For Love or Money: How Do Doctors Choose Their Specialty?

Jennifer Nelson

July 17, 2023

Medical student loans top hundreds of thousands of dollars, so it’s understandable that physicians may want to select a specialty that pays well.

But overwhelmingly, the physicians Medscape spoke to said they chose a specialty they were passionate about rather than focusing on going where more money was. Moreover, most advised young doctors to follow their hearts rather than their wallets.

"There is no question that many young kids immediately think about money when deciding to pursue medicine, but the thought of a big paycheck will never sustain someone long enough to get them here," says Sergio Alvarez, MD, a board-certified plastic surgeon based in Miami, Florida, and the CEO and medical director of Mia Aesthetics, which has several national locations.

"Getting into medicine is a long game, and there are many hurdles along the way that only the dedicated overcome," says Alvarez.

Unfortunately, he says it may be late in that long game before some realizes that the pay rate for certain specialties isn't commensurate with the immense workload and responsibility they require.

"The short of it is that to become a happy doctor, medicine really needs to be a calling: a passion! There are far easier things to do to make money."

Here is what physicians said about choosing between love or money.

The Lowest-Paying Subspecialty in a Low-Paying Specialty

Sophia Yen, MD, MPH, co-founder and CEO of Pandia Health, a women-founded, doctor-led birth control delivery service in Sunnyvale, California, and clinical associate professor at Stanford University, Stanford, California, says you should pursue a specialty because you love the work.

"I chose the lowest-paying subspecialty (adolescent medicine) of a low-paying specialty (pediatrics), but I’d do it all again because I love the patient population — I love what I do."

Yen says she chose adolescent medicine because she loves doing "outpatient gynecology" without going through the surgical training of a full ob/gyn. "I love the target population of young adults because you can talk to the patient vs in pediatrics, where you often talk to the parent. With young adults you can catch things — for example, teach a young person about consent, alcohol, marijuana’s effects on the growing brain, prevent unplanned pregnancies and sexually transmitted infections, instill healthy eating, and more.

"Do I wish that I got paid as much as a surgeon?" Yen says yes. "I hope that someday society will realize the time spent preventing future disease is worth it and pay us accordingly."

Unfortunately, she says, since the healthcare system makes more money if you get pregnant, need a cardiac bypass, or need gastric surgery, those who deliver babies or do surgery get paid more than someone who prevents the need for those services.

Money Doesn’t Buy Happiness

Stella Bard, MD, a rheumatologist in McKinney, Texas, says she eats, lives, and breathes rheumatology. "I never regret the decision of choosing this specialty for a single second," says Bard. "I feel like it's a rewarding experience with every single patient encounter." Bard notes that money is no guarantee of happiness and that she feels blessed to wake up every morning doing what she loves.

Career or Calling?

For Alvarez, inspiration came when watching his father help change people’s lives. "I saw how impactful a doctor is during a person’s most desperate moments, and that was enough to make medicine my life’s passion at the age of 10."

He says once you're in medical school, choosing a specialty is far easier than you think. "Each specialty requires a certain personality or specific characteristics, and some will call to you while others simply won't."

"For me, plastics was about finesse, art, and life-changing surgeries that affected people from kids to adults and involved every aspect of the human body. Changing someone’s outward appearance has a profoundly positive impact on their confidence and self-esteem, making plastic surgery a genuinely transformative experience."

Patricia Celan, MD, a postgraduate psychiatry resident in Canada, also chose psychiatry for the love of the field. "I enjoy helping vulnerable people and exploring what makes a person tick, the source of their difficulties, and how to help people counteract and overcome the difficult cards they've been dealt in life."

She says it’s incredibly rewarding to watch someone turn their life around from severe mental illness, especially those who have been victimized and traumatized, and learn to trust people again. 

"I could have made more money in a higher-paying specialty, yes, but I'm not sure I would have felt as fulfilled as psychiatry can make me feel."

Celan says everyone has their calling, and some lucky people find their deepest passion in higher-paying specialties. "My calling is psychiatry, and I am at peace with this no matter the money."

For the Love of Surgery

"In my experience, most people don't choose their specialty based on money," says Nicole Aaronson, MD, MBA, an otolaryngologist and board-certified in the subspecialty of pediatric otolaryngology, an attending surgeon at Nemours Children's Health of Delaware and clinical associate professor of Otolaryngology and Pediatrics at Thomas Jefferson University's Sidney Kimmel School of Medicine, Philadelphia, Pennsylvania.

"The first decision point in medical school is usually figuring out if you are a surgery person or a medicine person. I knew very early that I wanted to be a surgeon and wanted to spend time in the OR fixing problems with my hands."

Part of what attracted Aaronson to otolaryngology was the variety of conditions managed within the specialty, from head and neck cancer to voice problems to sleep disorders to sinus disease. "I chose my subspecialty because I enjoy working with children and making an impact that will help them live their best possible lives."

She says a relatively simple surgery like placing ear tubes may help a child's hearing and allow them to be more successful in school, opening up a new world of opportunities for the child's future.

"While I don't think most people choose their specialty based on prospective compensation, I do think all physicians want to be compensated fairly for their time, effort, and level of training," says Aaronson.

Choosing a Specialty for the Money Can Lead to Burnout and Dissatisfaction

"For me, the decision to pursue gastroenterology went beyond financial considerations," says Saurabh Sethi, MD, MPH, a gastroenterologist specializing in hepatology and interventional endoscopy. "While financial stability is undoubtedly important, no doctor enters this field solely for the love of money. The primary driving force for most medical professionals, myself included, is the passion to help people and make a positive difference in their lives."

Sethi says the gratification that comes from providing quality care and witnessing patients' improved well-being is priceless. Moreover, he believes that selecting a specialty based solely on financial gain is likely to lead to burnout and greater dissatisfaction over time.

"By following my love for gut health and prioritizing patient care, I have found a sense of fulfillment and purpose in my career. It has been a rewarding journey, and I’m grateful for the opportunity to contribute to the well-being of my patients through my expertise in gastroenterology."

Key Takeaways: Love or Money?

Multiple factors influence doctors' specialty choices, including genuine love for the work and the future of the specialty. Others include job prospects, hands-on experience they receive, mentors, childhood dreams, parental expectations, complexity of cases, the lifestyle of each specialty, including office hours worked, on-call requirements, and autonomy.

Physicians also mentioned other factors they considered when choosing their specialty:  

  • Personal interest.

  • Intellectual stimulation.

  • Work-life balance.

  • Patient populations.

  • Future opportunities.

  • Desire to make a difference.

  • Passion.

  • Financial stability.

  • Being personally fulfilled.

Overwhelmingly, doctors say to pick a specialty you can envision yourself loving 40 years from now and you won’t go wrong.

Jennifer Nelson is Features Editor, Reports at Medscape. Her work has also appeared at WebMD, Medical Economics, MedPage Today, as well as The Washington Post, AARP, US News & World Report, The Oprah Magazine, Women's Health, and others.

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