Latest / Cut & Tell / How to Choose the Right Medical Specialty | My Journey to Plastic Surgery

Transcript

How to Choose the Right Medical Specialty | My Journey to Plastic Surgery · Cut & Tell

• 0:00
  Hey there, and welcome to Cut and Tell.
• 0:01
  I'm Liz Malfras.
• 0:03
  I'm a newly minted plastic surgeon in the great city of Philadelphia.
• 0:06
  And this podcast is about my journey out of residency and into my first year of practice.
• 0:17
  So this is a special episode today.
• 0:20
  You know, we've been talking a lot about residency, about me getting started in practice, but today is a look back, back into med school.
• 0:28
  So one of the most common questions that I actually get still pretty regularly, is about specialty choice.
• 0:34
  Like, how do you.
• 0:35
  How do you pick which kind of doctor you want to be?
• 0:37
  And I just want to.
• 0:39
  I.
• 0:39
  I know that I.
• 0:40
  I have a kind of unusual journey for how I got into plastics, and so I thought it'd be useful.
• 0:46
  I'm close enough to it that I remember some of the thoughts that I had about why I was considering different specialties, what I wanted to get out of things.
• 0:54
  And so I figured it'd be fun to kind of just like, walk through it.
• 0:57
  This is.
• 0:57
  This is the last episode of season one.
• 0:59
  So this is going to kind of close out my education kind of season about residency, the very first days of practice.
• 1:07
  So that.
• 1:07
  So I thought this would be a nice topic to end things with.
• 1:10
  You know, it's really.
• 1:12
  It's.
• 1:12
  It's fun to think about specialties.
• 1:14
  The other thing that I like about podcasting and kind of why I wanted to do this is it's a little bit more stable.
• 1:20
  It's not as, like, ephemeral.
• 1:21
  Like, everything on social media, you post it, and then, like, 10 minutes later, it's, like, old news.
• 1:26
  And I do feel like I want this to be.
• 1:28
  This is.
• 1:28
  I took.
• 1:29
  I took notes.
• 1:29
  Like, I've got everything that I have to say about specialty choice in this episode, so buckle up.
• 1:35
  If you're not as deeply entrenched as some of us in the medical education pathway.
• 1:39
  Let me just kind of lay out how this works.
• 1:42
  So when you're.
• 1:42
  You're a med student, you spend the first two years just book learning, you know, just like, sitting in the library.
• 1:49
  And then the second two years, you spend in the wards.
• 1:53
  So that means, like, in the hospital on different rotations, where you're learning, learning about the different specialties, or at least some selection of them.
• 2:02
  Somewhere along that line, you have to figure out what kind of doctor you want to be.
• 2:08
  And depending on what you want to do, you might need to figure it out pretty early on, because especially for the more competitive specialties, you can't just.
• 2:18
  It's not just grades, y'.
• 2:19
  All, like, it's not.
• 2:20
  And like grades are largely like going away anyway.
• 2:24
  You gotta get some research going.
• 2:26
  You gotta like meet some people.
• 2:28
  There's all kinds of kind of different flavors to the different specialties and how you have to prepare.
• 2:33
  So this is a really important decision.
• 2:36
  It's very impactful and I remember being very stressed about it because some people come in and they're like, I've been, I wanted to be a cardiologist when I was 2 and I still want to be.
• 2:47
  That was definitely not me.
• 2:49
  I, I'm just, I've never been that kind of person.
• 2:52
  And so for me especially, I think it did require some real soul searching.
• 2:57
  Honestly though, it's also, it is fun to think about.
• 3:00
  Like this is one of those, I would definitely categorize this as that good stress.
• 3:04
  It's really a question about what you want your life to look like.
• 3:07
  Who do you identify with?
• 3:09
  Like, what.
• 3:09
  There's so many different kind of personalities and flavors with all these specialties and like, where do you fit?
• 3:14
  It also though, is a lot of pressure because this decision is, once you make it, it can be hard to undo.
• 3:20
  Like, you'll hear in my story, like, I went back and forth a lot, but once you pick it, especially once you apply to residency in that specialty, it's not impossible to switch lanes and people certainly do, but it
• 3:33
  gets a lot harder.
