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- Pearls of Wisdom
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Career selection is a very important part of the process of maturation for every medical student and for every health care professional in the United States and around the world. It is a dynamic and very heartfelt process which involves many different facets that occurs over a long period of time.
Frequently, medical students and other health care professionals will enter into their professional education program with a full understanding of what type of specialty, what type of physician they may want to be. They may know whether they want to be a pediatrician, or a neurosurgeon. They may know whether they want to deliver babies or do cosmetic surgery, but over the course of their medical education, as they interact with other types of health care professionals, as they develop relationships with other students and classmates, as they form relationships with career mentors and with our advising and counseling services, those decisions may change. As a matter of fact, we understand that the average medical student, from the day that they wake up in the morning full of energy and say “Today, I am absolutely sure that I know what I want to do. Today I know I want to be a surgeon, I want to be a dermatologist, I want to be an ophthalmologist” -- then on average, they will change their mind approximately 3.2 times. So please look forward to this, enjoy this decision, and understand that there is a process that you are going to go through.
It is exactly in that regard that we have created this website and mobile web application to enhance the career counseling for the College of Medicine in an attempt to provide you with a firsthand exposure to many members of our clinical faculty who have a good understanding of what needs to be done if you choose to pursue their specialty.
What I would like to do is rather than share with you thoughts on the process, I would rather share with you some questions that I would like you to put into the back of your mind as you not only watch these videos but hopefully as you meet the professors, as you work with your career mentors, as you go through the counseling sessions to help you select your career trajectory. First, I would like to call out the fact that this is a dynamic process. This process does not occur in a single day or a single hour or even over weeks. It frequently occurs over months. Typically a great deal of the formative information is gathered during the third year of medical school, and even during the early parts of fourth year. Frequently students will be refining their choices and indeed going through a healthy degree of searching in trying to determine which direction they want to make a choice.
Fortunately, the practice of medicine is wonderful in that people can build components just like you would assemble building blocks to add and to enhance specialty selection. So while your initial choice would be into a so-called core residency such as internal medicine or surgery or pediatrics, you could then go on in the area of pediatrics for instance, pediatric neurology, pediatric gastroenterology, pediatric cardiology, etc. And even from there, you could go on in the field of, let’s say, pediatric cardiology to interventional pediatric cardiology, pediatric cardiology imaging, and any number of other subspecialties thereafter. This is a dynamic process that will occur over your entire career during your lifelong learning in the field of medicine.
Among the questions that I would like you to think about are:
- Are your career interests in a core or a generalist type of career or are you interested
in a subspecialty?
- If you are interested in a subspecialty, what are the fellowship training opportunities and the subspecialty residency opportunities that may be of attraction to you?
- What are the similarities and differences between the careers?
- How long will it take to obtain board certification and become fully vested into practice?
- What are the employment opportunities in a given specialty in a specific part of the
- We are at a time now that there are shortages of both generalist physicians, particularly
in the areas of primary care (which of course includes general internal medicine,
family practice and pediatric) but there are also dramatic specialty shortages in
many of the subspecialty and fellowship trained areas. Knowing where those are and
knowing what the geographic considerations are of your family and your own personal
aspirations becomes a very important part of specialty selection.
- We are at a time now that there are shortages of both generalist physicians, particularly in the areas of primary care (which of course includes general internal medicine, family practice and pediatric) but there are also dramatic specialty shortages in many of the subspecialty and fellowship trained areas. Knowing where those are and knowing what the geographic considerations are of your family and your own personal aspirations becomes a very important part of specialty selection.
- What are the aspirational goals of your family?
- If you have significant personal relationships, either from your parents or the community in which you grew up, and if you need to return there or do not need to return there, those are very important considerations. Similarly, if your spouse, significant other or other family relationships have geographic considerations that you need to be on the “left coast” or the “right coast”, or if you need to stay in the Midwest, those should be front and center in your decision making capacity so you can tailor the choice of not only which specialty, but which programs to apply to accordingly.
- What preparation do I need in order to be a viable candidate in my selected field?
- The preparation for a surgical specialty is typically different than the preparation and the application process for a medical specialty, which is again different from pediatrics and somewhat different from obstetrics, etc.
- Am I interested in a basic science type of research career? Am I interested in a
teaching career? Do I want to be part of an academic health center? Am I interested
in a community practice type of career or a hybrid of all of the above?
