By Brent Schnipke, SDN Staff Writer
This column has been focused on providing clinical snapshots while exploring the factors that affect specialty choice for medical students. Some of these factors are universal, but so much is largely person-dependent—i.e., whatever is most important to the individual will be what ultimately makes the decision for him or her.
Probably the most important factor, realistically, is the exposure that each student has to any given specialty. It’s unlikely that a medical student will choose a specialty he or she hasn’t explored. My posts have focused on the clinical experiences I’ve had, which were a limiting factor in my personal specialty consideration. Each school structures their clinicals differently, which means that students at different schools might make different decisions because of different exposure. It is rare for a medical student to have a rotation in every specialty, but most students will be able to see the majority (excluding subspecialties).
Below are all of the specialties listed by the “Charting the Match Outcomes” resource of the AAMC. I used the information from 2016 to show what percentage of matching students were in each specialty. I offer a brief commentary on the specialties I haven’t yet addressed in this column, as well as a link to the articles which address specialties I’ve already written about. This will allow me to comment on “smaller” specialties (in terms of percentage of matching students), although I can’t fully comment on all of them, because I haven’t worked directly with them. (Additionally, I don’t comment on Urology or Ophthalmology below, for two reasons: I’ve done no rotations in either, and they have separate matching programs and thus are not included in the AAMC data.)
Anesthesiology is a four-year residency program with a preliminary intern year. It is a unique blend of medicine, surgery, and critical care. Anesthesiologists are experts in medications, and often work in team-based settings, collaborating with all kinds of surgeons, psychiatrists, and CRNAs. During my anesthesia rotation, I was impressed at the importance of the anesthesiologist’s role in direct patient care; besides managing the pain control and sedation during the operation, the anesthesiologists had an important job in easing the patients’ fears and anxieties, and ensuring that they are comfortable. Available fellowships include Pain Medicine, Pediatric, Obstetric, Cardiothoracic, and Critical Care. Approximately 6% of all matched residents match into anesthesiology.
Dermatology is a four-year program including a preliminary intern year. Dermatologists typically work in an outpatient setting, and are often a mix of procedural and clinical work. Available fellowships include Cosmetic, Dermatopathology, Procedural Dermatology, and Pediatric. Dermatology training spots make up 1.7% of all matched residents.
Radiology residents comprise 4.4% of all new residents. It is a four year residency with a transitional year requirement (five years total). During my brief rotation in radiology, I was impressed by the wide array of tasks radiologists must be competent in. In addition to reading all types of images—X-rays, CT scans, ultrasounds, and MRIs—radiology is a procedurally-oriented field. Interventional radiology is a somewhat separate but related field, but DR physicians often do procedures as well. This mix of technology, clinical knowledge, and procedures makes radiology a more patient-centric field than is often portrayed. Fellowships are mostly organized around anatomical distinctions and include Abdominal, Breast, Endovascular, Musculokeletal, Neuroradiology, Nuclear Radiology, and Pediatric.
Emergency medicine residents comprise 7% of all matched residents; you can read more about EM here.
Family medicine residents comprise 12% of all matched residents; you can read more about FM here.
General surgery residents comprise 5% of all matched residents; you can read more about surgery here.
Internal medicine residents comprise 7% of all matched residents; you can read more about internal medicine, including subspecialties, here.
Colloquially known as Med/Peds, these residents do a combined residency which lasts four years, rather than the six it would take if they were done separately. This creates career flexibility with numerous practice options upon completion. Statistically, this is one of the more competitive specialties because there are relatively so few spots available (only 1.5% of all spots). Med/Peds residents are eligible for any fellowships that either program alone is eligible for. There are other combined programs—Med/Psych, Peds/Psych/Child Psych, Med/Neuro, and more—but these are all very small in terms of numbers and so are not included in the Match Outcomes data.
Some surgical specialties remain embedded within general surgery training and exist as fellowship opportunities, while others are separate disciplines with their own integrated training programs. Neurosurgery is fairly competitive field (less than 1% of all residency spots) and is a seven-year long residency program, making it the longest non-fellowship residency. Fellowships within Neurosurgery include: Brain and Spinal Tumors, Cerebrovascular Neuroradiology, Endovascular Surgical Neuroradiology, Spine, Pediatric, and Skull Base Surgery.
