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Choosing Your Specialty: 8 Things to Think About

Choosing Your Medical Specialty

Selecting which field in medicine you are going to pursue can be difficult. Some medical students already know (or think they know) what specialty they want to pursue even before they start orientation. Others start to get anxious as the end of their 3rd year draws near, desperately trying to figure out which field suits them best.

Many students use the process of elimination as they move from one clinical rotation to the next, crossing off specialties they don't like and making a list of those they do.Click To Tweet

Many students use the process of elimination as they move from one clinical rotation to the next, crossing off specialties they don’t like and making a list of those they do. Only 5 or 6 fields of medicine are represented in the required 3rd-year clinical rotations, so exploring other specialties is often necessary. The following tips will hopefully help you in making your decision.

1. Explore Medical Specialties Early

All medical schools require students to pass the following required 3rd-year clinical rotations: Internal medicine, pediatrics, OB/GYN, and surgery. Many also require neurology, family medicine, emergency medicine, and radiology. Therefore, if you are interested in ophthalmology, ENT, or orthopedics, you may be asking, “When am I going to find out if I really want to pursue this specialty?”

Some schools provide elective time during the 3rd year, while many do not. As such, there is the summer between the 1st and 2nd years of medical school, as well as some time early in the 4th year to explore additional specialties.

Specialties which are not included in the required rotations include some of the most competitive residencies. Therefore, if you wait until your 4th year to learn about them, you have probably already missed the boat. Successful applicants for the most competitive residencies have already demonstrated their interest in pursuing a residency in that specialty by mid-way through their 3rd year.

Successful applicants for the most competitive residencies have already demonstrated their interest in pursuing a residency in that specialty by mid-way through their 3rd year.Click To Tweet

So, if you have even an inkling that one of the most competitive specialties might be the one for you, pursue it early. Try to do an elective with key people in your department early on. Sometimes, a Sub-I (sub-internship) or AI (away elective) at another school can be a great way to demonstrate your interest in pursuing a residency in one of these most competitive medical fields.

2. Surgical Specialties vs Diagnostics

One of the first things to decide is whether you want to be a surgeon or a diagnostician. Are you someone who likes to work with your hands? Do you like building things and fixing things? Do you like doing procedures (putting in central lines, suturing)?

If the answer to those questions is yes, you may best be suited for a surgical specialty. If you are someone who likes to puzzle over a case, think through a differential, and discuss it with your colleagues, a diagnostic specialty is likely your cup of tea.

If you are someone who likes to puzzle over a case, think through a differential, and discuss it with your colleagues, a diagnostic specialty is likely your cup of tea.Click To Tweet

Once you know whether you want to be a surgeon or a diagnostician, you will have answered a very big part of the puzzle. If you choose to go into surgery, your residency options include general surgery, OB/GYN, anesthesiology, ENT, ophthalmology, orthopedic surgery, neurosurgery, urology, and plastic surgery.

If you choose diagnostics, your residency choices include internal medicine, emergency medicine, family medicine, pediatrics, neurology, psychiatry, radiology, radiation oncology, dermatology, and pathology. Of course, many diagnosticians do procedures, and surgical specialists spend time being diagnosticians, too. So there is overlap in both directions.

3. Comparing Salary Between Medical Specialties

Many medical students choose their specialties based on compensation. They might see big dollar signs in their futures if they choose a specific area of medicine. As a result, the most competitive residencies in the Match are often the better-compensated fields: plastic surgery, orthopedic surgery, ENT, ophthalmology, neurosurgery, radiology, and dermatology.

Salary is obviously an important factor to consider when thinking about what kind of lifestyle you would like to have in the future. Still, I would caution you to find a field that you are passionate about, one that gets you excited. In 15 years, no matter how much money you are making, it won’t be enough if you are miserable and have to drag yourself out of bed every day for something you don’t love.

In 15 years, no matter how much money you are making, it won't be enough if you are miserable and have to drag yourself out of bed every day for something you don't love.Click To Tweet

Remember, too, that there are many things that you can do with your MD or DO degree. It’s possible to choose a field which is less competitive and not as well-compensated, such as primary care, and then later work as a consultant or hospital administrator. You could then find yourself making just as much as your friend from medical school who became a radiologist.