• 3:34
  And so this is a little bit too of like in Harry Potter with the Sorting hat.
• 3:39
  Like you want to be, you want to pick the specialty, that's your people, where you belong.
• 3:44
  And it can honestly sometimes also just feel sort of like it's out of your hands.
• 3:48
  And it's certainly by no means like an evidence based process.
• 3:51
  A lot of this is.
• 3:52
  So anyway, how did I end up in plastics of all places?
• 3:56
  So I started out very far from plastics.
• 3:58
  So I just to back up a little bit, I went to med school as an older student.
• 4:04
  So I took five years off, like, or, you know, that's how we say it now, but like, in reality I just had a different career for five years and then I decided to go back to med school.
• 4:12
  So I worked in health policy and a lot of my work was in sort of like healthcare measurement.
• 4:17
  So it was very like internal medicine focused if anything.
• 4:20
  But.
• 4:21
  And while I was working that job, I had the opportunity to get to know some doctors because I worked with this kind of committee of expert doctors.
• 4:28
  And that's really how I decided, like, I can do this.
• 4:31
  You know, Like I, I think up in, I think when I was Younger.
• 4:34
  I thought that med school was too hard.
• 4:36
  I didn't think I was smart enough, didn't think I had what it takes, which is sad to me looking back, but that's the truth.
• 4:42
  And so I think getting to work with these doctors directly sort of demystified it a little bit to me.
• 4:47
  And.
• 4:48
  And I also.
• 4:48
  I was tired of having a desk job.
• 4:52
  And then the other piece for me is I was at a point in my career, so I had a.
• 4:57
  I had a master's degree, and I was very successful in my time at the Institute of Medicine, the National Academies, but I was already at a point just like four or five years out, where I couldn't really rise
• 5:09
  up in that field without a terminal degree, so without a PhD or an MD.
• 5:16
  And that's not really.
• 5:17
  I felt at the time like it was very unfair.
• 5:19
  But it's just the reality, especially in something like health policy, where you have so many Doctors, so many PhDs working in that space.
• 5:26
  It just became clear to me that I was gonna be.
• 5:29
  I kind of had hit the ceiling on my current career.
• 5:32
  And so I honestly went to med school with the idea that, you know, if I hate this, if medicine is not for me, I can always just come back, and I'll be able to come back, and I'll be
• 5:44
  able to rise up again.
• 5:45
  That was always sort of my exit strategy.
• 5:47
  But obviously, in the end, you know, here I am.
• 5:49
  So that's not exactly how it happened.
• 5:50
  But I.
• 5:51
  I was someone who always was thinking about exit strategies.
• 5:54
  So early on in med school, I actually thought a lot about the idea of being a hospitalist, which I see now seems insane.
• 6:02
  But it's really interesting how how your mindset changes throughout.
• 6:06
  Throughout med school and how.
• 6:08
  How different your ideas of what these jobs are, like, are depending on.
• 6:12
  On where you're at yourself.
• 6:14
  So for me, part of the appeal of hospitalist kind of life was having the option to work.
• 6:20
  Like some.
• 6:21
  Some of them work, like, two weeks on, two weeks off.
• 6:24
  Like, having.
• 6:25
  Having a job where you work really intensely for a while, and then you have a big break.
• 6:30
  In a lot of ways, I think that was like, a match for my personality in a certain way, and that I'm an intense person.
• 6:36
  Like, I sort of like to, like, go, you know, full throttle on something.
• 6:40
  And I think that also was appealing to me because I had this distill interest in health policy.
• 6:46
  You know, I can, like, I can be a hospitalist, and then I can.
• 6:49
  I can write, I can do other stuff.
• 6:51
  During that other time.
• 6:53
  I Also think I.
• 6:54
  I, early on in medicine, was really enamored with some of the complexity of medicine.
• 6:59
  You know, I'm a nerd.
• 7:00
  And some of that stuff you learn early on in med school that I've definitely forgotten now.
• 7:04
  A lot of it, it's very interesting.
• 7:06
  Like, I got.
• 7:06
  I got into that kind of mindset of, like, this is really cool how all these systems work together.
• 7:11
  And so that was my initial thought early on.
