S6E17: The Intersections of Medical Specialty and Identity

Mariam: Hello, everybody. Welcome to my skincare ASMR. First, we're going to turn on the water to a lukewarm setting. Now take out your cleansing balm, open the lid, and scoop up some of the cleansing balm and put it on your dry face and melt away the day. Melt away the makeup, the sunscreen, the dirt, the pollution, the stress.

Hạ: Is this a meditation routine? It feels like a meditation routine here.

Mariam: Skincare is the best thing ever. It is literally . . .

Margaux: It's meditative.

Mariam: It is. It's what I look forward to every single day.

Hạ: Okay. Well, thank you, Mariam, for starting us on our new practice, which is that we will start with meditation via a skincare routine. For our listeners, hello. Welcome to "Bundle of Hers." We are in the actual studio.

Margaux: Rarity.

Mariam: I know.

Hạ: Amazing. This is my first time in the studio. And this is Hạ and I'm here with Margaux and Mariam.

Margaux: Woo-woo.

Mariam: Hello.

Hạ: What were you saying about how you're feeling about the episode topic, Mariam?

Mariam: Very excited because I'm in my feels about this topic.

Hạ: Oh, feels. Love it. There's also a beautiful TWICE K-pop song. It's called "The Feels." That's my plug for K-pop in the . . .

Mariam: Always got to have a plug.

Margaux: Always.

Hạ: There's always got to be a plug.

Margaux: Always.

Hạ: So to kind of set up on this topic, I actually wanted to start off by telling this story and it's called . . . I refer to it as the Mike prophecy story. Basically, for all of our listeners who don't know, in our medical school, we have this advisor who advises particularly for third- and fourth-years called Mike.

When I was just a new MS1 trying to figure out my life, I set up an advising with the MS1 and MS2 advisor, but she was out of town that day, so Mike decided to be the substitute advisor, which was very, very kind of him.

So I sat down and I was just trying to figure out my life, talk about how you explore and figure out your specialties, because MS1, undecided, trying to really get a vibe about things. And Mike goes and he pulls up the spreadsheet with my Clifton StrengthsFinder assessment. And for those who don't know, a Clifton StrengthsFinder is kind of like MBTIs, kind of looking at your horoscope. It just tells you who you are innately and your strengths apparently.

Margaux: Or at least it wants to.

Hạ: Well, I love looking at astrology and horoscopes, so I swear by the StrengthsFinder assessment. And so it tells you all of this. And he pulls it up and he was like, "Wow. Looking at all of your strengths, I get the sense that you're going to be the type of person who will be between at least two to three different specialties when it comes to decision time. And you're going to have to give something up to make the decision."

I was just an MS1 and I sat there. I was like, "No, Mike. Why did you say this to me?" And I was freaking out. I was like, "This is not going to happen. I refuse to become this."

Well, lo and behold, by the time I hit end of third year, beginning of fourth year having to decide between specialties, I was between two specialties and I could not figure it out for the life of me, which is why I refer to this as the Mike prophecy because Mike and Clifton's StrengthsFinder assessment prophesized my entire future.

Margaux: Yeah. Mike knows all.

Mariam: I know. He really does.

Margaux: Yeah. He goes back to even before Harjit, my, and Leen's time, but he also was a great help and guide for us too.

Mariam: Also a source of stress, I guess.

Margaux: Yes.

Hạ: We love you Mike, if you're listening.

Mariam: Shout out to Mike.

Hạ: But all of this is just to say, if you haven't figured it out by the story, is that this topic was talking about specialties. In a prior "Bundle of Hers" episode, particularly Season 3 Episode 1, Margaux, Leen, Bushra, and Harjit had been able to already talk a bit about choosing your specialty and expectations versus reality of it and talking about how envisioning your own way of practicing medicine.

For this episode, I really want to focus on what we were talking about with our big theme of the season, which is identity. So thinking about specialties as identity, really thinking about how does medical culture frame our chosen specialty as our calling? How does this really complicate the process of choosing a specialty?

And what does it mean when our chosen specialty and the community that we're going to belong in don't completely fit us? How do we reconcile that? Because all three of us are in very different points of our lives with specialty decision-making, right?

