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How Do You Choose a Medical Specialty? Five Penn Students, Five Paths to Residency

How do you choose a career path? Deciding to be a doctor is one big decision, but it isn’t the last one. Soon-to-be-MDs also have to choose a specialty. Some students enter medical school with their minds made up already, and sometimes their minds change along the way. Others, in the word of fourth-year Penn medical student Michael Stephens, start out a little more “undifferentiated.”

For Penn Medicine magazine and here on the News Blog, we have been following a group of medical students who entered the Perelman School of Medicine in the fall of 2015 and have shared periodic updates. Tomorrow, most of the students from this class (if they aren’t pursuing additional degrees or research that take extra time) will celebrate Match Day, the culmination of their application to residency programs when they find out where they will ultimately work for the first three or more years of their lives bearing the letters “MD.” The hospitals themselves are a matter of ongoing suspense, to be relieved only in the moment when each student opens that fateful envelope. They have already decided on their specialties, though. Here’s a glimpse into the thinking behind how five of this year’s graduating medical students chose their paths.


Claire Hirschmann: Emergency Medicine

I ultimately decided on emergency medicine for a few reasons. I believe it is the profession in which we see the reality of society most clearly, in which both how and whom we have failed to serve is most visible. It feels like a moral imperative for me to be in that space, and while I anticipate that seeing the downstream effects of our failures so persistently will be heartbreaking, I have hope that by inhabiting that space, I will be able to use what I witness to advocate for change in our systems.

I also love the creativity inherent to emergency medicine. I think emergency medicine is a new enough specialty that the scope of practice is relatively permeable: people hear a novel idea and say, “Oh yes, that is also possible within what we do.” With the opioid epidemic, for example, a variety of new strategies and innovations are emerging in using the ED as an intervention point for initiating long-term treatment of opioid use disorders. It is exciting to me that such creativity exists in this specialty, that people are willing to believe that the world is huge and full of possibility, and that emergency medicine providers define themselves as being nimble and inventive.

Practically, I love the work of the ED. I love interacting with the spectacular diversity of humanity and pathology. I love putting in sutures, making splints, and using my hands to do work. I love — and hope eventually to develop — the depth of knowledge and mental agility necessary to move smoothly from treating a sore throat to running a code.

I came into medical school wanting to do either emergency medicine or adolescent medicine; those interests have persisted but are now better informed by the other specialties I encountered in my rotations. OB/GYN, for example, amplified my interest in women’s health, and family medicine emphasized the power of working to prevent or forestall issues that can later emerge. As I plan my career in emergency medicine, I am interested in the intersection of reproductive health and the ED, particularly in expanding the role emergency medicine providers can have in ensuring that individuals’ reproductive health needs are met. Talking about this interest on the interview trail has been remarkable: I found that people were incredibly supportive of my vision and enthusiastic about helping me realize it. Such a reception has made me ever more convinced that this is the specialty in which I belong and will thrive.

Amanda Labora: Obstetrics and Gynecology

I entered medical school broadly interested in women’s health. Prior to matriculating at Penn, I completed a Fulbright research project on obstetric violence in Mexico.

I have had an inkling since before medical school that I would pursue OB/GYN. Ultimately, I found that it was the subject I most enjoyed learning about. I find the mixture of medicine, surgery, and primary care to be incredibly rewarding. 

I’m looking for an academic program where you get strong generalist training but where fellowship opportunities are available. One of the most important things to me is diversity of residents and faculty, and also dedication to the community that is served by the hospital system.

I’m also looking at institutions that have prominent champions of health equity because one of the major things that I’ve dedicated my time to since I’ve been here at Penn is Equal Treatment, a medical education platform that seeks to provide curricula on issues that negatively affect the health of people of color. My classmate Hattie Huston-Paterson and Dr. Horace DeLisser and I co-founded it together, and we have incorporated as a nonprofit in Pennsylvania. You can learn more about one of the issues we aim to educate about, the health of undocumented immigrants, in our recent podcast episode (co-produced with Doctors Who Create, an organization founded by our classmate Vidya Viswanathan).

Equal Treatment is a lifelong commitment for me. I have been paying attention on the interview trail to what sort of academic or community champions are present at those institutions, those who might help me to grow that work and continue it during residency.


