How to choose a medical specialty

Many physicians “just know” when they’ve found the medical specialty that suits them.

Reflect on the question “Can I imagine doing this every day for the rest of my career?” says Jozia McGowan, DO, an integrated learning director at Kansas City University of Medicine and Biosciences College of Osteopathic Medicine.

There are many factors to consider when choosing a medical specialty, including income potential, lifestyle, geography and patient population. To make the best choice for yourself, do an honest self-assessment so you truly understand your career and life goals.

Your specialty choice will determine the path your career takes and shouldn’t be a rushed decision.

Surgery vs. medicine

One of the first decisions students should start with is medicine vs. surgery. There are some specialties that have exposure to both, but this step can still help eliminate options early on.

While students are exposed to some specialties in their core rotations, Derek Meeks, DO, vice dean of Touro University Nevada College of Osteopathic Medicine, suggests students use their elective rotations to explore other possible specialty options.

“Ask physician mentors if there are specialties that you might not have thought about on your own that aren’t core rotations so you can be exposed to different fields,” Dr. McGowan says.

It’s also important to think about how much patient interaction you’re interested in. Specialties such as family medicine, pediatrics and ophthalmology often have a continuation of care element to them, which some specialties, such as emergency medicine and surgery, often lack.

Life outside of medicine

Choosing a specialty doesn’t just set you up for a career in medicine, it also impacts your life outside of medicine.  Consider whether a specialty fits the lifestyle you imagine for yourself in the future.

If you go into a surgical specialty, expect to start at the hospital early in the morning and possibly stay late at night. Emergency medicine physicians do work nights, holidays and weekends, but there tend to be fewer shifts. Physicians in certain specialties, such as psychiatry and dermatology, can often keep hours that are closer to 9 a.m.-5 p.m.

Dr. Meeks loved his ob-gyn rotation in medical school. He enjoyed surgery and delivering new life into the world, but the hours of an ob-gyn didn’t quite fit with the lifestyle he wanted.

“I spoke to my family and wife, and being on call as an ob-gyn just wasn’t for us,” Dr. Meeks says.

As an adrenaline junkie, he found a second passion in emergency medicine, which was more conducive to the life he wanted during his off hours.

Know what the field truly entails.

While a specialty might look like the right fit from afar, find out what the specialty is truly about before making a decision.

It is possible to switch specialties, but it can be financially challenging and time-consuming to go back into residency.

“I’ve seen so many people go into emergency medicine, become disenchanted and then leave the profession,” Dr. Meeks says.

To ensure you’re making the right specialty choice, spend time shadowing and talking to physicians in that specialty.

“Doing your research, not just passively online, but from speaking with physician mentors can help,” Dr. McGowan says.

While rotations can help students get a feel of a specialty, not all rotations are created equal, Dr. McGowan says.

“You might need to give a specialty another chance at a different location if you think you didn’t get a good feel for it during the rotation,” Dr. McGowan says.

Joining specialty interest groups can be another way students can find out more about different specialties.

Is your specialty a good fit academically?

The competition to match into residency is steep, especially for surgical specialties, dermatology and radiology. Your grades and board scores may impact your specialty choice.

While a student might want to match into an extremely competitive specialty such as orthopedics, to be a realistic applicant it’s typically necessary for their grades and board scores to fall in line.

“If your board scores aren’t above a certain threshold, your application won’t be considered by some program directors in these highly competitive fields,” Dr. Meeks says.

If your scores aren’t in the typical range for your desired specialty, but you still want to apply, Dr. Meeks suggests having a backup specialty.

Related reading:

Choosing the right medical specialty when you’re conflicted

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