How To Pick A Medical Specialty. Advice For Medical Students.

My favorite part of my job is teaching. There, I’ve said it. Yeah, it’s cool picking apart diseases and mix-n-matching treatment regimens for the optimal balance of cure and side effect. I love hand-holding people through concepts that are far beyond their educational level and helping patients and families make impossible decisions with uncertain data.

But give me a new third-year medical student who’s been dropped in the middle of the hospital for her First Real Rotation Ever, and I am just in heaven. I love teaching med students.

One of the things I love the most is helping them figure out what flavor of doctor they want to be. Third year is all about sampling it all, and experiencing what actually happens in the various medical specialties. You rotate through Surgery. You rotate through Internal Medicine. You rotate through Family Practice. You rotate through Anaesthesia. You rotate through Psychiatry. In fourth year, you’re supposed to be narrowing it down to your most likely options for residency.

It’s a tough process, full of uncertainty and soul-searching and fears about locking into the wrong option.

It can be overwhelming. The choices are practically endless. And there’s not all that much guidance out there to tell you how to narrow down your options for the best possible outcome for YOU.

So here are a few things I tell my students to keep in mind when they’re doing their rotations, and so far they seem to think it’s helpful.

1) The best choice of medical specialty will be something you enjoy AND something you are good at. Most people drop out the second condition. But think hard about this: If you pick something you enjoy but that you are no good at, it will be a disservice to your patients. If you pick something you’re good at but that you don’t enjoy, it will be a disservice to you. Look for something that will satisfy BOTH conditions, and you’ll be set.

2) Pay attention to what you DON’T want to do. If you hate Pediatrics or you couldn’t stand General Surgery, THAT’S A GOOD THING! Negative experiences provide you with good, solid information about the kinds of work you want to avoid, and why. It’s especially helpful if you’re overwhelmed with the typical too-many-options brainfreeze. Discarding the rotations you hate will cut out some of the noise from the data, and then it may be easier to see your eventual specialty stand out from the fewer options that are left.

3) It’s okay to take lifestyle into account. As a matter of fact, you should. You want nights and weekends to yourself? Go into Dermatology. You want a lot of money? Look at some of the surgical sub-specialties like Plastics. You’re all right with staying at work late to stabilize a patient? Think about something like Internal Medicine. Want shift work with solid start and finish times? How about Emergency Medicine? Take your personal preferences into account when picking what to do, because if you pick a lifestyle that won’t work for you, you’ll burn out.

4) Confusion is a GOOD thing, even if it’s getting close to the time where you have to commit yourself to an option! How can I possibly say that? What if the deadline for applications is right around the corner, and you STILL don’t know what you’re going to pick? Think about it this way. If you hated OB/GYN, that’s not going to be an uncertain thing; you will feel no confusion about it. Confusion means you have a bunch of options to pick from, and YOU THINK THEY’RE EQUALLY GOOD. That takes the pressure off, because no matter which one you pick, you’ll be satisfied with the result. (Unless you didn’t like any of them at all, in which case you may have a considerable amount of soul-searching left to do.) Don’t get scared if you’re still confused; you’ll land on your feet somewhere, and someday you’ll look back and realize that you made the right choice. No matter which one you pick.

5) Pick for yourself. I don’t care if your father wants you to be an orthopedic surgeon. I don’t care if your mother has been grooming you your entire life to take over her Neurology practice. This is your life and you have to be satisfied with your job.

6) Pick for your community. As a doctor you have a responsibility to serve society. Pick something that’s needed, something that will contribute a valuable service to the community you live in.

