The question of how to choose a medical specialty concerns aspiring physicians in all stages of their education, including premeds, first year med students, and especially those students who are considering applying to some of the most competitive residencies. Luckily, we have identified key information that you must know to make the right decision for you, your lifestyle, and your goals! In this blog, we have compiled a list of tips that will help guide you as you contemplate the many paths that your future medical career might take!
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After months of studying to get a good MCAT score, drafting dozens of medical school personal statements, and braving interview jitters, you’ve finally made it to medical school and chosen the right institution to prepare you for your future medical career! Now, in your third year, however, you face the daunting decision of choosing a medical specialty. With so many possibilities for residency program specialization and so much conflicting advice on Premed Reddit and other medical forums available online, the decision can feel overwhelming. Of course, it is important not to downplay the significance of this decision. Much of your immediate day-to-day life will be shaped by the specialty you choose, starting in your residency program and extending long-term thereafter.
Still, it’s equally vital to maintain a sense of calm about the decision, keeping a level head so that you can make the right informed decision with confidence.
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General Practitioner vs. Specialist
Before jumping into our Top 10 Tips for Choosing a Medical Specialty, let’s take a moment to consider the advantages and disadvantages of becoming a General Practitioner and compare them to the advantages and disadvantages of being a Specialist. Both options are equally valid and can lead to a fulfilling medical career, but it’s worth assessing each route to determine which one best suits your career needs and desires, along with your lifestyle.
Check out the most and least competitive residencies:
You’ve probably guessed by now that general practitioners cover a wide range of general health care needs. The types of ailments general practitioners address and the services they provide require a substantial breadth of expertise. Of course, given the necessary breadth of general practitioners’ knowledge, the depth of their knowledge about each medical specialty is not as great as that of specialists in each respective area.
Still, general practitioners must be knowledgeable about most medical specialties and stay current on advancements in medical research and treatments within all the medical specialties. While keeping up with developments in such a broad field is indeed a great responsibility, the nature of the general practitioner role also means that each day presents a new challenge. General practitioners never know the sort of cases they will see in a given day, which can be exciting to some physicians and overwhelming to others.
Unlike many specialists, general practitioners often provide longitudinal care for their patients. This sort of continuity of care necessitates additional expertise in approaches like preventative medicine and managing chronic diseases. Due to the long-term nature of their work, general practitioners tend to form stronger bonds with their patients. Further, as the first point of contact for many patients, general practitioners frequently refer patients to necessary specialists and play a significant role in coordinating the various members of an individual patient’s care team.
If general practitioners don’t specialize in one particular area of medicine, do they even attend residency programs? Of course they do! General practitioners are no less qualified, skilled, or knowledgeable than their specialist counterparts. Their qualifications, skills, and knowledge are simply different. Physicians filling general practitioner roles tend to attend Family Medicine or Internal Medicine residency programs in which they are exposed to the diverse illnesses and approaches to care required to attend to a variety of patient needs. Family Medicine and Internal Medicine residency programs typically span the course of three years, constituting some of the shorter program options.
Investing just three years in a residency program means general practitioners are able to start practicing and earning a salary much quicker than specialists who choose lengthier residency programs. Of course, every choice is a trade off in terms of advantages and disadvantages. General practitioners may have relatively brief residency programs, but their salaries are generally lower than those of specialists, as specialist are some of the highest paid doctors in the United States and Canada.
Like general practitioners, specialists also accrue a broad understanding of medicine and its various specific disciplines in medical school. Unlike general practitioners, however, specialists pursue very in-depth knowledge about one particular area of medicine. Although specialists do possess broad medical knowledge, staying up-to-date in all of the sundry specializations may not be a top priority because specialists’ responsibilities require a very profound understanding of their field and every current issue, treatment development, and technique within it. Oftentimes, specialists pick up where the depth of general practitioners’ expertise in that particular specialization ends, but this also means that specialists rely on general practitioners to holistically assess a patient first before referring the patient to the appropriate specialist.
