010 at 2:30 pm

I agree with your assessment of ROAD.  To me, it seems that doctors who love what they do and most especially love their area of specialty (for no other reason than their genuine interest in it), tend to be better skilled and talented with that specialty and treating patients.  In my experience, such doctors also tend to be more willing to continuously learn, especially with updates and new findings in their field.
I am concerned that a potential doctor would treat medicine and helping people in the same way people treat fashion and clothes.  I can't say I'm surprised because this might explain some of the inadequate treatment (and some downright incompetent treatment) from doctors that didn't seem to know much about their area of specialty.

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Dr. Bob (FP)

February 3rd, 2010 at 9:56 pm

Hmm.. 
I think this income thing is bogus.  There are no starving doctors out there.  With climbing rates of obesity, diabetes, elderly, etc., there will be too much work for all of us anyway.  I suppose radiology & pathology run the risk of being outsourced, but just about everyone else is pretty secure.  If you're a good physician with a decent personality you will always have a job. 
I recall reading in a financial magazine that happiness/satisfaction rises with income until about $70,000 per year, but after that more money doesn't make a signifcant difference. Even the lowest paid doc does better than that. There are a lot of crabby, unhappy specialists in the doctors lounge making $300k+.  
Do what you enjoy, because then you're getting paid to do what you love to do and it feels like you're not even working.

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Zine

February 24th, 2010 at 4:41 pm

I was advised pick the speciality where you enjoy the routine work. I love my job (orthopaedic trainee).

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