How and When to Pick your Specialty
Many people come to medical school knowing exactly what they want to do. I can’t tell you how many of my classmates knew from the start of first year that they wanted to be congenital heart surgeons, pediatric nephrologists, or rural family medicine docs. For every person that adamantly believed they would do X or Y specialty from the get-go, twice as many had no earthly idea. I fell into this latter group. In reality, the majority of students initially only have a general idea of what area interests them, for instance surgery vs. non-surgical fields, because of prior shadowing experiences, volunteer work, research, or a legacy of physicians in the family. In my case, I had no physicians in my immediate family. And despite extensive shadowing and volunteer experiences in high school and undergrad, nothing elicited a eureka moment that had me proclaiming “THIS IS MY CALLING!!!” I honestly didn’t have enough exposure to the bulk of medical specialties (over 120 according to the AAMC), and thus I started med school with an open mind.
Let me take pause and give a brief summary of how the four years of medical school are broken down. Generally, the first two years are spent in a lecture-based setting covering the Basic Sciences (anatomy, biochemistry, genetics, histology, immunology, infectious disease & microbiology, pathology, physiology, and then each individual organ system). The final two years are spent in hospitals, rotating through different clinical clerkships under the guidance of residents (doctors currently in their specialty training) and attending physicians (fully licensed doctors). Clerkships range from Family Medicine, General Surgery, Internal Medicine, Neurology, Ob/Gyn, Pediatrics, Psychiatry, and multiple elective opportunities based on your interests. Students take an active role in patient care and work within a hospital team. At Baylor College of Medicine, the Basic Sciences are condensed into 1.5 years rather than two. This not only allows students 2.5 years in clinical rotations, but also permits earlier exposure to how different fields are practiced. I found this earlier exposure immensely valuable. Students can decide what they do or don’t like sooner, and begin necessary research projects and build faculty relationships for mentorship and future letters of recommendation (more on this below). A larger cohort of medical schools is transitioning to this curriculum, which is invaluable for earlier clinical exposure.
Disclaimer: you will never be this excited in Med School
Alright…back to “picking a specialty”. Personally, I did not commit to Orthopaedic Surgery until almost halfway through my 3rd year of med school. This is pretty late in the game compared to most students. In all honesty, I initially thought I would do Neurology or Psychiatry because they dealt with structural and functional brain disease, topics I found intriguing. But once clinical rotations started, I quickly discovered that studying interesting science subjects like Neuroscience or Psychology is vastly different than actually treating patients as a Neurologist or Psychiatrist. By the time my 3rd year began, I had already finished my clerkships in Psychiatry, Neurology, and Internal Medicine (with an additional subspecialty month in Cardiology). And whether it sounds bad to say or not, I was 100% certain that I had ZERO INTEREST in any of those fields. I solicited advice from many fellow students, residents, and attendings. A surprising number told me “just do Ortho dude”, “you seem like you’d fit with Ortho”, “you’re such an Ortho-bro” (there’s a lot of stereotypes of different specialties and the people that go into them, a surprising number of which are pretty accurate). Before the start of my 3rd year, I’d only briefly considered Orthopaedics. All I knew about it was fixing broken bones and using power tools in the operating room. But bones and electric Dewalt drills did pique my interest.
To aid my decision, I shadowed a good family friend and Orthopaedic Surgeon on a Total Knee Arthroplasty (knee replacement surgery). I’d seen surgeries before, but this was my first Orthopaedic case. And it easily claimed the title of “most rough”. Bone shards and blood flew everywhere, the buzz of drills and saws echoed across the operating room, and the patient’s leg was continuously manipulated for proper alignment. Controlled chaos at its finest. Despite the rough and physical nature of most orthopaedic surgeries, they are also incredibly precise. Meticulous detail is needed to return the body to proper anatomic alignment. Technology in the form of multiple imaging modalities, 3D printing, and ever-improving prosthetic implants is employed to compensate for a patient’s deterioration or congenital deformity. A masterful understanding of anatomy is needed to account for all the angles, weight bearing axes, and location of important muscles, nerves, and vessels. The patient population is also one of the most diverse in medicine, ranging from children with congenital deformities, adults with chronic degenerative disease, complex traumatic factures in all age groups, and run-of-the-mill injuries like ACL tears and ankle sprains. The direct hands-on work yields real tangible benefits, with very high patient satisfaction rates.
After this initial experience, I further shadowed and scrubbed in on cases with multiple Orthopaedic Surgeons at Baylor College of Medicine, took night call with the residents at the county hospital, and read exhaustively about the field and its future directions. I made an effort to envision myself as an attending Orthopaedic Surgeon in each of these areas and practice models. Would I enjoy supervising and teaching residents? Would doing similar surgeries again and again bore me? Or would I relish the constant betterment of my skill? Did I like the directions in which the field was going and would I enjoy pushing it forward? Etc. etc. After all, your role as a student on any 1-3 month rotation will not be indicative of what that career path entails. So place yourself in your attendings’ shoes for every single rotation. That’s what you’re working towards, so it’s imperative to assess whether you’ll like it. By doing this, I found Orthopaedics to be the perfect mix of analytical thinking, physicality, technology, and breadth of the field to avoid banality.
Best part of Ortho....pretending to wear spacesuits
I knew I was late in the game on deciding to pursue Orthopaedic Surgery. Most students vying for very competitive specialties (Dermatology, Neurosurgery, Orthopaedic Surgery, Otolaryngology, Plastic Surgery, Radiation Oncology, Urology) begin research projects early on and also start working with faculty to develop relationships for letters of recommendation. Though I was somewhat “behind” in this regard, residency applications weren’t submitted until September of 4th year, so I still had almost one year to beef up my application. Luckily it worked out for me. My reason for detailing my relatively late decision on Orthopaedic Surgery is two-fold:
To illustrate the importance of actively searching for the specialty that fits your interests and demeanor. After my initial encounter with Orthopaedics, I spent the next several months engrossing myself in the many different practice models and aspects of the field, speaking with current residents and faculty, and reading as much as I could about it. I meshed very well with the Ortho residents and attendings in terms of personality, and I thought the logical and anatomic basis of the field was awesome. They were essentially performing engineering on the human musculoskeletal system, the scaffold that our bodies are built upon. And I loved it.
To dissuade the belief that you have to decide early to remain competitive. You’ll have plenty of time to pad the resume. I certainly did, and it has nothing to do with being super smart or anything like that (more on this below). Much more important is to really know what you’ll be happy doing for your career. Trust me, it’s worth the time investment. But to do this effectively, you really have to be engaged in your clinical rotations and take an active role in your education rather than passively wading through the curriculum set forth by your medical school…which is precisely what the next section is about.