Wednesday, January 26, 2011

Rank List Dilemmas

I thought that making my rank list would be about deciding what kind of program I want to go to- but it's turned into so much more than that.  It's about deciding what kind of person I want to be, what kind of life I want to have, what kind of surgeon I want to be....  none of which are questions that anyone else can answer for me.

There's one type of program- we'll call it Academic Central, that is great in a hard core, down and dirty surgery kind of way.  The residents are the coolest, slickest, most confident and cool-headed people I've ever met, and I want to be just like every single one of them.  They work really hard, but they save people's lives every day.  They come out of residency completely exhausted, but also as some of the best trained surgeons you'll ever meet. They publish lots papers and are taught by "famous" surgeons who have invented procedures and written textbooks. If I went there, I would have little/no life for 5 years- but afterward I would be on the track to becoming a world-renowned whatever-kind-of-surgeon I want.

The other type of program- we'll call in Community Galore, is much more laid back.  Smaller program with a heavy emphasis on bread-and-butter surgery cases (lots of gallbladders and appendixes).  They work less hours, and they see fewer super complex cases.  If I want to be a general surgeon, though, do I really need to see 14 Whipple's?  Probably not.  And as a 4th and 5th year, you operate fairly independently which makes you actually ready to operate alone in practice after graduating. Their average number of cases is higher than Academic Central's, and yet they work about 20 hours a week LESS (that's the magical thing about home call-  you stay at home at night and only come in if they need you) .  I would actually have a life for 5 years (the current residents have babies, run marathons, play poker 2x per week...) and I would graduate as a well prepared general surgeon, and I could go to fellowship if I want to (but no one will be beating down my door begging me to come to their program, like they would if I was from Academic Central).

I'm sure that half of you think its a slam dunk decision in each direction- but it's really REALLY not.  I don't think I'm ever going to be the world-renowned surgeon in anything, because that's not what I'm passionate about.  I don't care about being "famous" or "cutting edge", I care about having patients who I can take good care of and who I can help.  I'm going into surgery because I like operating and I like fixing people.  The more I do that, the happier I will be. 

I want to have a life outside of surgery too.  I've been told repeatedly that being in academics is general at the expense of any kind of family life.  I want to have friends, and see my family, and have my own family someday who I actually get to spend time with.   Call me crazy but don't get me wrong- I'm not lazy.  I don't have a single lazy bone in my body.  When most other medical students take a nap- I write a novel and run a marathon.   I'm not hoping for less time at work because I'm lazy; rather because I love all of my life so much that I want to have time for all of it. Balance.  I would love to start volunteering with Danny in my free time.  I'd love to become an adviser at my sorority for women interested in medicine. I want to write another novel.  I want to run half marathons.  I want to get married and raise good kids. I want to have a full and meaningful life, where I can point at five completely different areas of my life and say, "That satisfies me."  Surgery should be one of those areas- not all five.

And yet, there is a little voice in my head that says, "You HAVE to go to the most competitive program that you can.  You HAVE to always be reaching for the highest medical school, the highest program, the highest job. Otherwise, you're wasting all your hardwork and abilities."  My competitive nature tends to highly value adversity and difficulty; as though something being challenging innately makes it the most desired path.  True, I like challenges, but they need to have meaning.

So I'm stuck between this unrelenting drive that I have to succeed, do more, reach further; and the very real desire to be a well rounded person who is happy and balanced in every area of life. ADVICE WELCOME.


  1. So I've had a similar dilemma in med school (regarding doing Fancy and Important Research I don't care about vs. doing Insignificant research I love), and I got the best advice EVER from my mentor about it:

    "At a certain point, the idea that you do ambitious things so you can grab that next golden ring and make it into the next prestigious opportunity – that has to stop. At some point you have to say, “*This* is the point I was trying to get to. Now I have options – so what do I *want* to do?”

    Because there’s always going to be another golden ring you could grab if you wanted. At some point, you have to be content and accept that not grabbing the next ring – whatever it is – doesn’t mean that you’ve “given up”.

    The best college can be followed by the top medical school, then the prestigious residency can be followed by the prestigious fellowship, then the research grants, then the academic appointment – and if that’s what you want, fantastic – but if you don’t, when does it end?"

    Hope that helps. It clarified things for me, anyway. :)

  2. I'm just as torn. Do I want and AWESOME WORLD RENOWNED sister?

    Or do I want a sister that I get to see occasionally?


  3. this comment box is so small and I have so much to say.

    First piece of advice - make your decision and then don't second guess it. Don't look back and wish it away. When you make your decision, it will be the best decision possible (because you made it). You can take various paths from there but promise yourself from the get go - that once the decision is made, you will be full speed ahead.

    Second piece of advice - option one implies that greatness is only defined by classic success (more, better, higher, faster). I disagree - greatness can be defined by holding a sick child in Africa and giving them a bit of comfort in a comfortless world.

    Only you can define your success.

    I got it all. The wonderful opportunity to be a mother, wife, friend and to have a great career. You can have it all on either path - path one costs you dearly in the early years but may give you greater opportunities in the later years. Path two let's you have a better quality of life in the early years but may limit you in the later years.

    Tough decision - but this I know for sure. You will make the right decision.

  4. Be a cardiologist. Self serving comment from Dad.

  5. just browsing through the interwebs and found your blog! and i am in the EXACT SAME situation as you! trying to figure out my rank list (for gen surg! yay lady surgeons!) and having the same debate...academic prestige vs. community awesomeness. i'm basically flipping around my top 3 choices over and over...the rest of my list is pretty set. aak!

    i'll be bookmarking your blog! good luck with your rank list!

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