“I wouldn’t be burned out if I had studied the practice of my medical specialty as much as did perfecting my clinical skills in my third year.” A Disgruntled Practicing Physician
Choosing the right medical specialty through your third year rotations and fourth year acting internships is like an arranged marriage: you get a short period of time to irreversibly (good or bad) change the course of your life. Getting advice on these topics range from informal advice from ward attendings to hilarious stereotypes (http://theunderweardrawer.blogspot.com/2011/03/12-medical-specialty-stereotypes-2011.html) to formal studies on physician compensation (2015 Medscape Physician Compensation Report) and doctor attitudes towards their specialties (Medscape 2015 Physician Lifestyle Report). Most of the tips your hear about choosing the right medical specialty involve these common main topics: lifestyle, money, USMLE or COMLEX board scores, competitive specialties, and “follow your passion” type advice. We are not against this type of advice, but there are more precise topics to examine in your clinical clerkships find the right residency and subsequent medical specialty. While we previously discussed 5 poorly considered factors when picking a medical specialty, here are 5 unique factors that are often overlooked:
1) GRILL THE BILLERS & CODERS IN YOUR MEDICAL SPECIALTY
Less than 1% of M3s probably find the medical billing and coding department for their hospital to ask those on the front-line of the reimbursement battles they experience on behalf of their medical organization. In short, billing/coding involves finding the right codes to match the documentation of clinical services provided and submitting these forms to payers (i.e. insurance companies, government entities, private pay patients) for reimbursement. Billing is relatively straightforward if the clinicians follow the proper documentation guidelines. However, 70% of billing is “nagging” (trying to get payment timely, getting the proper amounts billed reimbursed, overcome administrative red tape inherent in the process). By talking to these professionals, you will learn a great deal administrative information about a particular specialty including, but not limited to: a) most common errors physicians make in documentation b) reimbursement difficulties in various medical specialties and procedures c)various major government guidelines (i.e. HIPPA) d) evolving medical technologies (i.e. electronic medical record management systems) and e) a general understanding if doctors are actually making what you think they are making.
BONUS TIP- This is a great tip to bring up in your residency interviews because you will be talking about subjects that a) most attendings/physicians know anything about b) you will give them something novel to hear rather than clinical data c) you look like you are showing initiative and they will infer you will do this in their program d) looked like you picked your medical specialty due to intrinsic motivation reasons.
2) EVALUATE NIGHTTIME CONTINUOUS SLEEP-
For example, generally, radiologists, dermatologists, psychiatrists, and pathologists get more continuous nighttime sleep than surgeons, family practice physicians, pediatricians, and internists. Remember, lack of sleep and intermittent sleep can make you tired throughout the day, which could potentially decrease your ability to deal with the non-medical parts of your life (i.e. spending time with family, optimizing finances, having fun, etc.). Continuous sleep is awesome and you should know this distinction going into your profession.
3) CHILDREN/ PRACTICE FLEXIBILITY- You may have children already or don’t know if you are having children. Most of you will, some won’t for various personal reasons. It’s much easier to have a child or raise a child as a psychiatrist than a surgeon. If you have children or plan to have any, consider not going into fields that required lots of overnight call, sudden emergencies, or frequent procedures/surgeries. Of course, lots of physicians have children in every medical specialty, but it’s really hard…. on both you and your families. This is especially key if you are the primary breadwinner or higher earner in your dyad. The underlying point to consider is know while a student if your medical specialty has the practical flexibility to absorb significant changes in your personal life. The more flexible it is (i.e. options to do telemedicine vs. being stuck in the OR physically), the less stress on you.
4)DOES YOUR PERSONALITY FIT WITH THE MEDICAL SPECIALTY?-
Patient encounters vary tremendously across various specialties. See if your desired medical specialty matches your intrinsic and quirky personality characteristics. Most med students focus exclusively on the clinical skills needed and entrance requirements rather than examining if they are a good fit with the medical specialty itself. While this subtopic could easily be several pages, here are some examples to consider when thinking about the right medical specialty:
- ER is filled with physicians with a low attention span or need constant stimulation. Psychiatry often attracts more patient physicians with a high attention span and avoid medically-intense situations.
- Those who like to work with their hands often choose specialties with procedures/surgeries.
- Some of those who don’t like to engage in the interaction process with real patients consider careers like radiology and pathology.
- Some fields attract those that who love differential diagnoses (i.e. neurology, internal medicine) while others focus on treatment efficacy (i.e. surgeons “heal with steal”).
- Don’t be a urologist if anuses disgust you. Personality fit matters when picking a medicalspecialty.
- If you love “thank yous,” then don’t be an anesthesiologist.
5) BEING OK WITH KNOWING LESS INFORMATION/SKILLS-It is ok to pick a medical specialty because you a) don’t want to remember many medical topics or b) your skills suck in many areas of medicine and you pick the specialty you can master. In medical school, you have to know almost everything to pass the various course and board exams. As a third year, you probably pretend you will go into that specialty to thoroughly evaluate the field. After graduating residency, generalists (i.e. family practice, pediatrics) generally have to know a little about alot of topics and specialists generally know alot about a specific field (i.e. dermatology, psychiatry). It is generally “easier” to learn alot about one topic (especially if you are interested in it) than remembering about many topics (especially if you don’t like many medical topics). In addition, sometimes you feel like you have one set of clinical skills and don’t think you can do anything else.
- a pediatrician must often keep up with their up-to-date reading of many different specialties because their patients/families will present many different complaints/questions throughout the day.
- a dermatologist generally needs to know extensively about dermatology, but feel comforted that they don’t have to know a great deal about OBGYN (which they will defer or “punt” to another specialty quickly).
- if you are good at poking, but would be a poor cutter (surgery), treating chart-o-megaly diseases (chronic conditions), and don’t like having lots of follow-up/long conversations with patients, consider anesthesiology as your desired medical specialty.
The point is that, even though you are programmed in medical school to try to maximize your clinical skills in nearly every facet of medicine, it’s ok to pick a medical specialty because you don’t want to do alot or being forced to remember alot. This attitude is called being “deficient” in medical school, but “efficient” in clinical practice.
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