7) Pick for the future.
Specialties are not static. While you’re always going to need generalists, it’s important to realize that there are a lot of forces pushing and pulling at the medical specialties. Some specialties have only a limited pool of patients, but a lot of doctors who want to go into that field. You may graduate med school to find that your chosen specialty has a LOT of competition, both for residency positions and eventually even for patients. Family Practice doctors are in trouble these days due to the pressures of reimbursement patterns and the advent of physicians’ assistants and nurse practitioners who can provide similar services but aren’t paid as much. As the space program shuts down, Aerospace Medicine is probably going to focus more and more on airline pilots and suchlike. It’s important to recognize where your chosen specialty fits into the grand pattern of things. It’s important to look to the future. So keep your eyes and ears open. Read the news and keep up on health policy trends. Listen to what people say about their doctors. Watch how different kinds of doctors are portrayed on TV and in movies. Use every resource at your disposal to try and predict what will happen five, ten, or twenty years from now. Plan ahead; this will be your specialty for life. And it’s easier to roll with the punches if you know what direction they’re coming from.

8) When in doubt, leave your options as open as possible. What if the application deadline is RIGHT NOW, and you still have no clue what you want to do? PANIC! PANIC! No, actually…please don’t. Okay, it’s a tough place to be. At this point, you’re going to want to pick something that gives you the most flexibility. Internal Medicine and General Surgery can be good options. They both have tons of sub-specialties that you can sample throughout residency, and either one of them will allow you to fine-tune a career for yourself out of the available options.

Well, that’s what I have. Any other medical people want to throw in a few pearls of wisdom? How did you choose your specialty? Students, what’s the best advice you’ve heard about this? Help us out in the comments section!

Best of luck!

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Published in: on January 10, 2012 at 4:57 am  Comments (52)  

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52 CommentsLeave a comment

  1. That was extremely helpful and I’ll have to keep that in mind for the possible distant future or maybe even for something else entirely. Thank you for sharing your pearls of wisdom!

    Oh and Hechu is back!

    Thank you again!

  2. Great Post

  3. I had a confusion abt the field which i have to choose for my future 2 days ago.. now i am fully satisfied after gone through this extremely useful post..now my options are wide open..whichever course i will get , i will try to be the best in that field. Thank u… so much.

    • You’re so welcome! I’m glad I could help!

      Dr. G

  4. very good post

  5. For me it’s very difficult to find something that will satisfy me for the rest of my life! I am afraid that I will get bored of whatever speciality I choose! Throughout the 3rd year I was excited about all the specialities at the start and then got bored in the last week….because regardless how varied the speciality is there are lots of repetitive task you have to do all the time. I love medicine don’t get me wrong but i want a speciality that will give me the varied option of let’s say surgery but with a good work life balance and that will keep me on my tiptoes. every time i fill in quizzes to find out my perfect speciality i get surgery in top 10 but i am afraid that will take over my life but then if i do something that gives me a good life balance i am afraid i will burn out and get bored and eventually not do my best….

    I am confused…when i talk to my tutors they all try to get me to do their speciality because they think that i will be good at whatever i choose to do….
    Any thoughts?
    Thanks
    Ana

    • What do you have the most fun with? Do that.

      What are you the best at? Do that.

      If nothing else works, consider this: Write down every specialty you’re considering on a slip of paper, and mix them up into a hat. Decide that the one you pick will be the one you do. Then pick. If you’re disappointed, then you don’t want to do it! Good way of narrowing stuff down, sometimes, when all else is equal.

      Best of luck!

  6. [...] How To Pick A Medical Specialty. Advice For Medical Students … [...]

  7. My story maybe quite different from others.I am 41yo. graduated 15 years ago .started ENT 1 year ago but not satisfied then tried for radiology,then I found the chance ,now I want to switch but got nervous and obsession maybe again become hopeless and dissatisfied. God bless all and me …..

  8. That was verryyy useful
    thank u soo much

  9. it’s really useful and i like it alot
    but i’m still don’t know , internal medicine or pediatrics , how i can choose , i try almost every thing and still don’t know , what should i do?

    • There are Med-Peds programs, if you really, deeply can’t decide. I almost did that myself. :D

  10. Hi Dr,

    This was a really useful post. I was wondering what is your take on this: Many medical specialties have stereotypes or collective personalities which may or may not be true all the time. However, if you do not fit with the collective personality, will you still go into a specialty? For example, some specialties seem to attract medical students who like to party and go clubbing, so if you’re not the clubbed type, will that affect your choice (especially if only 3 residents are selected each year and you might not be able to get along well with the other 2)?

