From Scrubs to Success: The Pros and Cons of Pursuing a Career as a Surgeon
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From Scrubs to Success: The Pros and Cons of Pursuing a Career as a Surgeon

Ari Horesh

Are you considering a career in the medical field and passionate about making a difference in people's lives? If so, becoming a surgeon might be the perfect fit for you. In this blog post, we will explore various aspects of joining this highly rewarding yet challenging profession - from education and skills required to job outlook and personal reflection. So grab your surgical mask and gloves as we dive into what it takes to embark on this fascinating journey – who knows, by the end of our exploration you might just find yourself eager to take up the scalpel!

What Does It Mean To Be A Surgeon?

To be a surgeon means possessing the skills and knowledge to perform various types of surgeries, such as invasive, minimally invasive or noninvasive procedures, while specializing in specific areas of surgery like orthopedic or cardiovascular.

Types Of Surgeries

Being a surgeon involves performing a wide array of surgical procedures. Medical students considering this path should be well-versed in the various types of surgeries they may perform throughout their careers. Here's an overview of some common types of surgeries:

  • General Surgery: Dealing with a broad range of conditions affecting various parts of the body, such as the gastrointestinal tract and abdominal organs.
  • Cardiothoracic Surgery: Focusing on conditions affecting the heart, lungs, and other organs within the chest cavity.
  • Colon and Rectal Surgery: Specializing in surgical treatments for disorders like colorectal cancer, inflammatory bowel disease, and diverticulitis.
  • Neurosurgery: Involving surgical procedures to treat disorders affecting the brain and nervous system, including tumors and traumatic injuries.
  • Orthopedic Surgery: Concentrating on the musculoskeletal system through procedures like joint replacement, ligament repair, or fracture fixation.
  • Plastic and Reconstructive Surgery: Treating patients with congenital defects or those requiring aesthetic improvements; reconstructive surgery focuses on restoring function and appearance after traumatic injury or illness.
  • Pediatric Surgery: Addressing surgical needs specific to infants, children, and adolescents with conditions related to growth development, congenital anomalies or trauma-related injuries.
  • Oral and Maxillofacial Surgery: Managing diseases, injuries or deformities concerning the face, jaws, mouth, neck or head region by performing complex dental extractions or facial reconstructions.
  • Ophthalmologic Surgery: Focusing on eye care issues such as cataracts removal, glaucoma treatment or corneal transplant procedures.
  • Urologic Surgery: Treating diseases affecting kidneys, urinary tract structures (in both male and female), as well as male reproductive organs disorders like prostate cancer treatments or vasectomies.

Understanding these different types of surgeries is crucial for medical students contemplating a career in surgery as each specialty requires unique skill sets and extensive knowledge in anatomy, chemistry, pathology among others fields relevant to their practice area

Specializations In Surgery

As a medical student considering a career in surgery, it's essential to understand the numerous specializations available in this rewarding field. Each specialization offers unique challenges and opportunities for growth and development throughout your career. Below is a list of some of these surgical specializations:

  • Cardiothoracic Surgery - This specialty focuses on the treatment of conditions related to the heart, lungs, and other parts of the thoracic cavity.
  • Colon and Rectal Surgery - Surgeons who specialize in this area treat diseases and conditions affecting the colon, rectum, and anus.
  • General Surgery - As one of the broadest specialties within surgery, general surgeons perform operations across several areas of the body while also taking care of sick patients in the SICU.
  • Gynecology - This surgical specialty involves treating conditions affecting female reproductive system such as ovarian cysts and uterine fibroids.
  • Neurosurgery - Neurosurgeons treat disorders that impact the nervous system including brain tumors, aneurysms, and spinal cord injuries.
  • Orthopedic Surgery - Focusing on musculoskeletal issues, orthopedic surgeons address problems with bones, joints, tendons, ligaments, and muscles.
  • Otolaryngology - Also known as ENT (ear, nose, throat) surgery, otolaryngologists manage disorders affecting these areas along with head and neck ailments.
  • Pediatric Surgery - Surgeons specializing in pediatrics perform procedures on infants, children, and adolescents with various health issues.
  • Plastic Surgery - In this field, surgeons repair or reconstruct physical defects to improve aesthetics or functionality for patients.
  • Urology - Urologists focus on treating diseases related to kidneys, bladder functions and male reproductive organs.
  • Vascular Surgery - These specialists handle conditions affecting blood vessels throughout the body except those found within the heart or brain.

