What Happens When a Doctor Realizes They Don't Love Their Specialty?

I saw a video from Dr. Frances Mei and I find her whole account genuinely interesting, because she talks about something we don't discuss much in medicine:

What happens if you get very far down the path of a certain specialty and just don't really love it?

It's a more trapping situation than most people outside medicine realize, and I want to explain why.

Medical training is very unique in how it's structured.

You don't just earn your doctorate, the MD or DO that all physicians have. After that, you do training, a residency program. And here's the catch: those residency programs effectively lock you into a specialty, and they take many, many years.

Now layer on a completely normal fact of training: it's very common for people to have a rough time in the first couple of years and feel pretty miserable. That's almost expected.

Which creates the actual trap:

And by the time you've sorted that out, you're stuck.

Once you're a couple of years in, you can't simply hop specialties.

You can't start in surgery, decide it isn't for you, and switch to anesthesia in the same year. You often have to repeat multiple years, which, understandably, is something almost nobody wants to do. You're being asked to throw away years of your life and income to correct a decision you made before you had the information to make it well.

The first time I encountered someone in this position, I was a second-year general surgery resident in the ICU.

Our fellow that year was doing a surgical critical care fellowship for a specific reason: she didn't like surgery and didn't want to do it.

She told me that every single year, she expressed to her mentors that she just didn't think this was for her and didn't enjoy it. And every year she got the same answer:

"It'll get better. It gets better every year."

It just didn't. And they kept saying it until she was completely finished with general surgery, five years in.

And then what do you do?

That's the part that has stayed with me. Five years of telling people the truth about her own experience, and five years of being reassured instead of helped.

Some of the comments on her videos are, frankly, a little crazy.

There's a persistent idea out there that because medicine is difficult to get into, and certain specialties are especially competitive, we should be so grateful to be in it that we should tolerate anything:

• Any treatment from patients
• Any schedule you force us to work
• And be excited about it

That's just not the reality.

I can fully recognize that it is a great privilege to care for patients, and still want to protect my mental health and my personal health. Those two things are not in conflict, and being asked to choose between them is the problem. It's the same dynamic underneath physicians being targeted online and the expectation that we give unlimited free medical advice.

People simply expect too much from us, and the way our training is structured, we don't have an out once we're down the path. That's genuinely unfortunate.

Here's what I believe, and it isn't specific to medicine at all:

That's true for doctors as much as it's true for everybody else. A physician who is respected, rested, and not trapped is a better physician, and that benefits patients directly. It's part of why I care so much about the culture of the team I build.

• Medical training locks you into a specialty through residency, and switching later means repeating years.
• It's genuinely hard to tell whether early misery is the training or the specialty, and by the time you know, you're committed.
• "It gets better" is what trainees hear, and for some people it doesn't, as with the fellow who told her mentors for five straight years.
• The idea that physicians should tolerate anything out of gratitude for getting in is not reasonable.
• Privilege and self-protection aren't mutually exclusive. People do their best work when they're treated with respect.

Thank you, Dr. Mei, for raising something we should talk about far more than we do.