Welcome back to the Pioneer Press! For those who have been tracking along, we left off in June/July of 2016 when we had just started rotations as second year medical students (M2s). Now it’s March of 2018… what have we been up to all this time?

M2 year flew by as we finished the second year of our basic science courses, a longitudinal rotation, and Step 1. In June 2017, we kicked off our M3 year by heading back to various clinics and hospitals (located primarily in Green Bay, Door County, and the Fox Cities) for our rotations. We spent our summer days working hard in the clinical environment and our evenings preparing residency applications.

Once applications were submitted around mid-September, we started receiving interview offers, scheduling them around rotations as well as Step 2 CK and Step 2 CS (which many took between October and December). Most people had finished residency interviews by the time January was over. M3s ranked the programs they applied to and submitted their lists by February 21st. Now, it’s just a waiting game until March 12th, when we will find out if we matched; on March 16th, we will learn where (with what residency program) we matched. We are all eagerly and anxiously counting down the days…

That’s our M2 and M3 year in a tight nutshell. During this waiting period until Match week, I’ve had a chance to catch my breath and reflect on where I was about a year ago, halfway through my M2 year. There were a lot of things going on at that time, but what was most stressful for me was choosing the medical specialty I wanted to apply to.

Not everyone struggles with this decision. I think a good way to represent the various medical student perspectives on choosing a specialty can be summed up simply in the illustration below.

Entering medical school, some of my classmates were closer to the left side of this spectrum, certain they would go on to a career in family medicine, pediatrics, or internal medicine (IM). I was far to the right. In the fall of M2 year, I was forced to seriously consider my interests; in the spring, we would have to rank our preferred rotation tracks for M3 year, which would determine the order in which we completed our clerkships.

I was torn. There were two specialties, emergency medicine and surgery, I knew I would enjoy based on prior experiences; other specialties, like psychiatry and IM, piqued my interest, but were new to me. In a compressed 3-year timeline, I could gain exposure to only three of these four specialties before applying to residency programs.

Knowing I had to take a bit of a gamble, the track option I ranked highest allowed me to complete rotations in surgery, IM, and psychiatry prior to applying. I shadowed a general surgeon while I was in college and remembered loving the OR. I worked in ERs as a medical scribe after college, which allowed me to see how IM physicians/hospitalists interface with the ED, but those were only peripheral experiences; I still couldn’t be sure about IM one way or another. Psychiatry in particular was a field I knew next to nothing about. I had no experience to draw from—not even a friend, family member, or distant acquaintance who was a psychiatrist or who had needed to see a psychiatrist. Still, I somehow felt drawn to the field. It was the biggest question mark on my list.

I finished my surgery rotation in the spring of M2 year. I had loved it but had reservations and questions. While I wanted hard and fast answers, I eventually realized I would have to be patient and see how other rotations went.

My next rotation was internal medicine. I quickly realized it was not the specialty for me and crossed it off my list. Psychiatry and surgery were the finalists.

When people hear this, they’re often taken aback, and I hear something to the effect of, “I can’t think of any two specialties that are more different”. I don’t disagree. Surgeons have the honor and responsibility of using their technical skills and dexterity to treat their patients. Psychiatrists help bring healing to their patients, but the nature of their patient-physician relationship often requires different boundaries—limiting if not altogether eliminating physical contact. Surgeons tend to see results immediately, whereas psychiatrists may invest months and years before seeing the fruit of their labor.

I addressed this decision from every possible angle I could think of. Questions ran round and round my head. I would change my answers frequently. Even when I occasionally felt like I was leaning heavily in one direction, regardless which way, I would get caught up in the knowledge that I wasn’t 100% certain. Then the questions would start all over again.

When I started my psychiatry rotation, things fell into place. I had found my calling. Without a doubt, I missed the art of surgery, the finesse it demanded. Surprisingly, though, the buzz of the OR fell away as I moved on to other rotations. In the end, the question I should have asked myself wasn’t which specialty I wanted to do more, but which one I couldn’t live without.

As much as I loved surgery, I kept coming back to patients who struggle with mental health. Each patient who has mental illness is distinct in their presentation, even patients who have the same diagnosis. I love getting to know a patient, learning how circumstances affect and are affected by their psychiatric problems, and seeing how medication and therapy can drastically change their lives. The opportunity and honor to understand how a patient thinks and responds—this is what I cannot live without.

I suppose that brings me back to the present moment, where my fellow M3s and I are continuing in our rotations and acting internships. In a matter of days, we’ll learn where the next 3-4 years (minimum) of training in our respective specialties will take us. Personally, I’m beyond ecstatic, both for myself and for my classmates. We are waiting with great anticipation.

P.S. Whenever the medical specialty decision/conversation starts floating around the medical student body, there are several comical algorithms for choosing a medical specialty that invariably get passed around (just do a Google search of “medical school specialty algorithm”, and you’ll get an idea). Using these algorithms, medical students can deduce (either jokingly or in total sincerity) what specialty is “right for them” based on stereotyped personalities, attitudes, or circumstances in various specialties. Some of these algorithms are hilarious; others are crude &/or outdated. And it goes without saying that there are many physicians who break all of their specialty’s stereotypes.

Written by Joanna Buck, the author of the previous blog post “Juggling Lemons.”