These residency programs generally range from three to six years of training, with most specific specialties occupying the latter half of that range. It is important to consider the length of time you’re willing to dedicate to a residency program, as you will see below in our Top 10 Tips for Choosing a Medical Specialty in 2023, but the choice is a bit more complex than just your preferred time commitment.
Say you’ve chosen neurosurgery as your specialty. Neurosurgery residency programs can extend to seven years of additional training after four years of medical school, all without a full salary to begin paying off any student loan debt you may have amassed due to high medical school tuition costs, which is constantly accumulating interest. However, on the other hand, when you finally begin practicing, your salary could be two, three, or even approaching four times the salary of a general practitioner. Needless to say, you would be very well compensated for the time and energy you invested, but it could come at the expense of your work-life balance. Moreover, your ability to establish enduring relationships with patients would be highly limited, and you would likely have to shape the rest of your life around early morning surgeries at the hospital each day.
As you can see, both options have their pros and cons. Your job is deciding what your priorities are and what you want out of your career and life.
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DO vs MD
Finally, before taking a look at our tips for choosing a medical specialty, it’s worth addressing any potential differences between the specialty options available to osteopathic physicians graduating with a DO degree and allopathic physicians graduating with an MD degree.
You may recall from your med school applications that osteopathic and allopathic programs differ from one another in approach to medicine and health care, but neither is necessarily “better” than the other. Allopathic MDs constitute the majority of physicians in the United States and Canada, approaching medicine from a strictly evidence-based perspective, while osteopathic DOs emphasize holistic and preventative care, often incorporating alternative treatments in the care they provide.
Of course, MD physicians may also integrate non-traditional methods in the treatment plans they create or focus equally on preventative care, but the curricula between the two types of med schools differ. DO school rankings demonstrate that the admission standards of programs are slightly less strict and don’t place quite as much emphasis on research or publication prior to matriculation. Nevertheless, physicians of both types must pass the same board exams in order to practice.
As for specialization, both MDs and DOs can and do pursue all available specialties. Osteopathic physicians tend to get a reputation for going into primary care because a large portion of them do, but a large portion of allopathic physicians enter primary care as well. The sheer number of allopathic physicians means more MDs are present in the various medical specialties, but DOs also possess the option to specialize, despite their smaller ranks.
Still, the most competitive residency programs frequently end up admitting more allopathic MDs than osteopathic DOs simply because of their admission requirements. The bottom line is this: MDs and DOs both possess the ability to specialize in any discipline, provided they have the required experience, grades, and scores, and references, to be admitted.
Ok, now that we’ve cleared up a couple of common points of confusion, it’s time to dive into choosing a specialty! Below are ten pieces of advice that will help guide you as you reflect on your options and ultimately choose the right medical specialty for you.
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Top 10 Tips for Choosing a Medical Specialty in 2023
Here are our Top 10 tips for choosing the right medical specialty:
Now let's unpack these below!
Tip #1: Reflect on your interests
Upon first glance, this tip may seem obvious and not worthy of discussion. Yet, you’d be surprised at how often it is neglected! Many medical students are unable to ignore the persistent (and usually unsolicited!) advice coming from family, friends, and peers, to the detriment of advocating for their true interests and passions. Alternatively, some medical students select their specialty of choice by speculating about which specialty offers the greatest potential for a match. Even a near-guaranteed match is not a guarantee for success or professional fulfillment. Also, remember that the medical specialty you pursue will be highly influential in shaping your future. Your future, not the future of your family, friends, or peers. And remember why you want to be a doctor, not your mother, father, aunts, and uncles.
Take some time to truly reflect on your clinical interests. Which topics ignited your passion to know more throughout medical school? Was there a particular rotation in which you not only thrived, but enjoyed? The decision is yours, but it is not one to be taken lightly. Invest time and effort into your reflection so that you can make the wisest decision possible.
