Choosing a medical specialty

It’s that time of year, 4th year medical students (like me – kind of) are choosing their future careers and starting to interview all over the country in their residency programs of choice. I’ve been notably quiet – subsumed in work, study and applications – but I am catching up on writing about the clerkships I’ve done in the meantime (Pediatrics, Psych, OB/Gyn and Family Medicine). But since I’m applying for residency now (MD/PhDs have an abbreviated 4th year) I figured now would be a good time to tell people about what this is like, and in the coming months what cities I’m going to be in from time to time.

Choosing a medical specialty is a big decision. I’ve necessarily made up my mind, am very confident I’ve made the right choice and encourage you to take bets on my choice – it will be fun to see what people think. But the decision making process is famously difficult and many different strategies have been devised to help the indecisive (not me). Perhaps most famous is this chart first published in the BMJ by then-resident Boris Veysman:
i-edbcd560d6996b5e5b969f2deb9aeb99-Medicalspecialty.gif

If you’re very patient you can answer 130 redundant questions at this site offered by UVA to help you make up your mind, or read one of the books on the subject.

Then there is the famous Goo index, which I think may be quite useful. Basically, chose your specialty based on which types of bodily fluid you can stand being in contact with every day for the rest of your life. If you have a low tolerance for any goo, psychiatry or neurology might be up your alley. If you can take any fluid being sprayed at you at high velocity, surgery may be an excellent specialty for you.

Then there is the general opinion among the goo-heavy specialties that you should avoid the goo you dislike the most. For instance, if snot is bothersome, avoid pulmonary specialties and pediatrics. If it’s urine, maybe you shouldn’t go into urology (or if you don’t want to stare at genitalia all day). If you don’t mind blood but don’t like any of the stinky stuff, maybe neurosurgery is the right match. It’s all about balancing your goo exposure.

If you don’t want to get divorced during residency, maybe read this paper. The surprising result? Psychiatry is the worst at a 50% cumulative divorce rate followed by surgery at 33%, and most other medical specialties between 22-30%. I guess psychiatrists drive their spouses nuts when they bring their work home.

There is the Myers-Briggs guide to specialties which is only useful if you’re the type of person that likes astrology or other advice based on vague, general descriptions of people coached in psuedoscientific drivel. There is a lot of study of personality traits specific to different specialties, a review of the subject concludes that for the most part medical students tend to be too homogeneous for the blunt-instrument personality tests to distinguish something so specific as an ideal career choice and there is more variation of personalities within a given field than between fields.

So, using these highly-scientific and time-tested methodologies, which kind of medicine would you like to practice? Which do you think I chose?

Comments

  1. #1 Bob O'H
    November 7, 2008

    Which do you think I chose?

    What’s the technical name for “diseases of the rich”?

  2. #2 PalMD
    November 7, 2008

    This is a stage that happened to be easy for me, but at which many students make very bad choices. After choosing to go to medical school, choosing a specialty is really the most important decision in your professional life.

  3. #3 Stan
    November 7, 2008

    BobOH asks, “What’s the technical name for “diseases of the rich”?

    The classic diseases of the rich would be the presbydysaestheticoses, including facial keratoses, generalized loss of skin turgor, and sagging boobs. I would recommend a residency in either dermatology or plastic surgery as close to Beverly Hills as you can get.

  4. #4 Dianne
    November 7, 2008

    Which do you think I chose?

    The one you had the most fun in.

  5. #5 Dianne
    November 7, 2008

    I think we need a second chart for people already in internal medicine to decide about their sub-specialty.

    Attention span:
    essentially infinite–rheumatology
    long–hematology
    moderate–general internal medicine
    short–cardiology

    How nice are you really?
    very–med/peds
    so-so–
    should have been a surgeon, really–cardiology

    How do you feel about patients dying?
    I can handle it–oncology
    ACK!–allergy/immunology-or retrain in dermatology

    How well do you tolerate ambiguity?
    well-rheumatology, g med
    so-so–endocrinology
    show me the tissue or get out of my office–oncology

    Like numbers?
    yes–nephrology or ICU
    no–hmmm…rheumatology maybe? med/psych?

    Are you fond of blood and poop jokes?
    yes–gastroenterology
    no–anything but GI

    And so on. Anyone else have suggestions?

  6. #6 Tsu Dho Nimh
    November 7, 2008

    Mark –
    I love the flowchart.

  7. #7 MarkH
    November 7, 2008

    Dianne is certainly correct. I did have the most fun in the rotation I chose. And the subspecialty within it that I like would actually have me working a great deal of the time with the poor and uninsured.

