Tuesday, February 5, 2013

Another question about choosing a specialty, this time from a wife

I recently came across your blog, and I have found it very insightful. What you can recommend in terms of advice for my husband and me. My husband is a 3rd year medical student, and he is not sure what type of residency he wants to go into. He has finished most of the required clerkships (peds, surgery, surgery sub-specialty, and family). Currently, he is finishing up internal med, and will do psych next, then obgyn. We constantly check in on what he is interested in, and weigh the pros can cons of each in terms of possible residency choices. He loves ped surgery, surgery, emergency med, and certain aspects of internal med. What he and I find most challenging, is how does he pick between medicine and surgery, when you've only had limited exposure to both, and enjoy both? What type of advice can you give regarding this aspect?

Also, what advice could you offer to the spouses of a medical student? I want my husband to be happy in his chosen field, but I just want to make sure that I AM happy as well. For instance, my husband LOVES peds surgery; however, it is a long road to get there and extremely competitive. If he did decide to go this route, then it would be years of general surgery residency, fellowships, research and with only 30 pediatric surgery spots in the nation, it might be near impossible to get into. If he did decide to do this, I would never see him (and I'm already finding medical school difficult because we hardly see each other). So, I'm hoping you have some insight or words of wisdom regarding what kind of advice and support will be beneficial for both of us during this difficult time? I don't want him to go through years of medical school, only to "settle" for a specialty that will not give him any joy or purpose. However, I want to make sure that I will be happy, and I know "settling" for certain specialties gives you a decent work/family balance. Is there any advice you can provide regarding this very important decision in his medical career, and any possible next steps?

Good questions and I'm afraid there are no simple answers.

Here's a link to a blog I wrote (which contains a link to yet another) on the subject. Both pertain more to the situation with married female doctors but much is universal.

Peds surgery is pretty competitive with about 2+ applicants for every slot. Last year there were 40 positions offered. Here's a link to the data:

Go to page 61 for the peds surgery stats. All other fellowships that are NRMP matched are in this report.

Unless your husband does something that's a 9 to 5 specialty like derm (also very competitive) or radiation oncology, long hours are part of the deal. Also, the degree of boredom of a specialty is inversely proportional to the hours. For example, PM&R is very boring but the hours are short.

I have always maintained that one must choose a specialty that one likes and not base the choice on money, prestige or hours. Your husband will have to go to work every day for 35-40 years. It's hard to do that if you hate it. There are a lot of unhappy docs out there and many of them did not choose their specialties wisely.

I wish I had a magic solution for you and him. I regret I do not.


  1. Just as an aside, when I started my practice, I worked 7AM to 9 or 10PM 5 days a week, and did some work on Sat/Sun as well. I rarely took vacation. I am a radiation oncologist ;) Even now, I don't work as much (maybe just 50-55 hrs/week), but I do spend time each day engaged in learning even though I may not be at the office. In general, I still get to the office at 7AM every day however.

    I would also say, don't discount choosing anything on account of money, prestige, or hours. It can't be the end-all, be-all, yet it's denying basic human nature to say we don't or shouldn't make choices based on these facets. It all factors in. Seeking prestige or good remuneration is nothing to be ashamed of. Looking for more time off is something we all do, eventually; reasonably planning for that in a career choice seems valid. Yet as my grandfather used to say, "Don't stoop to be the President if God calls you to be a ditch-digger." If someone truly wants to be a ditch-digging surgeon or ditch-digging dermatologist, or whatever, they will be.

  2. Great insight! My husband is not a doctor, but a newly practicing attorney and it is VITAL that a person who faces long hours, no matter his specialty, find something that he can be passionate about.

    As wives (and I can empathize to some degree with what you're going through, our kids and I hardly saw him through his master's degree and his law degree), we have to do our best to make sure that they are happy in what they do. Otherwise, they'll bring that unhappiness home and it's not great for a marriage.

  3. Todd and Mitzi, thanks for the great comments. I'm sure they will help the young woman who asked the question.

  4. I chose surgery because I felt like it was worth running around in the middle of the night for. My father is a surgeon and I knew the lifestyle risks, in fact I tried to like a lot of the lifestyle specialties but just couldn't get excited about them. I really made the decision because I was excited about the consults as a medical student when I was on call. Obviously I'm not as excited about draining abscesses or seeing non-operative consults in the middle of the night, but that was my clue in that it was what I wanted to do.

  5. Justin, I appreciate you thoughts. Thanks for reading. Good luck.