Can I find a middle ground when I specialize?

[Pr1d3D0c]

I am a incoming MS1 who is undergoing somewhat of a crisis. I have promised myself that I want to make as much of a strong impact on the field of medicine as I can throughout my career. As a health policy student, I hear multiple times in a single day about the importance of primary care in reducing healthcare costs and improving health outcomes.

However, I have always been interested in body systems. I like the idea of learning and becoming an expert in a certain area and believe that I have a certain gift for understanding minutia that would also lend well to a specialty. I even took the SDN Specialty quiz and after answering very honestly I found primary care fields ranked at the bottom and specialty fields at the top, as I expected.

Essentially, I am at somewhat of a conflict as primary care pulls me due to ethical considerations--I believe primary care has a profound impact on people's lives and we need more good primary care physicians. However, I also believe that I in particular will be most happy and my skills fit best in specialized fields.

Ultimately, my question is if there are any fields where I can fulfill both of my interests--in helping populations while also using what I believe are my innate skills? I know that specializing is much down the road, but I just have been thinking about it a lot lately, as I reflect more on what I have learned in my major with graduation closing in.

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[flapjack3d]

I am a incoming MS1 who is undergoing somewhat of a crisis. I have promised myself that I want to make as much of a strong impact on the field of medicine as I can throughout my career. As a health policy student, I hear multiple times in a single day about the importance of primary care in reducing healthcare costs and improving health outcomes.

However, I have always been interested in body systems. I like the idea of learning and becoming an expert in a certain area and believe that I have a certain gift for understanding minutia that would also lend well to a specialty. I even took the SDN Specialty quiz and after answering very honestly I found primary care fields ranked at the bottom and specialty fields at the top, as I expected.

Essentially, I am at somewhat of a conflict because primary care pulls me because of ethical considerations--I believe primary care has a profound impact on people's lives and we need more good primary care physicians. However, I also believe that I in particular will be most happy and my skills fit best in specialized fields.

Ultimately, my question is if there are any fields where I can fulfill both of my interests--in helping populations while also using what I believe are my innate skills? I know that specializing is much down the road, but I just have been thinking about it a lot lately, as I reflect more on what I have learned in my major with graduation closing in.

The world also needs good specialists. You can't do everything. Unless you are directing policy, then you can really only worry about making an impact in your chosen field.

FYI There are many population health issues that specialists are better able to study compared to primary care physicians.

 

[Pr1d3D0c]

The world also needs good specialists. You can't do everything. Unless you are directing policy, then you can really only worry about making an impact in your chosen field.

FYI There are many population health issues that specialists are better able to study compared to primary care physicians.

Thanks! Out of curiosity do you have any examples of the emboldened?

 

[wysdoc]

I am a incoming MS1 who is undergoing somewhat of a crisis. I have promised myself that I want to make as much of a strong impact on the field of medicine as I can throughout my career. As a health policy student, I hear multiple times in a single day about the importance of primary care in reducing healthcare costs and improving health outcomes.

However, I have always been interested in body systems. I like the idea of learning and becoming an expert in a certain area and believe that I have a certain gift for understanding minutia that would also lend well to a specialty. I even took the SDN Specialty quiz and after answering very honestly I found primary care fields ranked at the bottom and specialty fields at the top, as I expected.

Essentially, I am at somewhat of a conflict as primary care pulls me due to ethical considerations--I believe primary care has a profound impact on people's lives and we need more good primary care physicians. However, I also believe that I in particular will be most happy and my skills fit best in specialized fields.

Ultimately, my question is if there are any fields where I can fulfill both of my interests--in helping populations while also using what I believe are my innate skills? I know that specializing is much down the road, but I just have been thinking about it a lot lately, as I reflect more on what I have learned in my major with graduation closing in.

You can get involved in your state medical association or AMA as a way to keep informed about laws and policy.

 

[Matthew9Thirtyfive]

Also, FYI you can practice primary care and a specialty. There are several GIs in my hometown who practice 60% GI and 40% General IM (or some similar breakdown), and it is not a small town (71,000 people, plus it is surrounded by towns of 45,000+, which all run into each other).

 

[Pr1d3D0c]

Also, FYI you can practice primary care and a specialty. There are several GIs in my hometown who practice 60% GI and 40% General IM (or some similar breakdown), and it is not a small town (71,000 people, plus it is surrounded by towns of 45,000+, which all run into each other).

This is very cool. I didn't know that!

 

[Matthew9Thirtyfive]

This is very cool. I didn't know that!

It also works in surgery. All the vascular surgeons I worked with over the 8 years I was in the OR practiced a good mix of vascular and general surgery.

