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!

Published in: on January 10, 2012 at 4:57 am  Comments (95)  

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  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 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?

    • 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 …..

    • Currently radiology is pretty easy to match. That’s because the job market has drastically fallen since c. 2009.

  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. 😀

  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.

      • I agree with Dr. G! There are all sorts of personalities in various specialties. There are extrovert radiologists, and introvert emergency physicians.

        Plus, you can often arrange work around your personality and other needs. At least to a degree.

        Not to say you shouldn’t consider stereotypes, but take them with a grain of salt.

  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 ):

    • Fifth year med student? I take it you’re not in the US? If not, then my understanding is other nations have give you time to rotate through various specialties even after graduation from med school. I know in the UK and some Commonwealth nations, after med school, you have to do 2 years of essentially general medicine, which is paid of course, but where you can rotate through different specialties to see what you like. If that’s where you are, then I think it’s a great opportunity to explore what you enjoy most. Unlike American med students who have to decide before graduating from med school!

  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


    • 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.

    • same is happened with me .now i want to do patho

  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.

    • On the other hand, don’t spend too much time with people who are chronically unhappy! There are plenty of ways to get into your ideal specialty even if you can’t get in right away. (Well, unless you’re aiming for something super competitive.)

      Plus, there are actually many good specialties where people can be happy in. For example, I know someone who didn’t match into anesthesiology, which he wanted so badly, and had to “settle” for IM, but given the uncertain anesthesiology job market and future, this was a blessing in disguise! Now he’s going to be a pulm/cc physician, which is just as lucrative and just as exciting, and he’ll be treated much more respectfully by hospitals and colleagues. No more, “anesthesia, lower/raise the table”!

      • Anesthesia uncertain job market?? Please…anesthesiologists will always be in need. No anesthetist no surgery, simple.

        • Notice I never said there’s no “need” for anesthesiologists. Instead, I said the job market and future for anesthesiology are “uncertain.” Just re-read what I wrote above. You’re burning a strawman.

          1. The trend is compensation for anesthesiologists is headed down while hours are headed up. Just look at credible medical salary and compensation reports. Your school or residency should have access to them.

          2. The future of anesthesiology in the US (which is the context we’re talking about in this thread) is the Anesthesia Care Team (ACT) model – i.e. anesthesiologists managing CRNAs at a ratio of 1:2, 1:3, 1:4, or even more. Approximately half of all surgeries in the US already employ this model, and the future only looks like it will increasingly employ this model. In other words, anesthesiologists should expect to do less and less of their own individual cases, and more and more managing several CRNAs at a time who do the cases themselves. And CRNAs aren’t only doing ASA-1 or ASA-2 cases, but they are even doing ASA-3 and sometimes ASA-4 cases. Anesthesiologists take on all the medico-legal liability under this arrangement too. No, thanks, I’d rather be responsible for my own patient, not be responsible for 2 or 3 other nurses (CRNAs) and what happens to patients under their direct care and my supervision! Yet, unless there’s drastic change, that’s the future.

          3. Not to mention private practices are being bought up left and right by AMCs. The future for anesthesiologists is currently moving towards being an employee rather than a partner. There are still some strongholds of good private practice groups (e.g. Midwest), but these are increasingly getting less and less.

          4. The American Society of Anesthesiologists (ASA) is in fact recommending the PSH. That’s not a solution, but an unfortunate future.

          I could say a lot more, but these should suffice for now.

          • Thank you so much for this post dnt know how I stumbled upon it but am a third year med student and you described my state of confusion. Am able to rule things out but not totally in. I like a fast paced and hands on speciality but am a very good orator, Love to see pts and talk to them and most of them always have kind things to say. I like gen surgery right now and Ed for the shift work cos I love some me time, but I also do well in consulting like Office hours and all. I hope I figure it all out soon. Any input will help

  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

    • I agree both EM and rads are solid choices for the right person. Although EM currently has a far brighter future.

      Rads jobs and the future look very dismal at the moment. Everyone does at least 1 fellowship and some even 2 (or more) fellowships in radiology just to remain competitive enough to get a job. So that’s 5 yrs to become a diagnostic radiologist + 1-2 yrs fellowship (e.g. IR, mammo, MSK, neuro). So at least 6-7 yrs in training before you can get a job.

      Most jobs aren’t in metro areas. But if you’re willing to live 1-2 hrs outside of metro areas, then you should be able to get a decent job.