    Thank you very much!

    • Well, I’m not going to argue with the “collective personality” thing. Orthopedic surgeons tend to be god-complex jocks, pediatricians are nicer than your run-of-the-mill internal medicine doctor, ER folks like to ski, and psych docs often have some weird quirk that just makes you watch them out of the corner of your eye.

      However, I wouldn’t base a life decision on something like that. Stereotypes only go so far. And beyond that, different programs have different personalities too. Pick what specialty fits you the best, and then interview widely to get a sense of which programs fit your personality best.

      It’s important to get along with your fellow residents, of course….but remember that residency is a finite training period, and you’re picking a career.

      You’ll probably make it work, so pick the specialty that fits you best and worry about the other stuff some other time.

  11. Hello dr; thanks for your post its very usefull , actually I am medical student fifth year and still I didn’t find the speciality that I am in love with , all speciality seems equal , for sure there are some speciality I don’t like it but still I don’t know what I like or what I am good in , and finally I am thinking abt pediatric or medicine coz they have many sup speciality , but I am thinking also abt orthopedic but I am female and I am considering social life , I am just confuse till now ):

  12. I am a first year internal medicine resident, recently after 7 months in the program i noticed that i am not enjoying it and i feel that i am not good at it…
    I was confused in the begenning o choosing the specialty, and i were sure that i am good in obs/ gyn and i put it as my first option then changed it to internal medicine after i have been influenced by the residemts in obs/gyn and my mum opinion…

    Now i am very confused shall i continue in a field that i dont enjoy or shall i change to the field i always wished to specialized in!! In addition to that i am thinking that almost i finished one year from my residency years….

    I will be pleased to hear ur advise and suggestions

    Regards
    Ayesha

    • Listen to your passion…. its never too late. you still have a life ahead of you for practising. Practise what you are good at. your patients would bless you.

  13. I was forced into my specialty because the one I wanted didn’t want me. The best part of my day is turning the key to my car to drive away from the hospital parking lot. The worst part is waking up.

    Don’t be a loser. If you are, you’ll become this.

  14. very useful post….

  15. Found dis post extremely useful thank you :)..m confused on a matr.being a gal choosin emergency branch medicine ? How wel does it go ? Ryt now m career focused so i feel ll b bl to handl dis branch but ahedin life wen i ll ve many more responsiblts unsure about DM..or do i opt fo radiology ??

    • I have a lot of female friends who are in Emergency Medicine, and for the most part they seem very satisfied with their choice. Emergency these days is done in shifts, which sometimes gives a better lifestyle; for example, even if a patient crashes, you wouldn’t get stuck in the hospital all night with them….you can pass them to the next doctor to take care of. Also, shift-work is easier to schedule around your real-life responsibilities.

      Radiology is also awesome and pretty flexible, though I don’t know quite as much about the setup.

      Best of luck choosing; I’m sure you’ll be able to make it work!

      Dr. G

  16. good one … this will surely help … thank you so much ….

  17. Hello! This post was wonderful and very useful. I’m a Pre-Med student currently and I know I have a ways to go before I have to make this decision, but it’s exciting to think about and I just wanted some input. I’m working at a hospital currently in the surgery center. I have fallen in love with surgery and have a strong feeling that that’s what I want to pursue. As a woman planning on having a family someday, what specialties are the best for that type of lifestyle? From what I’ve seen in my experiences, I found general to be interesting as well as plastics and cardiothoracic. But, I still have more to see and a long way to go. Any advice would be great! Thank you!

    • Hi, Kelly

      I’m not really the best person to ask about surgery lifestyles. My best advice, though, would be to find a mentor: someone in the field that could act as an informal advisor. Someone who has a job like the one you eventually want, who will let you shadow them, ask them questions, who will ask you questions to guide you, and will let you in on the secrets they’ve learned over their own journey. A mentor in your field will be invaluable, and can help you with these and a lot of other questions!

