In a future doctor’s life, there are fewdecision as important and nerve-wracking as deciding on a specialty.
Everything from your life during medical school, to your life in residency, to your life beyond residency are all dramatically influencedby this singular decision.
How much money will you make? How much time will you have for your family? Will you be burned out and miserable or will you love what you do? This is how you should go about choosing amedical specialty.
We’ll cover the thought processes and practicesyou should go through to ultimately land on a specialty that is best suited for you.
But an important part of the decision making processis hearing from other doctors and learning what drew them to their field, what they loveabout it, and what they wish they did differently.
For that reason, we’ve started an all newseries called The Insiders Scoop available exclusively on the Med School Insidersblog, where we highlight individual doctors across various specialties.
If you’d like to receive updates any timea new specialty is featured, be sure to subscribe to our newsletter at MedSchoolInsiders.
Data from a 2018 survey conducted by the AAMC on medical student specialty choice revealed that over the course of medical school, mostmedical students change their preferred specialty.
Only a quarter of respondents indicatedthe same specialty between matriculating and graduating.
And I can identify with that statistic.
I initially started medical school wantingto go into pediatric gastroenterology but I ultimately switched to plastic surgery.
I go over that journey and the process thatled to my decision in a video on my vlog channel.
Link in the description below.
Interestingly, students that had the highestrate of congruence, meaning they did not change their specialty, chose orthopedic surgeryat 50.
2%, pediatrics at 42.
9%, and neurosurgery at 35.
I’m not quite sure what to make of thosenumbers.
What do you guys think? Let me know down in the comments below.
We now know that the specialty you decideon has tremendous immediate as well as long term ramifications on your life.
We also know that most medical students endup changing their mind over their 4 years in medical school.
So where do we go from here and how can wecreate a system to decide on the best suited specialty for ourselves? Most commonly, people refer to compensationas a significant factor to help sway your decision.
I don’t blame them, particularly when medicalstudents graduate with close to $200, 000 in debt.
I’ve covered the top paid specialties ina previous video, including the factors that lead to certainspecialties being highly compensated and others less so.
Link in the description below.
While compensation is important, I would arguethat most physicians are quite comfortable, and compensation differences between specialtieswill be far less important than other factors in helping you lead a happy and fulfillinglife.
Therefore, compensation should NOT be a primary or even secondary factor inmaking your decision.
Other, more important factors to considerinclude what type of relationship and interactions you want to have with your patients, the work-lifebalance you desire, how much or little you enjoy performing procedures, the typesof patients you generally work with, and who your colleagues will be.
Does the specialty excite and captivate you? Can you imagine doing this for the rest ofyour life? Often times, medical students fixate on rarecases or procedures that are particularly exciting in their field.
However, it’s important to remember thatthese zebra cases are few and far between.
More importantly, determine whether or notdoing the bread and butter, meaning the things you are more likely to see day afterday, is something you can actually live with.
We’ll now cover a systematic approach to help you narrow down a category or group ofspecialties for you to deliberate on.
First, what organ system or clinical questionsdo you find the most exciting and stimulating? If you enjoy pharmacology and physiology, anesthesia may be a good fit for you.
If you love anatomy, like I did, then considera surgical specialty.
If you are fascinated by the brain and howit works, then neurology or neurosurgery are appropriate considerations.
Next, assuming you plan to practice clinically, do you want direct patient care or indirectpatient care? Indirect patient care would include specialtieslike radiology or pathology.
Direct patient care would include most everythingelse.
Next, assuming you want to have direct patient care, determine whether you’d like a primarilysurgical practice, where the operating room is the focus of your day-to-day, or a primarilymedical practice, where procedures are relatively rare.
Surgical specialty examples would includegeneral surgery, plastic surgery, orthopedic surgery, and the like.
Medical specialties include internal medicine, pediatrics, psychiatry, family medicine, and other less procedurally focused specialties.
On average, these medical specialties emphasize patientrelationships and clinical reasoning, but will often require a high degree of patience.
You can also opt for a middle ground, likeurology, dermatology, OB/GYN, or anesthesia that allow for a mix of both.
Another important consideration when answeringthis question is the level of patient contact and continuity that you prefer.
