How to decide on a medical specialty

Pre- Clinical Years

In my own experience, it’s hard to know for sure what you enjoy prior to clinical rotations, but I do think you can start to get a sense of it during the clinical years.

1. If you are in the hospital for any ‘physical exam skills’ or ‘clinical skills’ type course, you can start to get a sense of which departments you enjoy being in most. You’ll also be able to talk with different faculty members about their specific job during these experiences.
2. Pay attention to what topics you most enjoy studying – which patient cases seem the most interesting? This doesn’t always directly translate to what you’ll enjoy in practice, but it’s helpful to keep a running list of the topics you most enjoyed studying.
3. Shadow in departments you may be interested in during the pre-clinical years! Faculty are generally very happy to allow medical students shadow, sit in on surgeries, etc! Take notes on your observations – not so much the details of what you learned, but about culture, what people say about their specialty, what it looks like the majority of the time is spent doing, etc. That said, recognize that during shadowing, you won’t see all the hours of paperwork involved. The attending or residents will send you home when the interesting parts are over and then they’ll write all the notes on their own.
4. Talk to faculty in various specialties about their work, their research, and how what they do fits in with their life overall.

Clinical Rotations

This is really the time in which you’ll make your decision about what field you want to enter because you’ll be in the hospital all day, 5-7 days per week. If you don’t make a final decision, at the very least, you’ll narrow it down to a few different fields you could be happy entering.

1. During each rotation, write down how you feel about the types of cases you’re seeing, the patients you’re interacting with, the residents and attendings you’re learning from, the culture, etc. Write down the specifics about what you enjoyed and disliked about the day to day work in that given specialty. I did this for every single rotation, and found it helpful to look back on.
2. Pay attention to the residents you are working with and whether you get along with them or not. Think about the attendings and how your personality meshes with theirs. Look at how close the residents are with one another. All of these things contribute to the culture in a given specialty. Culture does vary significantly from one institution to another, but it’s still worth paying attention to.
3. Lifestyle is important (to most people), so pay attention to what it looks like the work life balance is in each specialty you rotate through. Residency is temporary, and for pretty much every field, there is less work-life balance as a resident than as an attending. Get a sense of how the residents are feeling and what they believe the challenges and benefits of their specialty are. Beyond that, pay attention to the attendings’ lifestyle and apparent job satisfaction. Do they seem to have a lifestyle you would want 10 years down the line? Disclaimer- I’m not trying to push anyone to focus on lifestyle or work-life balance if that’s not a top priority to you. And if you find a field you truly love and enjoy, you may not even care about work-life balance anymore. For most people, though, I think it’s a factor to consider.

Narrowing Down / Making a Decision

If you’re stuck between two or more choices, doing a sub-internship / acting-internship is a great way to get more information and make a decision. I know that’s fairly obvious information, and of course you don’t want to do way more sub-internships than necessary since they are a lot of work. I only did one sub-internship because I was only considering one field, but I learned so much more about that field and the work flow through the sub-internship than through the clerkship/rotation as a third year! If you’re deciding between multiple fields, I think you pretty much have to give yourself a fair shot at both fields by doing multiple sub-internships.

I’m no expert, but I do think that it’s important to consider two things heavily when making a decision. The first is to evaluate how much you enjoy the ‘bread and butter’ of the field- i.e. identify what you will spend most of your time doing and make sure you would be happy doing that day in and day out. I’m sure no one enjoys the paperwork and notes aspect of medicine too much, but besides that, do you enjoy the people, the patient demographics, and the common issues?

Second, I feel like it’s risky to assume you will 100% be able to sub-specialize. I think you should plan to enter a field you’d be reasonably happy being in assuming you have to be a generalist- whether that’s an internist, a pediatrician, a surgeon, etc. Assume that there may be a chance you either don’t match into a fellowship, have unexpected family obligations arise and maybe can’t relocate for fellowship, have financial obligations arise that require you to start working as an attending rather than as a fellow, or that you might change your mind for any other reason.

Say you enjoy procedures and you’re deciding between two options like general surgery and cardiology (which can be fairly procedural), but you’d hate working in internal medicine if you didn’t get to do cardiology. I feel like in that sort of situation, you’d be banking on getting into fellowship since doing cardiology REQUIRES that you match into fellowship. I personally would find that a bit of a risk and would probably encourage choosing general surgery. I know it’s not that simple, but I’m fairly risk averse and would think the decision through in that way. But then again, who am I to even give advice on this topic since I’m not going into general surgery OR internal medicine!

Thanks for reading and I hope this was helpful! If you have any additional tips, please drop them below in the comments- I always love hearing from you guys!

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