 

[mistafab]

It makes no sense to me for people to feel morally obligated to do primary care. In no way at all is that the most ethically "right" way to go. There is no "right" way.

If you really wanted to help people, you wouldn't be a doctor at all. You'd be mother teresa.

Silliness aside, specialists help lots of people that need help. Lots of times, there are no specialists around at all, making people have to drive hours just to get an appointment for their kid. I mean, you can't argue that primary care is more important than specialists at all. The argument just falls apart.

 

[flapjack3d]

Thanks! Out of curiosity do you have any examples of the emboldened?

Most population health issues, tbh. PCPs are on the front-lines, but the breakthroughs in population cardiovascular health research for example is going to be done by cardiologists (or public health PhD's).

 

[Pr1d3D0c]

It makes no sense to me for people to feel morally obligated to do primary care. In no way at all is that the most ethically "right" way to go. There is no "right" way.

If you really wanted to help people, you wouldn't be a doctor at all. You'd be mother teresa.

Silliness aside, specialists help lots of people that need help. Lots of times, there are no specialists around at all, making people have to drive hours just to get an appointment for their kid. I mean, you can't argue that primary care is more important than specialists at all. The argument just falls apart.

It's more or less just that my major really discusses the economic/social impacts of good primary care on the healthcare system as compared to specialties. The shortage of doctors is in many ways not dispersed across the system but instead localized to primary care and rural areas. This definitely has given me pause.

However, you all do raise a good point that I can still make a difference in a specialty if I truly do care enough.

 

[cactusman]

The impact of primary care is also largely a population thing. If you're a PCP for the residents of Winnetka, you're not improving anyone's access to primary care.

 

[3member]

It also works in surgery. All the vascular surgeons I worked with over the 8 years I was in the OR practiced a good mix of vascular and general surgery.

I was wondering how this worked, could you elaborate on how someone would go about dual-specializing? Does it require another residency, etc? For instance, the "60% GI and 40% General IM" docs?

 

[Pusheen]

Ob-gyn and general surgery have a little bit of both primary care and specialty care in them if you're interested in something like that

 

[3member]

For most IM, you get a residency in IM, followed by fellowship in the specialty.

that makes sense now that i think about it - GS --> vascular surg fellowship, etc. thank you!

 

[Matthew9Thirtyfive]

that makes sense now that i think about it - GS --> vascular surg fellowship, etc. thank you!

Yeah, they all did general surgery residencies and then vascular surg fellowships.

 

[neoevolution]

Also, FYI you can practice primary care and a specialty. There are several GIs in my hometown who practice 60% GI and 40% General IM (or some similar breakdown), and it is not a small town (71,000 people, plus it is surrounded by towns of 45,000+, which all run into each other).

This is very cool. I didn't know that!

I was wondering how this worked, could you elaborate on how someone would go about dual-specializing? Does it require another residency, etc? For instance, the "60% GI and 40% General IM" docs?

I've heard that docs who do this are less likely to get referrals from other primary care docs for their specialty because the patients are likely to transfer over all of their care. It also will reimburse less which is why it's not super common. Surgery is different because it's not as longitudinal care usually and the vascular surgeon is likely getting referred to from a medical physician rather than a general surgeon anyway

 

[momo_in_homaha]

In the future there just won't be enough primary care MD doctors to meet the demands. A lot of that work will be done by NP's and PA's. That's not good or bad, it's just the reality. I used to be set on primary care too, but the more I see of it, the more I realize I would be less happy than in an IM specialty.

I understand exactly where you're coming from, OP - I feel like I could have written this post myself! But you have to pursue something that will make you happy on the day-to-day and not something you do just out of pure obligation. I'm also interested in health policy - I'm hoping to get an MD/MPH with a concentration in health policy. That's another way you could pursue a specialty and still get to make a policy-level impact!

 

[Pr1d3D0c]

In the future there just won't be enough primary care MD doctors to meet the demands. A lot of that work will be done by NP's and PA's. That's not good or bad, it's just the reality. I used to be set on primary care too, but the more I see of it, the more I realize I would be less happy than in an IM specialty.

I understand exactly where you're coming from, OP - I feel like I could have written this post myself! But you have to pursue something that will make you happy on the day-to-day and not something you do just out of pure obligation. I'm also interested in health policy - I'm hoping to get an MD/MPH with a concentration in health policy. That's another way you could pursue a specialty and still get to make a policy-level impact!

This is exactly how I feel. I am also applying MD/MPH and I think this is how I will make a difference overall. I really think my skills lend best to specializing, honestly.