Whether you're in an allopathic or an osteopathic medical program, choosing a specialty often falls toward extremes: Either it's as clear as day and hits you with unquestionable clarity or it's a greater struggle than med school itself. An article in The Pan African Medical Journal observes, "While the career-choice stage of a student's life was expected to be filled with enthusiasm and optimism, it was instead found to be one of the most critical and stressful times due to the complex, dynamic and multifactorial nature of the decision-making process." The authors go on to describe the stats of how many students change their preferred residency specialty prior to completion of medical school. According to an Association of American Medical Colleges report, 56% make a switch. Whether this is for better or worse is unknown. We do know that a significant number of residents and physicians change specialties to unrelated fields. Specialty Choice and Burnout Unfortunately, many medical students make these critical life-changing decisions under increasingly pressured circumstances. They worry about the debts that are unmercifully accruing with compounded interest, at sometimes exorbitant rates. Some may feel pressured by the expectations of their parents, who may have spent a lifetime of toiling to build a practice and a namesake that their child can someday inherit. Still others are motivated by prestige and cannot live with themselves if they "settle" for less than the very best that they can possibly achieve. These are all potentially regretful reasons. Medical Specialty Free Quiz With physician burnout and suicide reaching alarmingly high rates, we have to ask what role this critical decision plays. This burnout has been described by some as a "global public health crisis," yet it remains the elephant in the exam room at most medical institutions. According to Pamela Wible, MD, author of Why 'Happy' Doctors Die by Suicide, a disturbing trend has emerged. "When accounting for numbers of active physicians per specialty, anesthesiologists are more than twice as likely to die by suicide than any other physician. Surgeons are number two, then emergency medicine physicians, obstetrician/gynecologists, and psychiatrists." Interesting to note is that the specialties on polar ends of the board score spectrum seem to be the ones with the highest risk for physician suicide. We can only hypothesize what this means. Does Future Happiness Hinge on Specialty Choice? Is it possible that some med students pick specialties that match their greatest potential for prestige rather than what would make them happiest? Do some psychiatrists pick that field merely because they struggled to perform well on the boards rather than because they have a genuine interest in the field? Are they among the most at risk for suicide because of their own mental health struggles, which drew them toward this specialty in the first place? Do more OB/GYN physicians die by suicide because of the incredible burden of stress in dealing with the malpractice claims that are so intimately tied to their profession? The gravity of the lifetime specialty decision certainly deserves a little more gravitas than a Venn diagram. The questions go on and on. There is still so much we do not know. What we do know is that board scores are make-or-break for choice of specialty and that a potential association has emerged between specialty and suicide. Very few clear conclusions can be drawn without more data, except for this one: Knowing that burnout and suicide may correlate with specialty choice, shouldn't we be focusing more resources on providing adequate guidance so that med students do not make irrational decisions that may haunt them for the remainder of their professional lives? "Know thyself" is an oversimplified, bordering-on-trite takeaway. Most medical students do not make the time nor have the resources to self-reflect under professional guidance, during which they may be forced to be introspective and question their values and decisions. Perhaps that is why a few schools have begun to institute mandatory sessions with trained psychologists. The gravity of the lifetime specialty decision certainly deserves a little more gravitas than a Venn diagram. Because it's not just about money or debt repayment. It's not just about prestige. It's not just about personality or technique. It's about digging deep to find your place in this world, clearing out the clutter, freeing yourself of whatever albatross may be holding you back from realizing your individual purpose, not just your potential. Experience tells me that those who truly follow their hearts promise that they've never worked a day in their lives. You know it the moment you meet them. Source
