What Kind of Doctor Do You Want to Be?

There are many decisions that physicians need to make in medicine. The first and most important is what kind of physician they want to be. Some physicians know what kind of doctor they want to be from the start. But, most have to find their way on the journey through their medical education and beyond.

There are many different specialties, subspecialties, and other activities to choose from in the medical field. So, how do you decide what you want to do in medicine? Obviously, the answer will lie in an individual’s personal preferences, but one can narrow the decision down by asking oneself exploratory questions. Some of these questions include:

1. Do I want to work in academics or private practice?

Academic medicine involves clinical work, but a portion of the time is dedicated to teaching trainees and performing research. Teaching medical students, nursing students, nurses, physician residents, physician subspecialty fellows, nurse practitioners, and other learners is often the responsibility of academic centers. Research in medicine and science is also a focus of academic medical centers. This includes research in the basic sciences in the laboratory setting to clinical studies that evaluate behaviors, treatments, diagnostic evaluations, supportive therapies, and many other aspects of clinical medicine.

Private medical practice involves mostly clinical care. But, there are opportunities for teaching and research. Medical teaching programs will often send students to community medical practices to learn from physicians in the private practice model as well. Private practice physicians can also be adjunct faculty at nearby academic centers and can participate in research activities. Nevertheless, a major focus of private practices is the clinical and business aspect of medicine. Running a medical practice takes a different skill set than academic medicine. While there are definite challenges and demands in academic medicine, the challenges and demands of private practice can easily exceed those of academic medicine through the sheer fact that a physician is responsible for all aspects of the practice and does not have the institutional support that those in academic medicine have.

2. What kind of work schedule do I want to have?

There are a variety of work schedules in medicine. There are some schedules that are traditional work hours (i.e., 9 am to 5 pm), some schedules that are shifts (i.e., 12-hour blocks), some with overnight calls in the hospital, some with a 7-day service week work block with a week or 2-week period without clinical responsibilities until the next service week, and a number of other schedule types or combination of schedule types. Different venues, such as hospital wards, surgical centers, outpatient clinics, and emergency rooms, have different staffing schedules. Also, the coverage hours will depend upon the number of physicians in the group to share the workload. The multitude of medical specialties and subspecialties have work schedules that can be unique to the area of medicine in which one desires to practice. A work schedule can have a significant impact on one’s life inside and outside of medicine. The job-related program that supports the kind of life that one wants to live is of no small consideration and is ultimately very important to consider when choosing a career in a specific area of medicine.

3. What patient population do I want to serve?

The patient population that one serves in the medical specialty of one’s choice is an essential consideration when picking a desired area of medicine. One has the option to focus on a specific age group, from infants to the elderly, or choose to treat all different age groups. One can pursue gender-specific healthcare (i.e., women’s health), treat specific racial/ethnic groups, care for people of different socioeconomic classes, and focus on communities in a particular geographic location (i.e., rural, urban, particular state, and other areas) or cater to an assortment of other demographic characteristics of a patient population. The needs of different populations of patients, even within the same medical specialty, can be very different and offer a variety of challenges that a physician may or may not want to encounter in their career.

4. Are medical procedures something that I enjoy in medical practice?

Procedures can provide significant job satisfaction for some physicians. Also, the answer is not all or none. There are a variety of medical specialties and subspecialties that require a varying amount and different types of procedures. One can choose what proportion and type of procedures based on what they are interested in. The area of surgery (with a variety of surgical subspecialties) requires a significant amount of time dedicated to extremely invasive procedural activity (i.e., exploring the abdomen or chest by creating an incision through skin into a body cavity). However, there are other medical areas, such as intensive care medicine, emergency medicine, gastroenterology, radiology, cardiology, and others, that may not require as much procedural activity. These non-surgical specialties may utilize less invasive procedures, such as using ultrasound technology for imaging different organs, or more invasive procedures by placing catheters, tubes, and devices through the skin or different orifices of the body. Clots from blood vessels can be removed, abnormal retention of fluid in the chest can be evacuated, and special tubes can be placed in the airway to assist with breathing. There is almost an endless variety of procedures to satisfy any physician’s interests. Nevertheless, there are also specialties in which no procedures are required and that is something that is appealing to a number of physicians as well.

5. Are there sciences or other coursework that I learned in medical school that I would like to carry over into my medical practice?

In medical school, we take classes that include biochemistry, physiology, medical ethics, biostatistics, anatomy, pharmacology, pathology, and many others. While medical specialties and subspecialties utilize lessons from all courses in medical school, some use more of some areas than others. For instance, general surgery, surgical subspecialties, and radiology utilize a greater proportion of anatomy than psychiatry, intensive care medicine centers around physiology to a greater extent than general pediatrics, and pathology emphasizes…well…pathology. In every area of medicine, one can utilize the important lessons learned in medical school. However, some areas of medicine may utilize more of the basic teachings than others. So, if one has a particular area of interest in coursework from medical school, one can find an area of medicine that allows him or her to utilize those lessons in a way that provides greater satisfaction and intellectual stimulation.

6. What kind of community involvement do I want in my career?

The profession of medicine is designed to serve individuals and society at large. There are opportunities to serve on a micro level while dealing with direct patient care and addressing individual health concerns. But, there are also opportunities to deliver care to an entire community on a macro level and focus on population health through involvement in public health measures, advocacy for specific disease prevention or care models, and work on government health policy development. One can create support groups for various populations with health risks or teach parents about normal childhood development and provide them with anticipatory guidance about what to expect of their growing child. In every medical specialty, there is the opportunity to become involved in community interactions that can focus on teaching, advocacy, and being a resource for patients, families, schools, institutions, companies, governmental agencies, and other groups.

Some physicians know what kind of doctor they want to be from the start, but most have to find their way on their journey through their medical education. The questions above serve as good ways to assess one’s needs and desires in the field of medicine. There are other questions that can serve as a needs assessment as well, but the above questions provide a good place to start the inquiry.

While one typically sees the journey of deciding what kind of doctor one wants to be starting in medical school, the journey often continues after training, during the middle of a career, and beyond because there are even variations of types of physicians within specific medical specialties and subspecialties. As a physician matures within their specific medical specialty or subspecialty, their interests may change and evolve. Choosing the area of medicine in which one wants to practice is an important decision for any doctor for sure and there is a journey to the realization of which kind of doctor one wants to be. But, one must recognize that the journey to becoming the kind of doctor one wants to be may deviate and change along the way and the ultimate kind of doctor one becomes may be different than was initially intended.

For those established physicians in the audience, what have you found helpful in deciding what kind of doctor you wanted to be?