    But which was it?

  8. #8 ctenotrish
    November 7, 2008

    I think you chose peds. And we need more good pediatricians!

    “I guess psychiatrists drive their wives nuts when they bring their work home.” Or spouses, as the case may be.

  9. #9 Adrian W.
    November 7, 2008

    This posts demonstrates why I’m studying computer engineering instead of medicine. Electrons don’t bleed or die.

  10. #10 Dianne
    November 7, 2008

    My guess is internal medicine. Because it is the most fun specialty therefore it must be the one you had the most fun in. (Yeah, the logic is circular. What about it?)

    But if I’m really going to guess, I need at least one further piece of information: what are your favorite and least favorite procedures?

  11. #11 The Perky Skeptic
    November 7, 2008

    Dianne may be right– but I dunno, our MarkH just might be crazy enough to be an ER doc! ;)

  12. #12 CaladanGuard
    November 7, 2008

    I don’t envy the people who have to choose. Lucky for me the fine folks at the Australian Defence Force payed my way through med school (with a shiny 90K salary on top of having no debts) So Military Medicine it was for me.

    I’m not sure I know enough about you to guess though, hard enough for people to know what they’re going to do themselves, let alone guess for others.

  13. #13 MitoScientist
    November 7, 2008

    As an aspiring physician, I really think that hematology/oncology will be the specialty for me. Although I am fully aware that may change when I go through rotations. My guess for you Mark is emergency medicine, or perhaps infectious diseases. Get on with yo’ bad self!

  14. #14 Interrobang
    November 7, 2008

    I guess psychiatrists drive their wives nuts when they bring their work home.

    So, uh, there are no female, straight psychiatrists in your world? (You could have said “spouses,” and that would have been accurate in all cases and not sexist, to boot.)

  15. #15 Matt Springer
    November 8, 2008

    According to the chart, I should be in radiology if I were a doctor. Fits pretty well actually, as it’s the closest thing to physics.

  16. #16 MarkH
    November 8, 2008

    Fixed, sorry for the inadvertent sexism. There is no excuse.

  17. #17 MarkH
    November 9, 2008

    I guess I’ll have to give people a better hint.

    I don’t like rounding for hours…

  18. #18 Dianne
    November 10, 2008

    I don’t like rounding for hours…

    Ok, not internal medicine then…Emergency medicine maybe? What are your feelings on goo? Favorite/least favorite types of goo?

  19. #19 Rogue Epidemiologist
    November 10, 2008

    Had I made the cut, I’d have gone with infectious disease, but it’s not on the list. The Myers-Brigg assessor was an odd one — I’m an ENTJ, and I work in public health. Sure enough, that’s the one at the bottom of the ladder for NTs.

    Goo doesn’t bother me so much, but I sure don’t like seeing bulging veins and cartilaginous sinews.

  20. #20 NM
    November 12, 2008

    Epidemiology – If you dislike gooey 95% confidence intervals

    Public Health – if you dislike goo in any form in the drinking water

  21. #21 Dianne
    November 12, 2008

    So? Are you going to tell us or just let this thread drift off the page with the question unanswered? My current guess: emergency medicine. You’re obviously crazy/hypomanic, being a blogger and EM requires virtually no rounding.

  22. #22 MarkH
    November 15, 2008

    ER is getting closer. I don’t know if I should make it a surprise or not, but I’m amused by what people think I would choose.

    I’m interviewing right now all over the country, so yes, I have made up my mind. I guess I’m gratified that everyone doesn’t think I’m mean. I always thought I am kind of a jerk, but hopefully a jerk for a good cause.

  23. #23 The Perky Skeptic
    November 16, 2008

    LOL, if you think you’re mean, does that mean you’re opting for surgery? :D

  24. #24 Joshua
    November 17, 2008

    Following the flow chart, I should be in Emergency Medicine. ;)

    However, correcting for my dislike of exposure to goo, I think I’d be best off following the “Sane” branch down to Radiology.

    Good times!

  25. #25 storkdok
    November 28, 2008

    Trauma surgeon?

  26. #26 The Chemist
    November 28, 2008

    Acupuncturist!
    :-P

    (No clue.)

  27. #27 AJL
    October 22, 2009

    This may be a year late, but I just had to come around and say something.

    I’m a pre-med student. I looked at this chart and cracked up so loud my partner said “What?” from the next room.

    My three top interests in medicine are psychiatry, neurology and emergency medicine. One of these is not listed. The other two are pretty much where people who know me would have guessed they’d be.