How I Got Here: Choosing a Medical Specialty
The Personal Statement is part of the residency application packet for specialty training in the USA. It complements the curriculum vitae detailing the applicant’s education and previous experience, and the recommendation letters from faculty members or other people that have worked with the applicant. My Personal Statement began with “I was the Orthopedic Disaster of the Year” – while I did not break any bones, I had three separate sprains in three separate body parts, all within my second year in college. I will spare you the details, but these injuries got me interested in making the musculoskeletal system the focus of my medical career.
Like most first year medical students, I had no clue what Rehabilitation Medicine was – therefore I focused on Orthopedics as the specialty of choice. I remember listening to a lecture on the anatomy of the hand, thinking “I would like to be a hand surgeon, I better get used to seeing these muscles and stuff mangled and all.” This was the mindset throughout medical school, with a bit of waffling and flirting with Otorhinolaryngology (ENT, or ear-nose-throat) because my grandmother who graduated from medical school in 1942 was an EENT physician (eyes + ENT; ophthalmology has since separated itself). I never considered ophthalmology.
Let’s set aside ENT for now and fast forward to my third year in medical school, sometime during my psychiatry rotation. On a whim, I did an internet search with a dial-up modem connection, on a browser called Netscape and a search engine called Alta Vista (Google did not exist yet). I typed in “performing arts” and “medicine”, because why not mix something I love (music) with what I will be doing for a living (medicine). Lightbulb moment: I found the Performing Arts Medicine Association (PAMA) website! The field actually exists! The next question then was: how do I get there? How do you specialize in that and what training do you need? [partial answers in this blog post]
ENT was fascinating enough to make me sign up for extra time with the department for an elective rotation. However, that same elective rotation dissuaded me from making that my life’s work, mainly because everything was so small and had to be accessed through holes in the head. What I did get out of that elective rotation was time to work on my piano album (recorded on cassette tape) and time to read about Performing Arts Medicine. By this time I had some inkling that Rehabilitation Medicine also dealt with the musculoskeletal system, so that moved up from third place to second place among my specialty choices. Orthopedics was still leading.
Rehabilitation Medicine finally won over Orthopedics when I realized I did not like being in the operating room. During my Anesthesiology rotation in fourth year (another “operating room” specialty), I was reading The Musician’s Survival Manual, a book about preventing injuries in musicians. I flipped it over and read the back cover’s “about the author” blurb: Richard N. Norris, M.D. was (is) a physiatrist. Another lightbulb went on and I started doing a deeper dive into Rehabilitation Medicine.
The focus on function and improving quality of life got me hooked, and it was easy to see how assistive devices (crutches, etc.) and prostheses (artificial limbs) made people more independent. I really didn’t like managing critically ill patients either, so Rehabilitation Medicine made sense: patients were already on the mend (theoretically). At some point I realized it was not all bones and muscles – rehabilitation’s other primary concern was the neurological system. Which meant I needed to do the long-ish neuro exam on all patients. I had to grapple with that at first but in the end I figured it was a trade-off I could live with: after all, one gets better and quicker with practice.
Once I settled on this choice, I felt a sense of peace. It was meant to be. I’m still here 🙂
Notes:
* I write a bit more about this “extra time” in a flashback – see my blog entry on Ear-Nose-Throat in the Journal of Internship (JOINT) category.