      Also, keep in mind rads is no longer a lifestyle field. It’s better than a lot of other fields (e.g. general surgery), but it’s not as good as many other fields either (e.g. some surgeons will have a hard residency but after residency they can have a far better lifestyle than many radiologists). In radiology, you could easily be working Mon-Fri 10-12 hrs or even more per day + take call once a week and work weekends 1-2x per month too. And the pace of reading images and dictating them is pretty fast. 100-150 images per day is typical.

      Teleradiology is not secure. It sounds nice on paper, but in reality, you’re going to have a hard time making connections with people, and thus getting a good job. Just do it as a temporary measure while you’re looking for a job if you can’t find anything. I know of people who have graduated from fellowship and are still looking for jobs. I trust they’ll eventually find something, but it kind of sucks to be a physician and have such a hard time finding a job. But as long as you’re geographically flexible, or willing to do what others aren’t willing to do (e.g. work nighthawk), then you should find a decent job.

      Although salaries are falling. But that’s for many other specialties, not just radiology.

      However the environment in radiology is generally still pretty stress-free. Not like the OR for example. Radiologists tend to be very nice people too, at least in my experience.

  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!


  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!


  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.


    • Hey Dan (good name)!

      Also keep in mind, yes, orthopods have a very rough residency, but after residency they can have very nice lifestyles. I wouldn’t necessarily choose a specialty based on lifestyle during residency. Lots of residencies are pretty hard. But instead look beyond residency and see what’s possible. I’m not an orthopedic surgeon, but from what I’ve seen, as an orthopedic surgeon, I expect you could probably dictate when you want to work and when you don’t and so on. As long as your partners are okay with it, and you don’t mind sacrificing money.

  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!


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

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


  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!


  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!


  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

    • 20 years old is certainly not too old!!! At least we Americans wouldn’t consider you too old at all. In fact, most Americans would still be in college (usually 18-22 yrs old).

      But it sounds like you’re in a different country? I don’t know the sociocultural expectations in your country. But I know in the US and other nations like the UK and Canada, you won’t be considered too old.

      You could do whatever you like to be honest at this point in your life! The future is still wide open for you! 🙂

  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.

    • I wouldn’t worry about prestige. Prestige is what you make it.

      Also, I never thought of pathologists as less prestigious than IM. In fact, IM often has to consult pathology.

      It sounds like you’re also hung up on salary? But at least in the US, both have the potential to do well. Pathology faces a very difficult job market. But if you can get a job, you should be able to make about $250k-$300k per year starting. Whereas general IM, if you are a partner at a group, you can make just as much if not far more than pathology, and there are far more generla IM jobs than pathology jobs currently. I know a general IM physician in a private practice (partner) that makes $450k per year. He might be an outlier, or his group might be. Salary depends on payer mix in the US, and some places have great insurance plans where you can make tons of money if money is your goal. Most hospitalists probably work 26 weeks per year for about $250k per year.

      Of course, some IM subspecialties do very well too. Although others like cardiology face an oversaturated market.

  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

    • Ophtho has a great lifestyle post residency. They have very low starting salaries ($150k per year). So the first few years may be lean. But after making partner, you should do very well.

      I can’t speak to the female issues because I’m a male. But there are plenty of female ophthalmologists and they seem to be doing fine.

      There are other specialties which involve “medicine” and “surgery” like urology, OB/GYN, general surgery + breast fellowship, etc.

      • I really dont know where you get your facts from but ophthalmos getting 150k to start??? Bud, brush up on your googling skills and open up your eyes. You’re misinformed and misinforming others. Stop.

        • Seriously, dude? Are you a med student? Yes, American ophthalmologists start low, but as I said they do very well after becoming partner. They have a great future. I never claimed otherwise. You need to work on your basic reading comprehension deficiencies.

        • Dan is right. jdillpickle sounds like an IMG since his or her English is a bit off. Nothing against IMGs, but they may not know the U.S. medical system very well.

  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.

    • Don’t focus so much on aptitude (or lack of aptitude). You can be trained in a lot of things depending on what you want to do. Focus more on what you enjoy!

  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 .

    • It sounds like you really want surgery.

      Also, it sounds like you’re allowing your father to dictate your life far too much. Do you have something in your life keeping you so dependent on him and his opinion?

      Both medicine and surgery are great options though. But again your heart is evidently very much in surgery. It sounds like what’s holding you back from pursuing surgery is your father. Maybe have a heart to heart discussion with him?

