For the Love of Medicine: Remedies for Surviving “Specialty Shaming”

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By Shoshana B. Weiner

“You’re making a terrible decision.”  The surgical fellow was on a rant.  I stood silently for some thirty minutes trying to maintain my composure as he criticized my decision to apply for a pediatrics residency. This memorable event occurred during my surgical rotation, and yes, during a surgery. Apparently, in this fellow’s view, the biggest problem with pediatrics is that it is a team-based field.  When people work as a team, he insisted, everyone “needs to have their own say and nothing gets done.”  Instead, he argued for a more directive approach – say what needs to be done and that’s it.  End of story, no questions asked…

He had plenty else to say that day.  While this scenario is rather drastic as far as “peds-bashing” goes, the sentiment is not unique. I  have had other more subtle negative reactions to this very personal decision.  “You know what you’re getting into, don’t you?” a mere acquaintance asked.  “Your hours will be hell.”  Not much later, a family friend at a dinner party frankly stated, “Well, you’re never going to make money in that field.” In discussing this with my peers, I realized this is not atypical.  One friend applying in psychiatry is often informed she will not practice “real medicine” while another applying for surgery is told she will never have time for a family.  Unfortunately, specialty stereotypes linger as “illusions we create in order to make sense of a messy world.”1 The common denominator is an instinctual negative reaction to the decisions of others.

To counterbalance this, I would like to point out some wonderful interactions I have had with mentors in multiple specialties.  During my second year of medical school, I attended weekly “Introduction to Clinical Medicine” sessions at a local Emergency Department (ED).  Our ED small group physician-facilitator was a pillar of support and encouragement.  He continuously emphasized that we could accomplish whatever we set out to do and reminded us that medicine would only be fulfilling if we chose a specialty we loved. His words stuck with me through the most rigorous months of third year.  On a similar note, a mentor in pediatrics has taken the time to meet with me both in person and over the phone to encourage and guide me through the decision process. Not least have been my classmates, who have been unwavering in their encouragement both for me and for each other.  These gems have formed my support system and have been my source of sanity throughout this process.

Still, the opposite end of the spectrum is all too prevalent.  Maybe it’s because we’re hard-wired to negative bias that we have to work that much harder to engage a positive lens.2  I believe that the remedy lies at the heart of medical education.  The cynicism and denigration that has crept into our profession must be combated at the very beginning of a student’s medical career with a culture of community and support.3  Those times that physicians, anywhere on the spectrum from interns to department chairs, have sat down and taught me what they could rather than looking the other way or treating me as “just another medical student” have been the best and most exciting parts of my training.  I hope that educators in the classroom and on the wards can find ways to engage students in a positive learning environment4 and offer encouragement in order to build resilient and confident doctors who are and will remain invigorated by the medical field.  What you say and what you don’t say makes a difference.

Dr. Sunit Das, a Toronto neurosurgeon and scientist with a humanities background, advised, “Do the things that actually mean something to you.  Don’t let people tell you that choosing a particular identity in medicine is going to limit you from having the other things that you want.”5

I’m putting the finishing touches on my pediatric residency application now.


Shoshana B. Weiner is a fourth-year medical student at Albert Einstein College of Medicine. where she conducts research in pediatric hematology-oncology.  She has written for Current Oncology, American Medical Student Research Journal, KevinMD, and The Doctor’s Tablet.