• 7:14
  When it actually came time to get serious, though, I sort of changed my tune.
• 7:19
  I got really interested in urology.
• 7:21
  As often happens, this was because of a mentor.
• 7:25
  I think a lot of times we get into a specialty kind of area, and it's because there's one or two people who we connect with, and we're like, this is who I want to.
• 7:34
  This is who I want to be.
• 7:35
  Like, this is who I want to work with.
• 7:37
  And that's how you end up there.
• 7:38
  So urology, for me, I had this really great friend who is famous at this point, but she hasn't always been that way.
• 7:44
  I knew her before that.
• 7:46
  Rachel Rubin is a urologist who specializes in women's sexual medicine and sexual medicine in general.
• 7:52
  She is amazing.
• 7:54
  And I knew her back, like, before she went to residency.
• 7:59
  And so I just.
• 8:00
  I found her kind of journey really inspiring.
• 8:02
  She really liked urology.
• 8:04
  I thought it was kind of awesome to be a woman in urology.
• 8:07
  And I also had started to think that I wanted to do something where I would be able to do procedures and clinic.
• 8:15
  So this is.
• 8:16
  I don't.
• 8:16
  I don't.
• 8:17
  To me, this is, like, me inhabiting my old brain, like, now.
• 8:20
  That doesn't make any sense to me.
• 8:21
  But at the time, I remember just, like, saying to myself, I want to do something where I have procedures and clinic.
• 8:28
  And I think my reasoning was that I knew I wanted to do something with my hands, but I also knew that I.
• 8:37
  I didn't know that I wanted to do, like, the level of intensity of, like, general surgery.
• 8:42
  Like, I'd seen some of that, and I wasn't sure that was me.
• 8:44
  So I think it was partly me hedging, being like, how can I have it all?
• 8:48
  How can I have a lot of options again?
• 8:50
  I'm also, like, always a catastrophizer.
• 8:52
  And so I also thought where you have procedures in clinic gives you a lot of flexibility.
• 8:56
  You can, you know, early on do more procedures, you can flex to do more clinic.
• 9:00
  I just sort of felt like I had, like, a wide open field.
• 9:02
  The other thing that was on my mind Is that specialties like urology, so these kind of like, specialty surgeries, some of the other.
• 9:10
  Some of the other more competitive specialties, you need some lead time to get into those, and you don't really so much if you want to be a hospitalist.
• 9:17
  And so I also, I think, was feeling like I should kind of try this out, see if urology feels like a good fit for me.
• 9:24
  And if not, hospital is still there and I won't.
• 9:27
  I won't have lost anything.
• 9:28
  So I tried my best, especially in my second year of med school, to start getting involved a little bit in urology.
• 9:35
  That was kind of several different things.
• 9:37
  I did some shadowing.
• 9:38
  I met some other really great, awesome urologists who I really liked and was, like, feeling good about.
• 9:43
  Like, I think this person.
• 9:44
  This is like a good personality fit for me.
• 9:46
  And then I also got involved in some research.
• 9:48
  And so I kind of got.
• 9:50
  I sort of, like, tried to invest in this world.
• 9:52
  I could imagine myself as like, I'm a urologist.
• 9:55
  What does that look like?
• 9:56
  And I sat with that for a long time.
• 9:57
  Like, honestly, I thought urology for a good stretch of med school.
• 10:00
  There are a couple other specialties that I kind of flirted with briefly along the way.
• 10:05
  For me, there was one point where I had.
• 10:06
  I think I had a slow month.
• 10:07
  There was some rotation I was on that wasn't super busy.
• 10:11
  And so I found, like, you know, I very did this very deliberately.
• 10:17
  I.
• 10:17
  I went out and I was like, what are other specialties that are intriguing to me?
• 10:21
  Let me find somebody and I'll go, at least spend a day.
• 10:24
  Know, just try to get a flavor for it.
• 10:26
  I remember shadowing with interventional radiology.
• 10:30
  Again, I had this idea of, like, procedures in clinic.
• 10:33
  And so I was interested in this sort of like, interspace.
• 10:36
  And then I also visited someone in interventional cardiology.
• 10:40
  Again, similar vibes or like, medicine, procedures, et cetera.