  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

    • Residency is quite different than life post-residency. Lots of residents doubt their choices during residency. I’d talk to your mentor(s) about this. See if it’s residency that’s making you doubt your love for peds or if it’s the field itself. If it’s residency, then you can endure residency, and be happy afterwards. But if it’s peds itself, then there may be more to think about.

  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:
    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?

    • Retina is the most lucrative in ophtho I believe.

  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 ?!

    • That’s an entirely personal decision. It’s up to you what you like, how much you want to give up, etc. Best to talk to a mentor rather than people online.

  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!

    • Peds in the US is 3 yrs. If it’s 3 yrs, then you could finish the residency, and then apply to OB/GYN afterwards. You could have both.

  37. Hello! Thanks for your post. My problem is that I like to do everything in medicine, besides I really appreciate my free time. As in, I like to diagnose a patient, plan the management, I love manual procedures like endoscopes or so, I like good prognosis and rapid results. I want a scheduled life with all of the above which makes it quite impossible to choose a medical speciality. I would appreciate some advice.
    Thank you.

    • Dear ACEM, I’m soon to start internship and I’m interested in emergency medicine. I would like to please ask how many years it would usually take to become an emergency physician upon graduation from medical school? Is it intern year + RMO year + 5 years registrar (assuming one is accepted into the college straightaway)? Cheers, MikeHi Dr. Tan-Lucien Mohammed,

      “My problem is that I like to do everything in medicine,”

      Family medicine and emergency medicine allow a bit of everything except surgery. Also, general internal medicine, which covers a lot, but they don’t do everything (e.g. kids).

      The one that truly does “everything” in medicine is maybe general surgery + critical care fellowship.

      “besides I really appreciate my free time.”

      Yeah, so does almost everyone in medicine!

      “As in, I like to diagnose a patient, plan the management,”

      You’re asking for nearly the impossible in modern medicine. Pathologists and radiologists are the ones who primarily diagnose most patients. Not that other physicians can’t or don’t diagnose. Of course not. But given our medico-legal environment, we have to have a lab or imaging test to confirm. So we rely on our colleagues the pathologists and radiologists to give the final word.

      However, pathologists and radiologists aren’t normally involved in treatment and management. They do things which obviously affect treatment and management. But they’re generally speaking not the ones most intimately involved with treatment and management. But most other physicians are involved in treatment and management to some degree. A better question to ask, perhaps, is what diseases or conditions can you see yourself treating and managing?

      “I love manual procedures like endoscopes or so”

      There are all sorts of “manual procedures” in medicine. Of course, generally speaking, surgery gets the most procedures. But even a family physician can do procedures. Even a general (non-interventional) radiologist can do procedures. It really depends on what type of procedures you’re looking to do.

      “I like good prognosis”

      I suppose it depends on what you mean by “good prognosis.” But broadly speaking, I don’t think there are many if any fields in medicine which always have a “good prognosis.” Maybe preventative medicine?

      If you mean something more like “usually have a good prognosis,” then just look for something which involves generally healthy patients. Usually outpatients. Like pediatrics routinely does well-child care. But you still have to face the prospect that there are unwell kids!

      It’s almost easier to rule out specialties for you. For example, you wouldn’t like most surgeries (maybe ophtho might be ok, depending on what sort of “good prognosis” you’re looking for). You wouldn’t like anesthesiology where even a healthy patient undergoing a routine sort of a surgery can crash in literally seconds. Definitely not critical care medicine where so many die. Not emergency medicine. Not hematology/oncology, not palliative care. Not cardiology. Probably not gastroenterology. All these have strong elements of patients with less than “good prognosis.” Heck, I think even a dermatologist may sometimes have to deliver the news that a patient has melanoma.

      “and rapid results.”

      There are specialties which have rapid results like anesthesiology, but they don’t exactly have the other things you’re looking for like a good prognosis or easy regular hours (because you never know when the last surgical case will end in the day!). By the way, the ROAD specialties are a misnomer. Maybe only derm still qualifies as a ROAD specialty. Maybe ophtho, although they are losing tons of money. But radiology, ophtho, and gas are definitely no longer easy lifestyles with good pay. There may be some older partners who are living the good life in these specialties. But the younger medical students will no longer have it easy. Radiology there are few jobs left, and most jobs are a couple of hours outside of the large metro areas, you have to do at least one if not two or even more fellowships to find a job, you are working probably on average 60 hrs per week reading tons of images (increased volume), but for a lot less money (decreased reimbursements), etc. Anesthesiology is certainly not a lifestyle specialty, not when you’r also averaging 60-70 hrs per week in private practice as the norm, and being threatened by takeover from AMCs, CRNAs encroachment, where you also have to taken on liability (malpractice) from CRNAs, and God forbid if you have a payer mix of mainly Medicare because anesthesiologists are reimbursed at so little on Medicare (like many other specialties), etc.

