My medical school was a four year program-- two of the programs in Canada are squished into three. If I thought that my friends and I were forced into choosing a specialty ridiculously early, I can't imagine how the people in the three year programs do it. By the end of second year, it was already all we thought about. My two best friends were already committed to their specialties-- one was going into pediatrics, and the other into psychiatry. Since they were among the top students in the class (I was nowhere close, but comfortably sitting around the middle) they didn't have to worry about getting a spot. Of course they both did anyway, but that's the nature of the super-competitive medical school mentality... it doesn't matter how good you are, there's always that underlying fear that you're not good ENOUGH.
My first interest was plastic surgery. Not the boob-job-tummy-tuck kind of surgeon, but the kind that puts people together after horrible disfiguring accidents. I loved surgery, and I loved the variety of stuff I saw. Most of all, though, I loved that it was more careful than other surgical specialties. And you really saw the results of what you did. Most of all, though, it was cool.
There were definitely a few drawbacks to opting for plastic surgery. First and formost, it's a bloody hard specialty to match into. There are all of about 8 spots in all of Canada. You have to be the best of the best to match into it, and I definitely wasn't. I didn't have the inclination or the patience to do what was needed to secure one of those spots-- I had no urge to put in the crazy surgery hours (easily 6am-7pm on a regular day), was no good at sucking up to the 'right' people, and had too many interests outside of medicine that I had no intention of giving up. There were other things to consider too-- the surgical lifestyle, for one. It's brutal. At least it certainly is during residency, which could be anywhere from 5 to 7 years. Are you kidding me? I was late to start medical school to start with, and now I could be delaying the start of my life until I'm pushing 40? Not freaking likely. And don't even get me started on what that could mean if my biological clock ever finally kicked in...
Thankfully, that was at about the same time as I did my clerkship rotation in emergency medicine. It seemed the best of all worlds, and combined everything I loved about medicine. I got to do procedures (enough to satisfy the 'working with my hands' aspect that surgery gave me without having to endure the marathon enduro-surgeries that some of the reconstructive ones seemed to be). I got to see the variety I was craving. The pace was fast enough that I was always able to get through a shift without looking at my watch. I got along well with other emergency medicine residents and staff... they were 'my kind of people'-- friendly, outgoing, usually athletic and always with a short attention span. I felt very 'at home' in the ER environment. And I was equally interested in the sore throats and sprained ankles as I was in the heart attacks and trauma. Best of all, it was a lifestyle I could live with.
But the decisions didn't stop there. In Canada, there are two roads to working in the emergency room. The shortest and most common is to do family medicine. After a 2 year family medicine residency (of CCFP, for the Canadian Council of Family Physicians) you are free to work shifts in emergency medicine in most smaller centres in the country. If you want to be more specialized, you can add a third year onto that residency to concentrate on emergency medicine. With the 2+1 option (aka CCFP-EM) you're equipped to work in almost any emergency room in Canada. Even most of the ones in big cities like Toronto and Vancouver are staffed largely by CCFP-EM's. The second path is through the FRCP program (Fellow of the Royal College of Physicians). The FRCP program is a five year program that is meant for physicians who want to specialize in emergency medicine and work in an academic setting. This will usually combine emergency medicine with teaching, research and administration. For some reason that I continue to question to this day, I chose the latter.