It's alright to know you want to go into a category of medicine- surgery, med, or psych, for instance- but if you want to do like, "forensic psychiatry," "interventional pulmonology," or "neurosurgery" for example, there is a good chance you're setting yourself up for some pain down the road. Like, I know I never want to do surgery, it's just not me, nor do I want to do radiology or anything to do with cancer. So I'm a med guy or a psych guy (god help me, psych is growing on me). IM is appealing, as is psych, pulm and EM. When I'm doing my rotations, there's a good chance I'm going to hate one or two of these fields and they won't meet my expectations. There's enough training positions and options, however, that if I don't enjoy or match one, I can probably match another. It would be extremely hard for me to end up hating my life and career with such a broad range of interests from which to choose, which are not highly competitive to get into to boot.
But when people pick these niche areas prior to being exposed to what actual practicing physicians face in the field, and that is their only reason for doing medicine, that's a bit of a problem. It's easy for a kid to say "I want to work with dying people with cancer all day erryday!" Then they go into practice and realize it's emotionally too draining, that they can't handle fighting for reimbursement with companies that would rather let people die than pay out for an effective new drug, etc. Worse still, with these extremely competitive fields, there are far fewer training positions than those that want to train in them, so even if they love the field, they very well might never ever get to practice. If you don't have interests outside of a niche specialty or subspecialty and you end up in one of these situations, you're SOL and 250-400k in debt, which you'll be forced to slave away in a specialty you don't like for the next decade or more to pay down, on top of losing 7-10 years of your life in the training process. That's damn near two decades being gambled for, all on the off chance they both actually really love a specialty they've never practiced first hand and that they will match into said specialty. If you win, you win big. But the chances of losing, well, they're high, and you'll be losing enough time to watch your kids grow up, all because you thought you wanted to be a neurosurgeon or radiation oncologist when you were damn near 20 years old.
