Twelve Steps for Choosing a Specialty

Anne Vinsel, MS, MFA


September 02, 2009


I need to declare a medical specialty before long, but I have so many conflicting feelings and thoughts about various clinical areas. How can I make the right choice?

Response from Anne Vinsel, MS, MFA
Project Administrator, Graduate Medical Education, University of Utah Medical Center, Salt Lake City, Utah

It's time for fourth year students to get serious about choosing their specialty area. Some of you are lucky, and everything lines up: you know which clinical area interests you most, your board scores and grades/letters are all in the correct range, and you have helpful professors on your side. For you, it's just a matter of doing the paperwork on time. You can stop reading here.

But I know there are many others of you out there who aren't sure what specialty to choose. Or, you're torn between 2 or 3 specialties. Or you know what you don't want but aren't sure what you do want. Or you know what you want, but aren't sure if your qualifications are strong enough. Read on!

If you're stuck, here's a decision tree to follow:

  1. Find or make a list of all the specialties available directly after medical school (ie, skip fellowships).

  2. Cross off the ones you definitely don't want. You don't need a string of reasons beyond the fact that you simply can't see yourself doing it long term.

  3. Perform a Google™ search with the phrase "choosing a medical specialty." When I tried it, I got about 89,800,000 entries. Set a timer for no more than 1 hour and browse through the first several pages. Take some of the "what specialty are you?" quizzes. If nothing else, they will give you some ideas and possibly make you think about specialties you haven't explored. You can safely avoid making an exact ranking of specialties at this point. Just see which specialties you seem to be most suited to and which you should rule out.

  4. Now, list several specialties you can see yourself doing long term, no more than 6.

  5. Research those specialties in your institution. Go to the departments and make friends with the residency program coordinators. If you haven't already done so and haven't rotated in the program, arrange to shadow a faculty member for a day. Talk with 1 or 2 residents and check out the pros and cons of the specialty. Finally, ask the program coordinator if your board scores would be in a competitive range. Most program coordinators won't share their board score cut - off, but they likely would tell you if your scores are within range.

  6. Narrow your list to 2 or 3 specialties. Now, and only now, talk with family and friends. Tell them you're thinking of these specialties, and get their opinions. Listen hard, and get them to articulate the basis for their opinions.

  7. Delete any reasons related to job shortages or oversupply of physicians in a specialty. You don't need 200 jobs, you only need 1, and you should be prepared to relocate somewhere less attractive if you choose a specialty that's overcrowded or not in much demand. Plus, demand can change by the time you finish training.

  8. Delete any reasons related to lifestyle or money, unless those concerns come from your significant other.

  9. Delete heritage reasons ("Your father is a surgeon; you should be one, too").

  10. Now, write down your own pros and cons, independent of all the advice and aptitude testing and board scores. Be honest here. If your priorities are lifestyle, having children during residency, income, opportunities for foreign travel, or avoiding rough circumstances, then rank them appropriately. What fascinates you, what could you be passionate about? Don't be at all logical here.

  11. But do be logical in this next step. And brutally honest with yourself: Did you barely pass the boards? Internal medicine might not be for you, even if you really enjoy outpatient medicine. Do you tend to avoid or dislike patient contact? Don't consider family medicine or pediatrics. Do you have high board scores, want a benign lifestyle, but aren't very visual? Don't pick radiology.

  12. If you follow all these steps, combining thoughtful reflection on what makes you happy with an objective look at your strengths and weaknesses, one option should start singing out louder than the others. And that's your specialty.

Note that you should take other people's views of your strengths and weaknesses into account, but not necessarily follow their advice. Spouses are a special case because you are making a joint life together. Still, the final decision should be yours, informed by some actual data that help you determine "the best fit" between you and your specialty-to-be.

You can do this in a week; don't procrastinate and don't make the problem bigger than it is. If you choose a specialty that turns out to be a bad fit, you can still change after the first year.

Be practical, but don't limit yourself. I know a physician who started medical school at age 38, one who had to take the boards several times, one who barely passed one of her steps by 1 point, and another who doesn't like patient care. The first one is now practicing radiology in a large private clinic, the second is a fellow in a high-risk obstetric anesthesia program at a very prestigious academic medical center after switching from surgery because of physical limitations, the third is a fellow in a neonatal intensive care unit after completing a successful pediatrics residency, and the last is working for a large drug company doing information technology, his real love.

Even if you are "nonstandard," you can find a specialty you will love and which will value you. Good luck!