My medical indecision

I had written previously about the huge question that medical students face when they are forced to pick a residency. I was only a lad of 22 when I first realized that in some regard, my career choice would fall somewhere along the greed-altruism spectrum. At one end is the Paul Farmer-esque physician who fights relentlessly for the health and well being of the poor and the underserved. On the other end is the Beverly Hills plastic surgeon whose practice is largely economically driven and makes millions off of people's personal insecurities.

I have pondered endlessly on this topic. A huge part of me wants to specialize in something. I always envied the cool, collected surgical specialist who provides their unique skills and focused knowledge whenever the primary care doctor requests a consult. At the same time, I am truly inspired by people like Paul Farmer whose dedication to places like Haiti are truly making a difference in the lives of the poor.

Aside from these issues, I also found myself interested in about every medical specialty I tried. From family practice to radiology to medicine to plastic surgery, at one time, I entertained the idea of chosing most any medical field as my career (with the obvious exception of Ob/Gyn, the worst job on the planet).

But, after all this, I think I am down to something that might resemble a decision. Sort of. I am fairly certain that I want to work in some sort of emergency care setting. This limits me to a short list of fields. Emergency medicine, trauma surgery, and ortho trauma are really the only people who spend all their time in the ER. I have always had an interest in EM, but wonder if I would really want be an EM physician taking care of drunk teenagers at 4:30 am when I am 60 years old. Trauma surgery was a possibility, but I dont think I can subject myself to the world of general surgery. I have a healthy fear of colostomy bags and also would like to someday have a life outside of the OR.

In my twisted logic, this leaves me with two options. A five year, combined emergency medicine-internal medicine residency (aka EM-IM) and ortho trauma. EM-IM would give me a very diverse background but more importantly, would give me an easy out of the emergency room when I am too old to stay up all night. An EM-IM doc is just as comfortable in an emergency as they are on the wards or in a private clinic.

Ortho trauma would let me be a specialist, but would allow me to treat patients that acutely and desperately need orthopedic intervention. Ortho trauma surgeons assess, manage, and operate on victims of major trauma. They would set your 8 year old's broken arm but also spend 10 hours in the OR repairing a trauma patients shattered pelvis. I think being a specialist like this would help me get past the whole depending on consult problem I see with fields like medicine or pediatrics.

In a sense, I am down to the same argument as before, whether I want to know a little about a wide variety of topics or know a lot about one topic. But for the first time I have some direction and some idea of where I might end up in 5-6 years.

More importantly, this small step toward a decision has allowed me to think about how I would set up my 4th year rotations. Currently, I am planning on doing away rotations in EM and ortho trauma early on to help me make up my mind.

Well, thats where I am. Would appreciate any comments!