Choosing a Residency program

Recently a senior medical student requested me to help with the decision making about the specialty to choose for post graduate training (residency). There are some people who are lucky enough to face this dilemma while quite a few are forced to make do with whatever is available after others have left with the meat.

Because there are many people in this predicament, I thought it appropriate to post this email, suitably modified for public reading, without in any way diluting the contents.This is what I had to say:

Understandably, you feel you are having to choose at what is more than a fork in the road.It would perhaps be appropriate if I begin with the generalizations and then go onto the specifics.

(1) Who am I?

Our perceptions and beliefs shape the path we take and no matter what the destination, the path has its special contours that are conferred upon it by our mechanism of making sense of ourselves and our world. A laid back person's career in an aggressive field will always be that way (laidback) in contrast to an aggressive person's track in a relatively docile field. Two contrasting fields are neurosurgery and pathology. Hence it is important that you try to place yourself as to who you are : your appetite for risk, need for personal time within the demands of a professional life, your values ( example: "money is the most important thing" versus "balance is the most important thing"; another one being caring versus ambition, both being laudable depending on your background) . It is from this platform that your choice of speciality should ideally emerge. So while 'know thyself' is a very high philosophical ideal, the basics of a sense of self are certainly there in all of us, we only need to highlight it before we take the plunge.

(2) What feels like a calling  to me?

This is another important factor, and here's why: like most professional endeavours, any branch of medicine, at the level of day to day execution, is fairly monotonous. If a given branch does not appeal to you in the manner of a calling then it is very hard to cope with the monotony of such a life. A sense of being called upon to a specialty makes it far more easy to deal with this daily aspect of the professional life. Selecting a speciality in the hope of the elusive, once- in -a -long -while- discovery, award or  paper or treatment protocol  with your name being credited for it is a sure formula to frustration. While all of it is indeed very welcome, that alone cannot be the basis of selection of a specialty. I would rather that these follow as a result of or a byproduct of your sense of calling to what you choose as your life long pursuit. 

(3) What about money?

It is typical of many medical students to get enamored by the glamour and income of a certain speciality and decide to pursue that field. Some people rationalise it as a field in which there is little competition or one in which it is easier to settle down in life and so on. Never do that just for the sake of fame or income. Both of these will come to you in abundance if you love what you do, no matter what you do.

(4) Do I have to be outstanding?

Yes, so far applying yourself to the issue at hand is concerned, and no when it is with reference to where you are in comparision to peers. Do your best. Choose a speciality where you see yourself achieving substantial results while exerting well within your abilities. This is called the Peter Prescription ( which is in answer to something known as the Peter Principle; do look it up and spend some time understanding its import).

Alright, now to the specifics... I hope you are still reading this!

Though all branches of medicine cater to the human needs,and so all of them are equally sacrosanct, certain branches are known to be more demanding on one's reserves and can bog a person down. Emergency medicine, neonatology, superspeciality (very niche areas of)  medicine / surgery are such branches.When selecting between, for example, internal medicine and pediatrics which are so similar to the candidate attempting to select from the two, perhaps, internal medicine offers more variety and sufficient challenges, while both offer the possibility of a solo practice. However, pediatrics also has its own unique challenges and diversity.

If you have specific ideas about work-leisure or work-home balance, you should factor these into the decision making. Being an individual in practice and being a multi-role person ( spouse, parent, child, sibling, artist, dancer, and a medical professional)  in practice are two very different endeavors and one needs to think about when selecting one's specialty. A high demand professional profile is not suitable for the later type of person. 

Leaning toward teaching or research ? Do remember that getting to the very top notch is dependent on a very networked state of affairs and difficult to get a foothold onto unless  your academic pedigree is great. Finding funding for your research or academics is a big stressor too. Are you game for this big game?

Multi-faceted persons are a blessing to the society, and it is quite likely that you are one such person. Such people need a good deal of autonomy and control over their schedules to feel fulfilled in all areas of their work/existence. Let this be one of the guiding principle as you attempt to make a choice of your specialty.

I just hope I havent gone overboard in my enthusiasm to be of help. Again this is just one bit of 'wisdom', and there are any number of ways you can approach this issue, so please dont feel pressured to internalize this if it doesnt resonate with you.

Best wishes to you.