The hardest decisions aren't the ones with a clear answer. Those sort themselves out once you have the information. The hard ones are where you're choosing between several things you value and you don't want to compromise, give any of them up, or lose something in the trade.
Most of the biggest decisions a physician ever makes get made in their twenties.
Think about the traditional path. Straight through — college, medical school, residency — which means you've been a student your entire life. You have some idea of what you value. But you've never lived a truly independent life, the kind where you find out how those values stack up against each other when they're forced to compete. And that's exactly when we're asked to choose. A specialty. A training location. A practice type.
We're deciding what will matter to us at fifty before we've finished being twenty-five.
Anyone making a career choice in their twenties experiences this. What makes it sharper for us is that our paths are rigid. Once you pick a specialty, pivoting to another is hard and costly. And each specialty carries its own baggage — it is tied to certain practice environments, certain hours, a certain shape of life. Many of us chose a specialty based on what was most interesting with little knowledge of the life the existed outside of work.
The decision you made at twenty-four keeps voting long after you'd have cast a different ballot.
That's why support early in training matters more than we tend to admit. And it has changed a great deal since I started medical school in the late nineties. What existed for me then and what exists for students now are not the same thing.
Which is what this week's podcast episode is about. My guest is Billie Ruden, who does academic and career advising at the University of Iowa Carver College of Medicine. We talk about how schools are supporting students through these decisions now — not just handing them a match algorithm and wishing them luck, but helping them get clear on what they want before they're locked into chasing it.
If you're a student or a resident, give it a listen. And if you're further along — if your life has changed and the thing you chose in your twenties no longer aligns with your life now — that isn't a failure of the decision. It's what happens when a person keeps growing after Match Day.
I'm here if you need me.
— Ben
P.S. — Here's my question this week. What did you choose in your twenties that you'd choose differently now?
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