Choosing a Medical Specialty

Now that I’m nearing the end of my MD-PhD (1.55 years to go!), I’m going to have to actually decide what specialty to call my own. It’s rather comical as I think back on the many different areas of medicine I was convinced I’d go into, only to change my mind the following month, etc. Since I’m in the dual-degree program, I’ve had even more time than the typical medical student to ponder what field I’d be happiest in; or if I even want to see patients at all, or just do 100% research after finishing.

I remember in college, I applied to medical schools with the goal of doing Internal Medicine followed by a fellowship in Infectious Disease (a subspecialty of Internal Medicine). I was doing research in a lab studying Virology and I had the opportunity to work on some ideas for vaccines against Hepatitis C. I loved what I did and imagined myself continuing this type of research and seeing patients in this field. However, then came the beginning of graduate school, and my work on DNA damage and repair moved my interests toward Medical Oncology (also a subspecialty of Internal Medicine). Following that, during the first two years of medical school, our classes in Histology, Cell Biology and Pathology grabbed my attention, so for a while I imagined myself doing Pathology as a specialty. But then came our Neuroscience course, which was so well-taught and interesting that I convinced myself I would do Neurology, a notion which was furthered by a physician-mentor of mine who was a Neurologist. Even though all these ideas came quite early in my education, I was very serious about looking into each one. I would research a bunch of different residency programs on the internet, talk to physicians in those fields, etc.

Then came my first exposure to patients. My first clinical rotation was Pediatrics, and I loved it. In order to combine my previous interests, I decided I’d do… Pediatric Neuro-Oncology! Talk about specialized. But I was so convinced I wanted to do this that I even paid out-of-pocket (several hundred bucks!) to go to a medical meeting in the local area devoted to central nervous system germ cell tumors, which is even more specialized (this is a rare sub-class of brain tumors). I contacted several physician-scientists who did Neuro-Oncology to get their perspective, and needless to say, they were surprised to be hearing from a student who still had a few years left before he’d even started a residency, much less a second fellowship (a Pediatric Neuro-Oncology fellowship would be an additional 1 to 3 years after 5 or 6 years of previous residency and fellowship).

Unfortunately, the meeting I went to was way over my head, and I kind of lost interest. In fact, at this point some exciting things were happening with my research in the lab, so I kind of lost interest in doing a residency altogether, and wondered if I should just do research 100% after getting the MD-PhD. This idea persisted until I attended a conference geared toward medical students doing research. The people I met and the talks I attended were so inspiring that I decided I really wanted to keep active in both worlds of clinical medicine and basic science or translational research. I did more clinical rotations interspersed with research in the lab. I really enjoyed psychiatry (I almost considered it, but not enough to look up any residency programs) and was fascinated with aspects of OB-GYN, especially High-risk OB. But then, my wife was pregnant with our first child at the time, so it kind of makes sense why I had a lot of motivation to learn.

The following year I did more research toward my PhD, interspersed with my Internal Medicine and Surgery clinical rotations. I also had an opportunity to do a 2-week elective in Radiation Oncology, which I had become very interested in through a friend. Perhaps it was due to my friend’s enthusiasm, but even before I did the elective, I convinced myself that’s what I wanted to do, and I again looked up a ton of residency programs, etc. However, when I finally did the elective, it just didn’t hold my interest. At least it would be easy to rule out!

When I finally did Internal Medicine, I told myself “Now THIS is why I came to medical school!” I not only enjoyed my in-patient hospital experience at the very busy county hospital, but I even loved the out-patient clinic experience (I never liked clinic much in the other specialties). Around the same time, I went to that same conference for medical students again and met some physician-scientists successfully conducting labs doing translational research in Infectious Disease and seeing patients part time. This reinforced my decision for Internal Medicine and now I was convinced I would do an Infectious Disease fellowship, coming full-circle to what I wanted to do since I was in college. This meant, of course, spending lots more time looking up residency/fellowship sites on the web and pondering which places also had the best research programs in that field, etc.

I wasn’t too interested in Surgery when I started it several months later. By the end, however, I became less sure of Internal Medicine. General Surgery was so interesting and the traumas and operating room experiences so exhilarating, and there was a need for research here as well. Hmm… maybe I could do Surgical Oncology… Well, I haven’t been inspired enough to look up residency programs in Surgery yet, so maybe that’s a sign that I shouldn’t pursue that path any further.

During and after all these experiences, I know my parents don’t believe anything I say now about what specialty I’m going into (my wife still does – bless her soul… or at least she says she does). Nevertheless, I’m pretty sure that I’ll be applying to Internal Medicine residency positions in the latter part of 2008. I don’t have to decide now, but I’m still thinking either Medical Oncology or Infectious Disease as a subspecialty. Feel free to tune in during the next several months to see if I change my mind again…