Do you enjoy talking to patients and forminglong-term relationships? And if so, internal and family medicine provideample opportunity.
Or do you prefer brief and efficient patientinteractions? If so, emergency medicine, anesthesiology, and manysurgical specialties are better suited for this preference.
Now when I first started medical school, I rememberthinking that work-life balance wasn’t important.
This is a common sentiment amongst pre-medand medical students.
However, by the time you reach the end ofmedical school and have been put through the wringer, you begin to realize how importantlifestyle is.
It’s easy to simply correlate challengingor unpredictable work hours with higher rates of burnout, but it’s more nuanced thanthat.
On average, surgical specialties have muchmore challenging hours than non-surgical specialties, but the burn out rates are not necessarilyhigher in surgical specialties.
The 2019 Medscape National Physician Burnout, Depression, & Suicide Report provides data on the burnout rates acrossvarious specialties.
The highest rates of burnout are found inurology at 54%, neurology at 53%, physical medicine & rehabilitation at 52%, internalmedicine at 49%, and emergency medicine at 48%.
The lowest rates of burnout were found inpublic health & preventive medicine at 28%, nephrology at 32%, pathology at 33%, ophthalmologyat 34%, and otolaryngology and plastic surgery at 36%.
Factors that were cited as most contributoryto burnout include too many bureaucratic tasks, such as charting and paperwork, at 59%, spendingtoo many hours at work at 34%, and increasing computerization of clinical practice at 32%.
An often understated yet highly importantfactor is determining the type of patients and the outcomes you are most comfortablewith.
Entering my surgical rotations, I felt drawnto neurosurgery given my interest in anatomy and love for neuroscience, which is what I majoredin.
However, the surprising lack of precisionin neurosurgery, but more importantly the poor outcomes of neurosurgery patients, turnedme off from the specialty.
Consider the typical patients you will encounterin your specialty of choice.
The types of patients and interactions emergencyphysicians face on a daily basis is far different from what the average pediatrician or orthopedicsurgeon would face.
Lastly, there are a few considerations you should keep in mind, although these will likelynot be as important as those previously mentioned.
First, assess your own skills.
While most skills can be learned, there’salso some benefit to playing to your strengths.
On average, we enjoy things we’re good at.
If you’re a klutz and particularly uncoordinated, then procedural focused specialties may not be a good fit.
Next, consider the competitiveness of a specialty.
If you’re barely managing to get by in medicalschool, then the chances of you matching into something like plastic surgery may be relativelyslim.
That being said, I’m a firm believer thatthe majority of one’s performance in college or medical school is dictated by their studystrategies, habits, and systems.
If you’re struggling in college or medical school, ourteam of exceptionally qualified and effective tutors at MedSchoolInsiders.
com can help youturn things around.
We stand for results at Med School Insiders, and our tutoring is a perfect example of this.
Third, consider what type of activities you’dlike to engage in outside of clinical practice.
Research, teaching, policy work? In most cases, this preference is more importantin determining your practice type, meaning private practice vs academic vs community, rather than your specialty choice.
Addressing the previously mentioned questionsshould do a good job in narrowing down your specialty of choice.
You now likely have only a handful of specialtiesthat you’re considering.
But prior to pulling the trigger and committingto one, however, it’s essential that you get clinical exposure.
If it wasn’t for gaining clinical experience, I would not have realized that gastroenterology was not a good fit for me.
Make sure you shadow attending physiciansin your areas of interest as much as possible.
Specialty clubs and talks from physiciansacross various specialties are also a great way to gain exposure to different specialties.
And our new series, The Insiders Scoop, is another great way to gain insight in a particular specialty.
Link in the description below.
Once you’ve decided, the next step is makingsure you match into a desirable residency program in your specialty of choice.
For this reason, it’s essential that youmake your residency program application as authentic as possible.
Don’t fall into the trap of researchinga specialty and finding one you love, only to submit a residency application that sounds toosimilar to your colleagues.
The personal statement, letters of recommendation, and soft parts of your application are just as important as your USMLE Step 1 and Step2CK scores.
If you need help with your residency application, our team of advisors with real residency admissions committee experience can help.
com to learn more.
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Thank you all for watching, let me know ifyou have any additional questions, and I will see you guys in that next one.