• 10:44
  And there were a couple others along the way, but those are the.
• 10:46
  The two that I most remember.
• 10:47
  But neither of them really grabbed me.
• 10:49
  Like, I don't know, I just didn't maybe.
• 10:52
  And again, a lot of this is hard to suss out.
• 10:54
  Like, is it just that I didn't, like, the personalities weren't a good match?
• 10:56
  Did I just go shadow on, like, a weird day?
• 10:59
  Or, like, is that clinic not the kind of clinic for that that I would want to be a part of?
• 11:04
  You're always making this kind of decision on very weird, imperfect, random kind of information, but that's.
• 11:11
  That's what you got and that's what you gotta move forward with.
• 11:13
  So I really.
• 11:14
  I.
• 11:15
  I felt like I looked around, thought about some other things, still liked urology the best.
• 11:19
  So I was, like, fully on board with urology pretty deep into third year, and then was getting comfortable.
• 11:24
  Med school threw a big twist my direction.
• 11:27
  So I was on my general surgery rotation at the va, and at this point, I was still, like, set on urology.
• 11:32
  So I was very invested in that.
• 11:34
  Like, you got to do well on gen surge if you want to do subspecialty surgery.
• 11:38
  So I was, like, working my butt off.
• 11:40
  And we had this case.
• 11:42
  It was colorectal cancer reconstruction or colorectal cancer resection that I was a part of with the general surgery team.
• 11:50
  So this surgery is.
• 11:52
  It's called apr.
• 11:53
  I won't.
• 11:54
  We'll belabor it.
• 11:55
  But basically.
• 11:55
  Basically, they get an ostomy, and you remove the anus.
• 12:00
  So, like, you.
• 12:00
  You basically leave this huge hole where someone's butt was.
• 12:03
  And this is not.
• 12:03
  This surgery is a lot.
• 12:05
  It's.
• 12:05
  This isn't.
• 12:06
  For me, at that point, I had not really seen something like this.
• 12:08
  This is a.
• 12:09
  It's a very big, very open surgery.
• 12:11
  It is sort of shocking, honestly.
• 12:13
  Like, I was still early enough to be like, wow.
• 12:16
  And at the end of that case, I remember this moment where, you know, this patient has their bellies open.
• 12:22
  They got a new ostomy.
• 12:23
  They got this giant wound.
• 12:25
  And then all of a sudden, the surgeons and looked at each other, and they're like, okay, job done.
• 12:30
  And everybody starts walking away.
• 12:32
  And I remember being like, what?
• 12:35
  This.
• 12:35
  This is not done.
• 12:37
  Like, how.
• 12:37
  This is obviously not complete.
• 12:38
  Like, what are we.
• 12:39
  What are we doing?
• 12:40
  And as a.
• 12:41
  As you often are, like, as a messenger, like, you.
• 12:42
  You're just like.
• 12:43
  You're just.
• 12:43
  You're behind.
• 12:44
  You're trying to understand what's going on, but no one's telling you.
• 12:47
  And so that's sort of what I was thinking at the time, as I was like, y' all have.
• 12:50
  We have.
• 12:51
  We helped this man.
• 12:52
  It doesn't really look like it.
• 12:54
  Q Plastics TEAM so I was so, like, not cool with what was happening in this or that.
• 13:00
  I asked if it was okay if I stayed, because plastics was gonna come in to close, and in my mind, I was looking at this, and I was like, how are they gonna close that?
• 13:09
  Like, that's not.
• 13:10
  That's too big.
• 13:10
  That's not gonna work.
• 13:11
  I had no idea how this could possibly be closed.
• 13:15
  So in comes plastics.
• 13:17
  Plastic surgery at this institution was two amazing young Women attendings.
• 13:23
  They are amazing.
• 13:24
  They mentors of mine.
• 13:26
  Their names are Katherine Hannon and Lauren Patrick.
• 13:29
  They have a practice.
• 13:30
  They work together, actually, in D.C.
• 13:32
  still.
• 13:33
  And they changed the music from whatever like, yacht rock it was to Taylor Swift.
• 13:38
  And they just got to work.
• 13:39
  Like, they were so cool.