Being aware of these surgical specializations helps you choose a path that best aligns with your interests and skills within medicine's dynamic landscape while allowing you to make a significant impact on patient outcomes using cutting-edge surgical techniques and equipment in your practice throughout your professional journey as a surgeon.

Education And Training Required To Become A Surgeon

Becoming a surgeon requires extensive education and training, including an undergraduate degree, medical school, and a residency program; read on to discover the specific requirements and qualifications for this highly specialized profession.

Undergraduate Degree

When it comes to becoming a surgeon, having an undergraduate degree is a crucial starting point. This typically involves four years of formal education in subjects such as biology and chemistry that are pertinent to the medical profession. It’s important to take classes in these core areas as they provide the foundational knowledge necessary for medical school.

Once you have earned your bachelor's degree, it’s time to focus on getting into medical school. Requirements vary by program, but generally, schools look for well-rounded candidates with excellent grades and test scores. Keep in mind that acceptance into medical school can be quite competitive so be sure to keep your GPA high and start gaining relevant experience early on through internships or shadowing programs at hospitals or clinics.

Medical School

As someone who has been through medical school, I can tell you that it is a rigorous and demanding process. To become a surgeon, you first need to complete a four-year bachelor's degree, followed by four years of medical school. During this time, you will learn about anatomy, physiology, pharmacology, and other essential areas of medicine.

Many medical schools also offer specialized surgical training programs that allow students to gain hands-on experience in the operating room. These programs typically involve working closely with experienced surgeons to learn important surgical techniques and procedures. If you are serious about becoming a surgeon, then be prepared for long hours of studying and hard work during your time in medical school.

After completing medical school, aspiring surgeons must go through at least five years of residency training before they can become certified by the American Board of Surgery or the Royal College of Physicians and Surgeons of Canada. This residency period is critical because it allows young doctors to gain real-world experience under the guidance of more experienced surgeons while also refining their skills in various surgical specialties such as neurosurgery or orthopedics.

Residency Program

The surgical residency program is a crucial part of the education and training required to become a licensed surgeon. It typically lasts for at least five years, during which time residents gain hands-on experience performing surgeries under supervision. This program provides residents with invaluable exposure to a wide range of surgical procedures, patient care, and ethical considerations.

To enter into a general surgery residency program, you'll need to obtain your medical degree first. Then you can apply for this highly competitive program that will not only provide specialized training in areas like anatomy and physiology but also prepare you for board certification exams later on. Once completed, you'll have obtained the necessary qualifications and licensure required for practicing as a skilled surgeon.

Skills And Competencies Required To Be A Successful Surgeon

To become a successful surgeon, one must possess the necessary skills and competencies such as dexterity, attention to detail, decision-making ability, mental strength, communication and interpersonal skills, and leadership abilities. Discover more about what it takes to excel in this challenging yet rewarding profession.


As a surgeon, one of the most important skills you need is excellent dexterity. This means having precise control over your hand movements and being able to coordinate them with what you see through the microscope or endoscope. In order to become a successful surgeon, you must have good fine motor skills, manual dexterity, and sensory-motor control.

Surgical proficiency also requires surgical technique expertise which is primarily taught based on comfort and current ability. Improving your dexterity can help improve your surgical skills as well. With practice, it's possible to develop these abilities and master complex operations that require delicate manipulation of tissues.

Cultural sensitivity and interpersonal communication are also critical for medical professionals. It helps in applying socio-cultural awareness in healthcare delivery while engaging with different colleagues from diverse cultures within the same professional community where strong emotional intelligence is vital too.

Attention To Detail

As a surgeon, paying close attention to detail is vital when it comes to performing successful surgeries. I have learned that being precise and accurate in every step of the process is essential for ensuring positive outcomes. Diligence and perfectionism are also necessary attributes as even small errors can potentially compromise patient safety.

In surgery, focus and coordination are crucial elements that require careful attention to detail. My hand-eye coordination has been honed through years of practice and training, helping me perform complex procedures with precision. Analytical thinking and problem-solving skills come into play during surgeries when unexpected complications arise, requiring quick decision-making abilities.

