I haven’t always wanted to be a physician, but when I learned about a profession that was innately altruistic, allowed me to work with people, to teach people, to constantly learn AND to make a good living, I was all too excited. Going into medical school I thought I might want to be an OBGYN, but I wasn’t sure. I had great clinical experiences related to women's health, but my exposure to all that medicine has to offer was definitely limited. Medical school was an amazing time for exploration, but there came a time when I had to make the biggest career decision EVER. Deciding what specialty I wanted to pursue was daunting. Knowing that once you choose a specialty you are pretty much locked-in put so much pressure on the decision. I had to pick the PERFECT specialty. I wanted to share some of the things that I considered when making this big decision because I belabored... a lot.
First thing’s first. Many people change their minds. I was always impressed by my classmates who came into medical school knowing the specialty they wanted. I was even more impressed, and honestly surprised, when these same individuals ended up matching in that same specialty. That is to say that PEOPLE CHANGE THEIR MINDS. Coming into medical school, I wanted to do OBGYN and then switched to PM&R. Thennnn I was hooked on using medieval torture tools in the OR (orthopedic surgery). Let’s just say there were a few more switches along the way before I landed at my final decision of PM&R. I considered the following questions when making my final decision. I hope they help to facilitate your decision making.
How much patient contact do you really want?
I don’t know too many people who went into their medical school interview saying they didn’t care about seeing patients at all, but as you grow as a medical student and clinician, I think it becomes pretty clear how much time you want to spend with patients. Do you want to counsel them one-on-one? Do you want to have short periods of interaction and then never see your patient again, or do you want to see them every.single.month? I found myself loving the counseling aspect of medicine. It allowed me to put on my teaching hat as well as serve as an advocate and cheerleader for my patients during their times of need. This meant I picked a more patient intensive specialty.
How much do you want to work with your hands?
As you can imagine or may already know, there are specialties that work with their hands more than others. Many people approach the decision of choosing a medical specialty by determining whether you want to be a surgeon or not, and then go from there. I personally don’t think it is so simple. There are many specialties that are a mix of surgical and clinical. There are also specialties that allow you to work with your hands and do less invasive procedures. I do think that you have to decide whether you want to be cutting people open in order to earn money, because that will really narrow things down for you. I found that I wanted to work with my hands, but I was ok with doing less invasive procedures like biopsies, injections or lumbar punctures which allowed me to focus on specialties such as anesthesia, PM&R, family medicine, and emergency medicine. These fields allow tons of hands on patient procedures without the necessity of a surgical residency.
Where do you think you might want to practice?
While this was not a huge consideration in my decision, know that the more specialized you get the more relegated to larger cities you will be. It might be hard to have a thriving practice as a pelvic floor specialist in Buford, Wyoming.
How much innovation and technology do you want to use?
Medicine is constantly evolving and changing. If you are interested in research and use of technology in your future practice, consider how this might fit in with your specialty choice.
When do you want to ACTUALLY start making money?
As I face four years of residency (I just matched into PM&R) I realized how far away I am from actually making money. I don’t recommend making a decision soley based on this, but I am a bit older for a medical student (it’s never too late and you are never too old), and I knew I wanted to make an attending’s salary before I turned 35…..
How much money do you want to make?
This can often be seen as a taboo factor to consider, but please consider this! If it matters to you even one iota, do some research and ask questions. I have heard every spectrum of opinion, often offered in an unsolicited fashion. Many physicians say it will all work out and that they have never struggled with money. I have also heard the opposite. Physicians are work backbreaking hours to be able to afford loans, kids and life expenses. Doctors make good money, but there is such large range in what doctors make based on specialty and location of practice. It is good to have an understanding of this so you can make the best decision for you.
Team vs more individual practice?
Medicine is a team sport! I cannot repeat this enough. However there are specialties that allow you more autonomous control over patient care and specialties that require coordination between multiple teams of individuals. While managing the goals of so many cooks in one kitchen can be frustrating, I found that working with lots of consultants and teams of different care providers offered me the chance to learn from a host of different perspectives. PM&R is the ultimate team based specialty and I love it!
Work life balance?
Please consider this. I know many people for whom medicine is their one true passion. I am extremely passionate about medicine, but I did not want my role as a doctor to define who I was. For this reason I sought out specialties that provided me time to pursue my other passions as well. Many people suggest the ROADS specialties (radiology, ophthalmology, anesthesiology and dermatology). I believe many specialties allow flexibility in hours after you complete residency, so keep this in mind. However some are more flexible than others. Make sure to ask your attendings how flexible they see their specialty being. Some specialties that are gaining popularity because they are more flexible include psychiatry, anesthesia and PM&R.
How competitive are you as an applicant?
Many things are going to change with the advent of a pass/fail Step 1. This being said, I firmly believe there will always be some metric used to exclude candidates. Be mindful of these and be honest with yourself. With hard work you can meet these requirements, but it is also important to consider whether there are other things that might make you happy if you are not in the ballpark. NRMP data and Texas Star (if you can get access) are helpful to determine if you are competitive.
What are your strengths?
Let’s be real. There are certain skills that are more innate than others. If you have no hand eye coordination, a surgical specialty will likely be harder for you. I think it is valuable to take stock of your strengths and consider how you can apply those to your specialty of interest.
This is not a comprehensive list, but I did want to leave these questions here for you to ponder. I also compiled a list of resources for you to do a deeper dive. Feel free to reach out with more questions or leave comments.
A Useful Book:
Information on various specialties: