I think the people that have "helping people" in their top 2-3 motivations for medicine are the ones that burn out the quickest. If you have 10 patients, you can't help 3 because of financial/insurance BS & 2 because of administrative/policy/guideline/legal BS. Of the other half, you can't help 3 because of compliance BS. Of the last 2, you'll probably help 1 but the BS might come back, and the other just won't get better because the available treatment options are BS or the patient's genes are BS, or both.
Of the other motivations mentioned above, enjoying the daily tasks/science/technology is a good one for some, but like most daily occurrences, monotony kicks in eventually & the enjoyment level typically plateaus/declines. Lifestyle/life outside of work is also very influential, but this itself can be heavily influenced by factors independent of medicine - spouse/children/family, location, health, personality/psyche, ability to cope with stress, etc.
What I don't think was mentioned that will definitely play into choosing a specialty for me anyway is personality "fit" with your peers & coworkers in the field. It's fairly obvious that most specialties attract a specific type of person or small range of personalities. Same goes for practice setting - academic/community, urban/rural, small/large group, etc. Now matter how much you think you'll enjoy doing X procedures or Y patient interactions in Z practice setting, there will undoubtedly be BS that will blunt that enjoyment to a certain degree. But dealing with that BS on a daily basis is much more tolerable when you're around good people that keep you coming back for more vs. tackling it alone or worse, alongside people you can't stand.
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Disillusioned With Medicine
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