Overall, becoming an excellent surgeon requires patience, empathy towards patients, active listening skills for effective communication with other healthcare providers involved in the surgical procedure- all qualities that demand a high level of attention to detail.

Decision-Making Ability

As a surgeon, the ability to make critical decisions is essential. With so many variables involved in surgical procedures, it's important to be able to analyze situations quickly and make informed choices. Whether you're deciding on the best surgical technique for a particular patient or determining the appropriate response to an unforeseen complication during surgery, your decision-making ability will be put to the test.

To develop this critical skill, surgeons must have extensive knowledge of anatomy and physiology as well as experience in performing surgeries. This allows them to quickly assess a situation and determine the best course of action based on their medical expertise. Additionally, strong communication skills are vital when collaborating with other healthcare professionals during complex procedures where teamwork is required.

In summary, possessing strong decision-making abilities is crucial for aspiring surgeons. It involves not only clinical competencies but also interpersonal skills such as clear communication and collaboration with other healthcare professionals during surgeries -- all while keeping patients' safety top-of-mind at all times.

Ability To Work Under Pressure

As a surgeon, the ability to work well under pressure is crucial for success. Surgeries can be highly stressful, and require quick decision-making and precision. Surgeons must have strong stress management skills in order to stay calm and focused during high-pressure situations.

In addition, surgeons must be able to think quickly on their feet in emergency situations that may arise during surgeries. Fine motor control is also essential as even small mistakes can have major consequences. However, with proper training and experience, surgeons can develop the agility and dexterity needed to navigate delicate procedures with ease while managing high-pressure conditions effectively.

Communication And Interpersonal Skills

As a medical student, it's important to understand the role of communication and interpersonal skills in becoming a successful surgeon. These skills allow you to build strong relationships with patients and medical teams, which is critical for providing patient-centered care. In fact, the Accreditation Council for Graduate Medical Education (ACGME) has identified communication as one of the six core competencies required for surgical training.

Effective communication allows surgeons to gather accurate information about their patients' conditions and concerns, which helps inform treatment decisions. Excellent interpersonal skills also enable surgeons to work collaboratively with other healthcare professionals, such as nurses and anesthesiologists, thereby promoting effective teamwork in the operating room. Furthermore, good communication can help minimize conflicts that may arise during consultations or procedure planning by fostering trust between all parties involved.

Leadership Skills

As a surgeon, leadership skills are crucial to your success. You'll be working in teams of medical professionals, including nurses and anesthesiologists who all rely on you for guidance. Communication is key when it comes to teamwork, so having excellent interpersonal skills will help you work smoothly with others. Being able to lead a team under pressure is vital since surgeries can be unpredictable at times.

In addition to leading your team during surgical procedures, a strong leader must also make difficult decisions regarding patient care outside of the operating room. Surgical complications can arise even in the most successful surgeries, and it's up to you as the surgeon to decide how best to proceed while keeping the patient's well-being at the forefront of every decision-making process. With excellent leadership skills that include adaptability, logic and efficient decision making abilities, you'll thrive as a surgeon both inside and out of the operating room.

Pros And Cons Of Being A Surgeon

Being a surgeon has its upsides, such as high salaries and job satisfaction, but also comes with downsides like long working hours and high levels of stress.

Pros Such As High Salary And Job Satisfaction

As a medical student, one of the major factors that you may consider when deciding whether to pursue a career in surgery is the potential for high salary and job satisfaction. Surgeons are among the highest-paid healthcare professionals, with an average annual income of over $400,000. This compensation can increase significantly with specialization or additional credentials within the field.

Along with financial rewards comes job satisfaction from helping others and saving lives. As a surgeon, your work directly impacts patients' lives by diagnosing conditions and performing procedures that help them regain their health. The ability to make such a positive impact on people's lives is gratifying and fulfills many surgeons professionally while also affording them prestige in society.

Cons Such As Long Working Hours And High Stress

As a surgeon, it's essential to remember that long working hours and high-stress levels come with the job. Surgeries can take several hours, and if complications arise, surgeons may have to work even longer. This can lead to fatigue and burnout over time.

Furthermore, being responsible for people's lives in the operating room can be incredibly stressful. Surgeons must make quick decisions under pressure while performing complex procedures. Mistakes can result in significant consequences both for patients' health and surgeons' careers.

