Decisions, Decisions: After Choosing a Medical Life, Time to Choose a Specialty

PETER “BUZZ” MARCOVICI’05 STARTED WORRYING ABOUT THE kind of doctor he wanted to be in his second year at P&S, so he decided to use scientific methods to channel his worrying into useful inquiry.
“As the elation of being admitted to Columbia faded, the reality of the rigorous work schedule emerged,” Mr. Marcovici wrote in the paper he authored about his research into why radiologists become radiologists. “Fortunately, the material we medical students learn is inherently interesting and meaningful. But in order to maintain the intensity and commitment required to be successful, medical students tend to rely on something else. That is, in some far off time they too will become doctors.”
The curriculum has little time devoted to how to choose a specialty. “The process of selecting a specialty for medical students is often a random, haphazard sequence of personal interactions, reflections, and projections of the future. We bounce ideas off of each other, slowly constructing an image of the various specialties based on little more than brief encounters with clinicians and scientists,” he adds.
While still in his second year, Mr. Marcovici decided to take matters into his own hands. He surveyed radiology faculty (attendings, fellows, and residents) to learn why they chose radiology as a specialty. “Radiology was selected as my case study for several reasons,” Mr. Marcovici says. “First, radiology offered practical benefits in terms of my research method, a personal survey. They are clustered in few locations within the hospital, making polling relatively easy. Second, radiology is a field that incoming medical students know relatively little about. I wanted to understand when and why people were drawn to a specialty that is not commonly evoked in the classic images of a doctor.
“Third, having some personal interest in radiology, I wanted to use this paper as a means of understanding my own professional development. I wanted to personally meet some of the medical center radiologists and discuss their specialty with them.”
Mr. Marcovici distributed a 10-question survey to radiology faculty personally and by e-mail during November and December 2002. His questions were chosen to determine when the faculty chose radiology as a career, their current impressions of the specialty, and the faculty members’ perspectives on the two best and two worst attributes of the profession. To increase the response rate, Mr. Marcovici visited radiology department offices and reading rooms, including those of general adult, pediatric, neurologic, and interventional radiology. He also attended a morning radiology conference to solicit input. He e-mailed the survey to all radiology attendings at the medical center.
“Overall, the response was very positive,” says Mr. Marcovici. “Some radiologists were surprised a second-year medical student would be interested in learning about radiology. The written comments were especially interesting and thoughtful. Many of the radiologists were eager to know more about my research. In fact, several were happy to share much more about their own professional development and specialty selection process.”
The 49 respondents included 17 radiology residents and 7 fellows; the remainder were attendings. “In general, our radiologists did not know they were going to select radiology as a career before medical school. The current residents, however, were somewhat more likely to have preferred radiology as their career before they started medical school than were the attendings and fellows.”
Most radiologists are happy with their specialty choice. “The enthusiasm for their work was clearly evident in the interactions I had with many of the radiologists,” Mr. Marcovici says.
The radiologists’ responses about the best and worst characteristics of their field varied considerably. The top two “best aspects of radiology” were “variety of work” and its “intellectual” nature. Being an “expert” was important to some respondents. “So, the best aspect of radiology seems to be the cerebral nature of the work,” Mr. Marcovici surmises.

variety of work
intellectual nature
being an expert
good hours
modern technology
lack of patient contact
bad hours
daunting technology
less appreciated among medical specialities
department less powerful

The second most common “best aspects of radiology” were “good hours” and “modern technology,” but, coincidentally, the hours and technology were cited by others as the “worst aspects of radiology” — “bad hours” and “daunting technology.”
In describing the “worst aspects of radiology,” the doctors also varied widely in their responses. However, a clear winner for the “worst aspect of radiology” came through loud and clear: “lack of patient contact.” Many respondents cited their role in patient care as “less appreciated” than other specialties. Several noted that because they do not directly attract paying patients the way other clinical services do, they have “less power as a department” within the medical center.
Although many radiologists call their hours the best aspect of the specialty, others said long hours and high volumes of work were among the “worst aspects of radiology.” The long hours leave little time for research, making some radiologists say they feel like they “work at the post office” or their work is often tedious or monotonous.
Several comments were made about the “huge knowledge base” and “years of training” involved in their field. With the variety that radiologists appreciate comes a broad knowledge base that takes years to accumulate, Mr. Marcovici says.
“The majority of medical center radiologists did not choose their specialty until after they had done their clinical rotations, and the practice of radiology was mostly, but not totally, what they expected it to be,” says Mr. Marcovici. “In devising this project, my goals included a more general understanding of the specialty selection process, using a focused example as a case study. One can conclude from this study that spending time on the clinical wards is when many specialty choices are eventually made. I also discovered that a student’s interaction with particular individuals influences their selection and that often other specialties are decided this way as well. From that, I conclude that personal interactions, and not simply the specialty itself, are weighed heavily in the specialty selection process.”
Mr. Marcovici has decided to continue to explore all specialties, a path he is following during this, his third, year at P&S. “I’ll wait until I spend time in each to make my decision.”

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