• 13:41
  And basically what they did in this surgery, this is like, the first plastic surgery I ever saw, is you take the muscles from the insides of your legs and some of the skin, and you basically, like, flip it
• 13:52
  up to close this giant hole where the butt was, and then you're able to close up the incisions on the leg so there's not any open wounds.
• 14:00
  And this just totally.
• 14:02
  I didn't know anything about this.
• 14:03
  I was like, what?
• 14:05
  This happens?
• 14:06
  This is a thing?
• 14:07
  And it just totally blew my mind.
• 14:09
  And right away, I got launched because I'm, you know, I'm a.
• 14:13
  I'm a stress person.
• 14:14
  So I immediately started to get worried.
• 14:16
  Honestly, like, I was really excited to see this, but I was also like, oh, no, it's too late.
• 14:21
  I really.
• 14:22
  I thought at the time that it was too late for me that I could not possibly change streams from urology.
• 14:27
  It was, like.
• 14:28
  I think it was January of my third year.
• 14:30
  And so you're already at that point, looking towards applying.
• 14:33
  I did all my research.
• 14:34
  I was, like, ready to go.
• 14:36
  And I was like, oh, no.
• 14:37
  What have.
• 14:37
  What am I gonna do?
• 14:38
  Like, I just.
• 14:39
  I just have to go ahead with urology.
• 14:41
  And luckily, I talked to a lot of my friends about it, talked to my.
• 14:44
  Talk to my husband about it, too, and they basically convinced me, like, it's not too late.
• 14:49
  And what I had to sort of grapple with was that even just seeing this one case, I had such a reaction to it.
• 14:56
  It was so clear in that moment that, like, this is me.
• 15:00
  And that felt so different than what had happened with urology.
• 15:03
  So urology, I think I was a very deliberate practical choice.
• 15:06
  I was like, these are the things I want.
• 15:08
  This matches that.
• 15:09
  This seems cool.
• 15:10
  Like, let's do it.
• 15:11
  Whereas plastics, I saw it, and I was like, oh, that's what I want to do.
• 15:16
  And then when I reflected on my urology experiences, honestly, my favorite in urology had been the complex reconstructive cases.
• 15:25
  And so to me, that sort of made sense.
• 15:26
  I was like, the things that I liked about those urology cases are kind of the main thing that's going on in plastics.
• 15:33
  That's.
• 15:33
  That seems like what I like.
• 15:35
  Like, you know, some of this is not definable, but that's what I found compelling.
• 15:38
  And if that's what I found compelling, I should do the field that's mostly that instead of doing urology and then trying to like specialize in this hyper specific thing.
• 15:47
  So at that point I got to work.
• 15:49
  Like let me tell you, this was a busy time.
• 15:51
  So over basically was right before I think New Year's.
• 15:54
  So over that holiday weekend I made this whole plan.
• 15:58
  I was like, if we're going to do this, we got to get serious.
• 16:01
  And a lot of it was networking.
• 16:03
  So I made a lot of efforts early on just to make connections in plastics.
• 16:08
  I reached out to some folk who had graduated from my program in the recent past who had done plastics and that was, that ended up being one of the most helpful things just to understand what I needed to
• 16:18
  do from the specific perspective perspective of my institution and like what resources I had.
• 16:24
  And I just, I don't know, I just, I was able to, I was able to get there.
• 16:29
  It was a, a time of a lot of work.
• 16:30
  But even that late in the game I was able to turn things around.
• 16:34
  And then as one little coda, I did.
• 16:36
  So obviously I matched in plastics and was very happy.
• 16:39
  But I did do a derm rotation after I'd matched in plastics.
• 16:44
  And I remember thinking at the time, like, what do I do if I go to derm?
• 16:48
  And I'm like, wait, this is even better.
• 16:51
  Like, well, I was like, almost was nervous about doing this rotation cuz I like didn't want to be.
• 16:55
  Like there's a lot of, there's a lot of peeling about derm.
• 16:58
  And so anyway, fortunately, after a couple of their Kodachrome sessions, which are literally like, they sit in a dark room and look at pathology slides and like talk about like a different language I don't understand.
• 17:10
  Fortunately for me, I, it was not, I was not drawn away.
