Choosing a medical specialty is an interesting and frequently discussed topic. Some have even done research on it to better understand and predict individual choices to help shape medical education, human resource management and policy-making.1,2
On a personal level, some of us wish there were a crystal ball that could point us in the "correct" direction to go. For me, it was a journey back home to Singapore after medical school. This was followed by years in basic specialist training, advanced specialist training and as an associate consultant. Each step required decisions on which area of medicine I planned to focus on. Some decisions came easily, while others were a bit harder and took longer. These are some of the lessons I have gleaned from my journey, together with some insights from my colleagues.
Know yourself
Your interests and passions
Firstly, what clinical questions or organ systems do you find the most stimulating? Other areas to consider are:
- Direct versus indirect patient care;
- Procedural versus non-procedural care;
- Curative versus chronic care; and
-
Patient population.
Many books,3,4 journal articles,1,5 and websites have proposed algorithms or questionnaires6 to help bring clarity to the matter. However, many of these have been written for an overseas context. Hence, do consider the recommendations in relation to your chosen place of practice.
Secondly, beyond clinical medicine, there is a wide range of non-clinical areas that we as clinicians are involved in. Research, medical education, administration, quality improvement, data analytics and artificial intelligence are just a few examples. Hence, you may wish to consider how your chosen field will give you avenues to hone these interests. In addition, start building up your CV in your preferred areas.
Your strengths and weaknesses
A mentor once shared with me an analogy: "Choose a specialty that harnesses your strengths. You will then be like a snowball rolling down a hill – gradually and easily gaining momentum and growing in strength." As much as I laughed over it about having to be "round and white", it is true that if you lean into your aptitudes, you may find it easier as you grow to be an expert in your area of practice.
Your life situation
Just as we recognise that our patients are not just collections of medical conditions but are unique individuals, the same can be said about every doctor. Work-life balance is important. Be aware of your life situation and responsibilities. Dream of where and what you wish your personal life to be, then consider where your desired location of future practice is and what type of work hours you are willing to accept.
Know the specialty
The people and the work
During our time in medical school, we are influenced by the clinical attachments we had or the tutors who mentored us. Where possible, keep in touch with these mentors to learn more about their specialties and their work. Participation in the various interest groups within your medical school or postgraduate deaneries may help you learn more about their areas of specialty and put you in contact with other people within these fields.
Attend a conference or a grand round. At the end of the event, you may have better insights on whether the topic inspired you to know more, or otherwise. Do a clinical rotation in your specialty of interest. This allows you to get an insight into the type of work done and patient population, and a sense of the culture of the specialty. One of my previous consultants allowed me to join her clinics and consultation rounds to get a taste of what work was like as a senior doctor in that field. The clinical rotation will also allow you to meet many doctors in the field of practice. Speak with the trainees, as well as the younger and the established specialists in the field. Each will be able to give you a different perspective into your area of interest and also provide career advice.
The evolution
The world is ever-changing, and medical advances are moving at a rapid speed. For example, things have changed tremendously over the last century in the field of renal medicine. This started with the introduction of haemodialysis in the 1940s,7 when a fatal case of end organ damage became a chronic health condition that an individual can endure and continue to lead a fruitful life. This was followed by the first kidney transplantation in 1954.8 Currently, we are being introduced to wearable dialysis devices,9 genomics and even the possibility of a cure for end-stage renal failure.10 We will need to continually keep abreast of advances and evolve our practice of medicine, and not just in our chosen field.
Know your time
Do not rush into making a decision
A wise resident once shared this with an incoming batch of residents: "Never worry if you are too young or too late for residency. Every path you take will shape you to become a better physician."
When we start our career, we may feel the pressure to get into a training programme or clear our postgraduate examinations as fast as possible. However, take the time to experience various specialties and places of practice. This will lay the strong foundation which your future training will be built upon.
Be joyful and be flexible
No journey will be easy or smooth sailing. The reasons that spurred you to make the initial decision will be the reasons that get you through the tough climbs and deep ditches. They may also be the reasons for you to continue and to find joy daily.
Closing thoughts
As you consider the above points mentioned, we also need to acknowledge that the answer to these questions can and will change over time. A study on resident physicians had an interesting conclusion: "The plasticity and resilience of physicians were more important for their life satisfaction than was matching personality to the prototype of a particular specialty."11 Hence, having the resilience to change with the moving situation will put you in good stead.
Finally, we may at times have to change the direction in which we are journeying. It may occur when your life situation changes or when you discover more about yourself. It does not always mean that your initial decision was wrong. Rather, be content that the best decision was made with whatever was known at that point in time. There is no "wasted" journey. The experiences and lessons we learnt and, more importantly, the mentors and friends we made along the way are the treasures we collect.
I wish every reader happiness in your continued journey in medicine, regardless of your age or stage in life.
Worried or uncertain about the JD life?
The SMA DIT Committee runs and provides several resources to help JDs as you grow into fully fledged members of the profession.
The SMA House Officer's (HO) Handbook
The SMA HO Handbook will help to orientate you to the roles and duties of a HO and comes with practical tips on daily work and call duties.
Check out the following link to download the Handbook: https://www.sma.org.sg/highlights/The-House-Officers-Handbook-(21st-Edition)
SMA Junior Doctor (JD) Helpline
Are you dealing with a sensitive subject or in need of someone to speak to? The SMA JD Helpline is a safe space to share your thoughts and concerns with an SMA volunteer.
The SMA JD Helpline can be accessed on Telegram by searching @smahospbot or visiting t.me/smahospbot.
Ask Me Anything initiative
If you have any questions or feedback about the medical profession, you can ask them anonymously via the Ask Me Anything portal. The SMA DIT Committee will raise your concerns and share the answers via various SMA outreach platforms.
Send in your questions, concerns and feedback at https://bit.ly/3Sg2OrB.