      “I want a scheduled life with all of the above which makes it quite impossible to choose a medical speciality.”

      Sadly, yes, it is impossible to have all these things and also a “scheduled life” with reasonable hours. The safest is a surgical specialty like ENT or urology. But these still mean enduring many years in a sleepless and hard working residency! But once you are an attending, as long as your partners don’t mind, you could just take on the cases you want, and if you don’t mind making a lot less money, then you could probably just work “part-time.” Of course, keep in mind, “part-time” in medicine is often close to “full-time” in the rest of the world – i.e. around 40 hrs per week is considered “part-time” in many if not most specialties. A neurosurgeon could work “part-time” and make good money, but you still have to endure a super intense neurosurgical residency.

      Anyway, it sounds like you’re still a med student at this point. I recommend just doing what you love without consideration of the lifestyle because the lifestyle can be (to some degree) what you make it. Although everything in medicine is not “lifestyle friendly” if you are comparing a specialty to a regular office job. Even dermatologists who want to make great money have to work long hours. So as long as you are comparing a specialty to another specialty, and not a specialty to a typical 8-5pm office job, then we can say some specialties have a better lifestyle than others.

      Bottom line: Just do what you love. Or at least what you don’t hate.

      • Thanks for your detailed answer which shows your concern. I have to choose my residency in 3 months which is why I have been doing some research. Thanks again 🙂

        • Glad I could help! It’s hard, but I suppose emergency medicine might best fit what you’re looking for. Nothing is perfect, and emergency medicine isn’t either. But currently it seems to have a good future (unlike many other specialties), it’s fast-paced, involves some procedures, if you don’t mind giving up money for time then you could just work part-time and have a good “lifestyle” (though you’ll still have to do your share of nights, weekends, and holidays, unless you can make special arrangements with your group or hospital), etc.

  38. loved this post! 4th year of med school just started for me and i enjoyed almost all of my third year rotations except a few like ENT and did well on the aptitude tests too.problem is orthopedic surgery is on the top of my list for now but firstly im confused whether its good for females seeing how very few of them opt for of it..Also i enjoyed the surgical rotation immenesly but aptitude wise i feel im better at medicine..hence now its a tug of war between what im good at n what im intrested in.Their still time left until graduation and i hope i have more clearer perspective till then.

  39. Hi. Thank you for your post!
    I know that, in the end, the specialty choice is only mine…but I keep looking for advice until then.
    I am deciding between Radiology and Psychiatry.
    Radiology was my first option for a long time. Things that I like about it: intellectually challenging; clinical correlation; less bureaucracy; lacks “social” issues; less need to be on top of insurance payments; not emotionally draining.
    I have concerns regarding the “new” life and future of radiologists: long hours, more calls, insecurity of job market, being an employee with no voice and a slave of private practice.
    Ultimately, I would like to like what I do and have a decent life with time to travel and do my hobbies. Knowing myself, I would not want to live every day of my life under pressure and with no time for my personal life.
    Psychiatry would give me this flexibility. I like the field itself. I have some of the personality traits and skills that would help me in Psychiatry, I believe… I am just concerned if the “social” work, bureaucracy and demanding patients would drain me and I would regret my choice… Any input is welcome. Thank you!!

  40. This is a very helpful post. I’ve been thinking of which specialty to pursue for the past 2 years and it seems like I love every rotation I’ve been into. but still, don’t know what I really want up to now.

  41. I just started my diploma in family medicine and planned to pursue further to obtain my FRACGP. What do you think of family medicine speciality and how lucrative is the speciality. Any future sub speciality prospect for this speciality?

    • Is FRACGP Australia’s General Practioners? That’s different than the US. There are probably different prospects depending on the nation you’re qualified to work in. I hear GPs in Australasia do quite well though. In the US average salary is around $200-$250K per year for a family physician (GP). You can work a reasonable lifestyle too.