      And like you said, there’s a lot of time to explore options. You’ll be fine! Best of luck!
      :D

  18. As a current student who has a few days to decide between IM, Neurology and Pediatric Neurology, I welcomed the comment on confusion being a “good thing”.

    • Glad I could help out, at least a little bit!
      :D

  19. The post was very helpful. My problem is that I get bored very fast and sometimes I am afraid I will not be able to handle the hard-stuff like terminal patients or patients who have diseases that you only treat but never cure. So that is why I was looking towards surgery. But I hate general surgery, so I shifted my attention towards orthopedics. It would be okay i guess. I think i’d like more the orthopedic side and not the trauma side.
    But the lifestyle scares me. I am afraid to give a big junk of my time out. It sounds selfish but I feel that I sacrificed so much compared to others my age that it makes me feel entitled to have my free time. I am not that outgoing or clubbing type it is just a gut feeling. But nobody talks about lifestyle’ there is no way to get info on what is a day-to-day activity of an orthopedist.

    • Hi, Dan

      Can you do a rotation with some orthopods and see how you like it? That’s the best way to get info on the day-to-day experience. And let me tell you: You’re allowed to want some time to yourself. Period. You have to take care of yourself if you want to take care of your patients. An unfulfilled doctor usually turns out to be a jerk. No one wants that.
      :D

  20. First of all, I am extremely thankful for this blog, ever since a friend shared it to me. It has shed a bit of light, especially now that I need to decide.
    I have passed the boards a year ago, and decided to take a year off to “find myself” . Now, it has been a year, and I still feel that I am “lost” or confused. I feel like I might choose the wrong one for me, and I might regret it and waste my time. What if I feel I’m not good at any of it, how do I choose then? I’m just in a lot of confusion really.. but I do want to specialize at something. I just don’t know what. I hope you could share your thoughts on this matter. Thank you very much

    • Hi, Jee

      If you don’t like any of it….have you asked yourself if you really want to do medicine? I’m not trying to tell you to quit or anything; I’m just wondering if you’ve had an honest conversation with yourself about whether you still want to go ahead with medicine, and why.

      I’m taking a year off, myself, at the moment, and I’m enjoying the heck out of myself but also itching to get back to work. Are you also itching to get back to it? What aspect are you looking forward to getting back to? The answer to that question might help direct some of your decision-making.

      Best of luck!
      :D

  21. Thank you for the post. That was very insightful.

    • Glad it could help, even if it’s just a little bit!
      :D

  22. Dear Dr. G
    I really liked your post. It’s November and I haven’t decided yet what I want to do. The deadlines are here. I’m an IMG, I did a couple of clinical rotations in Harvard Medical School and did great: Plastic Surgery and Anesthesia. I had to do an internship in order to graduate in my country and I loved each and everyone of my rotations OB-GYN, Internal Medicine, Family Medicine, Pediatrics, Surgery, etc. I performed very well in all of them. Aptitude tests indicate gastroenterology, radiology, plastic surgery, allergy/immunology in my top 10. I don’t know what to do. I have to take into account that I’m an IMG, not US seniors. I don’t have any kids, but eventually I would like to have a family, and would like my free time. I’m so scare of choosing the wrong specialty, more than I’m scared of not matching. I think I found this post for a reason… Please, help me. God bless you.

    • Hi, Uci. IMGs have a tough time in the US medical field. I’m trying to help a friend apply to Internal Medicine; she’s a practicing ophthalmologist from China who wants to do Internal Medicine. She’s really having difficulties; I hope you’re faring better.

      It sounds to me like whatever you pick, there are things about the specialty you’ll enjoy. I don’t believe there’s any One Right Specialty for any one person. As long as you can eliminate the wrong ones, you’ll probably be fine. There are a lot of things to consider; it’s a tough choice to make. One thing you can do is to pick a maximally flexible specialty, such as Internal Medicine or General Surgery, and refine your career goals from there.

