How to Choose a Medical Specialty for Residency

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Luckily we lived in San Diego, so it was still warm out when I dragged my girlfriend on a late night stroll. Most couples out at that hour were enjoying the balmy summer evening by hitting the bars, grabbing ice cream before the shops closed, or hoping to see the green flash as the sun dropped below the horizon. We, on the other hand, had a much more important goal: to figure out what specialty I wanted to pursue after medical school. I had talked to professors, completed fourth-year rotations in both specialties I was considering (pediatrics and psychiatry), and talked to residents in both fields. Yet I was still no closer to making a final decision than when I started the process. With residency applications rapidly approaching, I only had one option left: to continuously walk around my neighborhood until I could make a final decision. 4 miles, 96 minutes, and several arguments later, I finally had my answer. Looking back now, three years after deciding to apply to residency in psychiatry (with absolutely no regrets), I still believe that deciding my specialty was one of the most difficult parts of medical school. The process requires you to decide the rest of your career based on advice from a few experienced people and 1-2 rotations that may not actually be the most accurate representation of that field. While there is no algorithm for selecting the right specialty and there are more factors to consider than I could possibly discuss in this post, here is an outline of some of the most important things to consider when choosing your medical specialty.    

Sample Several Different Specialties

If you think of possible medical careers as a Vegas buffet of choices, most medical school curricula only provide students the chance to sample a handful of dishes. The standard third year medical school curriculum includes core rotations in internal medicine, general surgery, ob/gyn, psychiatry, neurology, pediatrics, and family medicine. While core rotations provide great exposure to most of the traditional medical specialties, they don’t offer clinical exposure to the vast majority of less traditional specialties. Even if you’re interested in one of these “non-core” specialties, it’s hard to gain adequate exposure. Some medical schools provide additional elective time to try these specialties, but these blocks are generally limited in number and duration (usually only 1-2 rotations for 1-2 weeks each). With this limited clinical experience, it can be very difficult to know if you like some of these non-core specialties that most students do not rotate through. All medical students, regardless of year, should try to actively sample as many specialties from the buffet of medicine as possible before applying to residency. By taking advantage of clinical electives in first and second year, shadowing opportunities, or extracurricular clinical experiences, you will have the chance to sample many more specialties than are included in your school’s standard curriculum. A quick arrangement to shadow one of your school’s faculty for an afternoon may result in a fulfilling career you otherwise would have never known existed.    

Procedural or Non-procedural? That is the Question

The first step in actually choosing a specialty is narrowing down the dozens of potential options to a handful of potential fields. The hard part of this process is finding an effective way to narrow down so many possible careers to a select few. One great way to start this process is to chunk specialties into larger groups based the general characteristics of these fields. The most common strategy I have seen budding doctors use to group potential specialties is to separate them into procedural (i.e. surgery, anesthesiology, interventional radiology) and non-procedural fields (i.e. psychiatry, radiology, pathology). While this isn’t a perfect process, as many specialties have both procedural and non-procedural components (particularly emergency, internal and family medicine), it can help you identify a broad group of residencies you may prefer over others. This can be particularly helpful early on in the selection process to steer you toward the right group of specialties. Unlike my medical school roommate, who loved nothing more than the smell of soldered bone in the operating room, I tended to hide behind colleagues when senior residents were looking for volunteers to try suturing or lumbar punctures. Procedures just were not for me. As fourth year began, I spent most of my attention looking into traditionally non-procedural fields, knowing that I probably could not get away with hiding in the back of the room for an entire residency. While I still had a lot of fields to choose from, making the distinction between procedural and non-procedural fields helped me eliminate about 50% of my options quite easily.    

Consider the “Bread and Butter” of Each Specialty

Every specialty has its “lobster,” the rare item that gets everyone excited when looking at the menu. For an emergency physician it may be performing an emergent thoracotomy to relieve a patient’s tension pneumothorax moments before they suffer cardiac arrest on the gurney. For an internal medicine physician, it may be diagnosing the rare acute intermittent porphyria in a sick patient no one else could figure out. While such cases get most people excited about these specialties, like the lobster these diagnoses are rare. Most specialties are defined by their “bread and butter,” the everyday cases that comprise most of a physician’s workload in their field. Again for emergency physicians it may be cellulitis or fractured bones. For internal medicine physicians it may be pneumonia and congestive heart failure exacerbations. If you pick a specialty based on the exotic cases which are few and far between, you may be left dissatisfied with your day-to-day work. If, on the other hand, you are just interested in the bread and butter cases as the lobster, you will be much more likely to find that specialty fulfilling.    

The 3 L’s of Residency: Lifestyle, Lifestyle, Lifestyle

As important as it is to understand what type of medicine you are interested in, it is just as important to recognize what type of lifestyle will make you happy during your training and beyond. Each medical specialty has its own unique lifestyle that is important to take into consideration when choosing a future career. While lifestyle should likely not be the primary reason you pick a specialty, it should certainly be something you consider when making your decision. Some people “work to live.” In other words, they value free time to pursue non-medical interests and hobbies and know they would not be happy without the freedom to pursue those interests. These individuals will want to avoid specialties with 80+ hour work weeks and minimal weekends off. On the other hand, some people “live to work.” They find joy in high-intensity work environments and derive happiness from strenuous work. These individuals would thrive in a high-acuity medical field such as surgery.    

Concluding Thoughts

Remember these 4 crucial points when deciding on your medical specialty. If you would like further advice and assistance, our Med School Insiders team of advisers is a great resource to help you through this process. There is nothing better than the advice of a resident or attending physician who has recently gone through the same process! Most of all, trust your gut and know that with hard work you will ultimately achieve your personal and professional goals!
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