Ever since I started my medical school journey, and perhaps even slightly before that, people have asked me what field I eventually want to pursue. And for the past three years, my answer has always remained “I don’t know.” Whilst nothing has changed and I am not writing this to suddenly announce my surprise commitment to a specialty, I would like to share what my priorities are in choosing my future area of expertise.
Priorities. Surely it must just be what area of medicine I enjoy right? “Oh, just pick whatever you are interested in the most, that’s the only thing that matters.” I can’t even count the amount of times I have heard variations of this statement, and to a certain extent I agree. Of course, for me to be able to do the same job every day without wanting to throw myself off a cliff it is a necessity that I have an interest in it. But to believe it is the ONLY factor is a bit idealistic and naive. There is so much more to think about.
Namely, can I see myself surviving and thriving in the training program? And how practical and realistic of a career choice is it? Of course the fact that there are doctors in every single field proves they are all achievable and a sustainable career choice. But, is it for me? Not all doctors are the same, we have different values and personalities that complement certain specialties. For example, I have heard on the grapevine that to be accepted into a general surgery training program it can take up to six years of working as a unaccredited registrar before you are bestowed a spot. Six years of blood, sweat and tears before you can even begin your journey, and you’re not guaranteed anything. Add on the six year duration of the actual program and the years you have already worked as a junior doctor, you might see your fortieth birthday before you finish your exams.
To some it makes no difference, time is irrelevant as long as the final destination is achieved. I greatly admire their perseverance, and to my friends who plan on venturing onto that tedious road I wish them the best of luck. But to others, including me, it’s a tall order, especially considering by the time I’m applying they will only become harder to infiltrate. I’ll be honest, I enjoyed my surgical rotations as a student. I appreciated the definitive treatment that you can provide as a doctor and the extraordinary anatomy you are privy to in theatre. But to ask me to slave away for the next ten to fifteen years of my life and be prepared to put everything on hold for a future that may not even be guaranteed, that hurts. Yes, you never know until you try and there is a possibility it could come to fruition without a hitch. But realistically that is unlikely and also a commitment I am not sure I have the tenacity and strength to endure, nor do I feel passionate enough about to make those sacrifices. Some will see it as a sign of weakness, but my personal life is important to me and I would like to have a career that maintains some remnants of work- life balance. I don’t want to be coming in at 5am and leaving at midnight every day (I’m not even exaggerating this has happened to doctors I know) and become a stranger to myself as well as the people I know and love.
The same thing goes for specialties that require you to be on-call for the rest of your life (damn you obstetrics) or to do shift work (looking at you emergency medicine). I struggle to function once my bedtime of 10:30pm hits, so the thought of being alert and on the ball until 8am the next morning horrifies me. I know that night shifts will be a compulsory part of being a junior doctor and during advanced training, but if I can avoid it once I become a consultant that would be ideal. I studied my ass off for twenty years dammit, I want to have a say in what hours during the day I work. It’s why areas such as dermatology and general practise can sound so appealing, with a strict nine to five daily schedule and minimal middle of the night phone calls. This doesn’t mean I am going to rule out all specialties that threaten my beauty sleep, if I find a field I am passionate enough about I don’t think I would mind the occasional week long night shifts. But I am not going to lie and say it isn’t something I’d be contemplating.
Now, to the other question. It can be hard to determine whether or not you can thrive in a job long-term if you’ve never experienced it, but we can always try to make educated guesses. I had my psychiatric rotation in the second half of last year and I found it extremely interesting. You come across a myriad of subtly different diagnoses and trying to prise apart someone’s mind to understand their current predicament can be very rewarding if you are able to help them in some way. But when I think about doing it for the rest of my life, I am apprehensive. Why? It’s complicated.
Many of the psychiatric patients we see at the hospital have been chronically disabled from their mental health problems for so long, trying to help them escape from the dark crevasses of their mind can prove to have a mental and emotional toll on yourself. And even when you are able to make some progress, the recovery process is often gruelling and incomplete, which is why patients are well known within the ward due to recurrent relapses. It takes a lot of emotional control to not succumb to the bleak side of psychiatry, and the ability to create barriers and separate work from one’s personal life. That is hard for me as I have a tendency to become emotionally invested and attached to patients rather easily. I am a sensitive and emotional being, so being exposed to such things all day, every day will likely drain the life out of me. And before you tell me it is imperative to never bring one’s work life home with them I’d like to point out that I know, it is true in every line of work regardless of what you do. I even wrote a post about it (Don’t take it home with you). I am also certain that with repetitive exposure comes desensitisation, and the more cases I see the less it will haunt me. But even then psychiatry seems like an exceptionally vulnerable and at times harrowing field of work, where the dissection of people’s minds and lives can leave a huge burden on the doctor’s own psyche. And even if I think I can handle it, I have the right to say no. I’d rather not test the limits of my own mental health if possible.
So, where does that leave me? I’m not sure. I am in no rush to decide upon a specialty, and whilst it would be nice to have a “Eureka!” moment and realise where my potential lies, I am content with slowly plodding along and figuring it out along the way. I have begun to rule out areas that do not interest me, and as the list becomes shorter and shorter hopefully one day I can update you all on what I shall become. This post was never intended on answering the question, but to highlight that for me it is not as simple as deciding on what I am interested in, but also whether or not it fits within the puzzle that is my life.