      I’m sorry I can’t be more help than that, but I’m sure you’ll be all right! Everyone has a tough decision; it sounds like you’re in a good position because there are a lot of things you’d be happy doing!
      :D

  23. Thanks for your post! It’s great! Super helpful to say the least. I’m just a med student and trying to figure out what specialty to pick. Right now I’m still interested in so many different things. Except for surgery, I don’t like anything surgical (though I spent some time with an anesthesiologist and loved that side of it). Generally I’m definitely more on the medicine side of the divide! Could I ask you a few hopefully quick questions please?

    1. With emergency medicine, I really like this, but I’ve heard burnout is very real. But I want a career that I can work for the rest of my life. Is it true emergency physicians burnout after say age 50 or so? Is burnout in emergency medicine as real as I hear?

    2. As I mentioned, I really loved the time with anesthesiology, and enjoyed seeing some of the ICU/critical care (cardiac ICU). I like their lifestyle. This seems like a great specialty too. Any thoughts on anesthesiology?

    3. Finally, and totally different change of pace, but I loved oncology and oncology patients and oncologists. Some of the most wonderful doctors I’ve ever met! Any thoughts on oncology as a field it seems to overlap a bit with palliative care?

    Cool thanks so much in advance!

    • Hi, Patrick! Glad to help!

      First of all, sounds like you’re in a pretty decent position, and whichever you pick, you will probably be happy to be there!

      1. I can tell you from personal experience that burnout is very real, but it’s not limited to specialty. The trick to medicine is that there are many different ways of working in each specialty, and if you’re self-aware and honest, you’ll probably be able to find a good balance that works for your life. Emergency is interesting in that it’s shift work, and that you can eventually schedule your shifts to fit your lifestyle. This is a benefit that you don’t find in many specialties. So, yes, it’s hard work (it’s all hard work!), but depending on who you are and how well you manage your time and how much you love what you’re doing, you can find a good balance that won’t burn you out.

      2. Anaesthesiology is best described as “extreme boredom punctuated by extreme panic”. It’s not for me, but a lot of people love it! I personally love the ICU environment. You can also get to critical care through Internal Medicine.

      3. Oncology is a wonderful specialty. I wish more oncologists used Palliative Medicine as a tool in their medical toolbox. You’d specialize in Internal Medicine and then do a fellowship in oncology.

      Best of luck! Looks like you’re in pretty decent shape!
      :D

  24. My case is quite different, I am in my 4th year of studying medicine but I really wanted to be a medical assistant . I am already tired of wanting to be a doctor but I opted for this field because I enjoy it and it’s really easy to comprehend but the duration of school ( 6 years ) and work hours discouraged me that was why I chose the medical assistant job but was pressurized by my family to study medicine. My questions are, is it too late to change and if it is not too late, what measures do I need to take plus the consequences ? I am 20 years and thanks for the post

  25. very very confused between pathology and internal medicine.
    I like both,both are great specialties ,however IM is more prestigious and showy and if I pick a procedural subspecialty that’s for sure will get me high salary.

    On the other hand pathology is broad, very well paid and unique,unfortunately people do underestimate it and keeps telling you that you are a lab worker and you work for physicians ,you will never be health care leader cause you lack the clinical sense

    MY Heart with pathology and MY Mind with Internal medicine
    Guide me please.

  26. Hello!
    Howdy guys?
    This blog is awesome and I have been reading all the comments but I didn’t see any enthusiast aspiring to be an ophthalmologist here.. I like Ophthalmology.. but I don’t have any guidance. As a female would it work for me?
    I want life with style and I want to be good at something that I do.. Plus I don’t just want to stick to medicine.. I want to be involved in surgeries too. Please somebody enlighten me. If you have suggestions for any other field please feel free to share!

    • I enjoy ophthalmology, did 4-mo of elective practice at it..but I’m not sure if I like it because I enjoy it at heart or simply because I learned about it and understand it. I’m afraid if I chose ophthalmology I’d get bored of just eyes

  27. Tnx Doc for the blog…I am now Emergency medicine Resident…I though i like to work on shift, and once i leave the hospital, no more house calls and the like…

  28. Thanks for this list, it’s really helpful. My greatest problem at the moment is that I don’t think I’m particularly good at anything and I have to decide in a month, I just have no idea.