4. Consider the Ick Factor

Most medical students don’t mind seeing a little blood. After all, everyone has to pass anatomy and dissect a human cadaver to graduate from medical school. That being said, some fields of medicine require constant exposure to blood, feces, urine, pus, and vomit. The specialties with the most exposure to these bodily fluids might be emergency medicine and general surgery.

Some fields of medicine require constant exposure to blood, feces, urine, pus, and vomit.Click To Tweet

If you prefer talking to patients and not seeing a lot of blood, maybe psychiatry or neurology would be a good choice for you. Check out the Goo Tolerance Index, which is a fun (i.e. not scientific) way to find out what specialty is good for you.

5. Know Your Strengths and Passions

Be true to yourself when choosing your specialty. Know what you accel at and what you don’t, and choose a specialty that will allow you to succeed. If you love the idea of being a neurosurgeon, but your spatial skills are terrible, don’t go chasing after a field which will likely leave you frustrated. You can teach a person a lot of things, but your spatial ability isn’t one of them.

If you like to take your time in making decisions and don’t like acute situations, emergency medicine and anesthesiology are probably not for you. If you don’t like working with small, delicate things, ophthalmology and ENT are probably not for you. What if you love the idea of doing a thorough exam and localizing a problem? Neurology may be the best choice for you.

If you like to take your time in making decisions and don't like acute situations, emergency medicine and anesthesiology are probably not for you.Click To Tweet

6. Most Competitive Residencies vs Least Competitive Residencies

Given that some specialties provide better compensation than others, some fields in medicine are more competitive than others.

What are the most competitive residencies to match into? They include the following:

  • orthopedic surgery
  • ENT (ear, nose, and throat, or otolaryngology)
  • ophthalmology
  • neurosurgery
  • plastic surgery
  • dermatology
  • radiology.

Unfortunately, lower grades and USMLE scores can be prohibitive for students seeking to enter these most competitive residencies. It is important to be honest with yourself about this.

This does not mean that you shouldn’t reach for the best program you can. But if you want to go into dermatology and you barely passed Step 1, take a moment to reconsider. Is it better to match in your 2nd favorite specialty rather than not match at all? It’s up to you, but be realistic when considering your odds of success by taking note of which specialties are hardest to match into.

7. Variety or a Lot of the Same?

Some medical specialties include more variety, while others are very specialized. Internal medicine, family medicine, pediatrics, neurology, and emergency medicine are areas which have a huge variety of medical problems. These stand in stark contrast to fields like neurosurgery and urology, which deal with a specific set of medical problems and procedures that must be practiced many, many times to achieve proficiency.

If you want to be the best in the country at a specific surgical technique, a surgical specialty will likely make you happy. If you want to be a jack of all trades, seeing a little bit of everything every day, pursue internal medicine, family medicine, neurology, pediatrics, or emergency medicine.

Do you want to be a jack of all trades as a physician? Or would you rather be the foremost expert in the country at a specific surgical procedure?Click To Tweet

8. You Gotta Love Your Organ

No matter what specialty you choose, there will be some redundancy to what you do. You will have your bread-and-butter cases in any specialty, and you’ll have body parts that you deal with more regularly. You will see a lot of ear infections as a pediatrician. OB/GYNs will see a lot of female genitalia. Orthopedic surgeons will see a lot of shoulders and knees.

So make sure that whatever specialty you choose, you like the organ involved. Let’s say you love the birthing process but don’t love the idea of dealing with the vagina every day. In that case, OB/GYN is probably not the best match for you.

Make sure that whatever specialty you choose, you like the organ involved. Click To Tweet

Listen to the Specialty Stories Podcast

If you’re looking for a window into the many medical and surgical specialties, as well as how they’re practiced in academic vs community settings, check out the Specialty Stories podcast! I’ve interviewed dozens of physicians now in many different specialties about what their day-to-day life is like, what their training was like, and whether they would choose the same specialty again.

Another type of episode I’ve been recording for Specialty Stories is “Match data deep dives.” In those episodes, I go over the residency match data from the NRMP to see how many applicants successfully matched into a given specialty and how many went unmatched. This gives you a sense of which are the most competitive residencies, not just in a vague sense but really concretely looking at the numbers.

Check out the Match data deep dives: anesthesiologydermatologyemergency medicinefamily medicine, general surgeryneurosurgeryOB/GYNophthalmologyorthopedic surgerypathologypediatricsphysical medicine & rehabilitationpsychiatry.

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