You've survived almost EIGHT YEARS of intensive schooling and, dare I add, intermittent torture. You are possibly mildly in debt, or at least way behind saving for retirement. Most of your friends make more money than you, and ALL of them have more spare time. BUT, up ahead, you see a light... blazing more brightly with each passing day: graduation.
What's next? Disneyland? Rampage of revenge? Huddling in a ball and crying for days as though you just survived a plane crash? Perhaps. But the biggest question for most mudphuds is:
What the heck am I gonna do with the five years of employment I have before I retire?
It's very fun to see where your friends end up. Some you expect, some come out of left field. It's even more interesting to hear why they choose what they choose.
For me, it's peds because they are a lot of acutely ill patients that you can actually make almost or completely better. And it's derm because, well, dermatology is the awesomest thing ever.
A lot of people think of derm as lots of acne. I think that in some private practice settings that's true. But what I want to do--academic derm--is very different. There is a huge variety in patients and conditions, lots of research, surgery... it's heaven. I love that people come from hours and hours away to see you, and that often you are able to help them when numerous previous doctors have not been able to. I love seeing them come back better, and happy. Also, don't discount how horrible some of these conditions can be. I have seen many patients that are physically debilitated, and that isn't including the ones who don't date because of embarrassment.
Anyway, enough about my choice. The thing is to figure out yours. From what I've seen you need to answer an important question:
Do you want to do research? It seems a lot of mudphuds end up burned out on research. It's very sad. I can't blame them, but I wish we could figure out why this happens. I mean, yes, graduate school is often hellacious. But a lot of what makes it so is intrinsic to graduate school and not research in general. In any case, be honest with yourself, and decide if it's for you. I think it's important to choose this before you settle on a specialty, because some are much more amenable to research than others. It's good to find an example--someone who is in your field of interest who is doing what you would like to do, and--this is important--doing it well.
For me, I was trying to decide between peds rheum and derm, and what it came down to was research. Peds rheum is a very under served specialty, and the clinical aspects would always be so demanding that doing research would be very difficult. And here's the thing: research is hard enough without adding extra crap.
Anyway, those are my nonsensical ramblings. Now that I've chosen my field my full-time job is arranging meetings to try to be admitted to said field, and it's time to get back to that. Please share your thoughts on field selection below, and with luck your 4th year schedule will allow you, as mine has, to mull these things over at some length. And also to have days where you don't have to change out of your pj's.