Mariam: Yeah.

Hạ: As I had alluded with the Mike prophecy, I was between two specialties. It was pediatrics and OB-GYN. And while I have matched into pediatrics, I actually dual applied and it's a very secret thing being a dual applicant, though my mentors and a lot of my advisors were aware of the process. And that's why the concept of specialty as identity is so paramount to me, because it was something that really bogged down and really affected my whole decision-making process.

Margaux: Hạ, I love that we're talking about or revisiting specialties but with the emphasis of identity, and I think many of our listeners will probably be familiar with a lot of the TikTok identities, particularly Dr. Glaucomflecken, etc., who have kind of emphasized the stereotypes and identities that come along with different specialties.

And so I think it's really important to acknowledge that these identities and stereotypes exist within specialties, but also to your point, we don't all have to fit those stereotypes to belong in the specialty.

And I think finding your specialty is much more than the stereotype, but medical school and our sort of medical culture makes that very, very difficult. And so I don't know. It's kind of like we have the ghosts of the past, future, and present here at the table, which is cool. So I don't know if we want to start with the past, me, or the future, Mariam.

Mariam: Oh, my gosh.

Hạ: I love the past.

Mariam: I think of the "Christmas Carol" sequence of events.

Margaux: That's exactly what I was referencing.

Mariam: Yeah. So let's talk about the past.

Margaux: Ghost of matching past?

Mariam: Yeah, I love that.

Hạ: Yeah. Ghost of matching past. This episode is "A Specialty Carol."

Mariam: "A 'Bundles of Hers' Specialty Carol."

Margaux: "Specialty Carol." So thinking back in that episode how I referred to . . . I talked about my specialty in first and second year that I thought I was going to do was pediatric orthopedics, which is so different than what I'm doing now, which is pediatrics and child psychiatry.

For my first and second year of med school, I shadowed a lot. I was very involved with the different student groups. I was working particularly with one mentor who, I think when I reflect back, was a big reason why I liked the specialty. Not the actual specialty itself, but the work of the specialty.

And I think that's something that's important, is who our mentors are can really make us feel like we belong. And that's part of identity, right? It's finding our community, and if you really connect with a mentor or someone that you're shadowing with and they really reach out to you rather than close off their doors, it can make you feel like, "Oh, hey, this is a community that I could find myself in."

And I think it's very important to recognize that one person's interaction with you is not definitive of an entire specialty, nor is it going to be predictive of how you will actually like doing the work.

Being a medical student shadowing, and not having the weight of the responsibility of the work, is very different than being in attending bearing the full weight of the responsibility in the work of the specialty that you choose.

Essentially, I came to a point in third year where I was at a real . . . I had a lot of internal dissonance and identity soul-searching about saying, "I want to be a surgeon. How can I like psychiatry?" Because I loved my psychiatry rotation.

Kids, I knew all along that I was going to do pediatrics, so that was not really a hard thing. But this conflict of, "I must be a surgeon," that stereotype and that identity really butt heads with now this idea of a psychiatrist.

The stereotype is some old dude in a herringbone jacket or something just sitting in an armchair psychoanalyzing people, and that's not me, but why do I love this so much?

I didn't expect to have so much actually anxiety and literal internal dissonance around coming to the decision that maybe I didn't want to do surgery and letting that go. It took a lot of reflection, but when I think about it, I really do think it was because I felt welcomed by that one mentor and the community of what she represented.

The other part of it, I think, is my own personal need to contradict everything, and so I'm like, "Oh, ortho is for white bros. F that. I'm going to do it, right? I can do it too." And that was also something I needed to recognize in me. It's not a reason to go into the OR for the rest of your life.

And so I realized through my surgery rotation that outside of that mentor that I had, the rest of the people I was interacting with, the type of work, the schedule, it wasn't who I was.

And that takes a lot to sometimes uncover those truths of the glory of being a surgeon, because our society stereotypes that and what that means, with now being like, "No, I actually am rejecting that for myself and learning a lot about who I am."

So it was a real identity journey and I struggled with it a lot even up until when I was doing my applications. I think I kind of solidified when I finally submitted my applications for triple board, which is pediatrics and child psychiatry combined program, that I was comfortable in this sort of identity and path of who I was going to be in the specialty.

