I was in medical school in the late 1970s and struggling to select a specialty. Every rotation was fascinating, and I loved each clinical experience. I was running out of time to choose my career objective, though. I would soon need to apply for interviews.
Family medicine was at the top of my list. I had worked for years as an orderly in a hospital near my home that had a family medicine residency program. I knew and respected all of the residents. They were my role models. Family medicine was an up-and-coming specialty still finding its place in the medical community. I participated in the Family Medicine Interest Club at my medical school, attended conferences, and shadowed family physicians whenever I could. It felt like home.
So, as I kicked the tires on medicine, surgery, pediatrics, psychiatry, and the other specialties during my rotations, I compared each of them to family medicine. I created highly subjective lists of pros-and-cons for each specialty, and none seemed a better fit than family medicine.
Then, as the time to make a final decision about interviews drew close, I rotated through obstetrics/gynecology.
Suddenly, I was not so certain. Basic obstetrics was central to family medicine, and I discovered that I really did not like delivering babies. When deliveries went well, they were fine. But occasionally, things could go very wrong and finding an obstetrician could be a scramble. Even routine deliveries could occur as clinic was supposed to begin, during dinner, and in the middle of the night. I don't mind stress and emergencies, but it seemed unlikely that I would be happy delivering babies for my entire career.
This made me rethink my priorities. Now, I knew that I liked everything except OB.
What is family medicine without obstetrics? I wondered. Right, I thought. General internal medicine! This became my new focus. Continuity of care. Getting to know people well (or so I hoped). And no obstetrics. Ideal.
I switched my interview plan from family medicine to internal medicine and visited several wonderful programs. I used paper-and-pencil to apply to about eight programs (which will amaze today's students who submit electronic applications to anywhere from 75 to 150 residency programs), and filled in my match list, which was, in those days, due in mid-December.
In January 1980, I rotated through surgery as an M4 sub-intern. This would be my final surgical rotation, and I realized I would never again set foot in an operating room. As the rotation ended, I realized how much I loved the creative energy and the excitement of surgery. I would never again be in that environment. This made me both sad and ripe for suggestion.
In February, I started a rotation in nephrology, a particularly engaging medical specialty. I spent a memorable day tracking and graphing the urine electrolytes of two very sick patients in the ICU. As I was leaving the ICU, I ran into James Hutchinson, MD, an otolaryngologist I knew. "What specialty did you decide on?" he asked.
“Internal medicine.”
“Do you like diabetes and hypertension?”
“I dunno. I suppose,” I responded.
He stared at me. “You go into internal medicine and you will spend the next 35 years of your life just taking care of those two diagnoses.” He turned and walked away.
Really? Needless to say, this shocked me. What if he is right?
I thought back to my lists of pros-and-cons. Why had I ruled out a surgical career in the first place? It boiled down to this: At 6'2", it was hard to find scrub clothes that fit. In the attempt to figure out which specialties to include and exclude, I had decided that I did not want to spend my career wearing pants that were too short.
“Hmm," I thought. "I think I can get over that...” I switched from nephrology to otolaryngology for the rest of the month. I was in heaven. Sure, my pants were too short, but it wasn't the problem I had imagined.
When Match Day arrived in March 1980, I was paired with the medicine program at the University of Kentucky. One of my associate deans went to bat for me. After a few phone calls and a couple sleepless nights, the medicine program director at Kentucky realized he could hold me to my match agreement but that I would be a very unhappy intern. He released me from my agreement.
In a situation that would never happen these days, there were otolaryngology positions unfilled at several institutions, including Henry Ford, Mayo, and the Medical College of Wisconsin. The otolaryngology chair at my medical school, David Caldarelli, MD made some calls for me and I had phone interviews over the next two days. Kathi and I drove up to Milwaukee, a town I had only driven through but never visited. After quick meetings with Roger Lehman, MD (otolaryngology chief), and two faculty (Robert Toohill, MD and James Duncavage, MD), I realized that I had found a home. I signed a contract.
I never looked back although I did look down. When I did, I noticed, once again, that my scrubs pants were always too short. It was more than worth it.