Finding fit and flow: How to choose a residency path

The concept of “fit and flow” has been longstanding in our profession since its inception. Taken from A.T. Still’s autobiography, “the rule of the artery is absolute, universal and it must not be obstructed.” Flow is often defined as steady movement along a fluid trajectory without resistance. Similarly, from a psychiatric perspective, “flow” is described as a peak mental state in which one is fully immersed, focused and full of energy.

The essence of peak performance relies on this concept. You have likely experienced times when you were so immersed in an activity, it felt like time stood still. You naturally knew what to do, formulated options and put solutions in place without awareness of the passage of time. After working for countless hours in these settings, you feel uplifted, energized and inspired, rather than mentally and physically exhausted.

What residency trajectory paths ignite this spark in you? Perhaps you completed a rotation in family medicine and felt at home speaking with patients and drawing knowledge from multiple specialties to apply a holistic approach. Or maybe second assisting for an ORIF surgery left you feel empowered and motivated.

Psychologist Mihaly Csikszentmihalyi defines flow as “the state in which people are so involved in an activity that nothing else seems to matter; the experience itself is so enjoyable that people will do it even at great cost, for the sheer sake of doing it.”

What ignites that feeling for you?

Here is an overview of signs for “fit” and “flow” broken down by specialty, highlighting general personality tendencies and trends in the most popular residency tracks for osteopathic medical students:

• Family medicine: These physicians are often known as the patient-centered “generalists” who enjoy connecting with patients, ideally over a lifespan and across generations. They are interested in longitudinal care of patients, “from birth to death.” The long-term relationships with patients and families tend to be a priority in care. Community-focused health models in several practices are common in this specialty. There are also ample opportunities to practice OMT skills. Culture tends to be family friendly, with currently more women than men in this specialty. Practice trends toward addressing social justice and care for vulnerable populations. This specialty is one of the quintessential paths for osteopathic physicians to practice patient-centered holistic care in collaboration with communities.
• Internal medicine: This specialty tends to attract analytical, detail-oriented problem-solvers. Physicians who practice general medicine often enjoy working in teams, embracing diverse patient populations, developing relationships with patients and managing multiple medical challenges. Specialists tend to enjoy delving deeply into a specific organ system/finding etiology of medical conditions within a specific area. The potential career trajectories are extensive with a wide range of salary and lifestyle options.
• Obstetrics and gynecology: These physicians are passionately focused on women’s health. As part of training, they are also specialized surgeons. They often have a love of obstetrics and the female organ systems, and tend to be drawn to focused areas of patient care. Hours can be extensive, particularly during residency training. Those who love this career will often work extended hours spent in deliveries, surgeries and patient care. The ability to work well in teams is essential. Post-training opportunities for lifestyle choices around schedule have increased in recent years. However, this specialty remains high-intensity and fast-paced. Pay tends to be on the higher end of physician salary range. If you decide to pursue this career track, get ready to enter a profession of high stakes, high rewards.
• Pediatrics: If you spot a jovial, laughing physician at a conference with a brightly colored animated tie, it’s likely you’ve found a pediatrician. These physicians are typically known as fun-loving, compassionate physicians who enjoy children and can turn just about any challenge into play. The most important aspect of this role is a love of babies, children and teenagers. A hearty immune system is a plus, especially during your first year of residency. The salaries and options for careers in this specialty are similar to internal medicine: inpatient and outpatient opportunities (or combined), community and/or hospital settings, academic and/or community service focused. Like internal medicine, there are multiple opportunities for pursuing a fellowship. In keeping with the focus of the profession, lifestyle tends to be quite congruent with support for time with family.
• Psychiatry: If you have read this far while keeping in mind your personal characteristics and traits that align with a profession, you may be a psychiatrist. Psychiatrists tend to be communicators who possess a genuine fascination with the innerworkings of a patient’s psyche. If you feel too rushed in primary care settings and have thoughts such as, “I asked about blood pressure, but how will I really get to know my patients?,” psychiatry might be your calling. Psychiatrists typically love to listen to patient stories while identifying core etiologies of problems. With increased demand for physicians in this specialty, average to higher pay for medical specialties, and opportunities for schedule flexibility, this career path has become increasingly popular (and competitive) in recent years.
• Surgery: Physicians who specialize in general surgery are often hard-working, high academically achieving, dedicated proceduralists who love being in the operating room. First and foremost, you must love surgery. Surgeons often describe their career path as the only profession they could imagine making them truly happy. They are so “lit up” by an opportunity to be a part of surgery, the intense hours and physical requirements take a backseat. Leadership skills are a must. Salaries are potentially quite high in this profession, especially with fellowship/specialty pursuits. Lifestyle and schedule flexibility have historically been challenging. The profession can be incredibly rewarding for those who love this specialty and can imagine nothing else.
• Osteopathic neuromusculoskeletal medicine (NMM/OMM): Our NMM practitioners are dedicated, passionate physicians who love working with their hands and deeply embrace the foundations of the osteopathic approach to care. This track is the flagship residency of our profession and reflects the true distinctiveness of osteopathic medicine. A.T. Still founded our entire profession on the basis, understanding and evidence that the body has an innate ability for self-healing. DOs who complete NMM/OMM are the masters of this foundation of medicine. The NMM/OMM specialty offers a myriad of opportunities to practice in hospitals, teaching facilities, research institutions, community-based practices and private practices. If you enjoy the hands-on aspects of osteopathic practice, and you are deeply committed to fully embracing the tenants of our profession, this career track holds great promise for you.

The above are generalized guidelines to get you started, outlining general trends within specialties. They are not intended as a one-size-fits-all approach to choosing a specialty. What’s most important in finding your path, is to find the environments and circumstances that most line up what will lead to “flow” for you. Only you can determine that path. Once you find it, you will be unstoppable.

Related reading:

What to do if you don’t Match into residency

Five more unique electives for residency