How to Choose a Specialty

[TexasPhysician]

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Throughout my first three years of medical school, I seriously considered at least 7 different medical specialties. At first I was sure that I would apply Emergency Medicine. Then I switched to Dermatology. During my clinical rotations as an MS3, I enjoyed almost everything (except surgery).

There were some moments where I became envious of friends of mine that had everything planned out from the beginning. A friend of mine was 100% neurosurgery from day 1. Now he is a neurosurgery resident, and he loves it. He admits that he could do neurosurgery 120 hours/week for the rest of his life and still love neurosurgery. I know numerous people like this. They try a medical specialty, and they absolutely fall in love from day 1.

Then there is me. I wasn't in love with any field, but I enjoyed at least a dozen. Stuck between too many choices, I began narrowing down fields by what I wanted in life. I love medicine, but I also love family, friends, the outdoors, and numerous other activities.

I narrowed my list down to fields that seemed fun but also had a great lifestyle.

My list:
Emergency Medicine
Dermatology
Radiology
Psychiatry
Anesthesiology
PM&R

I had otherwise considered things like gastroenterology, pediatrics, sports medicine, cardiology, and other specialties that were more demanding. They were all fun in doses, but the work appeared to wear down those residents. They never appeared as happy.

From my list of 6 specialties, all were fun, and had a good lifestyle. Finally I had a place to start. One by one, I found reasons to shorten my list. Radiology required a boring dark room. I discovered my inability to distinguish rashes. And so on.

Psychiatry turned out to be the last specialty left. Two years into residency, and I have grown to absolutely love my field. I'm not saying psychiatry is the answer for everyone. I think I could have easily chosen PM&R or anesthesia and loved it too. I find so many aspects of medicine fascinating.

I tell you my story, because I've come to learn that many of my past classmates were like me. They reached the status of MS4, and they still had too many specialties to choose from.

Instead of considering lifestyle (or other important things), many just picked whichever specialty was currently their favorite out of 5 or so possibilities. Others picked Internal Medicine or Pediatrics because those fields are general. That way you can choose your specialty/fellowship later.

Now only a couple years into residency, I am already seeing unhappy burned-out old classmates. Not just a couple either. I'm talking about a sizeable bunch of old classmates. All are currently in non-lifestyle fields. Some have already switched fields, and others are desperately trying to get out. It pains me to see so many unhappy friends.

If you are one of the lucky few medical students that is 100% sure about a rigorous field, do NOT reconsider it based on this story. You are most likely making an excellent choice. One of my best friends is die-hard ortho surgery, and after 80 hours in a week, he still can't get enough. He is very happy!

If you find yourself enjoying too many aspects of medicine, forget about your specialty flavor of the month. Sit down and honestly think about what you want your life outside of medicine to look like. Think about where you want to live, how much you want to work, how many kids you want to have, etc. Then evaluate which fields will allow you to also accomplish those other life goals.

Even if you are 90% sure that pediatrics is for you, sit for a minute and wonder if another field might better fit your lifestyle goals. 48 weeks of 85 hours/week of pediatrics is a lot of pediatrics in a year. Will you still enjoy what you do? If not, there is no shame at considering PM&R or dermatology or any other lifestyle field.

You may only learn that you love pediatrics more than you expected. You may realize that the pediatric field is too stressful for you.

I ended up choosing psychiatry, when I could have done many other things. It turned out to best fit my lifestyle wants, and I find it to be incredibly interesting as well. I find myself happy in other aspects of life, and it carries over into patient care. I study more not because I must but because I really enjoy it. Now I can't believe I considered anything else.

You are already on your way to becoming a physician. No matter which field you choose, you will help thousands of people. Before you apply, just be sure to consider YOUR needs as well. You have earned the right.

I wish you well!

 

[CatFactorial]

Nice post, thanks for sharing.

 

[PMPMD]

My list:
Emergency Medicine
Dermatology
Radiology
Psychiatry
Anesthesiology
PM&R

I had almost the exact same list (except Derm). I also went to med school in TX.

