Getting into medical school is just the beginning. Choosing a specialty is one of the most important decisions you’ll need to make during medical school. While some people have a very clear idea of which specialty to choose from the very beginning of their medical education, there are plenty who don’t decide until closer to Match Day. If you’re still in the undecided category, here are a few tips to help guide you along the way.
Should I Pay Attention to Specialty Lists?
Some people try to choose a specialty by consulting lists of the most in-demand specialties, the “easiest” specialities, or the “happiest” specialties. The truth is, although there are trends in every specialty, most of these things are subjective and differ for every person. Demand for specialties tends to fluctuate quite a bit over the course of a career. Patterns like this tend to be cyclical. The “hot” specialty right now might end up oversaturated in the future, while a “low demand” specialty might actually be in high need in specific geographic regions. Similarly, if you enjoy doing procedures above all else, you probably won’t be happy in a specialty where they’re rarely performed, even if it does rank highly in terms of overall “happiness”. While lists like this might seem useful at first glance, it’s important to keep in mind your own individual needs when it comes to choosing a specialty.
What About Choosing Medical Specialties Based on Compensation?
Choosing a specialty based on compensation can be equally perilous. While a plastic surgeon might make much more than a pediatrician, those extra earnings might be offset by being unhappy with the type of work you do if it results in you burning out and quitting medicine entirely. If you like two specialties equally, it might make sense to choose the one that pays more; otherwise, choosing a medical specialty on the basis of compensation alone is likely to lead to career dissatisfaction.
OK, So How Do I Choose Then?
Unfortunately, there’s no simple flowchart that will direct you to the perfect specialty. However, there are some general principles that might help you decide if a particular specialty is a good or a bad fit.
Decide between medical and surgical
One common place to start when deciding between specialties is between a medical or a surgical specialty.
Medical specialists in general do not operate on patients, or they perform minor procedures that can be completed in an office setting – think internal medicine, pediatrics, neurology, pathology, psychiatry, and radiology. Surgical specialties, such as general surgery, orthopedic surgery, and plastic surgery, are predominantly based in the operating room.
Some specialties blur the lines between the two, involving a combination of office-based and OR-based procedures – ophthalmology, dermatology, OB/GYN, and urology are all examples. Deciding whether or not you want to spend time in the operating room on a regular basis is a great place to start if you’re undecided on specialty choice.
Consider specific patient populations
If you’re planning on serving a specific patient population, like pediatric or geriatric patients, be sure the specialty you’re considering allows you to serve that patient population. For instance, if you know you want to treat both adults and children, a residency in internal medicine alone probably won’t prepare you as adequately as a residency in family medicine or a combined med-peds residency, and choose accordingly.
Think about prerequisites for fellowship
Certain subspecialties also require specific residency experience. If you want to be a cardiologist, gastroenterologist, or infectious disease doctor, a residency in internal medicine might be required beforehand.
Be sure to familiarize yourself with any needed prerequisites for a fellowship before submitting your residency applications.
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Tips and Strategies for the Process
Before applications open
Most medical students will need to choose a medical specialty by the time they apply for residency, during the fall of their final year. If you have plenty of time left before Match Day, try to get broad exposure to a number of specialties. If you’re considering two different specialties, elective rotations during your early clerkship years are a great time to “try out” a specific specialty to see if it might be a good fit for you. Working as a “sub-intern” or completing an acting internship can help you figure out whether the day-to-day work of a specialty appeals to you or if you’d be better served looking elsewhere.
After applications open
If you truly cannot decide by the time applications open, it’s possible to apply to multiple specialties during Match Day. This can come with some risks and benefits. For those applying to highly competitive specialties, it’s common to apply to a “backup specialty” in case you do not manage to match with your specialty of choice. This can allow you to complete an internship or transitional year without interruption while you re-apply in the next application cycle, potentially avoiding a resume gap.
This strategy can come with some risks as well. If you are undecided on your specialty and intend to apply to multiple specialties, you should notify your advising office to avoid making mistakes when submitting your application. Medical students should take special care to make sure they submit the proper letters and personal statements to the correct programs when applying to multiple specialties.
Sending a letter to a program saying you would make a fantastic surgeon will probably not have the intended effect if you are applying to psychiatry!
What if I don’t match the specialty I want?
Even if you don’t match your specialty of choice, there might be a way that you can still practice the type of medicine that interests you. Didn’t match to orthopedic surgery, but still want to treat common sports injuries? Maybe a sports medicine fellowship after a family medicine residency is right for you. Fascinated by biopsies and skin lesions, but didn’t match dermatology? Taking extra electives in dermatology during internal medicine residency could help scratch that itch. In medicine, there are often many paths to the type of career you want. If you’re willing to be flexible, there are usually ways to achieve your goals. There’s always the option of trying again in a future match cycle as well, or even returning to complete a second residency or fellowship later in your career.
In Summary
There’s a lot that goes into choosing a medical specialty, and much of it is subjective. If you’re unsure about choosing a specialty, be sure to get broad exposure to plenty of practice styles during medical school to see whether there’s a particular one that appeals to you. Even if you end up matching to a specialty you didn’t intend, don’t fret – there are plenty of opportunities to shift your practice after training, whether through additional fellowships, residencies, or continuing medical education. Keep an open mind during your training, and you’ll be sure to find a way to practice as the type of doctor you always wanted to be!
