Guest Post: Second-guessing career choices

As of today, I am one month from adding those long sought-after and hard-earned initials to my name, M.D..  I matched at my number one choice in a very competitive “lifestyle specialty,” have a fabulous husband who has helped me through the emotional turmoil that is medical school, and two young boys who make me laugh and smile every day.  I sit here, where I worked so hard to get, wondering if I made the right decisions.
              
My grandfather died from CML when I was 6, the years prior to his death being spent meeting his medical needs.  My experience of the impact of illness upon a family drew me toward medicine and at the age of 6 I embarked upon the road to becoming a physician.  While I could not understand this at 6, I suspect now, that I yearned for some power over illness and becoming a doctor seemed to meet this need.

In high school I decided upon pediatrics.  I continued to follow this path, volunteering with pediatric oncology programs and the like.  One summer during college I returned to my hometown and happened to find my way into a women’s health clinic where I served as an intern, counseling women on abortion procedures and birth control.  I loved every minute of it and was eager to learn more so that I could help my patients.  I got involved in activism in a way I hadn’t before.  From the day I started, I knew that Ob/Gyn was my calling.

Halfway through my third year of medical school, however,  I stood in the OR, 33 weeks pregnant, having held a bladder blade for who knows how long, thinking I just couldn’t do this anymore.  My ob/gyn rotation, the 6 weeks I had expected to confirm my career choice, left me wanting.  I hated the OR, I really didn’t want to be like the residents I was working with, I wanted to see my family, and I didn’t want to worry about the malpractice.  The 3 past weeks I had spent on the gyn service had been 3 of the most trying of my education to that point.  The next week I moved on to the OB portion of my rotation and absolutely loved it.  I loved following patients through prenatal care and delivery.  I loved the raw emotion and I never thought of it as work.  I was thrilled to be able to be part of my patient’s lives in such a real way.  Maybe I could do this after all.

My son was born at 37 weeks and after having a placental abruption, I was scared to death of ever being the doctor in charge of a delivery like my own.  I lumped together my loathing of operative gynecology with my new-found fear of the sudden twists a routine low-risk pregnancy can take and decided against ob/gyn.  This, despite my love of prenatal care, primary care, and procedures.  This despite the relative ease I had with the material, my true interest and passion in the field.  My decision was final, I didn’t think I had what it took to be an ob/gyn.  I set about finding another specialty and over the next year and a half (I took 5 years for medical school) flipped-flopped between fields.  My husband calls my decision making process the Hamlet approach, one which I do not suggest to other medical students choosing a specialty.  In the end, after much drama and many second guesses of myself, I landed a spot in Dermatology.  In the end, it was a well thought out, rational decision.   I was thrilled with my match for all the reasons I told myself I should be.   Dermatology offers a great combination of surgery and medicine, plenty of small, what I like to call non-scary surgeries, great pay, weekends to spend with my family, and the list goes on.

One week after my match, my second son was born.  Within a few days, I immediately felt that my decision to go into dermatology was the wrong one.   I felt an immense sadness knowing that I may never be involved in birth in such a personal way.  I cannot be sure what part of this to attribute to the fact that I may not have any more children myself and what to attribute to my second thoughts about my career choice.  I know teenagers can get emotional about acne and that skin cancer is a very real and serious problem, but I have a hard time getting emotional about accutane and imiquimod, in the way I get emotional about abortion and pregnancy.   I have begun to look at the medical journals that arrive in the mailbox in a completely different way.  While I want to read the articles on preterm birth, I feel I must force myself to concentrate on the newest treatments for lice and scabies.   

So it is that I sit here, wondering which would have been the more perfect decision, ob/gyn or dermatology.  Perhaps that is my problem, that I believe there was a perfect solution.   To be honest, my family came first in my decision to pursue dermatology over ob/gyn.  My husband has been a saint throughout my medical education, finding ways to occupy himself as I set about marathon study sessions most every weekend, taking on more than his fair share of childcare duties, and making numerous sacrifices in terms of his career, so that I may follow my dream of becoming a doctor.  I made the decision to become a dermatologist, in part to allow us to have a life with a bit more balance, where he will eventually be able to follow his own career goals.   But as I reflect upon my decision, I wonder if it was actually to his benefit and to that of my children.  Would I have been happier doing something where I did not have to convince myself that my work was important?  If I felt like I was making more of a difference with my work and truly loving it, would I be a better mother and role-model?  Or would the continuous strain on my family and relationship with my husband have outweighed this benefit?

For those who have lived through this decision, what are your thoughts?  If you had it to do over again, would you?  Have any of you switched specialties after your initial match?  How have your spouses and children dealt with the continuous demands of your career in medicine?