"So what specialty do you want to do when you grow up?"

The doctor's equivalent of "What do you want to be when you grow up?" You get asked that on a semi-regular basis, from peers to seniors to patients and their families. You have to be careful about what you say, because you don't want to paint a bad picture of any specialty -- and obviously there are pros and cons with all specialties.

I love old people. I loved doing medicine of the elderly. The patient group is so diverse, wise, witty, and so graciously uncomplaining. Their medical conditions are multiple and complex, and there is so much to learn. You never truly specialise because there are all sorts of health conditions that afflict our elderly population, so you have to be up to date with everything. But because of the cuts to social and community support, the elderly are often subject to unnecessarily prolonged hospital stays and that frustrates me. Or because of cuts to their care package, they had an accident and ended up re-admitted to hospital, and all the hard work everyone put in (including the patient!) have to be redone from the beginning -- rehab, rehab, rehab, treat that urine infection, more rehab, treat more hospital-acquired infections, discharge.

Acute medicine? Turnover is quicker, they are also complex and not particularly specialised. You see them at the door, acutely unwell, and you see them onto the road of recovery. Satisfying and usually without as much of the negative impact of cuts to social care. However, you remain a registrar into your thirties and as a consultant, you remain on-call on a regular basis... for as long as you work. I'm not sure if I can be woken up in the middle of the night when I'm sixty years old and be able to function as the most senior person in the medical team and answer complex questions.

Surgery? Complex, challenging, exciting, and so much fun. Ten years of specialty training (if you include years out doing fellowships and abroad experience and research) before you hit consultant level. Intense and antisocial hours until you hit that point.

Basically: I can't decide.