Choosing a Specialty: Narrowing Down Your Options

This column has focused on the process faced by every medical student, especially third-years: learning the basics of clinical medicine while trying to choose which specialty is for them. This is not an easy task, and although for many it begins before the third year, it usually is not solidified until clinical experiences confirm a student’s passion and proclivity for a certain discipline. The articles in this column have sought to offer particular stories and experiences that may be typical of a specialty, highlighting as many of the “core” specialties as possible. I am only one person, and these experiences are from my perspective as I try to sort through this process myself. This article will explore the process of narrowing down your specialty choice, including some things you may want to consider besides the obvious question, “which specialty do I like the most?”
For most students there are positive and negative aspects of every specialty. Some of these aspects are obvious; for example, if you enjoy spending time in the operating room, you are probably already inclined to pick a surgical specialty. Some aspects are more nuanced; for example, a psychiatry resident I worked with discussed her original intent to pursue OB/GYN. However, she realized that talking to the women was what she enjoyed, not the procedures and diseases of the specialty. This led her to pursue psychiatry, with plans to focus on women’s mental health. Beyond the obvious questions of what each specialty does – that is, how they spend their days – there are somewhat intangible aspects embedded within each specialty. This creates nearly innumerable factors to consider, and each student should reflect on which factors are most important to him/her. Following are several prominent factors that may help you in your decision-making process.
Procedural vs. Non-Procedural
One of the first distinctions advisors and mentors encourage students to make is to decide whether they are procedurally-oriented. This distinction is probably the most tangible and one of the easiest decisions to make, which it is why it is often the first area of focus. It can also be helpful to decide this early because procedural specialties tend to be more competitive than non-procedural, so you can decide to pursue research or other projects in the field. Students inclined to work with their hands, perform operations, and see physical results of their efforts will likely be drawn to a procedural specialty. Non-procedural students may prefer working with their minds more than their hands (although of course all specialties require critical thought) or may simply like the flow of a clinic setting more than the operating room. While most specialties contain a mixture of procedures and non-procedural responsibilities, some are certainly biased towards procedures: You may consider general surgery or a subspecialty, plastics, neurosurgery, OB/GYN, or interventional radiology. If you are inclined away from procedures, consider psychiatry, diagnostic radiology, pediatrics, family medicine, internal medicine, or dermatology. Students who are looking for a mixture may pursue any specialty, but particularly consider anesthesiology, neurology, ophthalmology, gastroenterology, cardiology, or urology.
What Don’t You Want to Do?
A different approach, one that has probably already occurred to you, is to consider what kinds of things you hate doing or make you miserable (or nauseous). Although this may sound extreme, it can be an efficient method of ruling out certain specialties, leaving a smaller pool from which to decide. This method was suggested to me by a gynecological oncologist. “Many people are grossed out by the idea of women’s health, and some of the things we have to do,” she said. “For me, it’s feet and eyeballs. Those were the things I wanted to avoid.” This straightforward approach may work for you, but you might also consider what activities you do or don’t enjoy. If you get migraines from looking at screens all day, you should probably avoid radiology. If you lack physical stamina to stand for long periods of time, vascular surgery might not be for you. Considering the components of each specialty from this perspective may help you rule out a few options, moving you closer to making a decision.
With Whom Do You Want to Work?
Are there certain populations you are especially passionate about helping? If you like working with children, that may steer you towards pediatrics, or one of the numerous other specialties with a pediatric subspecialty (such as radiology, surgery, or psychiatry). If you enjoy interacting with the elderly, you might be inclined towards geriatrics or palliative care. If you want to work with athletes, pursue sports medicine or orthopedics. Do you prefer to work with the really sick patients and provide high-acuity care? Consider surgery, critical care, or emergency medicine; if you prefer healthier populations, you might consider pediatrics or obstetrics. Though variation is common, each specialty tends to have a certain type of patient that they frequently see, and clinical rotations can be the perfect time to learn the patient populations with whom you connect best.
Similarly, consider not just which patients you want to work with, but which doctors. You may find yourself drawn to a specialty because of the average physician in that specialty, more so than a characteristic of the field itself. If you find yourself drawn to those who have chosen a given field, it may be due to a natural fit in terms of demeanor, approach to medicine, and personality. I spoke with a pediatrician, for example, who thought he wanted to do internal medicine, but he found that every doctor he enjoyed working with and wanted to emulate was a pediatrician. This led him to look more closely at the specialty and ultimately choose it, and he is now happy in his field. Conversely, one of my trauma surgery attendings intended to be a pediatrician, but found himself turned off by the pediatricians with whom he worked. Instead, he enjoyed the mindset and approach to medicine espoused by general surgeons, and has found great satisfaction in his career. Because each field is broad, there will be plenty of exceptions, but it may be useful to consider as you observe attendings and residents in each of your rotations.
A Measure of Uncertainty
Similarly, medical students need to decide if they are okay with some measure of uncertainty, or if they prefer to make clear-cut decisions. Students drawn to pathology, for instance, often like the fact that they can make diagnoses; they may not get to manage the patient, but they can answer with certainty the focal question of diagnosis. Likewise, surgeons are often able to directly visualize the source of a given problem and correct it, whether it is an acute bleed, a tumor, or simply the patient’s gallbladder. Other specialties deal in less certain terms: psychiatry, for instance, which asks physicians to sort through complicated patient histories and rely heavily on clinical judgment. Although this is true of all fields of medicine, some specialties rely more on it, so consider your approach to solving problems and how comfortable you are with uncertainty.
These are just a few of the many, many factors that comprise the complex decision of choosing a medical specialty. As mentioned, some factors are obvious and can easily be obtained from basic demographic data – these include length of training, availability of jobs, work/life balance, and salary. Again, remember that you may have different priorities than other students, and that figuring out what your priority is may be the hardest part. As I continue to explore the various specialties for myself, I’ll continue to share common threads and connections that I find within and between each of the major specialties. Be on the lookout for next month’s post, highlighting the field of Psychiatry!
Central to the skillset of every physician is the differential diagnosis; this is the process by which new patients are evaluated to establish the most likely diagnosis. Similarly, the first clinical year of medical school is like a differential for each student, except instead of a medical diagnosis, students are seeking to determine which specialty they will choose. This column explores this differential: experiences from each rotation by a current third year student.
Brent Schnipke is a third year medical student at Wright State University Boonshoft School of Medicine in Beavercreek, OH. He is a graduate of Mount Vernon Nazarene University with a degree in Biology. His interests include medical education, writing, medical humanities, and bioethics. Brent is also active on social media and can be reached on Twitter @brentschnipke.

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Brent Schnipke, MD is a writer based in Dayton, OH. He graduated medical school in 2018 and is psychiatry resident at Wright State University Boonshoft School of Medicine. His professional interests include medical humanities, mental health, and medical education. Brent Schnipke, MD is a writer based in Dayton, OH. He graduated medical school in 2018 and is psychiatry resident at Wright State University Boonshof...