How to Pick a Medical Specialty | Why I Chose Ophthalmology

At the beginning of medical school, residency seemed like a distant mountain on the horizon.  I knew it was there, but it felt like ages before I would have to climb it.  Besides, how could I decide what to specialize in before finishing all my core med school classes?  This perception was solidified by upper classmen and faculty alike who told us to “focus on classes” and “you’ll figure it all out during 3rd year”.  Lucky for me, partway through 1st year I decided to start exploring specialties on my own instead of waiting for 3rd year.  This leads me to my first piece of advice in regards to selecting a medical specialty:

1. Start exploring NOW: I can’t stress this enough.  Choosing your career is a decision that merits as much time, sweat, and effort that you can muster.  Medical school just gets busier leading up to application time, so the sooner you start exploring the better!  In fact, I would argue that 3rd year is a terrible time to start exploring different specialties.  How many specialties will you rotate through during 3rd year?  The correct answer for most schools is 8.  How many specialties are there?  The NRMP lists 48 residency programs, which doesn’t include ophthalmology, bringing the number of different residencies to 49.  If you then consider fellowships as well as different practice settings you quickly arrive to hundreds of different specialties.  If you don’t like any of the 8 specialties you rotate in during third year, then you are up a creek without a paddle because applications are due a mere 2-3 months into 4th year.  Also, shadowing during your free time as a third year is nigh impossible, due to the strenuous nature of your clinical duties.  So if you have waited until third year then you better hope you’re good at guessing or that you fall in love with one of the core specialties.  One of the great things about being a medical student is that setting up shadowing experiences is extremely easy, as opposed to being a pre-med where you have to fight tooth and nail for an opportunity.  During first year I asked 4th year students which attendings in different fields were the most approachable, and then I would reach out to them.  Easy peasy!

2. Don’t be afraid to change your mind: Just because you have been set on ortho since the day you benched 250 doesn’t mean you can’t change your mind.  Going into third year I knew that I really liked Ophthalmology (due to shadowing and research), but I kept an open mind on each rotation and was willing to change my mind if I found something I loved more.  In the end, I loved Ophthalmology the most!  But give yourself the freedom to keep exploring fields even if you think you have found ‘the one’.  This includes if you are partway through 3rd year, have done a ton of research in a competitive field, but suddenly realize you love something completely different even more.

3. Surgery or Medicine? This is a question that I would urge every M1 to confront.  As an M1 I liked the idea of the operating room but had never actually seen a surgery.  To rectify this, I contacted a senior general surgery resident and set up a day that I could spend with his team in the OR.  IT WAS AMAZING!!!  They let me follow several ORs throughout the day and explained what they were doing.  I could bounce from room to room and check out different surgeries.  It was a buffet of awesomeness!  When I met Mrs. DA for lunch I had this big grin on my face, and I told her I knew I wanted to do something surgical.  You might find that you detest the OR, and that’s ok!  You just whittled down your residency selection.  You might find you love the OR, which also means you’ve whittled down your selection.  Or you might like it but not be sure.  That’s cool too.  The point is that you’re learning about yourself.  On the flip side, you should also set up shadowing on medicine rounds.  Medicine is a completely different world than surgery.  You might find you love ruminating over a complex problem for days, making adjustments and monitoring the results.  I found that I enjoyed medicine more than I thought, and wanted to make sure my career included this kind of problem solving.  You may also find that you love the basic science behind a field, but then when you shadow said field you realize that the clinical application is extremely boring, which was my experience with pulmonology.

4. Narrow your search: Once I knew that I loved surgery while still enjoying medicine, I began to look at specific attributes of each field as I continued to shadow.  Did I like the workup of new patients in that particular field?  What was clinic like?  Were the attendings happy?  After shadowing in ortho for many weeks I learned that broken bones, tendons, and ligaments just didn’t spark my imagination.  That was a shock to me because I enjoyed ortho surgery.  I also looked at the happiness of the attendings.  Did they see their kids?  Did they have hobbies?  You have to be careful with this one, because each attending is very different, but if you shadow multiple attendings in a department you will pick up on patterns.  After more OR days I learned that bowel surgery wasn’t my thing, but I still enjoyed the OR.  I seriously considered emergency medicine after shadowing in it several times, but just couldn’t commit.  The breakthrough moment for me came when I spent a day in ophthalmology surgery.  The surgeon sat down at the microscope, and suddenly I was looking at a giant eye on a flat screen television.  My eyes were riveted to the screen as the surgeon made his first cuts into the cornea.  I was excited by the elegant technique required to create the capsulorhexis to access the lens clouded by cataracts.  After breaking up and removing the cataract through a tiny ultrasonic vacuum, the surgeon inserted an artificial lens calculated to correct the patient’s vision.  I couldn’t believe what I was watching!  The surgeries in ophthalmology that day captured my imagination, and I left the OR thinking, “This is what I want to do with my life”.  I was even more elated when I shadowed ophthalmology clinic later that week and found that it included diverse pathology, interesting work ups, an awesome physical exam, and some of the coolest technology found in medicine.  Ever seen a post-op cataract patient who is effusively grateful for the return of their vision?  It’s awesome!  My first day in ophtho clinic I watched a 1st year resident shoot lasers from his forehead through a handheld lens to obliterate the peripheral retina of a diabetic patient to reduce its metabolic demand.  Lasers from his head!!!! So cool!  Ophtho has such a cool mix of lasers, imaging techniques, surgeries, all in such a unique and isolated field!  I found myself reading about ophthalmology and watching ophtho surgery on my own time, and was so grateful I had found a field for which I felt genuine passion.  If I had waited until 3rd year I might have never found ophthalmology.

