The dean addressed my class last year. Being MS2's on the verge of Step 1 and clerkships, I know that we were all anxiously awaiting our big leap into third year, away from the daily grind of lectures & exams - that felt like a more intense extension of undergrad. I know I definitely was.

Our dean was very sincere and wanted us to remember that while medicine is absolutely a calling, it is also a job. A job that we will have to go to, make a living from, and often spend more time at than we do at home. This struck me as a surprise, though it shouldn't have - my husband has been telling me this for years. Still, I refused to believe it. After all, my personal statement it its meticulously crafted wording, imagery and passion did not have room for the possibility that medicine could be reduced to a "job."

As third year has slowly marched past its half-way point, the pressure to commit to a speciality is very real. For some, third year confirmed their interests and solidified their career goals. For most, however (myself included), it has been a year of soul searching. While the hours we work as third years are usually less than the residents, it's the most time many of us have worked in our lives. On top of spending hours at the hospital or clinic, we still study and balance families - a huge transition from the lecture-based schedules of our past. It is also the first time we have become active participants in the care of our patients. The experience is life changing; no amount of research or shadowing can give you a better perspective into a specialty than third year, which is limited to begin with.

I've heard of third year students becoming "jaded," but now I like to think I have a little more insight into the issue. In my experience, we retain our passion for helping people, improving their lives through medical care, and genuinely care about the well-being of our patients. But something definitely changes and that's the sudden realization that we will have to factor in our priorities (family, personal time, hobbies, etc) into our lifelong career. And that's where the the big questions arise: what field of medicine will make those brutal years of residency worth being away from the things and people we love? What will I be happy doing many years from now?

I've been reading Dr. Paul Kalanithi's memoir "When Breath Becomes Air" (which is just absolutely wonderful by the way). In it he mentions that he watched as:

"one by one, many of my classmates elected to specialize in less demanding areas (radiology or dermatology, for example) and applied for their residencies...by the end of medical school, most students tended to focus on 'lifestyle' specialties - those with more humane hours, higher salaries, and lower pressures - the idealism of their med school application essays tempered or lost."

This paragraph struck me. The latter part of it putting into words some of the emotions I had been battling through. I went into medicine because it is my calling and I never saw myself doing anything else. I had experiences that solidified my passion, and some that even cost me my own health but also clarified what kind of doctor I wanted to be. In my med school personal statement I promised to approach the care I provide holistically, with humanism at its core. That hasn't changed. But I would be lying if I said I have not grown and changed in the years since starting med school. I've become more of an adult in med school, not only because I've hit the mid-20's mark but also because I have a clearer vision of what I want in life and how I want to make an impact. I've learned that placing your work above yourself and your family is detrimental and, frankly, unsustainable. So certainly, at some point your interests must come before your patient's when it comes to being able to take care of yourself. How can we provide the best care when we ourselves are far from whole? Medicine is a calling, but doctors are also human.

We are not only searching for the field of medicine we enjoy the most but also making an attempt at predicting what we will still get out of bed for in 30 or 40 years, when our bodies have inevitably lost their youthful vigor; when our priorities have changed and we simply see life differently.  As one of my attendings so eloquently put it, "as humans, we are tragically bad at predicting what will truly bring us happiness." And when it comes to choosing a specialty, the stakes are pretty high. Some people may choose to switch specialities mid-residency, but for most of us that's not an option when years of education, student debt, and anticipation are relieved by the light at the end of the tunnel that is completing residency and being a bonafide doctor.

For all of these reasons and many more, choosing a specialty is hard. I feel very privileged to be in a position where I've earned the right to make this decision but it is a big one indeed.

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I am really interested to hear what other med student's thought's are on the subject, so please leave a comment below!