How I Chose Neonatology

Like many 3rd year medical students, my friend Clare is currently making a huge life decision: what specialty to go into after medical school. Although everyone’s thought process is a little (or maybe a lot) different from anyone else’s, she inspired me to share how I got to where I am and I hope someone thinks it’s useful!

When I started medical school I was absolutely certain that I was going to do something surgical and was pretty convinced I’d never want to work with kids. I remember telling classmates I wanted to do surgical oncology and almost as distinctly remember feeling like I didn’t really believe it myself.

During our first two years of med school we were all assigned a primary care preceptor that we worked with one week per semester for a total of four weeks, and I happened to be assigned ob/gyn and surprised myself by really enjoying it, partly because I thought I’d like getting to be in the OR as part of my job description. After that, I started getting involved in the ob/gyn interest group, started a Well Woman Clinic at the free clinic I was running, shadowed in labor and delivery almost every weekend, and when my classmates placed bets about what everyone would end up going into, there was a very clear prediction that this is what I would end up doing.

Then I got to third year of med school. I started out on pediatrics and felt a click, even though I tried to ignore it at the time. Everyone I was working with made me want to be a better version of myself and there was not a single person in the department who didn’t seem to enjoy coming to work every day. I remember feeling some disappointment because I thought that lumbar punctures were the most exciting thing they got to do in terms of procedures, but overall I really felt at home on that rotation and the standards were very high for my next rotation, ob/gyn. At this point I was expecting to like it even more and was so excited to get started.

The first part of my ob/gyn rotation was gynecologic oncology and thought I was for sure going to find the perfect fit – surgery and ob/gyn and interesting medicine! What could be better? But even though the residents all seemed like they wanted to do a good job (and one even liked it so much she received her match letter that week to stay at that hospital for gyn onc fellowship), no one seemed as happy as the pediatricians I’d just left. I thought the OR cases were long and dull and even the attending surgeons seemed to wander in and out during long, drawn out pelvic exenterations (google that only if morbidly curious) and outcomes for the patients were incredibly depressing to me. Ok, I thought, not gyn onc but I still am going to like ob/gyn in general!

I got to labor and delivery after that and did fall in love. I liked c-sections, rounding, catching babies, and going to triage and to emergency situations. But what I noticed was that my attention after deliveries was almost never given to the mom – she and her placenta were nowhere near as interesting as the actual human being that had magically just appeared in the room.

The rest of third year I spent comparing things against pediatrics, and briefly entertained the notion of family medicine so I could do both children and women’s health, but decided I wanted the option of further sub-specialization. I thought for about 2 seconds that pediatric surgery would be cool, but then had the worst four weeks of medical school on that rotation (no one seemed happy or well rested!) and quickly crossed that off the list. Anesthesia seemed appealing too, but I missed the opportunity for continuity of care and so off the list it went. I randomly really liked the neuro ICU (probably my favorite 2 weeks of medical school) which in hindsight was actually fairly foreshadowing, but couldn’t see myself taking care of adults only, forever. Or doing a neurology or emergency medicine residency. I never really considered psychiatry, derm, radiology, neurosurg, ENT, ophtho, pathology, internal medicine, or ortho, but did briefly flirt with the idea of urology or CT surgery after enjoying both of those rotations. I decided against them due to the lack of variety I’d end up getting to see.

So I matched in pediatrics and started developing my interest in health care delivery, which was something I’d first discovered I liked before med school when I was working at a free clinic and had picked up some experience in while running my own free clinic during MS2-MS4. Access to care and the way it affects outcomes is fascinating and at times disheartening, so I wanted to find ways to address it. I got so far as taking the LSAT with a plan to pursue advocacy work with a law degree, but found myself developing a serious case of imposter syndrome. Something just wasn’t quite right.

Enter the NICU. At first I’d been dreading it: tiny, fragile, confusing humans who are locked up in boxes which they don’t leave for weeks and months at a time. Kind of creepy when you think about it that way. The first month I was there I didn’t let myself even entertain the notion of a career defined by tiny humans, but I did love going to deliveries, doing procedures, and helping families take healthy babies home. After I covered the unit for Christmas and came back to the NICU for a second full rotation, I couldn’t deny that I was coming in early and leaving late and reading everything I could get my hands on in a way that I just hadn’t in a long time, and once I finally started letting myself believe I was going to do this forever, I felt like my whole personality changed and my imposter syndrome started to really quiet itself down.

Meanwhile, I’d applied for and gotten into LUCENT, which is a primary care track that meant I got extra elective time to do outpatient rotations and gave me protected academic time to work on projects that improve healthcare delivery for our underserved urban population. I loved that too, and liked the continuity a pediatrician has with patients that creates a fun and special bond. One of the attendings that I worked with (and continue to work with) is actually a neonatologist who follows patients in a high-risk clinic after discharge, and this helped me find the final piece of the puzzle that tied all my interests together. (Except inserting IUDs. I haven’t found a way to get to do that with this plan…)

Neonatology with a focus on outpatient follow up gives me just about everything I could possibly dream of, from critical care to primary care, intense and interesting inpatient experiences to expanded clinic appointment slots for complex medical needs, deliveries and code situations to advocacy opportunities for improved access to care for high risk patients, and unique transitional physiology to unique children with different developmental needs and personalities. I feel like I’ve found the perfect fit and want to encourage anyone who doesn’t feel 100% certain about forced career choices that there is a very strong likelihood that you’ll find something you love and excel in if you trust the process and stay open to new ideas along your path.

I know this is really long-winded but it took nearly six years for me to figure out what I wanted to do with my life after deciding to become a doctor, so the thought process was also fairly drawn out! If you have thoughts on specialty choices I’d love to hear about them!

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