  29. it’s verv helpful and aid me alot ,i was completely confused but when i read this i get oriented to my sp
    thank you alot

  30. Hello every one.I have graduated in 2012 I had completed my internship,after that I planned to chose surgery ,but my father insisted me to go in medicine. I started preparing for my licensing exam that has a major component of medicine,after preparing I appeared in my mrcp exam on the ,request of dad as ,he gave me a option that just appear in this exam if you manage to clear then it’s ok ,keep it as a second option and you can continue for your favourite speciality, luckily I cleared my mrcp part 1 which is a internal medicine diploma exam from uk and I also had cleared my plab ,so now my dad is forcing me to give mrcp part 2 .he said as you have done so far so good in medicine ,y don’t you continue it further,if you will go for surgery then you will be late and burned out in between your training,so this is my situation .i am going well with medicine but at the back of my mind I always think ,y i cant do surgery ? Iam not rigid on my decision I have a flexibility in my nature about my profession ,but confusion haunts my mind ,when iam sitting alone or I hear some gossip about a hot shot surgeon,I am also fully aware that I have not done well in surgery during my internship but still iam confused. Please help me overcome this confusion .

  31. It is a really helpful post.
    But actually I need a some help, when i was in internship in pediatric I was very happy doctor and I took an extra duty to build my interest ,also I maked a lot of discussion about the cases , really this field attracted me …so now I am resident in pediatric but suddenly I lost my interest , indeed I do not like to see any child and I am not interest to study any thing about this field , i noticed myself that I am complaining so much to my family and to my friends
    Now I am think about infertilty and it has alots of advantage (even more than pediatric ) really I want to make a decision to pass on my life but until this moment i can not

    Please can u give me an advice and thanks alot

  32. Hi! I’m an incoming 3rd year Med Student and I had to follow your blog! My heart skipped a beat knowing I’ve found a doctor who blogs too – and shares the wisdom gained from personal experience! I was like in my “Eureka” moment when I read this part of your blog Doc, especially after knowing there’s someone out there willing to help out medical students like me.
    Anyway, I was trying to plan on my Medical Career and found this helpful blog for specialty options. I appreciate the wisdom you’ve shared in this one. Will definitely be following your blog! :) God bless Doc!
    I hope you get to visit my blog at: blissicalardencies.wordpress.com
    I’d very much appreciate that. Thank you!

  33. […] Picking a Specialty […]

  34. dear doc, this is nice post,can u elaborate me ,how much earnings in ophthalmology ?i am interested in it, can u made top earnings list of specialities?

  35. HMMM, nice post ..really thanks
    i need help actually :(
    iam in the internship year , i was extremely convinced with plastic and reconstructive surgery and iam studying for MRCS exam already but during these days i met a lot of doctors who adviced me not to take this speciality because it is very exhausting and specially for females as i won’t have enough time for me or my family :(
    now iam confused , what to choose : continue my way or change to more comfortable speciality ?
    i have interests outside medicine and i need that free time for myself actually :/ so , what to do ?!

  36. Hello everyone!
    This is a really great post and it helped abit with my dilemma. However, I would like your oppinion on it as well, please.
    My dream has always been OBGYN. I loved the rotation in med school and I even did an internship. However, due to some unfortunate event (long story short) I got into Pedes instead, which I never thought about but in time I liked it. But now, after 2 years I have the possibility to get into Ob, and I don’t know what to do. On one side Ob has been my dream -the diversity, the surgery, the unexpected- but I don’t want to work unpredictable hours, have little free time with my family, and have a high liability. Maybe it’s the country I live in but if I put the pros and cons, I feel it’s just not worth it, especially for females. In Pedes I could have an easier life style and a family, but I don’t think I could stand all the screaming and annoying parents my whole life, even though it’s also a very diverse field. And even if I should not think about it, there is a difference in the average salary.
    What do you think? I would appreciate your advice!
    Thank-you.


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