 

[PMPMD]

Not to make light of your helpful post, but I found this hilarious:

 

[Jack is Back]

Throughout my first three years of medical school, I seriously considered at least 7 different medical specialties. At first I was sure that I would apply Emergency Medicine. Then I switched to Dermatology. During my clinical rotations as an MS3, I enjoyed almost everything (except surgery).

There were some moments where I became envious of friends of mine that had everything planned out from the beginning. A friend of mine was 100% neurosurgery from day 1. Now he is a neurosurgery resident, and he loves it. He admits that he could do neurosurgery 120 hours/week for the rest of his life and still love neurosurgery. I know numerous people like this. They try a medical specialty, and they absolutely fall in love from day 1.

Then there is me. I wasn't in love with any field, but I enjoyed at least a dozen. Stuck between too many choices, I began narrowing down fields by what I wanted in life. I love medicine, but I also love family, friends, the outdoors, and numerous other activities.

I narrowed my list down to fields that seemed fun but also had a great lifestyle.

My list:
Emergency Medicine
Dermatology
Radiology
Psychiatry
Anesthesiology
PM&R

I had otherwise considered things like gastroenterology, pediatrics, sports medicine, cardiology, and other specialties that were more demanding. They were all fun in doses, but the work appeared to wear down those residents. They never appeared as happy.

From my list of 6 specialties, all were fun, and had a good lifestyle. Finally I had a place to start. One by one, I found reasons to shorten my list. Radiology required a boring dark room. I discovered my inability to distinguish rashes. And so on.

Psychiatry turned out to be the last specialty left. Two years into residency, and I have grown to absolutely love my field. I'm not saying psychiatry is the answer for everyone. I think I could have easily chosen PM&R or anesthesia and loved it too. I find so many aspects of medicine fascinating.

I tell you my story, because I've come to learn that many of my past classmates were like me. They reached the status of MS4, and they still had too many specialties to choose from.

Instead of considering lifestyle (or other important things), many just picked whichever specialty was currently their favorite out of 5 or so possibilities. Others picked Internal Medicine or Pediatrics because those fields are general. That way you can choose your specialty/fellowship later.

Now only a couple years into residency, I am already seeing unhappy burned-out old classmates. Not just a couple either. I'm talking about a sizeable bunch of old classmates. All are currently in non-lifestyle fields. Some have already switched fields, and others are desperately trying to get out. It pains me to see so many unhappy friends.

If you are one of the lucky few medical students that is 100% sure about a rigorous field, do NOT reconsider it based on this story. You are most likely making an excellent choice. One of my best friends is die-hard ortho surgery, and after 80 hours in a week, he still can't get enough. He is very happy!

If you find yourself enjoying too many aspects of medicine, forget about your specialty flavor of the month. Sit down and honestly think about what you want your life outside of medicine to look like. Think about where you want to live, how much you want to work, how many kids you want to have, etc. Then evaluate which fields will allow you to also accomplish those other life goals.

Even if you are 90% sure that pediatrics is for you, sit for a minute and wonder if another field might better fit your lifestyle goals. 48 weeks of 85 hours/week of pediatrics is a lot of pediatrics in a year. Will you still enjoy what you do? If not, there is no shame at considering PM&R or dermatology or any other lifestyle field.

You may only learn that you love pediatrics more than you expected. You may realize that the pediatric field is too stressful for you.

I ended up choosing psychiatry, when I could have done many other things. It turned out to best fit my lifestyle wants, and I find it to be incredibly interesting as well. I find myself happy in other aspects of life, and it carries over into patient care. I study more not because I must but because I really enjoy it. Now I can't believe I considered anything else.

You are already on your way to becoming a physician. No matter which field you choose, you will help thousands of people. Before you apply, just be sure to consider YOUR needs as well. You have earned the right.

I wish you well!

Good post.

I feel like you, that I have lots of interests and it's hard to narrow it down.

