Some thoughts on specialties

Over Thanksgiving break, a number of people asked me what kind of specialties I'm interested in and whether I know yet what I want to be when I grow up. Although some enter medical school knowing exactly what they want to do - and end up doing it - a sizable majority of medical students have absolutely no idea until they're practically forced to make a decision at the beginning of fourth-year.

"That's what third-year clinical rotations are for," is my short answer when people ask me about specialties. I want to keep an open mind and not close any doors until I have experience-based reasons to do so. That said, there's also a long answer; but it should be kept in mind that this long answer is time-sensitive as it will necessarily change as I'm exposed to new material and new experiences.

So, without further ado, here is my specialty differential (at this moment, in no particular order):

1) Neurology: I have a background in neuroscience, so I obviously find the brain a fascinating subject intellectually. How that translates into day-to-day clinical practice, I'm not yet sure. I have shadowed several neurologists, including my Mentored Scholarly Activity adviser, but I won't get a full picture until my third-year neurology clinical rotation. I am interested in movement disorders, seizure disorders, and perhaps interventional or pediatric sub-specialties.

2) Emergency Medicine: I have been working for the past year in the Emergency Department with my Foundations of Doctoring preceptor. I like the pace of the job. I like that I'm (usually) presented with an acute problem that needs to be fixed immediately. I like the fact that I'd be doing procedures (e.g. lumbar puncture, joint aspirations) in addition to medicine. I like that I'm helping people who typically do not otherwise have access to medical care. I like that I would be working shifts and could leave my work at the hospital. That's especially important to me as I'd like to eventually have a family and be more than a nominal presence at home. I also like that my skill set could be put to good use in volunteering for organizations that provide medical care abroad.

3) Surgery: I like doing things with my hands - I have good manual dexterity from all those years of playing video games, and I'm good visuospatially. But, I know nothing of what surgery is actually like and how good I actually am with my hands. I'm also skeptical about the surgery lifestyle. My interest in surgery will come down to my third-year rotation experience.

4) Nutrition/Metabolism: It turns out that I really enjoyed the nutrition/metabolism unit that we just finished. I found it surprisingly interesting and applicable to everyday health. I'm a strong believer in preventative medicine, and specializing in nutrition or metabolism would be consistent with that value. Plus, with the obesity epidemic, the need for such physicians will only increase. I worked for four years in an eating disorder clinic, and my very first job in high school and college was chart review and data entry for a bariatric surgeon who performed laparoscopic gastric bypass surgeries. A career path in nutrition/metabolism would be consistent with what I've done in the past; still, I know very little about it in terms of clinical practice options and need to do some homework.