Despite these challenges, many surgeons find their work incredibly rewarding due to their ability to save lives and improve patient outcomes. However, it's crucial for medical students considering surgery as a career path to carefully evaluate their own abilities, values, motivations before making that decision because it is not suitable for everyone in terms of long working hours and high-stress levels.

Job Outlook And Salary For Surgeons

The job outlook for surgeons is positive, with a projected growth rate of 7% from 2020 to 2030. Surgeons also enjoy high salaries, with the average pay ranging from $409,665 for general surgeons to $701,927 for neurosurgeons. Want to know more about the demands and rewards of becoming a surgeon? Keep reading!

Increasing Demand For Surgical Procedures

As a medical student, it's crucial to stay up-to-date with the latest trends in healthcare. One significant trend is the increasing demand for surgical procedures. According to research, demand for general surgery is projected to exceed 25% by 2025, which means that there will be ample job opportunities for those interested in becoming surgeons.

Furthermore, advancements in medical technology have expanded the types of surgeries available and improved patient outcomes significantly. As such, many people are now opting for surgical solutions to address their healthcare needs rather than relying solely on medication or other non-surgical interventions.

Therefore, if you're considering becoming a surgeon, this trend points towards a promising career path with excellent job prospects and growth potential throughout your professional life.

Average Salaries For Different Surgical Specializations

When choosing a surgical specialty, it's essential to be aware of the varying average salaries associated with each area of expertise. While financial compensation should not be the sole factor in your decision, understanding the potential income can aid in making an informed choice. The table below provides an overview of the average salaries for different surgical specializations:

Surgical SpecializationAverage Salary
General Surgery$353,000
Plastic Surgery$385,000
Orthopedic Surgery$450,000+
Cardiothoracic Surgery$500,000+
Pediatric SurgeryVaries, but generally between $400,000-$600,000
Vascular SurgeryVaries, but generally between $400,000-$500,000
Urologic SurgeryVaries, but generally between $350,000-$500,000
Ophthalmologic SurgeryVaries, but generally between $300,000-$500,000

It's important to note that these figures are only averages and can vary depending on factors such as location, experience, and the individual hospital or clinic setting. Additionally, salaries may also be influenced by the rising demand for certain surgical procedures in the future.

Alternatives To Becoming A Surgeon

If becoming a surgeon doesn't seem like the right path for you, there are alternative careers in the medical field such as working as a physician assistant, nurse practitioner or anesthesiologist.

Physician Assistant

As a medical student, you may be wondering if becoming a surgeon is the right career path for you. However, it's important to note that there are other options available within the surgical field. One viable alternative is becoming a Physician Assistant (PA). PAs have a similar disease-centered curriculum model to that of medical students and receive education in general medicine, including surgery.

To become a surgical PA, one must meet licensure, certification, and education requirements. While completing a residency is typically not required for many PA jobs like it is for Medical Doctors, hands-on clinical experience may still be necessary depending on the job or specialization chosen. Approximately 25% of PAs have chosen to specialize in general surgery or another surgical subspecialty.

Nurse Practitioner

As a medical student, it's essential to explore all the possible career paths available in the healthcare industry. One alternative to becoming a surgeon is to pursue a career as a nurse practitioner. A nurse practitioner requires advanced education, such as earning a master of science in nursing degree, and has the ability to specialize in their preferred patient demographic or field of study.

Nurse practitioners play an important role on the surgical team, working alongside surgeons to see patients and provide essential care. Research has shown that patients under the care of nurse practitioners have fewer hospital readmissions and potentially preventable hospitalizations. As you consider your options for specializing in the medical profession, it's important to weigh both opportunities' demands and rewards before making any decisions.


As a medical student considering a career as a surgeon, it's important to also consider anesthesiology as an alternative path. Anesthesiologists are highly trained physicians who specialize in administering anesthesia and managing all aspects of patients' medical care during surgical procedures. They complete a minimum of eight years of medical training after college, making them well-educated experts in their field.

One significant benefit for those considering anesthesiology over surgery is the high salary that comes with being an anesthesia provider. In fact, anesthesiologists are among the highest-paid doctors in the United States according to recent studies. However, it's important to keep in mind that this compensation comes with its own unique challenges and responsibilities, including properly detailing potential risks and alternatives related specifically to anesthesia.

