You have worked very hard and made significant sacrifices to get into and make your way through medical school. Now, you want to make the best decisions going forward to have a purposeful and satisfying life and career. Planning your next steps requires thought and contemplation. As Yogi Berra has been quoted as saying, “If you don’t know where you’re going, you’ll probably end up somewhere else.”
Know Your Why
The best place to start as you begin this journey is to understand your “why,” not your “what.”* Your why represents the quintessential or core principles of your being. It is a set of essential fundamental beliefs that drive you. Your what is that you are a medical student. Your why is your soul. Why are you a medical student? Why do you want to be a physician? Why are you interested in surgery or obstetrics-gynecology or internal medicine? Some people call this your passion, and the adage of “follow your passion” is certainly a commonly repeated phrase among career counselors.
I, however, believe one should dig deeper to really be accountable for your gift of life and find the problem of the moment that your skills and talents can help solve. Put another way, maybe it is not as important to find out what you expect from life as to discover what life expects from you.
Know Yourself
The next step is to know yourself. As Aristotle said, “Knowing yourself is the beginning of all wisdom.”† Figure out what you want to do in life, assess your unique skills, and determine how you can use your capabilities to accomplish your goals. Once you have figured this out, it is important to consider the following variables to achieve happiness and success in any career:
- You have to like it. It sounds simplistic, but if you don’t enjoy what you are going to dedicate your life’s work to, you will not only be miserable, but you will struggle to succeed. Work is hard, life is long, and any career has its unenjoyable times, unappealing tasks, setbacks, and dark periods. Nonetheless, if you like your work overall, you can weather these storms. A Gallup World Poll of 1 billion employed people recently found that 85% of people are dissatisfied with their jobs.‡ To paraphrase Robert Frost, these working people have nothing to look back on with pride and nothing to look forward to with hope. Don’t let yourself be one of these people.
- You have to be good at it. You don’t have to be great or the best at your chosen profession, but you must be competent. The world is full of people who did not realistically evaluate their talents and are trying to do jobs that are difficult and frustrating for them to perform. The most miserable people I have met in surgery deal with these challenges. They struggled every day in the operating room (OR) and lacked the confidence needed to truly enjoy their work. It is imperative to match your life’s plan with your innate talents and skills.
- Your chosen career must match your lifestyle. Obviously, different people have unique priorities. Some people are hard-charging professionals and live to work; others want to have very controlled lives and work to live. This choice is personal but extremely important, with no right or wrong answers. The one truism in this calculus is that you can’t have it all. You are not going to climb the corporate or professional ladder of success if you want to be at home every day at 5:00 pm and have every weekend free. Similarly, your personal or family life could suffer if you are always at work.
It is possible to achieve a balance between these two extremes, but often it requires either personal or professional sacrifice for many people. You have to decide what’s important to you and how you want to live your life. I once knew a man who was an excellent surgeon and loved his work; however, he hated the long hours, unpredictability of the work, and limited time he could devote to his hobbies. He slowly became more and more miserable, drifted from job to job, finally quitting the specialty. Don’t let this happen to you.
- You must take your life partner’s needs and expectations into consideration in choosing your career. Basically, for the sake of general home equanimity, your partner has to buy into and support your life’s goals and requisite sacrifices and you theirs. The normal household today has two working partners with a model of coparenting and shared chores. Failure to recognize this reality will lead to mutual resentment, dysphoria, and possible catastrophe. Certainly, you and your partner both can pursue significant career ambitions, but the sacrifices inherent in these quests must be mutually understood and accepted upfront.
- Although not as important as the previous points, I think it is important to like and relate to the people with whom you will be working. Most jobs and careers attract a certain type of person with identifiable characteristics and qualities. One of the things that attracted me to surgery and contributed to my enjoyment is that I truly liked the people in the field. They are extroverted, enthusiastic, take-charge, action-oriented people who want to solve the issue at hand and embrace teamwork. I was simpatico with this group, which contributed greatly to my satisfaction, success, and enjoyment during my career. The fact is, these are the people with whom you are going to spend most of your time. These are the people who will become your closest friends and confidants. These are the people who truly and uniquely know and understand what you are going through each day. These are the people with whom you will share your problems, the agony of your defeats, and the euphoria of your successes. So, it is important that you like and identify with them.
I had a friend whose daughter was a business savant. Upon graduation from Stanford University, she got a job on Wall Street as a derivatives investor. She excelled and quickly became the firm’s superstar with all the attendant perks, salary, and notoriety. One day she called her father and told him she was quitting. Obviously shocked, he asked her why, and she said, “Dad, if I stay here much longer, I am going to become one of these people, and I don’t share their values.” There is a lesson in this story.
- Perhaps most importantly, what you do in life must have a higher purpose than just making a living and having a successful career. There is nothing wrong with making money, feeding one’s ego, and achieving status, but your life’s work should have meaning. You don’t have to be Mother Teresa, but your efforts in this life must, in some way, improve and enhance the lives of the people around you, particularly those individuals who have disabilities or who are less privileged than you. In sum, you must give back.
