Two years ago, when I started this journey, one of our tutor asked us that... At that point, my plan was something in Internal Medicine...
Two years later, I wouldn't say I had changed very much, but my current plans are no longer the same...
One thing for sure (that is a very dangerous saying, you should never say never :-) ), is that I am not a surgeon. For one thing, I have very light essential tremor, but you can see that could be a problem for a neurosurgeon, so it is a good thing that I am not interested in that kind of specialty.
So, I am clearly more of a "medical" than a "surgical" person. In the last two years, I have tried to narrow it to what I wanted to do with the rest of my life... And it is way more difficult than I thought. I also realized that the pathophysiological side of a specialty does not represent the clinical reality of it. I love the pathophysio process of some auto-immune diseases, but in clinic, the work does not reflect it at all... So, I have to take that into account... My next life will be in clinic, that is what I have to look into.
My first ideas were infectious disease, haematology and rheumatology. Well, I realized that ID specialists are really more of consultants than treating physician. I was very surprized myself but I really love the relationship with the patients. Therefore, I don't think that being a consultant would be as satisfying as being responsible for the patient. For haematology, there is two sides of it, oncology and haematology. I don't want to do oncology, and doing only haematology would mean I have to do fellowship and work in a big university hospital. My husband and I have already discussed that and this is not the kind of life we want... And you know, it's not like it is a big "love at first sight" kind of thing... As for rheum, well, I spent a whole day with a rheumatologist the other day and I was a little disappointed... The diseases are very interesting, but in clinic, the exams are very much the same. And I am very interested in chronic pain, and the rheumatologist I spent the day with wasn't, so she refer the chronic pain patients back to their family physician.
And it made me realized that I would have to give up a lot of different patient type to go to a specialty...
And then comes my mentor who had followed me for my first two years of clinical skills... I believe he is THE one person who might have had the most influence on my journey since I started med school. Not necessarily by being a role-model (well, yes, he is a fantastic family physician), but by making me think and reflect on who I really am and what I really want to do... I think the turning point was when he said to me: "What couldn't you do as a family physician that you absolutely want to do?" And well, I am still trying to find it since... As a family physician, I could handle chronic pain patients, see HIV patients, manage rheumatoid arthritis patients and infiltrate joints that are inflamed, handle geriatric patients with their multiple problems and their two pages long medication list... all things I am interested in.
The other thing is being part of a real team that handle a patient. I want to be part of a multi-professionnal team, take the information that the social worker is giving me and evaluate the impact on the health of the patient, listen to the nurse who see the patient all day while in the hospital, discuss the medication interaction with the pharmacist... not that the specialists do not do that, but my way of seeing it is that they don't do it at the same level...
Right now, I am weighing all my options. However, at this point, FM is three steps ahead of the specialties. For the relationship with the patients, for the opportunity to do whatever you want with your practice (ok, maybe not whatever you want but certainly more than in specialty) and for the freedom to choose where you practice (because it is much easier to choose a place in FM than in specialty). And let just say that my husband would be thrilled, since it is much shorter journey...
So, if I end up in FM, let just say that this mentor would have a great part of responsibility for it :-) And if I do so, I know it would not be a second choice but a very well-thought decision. Our career guidance person (also a family physician) said to me the other day that it is written in the sky that I will be a Family Physician, and she believed that I am fighting against my destiny trying to do something else...
I haven't started clerkship yet, so let's wait until I have more experience with patients, see if I have another change of heart...
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