Here’s a youtube video of cataract surgery.  If you watch this and don’t think it’s awesome, then you’ve ruled out ophtho:

5. Find a Research Mentor: Whether you like research or not, this is still an important step.  Research in your chosen field will help you learn more about the field, publications will make you more competitive for the residency match, and a mentor can help you with your rank list and may even make calls to your top programs.  When selecting a research mentor you want to find a Doctor who helps medical students publish and is willing to take the role of your mentor.  Once again, I would suggest asking 4th year students who are going into your selected field for mentor suggestions. Your guiding mantra should be “publish publish publish”.  If other medical students have worked with a mentor for years and don’t have a publication, then find a different mentor!  When I sat down with my mentor for the first time we had a discussion about what we both expected of each other.  My mentor told me he was looking for someone dependable who could work on projects independently.  I told him I was looking for a mentor who could help me publish quickly, who would write a great letter one day, and who would make calls to programs close to match day.  My research mentor has been a HUGE benefit to my application.  Because I found ophthalmology early on I had time to publish more than once.  My mentor also let me shadow him, and we were able to develop a good relationship.  Almost every single one of my residency interviewers commented on the strength of my mentor’s letter, and I have no doubt that a large number of the interviews I received were due to my mentor’s influence.  Working with my mentor has been one of my best medical school experiences, and I am so grateful I started as a 1st year.  Remember, if I had waited until 3rd year none of this would’ve happened.

6. Lifestyle Considerations: How much of a role should lifestyle considerations play in your decision?  The amount will be different for every person, but the first and foremost reason for pursuing a residency should be based on passion for the field.  Make sure you will love what you do.  That being said, lifestyle considerations should play a role.  Do you want to spend lots of time with your family?  Maybe neurosurgery isn’t the best fit.  Are you going to be over $400,000 in debt?  That may make you think twice about lower paying specialties.  For all the idealism in the world you still have to take time and money into account, for ideals may fade but the cold hard facts of debt load, interest rates, and time away from home will remain.  I want to be there for my wife and kids in the future, and ophthalmology was extremely appealing because it allows me to do surgery while still having a life outside of work.

I hope these basic principles help you in your own search for a medical specialty.  They are fairly broad, and that is because each student’s situation will be different.

More ramblings on why I chose Opthalmology:

As stated above, I was initially attracted to ophthalmology because the surgeries really caught my attention.  I was enthralled with cataract surgery, oculoplastics, retinal surgery, trabs etc.  I discovered that ophthalmology has a wide range of surgeries, and found the operations to be extremely clever, due to the delicate and small nature of the eye.  I have never seen a happier OR than an ophthalmology OR.  I discovered that ophtho clinic has a ton of procedures as well, including a myriad of lasers, slit lamp procedures, and intraocular injections.  3rd year taught me that I don’t like rounding, and since ophtho is largely outpatient it keeps rounding to a minimum.  I loved the grateful postop cataract patients, and found that I didn’t miss life-threatening trauma cases.  The ophtho exam is difficult for medical students initially, but as I got better at it I started enjoying the workup of new patients.  Not only did I love the patients, pathology, anatomy, surgery, and technology, but I found that I really got along with the residents and attendings.  Ophthalmologists tend to have work-hard play-hard personalities and still find time for family and hobbies.

For all these reasons and so many more I have decided that ophthalmology is the perfect fit for me.  Yours might be orthopedics, emergency medicine, pediatrics, or 46 other specialties.  The point is, take an active approach now to finding the specialty that makes you want to read in your free time.  You’ll be grateful you did.

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