Coming into medical school without much idea of what specialty I wanted to do made me feel like a bit of an anomaly. I thought that in the same way I decided I wanted to pursue medicine in undergrad, I would also decide what specialty I want to pursue during medical school.
But during the first week of orientation, I felt that I couldn’t have been more wrong. By the end of the week I had met five future orthopedic surgeons, seven pediatricians, and four ophthalmologists. To say I felt a little behind was an understatement. Adding to this sentiment, phrases like “Medical School is really 3.5 years long”, “I started reaching out to my department’s PD last week,” and “Yeah I heard that’s getting really competitive” began to kindle a kind of neuroticism within me that I didn’t even know existed.
Naturally, the next “logical” step in my line of thinking was that I had to choose a specialty as soon as possible so I too could join the ranks of those who confidently espoused their commitment toward, say, infectious disease. In hindsight, much of this stemmed from feelings about transitioning into medical school. It felt like having something to anchor to, to be able to say something was certain in my life would help mitigate the massive uncertainty that presided over everything else.
However, as I started to attempt to whittle things down, the uncertainty only intensified. Choosing a specialty started to feel increasingly like the biggest gamble I would take in my life. If I chose something that had long hours, would I be compromising on potential family life? If I deferred to something with shorter hours, was I hedging my ambitions for a family that didn’t even exist yet? Should I choose the specialty that nurtured the workaholic side of myself and places other things on the backburner for the next few years? Or one that gives me more time but risks the prospect of always rueing what could have been?
Some advisors mentioned that shadowing might be the cure to my existential dilemma, but in that I found dislikes in specialties I thought were a “sure thing” and likes in specialties that I had ruled out. Now, I recognize that this is premature and much of the answers will reveal themselves during rotations. But when advice like “Do research in the most competitive specialty you think you might be interested in” is floating around, you can’t help but start to ask a couple of questions. And knowing that people struggle with this decision well into ERAS season and even into residency or practice makes me think that some of these questions don’t have straightforward answers.
In Latin, decide comes from the word decidere which means “to cut off.” One of the central dilemmas in choosing a medical specialty may lie in the fact that during medical school we become a tree of sorts, immersing ourselves in all different branches of medicine. During rotations we get a sense of so many different future versions of ourselves. A self who pursues surgery, a self who pursues neurology, a self who pursues family practice. And to choose one specialty can feel like cutting all of the other branches we worked so hard to grow, and closing the door on infinite future possibilities. We are only allowed to cultivate one version and commit ourselves to that course, which can be painful, especially if you are prone, like me, to thinking in “What ifs?”
Unfortunately there is no simple solution to this, but perhaps an appreciation for the magnitude of the task that lies in front of us is warranted. We change so much on a day-to-day basis, let alone on a year-to-year basis. There is no way of knowing how our priorities will change, how our life circumstances will change, or how the field we pick will change 20 years down the line. Almost all of this is decidedly out of our control and as difficult as it can be to relinquish that control, doing so can allow us to take a step back and critically evaluate some of the constants in our changing lives so far. What kind of actions or behaviors have consistently made us happy, no matter where we were in life? Was it, in fact, building things? Or maybe it was an insatiable appetite for reading, or perhaps a keen love for teaching? When we answer these kinds of questions, we can begin to develop a reliable and more authentic understanding of who we are at our core and anchoring oneself to this can help us navigate the sea of change and neuroticisms.
Through a deeper understanding of who we are, we can then move forward in deciding what specialty we want to pursue. And while we never truly know what will happen, we did what we could, which was making the best decision with what was available to us at the time. And perhaps those who I met during orientation week had already spent time doing that work and reflection. But for myself, I know that the journey ahead will be one of self discovery.
How are you approaching the decision of what specialty to pursue?
Neha Sahota is a second year medical student at USC Keck. Outside of medicine she likes to read, travel, and try new coffee shops. You can find her here on LinkedIn.
Illustration by Jennifer Bogartz