It's sad that we have to worry about burnout/stressing out in so many fields in medicine. Why would it be a bad thing to cap work hours at 70 or so hours a week? Are we lazy people if we don't want to work 24-36 hours at a time or 90/100+ hour weeks? How many careers throughout time have required such demands?

I find it funny that you can be considered a slacker in medicine if you would like to only work ~60 or so hours a week. The europeons have a better training system (better = more humane).

 

[Jack is Back]

It's almost like you have to chose b/t career or family to train as a physician in America.

 

[theseeker4]

Good post.

I feel like you, that I have lots of interests and it's hard to narrow it down.

It's sad that we have to worry about burnout/stressing out in so many fields in medicine. Why would it be a bad thing to cap work hours at 70 or so hours a week? Are we lazy people if we don't want to work 24-36 hours at a time or 90/100+ hour weeks? How many careers throughout time have required such demands?

I find it funny that you can be considered a slacker in medicine if you would like to only work ~60 or so hours a week. The europeons have a better training system (better = more humane).

Very true, but if they cut the hours back that much, additional doctors would be needed to fill in the hours that are no longer covered. Add to that the fact that, whether paid by the hour or by the procedure, the more hours worked the higher the salary. Obviously, most doctors are willing to work long, long hours to get good pay. Cut back on the time worked, and by necessity the amount of money earned would go down. It is always a trade off, cut back the hours and the money goes down.

Obviously the above applies to attending physicians. I would strongly support a lower cap on hours for residency training.

 

[PMPMD]

Very true, but if they cut the hours back that much, additional doctors would be needed to fill in the hours that are no longer covered. Add to that the fact that, whether paid by the hour or by the procedure, the more hours worked the higher the salary. Obviously, most doctors are willing to work long, long hours to get good pay. Cut back on the time worked, and by necessity the amount of money earned would go down. It is always a trade off, cut back the hours and the money goes down.

Obviously the above applies to attending physicians. I would strongly support a lower cap on hours for residency training.

Unfortunately, if resident hours get cut even more, at some point there will need to be an increase in residents per year, or years of training. More residents per year could produce a glut of practicioners and would hurt the already tight GME funding. Longer years of training would dissuade some from entering certain fields.

 

[tiedyeddog]

Awesome insights from someone who has been through it, thanks TP.

 

[PistolPete]

Very nice post, thank you!

 

[MajinVegeta]

your interest

 

[TexasPhysician]

It's almost like you have to chose b/t career or family to train as a physician in America.

A few friends of mine have been attempting to have children. I don't think any of them are trying hard (medical help, etc.), but they have stopped birth control months ago. We call it job-induced infertility. When you work long hours and are really tired, there isn't much ...... you know.

 

[LoveandHate]

Steps:

1) Determine what aspects of your life and work are important to you
2) Determine which fields maximize these aspects and make a list
3) Take Step 1
4) Determine which fields are still viable options
5) Match

 

[D elegans]

Steps:

1) Determine what aspects of your life and work are important to you
2) Determine which fields maximize these aspects and make a list
3) Take Step 1
4) Determine which fields are still viable options
5) Match

Huh?

 

[OneTyme]

A few friends of mine have been attempting to have children. I don't think any of them are trying hard (medical help, etc.), but they have stopped birth control months ago. We call it job-induced infertility. When you work long hours and are really tired, there isn't much ...... you know.

Ummm, I'm not sure what you're referring to. Can you be more specific please?