• 17:14
  Like, it wasn't.
• 17:15
  It's an amazing field.
• 17:16
  Like so much respect for it and also like definitely still envy them on certain days.
• 17:20
  But I realized I was like, no, no, no, these are not, these are not my nerds, you know.
• 17:24
  So to close things out, I do want to look back on of like did I pick right?
• 17:29
  Did this work out well?
• 17:31
  And I have thought a fair amount at different points in residency about, you know, like, what if I had picked something else?
• 17:38
  You know, like, do I have any regrets about this?
• 17:41
  Overall, I would say no.
• 17:42
  But there are some things.
• 17:43
  I think the main thing that I have realized about my specialty choice that I didn't understand going in is how serious Surgery is.
• 17:56
  Surgery is visceral.
• 17:58
  It is immediate.
• 17:59
  It has very fast, very intense consequences that can be hard to predict.
• 18:05
  People can die and do die getting plastic and reconstructive surgery.
• 18:10
  The st.
• 18:11
  The stakes are incredibly high, and I sort of knew this intellectually, but I think until you're a resident or honestly, like, I'm sure it's going to be even realer as an attending, you don't understand how that feels and
• 18:25
  how that is going to affect you.
• 18:28
  And what I've had to come back to, and this is something that I came to realize or sort of like, would.
• 18:35
  It's like almost like a mantra that I would say to myself when I was feeling stressed or when I felt like I wasn't doing a good job, is I truly believe in my soul that I am the kind
• 18:46
  of person that I would want as a doctor, as a surgeon, I'm incredibly conscientious.
• 18:52
  I, you know, like I've said, I stress about stuff.
• 18:55
  I'm anxious about stuff.
• 18:56
  That is the kind of doctor I want.
• 18:57
  I want that person to be worried about me.
• 18:59
  And so I.
• 19:01
  Even on my bad days, I come back to that.
• 19:03
  And that, I think, has helped me sort of maintain a feeling of security when I have a bad day, which always happens in medicine.
• 19:12
  The other thing is, I think there may be some other fields where you have more predictability, the evidence base for surgery and like, the.
• 19:19
  The reasons we do what we do it.
• 19:22
  I don't.
• 19:23
  I mean, I.
• 19:23
  This is my only experience to get in this deep, but I think it's.
• 19:26
  It's nowhere near as solid as something like, you know, like, cardiology, radiology, like, they're just.
• 19:32
  I just think there's so much variation.
• 19:35
  And no matter how good you are, no matter how much you prepare, no matter how much, you know, like, things just go.
• 19:41
  Can still go wrong, there's always complications.
• 19:44
  And that is a tough thing, I think, for all of us in the field, because all of us are.
• 19:51
  Tend to be like, type A perfectionist.
• 19:53
  Like, people who do not make mistakes do not like to make mistakes.
• 19:57
  And contending with that reality is tough.
• 20:02
  So there are times I definitely have had days where I.
• 20:04
  And I usually joke about it being derm, where I'm like, man, like, wouldn't it be nice today if I could just clock out and go home?
• 20:10
  And that would be it, you know, and we say that to each other.
• 20:14
  And I.
• 20:14
  I recognize that it's probably kind of rude to dermatologists because it's not like derm doesn't have its own stresses, but I think it's always n.
• 20:22
  I think it's natural to still have that grass is greener attitude every once in a while.
• 20:28
  But overall, I do feel that plastic surgery is the right match for my personality.
• 20:33
  I was like, we think about problems in a similar way, and I don't think there's anything wrong with it that way.
• 20:39
  Like, I think in a lot of ways, your happiness at work is going to be about who you're working with, and it's going to be.
• 20:46
  It's going to be about these factors that aren't just medicine, you know, like, it's not just the science.
• 20:51
  It's not like the factoids that you're using every day.
• 20:55
  It's a lot about the environment you want to be in.
• 20:57
  And plastic surgery honestly has some things that are special about it, especially for someone like me, who likes to have a lot of options, likes to have an exit strategy.
• 21:06
  I think that plastics has some of the most flexibility of any of the specialties, actually.
• 21:14
  And part of that is that it's, you know, like, I chose to go into private practice.