Essential Characteristics Needed
People have debated for years the essential characteristics needed to have a successful career in medicine and surgery. To me, they are largely similar to the traits needed to succeed in any of life’s significant pursuits. They embody the essence of the definition of professionalism—to put the needs of the person you are serving above your own needs. In my mind, the qualities most associated with this calling are:
- Above average intelligence. Medicine is a complex and changing field that requires elevated cognitive ability.
- Grit and stamina. There is an adage that medicine is not hard—it’s hard work. There is a lot of truth in that statement. Much of medical practice is just slogging it out day in and day out, with laborious, long hours. It’s an unpredictable business with emergencies and complications occurring at the most unpropitious and inconvenient times, often requiring significant extensions of the workday. When I was at Emory University, Atlanta, GA, we called it “going into extra innings.”
- Honesty. The sanctity of the professional as well as the quality and safety of patient care totally depend on an environment of veracity. The whole profession depends on an honest rendering of the facts of the situation, as well as an honest accounting of one’s errors.
- Humility. Medicine is one of the most demanding, challenging, and unforgiving professions on earth. As soon as you think you have seen it all and you are the master of the universe, you are going to get burned, and, unfortunately, so will your patients. No one has all the answers. We all have bad days, and we all come up short from time to time. We all need help and periodically need to get bailed out of tough situations. Quite simply, we are not as smart as we think, not as talented as we think, not as essential as we think, and not as bulletproof as we think. Arrogance that leads to the inability to see our frailties is lethal in medicine.
- Patience. You will be dealing with people at their worst. Some patients become ill or injured as the result of some self-destructive behavior. They are in pain and usually frightened. They are out of their comfort zone and have a sense of losing control. In these situations, it is critical that you show empathy and compassion. Often it is as strong a healing source as any medicine. Periodically it’s all you can offer. Frequently my inner thoughts have been, “There but for the grace of God go I.”
- Team player. Medicine is a team sport. As a surgeon, often you will find yourself at the top of the hierarchy. You don’t have to be Gandhi, but you must have basic leadership skills to guide the team, particularly in times of crisis.
- Sense of humor. Medicine is an emotionally difficult profession. We see and do things most people never experience. Human tragedy, unfortunately, is a daily occurrence in our field. In my experience, the human condition does not bear close inspection. It is easy to become jaded, hardened, and burned out from a daily diet of crisis and tribulation. To maintain your perspective, effectiveness, and sanity you need to have a sense of humor. I once heard someone say, “If I didn’t learn to laugh periodically, I would cry all the time.” Humor, for many people, is a crucial protective mechanism.
Position Yourself for Residency
- Academics are important, particularly if you are interested in a competitive residency. Test scores were of great importance but seem to be phasing out with the pass/fail grading system for the US Medical Licensing Examination and other standardized exams. But academic performance will remain a serious metric.
- Prepare for each day. Read about your patients and the procedures in which you will be taking part. Remember the old adage: “By failing to prepare, you are preparing to fail.” Get to know your patients and spend time with them to understand their problems, thoughts, and concerns.
- Show an interest in what is happening around you. If you don’t know or understand something, ask questions. Residents and attendings like and notice students who show an interest and are engaged. They also are more likely to take an interest in these students and their career goals.
- Approach each rotation with the same zeal. Keep an open mind. Most people change their career plans a couple of times. No matter what specialty you go into, the information in each rotation is important and helpful. As a matter of practicality, if you choose surgery as your career, most of your fourth-year rotations should be in the medical specialties. It’s an old maxim but still true that the best surgeon is an internist who operates.
- Show some leadership skills. Join the school clubs that interest you and become an officer. There are innumerable organizations where you can find meaningful fellowship and set yourself apart from the crowd. The American College of Surgeons (ACS) has many excellent medical student opportunities, including the Medical Student Program at the ACS Clinical Congress.
- Volunteerism is considered meaningful and offers numerous opportunities for involvement in every community and country. Shadowing a surgeon, working in free clinics, going on church medical missions, attending health fairs, and performing health policy work are wonderful ways not only to learn from others, but also to set yourself apart. Choose wisely. Make sure the work you do is meaningful.
- To best prepare you through this complicated process and avoid the many minefields, you will need a mentor—someone who has an interest in you and with whom you have a real connection. You can have, and it is frequently helpful to have, more than one, so you can listen to differing and helpful perspectives. It is critical, however, that one of these people is in the field you intend to pursue. Mentors can help you navigate the rotations and specialties, make reasonable choices, obtain subinternships, be successful in the application process, obtain meaningful letters of recommendation, and navigate the match.
Approach these years with joy and enthusiasm. Work hard and prepare every day. Thoughtfully consider your future place in the world of medicine with an introspective understanding of your inner “why” and an honest evaluation of your skills and talents. Match these answers to a problem you can solve or a need you can fill. If you do so, you will be accountable not only for the gift of life, but also you will be blessed with the happiness that comes from having a meaningful and purposeful career.
*Sinek S. Start with Why: How Great Leaders Inspire Everyone to Take Action. New York, NY: Penguin Group; 2009.
†Natali C. The Wisdom of Aristotle. New York, NY. SUNY Press; 2001.
‡Harter J. Dismal employee engagement is a sign of global mismanagement. Gallup blog. Available at: https://www.gallup.com/workplace/231668/dismal-employee-engagement-sign-global-mismanagement.aspx. Accessed February 7, 2022.