 

[SlickNickMD]

I think I've narrowed down to Ortho, Urology and Interventional rads-I'll be happy doing any of these as a career Highly specialized, technology driven, lots of cool procedures, never a boring day at work

 

[MossPoh]

I think I've narrowed down to Ortho, Urology and Interventional rads-I'll be happy doing any of these as a career Highly specialized, technology driven, lots of cool procedures, never a boring day at work

Really, NEVER? I don't know. I am interested in all 3 of those fields, but there have still been boring days with them. 😉

 

[SlickNickMD]

Really, NEVER? I don't know. I am interested in all 3 of those fields, but there have still been boring days with them. 😉

Correction slightly less boring than other specialties in my personal opinion

I just sat through an Interventional Radiology grand round, I had no idea what was going on but it was 😍

 

[paintballdoc]

If you have the grades, go for Derm. You will not regret it if you definitely like the field. The other fields are great, but there are many changes occurring in medicine. It is difficult to know what the face will be in 10-20years.

The way I see it, derm is fairly well-protected. There are multiple skin cancers that most PCPs and PA/APRNs will not touch (usually on the face). The other specialties have serious encroachment-->Rads has teleradiology and from what I can tell, it is becoming harder to find a job. Anesthesia obviously has CRNAs. You get the idea.

Also, derm (and obviously Plastics) are the only 2 real specialties that allow for self-pay cosmetics (if you can deal with that kind of patient). Plus, as a derm, you are not dependent on a hospital. This may be a big PLUS or NEGATIVE but to soon to tell with the ACOs and PPACA.

In the end, you still have to do something that you enjoy. You may also not want to exclude Allergy. Procedures are not too expensive so may be able to go cash.

Good luck.

 

[MossPoh]

If you have the grades, go for Derm. You will not regret it if you definitely like the field. The other fields are great, but there are many changes occurring in medicine. It is difficult to know what the face will be in 10-20years.

The way I see it, derm is fairly well-protected. There are multiple skin cancers that most PCPs and PA/APRNs will not touch (usually on the face). The other specialties have serious encroachment-->Rads has teleradiology and from what I can tell, it is becoming harder to find a job. Anesthesia obviously has CRNAs. You get the idea.

Also, derm (and obviously Plastics) are the only 2 real specialties that allow for self-pay cosmetics (if you can deal with that kind of patient). Plus, as a derm, you are not dependent on a hospital. This may be a big PLUS or NEGATIVE but to soon to tell with the ACOs and PPACA.

In the end, you still have to do something that you enjoy. You may also not want to exclude Allergy. Procedures are not too expensive so may be able to go cash.

Good luck.

Telerads isn't really a threat. I have no idea where the idea comes from that all these other countries that can't even meet their own healthcare demands are all going to be able to generate enough radiologists to reliably and accurately read all of the studies done in the US. Many of the groups pay out of their own pocket to have these services so they can get sleep and then reread in the morning. Jobs in high demand areas are tough to find. That isn't unique to radiology either. I know of multiple jobs with good groups that are unfilled right now because they aren't in the nice city type place.

By the same token, why couldn't the vast majority of derm being "teladerm" or allergy have "telallergy"?...you can do that with just about every field. Hell, with the introduction of the robots you could throw in some connectivity and have the person overseas doing a ton of the procedures as well. A couple of techs, some cameras and an internet connection is all you need.

 

[officedepot]

Correction slightly less boring than other specialties in my personal opinion

I just sat through an Interventional Radiology grand round, I had no idea what was going on but it was 😍

Well unfortunately grand rounds makes it look awesome but in reality a lot of the work is vascular access and angios. That's a majority but not all and it has good potential as well, assuming they don't give their procedures to other fields.

The other two fields you mentioned earlier I'm sure are the same way. Ortho is cool during residency but when you get out in the real world you will be in a group and primarly do just a few procedures. Not sure about urology.

Point beung that every field becomes mundane after a while. Plus slicknickmd aren't you premend? How do you know what you want to do already?

 

[SlickNickMD]

Well unfortunately grand rounds makes it look awesome but in reality a lot of the work is vascular access and angios. That's a majority but not all and it has good potential as well, assuming they don't give their procedures to other fields.

The other two fields you mentioned earlier I'm sure are the same way. Ortho is cool during residency but when you get out in the real world you will be in a group and primarly do just a few procedures. Not sure about urology.