Hạ: And I think when . . . I guess now "Christmas Carol" is the Ghost of Christmas Present that comes next, right?

Mariam: Yes, sure is.

Hạ: Okay. I just wanted to make sure. Margaux, as you were talking about that, there was just so much that you said that I was like, "Wow," and snapping my fingers. But I don't know how to snap my fingers.

Mariam: That was beautifully said, yeah.

Hạ: I resonated with a lot of what you were saying about identity dissonance and about also being drawn to certain fields because of communities or because of mentorship and other social factors and expectations too, and really trying to unpack that with who you are and what you want.

And so for me, my journey was actually very, very messy. I came into medical school thinking I was going to do a lot of different things, probably primary care focused.

When I entered third year, actually one of the things I thought I wanted to do was psychiatry, but after doing my psychiatry rotation, I realized it wasn't the best fit for me, but really hanging on for a good chunk of second year. And I think the reason why was because of Harjit and Margaux, seeing these badass psychiatrists or psychiatry-to-be people. I really resonated with it and I was like, "Oh, I want to join this field."

And so for a lot of second year, I was anchoring myself on psychiatry so much. And when I did my psychiatry rotation, I realized it wasn't the best fit for me even though I still really love all that the field has to offer.

I was a bit at a loss, and by the end of third year, what I realized was . . . Because for me, it ended up being kind of like a process of elimination and just seeing how I felt in rotations. And the two that I enjoyed the most were OB-GYN and pediatrics, which for a lot of people when you tell them, "I'm in between OB-GYN and pediatrics," people are very confused because they feel like two very different specialties.

And I think for the work it can feel very different, but I was really drawn to the core of both of them, which was really centered in advocacy and really centered in uplifting individuals and also having that primary care bent within it too, while still being a bit more targeted community that I didn't feel as overwhelmed versus when I was in family medicine.

So I was really drawn to them and I really liked the work. I really liked the patient community and I thought, "Okay, I'm going to do my two sub-Is and it will even it out." But as you were talking about, Margaux, there were so many other outside factors that were playing into my decision-making.

I felt like a lot of my closer friends within my class were in OB-GYN, so I felt this pull of this community within my class of people really going together. We got matching scrub caps and all of that. So it just felt like there was this great community in OB-GYN.

And there was just also this other sense that when I looked at OB, there weren't enough people who looked like me or who even thought like me. And I really felt this pull. I wanted to change this. I wanted to be the difference. But also, at the same time, because of the fact that I didn't feel like I belonged within OB-GYN, it was really hard for me to reconcile that and reconcile if I was willing to give up a lot of other things that I valued, such as wellness, such as my time to do things.

OB-GYN is a really hard training residency program, and I think people can bring in their passions in global health and medical education and mentorship and all of that. But with the time constraints and what you need to do in OB, it's a lot harder than maybe per se doing it in pediatrics where a lot of pediatric programs have pathways and evolved for you to do those types of work.

And thinking about, "Am I willing to give up my love of being able to tutor, work with medical students very deeply, and think about education and think about really working with the community?" And also just thinking about not doing call and getting to do night flow a bit more frequently. And so I was really grappling with what felt like two very different sides of the story.

And then everyone around me had really strong opinions about OB-GYN versus pediatrics, to the point that one intern in surgery recognized me randomly at a gelato shop based on my OB-GYN versus pediatrics debacle. He overheard me talking about this and he recognized me.

And some people are like, "I don't think you fit la surgeon, so I feel like your energy fits for pediatrics." Other people are like, "You would do so well in OB-GYN. I'd love to see you as an OB-GYN." When you get so many different thoughts and so many opinions and so many of these outside factors, it really clouds your ability to make judgments.

And the medical training system sucks so much. By the time I finished my two sub-Is and took Step 2, I was so burnt out that I couldn't feel like I could make a decision. And honestly, I couldn't do what Mike told me I had to do. I couldn't let things go.