 

References

  1. Kathy Oxtoby (2013). Do the classic specialty stereotypes still hold true for today’s doctors? BMJ Careers. http://careers.bmj.com/careers/advice/view-article.html?id=20015762
  2. Amrisha Vaish, Tobias Grossmann, Amanda Woodward. (2008).  Not all emotions are created equal: The negativity bias in social-emotional development. Psychol Bull. 134(3): 383–403. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3652533/#R153
  3. Darrell G. Kirsch.  Educating for Resilience and Humanism in an Uncertain Time. September 27, 2016. https://reflectivemeded.org/2016/09/27/educating-for-resilience-and-humanism-in-an-uncertain-time/
  4. Robert B. Shochet, Jorie M. Colbert-Betz, Scott M. Wright. (2015). The Johns Hopkins Learning Environment Scale: Measuring Medical Students’ Perceptions of the Processes Supporting Professional Formation. Acad Med. 90(6): 810-818. http://medicine-matters.blogs.hopkinsmedicine.org/files/2015/04/JHLES-Professional-Formation.pdf
  5. Alexandra Kilian.  Faculty Feature: Dr. Sunit Das.  Artbeat. https://utmedhumanities.wordpress.com/dr-sunit-das/

4 thoughts on “For the Love of Medicine: Remedies for Surviving “Specialty Shaming”

  1. Shoshana –

    Thanks for this thoughtful sharing of your memorable experience with a surgery fellow.

    While he certainly could have picked a better place to talk about his views of various specialties, and used a more user-friendly style than a rant, I’m wondering if you really would have been better off if he and the others did not share their thoughts about various career choices.

    My response to such comments is to explain why I disagree, and try to educate the other person on some of the advantages and attractions of a career in pediatrics. I would also have enjoyed the opportunity to challenge his claim that autocratic decisions are better than collaborative approaches.

    I have had many years to think about this and am better prepared to respond than a medical student, but I think that it’s generally a benefit to hear other people’s views about career choices, as well as other important decisions, especially at a younger age. Many heads are better than one, and I prefer candid discussions about such things to polite exchanges that conceal the other person’s real thoughts.

    “Support and encouragement” are often needed, but are not a substitute for honesty. I don’t think it’s “supportive” to endorse decisions that may be poorly thought out. Not every student planning a career in pediatrics or surgery has fully considered the pros and cons of such careers on family time, financial implications or other factors. If everyone is a cheerleader, we miss out on hearing perspectives that we might not consider.

    Perhaps your concern is more about the tone of such critical comments, rather than their critical nature. Ranting is not a good way to begin a discussion. But I would rather hear about someone’s strong opinions than live in a world where all of my impulses and intuitions are “supported.”

    Best regards,

    Norm Fost MD MPH
    University of Wisconsin – Madison School of Medicine and Public Health
    Department of Pediatrics and Department of Medical History and Bioethics

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    • Thank you Dr. Fost for taking the time to read this blog and to comment.

      I agree that there is a benefit to hearing other views about career choices (as well as other important decisions) as you note. Tone, content, and engagement make a difference. I feel fortunate to have had wonderful opportunities to discuss career choices with mentors who guided reflection on such choices and who valued candid discussion. Thanks again.

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  2. Good afternoon Shani,
    Having graduated from medical school in 1981 and having already chosen Family Medicine as my specialty of choice (by the time I graduated), I can certainly identify with your yearning to find your way and wanting to explore that path once you’ve found it. I realize that it can be difficult to maintain your interest and focus, especially if one is in an institution that values subspecialty and hospital based care over longitudinal, out-patient care. I would like to think that there is room for all comers. I agree with Dr. Fost when he suggests a value to having others ask and explore with you, why you choose what you choose. I can also hear the need to embrace certain values and virtues that you’ll want to embrace qua physician. Humility, and “giving the benefit of the doubt” will rank near the top and can be oh-so difficult to develop. I am sure that your choices and vocabulary reflect beautifully on your upbringing.

    Michael Felder, DO, MA
    Family Medicine/Bioethics
    Warren Alpert School of Medicine at Brown University
    Providence, RI

    Like

  3. Congratulations on your choice and continuing progress on your path to becoming a pediatrician. The surgeon would have been better served to express his concerns with possible pitfalls of shared decision making as opposed to denigrating an entire field of medicine. That being said, something to be learned from everyone. If not their positive attributes then recognizing the negative and assuring you will not incorporate that into yours. Best to you on your journey!

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