Challenges And Ethical Considerations In Surgery

Surgeons face many challenges and ethical considerations in their profession, including obtaining informed consent from patients, avoiding medical malpractice, and balancing the needs of patients with financial constraints.

As a medical student, it is important to understand the ethical considerations of informed consent in surgery. Informed consent requires physicians to disclose information about the proposed treatment options and potential risks and benefits to patients. This exchange of information helps empower patients by allowing them to make informed decisions about their healthcare.

However, obtaining informed consent can present challenges, such as patients' poor awareness of their rights and failure to provide adequate information. As a future surgeon, it will be critical to prioritize patient education and communication in order to ensure that they are fully aware of their options before making any decisions related to surgical procedures.

Overall, ethical standards require that surgeons provide transparent disclosures regarding surgical procedures so that patients can make well-informed choices based on comprehensive knowledge about available treatments. Failure on this obligation may result in legal or professional consequences for the physician involved.

Medical Malpractice

As medical students, it is important to understand the risks and challenges involved in becoming a surgeon. Medical malpractice is one of the most serious concerns that surgeons face in their professional lives. Adverse events can occur during surgical procedures, and errors or negligence can lead to patient injury or even death. It is essential for surgeons to prioritize patient safety and uphold ethical considerations while providing care.

In cases of medical malpractice, winning monetary compensation for injury requires proving that the injury resulted from negligence. However, studies have found that only a small percentage of people who were negligently injured actually sued their responsible physician. As aspiring surgeons, it is crucial to understand the legal and ethical implications of this issue and strive towards responsible conduct at all times. This includes disclosing any errors or adverse events in surgical procedures following legal and ethical considerations, seeking consultation appropriately, upholding professionalism and conducting risk management measures when necessary.

Balancing Patient Needs With Financial Constraints

As a surgeon, balancing patient needs with financial constraints often presents ethical dilemmas. Patients have the right to receive medical treatment regardless of their ability to pay, but hospitals and surgical centers must also manage resources effectively. Transplant evaluations are particularly challenging in this regard because they require balancing justice requirements with respecting patients' needs and desires.

In addition to considerations related to transplant evaluations, other procedures such as elective cosmetic surgery present ethical challenges due to financial limitations. Surgeons must weigh the risks and benefits of these procedures carefully while ensuring that patients understand the implications of their decision. Ultimately, maintaining trust in the surgeon-patient relationship is crucial in navigating these complex ethical issues successfully.

Personal Reflection And Assessment

Assessing your personal traits and skills, as well as considering your values and motivations, is essential when determining if becoming a surgeon is the right career path for you.

Self-Assessment Of Traits And Skills

As medical students, it's essential to assess our individual traits and skills regularly. Self-assessment tools can help us gain personal development, identify areas of weakness, and focus on improving our strengths. Evaluating and understanding ourselves is vital in achieving growth both professionally and personally.

In the field of surgery, self-assessment accuracy is crucial for practice improvement. Laparoscopic skills are one area that requires validation through self-assessment training tools to improve accuracy. Developing competencies and learning goals to clarify needed knowledge, attitude, and skills can enhance self-assessment accuracy in surgical practice careers like a surgeon or anesthesiologist. It's important to consider what skill sets we possess when considering a career in surgery or other healthcare fields such as becoming a physician assistant or nurse practitioner.

Consideration Of Personal Values And Motivations

As a medical student considering the possibility of becoming a surgeon, it is important to reflect on your personal values and motivations. Understanding what drives you and aligning that with the demands of this profession can help you make an informed decision. Reflective practice in healthcare encourages self-direction, while also improving motivation and enhancing quality of care provided to patients.

In doing a personal assessment, take some time to identify your core values such as integrity, accountability, compassion or social justice. These broad principles can serve as guiding lights for your future surgical career. It is also important to consider any biases or beliefs that may influence your choice; whether it be from family or cultural traditions or other external factors like financial incentives. Ultimately though, being clear about what motivates you can provide greater satisfaction and fulfillment in the long run.

How To Determine If Surgery Is The Right Career Path For You

To determine if surgery is the right career path for you, it's important to do your research, speak with practicing surgeons, assess your personal skills and values, evaluate the demands of the profession, and consider job shadowing opportunities - read on to discover more.

