The 3Ps of Choosing Your Medical Pathway


Shreeya R. Joshee
Vice Chair, ACP Council of Student Members

University of Nevada School of Medicine, Reno


I have known since I was very young that I wanted to be a physician. Most of my life had been spent on getting into medical school, and I never had a chance to think about what I would do once I got in. As a first-generation medical student, I also did not have any points of reference in my family of all the options available to me in this field other than the role of a general practitioner. As I look back on my decision to pursue internal medicine, I realize that it was a decision I made systematically throughout my years in medical school. By sharing my journey into finding this field, I hope it will be helpful to others when it comes time to make this all-important decision.

The first significant decision in choosing a medical specialty is deciding medicine, surgery, or a little of both. This is where the preclinical years shine. Some will be drawn to the hands-on skills learned during student interest group meetings, dissecting your cadaver in the anatomy lab, or assisting with other procedures. Others, like myself, reveled in developing a meticulous differential diagnosis, focusing on the big picture and preventative health, and truly enjoyed our physiology courses. Thus, I realized that I wanted to go into a field that was primarily medicine with an occasional procedure or two.

Now that one major decision was reached, I moved on to deciding what patient population I wanted to work with: children, adults, pregnant individuals, or all of the above. This next decision was reached during my second year. I rotated with a family medicine physician who did everything, an internal medicine hospitalist who focused on adults, and an ophthalmologist whose focus was the eye and nothing else. Of all these patient populations, I realized my passion was becoming a generalist but just for the adult population. Third-year clerkships solidified this decision and introduced me to the people in the field. I could genuinely see myself in internal medicine physicians at all stages of training. My confidence in becoming an internal medicine physician increased because I found my people within medicine. For some, going through third-year clerkships can do the opposite and completely derail the course they set during preclinical years. They may have enjoyed specific topics during the in-theory, but they find that during clinical years, they are drawn to clinical practice in another setting.

For medical students approaching that dreaded ERAS deadline in their respective application years, know that it's okay not to know your specialty, even up to the point of application. Some come into medical school with an exact pathway they have known since childhood, while others need to explore all the possibilities and see what awakens their passion. As someone who falls between these extremes, the best thing to help make this critical decision is following the medical specialty pathway's “three Ps”: passion, patient population, and people. Are you passionate about the topic matter or is it something that makes you want to keep learning more? Do you enjoy the population you intend to work with and the bread/butter ailments they will present? And finally, the people: Do you get along with those in the field and see the qualities you wish to embody in physicians who choose this specialty? Four years is a very short time to make such an important decision. Talk to your mentors, your family, and your peers. You will never completely understand everything this journey entails, but you can go in with as much information as possible. Meanwhile, enjoy your time in school and absorb as much as possible before the real responsibilities kick in.

Back to the December 2023 issue of ACP IMpact