Point beung that every field becomes mundane after a while. Plus slicknickmd aren't you premend? How do you know what you want to do already?

lolol nah chief I'm an MS3 I haven't updated my SDN account since I joined years ago

And I hear you every specialty has its so-called bread and butter cases but the potential for a wide variety of procedures if significantly higher in some specialties

 

[officedepot]

lolol nah chief I'm an MS3 I haven't updated my SDN account since I joined years ago

And I hear you every specialty has its so-called bread and butter cases but the potential for a wide variety of procedures if significantly higher in some specialties

haha ok. I personally like IR the best because think the stuff they do is cool and dislike the OR so much. Agree they have potential but I worry about turf wars still. You just never know I guess. Don't want to be delegated to pure vascular access.

However ortho does some cool stuff like lengthening limbs for congenital issues for example. I'm sure there's a lot more besides your typical joint replacement...


on topic: I think choosing a specialty is really hard. I still have trouble being 100% with one particular thing because I like aspects about other specialties as well. It's easy to say surgery vs no surgery. But once you decide that it can become more difficult. There's always like three things you kinda like and you have to weigh the pros and cons of each and just decide. And be aware at about 20-25% of residents (I think) will change fields. So if you choose wrong it's not the end but you will have spent a year doing something you don't really like unfortunately.

 

[smq123]

Correction slightly less boring than other specialties in my personal opinion

There are always boring days at work. And, TRUST ME, you will welcome those boring days. You might not think so now, but you will.

If every day were exciting, full of new and difficult obstacles that you had to think hard to overcome, you'd be exhausted and burned out in less than 5 years. Think about it - that's why the first half of intern year is so hard...EVERYTHING is new. At some point, you start to welcome a bit of routine.

However ortho does some cool stuff like lengthening limbs for congenital issues for example. I'm sure there's a lot more besides your typical joint replacement...

Not so much in private practice (which is what most people end up doing). And, frankly, if you're doing such specialized surgery like limb length correction, that really should be the bulk of what you do.

 

[PCOMSurgery]

Throughout my first three years of medical school, I seriously considered at least 7 different medical specialties. At first I was sure that I would apply Emergency Medicine. Then I switched to Dermatology. During my clinical rotations as an MS3, I enjoyed almost everything (except surgery).

There were some moments where I became envious of friends of mine that had everything planned out from the beginning. A friend of mine was 100% neurosurgery from day 1. Now he is a neurosurgery resident, and he loves it. He admits that he could do neurosurgery 120 hours/week for the rest of his life and still love neurosurgery. I know numerous people like this. They try a medical specialty, and they absolutely fall in love from day 1.

Then there is me. I wasn't in love with any field, but I enjoyed at least a dozen. Stuck between too many choices, I began narrowing down fields by what I wanted in life. I love medicine, but I also love family, friends, the outdoors, and numerous other activities.

I narrowed my list down to fields that seemed fun but also had a great lifestyle.

My list:
Emergency Medicine
Dermatology
Radiology
Psychiatry
Anesthesiology
PM&R

I had otherwise considered things like gastroenterology, pediatrics, sports medicine, cardiology, and other specialties that were more demanding. They were all fun in doses, but the work appeared to wear down those residents. They never appeared as happy.

From my list of 6 specialties, all were fun, and had a good lifestyle. Finally I had a place to start. One by one, I found reasons to shorten my list. Radiology required a boring dark room. I discovered my inability to distinguish rashes. And so on.

Psychiatry turned out to be the last specialty left. Two years into residency, and I have grown to absolutely love my field. I'm not saying psychiatry is the answer for everyone. I think I could have easily chosen PM&R or anesthesia and loved it too. I find so many aspects of medicine fascinating.

I tell you my story, because I've come to learn that many of my past classmates were like me. They reached the status of MS4, and they still had too many specialties to choose from.

Instead of considering lifestyle (or other important things), many just picked whichever specialty was currently their favorite out of 5 or so possibilities. Others picked Internal Medicine or Pediatrics because those fields are general. That way you can choose your specialty/fellowship later.