• 21:18
  Private practice is not an option, increasingly, in a lot of places for different specialties.
• 21:23
  And that's something you gotta think about.
• 21:24
  And I didn't.
• 21:26
  I definitely didn't plan to go into private practice.
• 21:28
  That was never in my head, really, like, pretty deep into residency.
• 21:33
  But I knew that plastic surgery, you could be a lot of different kinds of things at plastic surgery.
• 21:38
  You can be a hand surgeon, you can treat children, you can be a pediatric craniofacial surgeon, you can do general reconstruction, you can work in a hospital, you can work in private practice.
• 21:46
  Like, there's so many options.
• 21:48
  And that I think is a nice thing to have, or at least, I don't know.
• 21:52
  I guess what I'm learning from this conversation with myself is that I care a lot about options, flexibilities, exit strategies.
• 22:00
  And plastics has a lot of that.
• 22:03
  I don't know that that's the right way to think about it at all.
• 22:05
  Like, I really.
• 22:06
  In a lot of ways, I think this is a choice that you just make at a time in your life based on what information you have and you move forward with it.
• 22:15
  And if I look back, like, probably if I.
• 22:17
  If I'd been a hospitalist, I think I would have made that work, you know, Like, I think that there's.
• 22:22
  There's ways that I could have been happy in a lot of different specialties.
• 22:26
  And so it's not to say it doesn't matter, but it's just to say, like, you can.
• 22:30
  You probably have multiple possible pathways that you could choose that would lead to you being a happy, satisfied doctor.
• 22:38
  Professional.
• 22:39
  So my advice to anyone who is struggling with this decision is, I think the most important thing is just if you're not sure what to do, you need to get more information.
• 22:47
  Like, do not sit in your room and just like, you know, stress or like, make pros and cons lists or anything like that.
• 22:53
  Like, you gotta go out and see what it's like.
• 22:56
  Because the actual job of being a doctor is so different than a.
• 23:01
  I think what we theoretically imagine it to be, even in med school, because it's not.
• 23:06
  Again, it's not about that knowledge.
• 23:07
  It's not about the stuff that you know.
• 23:09
  It's about the patients you're seeing.
• 23:11
  It's about what your environment is like.
• 23:13
  All of that stuff I think matters a lot more for job satisfaction.
• 23:16
  So if you, if you have a couple specialties you're thinking about, just reach out to somebody, go spend a day with them, go sit, stand in the corner and look at what their life is like and think about
• 23:26
  whether that is a good fit for you.
• 23:28
  None of this is ever truly terminal.
• 23:30
  Like, as you, as you get deeper into things, it becomes harder to switch.
• 23:34
  And there probably are ultimately some paths that do get.
• 23:37
  Like, for example, like plastics.
• 23:39
  Plastic is so competitive and so, like, if you're deep into some other residency, like, it's not impossible, but you might be looking at taking a lot of additional years of your life to actually make that switch.
• 23:49
  But I do know many people actually in my residency that I came across who switched specialties.
• 23:55
  I think it's more common than people realize.
• 23:57
  So if you get into something and it's really not for you, you still have options.
• 24:01
  Like, yes, it gets tougher, but, you know, life is long and you gotta make the right choice for you.
• 24:05
  And like, for me, like, I would it have been great if I wanted to go to med school right out of.
• 24:10
  Right out of college, Like, I would be five years younger right now.
• 24:13
  That might.
• 24:13
  That might be kind of nice, honestly.
• 24:15
  But you, you can't control all this stuff, unfortunately.
• 24:17
  But I promise you, kind of no matter how you get there, you will look back on those experiences of trying something that ended up not being quite right for you and view it as use because you learn about
• 24:27
  yourself.
• 24:28
  We over emphasize this as like, this choice you have to make and then be done with it and like, move forward.
• 24:33
  And I think in reality, you should definitely view it as more of an exploration of who you are, what you care about, and what kind of options you have in the world.
• 24:40
  Thank you for listening to Cut and Tell.
• 24:42
  If you enjoyed this episode, please subscribe, rate us five stars and leave us a review.
• 24:47
  I love to read the reviews and then check out all of our other amazing shows and episodes@Hippocratic-Collective.com.