So I ended up dual applying. And I don't really encourage it because I think it's a pretty grueling process and you're constantly throughout the whole application cycle dealing with identity dissonance. You're dealing with trying to figure out, "Who am I?" As you're trying to sell yourself in interviews you're going, "Am I a pediatrician or am I an OB-GYN?" And it's very confusing and very conflicting a lot of times.

But I think for me, what ended up happening was I just kind of told my story the way I wanted to tell it, and I ended up figuring out through it, through the ways that people responded to my story, through the ways that I saw how I was thinking about things with my interviewers, that pediatrics really fit me a lot better. So I ended up ranking my pediatric programs a lot higher than my OB-GYN programs.

And I think that's the hard thing, is trying to still be really stoked about a specialty that you're going in and knowing that it's your great fit for you and that you love it wholeheartedly. It's not like the second choice or anything of that means, but still sitting there and going, "There was another future that I could envision for myself and I had to let it go. I made the best decision for me and I stand by what I did," it's still kind of heartbreaking.

The whole time I did this process, people kept comparing it to being in a relationship.

Mariam: Yeah. I just remember, Hạ, you being over at my place one time and I was like, "How are you doing?" And you were like, "Mariam, I think I'm going to officially break up with OB." I was like, "Oh, how can I support you?" I was like, "Oh, shoot." So, yeah, I could see how it felt like a breakup.

Hạ: I'm very overdramatic too, so that might have contributed to it.

Mariam: No. I can definitely . . . I feel like that makes a lot of sense. I guess going through it right now, I guess I'm the Ghost of Matching Future, right? This is Mariam, by the way. I'm on my second to last rotation of third year.

And I think when both of you guys were talking about your experiences, I've definitely seen you go through it, Hạ, this past year. And, Margaux, we've talked about your experience, and I think I can personally relate to a lot of the things that you have gone through.

Something that stuck out as you guys were speaking was this concept of radical honesty throughout this process and how difficult radical honesty is in general, but especially when you're going through this process.

And third year is a really challenging year because you kind of get a snapshot of what each specialty looks like. And while you're learning all the things and working really stressful hours and doing all these things, balancing being a medical student, you also have to maintain a level of self-awareness of what makes you happy and what fills your cup and make these really big future decisions.

And that's been kind of the challenge of third year. I feel like I'm in a better place now because I have come to a decision of which specialty I want to go into, which I will tell you guys in a minute.

Margaux: The suspense.

Hạ: Dun-dun-dun.

Mariam: I know you guys are very excited to hear what it is. But I wanted to kind of talk about my journey as I started third year and kind of how I came to the decision.

So when I started third year, I had kind of an interesting schedule. My first rotation was actually my four weeks of electives, which was interesting. It was an interesting way to start third year. I signed up for a derm elective because I flirted with the idea of going into dermatology, which I realize is now really hilarious because the cold open for today was a skincare routine.

I am really passionate about skincare and we had a derm week last year and I was like, "Oh, my gosh. What if I did this? What if I was a dermatologist?" And derm is a really competitive specialty, so I wanted to know straight away if I wanted to do derm.

So I did four weeks of it and I liked it. It was fine, but it was definitely not what I wanted to do. So then I jumped into neuro. That was my next core rotation. And honestly, the first few weeks, I remember just being really miserable on neuro. It was a really interesting specialty, but it was just not for me. I kept lying to myself and other people that I really liked neuro and that I might want to go into it.

Then I started my general surgery rotation and really liked being in the OR, but didn't fully vibe with it. And I then told a whole bunch of people, "I'm kind of interested in general surgery." So I literally just bounced around.

Then I did my medicine rotation and then I was like, "Okay, this is the one." I was pretty set on medicine to the point where I reached out to medicine specialty mentors and I was like, "I think I want to do medicine to pursue either oncology or palliative, or I could be a hospitalist. This is the one. I love medicine."

Then I did my family medicine rotation, and I loved family medicine and I was like, "Should I do family medicine?"

And then after that, I did my psych rotation and I was like, "What if I did med psych?" So, honestly, I kind of jumped around. It was kind of a chaotic year.

And I think with each experience, the excitement of being in that space and experiencing these things for the first time led to that, "Oh, should I do this?" I think third year offered me the opportunity of imagining things for myself that I wouldn't have ever imagined for myself before medical school and even in my first two years of medical school.