Now only a couple years into residency, I am already seeing unhappy burned-out old classmates. Not just a couple either. I'm talking about a sizeable bunch of old classmates. All are currently in non-lifestyle fields. Some have already switched fields, and others are desperately trying to get out. It pains me to see so many unhappy friends.

If you are one of the lucky few medical students that is 100% sure about a rigorous field, do NOT reconsider it based on this story. You are most likely making an excellent choice. One of my best friends is die-hard ortho surgery, and after 80 hours in a week, he still can't get enough. He is very happy!

If you find yourself enjoying too many aspects of medicine, forget about your specialty flavor of the month. Sit down and honestly think about what you want your life outside of medicine to look like. Think about where you want to live, how much you want to work, how many kids you want to have, etc. Then evaluate which fields will allow you to also accomplish those other life goals.

Even if you are 90% sure that pediatrics is for you, sit for a minute and wonder if another field might better fit your lifestyle goals. 48 weeks of 85 hours/week of pediatrics is a lot of pediatrics in a year. Will you still enjoy what you do? If not, there is no shame at considering PM&R or dermatology or any other lifestyle field.

You may only learn that you love pediatrics more than you expected. You may realize that the pediatric field is too stressful for you.

I ended up choosing psychiatry, when I could have done many other things. It turned out to best fit my lifestyle wants, and I find it to be incredibly interesting as well. I find myself happy in other aspects of life, and it carries over into patient care. I study more not because I must but because I really enjoy it. Now I can't believe I considered anything else.

You are already on your way to becoming a physician. No matter which field you choose, you will help thousands of people. Before you apply, just be sure to consider YOUR needs as well. You have earned the right.

I wish you well!

Great post.

Well said.

 

[JackShephard MD]

If you have the grades, go for Derm. You will not regret it if you definitely like the field. The other fields are great, but there are many changes occurring in medicine. It is difficult to know what the face will be in 10-20years.

The way I see it, derm is fairly well-protected. There are multiple skin cancers that most PCPs and PA/APRNs will not touch (usually on the face). The other specialties have serious encroachment-->Rads has teleradiology and from what I can tell, it is becoming harder to find a job. Anesthesia obviously has CRNAs. You get the idea.

Also, derm (and obviously Plastics) are the only 2 real specialties that allow for self-pay cosmetics (if you can deal with that kind of patient). Plus, as a derm, you are not dependent on a hospital. This may be a big PLUS or NEGATIVE but to soon to tell with the ACOs and PPACA.

In the end, you still have to do something that you enjoy. You may also not want to exclude Allergy. Procedures are not too expensive so may be able to go cash.

Good luck.

This sounds like advice for chosing a specialty with finances/business as your primary concern.

 

[ALFI]

if i was in medicine for the money i'd choose psych/derm/plastics/IR any of those

if i had the brains for it i'd go on and become an Epileptomologist but i thrive off human contact and action and i also have no life so EM it is....

if i could drive i would be a paramedic

 

[PrideNeverDie]

thanks for your post OP

psych is my #1 choice atm

 

[2012mdc]

Well unfortunately grand rounds makes it look awesome but in reality a lot of the work is vascular access and angios. That's a majority but not all and it has good potential as well, assuming they don't give their procedures to other fields.

The other two fields you mentioned earlier I'm sure are the same way. Ortho is cool during residency but when you get out in the real world you will be in a group and primarly do just a few procedures. Not sure about urology.

Point beung that every field becomes mundane after a while. Plus slicknickmd aren't you premend? How do you know what you want to do already?

I haven't had the private practice exposure in IR but the two academic places I rotated had a variety of higher end procedures - TACE, Y90, RFA, cryos, vertebroplasty, PTBD, TIPS, IVC filters, declots are some of things that come to mind.

Obviously much of this stuff can become mundane after a while but there was a lot of variety. I imagine in the private practice setting there is less though.