Tip #2: Procrastination is not your friend
Explore your options early! Juggling the responsibilities of medical school can be challenging, and the thought of adding one more item to your to-do list might be the last thing you want to do. If you want to equip yourself with the knowledge and exposure necessary to select the right specialty for you, starting to explore your options early is key. Depending on which school you’re attending, you may have the chance to explore different specialties in your electives, or you may have to invest some of your free time into delving into the specifics of the various specialties available. Even if you are exposed to several specialties through clinical rotations, there are 49 different areas of specialization in the United States and 39 in Canada, so understanding your options takes some research! For those of you who do not have the convenience of exploring specialties through elective time, summer breaks provide an excellent chance to seek out opportunities for widening your exposure to different fields and getting a feel for which specialty might be the right fit for you.
Use every possible resource you can to educate yourself on specialties that pique your interest. Reach out to professors and physicians at your medical school to see how they chose their specialties, seek advice, and utilize their connections to set up shadowing opportunities to get a glimpse of what working in a given specialty is actually like in day-to-day practice. If you’re interested in clinical research, make sure to pursue opportunities for research, whether that’s in research courses offered in your program, extracurricular involvement, or summer research opportunities at your university or another institution. Many of the most competitive specialties that require research experience also require an expression of your interest in that field early on, so don’t delay in educating yourself about the field(s) and getting involved in activities that will strengthen your profile as a candidate.
Tip #3: Keep an open mind
Whether you entered medical school with a particular specialty in mind or not, chances are you will change your mind at some point. Think back to where you were before starting your undergraduate education. You may have entered your program with concrete aspirations about which field you wanted to study and the career path you intended to follow, but did you graduate with those same exact interests? Chances are the things you learned in both your courses and in life may have motivated you to reconsider. You may have changed as a person, and will likely change in a similar capacity in medical school as your mind is opened up to new knowledge and new career possibilities.
Remember that changing your mind is normal, and even encouraged as you develop and learn more about what each specialty entails and what your priorities are. In fact, the American Association of Medical Colleges (AAMC) indicated in their report on residents that just 26.1% of medical school students reported interest in the same specialty field at the end of medical school as they did when entering medical school. That means 3 out of every 4 students change their minds! So, as you delve into different specialties through coursework, conversations with professors, and clinical rotations, try to keep an open mind. The specialties that end up appealing to you may surprise you!
Only 26.1% of medical school students are interested in the same specialty at the end of med school as they did at the beginning!
Tip #4: Forget about prestige
After the blood, sweat, and tears spent getting into medical school, covering how much medical school costs, and the effort required to succeed in your chosen program, many students feel they should aim for the most prestigious specialization available, but this may not be the wisest route.
While prestige can be tempting in that it offers a certain level of recognition for one’s efforts and abilities, it is neither the key to success nor insurance for professional satisfaction and fulfillment. Selecting a specialty requires a great deal of thought and in-depth reflection about your strengths and what your greatest weaknesses are. It can be easy to get carried away with imagining a dream life for ourselves in which we disregard important factors like work-life balance in exchange for a level of perceived prestige that we think will ultimately make us happier once we “make it.” In reality, if you don’t enjoy the process of getting to the point where you think you’ve made it, chances are that prestige won’t result in happiness either.
Instead of considering how prestigious a specialty may be, think about the things that really matter to your sense of happiness and fulfillment: How much does work-life balance matter to you? Is clinical research an important aspect of your professional aspirations? Which specialties intrigue you? How much does monetary compensation matter to you?
A note about compensation: while most American medical school graduates enter a residency program with substantial student loan debt, it is essential when choosing a specialty to remember that physicians in general tend to be well compensated. How much physicians of a particular medical specialty earn each year should never be your primary motivation for pursuing that specialty. Compensation is a factor, among others, that should be considered, but it should not serve as the driving force in your selection of the specialty that is the best fit for you. Keep in mind that becoming the highest paid doctor will not satisfy you in the long-term if you feel burdened by your duties as a physician.
