Just a few days ago, a mentee asked for advice about choosing a medical specialty. I told them that being a premed student is about finding your “why medicine.” What excites you about medicine? In medical school, you find your “how medicine.” How do you want to deliver care?
Choosing your medical specialty means knowing the answers to both of those questions—as well as a few others. Here’s a rundown of what you need to know to make a confident decision.
When should I choose my specialty?
Medical students come to choose their specialty at different times. Maybe you’ve always known you were destined for emergency medicine, or maybe you’re second-guessing radiology up until Match Day. At the latest, though, it’s best to decide by the tail end of your clerkship year.
What factors should I consider?
Say you’re a third-year student with interests in both pediatrics and obstetrics and gynecology. This is where breaking down the decision into smaller parts will be helpful. Here are four major components to consider as you zero in on your specialty of choice.
1. The medicine
What is the bread and butter of this field? When I found myself deciding between internal medicine and pediatrics, I thought about the most common internal medicine admissions: congestive heart failure (CHF) and COPD exacerbation. Sure, there were aspects of adult medicine I found exhilarating, but I could never muster enthusiasm for CHF or COPD. If the main issues in the field are of limited interest to you, it may not be a good fit.
2. The patient population
Pediatricians have an age-restricted population; urologists and OB-GYNs care for populations that are sex-restricted. If your ideal patient population does not map onto the field, the specialty may not be a good fit.
3. The lifestyle
Are you the type of person who wants to work 9 a.m. to 5 p.m.—or are you the type who is unbothered by a shift that may end at 3 a.m.? Are you excited by the shift work setup for emergency medicine? Do you hope for a field that caters to global health work? Are you interested in more time in the operating room, the clinic or the hospital ward? If you’re deciding between a few specialties, think carefully about what your life could look like as an attending in that field.
4. The culture
You’ll gain a sense of the specialty culture during your rotations. Pay attention to the personalities of the residents, fellows and attendings and how they engage with one another. Does their energy match yours? While individual and institutional factors play a role, certain personalities may be common to a given specialty. You will spend the entirety of your career in conference rooms and across lunch tables with individuals of that personality—if you don’t connect with these individuals, it may be a sign that the field is not for you.
How can I explore my options?
The best way to explore your options is to gain experience working in those fields. You’ll have the chance to do this in your third year of medical school, when you’ll take part in core clinical rotations that allow you to dive deep into various specialties.
Admittedly, there are many fields in medicine that may require some initiative for exposure, such as surgical subspecialties (ENT, ophthalmology, orthopedics, urology), dermatology, anesthesia or radiation oncology. So how should you navigate an interest in these careers? Explore early.
There are specialty-based interest groups geared toward first- and second-year medical students that provide exposure to faculty and research opportunities. These groups can give you clinical exposure prior to your clerkship year and can help you select your specialty.
What should I do once I’ve decided?
Your specialty of interest shapes how you prepare for your residency application. Some specialties, such as orthopedics or urology, will demand a significant amount of research experience prior to residency. Other specialties require audition rotations at institutions beyond your medical school in order to demonstrate your strength as a candidate. Some specialties, like integrated interventional radiology, are notoriously competitive and require high standardized test scores.
Once you’ve narrowed down your specialty list, meet with your academic adviser or a faculty member in the field to discuss how you can meet the requirements and stand out in your application. This will guide how you plan your fourth-year rotations, including audition rotations or elective rotations to help you better prepare for the field.
You’ll also need to know whether your specialty requires that you do research and, if so, for how long. This is where your academic adviser can jump in to help you as you start to build an application for that specific specialty.
What happens if I want to change my specialty?
Some of the anxiety related to choosing your medical specialty is the fear that once you decide, you have to stick with that specialty forever. But not to worry! You can change your mind about your specialty (or even medicine) at any point in your career. In fact, it’s common for individuals to change their career plans, whether just before residency applications, during the application process, during residency or even later in their careers. The Association of American Medical Colleges reports that nearly 75% of med students change their specialty preferences, while 20% of residents and 16% of practicing physicians switch their specialties to unrelated fields.
Before committing to a move like this, you’ll want to begin by listing all of the reasons why you want to switch as well as all of your requirements for your next field. Such a transition requires additional years of training, flurries of emails and re-application. This is by no means a decision to take lightly. But at the end of the day, it’s imperative to do what’s right for you, and if that means taking one step backwards to move forward with your ideal career, it’s worth it.