Job Shadowing

As a medical student, job shadowing can be an excellent way to determine if surgery is the right career path for you. It allows you to observe and gain firsthand experience in the operating room or hospital setting. To get the most out of your shadowing experience, it's essential to ask informed questions and be respectful of patient privacy and confidentiality.

During your time shadowing a surgeon or doctor, take note of their skills and competencies required to succeed in this field. This includes dexterity, attention to detail, decision-making ability, working under pressure, communication skills, and leadership abilities. Reflect on whether these traits align with your personal values and motivations before deciding if surgery is the right choice for you.

Speaking With Practicing Surgeons

As a medical student with aspirations to become a surgeon, speaking with practicing surgeons is crucial in determining if this career path is right for you. It's important to seek out professionals who specialize in the specific area of surgery that interests you and ask about their experiences, challenges, and rewards.

By talking with these experts, you can gain insight into the daily tasks and demands of the job, as well as the education and training required. Additionally, they can provide valuable advice on how to succeed in the field and navigate ethical considerations such as informed consent and medical malpractice.

Overall, speaking with practicing surgeons can confirm your decision to pursue surgery or help guide you towards alternative career options such as physician assistants or nurse practitioners. Take advantage of this opportunity to learn more about this challenging yet rewarding profession.

Researching The Field

As a medical student, it is essential to research the field of surgery thoroughly before deciding whether it's the right career path for you. There are various ways to do that, including job shadowing and speaking with practicing surgeons. The goal is to gain a deeper understanding of what it means to be a surgeon while also assessing your personal values and motivations.

One crucial aspect to consider when researching the field of surgery is the educational requirements and time commitment involved in becoming a surgeon. Surgical training requires extensive study in anatomy, physiology, diagnostic skills, surgical procedures, patient care, medical ethics/professionalism, among others. To meet these requirements successfully takes several years of hard work and dedication.

By researching the field beforehand through practical experiences like internships or volunteer opportunities at hospitals/surgical centers -and combing this experience with an honest self-assessment-one can weigh up demands against rewards of pursuing surgery as their profession.

Identifying Your Personal Values And Motivations

As a medical student, it's important to identify your personal values and motivations when considering becoming a surgeon. Surgery is a demanding and challenging career that requires dedication and sacrifice. Understanding what drives you and what you value can help determine if this path aligns with your goals.

For some, the motivation to become a surgeon stems from wanting to make an impact in people's lives through healing and saving lives. Others may be drawn to the challenge of performing intricate procedures or leading a team in high-pressure situations. Knowing what motivates you can provide clarity on whether surgery is the right fit for you.

It's also essential to consider your personal values such as work-life balance, job satisfaction, financial stability, leadership opportunities, among others before making any career choice. Regardless of skill level or experience, recognizing one’s personality traits will help identify which specialties are most suitable for surgical practice as well; knowing yourself helps promote better self-care too – making sure surgeons perform their best by avoiding burnout on top of everything mentioned earlier.

Evaluating The Demands And Rewards Of The Profession

As a medical student, it's essential to consider the demands and rewards of pursuing a surgical career. Surgery is a highly demanding profession that requires long hours and a significant amount of dedication. However, it also offers high job satisfaction and financial rewards. To determine if surgery is the right career path for you, evaluate both your professional and personal goals.

To become a successful surgeon, you'll need to complete a bachelor's degree and medical school, followed by an internship or residency program. Additionally, identifying your specialty area is crucial for advancing in your surgical career. While there are challenges associated with becoming a surgeon, evaluating the potential rewards can help you decide whether this career path aligns with your aspirations as well as sets up tailored professional goals that help maximize success.

Conclusion: Is Becoming A Surgeon The Right Choice For You?

As a surgeon myself, I can say that this career path is not for everyone. It requires a combination of natural talent and hard work to be successful, as well as the ability to handle high levels of stress in critical situations. However, for those who possess the necessary skills and are committed to patient care and surgical innovation, being a surgeon can be an incredibly rewarding profession.

When considering whether or not surgery is the right choice for you, it's important to evaluate your personal goals and values. Are you driven by the desire to help others? Do you have a passion for precision and operative techniques? Do you thrive in fast-paced environments where quick thinking is key? Answering these questions honestly will give you insight into whether or not surgery may be the right career path for you. Additionally, exploring alternatives like becoming a physician assistant or nurse practitioner can provide valuable perspective on other medical professions that may align better with your goals and skillset.

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