This past Wednesday our first year medical school class was given our final lecture on Management for the year, along with the assignment of producing a one page document that shows where we see ourselves in 10 years (and considering that most of the lecture was about career planning as future physicians, I’d guess they want us to have some sort of focus on where we see ourselves fitting into medicine). There’s a ton of flexibility with this assignment (I know Mike made something in Photoshop), but as you can imagine, I’m choosing to write. And what the heck, I might as well write it here.

The truth is that I have no idea where I’ll be in 10 years. “Obviously you don’t”, you say to yourself, since I can’t see the future. But I really mean that I’m pretty conflicted over where I actually want to be in 10 years. I always thought I knew what I wanted, but the older I get (and presumably the wiser I get) the more I realize I’m not exactly sure what I want when it comes to my career. Perhaps it will help if I give you a brief time line of my thought process since I first began to be interested in medicine.

In high school, I thought I wanted to be a doctor. Not just any doctor, but exactly a “pediatric neurosurgeon”. Boy, that sounded cool. Imagine how awesome it must be to remove brain tumours from kids and completely change their lives. Not to mention how prestigious being a neurosurgeon seemed.

During undergrad, neurosurgery lost its appeal – the intensity, the lifestyle, the hours were all far too much for me – not to mention job prospects for neurosurgery are not very good (the U.S. won’t even let newly trained Canadian neurosurgeons work there anymore, and neurosurgery staff positions in Canada are limited). I wanted a career with more flexibility for other things in my life like family, friends, and interests/hobbies. Neurology became more appealing.

All the while, I still wasn’t 100% sure I wanted to do medicine. When I thought about what I really enjoyed doing (e.g. mentoring, educating, starting projects like MedHopeful/MedChatter) and what I really didn’t like doing (e.g. studying), it made me question whether I was on the right path or not. To be fair, the opportunity to do those things I enjoy (like teaching) do exist in medicine, but I was still concerned over whether my heart and my head would be able to handle the large amount of studying I would still be required to do. While it’s true that at some point in your life you have to pick something if you want to support yourself and your family, keep in mind that it’s perfectly natural to not know for sure. There’s nothing wrong with keeping your options open and trying to figure out what will make you happiest.

Nevertheless, I got into medical school, and well, I guess there went that decision. As of last fall, I was inclining away from surgical specialties completely, as again, the lifestyle didn’t seem very attractive and I don’t think I want to spend hours working with my hands doing surgery – I am much more interested in the thinking, decision-making, and discussing with patients aspects of medicine. So, for the most part, that left internal medicine (and all its subspecialties) and neurology. I wasn’t considering family medicine because, to be honest, I thought it wouldn’t be as stimulating because I figured the more complex cases would be the ones in the hospital, and I want the challenge of difficult cases.

But then come this past weekend. I started thinking again about what made me happy. What I realized was that in my life my happiest moments where when I just spent time with awesome family and friends. I’m pretty sure I knew this all along, but it helped to finally put it into words and get it out there. There’s nothing I want more in life than an awesome family and awesome friends. I would give up my career in a second if my work life was compromising my relationships with my family and friends. For me, that’s a no brainer. While I agree that having a solid career is important for balance, it still isn’t my highest priority, and not what will keep me happiest.

In terms of my career, I think that I do want to teach (residents, clerks, medical students, etc.). I know some people don’t, but I actually really enjoy teaching and sharing what I know. I find a lot of joy in helping other people succeed. The videos and articles that I write – it makes me feel good to be able to help other people achieve their goals and do well. I also enjoy working in teams to try and come up with solutions to complex, real life problems, or finding better solutions or better ways to do things. In medicine, I think such opportunities would include things like trying to find ways to improve wait times, improve efficiency in hospitals, etc. I would also hope to do similar things sitting on boards for various charities and organizations. I think there is a chance I want these things more than what a doctor normally does (i.e. their clinical practice) – that’s not to say that I wouldn’t enjoy my practice as a physician, but that I think I might enjoy those even more and would want the opportunities and flexibility to pursue them.

So knowing this, why was I so quick to not consider family medicine? It would most definitely give me the flexibility to pursue my other interests in medicine (e.g. hospital consulting or whatever you call it), but also the most flexibility in terms of personal life. I could be completely autonomous, setting my own hours, etc. In addition, based on some conversations I have had, it is very doable for someone without a graduate degree to teach family medicine in an academic teaching hospital, whereas every other specialty most likely would require a graduate degree of some sort for one to have a shot at being a clinician-educator. It would also likely allow for the most time for me to enjoy life with my family and friends. And, again, if those are most important to me, family medicine is pretty attractive. Not to mention that I always have the option of doing a family medicine residency and then a fellowship after (e.g. emergency medicine, obs/gyn, etc.) if I want to do more than just family medicine.

I’m not going to deny that finances matter. While it’s true that there’s no reason why any physician, if they put in the work, can’t be quite well off, everyone’s long term goals are going to be different, and therefore, what type of financial support everyone is looking for is going to be different. Someone who plans to have 10 children is going to have very different financial goals than someone who plans on living alone, for example. It’s also common knowledge that there is a wide range in earning potential across the specialties. Some specialties on average bill as much as twice as much as others. You probably also make less doing education and research than the same type of physician who only practices. I’m well aware, for example, that I’d probably make significantly more doing certain internal medicine specialties than say neurology. These types of issues only make the decision even more difficult.

So in terms of what type of physician I see myself being, I honestly can’t say. If I had to pick at this point in time, I’d guess either in family medicine, neurology, or some specialty of internal medicine. But I honestly have no idea which. Regardless of what specialty I end up in, I do hope that I’m doing some sort of teaching and consulting in medicine, I am sitting on some cool boards of organizations/charities that positively support communities.

All that being said, nothing is more important to me than having an awesome family and awesome friends. Give me that, and I’ll be happy 10 years from now.