The Complete Guide to Choosing A Specialty

This article is going to be a conglomerate of other things I’ve written, which are in somewhat disjointed places; I’ve linked to the original articles below, where relevant. My goal is to collect these thoughts into a usable working guide for the average medical student. The ideal audience for this guide is a medical student with some freedom over which specialty he or she will choose, though I hope pre-medical students find it useful as well, and indeed probably anyone who is thinking about pursuing a career as a physician.

In regards to freedom over which specialty to choose, allow me to offer a disclaimer: I would say that many people will try to put medical students into a box that rules in or rules out certain specialties too aggressively. Looking at patterns, average scores, average profiles of matched students in a specialty, it’s possible to comment generally on a student’s chances to pursue the specialty he or she most wants to. However, each case is unique, and there are enough factors in the process to make it hard to definitively exclude any given student from any given specialty. That said, take seriously any advice from advisers, mentors, and other students who want to steer you away from trouble and have your best interests at heart. At the same time, don’t let anyone hamper your dreams, within reason. Keep an open mind, and don’t be afraid to consider all options before truly beginning the process of choosing a specialty.

What Kind of Doctor Do You Want to Be?

Any high school student who states his/her intention to become a physician knows this question, which people begin to ask almost immediately: The most common question in medical education, as I’ve written about before, is, “what kind of doctor do you want to be?” And so I want to answer that question first, because the answer is very important and, I would posit, has very little to do with specialty choice. On the surface the question asks if you’ve chosen which specialty you want to work in, but it gets at something much deeper, something that any medical student can begin to answer even when he or she has no clue of specialty. I always used to answer this question: “a good one.” People would laugh, but the point is true. One can work to become a good doctor regardless of specialty, and although certain skills are specialty-specific, most of what makes a good doctor is what makes a good person. Those traits can be developed and applied to virtually any field: curiosity and inquisitiveness, willingness to work hard and keep learning, kindness, gentleness, and empathy; efficiency and competence; humility and professionalism. That’s the kind of doctor you want to be, regardless of specialty.

But for choosing a specialty, let’s look more closely at some factors to consider. I’ll divide this into pre-clinical and clinical opportunities. I strongly recommend against making any definitive statements about choice of specialty before your clinical rotations in medical school. This is tricky for some, who are committed to a specialty for specific reasons (e.g., their end goal is to go into practice with family members), and also for those who chose medicine with a specific end goal in mind (e.g., I want to be a cardiologist, not just a doctor). But it isn’t really until you’ve spent 4-6 weeks doing something for 60 hours a week that you can really know it is or isn’t for you. Even if you have had extensive exposure to a specialty before medical school (e.g., your parent is an ob/gyn, you previously worked as an emergency room nurse, etc.), you’ve likely changed since then and may have new perspectives after completing pre-clinical work. Even after your rotation, you may still find you need more time to decide; more on that later.

Pre-Clinical Students

For the students just starting out, or if you have been progressing through school but don’t have any idea yet and would like to return to square one, here are some early things to consider and some resources you may find helpful. I find that choosing any career, job, opportunity, specific position, or activity can only be done wisely and intelligently if you know yourself. It is important to think about what drives you, your core values, and the traits and skills that make you who you are before you can begin thinking about how to apply those to a specialty choice. Given this, I first suggest completing some self-assessment tools, formal and informal, to gauge who you are and what you value. These include but are not limited to: Myers-Briggs, Gallup’s StrengthsFinder (now called CliftonStrengths), Enneagram, and Authentic Happiness. You may also find it helpful to sit down with friends and family who know you well, or even talking to a therapist or counselor if further self-exploration is desired.

From here, it makes sense to utilize the same types of tests to begin thinking about your values and skills as they relate to specialty choice. The best resource for this that I am aware of is through the AAMC, Careers in Medicine. I would recommend looking into this early—first-year of medical school, though if you didn’t do it then and you are past that, you should do it now. This comprehensive website will allow you to take various quizzes and inventories, track the assessments you complete, and eventually sort through the results. These assessments are valuable because they ask many questions, and then match you with respondents from specialties who most matched your own. (You can also browse more than 120 specialties, with detailed information about each, elsewhere on the same site.) Student Doctor Network also has a specialty selector tool, along with in-depth information about all available specialties. This tool and this information are based on this book; you can read my review of the book here. (There are other such books out there, but I haven’t read them and can’t comment on their utility or accuracy.)

The final component of pre-clinical approach to choosing a specialty is to get clinical experience. Any choice, such as specialty, is highly dependent on your exposure and understanding of a field, or else it will be biased only on limited exposure. Therefore, you can increase the accuracy of your choice by seeking exposure early and often to as many fields as you can. Through this—shadowing, or other exposure—you will undoubtedly cross paths with physicians who will offer you their thoughts and opinions on the specialty. Take these seriously; they will come into play later, during your official clinical rotations. Based on all the above, the average student will complete their pre-clinical education with a working idea of specialties they are very interested in, some they are moderately or marginally interested in, and maybe some they have no interest in, though at this point no specialty should be completely excluded (with some exceptions).