  42. Hi doc…useful post. 2nd time lookin at it.
    My story is bit long and little complicated but please bear with me.
    I am an intern in one of the hospitals in Africa. I have done my internal medicine and general surgery rotation. Now doing orthopaedic surgery then paediatrics.
    Before starting internship…I was sort of interested in internal medicine and pediatris, and didnt want anything to do with surgery. After rotating through medicine…I found it very vast…and my knowledge being very little. Im kind of losing interest in it.
    I didnt like general surgery as much. I am however starting to like orthopaedic surgery (which i also know very very little of)…I sort of want to make it work.

    I have a feeling ill be stuck between pediatrics and Orthopaedi surgery…although time is also a factor…and ortho takes way more years.,and u have to roatate through general surgery…which i dont want to.

    Your input wil be VERY HIGHLY APPREIATED.


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    How To Pick A Medical Specialty. Advice For Medical Students. | How To Kill Your Imaginary Friends

  44. Good day.. This post gives a lot of inputs…
    I would juz like to hear ur input in my situation.
    Eversince clerkship, I already love IM. But, i had year off bcoz I had an accident after I took the boards… Luckily, I still passed the exam.
    Now, i really want to undergo residency training but when I had my preresidency, I realized that I may LOVE IM, but I am not happy with IM residency. I had a hard time accepting it, bcoz I dont have any other specialization in mind. All i know is that, I hate OB; am not really inclined to treating kids; i dont like long ORs; I am not interested w/ the anesthesiologist’s work ( don’t get me wrong, i appreciate their job); I am reluctant in pursuing radiology and pathology bcoz I am not really good with these specialties.
    The only choices left are FamMed and EMed. But in our country, these specialties are relatively younger compared to others. And both are being looked down by others.. Can you pls tell what are the job opportunities or subspecialties in fammed and emed?

    • You say “All i know is that, I hate OB; am not really inclined to treating kids,” but family medicine and emergency medicine you have to be able to deal with both OB and peds issues. At least to a certain degree.

      In the United States, emergency medicine is an increasingly very competitive specialty (especially for IMGs)! it’s very lucrative, and it’s got a decent lifestyle (if you don’t mind night shifts, though it does get tiring after a certain age, but you can just cut down on your shifts). I have several friends who are in emergency medicine (including one at MGH or Mass Gen) and they love it.

  45. Hello,
    Very useful, indeed. I’m having a hard time choosing. What with 3 kids who have a chronic disease that needs care at all times. I’d like to specialize in internal medicine but I can’t shed that feeling of guilt because I won’t be at home for long hours. I really want to specialist in IM but am I being realistic?

  46. I Shalini want to become a cardiologist

  47. Hi!!! every one
    very good blog i should say to start with
    I Have completed my residenci in Internal Medicine and I am really confused between going for further specialisation or not?
    My heart says stay as internist but My brain says go for further specialisation?? Even if I listen to my brain then I am not able to decide the speciality..

  48. hi dr
    very nice post
    please solve my confusion
    i am interested in gynaecology since long , i love every procedure of gynae and everything they do,
    bt i also like opthal
    now when i am supposed to choose my carrier
    i am confused wuth the hectic schedule and emergency in gynae,my parents say m not dat hardworking to cope up gynae.
    i am too emotional to handle any casuality in gynae
    which z definitely unavoidable
    my second option opthal,,bt even my husband is opthalmologist…
    so everyone will say i should opt for anything bt not opthal
    now plz help doctor..what should i do..i l want only surgical field

  49. hi i have done a course in ophthalmology but my love towards internal medicine is still holding me back. but i really dont want to become busy on weekends , can u suggest me something or anything.. if i get into internal medicine will i be ok or will i regrett for not continuing in ophthalmology.

  50. hi very good blog i came across today
    I am an IMG from India and in my third year med school currently.
    I wish to do residency from US but hardly know what branch would be the right match for me….although have searched a lot …can u give me n overview in brief about certain branches-im,peds,path,rads,anaesthesia,EM ,pmr .
    Also what about scope of sports medicine for females??

  51. Hi. I am confused between neurology and internal medicine. I came up to this post which is really helpful. However, I didn’t have enough rotation for neurology to judgehowisthe practice post-residency? Isit lucrative practice? Subspecialties like neurocritical care do well? I just want to hear your opinion on this. Thank you very much! 🙂

  52. that was helpful
    i narrowed it down to medicine and surgery.
    im confused between the do i choose between the two.
    im confused.
    im afraid what if i dont do well in surgery and medicine it has lot to read and is tiresome.plz give advice.HELP!!

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