Choosing Your Specialty: The Process of Elimination & (I can’t believe I’m actually saying this) following your heart.

As I’ve said, when I started medical school I never, in a million years, thought I would choose to go into OB/GYN. I had a horrible experience in my OB/GYN rotation in nursing school, a few catastrophic deliveries and a bunch of tired, grumpy new moms who were annoyed (at best) with a fumbling RN-in-training. Plus, I’d never really been around pregnant ladies or new babies, and frankly found them and Plant Gestation to be completely alien and terrifying.

Then, at the end of second year, I delivered my first baby. Trust me, it was still terrifying (i.e. doctor unceremoniously shoving me into position to catch at the last minute and mom yelling “DON’T DROP MY BABY” over and over in the background), but it was also the most amazing thing I had ever done in my life. Still, there was no way I was going into OB.

I decided after a couple of months in third year that maybe I would like to go into something hospital-based (much happier there than in the windowless, claustrophobic confines of the clinic), working with adults (ruled Peds out the first day, love kids, hate practicing medicine on them), and with nice, scheduled shifts and no call (call sucks).

I spent months wavering mainly between ER, Hospitalist, Intensivist, and Surgery. I just couldn’t make up my mind and I drove all my nearest and dearest crazy with my endless lists of pro’s and con’s and entreaties to tell me “but what kind of doctor to you really see me as?” and finally for someone, anyone to just tell me what to friggin’ do.

While I was agonizing, I spent most of my spare time getting in all the deliveries, Gyn surgeries and extra OB/GYN clinic time I could. I loved OB. I did not love the prospect of crappy hours, lawsuits and what happens When Good Deliveries Go Bad. So I was getting all I could while the getting was good, before I’d have to leave it behind forever. I even signed up for two weeks of straight OB/GYN when we had the opportunity for a freebie, anything we wanted elective. It was the most tiring, challenging and best two weeks of my med school career to date. After that I started to soften towards the idea of OB/GYN, running the prospect by a few trusted attendings and allies.

There was the IM guy with his constant “Not that you’ll ever have to know this in OOOhhh-BBBB,” the OB/GYN attending who cautioned me of the seductive, soul-sucking, life over-taking power of the specialty, and my dad, who sounded immediately worried at the idea because “this guy he knows who is married to a family practitioner said OB’s have no life” and wouldn’t I like to go into ER instead? My dad is convinced I’d make a great ER doctor.

Well sh*t. There went that idea.

And I was back to agonizing over doing something else. Anything but OB/GYN. (Or Peds, no freakin’ way, although one of my favorite L&D nurses told me randomly one morning she thought I should do Peds, I have the “personality” for it. What??!! Okay, maybe I did lurk around the NBN occasionally hoping for the chance to feed a baby. But I just wanted to feed one. That’s it. I mean who doesn’t like to feed a baby??)

As time went on and I continued my rotations, I subconsciously began The Process of Elimination. I started to dread IM and FM clinic. I always love seeing patients but I was bored to tears seeing the same diagnoses – hypertension, diabetes, COPD; adjusting the same meds beta blockers, ace inhibitors, diuretics, inhalers, etc; and giving the same lifestyle changes speil over and over and over and over and over…..I decided in the middle of one particularly lengthy, chronic disease managing marathon that I was definitely a Doer, not a Thinker.

I also spent a lot of time in the ER. I really do like the ER but I found I like nursing in the ER. I’d always start out with the best of intentions, faithfully tailing the MD on duty, only to abandon them to start IV’s and help the nurses give meds, enter histories and do patient cares at the first sign of a drug seeker, frequent flyer or pediatric patient.

As for surgery, well I loved the OR from day one. I was on a first name basis with the majority of the surgical staff by the second week and they had my glove preference down by week four. But after my 15th appy and 20th hernia surgery, general surgery had completely lost its appeal. I was tired of the same six or so procedures and nodding earnestly when surgeons pointed out inguinal rings when I really had no idea what the h*ll I was looking at. Not to mention I spent exactly one day in endoscopy. One long day filled with inadequate bowel preps, polyps, mucus, and a bunch of sad, gagging, farting patients (who inexplicably eat a diet I can only guess is made up of just corn) that I will never get back.

It was becoming obvious there were some major, insurmountable things I didn’t like about the practice of all those specialties. I started to wistfully think of OB/GYN again. How, while I might have reservations about the lifestyle associated with the specialty (which I was finding could be fairly easily managed by choosing the right practice setting), there was nothing I didn’t like about the actual practice. OB/GYN clinic was the only clinic I really enjoyed by the end of the year. I love how active it is, always measuring fundal heights, listening to heart tones, cervical checks, doing paps, ultrasounds, colposcopies, physicals, etc. How every time I found a heart beat or cervix it was like the first time. I love how getting to participate in the care of all the women we see seems to be a privilege, how all their stories are unique. I love Gyn surgeries and sections, how satisfying it is to take out a troublesome uterus, tack up a saggy urethra, or tie tubes. How satisfying it is to scrub in on procedures where I can actually discern what the crap I’m looking at.

And of course, I love delivering babies.

It was at a delivery when I finally gave in for good.  I was on call one night and I only needed one more. A young mother came in laboring so I happily abandoned the ER. It was her first baby but she was several centimeters dilated and well effaced when she was admitted and I thought things would probably go fairly quickly. They didn’t. She labored for hours before she showed enough change to get an epidural. Her regular doctor wasn’t on call, the one who was wasn’t the most touchy-feely of the bunch, and I had established good rapport with her so I stayed. Finally, just like the first delivery I’d ever done, at 3 o’clock in the morning I held the baby up so she could see. She was crying, grandma insisting on a picture of me holding the baby, and that was it. There was no way that was going to be my last delivery. No way was I ever going to give it up.

The moral of the story is, if you’re struggling with what you do like, think instead about what you don’t like. Put lifestyle issues aside and think about the medicine. What clinics, diagnoses or types of patients do you dread? Look at what you’re left with. Again, lifestyle issues aside, which of these do you really enjoy? Which patients, diagnoses, and procedures could you see yourself not tiring of in 40 years?

Now you can think about lifestyle issues. Specifically, think this:

#1 – No matter what you go into you will have to carefully choose a practice setting that allows you to work and have the amount of family/free time you desire. This setting can be found for any specialty you choose.

#2 – No matter what you go into you are going to be working some long, hard hours and you will probably have call. This is Medicine, not fast food. No matter how much family fun time you get, you are still going to be spending a large portion of your life at work. You had better have chosen something you really like.

#3 – You have chosen to be physician, it’s not just a job, it’s part of who you are.

#4 – In the end, do what you love.