Similar to you, Hạ, I thought I was going to do primary care, I thought I was going to do a specialty like family medicine, family practice, because I think it fit my personality well and that's just kind of what I imagined for myself. But then I got to experience the OR and I was like, "This is really exciting." So I started to kind of imagine these possibilities.

And finally when I got to my OB-GYN rotation, which is the rotation that I'm on right now, I scrubbed into a C-section. And by the way, I kind of was like, "I'm not going to do OB because OB is not the one. It's like not medicine-y enough. It is just . . ."

I think you alluded to this, Hạ, but it has this reputation of having a little bit more of a toxic culture and the residency is really intense and I was like, "Oh, I'm not going to like this."

And then the second I scrubbed into the C-section, we delivered this baby, I actually started crying in the OR, like tears of joy and happiness, and I was like, "Oh, my gosh. That was the most beautiful thing I've ever seen." And I walked out and I told my resident. I was like, "Should I do OB?" and she was like, "Yeah, maybe."

And so the next few weeks just kind of went on, on labor and delivery specifically, and I just had the time of my life. It was just this fantastic experience. And it felt different than the other rotations that I had prior.

I think in the other rotations, I was trying to really convince myself that I could see myself in something because I was trying to imagine those possibilities for myself. But when I went through OB, I was like, "No, this is actually what I want. This is really filling my cup." I felt like six weeks wasn't enough. I'm definitely very exhausted. But it's been a really fantastic experience.

And so, yeah, OB-GYN, that's the one.

Margaux: Woohoo.

Mariam: But if next year I record an episode and I'm like, "I'm actually going to this other specialty," then I have a problem clearly because . . .

Margaux: No, you don't. You're allowed to change.

Hạ: No, you're totally allowed to change, as Margaux said.

Mariam: Exactly.

Hạ: It's funny because I feel like everyone in the Bundles were kind of like, "We feel like Mariam's going to land in OB." But you were high key very denying it. I don't know. I kind of always . . .

Mariam: Do you know what I think it was? Kind of going into our conversation about other people's expectations for us, I had heard a lot that I would be good in primary care, and I would also be good in OB because I worked in women's health before. But a part of me wanted to reject that when I started third year because I was like, "What if I could be a trauma surgeon? Nobody would expect that from a little Middle Eastern girl." You know what I mean? Like, "What if I was that girl?" Kind of like what Margaux said.

Margaux: Yeah, it's a real . . . You want to transcend the stereotypes, but at the end of the day, you have to come back to this radical honesty of, "Sure, I can do that." And you were absolutely capable of being that trauma surgeon if you wanted to.

Mariam: Yeah, totally.

Margaux: At the end of the day, you have to visit, "Is it filling your cup?" Because this is a career choice that you're going to be doing for the rest of your life.

Mariam: Unfortunately.

Margaux: Rewind back to our 80-hour workweek. You're in it and committed. So not to say you can't change. And I want to put a plug that third year in medical school is a very limited time of tastes of different specialties, and it's a very big decision to make and to sort of really know your identity and make that leap into what specialty you're going to choose.

I want to say it's not talked about that much, but it is possible to change courses. Once you start intern year, you can transfer. You can rematch. These are all options. They're harder, not as common, but you can do it.

Hạ: And I think the other thing is I just always want to give that space that it's okay to feel definite and then feel doubt and to waver. I think that a lot of times with medicine, we like to really push that our specialty is our one true calling. And I'm really happy whenever people tell stories where they're like, "Wow, I did this rotation and it just clicked." I'm like, "Good for you. I'm really happy for you." Like you, Mariam. I'm really happy for you.

But also there's a part of me that goes, "But that's not always the story." I want to normalize that it's totally okay for you to love a lot of different specialties and to love a lot of different things and realize that all those things that you love, even if they're not in the specialty you chose, it's still a part of your identity and it's totally okay to still lean into those loves and to still configure them as a part of your journey.

I feel that once a lot of people choose the specialty that they choose, they like to just go gung-ho. They like to lean into that stereotype. And I've done that too. The moment that I decided to rank pediatrics higher, I leaned into that stereotype about what a pediatrician is a lot more. But I think we need to give the grace that there is so much more nuance to specialty decision-making and what we love in medicine.

