I couldn’t have it any other way
In emergency medicine, I focus on the critical phase of medical problems, but I care for any patient with any problem at any point in their life. This makes me a generalist.
I work with plenty of specialists—people who are masters in their field. Their scope of practice is much narrower than mine. Their focus is sharper. If they are Ginsu steak knives, I’m a Swiss army. Patients will ask who the best shoulder doctor is. They don’t shop around for emergency physicians in the midst of a heart attack. The fact that I will not refine my skill set to a particular craft sometimes makes me regret my career choice. I will never be the “go to” person for anything in particular.
But the more I think about my choice, the more I know I couldn’t have it any other way.
It aligns with my definition of “doctor”
Neighbors stop over for questions about their blood pressure. Friends text with symptoms or ask me to look at their throat at their kitchen table. I’ve responded to in-flight emergencies. I cannot imagine calling myself a physician but being unable to do these things. I have known dermatologists who cower in their seats when flight attendants ask whether there’s a doctor on board. That will never be me—and there is tremendous pride in knowing that.
Before I became a physician, I imagined that any doctor would do these things. I knew that physicians specialized, but I had no idea how closed specialization can be. It never crossed my mind that some physicians simply wouldn’t care for certain conditions or patients. That an orthopedist would tell a patient to see their PCP rather than simply refill their insulin. Or that a surgeon wouldn’t order a necessary vaccination but would instead “wait for the primary team to do it.” Certainly not every specialist lives in so-well fortified a silo, but many do.
I’m not saying it’s wrong or right; I’m saying it’s not what I thought a doctor did. To me, doctors could do a little of anything. They could take care of a child or of basic injuries and were comfortable advising people on common conditions. Being a generalist has allowed me to be closer to what I envisioned doctors do.
There is diversity in what I treat
Within the past month, I’ve seen patients with diagnoses I have never seen before. I’ve been out of residency for ten years. If it’s not a new disease, it’s a new combination of diseases, new drugs, new procedures I’ve never heard of.
In medicine, common things happen commonly—any field will have some repetition. But as a generalist, you’re constantly open to any new condition that walks through the door. You’re open to all of medicine and that keeps things fresh.
I won’t plateau
If you’re the best hernia-fixer in the world because all you do is fix hernias, great, but there’s not a ton of advancement from that point. You’ll be the go-to hernia person, but you won’t move up. Unless something new comes along in the world of hernias or you pick a new thing to master, you’re pigeon-holed.
As a generalist, I haven’t picked any particular thing. I have a thousand directions I can grow. I might not be the best in the world at one thing, but I’m pretty good at a lot of things and I can always get better in others. There is always a skill to brush up on or a diagnosis to learn more about.
More skills mean more transferability
For many people, clinical medicine isn’t the end of the road. They want to work in writing, in administration, or other non-clinical jobs. Working as a generalist means you’re exposed to a wider range of patients, procedures and situations. You’ll solve a much wider range of problems than a specialist will. The more you’re exposed to, the more robust is your tool belt.
Many of those tools are transferable to other fields: the ability to problem solve, to communicate, to establish rapport, to lead a team through crises. The more situations you manage, the better your skills become. The better your skills, the more opportunities you’re competent to take advantage of.
Diversity in the patients I see
There is no other specialty that treats any patient—from neonates to end of life. Rich, poor. Educated and not. Pregnant, trauma, medical or all of the above.
This means that the types of patients I see are often new to me. There’s a wide range of who I care for which keeps things new, even with the same medical condition. Poor heart attack and rich heart attack are not the same heart attack. I get to see them all.
A generalist’s range of patients being so wide also means that we must be good at communication. We have to be excellent, quickly establishing rapport with anyone at any time. This is an enormously important and beneficial life skill.
Flexibility in jobs and location
Not every hospital needs a left pinky surgeon, but every area needs primary care specialties and emergency medicine. There are abundant opportunities to work. I could move to any location in the US I’m interested in (maybe not any hospital, but definitely any region). The choice to be a generalist leaves many doors open and provides flexibility in job opportunities.
Collaboration with medicine as a whole
I consult or work with every specialty in the hospital. This means that I have to understand other specialties. I have to be able to call them at three in the morning and speak their language. They have to trust what I’m saying, which means I have to know what they’re looking for. I have to understand how the OR works, the implications of activating a cath lab, or the limitations of a surgical service.
This forces me to stay up to date with medicine in general and how emergency medicine fits in. I can’t be too isolated in emergency medicine or I won’t survive. As a generalist, my network is medicine as a whole.