8 Things to Think About When Choosing a Specialty

Selecting which field in medicine you are going to pursue can be a difficult decision for some medical students. Some students already know what specialty they want to pursue even before they start orientation. Others start to get anxious as the end of 3rd year draws near, desperately trying to figure out which field suits them best. Many use the process of elimination as they move from one clinical rotation to the next, crossing off fields of medicine 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 will hopefully help you in making your decision.

Take every opportunity to explore!

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 4th year.

Still, many of the specialities which are not included in the required rotations are very competitive, so if you wait until 4th year to learn about them, you have probably missed the boat. Successful applicants in these competitive specialities have already demonstrated their interest in pursuing a residency in this specialty by mid-way through 3rd year.

So, if you have even an inkling that a specialty might be the one for you, pursue it early and 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 a given field.

Surgery or 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 these 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.

Once you can distinguish 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, residencies include general surgery, OB/GYN, anesthesiology, and the surgical specialities including ENT, ophthalmology, orthopedic surgery, neurosurgery, urology, plastic surgery.

If you choose diagnostics, residencies 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.

Salary: Important but not everything

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

Salary is obviously an important factor to consider when thinking about how you see yourself in 10 years and what kind of lifestyle you would like. 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 everyday.

Remember too that there are many things that you can do with your M.D. If you choose a field which is not as well-compensated as others, such as primary care, and then later work as a consultant or hospital administrator, you could find yourself making just as much as your friend from medical school who became a radiologist.

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, particularly emergency medicine and general surgery.

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.

Know yourself

Be true to yourself when choosing your specialty. 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 spatial sense isn't one of them.

On the same token, 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 working with small surfaces or very delicate things, opthalmology and ENT are probably not going to make you happy. If you love the idea of doing a thorough exam and localizing a problem, neurology may be the best choice for you.

Level of competition

Given that some specialities provide better compensation than others, some fields in medicine are more competitive than others. The most competitive fields in the Match include orthopedic surgery, ENT, ophthalmology, neurosurgery, plastic surgery, dermatology and radiology. Unfortunately, lower grades and USMLE scores can be prohibitive for students seeking to enter residency programs in these fields. It is important to be honest with yourself about this. This does not mean that you should not reach for the best program you can, but if you want to go into dermatology and you barely passed Step 1 of the USMLE, take a step back and reconsider. Is it better to match in your 2nd favorite specialty rather than not match at all? That's only up to you.

Variety or a lot of the same?

Some specialities lend themselves more toward variety while others are very specialized. Internal medicine, family practice, pediatrics, neurology, and emergency medicine are areas which have a huge variety of medical problems. These are in stark contrast to fields like neurosurgery and urology which deal with a specific set of medical problems which must be practiced ad nauseum to achieve proficiency.

If you are someone who wants 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.

You gotta love your organ

No matter what specialty you choose, there will be some redundancy to what you do. You will see a lot of ear infections as a pediatrician. OB/GYNs will see a lot of female Instruments. Orthopedic surgeons will see a lot of shoulders and knees. So, make sure that whatever you choose, you like the organ involved. For example, if you love the birthing process but don't love the idea of dealing with the vagina everyday, OB/GYN is probably not the best match for you.[color=#000099][/color]

Happy selecting!
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