My Neurology rotation was incorporated into Internal Medicine, and indeed Neurology was previously a subspecialty of Internal Medicine (like Cardiology.) Now, however, it is a four year program focused more intensely, partly due to the growing areas of interest and research. Neurology is a field notable for its blend of clinical problem-solving and cutting-edge research. Although new modalities of diagnosis and treatment are often being developed, it remains a specialty where thorough history and physical are the most important components of patient care. Due to the breadth and depth of the field of neurology, numerous fellowships exist: Brain Injury Medicine, Clinical Neurophysiology, Endovascular Surgical Neuroradiology, Epilepsy, Neurocritical Care, Neurodevelopmental Disabilities, Neuroimmunology, Neuromuscular Medicine, Pain, Sleep, and Vascular.
Obstetrics and Gynecology
OB/GYN residents comprise 5% of all matched residents; you can read more about OB/GYN here.
Orthopaedic Surgery residents comprise 2.7% of all matched residents. It is a five year residency with training in clinical and surgical management of musculoskeletal pathology. Fellowships in Ortho are mostly anatomical, including Ankle and Foot, Elbow, Hand, Shoulder, and Spine, as well as Pediatric, Musculoskeletal Oncology, Reconstructive, Sports Medicine, and Trauma.
More commonly known as Ear, Nose, & Throat (ENT) physicians, residency training spots comprise 1% of all training spots. It is a five-year training program, and it includes a mixture of clinical and surgical training in a wide range of pathology. This is represented in the diversity of fellowships: Head and Neck Microvascular Surgery, Head & Neck Oncology, Neurotology, Otolaryngic Allergy, Pediatric, Plastic (Head & Neck), and Rhinology & Paranasal Sinus Disease.
First-year Pathology residents make up just over 2% of all spots, making it one of smaller specialties by number. It is a four-year training program if done by combining anatomical and clinical pathology; each separately is three years. Pathology among the specialties remains the closest to “basic” sciences.
Pathologists can work in a variety of practice settings and are often involved in education, since their training covers the basis of disease across many other specialties. Numerous fellowship opportunities exist within Pathology, including Transfusion Medicine, Chemical Pathology, Cytopathology, Dermatopathology, Forensics, Hematology, Medical Microbiology, Molecular Genetics, Neuropathology, and Pediatrics.
Pediatric residents comprise 10% of all matched residents; you can read more about pediatrics here.
Physical Medicine and Rehabilitation
Also known as PM&R or Physiatry, Physical Medicine and Rehabilitation programs hold around 1.5% of all residency spots. This specialty is lesser known, and train specialists who are competent in holistic healing. There are both mental and physical aspects to all forms of rehab, and Physiatrists must be able to manage both. There is often overlap with Neurology, since neurological problems are those which often necessitate rehabilitation. Similar to Neurology, PM&R is a four-year integrated residency program, and available fellowships include Brain Injury Medicine, Neuromuscular, Pain Medicine, Pediatric, and Spinal Cord Injury.
Integrated Plastic Surgery is a six-year program which trains specialists in Plastic Surgery. (It is also possible to train in General Surgery and then do a Plastic Surgery fellowship.) Plastic Surgeons specializes in precision surgery primarily of the skin and soft tissues. According to the match outcomes data, only half a percent of all spots available were in Integrated Plastic Surgery. Fellowships in Plastics include: Aesthetic/Cosmetic Surgery, Breast, Craniofacial, Hand, Pediatric, and Plastic and Reconstructive Microsurgery.
Psychiatry residents comprise 5% of all matched residents; you can read more about psychiatry here.
Radiation Oncology is a four-year residency following a one-year general internship year. This is a field that is growing, given advancements in technology which make it possible. Rad Onc specialists are trained in cancer pathology and treatment, focusing on areas in which radiation is a component of therapy. This is a relatively small specialty by training spots—only 0.7% of all matched spots were in radiation oncology.
Next month I will comment on something that’s been alluded to throughout this column but not yet addressed: changing one’s mind about specialty choice during or after applying and interviewing. Stay tuned!
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.
About the Author
Brent Schnipke is a fourth 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.