Tip #5: Think about the day-to-day
As you survey the specialties available to you after graduating medical school, don’t be led astray by particularly fascinating, but rare cases you’ve encountered in textbooks or clinical rotations. Part of why such cases are fascinating is precisely because they are rare! Remember that no matter how intriguing the case of such a patient might be, it is not likely that you would encounter that same level of stimulation every day. It is wise to think about the day-to-day responsibilities of your chosen specialty, as those tasks and procedures better reflect what the majority of your career will look like. Can you picture yourself taking on those responsibilities each day without tiring of them? Do you see yourself doing those procedures happily day in and day out? Granted, you will never know for sure until you actually do those things every day, but you can avoid the significant disappointment that will inevitably accompany a choice based on an attraction to the extreme cases within a given specialty.
Tip #6: Determine how involved you want to be with your patients
Although patient-centered care is the norm in most healthcare systems in the Global North, there are still variations in degree of patient interaction among medical specialties. Take, for instance, a radiologist. Yes, many specialists in radiology do consult with patients, but a great deal of their time is also spent reviewing images like X-rays and ultrasounds. Radiologists are often members of a full care team and relay their interpretation of images to other physicians who are in charge of delivering results to the patient and crafting appropriate treatment plans.
On the other hand, a specialist in family medicine is highly involved with his or her patients. Not only do family medicine doctors see more patients on a day-to-day basis, but they also tend to follow patients throughout the course of their lives, which involves building and sustaining strong and trusting relationships with patients. The degree to which you desire to interact with patients on a daily basis comes down to personal preference, and you must be honest with yourself about how involved with patients you would like to be.
Tip #7: Work Environment
Define where you want to practice. By where you want to practice, we don’t mean geographic location. Residency programs for specialties of all sorts can be found in numerous locations. Rather, think about what sort of work environment appeals to you. Would a bustling, hectic emergency department thrill you or exhaust you? Do you enjoy the intimacy of a small family medicine practice? Can you picture yourself conducting early morning surgeries in the operating room each day? Your working environment can play a substantial role in shaping your sense of job satisfaction and enjoyment. Consider a brain surgeon versus a dermatologist, for example. A brain surgeon would spend a significant amount of time in the operating room at a hospital, while a dermatologist, although they may occasionally conduct surgical procedures, will spend most of his or her time in an outpatient clinic. Take some time to reflect on which work environment would work best for you.
Tip #8: Get significant clinical experience in specialties you’re considering
Even if you have exposure to the specialties in which you’re interested through clinical rotations during medical school, seek additional clinical experiences. Try to shadow several physicians specializing in your area(s) of interest in order to accrue sufficient exposure to the field. Go to presentations from physicians in your specialization of choice, read up on hot topics within that specialization, and absorb as much information about it as you can so that you can make an informed decision. Oftentimes, these clinical experiences within different specialties can help you determine the specialties in which you aren’t interested, which is equally valuable. Part of determining the specialty you want to pursue is ruling out those that don’t interest you!
Tip #9: Decide how long you are willing to commit to a residency program
While some med school graduates feel invigorated and ready to pursue their chosen specialties, others graduate medical school feeling burnt out from the rigors of the last four years. You must reflect whether you are ready to spend time and effort on preparing your residency application, including your personal statement, ERAS letter of recommendation, residency CV, etc. This kind of commitment takes a lot out of students.
Additionally, when applying to a residency program directly after medical school, you have to think about how much time you are willing to commit to a residency program, as they vary in length from three to six years. If you’re considering specializing in plastic surgery, for example, you can expect your residency program to be about six years long in most cases. Three years is certainly a commitment, but six years is an even more significant commitment. Are you willing to hold off on earning a physician’s salary and paying down your student loans for six years? Do the higher salaries of plastic surgeons make up for the six-year commitment to a residency program? If you desire to have a family while enrolled in a residency program, do you have a supportive partner who can take over a great deal of childcare responsibilities and/or supplement your limited resident salary? Again, be honest with yourself about your needs and desires to determine the best specialty fit for you.