Sabrina Layne: Internal Medicine

Finishing clerkship year, I realized there was a lot that I liked throughout, but I was starting to home in on the idea of either doing some sort of medicine subspecialty that had a procedural component, knowing that I really like cardiology and gastroenterology (GI), and knowing that I like to interact with patients. Working up their initial complaint and taking their history is such an important part of that. But I also like some of the hands-on work and some of the immediacy of being able to provide an intervention for a patient. And then, thinking about that same idea but from the surgical perspective, I considered surgical subspecialties where I get to have more of the hands-on component, but that still had a degree of medicine or that sort of patient work-up or interaction within them. That’s what I was mainly choosing between, so I set up my electives to do back-to-back medical subspecialty/surgical subspecialty electives.

Now I’m very certain that I want to do medicine, likely cardiology or GI, which is very exciting.

The residency is three years and you’re being trained in all areas of medicine, with the idea that you could leave that program and go be a general practitioner. If you want to do a subspecialty, you’d do an additional fellowship after, which is anywhere from two to four years depending on what you’re doing.

I very much am thinking about academic medicine and absolutely want to be a great clinician. But also I am very excited about health systems innovation, and thinking about the structure of medicine, how that’s going to change going forward, and how we can deliver better care for our patients. I like teaching, too, so I think putting that all together seems to lend itself better to an academic career. In looking at residency programs, something that I’ve been thinking about a lot is whether they have that balance that I’m excited about: Do they seem to be an institution that teaches residents how to teach? Are they excited about medical education? I’ve developed a quality improvement interest during medical school. Do they have a track for that? Are there people interested in QI at their institutions?


Katie McDermott: Surgery

[During clerkships, I was] surprised by how much I loved surgery. It’s very exciting to see patients who are acutely sick sort of fixed over a couple of hours. I’ve really enjoyed the experience of seeing patients in clinic, then in the OR, and then watching them recover in the hospital. There’s a lot more continuity of care than I expected. The surgeons I’ve worked with have really positive relationships with their patients. There was a particular patient who came in when I was in the surgical ICU who was transferred from another hospital because she’d had sudden onset shortness of breath and was found to have a big mass in her airway. She came to Penn with a breathing tube, intubated, and really scared. Within probably an hour and a half, an interventional pulmonologist sedated her, took out the breathing tube, totally removed this mass, and she woke up breathing, talking, thinking, like none of it had ever happened. She was so, so relieved. It was very empowering for me as a medical student to see her after this really quick but really drastic intervention, and to then be able to explain to her and her family what had happened in a way that everyone understood.

I’ve spent my life in many ways trying to choose the hardest thing because it was the hardest thing, and was worried, starting clerkship year really liking surgery, that it was just that I thought that it was the hardest thing and that maybe I didn't actually like it. But I think clerkship allowed me to see that there are other things that are really hard that I did not feel nearly as excited about, which was reassuring to me on many levels.

I came into medical school not having a strong idea about what I was going to do, but sort of assumed that I would do something in internal medicine. And from my first day in the OR, I felt there wasn’t anything else for me. I found a lot of parallels between my time playing soccer and working as a team in surgery, which felt a little bit different from the way that a lot of other teams operate in the hospital. Being able to develop specific skills that you can see getting better with practice... And I just liked hanging out with surgeons.


Michael Stephens: Dermatology

I would like to practice in an academic context. I really enjoy medical education and the nuances of being in an academic setting. You see a lot of more challenging cases, more complex patients, and those are the kind of the patient populations I'm interested in, untangling complex problems.

Dermatology is kind of a unique specialty in that it is very cognitive, very medical, but it’s also procedural, which I appreciate. It's not strictly one or the other, and I lean towards medicine but I would be hesitant to let go of the procedural element in what I do. The actual medicine within dermatology, though, is really what attracts me to it. It’s kind of at the intersection of all of the foundational science things that I’m interested in: cell biology, immunology, infectious disease, which are all things that I've had a longtime interest in, since I started undergrad. What’s attractive about it is, there’s a lot to learn, it’s very rich in research, and there’s a lot of room for knowledge-furthering to that end. It’s a cool field.

Read much more about these five students, and classmates, and their journeys through the last four years in medical school, in the Spring 2019 issue of Penn Medicine magazine, coming soon! And watch the News Blog next week for our post-Match Day video featuring Labora and perhaps a few other students from this post, to find out where they are headed for residency.

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