- This gets into a question of "what is the application process?" and "what does it take to be competitive?" As I am sure you well know, your scores on the United States Medical Licensure Examination Step 1, your performance in your clerkships and in your preclinical years, as well as the evaluations and letters that you will obtain, are all woven together into the medical student performance evaluation letter which our College of Medicine produces for each and every one of our students. Your ability to successfully compete not only depends upon your grades, your exam scores, it also depends upon your interview. It depends upon whether or you choose to do audition electives, it depends upon what your experiences have been in the past, research in a specific area, and your clinical experiences.
- Put yourself into the role of an interviewer in a subspecialty, and there you are as a fourth year medical student interviewing for a career in neurology or a career in emergency medicine. The faculty member speaking to you says, “Why do you want to do this?” “What experiences have you had that have led you to believe this?” You need to be able to talk them through how you have reached this career selection revelation as to what specialty you want, and what experiences you have had that have reinforced this during the course of your life.
- How do you evaluate a residency program? What is important to you as an individual?
- We all want the most competitive, the best quality and the highest assurances of success
in the selection of residency programs but how do you ask those questions, questions
- How many residents will you enroll?
- What has been the geographic mix of those residents?
- What is your interest and experience in accepting students from the upper Midwest?
- What is career placement like?
- How many of the graduates tend to go into practice?
- How many of them go into academic medicine?
- How many nights am I going to be on call?
- How much do I get paid?
- How much vacation time do I have?
- How am I going to weave that all together with my needs and those of my family?
- We all want the most competitive, the best quality and the highest assurances of success in the selection of residency programs but how do you ask those questions, questions such as:
I think it is very important as you work with the various career mentors to ask them about their professional life, how many hours a week do they work and what options there are. If raising a family is something that is important to you or you have other commitments in volunteer work, perhaps you are very interested in medical mission work, or you want to have some aspect of research or scholarly pursuit in your field, the ability to balance the professional clinical life with other aspects is extremely important and very valuable. Please, don’t underestimate the importance of time with your family and the importance of pursuing things that give you the necessary relief, the necessary “mental health time” to keep you productive and successful in your professional career.
Understanding the differences between the specialties is extremely important. You need to weave that in to your own lifestyle aspirations. Not everybody has the same clinical practice aspirations. Some have very deeply embedded desires to have long longitudinal relationships with patients and families which tends to drive people into more primary care fields. Others are not so interested in the long term (decades long) responsibilities and relationships with patients, but are more interested in the acute care aspect such as emergency medicine, trauma care, critical care and pulmonary specialties, as well as many of the surgical specialties where the physician cares for a patient and a family over a period of time and then transition that care back to the primary care doctors, who will then provide the longitudinal care for that patient.
The information that you are going to get of course will begin to come from these videos and other resources that have been put together. They are excellent. They are very clear and I think they will provide the beginnings of a relationship with you for many of our senior faculty members, who can be the career mentors for you as you go through this thought and decision process. Please be sure that you also realize that you should talk to your classmates, you should talk to your family, you should seek out members of our alumni group of the College of Medicine who have graduated in the last several years who have pursued careers in dermatology and ophthalmology and pediatrics and other fields, and ask them what it’s like, ask them if it meets their expectations. If it does (and you are satisfied with their answers) ask them what process they went through in selecting residency programs, how many interviews they had, how many audition electives they did, etc. That’s the type of practical on-the-ground information that is going to help you be extremely successful in this pursuit. We have many excellent faculty to help you. I am sure all of our alumni are going to be very, very willing to talk to you, but unless you seek them out and ask these hard questions.
Sometimes it is viewed as stressful, arduous and an incredibly complex process. I assure you that as time goes on, the natural process will evolve, your wishes and your desires, your competitiveness, your aspirations and that of your family, will all be successfully woven together into a highly successful fabric that will not only get you off into a wonderful track of graduate medical education, but that will produce a highly satisfying and successful career.
In closure, I would like to thank you for taking the time to use this website and to also thank those who have worked so hard to make it possible, the Office of Student Affairs under the leadership of Dr. Patricia Metting, several of our senior faculty, who will introduce themselves, and also Mr. John Farag and Mr. Mark Tuttle, students who worked long, long hours to bring this together, with the creative talents of the Center for Creative Instruction. I wish you much success as you go through this process, and as your Dean, if I can personally be of any help to you in answering your questions, opening doors, creating contacts, never hesitate to call, email, or stop by. Thank you so much for your time, and safe travels.
Jeffrey P. Gold, MD