Tip #10: Be honest with yourself
We’ve mentioned this tip a few times throughout this article, but it bears repeating because it is crucial to making a wise choice. Be honest with yourself about what you want out of a residency program and future specialization as well as which skills you bring to the table. If dissecting cadavers in med school made you squeamish, you have to be truthful to yourself about that factor when considering a surgical specialization, for instance.
Being honest with yourself comes into play when assessing the strength of your application as well. The strength of your application is determined by several factors, including the quality of your application materials, your residency personal statement, your board scores, your letters of recommendation, and the ranking of your medical school. Knowing whether you are a competitive applicant requires a certain degree of self-awareness and being realistic about the level of competition for a given specialty.
Of course, many factors contribute to the strength of your application, but if you are trying to be matched to competitive programs, in the very least you should:
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1. When should I be narrowing down which specialty I want to pursue?
Great question! Residency program applications are typically submitted in your fourth and final year of medical school, which means the process of exploring specialties of interest has to start long before that. Of course, you will have exposure to a few specialties in your clerkship or clinical rotations, but this exposure is limited due to the short-term nature of rotations. The rotations you do are also limited in breadth, as you usually rotate through around 7 specialties, so you can’t gain sufficient exposure to all areas of specialization.
It’s wise to start exploring your options as soon as you start medical school. Seek out extracurricular opportunities to gain exposure to specialties that interest you and keep accurate notes about what you like and dislike about each. As for narrowing down which specialty you want to pursue, this should happen by some time in your third year of medical school. By this point you’ve gone through your coursework and begun your clinical rotations. You’ve also had over two years to explore different possibilities in order to make an informed decision.
2. What should I do if I cannot choose a specialty? Should I wait to apply to residency, choose the easiest residency or the highest paid residency?
Ultimately this decision rests in your hands alone, but consider waiting a year or two to apply to residency so that you have the opportunity to explore your options further in the meantime. This will also give you an opportunity to strengthen your CV through research or other clinical exposure so that you will not only apply with more certainty about your choice, but as a more competitive applicant as well!
3. How can I gain the necessary extracurriculars to demonstrate my commitment to a specialty that interests me?
First thing’s first: start early. It takes time to arrange extracurricular activities like shadowing or volunteering, let alone participate in them. Talk to your med school professors about how they made their decisions for residency and ask if they know about any relevant opportunities to explore the specialty or specialties that interest you.
Try to shadow multiple physicians in that specialty, explore research opportunities, and volunteer in clinical settings. Strive to find opportunities that are long-term so that you both get a firm grasp on the daily responsibilities of the specialty and accrue significant experiences that will help you write your personal statement in the future. These activities will also present opportunities to form strong relationships with supervisors who may be able to author a letter of recommendation for you when the time to apply arrives.
4. Are there special considerations in choosing a residency between osteopathic medicine and allopathic medicine?
No. Osteopathic and allopathic med school programs differ in their approach to care, but residency programs across the board are open to MDs and DOs alike!
5. To what degree should geographic location factor into my decision?
As you know, most specialties have many residency programs that span various geographic locations. Location should never be your primary deciding factor. The idea of spending a few years hanging out near the beach or in a bustling urban center can be appealing as you select where to apply, but remember that the majority of your time will be spent working.
However, if you have specific goals of practicing in a rural setting, for example, seeking out a residency program that gives you experience working in a similar setting is a smart choice. That said, if there’s a particular geographic location that you know you absolutely could not be happy living in, take residency programs in that area off your list.
6. Can I apply to a specialty in which I have little experience?
You have the freedom to apply to any specialty out there, but just because you can doesn’t necessarily mean you should. If you’re interested in a particular specialty but haven’t done anything to gain exposure to that area of medicine, it is unlikely you will be able to make a convincing case to admissions officers that you deserve a spot in their residency program.
Maybe you do have experience, though, but it just isn’t extensive. In that case, as long as you are able to demonstrate your suitability for the field based on the experiences you do have under your belt, you may have a shot. Remember that the more experience you have, the better, and this isn’t just in terms of being admitted. If you have little experience in a particular specialty, are you ready to commit the next 3-7 years of your life to pursuing it?
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