As a third-year medical student, Vamsi Aribindi, MD, had a problem: He liked everything. Sure, that made his core clinical clerkship rotations enjoyable. But with residency applications—the de facto deadline to finalize one’s physician medical specialty—looming, charting his next move was going to be difficult.
Internal medicine, emergency medicine, general surgery—they all had their appeal. But Dr. Aribindi was determined to pick one. He was on the precipice of applying to emergency medicine programs, when a comment from a surgical fellow during a rotation—"you’re 100% a surgeon,” she said—gave him pause.
After further exploration, Dr. Aribindi decided to pursue general surgery. Now a cardiothoracic surgery fellow, he offered insight on how he arrived at his specialty decision and what medical students should know if they are stuck between two paths.
Clerkships aren’t the full picture
It varies significantly by specialty, but a medical school rotation might not offer a student the full picture of what it’s like to practice in a specialty. This can be particularly true in surgery.
“Surgery is not one of those specialties where med students get a true idea of what it’s like day to day on rotation,” said Dr. Aribindi, an AMA member. “Deciding on surgery is like watching someone knit for six hours a day and then deciding you want to be a knitter for life.”
Like most medical students, he primarily assisted and retracted in the operating room, which is not ultimately what a surgeon does. He reflected on other rotations that tapped into the same skill set.
“There was a lot of running around and doing procedures,” he said of his emergency medicine subinternship. “I remember doing a laceration repair independently and thinking it was awesome—and that the part I liked best about the rotation was the procedures.”
For medical students he advised that it’s best to take note of what energizes you across all your rotations—and ask whether a specialty might eventually bring those elements together.
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Take the long view
When considering surgery, he would be assisting and covering the floor early during residency. But that role soon evolves.
When breaking down life in the specialties he was considering, he visualized himself doing common tasks in each specialty and considered how those would feel over time.
“Try to sit down and imagine your life, 10 years from now when you finish training,” he said. Think about and try to imagine what that would be like and what would make you happy.”
In doing this exercise, Dr. Aribindi found that several aspects of surgery would make him happy in the long term.
“I wanted to be doing something with my hands,” he said. “I wanted to be doing something physical. I wanted to have a sense of accomplishment every day. I wanted to be like the expert in this one area but also still use a lot of knowledge of physiology and medicine.”
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Think about lows
Reflecting on rotations, students may focus on the highs. But every specialty has cons that need to be factored into your decision.
“Think about the bad days and the worst parts of a specialty, can you deal with those?” Dr. Aribindi said.
For some surgical fields, major cons include being constantly responsible for patients, even at personal cost. “If you're at your kid’s baseball game or out with friends and your patient is not doing well you may have to leave whatever event you're at and go back and take care of your patients.”
By contrast, emergency medicine offered a job that allows physicians to leave work at work, but the day-to-day of working an ED could come with another kind of strain.
“There’s so much you can’t control and patients you can’t help,” Dr. Aribindi said. “Over 10 or 15 years, I would think that would really grate on me. It’s more important to pick a specialty where you can tolerate the worst days rather than one where you love the best days.”
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Don’t focus on fellowship
While Dr. Aribindi ended up going the fellowship route, he said factoring that possibility into your specialty choice is perilous.
“I ended up choosing cardiothoracic surgery, but I would have been very happy being a general surgeon,” he said.
“You always have to be ready and happy to stop with that next training program,” he said. “Don’t choose internal medicine just because you want to do cardiology. That fellowship might not happen for a number of reasons.”
The power of one
Many medical students submit applications to more than one specialty, but for Dr. Aribindi, that wasn’t the right path.
Despite seriously considering both general surgery and emergency medicine, he chose to focus solely on one. “I went all in on general surgery,” he said.
In his view, dual applying makes the most sense when it’s done to improve your chances of matching—rather than because you’re struggling with a specialty decision. A focused, consistent application, Dr. Aribindi believes made his Match success more likely.
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There’s no perfect fit
While the choice is significant, Dr. Aribindi encouraged students to see it in perspective.
“In the end you’re probably going to be OK, you’ll probably like where you end up, and if you can’t stand it, you can ultimately leave and re-apply,” he said. “It’s a tough decision, but there is no perfect decision in life. Make the best choice you can and then try to make the most out of it during residency, and remember you’ll have a lot more control to practice the way you like once you graduate.”
