When a physician-evaluator asks me what I want to go into when we first meet, I often hesitate. There have been a variety of reactions I've experienced, from a pat on the back and "that's a smart thing to go into," to the eye-roll and even a grimace, perhaps of envy. The latter occurs especially if the physician is obviously over-worked and frankly may have regrets about their own choice of specialty. One even tried to minimize the field by saying it's not a real specialty since there are no dermatological emergencies.
If their reaction is a negative one, I feel like I'm now two steps behind and have to work harder to prove myself and/or feed their own egos and their choice of a more grueling, self-sacrificing specialty. This may be a similar experience to those students going into other competitive specialties known to have a healthy work-life balance. The trouble is that I'm beholden to them, since they're the ones doing the grading and evaluating.
I wanted to ask the practicing dermatologists on the forum if they've ever experienced these interactions and how they navigated them to come out unscathed.
Yes. That was a big problem at my Med school and it was in fact very difficult to get a top grade on your core clinical rotations (medicine, surgery in particular) if you were not felt by the attendings to be likely to apply in that specialty. This was because there were only a small number of top grades they were instructed to give out (to the top 10% of students), so they reserved these for people going into that specialty, as getting top honors in surgery is obviously most important to the student who is planning on applying in surgery, and less important for the student applying in Peds for example.
On top of this, attendings-- and those at academic institutions even more so-- are like all people in that they naturally are inclined to favor a student who is choosing the same career path as they did, as this validates their life choices and also is flattering (it's always nice to hear someone genuinely looks up to you and wants to be like you when they grow up). The more alike they view you, the more they will probably be inclined to like you. For example, a plastic surgeon will like you better than your classmate if you are wanting to go into plastics but your classmate is going into orthopedics. They will like you even more if you are wanting to do plastics for the same REASONS they wanted to do it. They will like you EVEN MORE if you are going into plastics for the same reasons as they did AND you want to ultimately work at an academic institution like the one at which they work, doing the type of research they are doing. This goes on and on...
So, yes, the phenomenon you are describing is real and it affects all humans. Doctors are no different. Honesty in life is generally the best policy, and as long as there aren't ridiculous grading quotas (i.e. only the top 10% of students can be given top honors each rotation), then honesty will be the best route.
However, at my Med school, at the time I was a student, people hoping to go into Derm often concealed or flat out lied about their intended field, since they wouldn't likely get top honors in either medicine or surgery (and often not OB either) if they were fully open about having already decided on Derm. Not that I'm advocating it, but here is how people generally pulled off either of these strategies:
1) Conceal method: "I really love everything so far but [insert name of this rotation] has been the most interesting to me so far because of [insert reasons why this attending most loves his field, but not things so blatantly obvious that it looks like you are just kissing his ass]." This method may inspire your attending to make efforts to promote his field to you, so as to feel like he is the one who convinced you that medicine/pediatrics/etc is awesome and is now your field of choice.
2) Flat-out lying/sociopath method: "I've always wanted to do [insert name of rotation] because [insert reasons why that person likely went into it, based on whatever you have gleaned from your interactions with him and what he has written on his research group's homepage, assuming he is a researcher], and I would love to meet with you to strategize on how to improve my chances of matching and also to get career advice. My sincere goal is to do academics--I know a lot of other students probably say that during interviews, but I truly want to pursue academics and I know how difficult it can be to obtain grant funding, find the right institution, and get involved with the right research projects. If I could maybe meet with you during or after the rotation to hear your insight into these issues, it would be hugely helpful." This method convinces people of your stated intentions because it is much more extreme than an average ass kisser's superficial attempts to gain favor. Also, as long as the attending does not end up spending much personal effort on you (I.e., you don't actually waste his time in meetings about your fake career goals), then you may even convince yourself that you don't need to feel awful about your lies. The obvious downside to this approach is that, if you get too deeply involved with a false mentor, you will ultimately be shown to be a liar when you apply to Derm. So, you would have to be sure to not get SO close to a false mentor that it would get awkward if you don't apply to his field. I saw this method used successfully by classmates, but it is like playing with fire, especially if you completely lack con-man skills.
One last thing: for either of these methods to work at my school, the students were very consistent with their stories and did not openly discuss their career plans with ANY of their classmates, as it would've been likely that one of ther classmates would've snitched to the attending, even if accidentally ("Peter has been saying he wants to do Derm since second year"). So, if you have already been telling all your classmates you are going into Derm, it would be hard to do anything but be honest on your rotations.
