Medical

Navigating Your Future: A Roadmap to Specialty Exploration

Congratulations! You’re in medical school. What you will soon realize is that your answer to “What do you want to be when you grow up?” is going to have to change. Simply saying “doctor” is no longer enough. You need to start to figure out what kind of doctor you want to be. And, although applying to residency may feel very far off, there are steps you can do starting in your first year to help you pick the specialty that best suits you.
Most of us have fairly limited exposure to different specialties as pre-meds; mine consisted primarily of shadowing cardiothoracic surgeons. Yet there is a huge diversity among medical specialties, some of which you may have never heard about. Physiatry, anyone? Others you know of can be quite different than what you had envisioned. A friend of mine recently shadowed an interventional radiologist and was surprised by the surgical nature of the specialty.
With so many choices, how do you begin navigating your different options? First, realize that there are a number of factors to consider when you are exploring specialties.
Subject matter: This may be obvious, but do you find the specialty intrinsically interesting? As you begin to explore consider what catches your interest and why.
A day in the life: What does the life of an attending look like? In medical school, we get lots of exposure to the life of residents during third and fourth year, but it can be somewhat less obvious how attendings spend their time. You will not be a resident for the rest of your life (thankfully), so it’s important to get an idea about what your days will be filled with after training.
Training: What does residency training look like? Will you need to do a fellowship?  You can definitely argue that the length and difficulty of training do not matter if they get you where you want to go, but do consider how your training fits with your overall life goals.
Colleagues: Are these the people with whom you want to spend most of your waking hours? Different specialties attract different personality types. There are stereotypes about each specialty, some of which may carry a grain of truth, but it is important that you see for yourself. These are the people you will be spending a lot of time with. Talking with an anesthesiologist, he pointed out that it is critical to enjoy the company of your colleagues as “I spend more time with them than my family.”
Lifestyle:  What do you want for yourself in ten years? Twenty? This can be a taboo topic, but different specialties really do support different lifestyle goals. This goes beyond financial compensation to include things like work hours and call schedule. For example, while most physicians spend part of their time being on “night call” that looks far different for a psychiatrist than a transplant surgeon. If your goals include having kids and being home in time for dinner, you’ll want to find a specialty that may afford you that flexibility.
With these factors in mind, it’s time to map out your route to finding the specialty that best fits you.
First year: Your goal for first year is to explore as much as possible. I remember feeling like a kid in a candy store, what with all the interest group meetings, career panels, and shadowing opportunities that flooded my inbox on a regular basis. Take advantage of it!

  • Attend as many interest groups, career panels, and information sessions as you can stomach. They are a great opportunity to get a brief overview of the specialty and also make initial contacts with attendings and residents, who often offer shadowing opportunities.
  • Utilize on-line sources, including specialty interest surveys. Student Doctor Network and the AAMC both have career resources that include surveys to help you focus on specialties of potential interest. These surveys are based on various factors, ranging from your desire to do procedures to your interpersonal skills. When I took the AAMC survey three years ago, it pegged me as going into internal medicine (66%), followed by pediatrics (12%) or psychiatry (7%). In the end, I am going into psychiatry, so it certainly was not a crystal ball, but it did encourage me to think about what I wanted in a specialty. Of note, it is probably best to re-take the survey after having some clinical experience. At that point you will have developed a better sense of what you like. For example, whether you leap out of your chair or hide in a corner when a resident ask if anyone wants to try to lumbar puncture on a patient can help you narrow your career interests.
  • Talk to other students. Older students can make recommendations about faculty to approach in your area of interest for good shadowing experiences or research projects.
  • Ask to shadow. Attendings appreciate students who show initiative and enthusiasm. Your time is likely to be most flexible during first year, so take the opportunity to observe. This can also be a great chance to gain exposure to specialties you might not see a lot of during third year. Those interested in the specialties that make up the core of the third year experience – such as surgery, medicine, ob/gyn, etc. – will have ample opportunity to experience these fields. On the other hand, if you think radiation oncology could be your calling, early shadowing can be critical in your decision-making process as you won’t see much of it in a typical third year schedule.

Second year: Here your objective shifts slightly because, although you want to continue to explore, you also need to make sure you don’t unintentionally close the door to opportunities. If you are interested in a particularly competitive specialty, you need to start making those connections and figuring out what is required for a competitive residency application.

  • Consider doing a project in your specialty of interest. Competitive fields like dermatology, plastic surgery, orthopedic surgery, or ophthalmology may necessitate a significant research project, and even those not headed for highly competitive careers can benefit from early involvement. There are almost always a number of projects sitting on the back burner somewhere just waiting for an eager med student to comb through old medical records, hand out surveys, run some statistics, etc. This will give you the opportunity to work with those in the specialty and get a better sense of whether it is a good fit, while hopefully also contributing to the field. If you change your mind later, for example deciding you would rather go into pediatrics than ophthalmology, your time will not be wasted. In addition to being able to include the experience on your CV, your mentor may be able to provide a strong letter of reference, critical to a solid residency application.
  • Take the boards with a goal in mind. Although you really don’t need something to make yourself more anxious about taking Step I, having an idea about the score you’ll need to be a competitive applicant can help you to decide on your study strategy and deciding how many resources to commit.

Third year: This is where the rubber hits the road. All the hypothetical likes and dislikes you may have had about clinical practice can now be put to the test. I went into third year feeling somewhat terrified about the prospect of talking to patients; I thought I wanted a career in which they would be either asleep – anesthesia – or in black and white – radiology. Then, mid-way through third year, having overcome much of my talking-with-the-patient angst, I fell in love with psychiatry. Gaining actual experience in the field is invaluable in your decision-making process. With more information, it becomes easier to start narrowing your choices as you near the end of third year and prepare to submit your application early in your fourth year.

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  • Approach each rotation as though you might go into that specialty. Even if you know you will never be a pediatrician, give yourself the chance to reevaluate your preconceived notions about different fields.
  • Seek out an objective opinion. Make use of the advising provided by your medical school. Your adviser can give you a realistic sense of how competitive you are in a particular specialty.

Fourth year: Now is the time to finalize your decision, as your application will be due in September. While some students are confident in their specialty choice by the time fourth year starts, others remain on the fence.

  • Take advantage of electives in your field(s) of interest. Early electives in fourth year can help you confirm your decision by providing additional exposure in your field.

Realize that everyone experiences a certain level of third and fourth year “I can’t possibly decide” panic. I had a classmate who perseverated between ob/gyn and radiation oncology almost up to the point of turning in the application – he is now happily matched in radiation oncology. Take a deep breath. You will make a decision and it will work. Also, if it doesn’t, your choice does not have to be permanent. As I began researching different fields I was surprised to find a handful of (very successful) attendings who had switched fields. Two switched into radiology, one from medicine and another from orthopedic surgery; another switched into pathology from surgery.
Finding your specialty is a process, not a perfect science. While no field is perfect, with such diversity amongst specialties, you can rest assured that you will find something that works for you. By starting early and allowing yourself the time to explore throughout your first three years, you will put yourself in strong position to apply and match into the field that best suits you, putting you on the path to career success.

M
Megan Riddle, MD PhD, is a psychiatry resident at the University of Washington. She is a graduate of the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program. Megan Riddle, MD PhD, is a psychiatry resident at the University of Washington. She is a graduate of the Weill Cornell/Rockefeller/Sloan-Kettering Tri...