I’ve written about choosing a medical specialty throughout the third and even fourth years of medical school, but further discussion is warranted regarding the students who don’t choose a specialty in this “typical” timeframe. It is worth mentioning first of all: many people change their minds for many different reasons. I continue to be impressed by the students, residents, and attendings I meet who took circuitous and sometimes truly fascinating routes to become physicians. The same is true for finding one’s niche as a certain type of physician. Many students feel like everyone else has things figured out, but the truth is the path is not always clear cut. Even when the majority achieve a certain stage (e.g. practicing physician) by the standard route, there are always exceptions, and students may be surprised and encouraged at the myriad ways they can reach their career goals.
The typical route for choosing a specialty is in the third year or before, with most students settling on a choice by early fourth year. Applying for residency and interviewing can provide further clarification and confirmation, but some students figure out during the process that they are interested in pursuing a different field. This includes students who applied to multiple specialties and at some point choose one and to students who change their mind due to clinical or life circumstances during fourth year. Often, these students feel strongly about their choice, since it has been made with more time and experience. Interviews can be particularly useful for choosing a specialty, especially for students who dual-applied, because it becomes clear which training programs are more appealing when comparing them head to head.
The medical students who didn’t initially dual-apply but change their mind tend to do so for a variety of reasons. Most commonly, I’ve observed, it’s due to a change in values or simply a realization that the chosen specialty is not the right fit. Clinical experiences are often pivotal in this decision, which reaffirms the importance of strong clinical rotations at the beginning of fourth year, especially if any doubt remains about one’s specialty. The students who decide to switch may be able to re-submit ERAS applications for a new specialty and are often able to call programs and explain their situation, with variable luck on acceptance for interviews and ranking. This depends on timing. If early in the cycle (e.g. September or October) then interviewing at enough programs to Match is reasonable; changing later in the year makes this more difficult, but not impossible. If it doesn’t work, students may wait a year and take further clinical or educational work in their newly-chosen field, then re-apply to the new specialty. (This is similar to students who do not match in a chosen specialty and would still like to pursue that specialty; see below.)
Match Day and Last-Minute Changes
For many medical students, March of senior year is one of the most important months of training. After years of preparation, application, and hypotheticals, certainty finally arrives in the form of a Match. (Note: this doesn’t always happen in March – some specialties follow a different schedule and osteopathic students often follow a different schedule as well. The process is otherwise virtually the same.) Match Day is the time when students find out where they will be completing residency training, without which a graduated medical student cannot practice medicine in the United States. This is an exciting day for most students, but each year many students go ‘unmatched’ – they do not match at any of the programs they ranked, and they must instead enter the Supplemental Offer and Acceptance Program, or SOAP. From this program, many students do ultimately match at a training program, but it may not be in the student’s original chosen specialty. These students may find themselves “choosing” a specialty which was not their first choice, but which enables them to match and continue with residency training. Often, these students are satisfied with their chosen field, focusing on factors which allow them to be the type of physician they hoped to be. (What kind of doctor a student wants to be only partially has to do with specialty, as I wrote about here.)
Unmatched students have options beyond the SOAP as well, if they choose to wait and reapply the following year. This is a good option for students who have a clear and fixable reason for not matching and are strongly committed to a chosen specialty. Students are statistically less likely to match the second time around, but every year many students do it successfully. For more information and tips for students in this position, check out the articles here and here.
After Graduation – Career Changes as a Practicing Physician
What about the matched and graduated students who feel they have made a wrong choice? Again, there is a story and example for everything. I have worked with several residents who completed an intern year, only to determine they are unhappy in their chosen field for any number of reasons. These residents usually reapply to programs in different specialties and are able to complete their training and practice in their newly chosen field. I have also known attendings who have practiced in a field before deciding to pursue a different area of training, willingly re-entering residency or fellowship to find the right specialty for them. In some cases, there are accelerated programs that allow physicians to change specialties, but these are becoming less common.
One OB/GYN, with whom I worked prior to medical school, had originally trained and practiced as a family doctor. After five years, he missed delivering babies and working in the operating room, and decided to go back to training. He had a better perspective on his choice after actually practicing in the field and really determining why he was making his choice. I asked him about the hard choice of going back to residency after finishing training. “I don’t consider it a hard choice now,” he said. “I’m in the right field and I’m happy. That’s better than doing something I didn’t enjoy, and it’s worth the extra training.”
The point of all this is to demonstrate that not everyone fits neatly into the typical timeline, and although it may seem unthinkable, it is possible to choose a specialty at a different pace. The system is not set up for this to be easy, but if there is another way to do it, it has almost certainly already been done. The physicians I’ve spoken with who changed fields were unanimously happy with their choice. In a field that forces so much delayed gratification, it may be unthinkable to delay even further. However, satisfaction in a career by being in the right career is ultimately more important.