Choosing the right medical specialty when you’re conflicted

Finding the right medical specialty often requires both exposure and soul-searching. During medical school, most students change their preferred specialty choice.

Roughly one-quarter of respondents to a recent survey of more than 11,000 graduating med students reported the same specialty preference as they did on their matriculating student survey.

Eleven percent of students entering DO schools were undecided about their desired medical specialty, according to a recent survey.

Many first-year students like Nicholas Tito, OMS I at William Carey University College of Osteopathic Medicine, have already begun the process of specialty exploration. Doing this before you start your clinical rotations can help you better determine the best path to take to successfully Match. Here are four tips on identifying the right specialty for you.

1. Eliminate specialty options early

Begin specialty exploration early in medical school through shadowing and informational interviews, suggests Melva Landrum, assistant director of career development at the University of North Texas Health Science Center/Texas College of Osteopathic Medicine.

Doing this can help you eliminate specialties that aren’t right for you early on.

“The best service you can do for yourself is to try to take every opportunity, even if you know you’re not interested,” says Tito.

The pressure to decide on a specialty as soon as possible is rooted in taking steps now to be a competitive applicant for residency, he says.

Dr. Landrum agrees.

“Every specialty will have things you need to do to properly prepare,” says Landrum.

For example, emergency medicine residency applicants are encouraged to provide SLOEs, or standard letters of evaluation, to be competitive. A SLOE is similar to a traditional letter of recommendation but specific to emergency medicine.

Students ideally should make a firm decision on a specialty by no later than the middle of their third year, Landrum says.

2. Understand that grades don’t paint the whole picture

Some students with exceptional grades and intentions to go into a primary care residency will receive feedback to try matching into a more competitive specialty.

“One of the biggest mistakes students make when choosing a specialty is choosing based on their grades as opposed to what they’re passionate about,” Landrum says.

Grades and test scores are important factors when it comes to getting interview requests from residency programs, but program directors are looking for well-rounded applicants, Landrum says.

“Success in the match is determined by more than just scores and grades,” she says. Even if a student’s grades are slightly below the suggested average for their desired specialty, they can still take steps to be a competitive applicant, such as getting involved in research and activities that the particular specialty values.

3. Don’t put the decision off

If you’re unsure of a specialty, advisors don’t recommend completing a traditional rotating internship to buy more time.

After starting an internship in July, registration for the next year’s Match occurs just three months later in September.

“You’re going to have to apply for residency a couple months later, so there’s not a whole lot that can change,” Landrum says.

Students considering this option should ask themselves what will change in the next year and how they plan on developing a specialty focus, suggests Elizabeth McClain, PhD, an associate dean at WCUCOM.

Physicians who have already graduated from medical school have a harder time matching. About 44 percent of MD school graduates matched into a first-year residency position versus 94 percent of MD seniors, according to 2018 Match data.

“When you reapply for residency, your chances of matching decrease drastically,” Landrum says. “The residency process is so competitive, unfortunately, programs are going to assume you’re reapplying for residency again for a negative reason.”

4. Self-reflect on what you truly enjoy

When considering a specialty, keep an open mind and be flexible.

Marc Price, DO, president of the New York State Academy of Family Physicians, intended to become a surgeon. He loved working with his hands and the procedural side of medicine. During his intern year, he realized he enjoyed patient interactions and long-term care more.

“Many medical students and doctors are very goal-oriented. We get one goal in our mind and that’s where we head, come hell or high water. Sometimes it’s worth taking a step back and asking, ‘Is this the path we want to take?’” Dr. Price says.

At the end of his intern year, Dr. Price was offered a surgery residency contract at the institution where he was training. He turned it down and went into a family medicine program instead.

“Don’t get pigeonholed into one way of thinking. You have to realize what makes you happy,” Dr. Price says.

Dr. McClain of WCUCOM also advises choosing a specialty for the right reason.

“Make sure you are a competitive candidate first, then make sure you are excited, intrigued and dedicated to your specialty,” Dr. McClain says. “Your excitement will fuel your success, and you and your patients will benefit.”

Further reading:
Quiz: What’s the ideal medical specialty for your personality?

5 medical specialties you didn’t know existed

How I practice: Rheumatologist finds a calling and a highly rewarding specialty