The specialty selection process is their first major decision about their professional career and most medical students struggle to make the “best” decision. It seems like everyone has a solid opinion regarding the best specialty for an aspiring doctor. That “everyone” could be a parent, advisor, medical trainer, or even an aunt at the family function.
From urology to anesthesiology, there are more than sixty (60) professional specialties, as well as many subspecialties, which can make it overwhelming for a future doctor to decide. If any learner or medical graduate is reading this article, they are in the right place. This article highlights the best-kept medical specialty selection secrets, facilitating learners to make the best career choice.
Choosing the Right Medical Specialty
- Do you prefer direct patient care or more indirect public health experiences?
- Do you prefer more varied types of patients or do you feel more comfortable with a certain age group or demographic?
- Are private practice and autonomy more your style or would the innovative academic medicine sector be a better fit?
Specialty preferences are very diverse, which gives medical school graduates the freedom to pick from a broad range of medical fields. Few are based specifically on an organ system, such as the heart (cardiology), brain (neurology and psychiatry), and genitourinary system (urology). Others offer all-inclusive medical care for the selected population groups, like women (gynecology and obstetrics) and children (pediatrics).
Some medical professionals have more specialized clinical settings, procedures, and technologies that are involved in their practice. These specialties include radiology, anesthesiology, pathology, emergency medicine, and many others.
A medical practice may also be divided more generally into the following main groups:
- Primary care specialties/generalists (long-term comprehensive medical care)
- Secondary/tertiary care (the referral-based care).
Generalist specialties such as family practice, pediatrics, and internal medicine are considered primary care fields. The more specialized areas like dermatology, gastroenterology, and cardiothoracic surgery often belong to the latter category.
However, even if the future physician had a firm grasp on the differences in each clinical practice, this would still leave many personal goals and personality differences unaccounted for. And these, arguably, are more important for long-term satisfaction and resistance to burnout.
Factors to Consider for Decision Making
According to the Association of American Medical Colleges Survey 2019, there are around 11 factors that influence the decision of students while choosing the medical specialty. The factors having strong to moderate influence as identified in the survey include:
- Personality fit
- Specialty content
- Role model influence
- Work/life balance
- Fellowship training alternatives
- Family plans in future
- Income expectations
- Duration of residency
- Competitiveness of medical specialty
- Family expectations
- Education debt
Residency program directors and medical educators also point out some of the most important factors that they run across when discussing ranking factors with their students.
A. Research Resources Used
One important factor is the resources used to research the specialty the student is interested in. Usually, the most popular and effective research resources that medical students use are mentoring and advising. This allows for sharing of first-hand experience that a student can greatly benefit from. Also, participation in extramural and in-house electives allows for personal and experiential learning within the specialty.
Medical students need to be honest here to realize what they are good at.
If a student is not a “people person,” perhaps he/she shouldn’t choose a predominately clinical environment. Saying that just because they hate one clinic environment does not imply they hate the clinic.
The clinic is a different experience based on the patient population, student attending, his/her role, and the topic. Maybe a student is indifferent to primary care clinics, ophthalmology clinics, or even breast imaging clinics but ENT, melanoma, gynecology, and derm clinics could be their favorite rotations.
Similarly, if a student is clumsy with their hands, maybe they shouldn’t choose a surgical or procedural specialty. If the student is in the third or fourth year, they should realize that their skill set will enhance with residency. But if they are significantly less coordinated than a normal human being, it may be time to do some soul searching.
If a student is in the first year and interested in a procedural or surgical specialty (which includes dermatology, emergency medicine, and anesthesiology) we suggest they adopt a hobby that needs good hand-eye coordination – like video gaming, cooking, or knitting.
C. Training Duration
A popular piece of advice usually given is to examine the attending’s lifestyle – not the resident’s – since that will be their life for the foreseeable future. This can be difficult to see based on how long the residency training could be and at what point a student is at in their life.
Residency happens during most people’s late 20s or early 30s – this is a very important time of one’s life. At this age, most people start families, make lifelong investments, etc. If those things are significant to you, consider the differences in a 2-year vs a 7+ year residency.
D. Intellectual Curiosity
When you decide to practice medicine, you make a life-long commitment to life-longer learning. Due to this, it’s vital to go into a field that seems interesting. Every medical specialty has some cool procedures, but you must discover the key features or functions that specialty does and that these align with your abilities and interests. If it’s not a passion, keeping up with the latest research and journals will be a task avoided rather than enjoyed.
It is important since these tasks become a doctor’s “bread and butter.” Be true to your personality, interests, and mind. Don’t let others determine your life. For many people, dermatology is the absolute worst; to others, that’s only job security.
But also realize that the 1-5% of each specialty must also be enjoyable. Junior doctors may go into gastroenterology with the expectation that IBS will only make up 1% of their practice. If they hate that 1%, it can really drain the enjoyment out of the other 99%. In this interview, Brent Lacey MD gives his thoughts on what the best thoughts are for specialty selection.
D. Expected Salary
This is another factor that medical specialty demonizes, but you should never overlook the fact that it is about your career. If you want to have a certain lifestyle, you must be able to afford it. If you are heavily indebted, you would have to earn more money than your classmate who is not indebted to maintain the same or similar lifestyle.
Now, let’s flip the coin and know that medical reimbursements are quite volatile and will most certainly change during one’s lifetime. Things change rapidly. Hence, you should keep your expected salary in mind. However, this should only be a small consideration.
Also, remember that salaries can be highly variable based on the patient population and your chosen “niche.” Skin cancer and cosmetics make the two highest-paying fields in dermatology, but not all students are interested in either.
Changing Your Specialty
It’s not a state you wanted to find yourself in: recognizing your chosen specialty isn’t the right fit. It is important to note that changing specialties during a residency requires lots of effort and strategy, not to mention possible disruptions to your medical training and life. The good news is that you have the option to change your medical specialty.
While deciding on your next steps, it is better to find allies who may guide you well through the process. If there is someone you know having firsthand experience and knowledge about changing specialties during residency, they can give helpful advice. Take it.
Consider discussing it with your program director or faculty members from your medical school. Try to find someone who is compassionate enough to realize that you could still be a great doctor, even if you adopt another specialty. You might require letters of recommendation to support your application, and these faculty members can be of help here as well.
It is also recommended to discuss with the program directors or faculty with awareness of the specialty you want to switch into. This gives you valuable insights regarding whether the program you want to adopt would offer you what you are looking for. You may also inquire about specialty-specific credentials that you can investigate to boost your chances of acceptance into the new program.
Your choice of medical specialty is an important decision and should not be taken lightly. There are also many medical careers in non-clinical medicine that may be a better fit. Through research and perseverance, you will be able to determine your personal criteria for occupational selection that holds the most weight.
Gaining hands-on experience is a great way to gain an overview of the daily expectations within each field of medicine. For information on preparing for clinical experience within each specialty, consider exploring our USCE Guide and gain the most out of your clinical rotations.