Last Updated on June 26, 2022 by Laura Turner
For medical school students, perhaps one of the most difficult choices to be made in the course of their education is what area of medicine to specialize in—or whether to go into general practice. Part of this problem is the wide variety of specialties to choose from: the AMA lists around 200 medical specialties and sub-specialties.
Part of it also may be that there are a variety of factors–from expected income to the demand for certain specialties to the personalities and preferences of the individual medical student–to be taken into consideration before a decision can be made. Understanding all of these factors can take some time, but it can also make this very important decision a little easier.
Top 10 Specialties – By Demand and By Income
Two factors which many med students take into account when choosing a specialty are the demand which exists for that particular specialty and the associated compensation, which varies widely from one specialty to another. According to Becker’s Hospital Review, the top in-demand specialty areas (and their associated incomes) are as follows:
1. Family Physician ($198,000)
2. Internal Medicine Physician ($207,000)
3. Psychiatrist ($226,000)
4. Hospitalist ($232,000)
5. Nurse Practitioner ($107,000)
6. Obstetrician-Gynecologist ($276,000)
7. Orthopedic surgeon ($497,000)
8. Emergency room physician ($345,000)
9. Pediatrician ($195,000)
10. General surgeon ($339,000)
Now, compare this to the Medscape Physician Compensation Report for 2016, where doctors across the country gave information on their incomes:
1. Orthopedic surgeon ($443,000)
2. Cardiologist ($410,000)
3. Dermatology ($381,000)
4. Gastroenterology ($380,000)
5. Radiology ($375,000)
6. Urology ($367,000)
7. Anesesthiology ($360,000)
8. Plastic Surgery ($375,000)
9. Oncology ($329,000)
10. General Surgery ($322,000)
What These Numbers Mean for Med Students
These numbers, when looked at closely, hold some potentially useful information for medical students considering what to specialize in.
First, it is important to note that psychiatry has come in third place on the list of in-demand specialties. In fact, the site notes that sometime in the last year, the demand for this specialty spiked to an all-time high. For med students interested in working with populations with mental health conditions, there will certainly be a nationwide need for this kind of healthcare professionals. And the situation may be even more serious than the numbers themselves show. In commenting on these numbers, Travis Singleton, senior Vice President of Merritt Hawkins (the company which gathers this data every year), notes that “Mental health is a topic that the health system and patient themselves often avoid. For that reason, psychiatry can be considered the “silent shortage”, even though shortages in psychiatry might be even more acute than they are in primary care.”
Secondly, a lot has been written about a shortage of primary care physicians across the country, so it is helpful for medical students to also be aware that general practice tops the Merritt Hawkins list for in-demand areas–and has done so for the past 7 years. Mark Smith, Merritt Hawkins president, notes that “The new mantra in health care is to be ‘everywhere, all the time’. This means reaching into communities with growing number of free-standing facilities or other sites that are convenient and accessible. These facilities have one thing in common: they all need primary care physicians.”
Thirdly, it is also important to note that the highest-paid specialties are not necessarily the most in demand. Comparing the two lists above, only two of the specialties with the highest incomes – general surgery and orthopedic surgery – make the top ten specialties that are in the greatest demand.
Other Considerations for Popular Specialties
Income and job demand, while important, are not the only considerations when choosing a specialty, however. The Becker site notes that when making this critical decision–which can impact the choice of residency and the course a medical career–it is also important to be realistic about one’s academic and clinical background, including personal strengths and weaknesses. An honest assessment of these may feel difficult, but it can help form a realistic idea of the chances of matching into a residency in an area of interest. Keep in mind, however, that residencies for highly popular specialty areas tend to more competitive. Becker recommends that students who are applying to these more competitive slots apply to many programs and/or also apply to less competitive ones in order to ensure that they match into a residency program.
A Little Soul-Searching
Gap Medics, in their article on questions to ask yourself when making this decision, include:
• The amount of patient contact you enjoy and the particular patient population you want to work with. While patient contact in some form is part of all medical practice, some specialty areas dedicate a much higher percentage of clinical time to patient contact than others.
• The kind of setting you want to work in and kind/length of hours you want to work. Hospitals and other medical centers, clinics and other medical settings all have their advantages and disadvantages. Knowing the kind of setting you prefer can be useful when thinking about a specialty.
• Whether you like variety or routine in your work and the amount of time you like to spend doing procedures. Some specialties, like surgery, put a much greater emphasis on your clinical, procedural skills.
• How much stress/how fast a pace you can work under. While most health care settings require a fairly brisk pace, this is more emphasized in some areas such as emergency medicine.
• What aspects of medical practice you most enjoy. This is a purely personal question and relates to what parts of your job you find most fulfilling and this could help guide you to an area you enjoy.
What Makes a Specialty Popular?
In another article on the Gap Medics site, writers take a look at five popular specialty areas – Internal Medicine, Surgery, Pediatrics, Family Practice and Emergency Medicine – and discuss why so many doctors are attracted to these particular areas of practice:
• Internal medicine, the article notes, gives doctors the chance to help treat patients with a wide variety of cardiac, respiratory, neurological and gastrointestinal disorders and appeals to doctors who like to see a full range of patients. Since many internal medicine physicians are in private practice, hours can be more stable and predictable than in other areas.
• Surgery, whether general or specialized, is another specialty that is appealing in its prestige as well as for the fact that many specialized surgical areas are extremely well compensated. However, the article points out that many surgeons pull an extremely long work week – sometimes to the tune of 60 to 80 hours – and that the work can be demanding and stressful.
• Pediatrics is an ideal choice for doctors who are drawn to working with a young population with either acute or chronic conditions. And there is also a chance for doctors to specialize within this general category, with subspecialties like pediatric oncology.
• Family practice physicians, like those in internal medicine, will see patients across the life spectrum with a wide variety of health conditions, which can appeal to many doctors. Also, many such doctors are in private or group practice which can also lend itself to more stable and predictable hours and make the work/life balance easier.
• Emergency medicine is also a popular specialty and can appeal to people who enjoy working at a fast pace, sometimes in life-or-death situations for patients who require immediate care. The article points out, however, that stress levels in this kind of practice can be extremely high.
Take a Deep Breath…..
If this seems like a lot of information to consider–it is. But the good news is that most medical students do not make a final decision about specialty practice until sometime between there 3rd and 4th year of medical school – and that, during the course of their medical education, around 70% of students will change their minds about the area in which they want to practice. A decision should be made, however, by December-February of the 4th year when the applications for residencies begin; the residency match will take place in the spring in order to–ideally–match new graduates with residencies in areas in which they want to practice. Once a residency is chosen, however, changing to another residency can be more difficult so it is important to know for sure by this point that a certain area of practice is right for you.
To sum up, choosing a specialty can be a complex and difficult decision for many medical students. Knowing what specialties are most in demand and what their associated incomes are is helpful, but there are many other factors to consider, including academic and clinical strengths and weaknesses as well as personal preferences in regards to factors like the amount of patient contact, the preferred work setting, and overall what is most enjoyable about medical practice as a whole.
Not sure what specialty best fits you? Take SDN’s Specialty Selector assessment to find out which specialties best fit your personality and priorities.
Brian Wu, MD, Ph.D., MNM, graduated from the University of Maryland with a Bachelor’s of Science in Physiology and Neurobiology, and graduated from the Keck School of Medicine (University of Southern California) with an MD with a focus on holistic care and treatment. He currently holds a Ph.D. in integrative biology and disease for his research in exercise physiology and rehabilitation.