Medicine Monster
Time to find myself.

Medicine Mensch 9, in which I specialize, specialize, specialize.

MEDICINE MENSCH
Job Hunt: Choosing the Right White Coat
By Zackary Sholem Berger
September 2, 2005

I am 32 years old, and it's time to decide what I want to be when I grow up.

I do have things narrowed down somewhat: I want to be a doctor. But what kind? I don't have the luxury of thinking it over much longer. The time has come to apply to residency programs (the four-or-so-year stints of hospital-based indentured servitude marking the start of a doctor's career), and I need to decide on a specialty.

There are many different kinds of physicians. A Web site run by the American Medical Association lists more than 50 specialties, ranging from aerospace medicine to colon and rectal surgery. Each has its partisans and its detractors, but finally the decision is my own.

Many medical students ask themselves whether they should apply to one of the "lifestyle residencies" — specialties chosen because of desirable salaries or fewer demanding hours. There is a whiff of snobbery in this label. Medicine is, after all, still an attractive profession for many, precisely because it offers a comfortable living. Even those specialties that are not the highest paying certainly are no road to self-denial. By most definitions, doctors are still rich. Isn't lifestyle a reasonable criterion for choosing a career?

I won't even say which specialties are considered "lifestyle residencies," because the definition changes every five years. Each specialty, no matter how unpopular or looked down on at one time, is redeemed eventually through market forces. Take, for example, circus medicine (not a real specialty, as far as I know). It used to be that no one wanted to be a circus doctor, dodging screaming children all day and putting casts on unlucky trapeze artists. But the wheel of fortune turned, and some students discovered the attractions of the specialty. The pay is not bad, and the hours are reasonable: The shows are at regular times, and in between you can hang out with the Siberian tigers or do whatever else you want. Plus the popcorn's free. Suddenly it's a buyer's market, and circus showmen have more applicants than they can handle. How did circus medicine get more popular? The specialty didn't change at all, but more medical students discovered that they'd rather do something else during their residency than work 18-hour days.

Ideally, our passions and our needs would coincide. What we want to do would be precisely what we're trained to do, and a good bit of money would be made doing it. Sometimes, though, it works the other way: Money (and livable hours) point out a career to us that we wouldn't have thought of before. To go even further, there's nothing wrong with moneymaking as the chief criterion for one's choice of medical specialty or any other profession. The rabbis of the Talmud tell us to teach our children a trade, not a career. If our child can make a good living in something legal, nine to five, and completely dull, there is no reason (according to this strain of Jewish thought) for her employment to have a larger redeeming social value. Her redeeming value should come from her spiritual life, not her professional one.

But of course, work is more than work. It shapes our life. The stereotypes that medical students attach to various specialties are only partially untrue. Certain specialties are known to be impatient with abstractions, abrupt and unfriendly, while others are known for indulgent book-learning and a tendency toward long-windedness. Even if a doctor doesn't conform to these stereotypes when he enters these specialties, he might be brought more into line with them, both by working with his colleagues and by the particular kind of medicine for which these personalities make sense.

So instead of choosing a specialty (or a job) that makes possible the rest of your life, you can choose one that becomes your life. The rabbis were experts in choosing a "clean and simple trade," a profession that provided both sustenance and space for what they held to be life's most important pursuit: the study of Torah. But they didn't have as much to say about choosing careers that provide professional satisfaction, possibly because this wasn't relevant either to their historical moment or to their economic class. (The same rabbis also said, "The best of doctors are bound for hell." But that's a discussion for another time.) Later Jewish thought does see a place for intellectual and professional absorption in things other than Torah — a career for career's sake — as a worthwhile way to spend one's time.

The answer to all this is the punch line of an old joke: You're right, you're right and you're right, too. Someone who chooses a career (or a medical specialty) for the sake of personal satisfaction might find out years later, when it's too late, that his personal satisfaction depends not only on intellectual and spiritual sustenance but also on having time to spend with one's family as well as money to buy what one needs. But one who chooses a job that leaves time for the rest of life might discover that the rest of life feels boring without the stimulation of a demanding profession.

I'm still not sure what I'll be. Maybe I'll run off and join the circus to cure the age-old medical syndrome of big red noses and oversized feet.

Zackary Sholem Berger, a fourth-year medical student, accepts all well-meaning job advice at doctor@forward.com.