Clinical Rotations

Every clinical rotation will have pros and cons, but in general these will be your best chance to figure out if a specialty is for you. Although this can be biased by numerous factors (who you work with, where you work, hours, feedback and evaluations, etc) there are some general strategies that can maximize the value of each clerkship. (Note: clerkships have plenty of functions besides choosing a specialty, but that’s not where this article is focusing.)

Make sure you attempt to look at all aspects of the field. Your clerkship is the best chance to really see what its like to do it. ask everyone you meet – residents of all levels, attendings, etc. Gather as many opinions as you can about the field. You’ll find common threads and perhaps unique perspectives that can build you towards your own understanding of a field. Further, you can also gain a more accurate understanding of what a specialty is like if you take the rotation seriously, immersing yourself in it. If you can manage to do this with each rotation, spending your four to eight weeks really functioning as if it were your specialty, you will more confidently be able to say if a specialty is possible for you.

Some miscellaneous aspects of various specialties can be considered at this point. Primary considerations are likely to be academic interest (pathology, common diseases, possible research interests) and practical interest (day-to-day tasks and lifestyle). Secondary considerations may include, but are not limited to: Do you prefer to do procedures, or not? Put another way, are you more of a “thinker” or a “doer”? Do you want a job where you are mostly sitting, mostly standing, or mostly moving from one thing to another? Do you prefer to have general knowledge of many things or to be an expert on one or two things? Also, consider the aspects of medicine that you like or don’t like which are not tied to a certain specialty, i.e. choosing between inpatient and outpatient, choosing between primarily urban or rural settings, and choosing between academic or community-based practices. (For further reading on factors to consider, you can read this article.)

As you go through each rotation, following the advice above, you can begin documenting your thoughts and feelings about each specialty. It may be helpful every few weeks to revisit this list, making adjustments as your experiences changes. Talking to other medical students, residents and attendings you trust, as well as family and friends outside of medicine can further clarify your thinking. As you approach the end of your third year, there are two important steps you can take to narrow down, and eventually finalize, your decision: first, most importantly, take a second look at the specialties you have most seriously considered. This can be in the form of early fourth year sub-internships, away rotations, self-structured electives, or shadowing. It is important to further investigate aspects of the specialty you may not have seen the first time around (inpatient vs outpatient, different attendings, academic vs community, etc.) More about this can be found here.

Second, begin building your application for residency. Even though the application is not due until the fall of your 4th year (or the calendar year before you will begin residency) you can begin looking at what you will need many months before. As you begin to plot out the different aspects—updating your CV/resume with relevant activities, summarizing your various research projects, and drafting a personal statement, certain themes and patterns may begin to emerge. The personal statement can be particularly valuable for this; by articulating your interests and passions and career goals, the right specialty may become clear. Finally, as you think about who you may ask to write you a letter of recommendation, you may be reminded of which physicians have most inspired you, and you may consider whether that relationship was due to personal characteristics or is specialty-dependent.

Finalizing Your Decision

This article discusses my thoughts on how interviews can further refine your decision. Lest you fear that you will never decide, or that you are making the wrong decision, consider how you might eventually change your mind. Ultimately, just as your understanding of medicine and being a physician has changed and will change throughout your career—an inevitable part of experiencing more and learning more—your understanding of your specialty will too. Just as with your decision to become a doctor, your decision to specifically become an endocrinologist, intensivist, adolescent psychiatrist, or whatever you decide will be something you grow into. And if you decide later to change your mind, there are avenues for that as well. Medicine is a wonderfully broad field full of opportunities, so choosing a specialty doesn’t have to be something you do once and are fixed into, but something that you can reevaluate and continue to do as you develop in your career.

Conclusion

Answering the question, “what specialty are you going into?” is hard for medical students to answer other people, but realistically you only need to be able to answer it for yourself. There are so many complex reasons that any of us do anything, let alone something as big as a career choice. When you try to explain it to others, it might come out sounding oversimplified or cliche. Just remember that it’s probably not fair to categorize any specialty by a single characteristic, and that there is so much variety in how physicians practice. The nuances that will shape your own career are not something to shy away from, but to embrace as a unique opportunity for you to become the best doctor you can be.

(For my personal overviews of particular specialties, you can check out Ob/Gyn, Pediatrics, General Surgery, Psychiatry, Family Medicine, Internal Medicine, Emergency Medicine, and others. For my end of medical school reflections on becoming a doctor, including further discussion of the idea that the kind of doctor you are is less about your specialty, check out this piece. Thanks for reading, and good luck!)