What are the biggest challenges in your specialty today?

When the program director at my second interview asked me, “What are the biggest challenges in plastic surgery today?”, I froze. I had not prepared for this question. Of course, there is no right answer, but the question gauges how well versed you are in the current events of a particular field.

How do you determine topics to discuss? Pay attention at grand rounds. Read primary research articles published in journals in your field. Ask the clinical mentors you know for their input. Try to formulate 3-4 areas that you could briefly speak on if asked this question. When thinking about topics, it may be helpful to consider different aspects of healthcare delivery and find out what discussions are being held in your specialty.

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Hot Topics

There are so many examples of hot topics that can present unique challenges to a field. A commonly used drug is given a new black box warning. A new randomized control trial reveals a new treatment management paradigm that conflicts the prior principles. New legal policies are set in place. Programs aren’t going to care what your opinion is or if you are the expert on the issue. Just being aware of the discussion demonstrates insight and interest which is what they are testing.

For example, the summer of my application cycle, the FDA recalled specific models of textured breast implants due to the products being linked with breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Given the role of implants in breast reconstruction and cosmesis, this was an incredibly hot topic of conversation at the time. Citing a hot topic as a major challenge to the field demonstrates a heightened awareness of current events which can serve as a surrogate for continual interest in a field and general knowledge.

Public Health

COVID-19 in and of itself is a world disrupting disease. The implications of the pandemic are also affecting every healthcare specialty and creating other public health concerns. Delaying elective surgery may mean missing what could have been a cancer diagnosis. Patients fearful of visiting healthcare settings may be lost to follow up for critical medications and care.

Your concerns could also be systemic. How does any field of medicine understand how to equitably deliver the scarce resource of healthcare? What role will third party payers continue to have on deciding what drugs can be used or procedures permitted?

The Business of Healthcare

Technological and legal ramifications alter the way that healthcare is delivered and the job security of physicians. There are reports of radiology reads being outsourced internationally with competing physicians that are contracted out from overseas at lower fees. CRNA’s are pushing for autonomy from anesthesiologists. Advanced practice providers compete in primary care with physicians in rural areas. While the priority on medicine is on patient care and safety, there are also tangible financial considerations that can drastically affect your field and your career in that field.

What is your solution?

If you cite a challenge, be prepared to briefly speak to how you think the situation may resolve itself or what strategies should be done to address it. Speak diplomatically. A great way to do this is to bring up one positive and negative aspect on both sides of the topic. You never know which side of the issue the interviewers might be on.

Of course there are innumerable challenges to any specialty or field. These categories and examples are here to assist you in your brainstorming and preparation.

What are some of the biggest challenges you see in medicine or in your field as a whole? Comment below to join the conversation.

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