Mariam: Yeah. And that kind of also is perpetuated, I think, by the branding culture of our school too, figuring out your brand so that you can put together a perfect application to apply to this very specific specialty. And I think that makes the process very complicated.

Margaux: I want to acknowledge too in that vein that we function in a medical system that silos specialties. You go into one specialty and that is your focus and your life, and you must sacrifice all your other interests.

What you were saying, Hạ, is you can still do reproductive justice. You can still have those aspects that drew you to OB. But I also want to put a plug that that system of siloed specialties isn't functional and isn't necessarily a good model, and we can start to change that and break it down. If you wanted to, you could work in an interdisciplinary pediatrics and OB-GYN clinic.

Hạ: Or we could start it.

Margaux: Yeah.

Mariam: Oh, my gosh, Hạ.

Hạ: That's so cute.

Margaux: Planted the seed.

Hạ: Soulmates.

Mariam: Oh, my gosh. You guys, a soulmate clinic.

Margaux: Look at me, a matchmaker.

Mariam: I know. We're going to have a picture of Margaux framed in our clinic as . . .

Margaux: I'll just be the psychiatrist.

Mariam: Oh, that's true.

Margaux: So cool.

Mariam: Oh, my gosh, you guys. A "Bundle of Hers" . . . And none of us are in medicine, which is funny, because "Bundle of Hers," the heart. You'd think at least one person would have been studying the heart.

Margaux: Cardiology. It's okay. We just appropriated.

Mariam: But a lot of people appropriate things in medicine.

Margaux: I know, right?

Mariam: Are we too much?

Hạ: Oh, yeah, are we too much?

Mariam: Our producer is like, "No. Stop this right now."

Margaux: Piece of advice coming from the Ghost of Matching Past and someone who's in a combined program, which kind of is the opportunity to do both. I would say that I don't fully identify with the stereotypes of either pediatrics or psychiatry, and I do find myself in this middle.

But what I will say that is really cool that started happening to me this year as a third year is I really felt more secure in that identity as a doctor or as a healthcare provider because I was able to start doing clinic visits. I felt confident in being able to talk with the patient, being able to know what medications, what diagnoses without having to second-guess myself or rely.

And of course, there's always learning and going back to your community for never-ending learners, right? That's what we are as doctors. But that part of me I would like to impart on you.

I feel like in medical school we feel so much pressure and influence from other people, from these snapshots in third year of what we get to taste of each specialty, but I think you will really feel rooted in whatever choice and whatever career you make as long as it's filling your cup. But also, as you gain knowledge, as you gain confidence, that's when you really become rooted in your specialty.

Mariam: Oh, I love that. That's so hopeful.

Hạ: That's so beautiful, Margaux. I'm glad that you still have some hopefulness deep in you with residency. It gives me hope.

Mariam: Whenever Margaux has hope or Harjit, the residents, I'm like, "Okay. It's going to be okay."

Hạ: It will be okay.

Margaux: It will be okay.

Hạ: Even with my 80-hour workweeks, it will be fine.

Mariam: Eighty-plus-hour workweeks.

Margaux: Yeah.

Hạ: It'll be okay.

Mariam: It's okay.

Margaux: We'll break that system down too.

Mariam: Yeah, we'll break it down.

Margaux: Smash it all down.

Mariam: We're going to burn it down.

Hạ: I feel like that Margaux's hopefulness is a beautiful way to end things.

Mariam: Agreed.

Hạ: So, to our dear listeners, I hope that this conversation either resonated with you or got you really thinking about specialty choices and identities and whatnot.

And if you feel particularly inclined, we have these really sweet "Power From Identity" pins. They're really cool. Very beautiful. Great for your lanyard or for your backpack, for whatever you want. So if you drop a message on our "Bundle of Hers" IG page, @bundleofhers, we will be able to give you one of these pins as you reflect on this episode. We would love to hear from you.

Mariam: Great. That's it.

Margaux: Bye.

Hạ: Okay. Bye. You can listen to us wherever you listen to podcasts.

Mariam: Oh, yeah. Bye.