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The search for a specialty during medical school is indeed a difficult one. Much like the newly engaged are constantly asked about wedding dates and venues, the freshly-minted medical student is grilled regarding their future career path. It seemed like the decision to become a doctor had some finality to it, but we quickly learn that other very important decisions lie ahead.

Like most medical students, I had a small, non-binding inclination toward a specialty when med school started. Years prior, in college, I had a rugby-induced broken nose repaired at the Surgicenter, and my salient memory of the experience was what a friendly and wonderful doctor my anesthesiologist was. “I could do that,” I told myself.

But, as medical school progressed, numerous other specialties seduced me with their merits and the personalities of residents and attendings therein. Anatomy struck a chord in me...could I morph this into a career as a surgeon? Or would internal medicine afford me the opportunity to more completely apply all the knowledge gained in medical school to the whole patient? As a third-year student, I found myself mentored under the wing of a brilliant otolaryngologist, who seemed to have 35 hours in a day devoted to surgery, clinic, research, and medical student advocacy (I later realized I had been enchanted by his charisma more than the specialty itself). My USMLE Step 1 and 2 scores were good enough for a competitive surgical subspecialty, and I did enjoy being the OR...is that where I belonged?

Before I rehash my entire residency personal statement, let me tell you where I ended up, and how I got there. I ultimately circled back to my original thought, and found myself applying to anesthesiology. Let me tell you what drew me there, with attention to how these ideals and thought processes can be applied to this big decision regardless of your specialty.

1. I enjoyed the company of the residents and attendings.

A good gauge of “where you belong” is how well you mesh with the people in that field. The residents and attendings at my home institution were competent, hard-working, but that could describe any department in the hospital. What was more important was their maintenance of an unpretentious, humble attitude while having the extreme responsibility of navigating a patient, oftentimes a horrendously sick patient, through a major surgery. They had no problem getting the job done while remaining a “background” player; that is, they knew their importance, but did not feel the need to seek out accolades and praise for just doing their job, no matter how demanding it was. They were regular, friendly people who happened to be incredibly knowledgeable and procedurally apt.

To do: Aim to end up in a field where the people around you are like-minded. Away rotations can let you see what a specialty is like as a whole, not just how the specialty is at your medical school.

2. The field offered a combination of quick, high-level thinking while at the same time being procedurally oriented.

One of the things that turned me off to some other fields was the amount of time spent away from patients, just stationed in front of a remote computer reading and writing notes and placing orders. Sitting next to the phone placing and taking consults. I wanted more time spent alongside actual patients, and wanted to perform and be involved in procedures, both big and small. Anesthesia gave me a chance to enjoy the satisfaction of everything from a peripheral IV to an awake topicalized intubation, and at the same time, allows me to play a crucial role in even bigger procedures like open-heart surgeries and open TAAA repairs. While I’m not putting the cross clamp on the aorta, I am intimately involved in the moment-to-moment events of the surgeries. At the same time, all of the 200 decisions I make over the course of the day are (intended to be) made based on science, the literature, and my training and experience up to this point.

To do: Find the balance of thinking and doing that make you feel good. Are you happier in the comfort of a lab looking at pathology slides? Or do you need an Adson in one hand and a scalpel in the other?

3. I found the flow of the day-to-day most enjoyable.

The daily routine of your chosen profession is much more important than your fascination with the pathophysiology that governs a medical discipline. As time goes by, the basic science of your medical education will fade into the background. It maintains and importance and forms the foundation of what you are doing, but what will really get you out of bed in the morning is your love of the tasks of the day ahead, not the second messengers of esoteric tyrosine kinase inhibitors. I liked the early morning wake-ups and sanctuary of the first 30 minutes of my day, setting up the OR in exactly the way I please. I enjoyed the major, multi-hour surgeries and all of the considerations they demand, but also found pleasure in the high-turnover rooms, keeping the day moving and striving for a safe efficiency. I did not choose this field because “I love pharmacology, physiology, and the instant gratification that comes with giving drugs in the OR.” It’s cool, and it is satisfying to know, but the tasks of the day are far more central to my satisfaction.

To do: Select a field where you enjoy the day-in and day-out flow and environment, not one in which you simply appreciate the basic science and pathophysiology.

4. There are many different career paths to go down thereafter

Despite choosing a specialty, there would be further decisions to make down the line. The first would be fellowship or get a job. If I chose a fellowship, which one? There are worlds of difference between pain management, cardiothoracic anesthesia, and critical care. The field as a whole requires knowledge of all of these subjects, among others. I was intrigued by the ability to further hone my skill set at the end of residency and gain even more expertise in a particular facet of anesthesia.

To do: While it will likely change along the way, consider the endpoints of your training and where you would like to ultimately end up.

Bear in mind, what I say here is only the advice of a lowly resident, but I hope you found it helpful. In this very early stage of my career, everything still has a magic to it. I’m sure that over time, some of the luster will fade, but as for now, it still fires me up. Just last week, I was part of an 18-hour pediatric surgery in which we ran a carefully titrated general anesthetic and utilized regional nerve blocks that I didn’t even know existed. When the patient woke up pain free and relatively quickly, it just felt good inside. Just make sure to do what you love, not what people tell you to do, and not what your scores say you should do. It sounds cliche, but it is for a reason.

24 hours could earn you 30 more points
Brian Radvansky

Brian Radvansky

USMLE Tutor & Senior Writer
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