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I'm not sure what specialty of medicine I'll be going into. In this, I'm not alone among my fellow medical students. Sometimes, it can seem as if we choose a specialty randomly, with little real idea of what lies in store for us. We bounce ideas off each other and our residents and attendings. Slowly, we get a feeling for the various specialties based on relatively brief encounters with clinicians and scientists.

At times this uncertainty drives me crazy; other times I lapse into a kind of Zen-like state, assuming everything will work out for the best. Occasionally, I read books, search the Web, or chat with doctors about different specialties. This can be helpful, but sometimes it just makes me more unsettled. All in all, I have a lingering sense that I'm working hard in medical school to become a …what?

So, last fall I decided to learn how a group of doctors at CPMC chose their specialty. This, I reasoned, could help elucidate the process of choosing a specialty. I chose to study radiologists for several reasons. First, they're concentrated in localized areas in the hospital, which makes them easy to find. Second, although very busy, they were willing to entertain my random questioning. Third, and perhaps most important, I have an interest in the specialty. It seems like radiology is becoming, or may have already become, a specialty that capitalizes on modern technology, becoming ever more powerful in detecting disease. In addition to diagnostic radiology, interventional radiology seems like it would also be very exciting.

Being a junior scientist, I decided to devise a survey. These were questions I asked the radiologists to rate or answer:

Dr. Ziv Haskal, above, professor of radiology and surgery, directs the Division of Vascular and Interventional Radiology. Dr. Haskal, who participated in Mr. Marcovici's survey, originally chose a residency in diagnostic radiology, intending to be a conventional diagnostic radiologist. But then he spent a month on a rotation with Dr. Ernie Ring, a charismatic physician and pioneer in interventional radiology at the University of California, San Francisco who "changed my mind about what I wanted to do," Dr. Haskal says. Interventional radiology, the field he specializes in, uses high-tech catheter-directed image-guided therapies to treat cancer, vascular, hepatic, and gynecologic conditions, obviating the need for surgery.

"I knew I would choose radiology before I started medical school"

"I knew a lot about radiology before medical school"

"Radiology is how I envisioned it would be when I started training"

"Radiology uniquely matches a /my personality type"

"Radiology provides a balance of daily work activities"

"Overall, I am satisfied with my specialty choice"

"What are the best and worst aspects of radiology"

I wandered around the hospital, survey in hand. A number of radiologists took time out of their busy day to sit down with me to tell stories of the path they took to their specialty. I also managed to get an e-mail list of the radiologists and blitzed it a couple of times. In total, 43 radiologists replied. I summed up the results, and wrote a paper about the project.

I categorized the responses according to level of training, i.e. residents, fellows and attendings. Generally, the earlier in training the respondent was at the time he or she took the survey, the earlier he or she made the decision to go into radiology. For example, many of the attendings stated that they chose radiology after completing medical school; some even after pursuing totally different specialties, such as neurosurgery. Meanwhile, the fellows made their decision (for the most part) late in medical school. And the residents had an average decision-making point during – or even before – the clinical years of medical school, suggesting an early interest in the field. I believe this reflects the fact that radiology has become more popular among medical students over the past few years.

I especially appreciated the honesty of the responses to the two best and two worst aspects of radiology. By far, the most frequent answers to the best aspects: "variety" and the "intellectual" nature of the work. There was one predominant answer about what was worst: "lack of direct patient contact."

I found it interesting that what some respondents called the best part of their choice, others deemed the worst. For example, some considered the hours to be the best feature, while others thought the hours were terrible. Likewise, the technology was cited as amazing by some, daunting by others. I'm not sure what to make of these conflicting views.

When asked how satisfied they were with their specialty – ultimately the most important measure – on a scale of 1 to 5, from lack of satisfaction to great satisfaction, the overall answer was a resounding 4.5

Clearly, the CPMC radiologists, at all levels, seemed happy with their specialty. The enthusiasm for their work was evident in the interactions I had with them. One told me that he not only found his job engaging and fun, but also that he felt at times like a photographer, able to take beautiful pictures.

Now, back to me. After doing this project, you might ask, "Well, are you going into radiology?" And the answer is, I don't have any idea! I still talk to people, read books and visit Web sites. I'm not sure I've made tremendous progress, really. One thing is for sure, though: I know where the radiology rooms are. My advice to the current first- and second-year medical students: Go ahead, find them. Once you do, you'll see that radiologists are great people who like to talk about what they do.

I'm guessing choosing a specialty won't happen for me until I spend a little time working in each. And that, I'm beginning to see, is what third year of medical school is all about. So, to those undecided souls out there, I offer some simple advice – try not to worry too much. Do your best to "Zen" down this road, and an answer is sure to eventually materialize from the murkiness, just as it does on an X-ray.

Note: Thanks to the CPMC radiologists – and if I do end up going into radiology – maybe I can get a letter of…oh, I'll just come by the reading room for that.

Buzz Marcovici '05 just started his major clinical year at P&S in which he'll sample many specialties through clinical clerkships.


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