How To Determine Which Area of Medicine Is Right for Me
Choosing an area of medicine or a specialty is one of the most important decisions you will make throughout your entire medical career. And so you may find yourself asking “Which area of medicine is right for me?”
Unlike most other professions, you cannot switch to a different area of practice after committing to a particular path—at least not without repeating several years of training. Thus, it is wise to think carefully about all of the features of different specialties and make a fully informed choice when appropriate. But what are all of these features? How do you figure out what is important, and how do you know whether you’ll value these criteria the same 20 years in the future?
Here we demystify the process of determining which area of medicine is right for you. We will review all of the factors you should consider when making your decision. Note that this is a highly personal decision. Your decision-making process should be individualized. However, some broadly applicable guidelines and considerations will help you make this important decision.
Overview of the Physician Training Timeline
It is important to keep the training timeline in mind. This way, you are aware of key milestones for making your decision or rather advancing towards it. Depending on your current stage in your education, your values, priorities, and goals will differ. For example, as an undergraduate, you should be thinking about whether medicine is the right career path for you. If you can’t see the appeal of any area of medicine, at least for physicians, then perhaps a different career path (in healthcare or otherwise) may better suit you.
Alternatively, you might be set on medicine but are also interested in research or business. In this case, you might be thinking about dual-degree programs. You may be considering if you should go into a DO or an MD program. Compare these considerations with those of an internal medicine intern, who might be thinking about sticking with primary care vs. applying to fellowships to subspecialize.
The general timeline starting from medical school goes like this: Complete preclinical years, paying attention to which areas of medicine are most interesting intellectually. Shadow, do research, and network based on your preliminary interests. Then complete clinical years (perhaps with a research year in between, depending on the competitiveness of the specialty you’re most interested in), including core clerkships, electives, and AIs. Consider away rotations for more competitive specialties (e.g., not necessary for IM or peds).
There are opportunities during M4 to explore specialties that fall outside the core areas of medicine experienced in M3. Once in residency, most specialties have opportunities to specialize through fellowships, which may require an application decision as early as the 2nd year (meaning you should be doing prep work during internship). Fellowship is the last step for most people, but certificates are available in many fields to further subspecialize or gain specific skills you want to use in practice
Medical Specialty “Hierarchy”: Key Decisions to Make Early On When Deciding “Which Area of Medicine is Right for Me?”
You may have heard that up to three-quarters of medical students change their preferred medical specialty at least once during medical school. It is an important decision and one to not make lightly. However, because there is a range of key decisions to make, it is best to start early. Key decisions to make include: Do you want to practice medicine or surgery, or perhaps something like radiology or pathology? Do you want to be a general practitioner or specialist? Lastly, do you want to work with adults, children, or both as your patients? Each of these decisions combines with the others to provide a more specific path.
Let’s say you want to practice medicine, value the role of general practice in the US, and enjoy working with patients of all ages. Family medicine may be the field for you. Alternatively, let’s say you discovered an interest in imaging, but want to focus on the brain and especially like thinking about neurology in children. This points to pediatric neuroradiology. Be aware, however, that openings for family medicine are far more numerous than pediatric neuroradiology. As discussed below, career opportunities and specialty growth should be factors you consider along with your core interests.
Personal Factors to Consider
There are various aspects of different specialties that will greatly impact your personal life. For example, do you want to live and work in a rural or urban area? If you choose a rare or more specialized area, such as neurosurgery, you will most likely be confined to working in a large academic medical center stationed in a large city. Alternatively, there is a massive need for family medicine physicians throughout rural America. Thus, your preferences for location and geographical flexibility are tied to the type of specialty you choose.
Next are the two features that everyone thinks of, sometimes first: salary and work-life balance. These are essential considerations as well. They should not be the sole or dominant factors, but things like how much you have in student loans, whether/when you want to start a family, and what your non-work life goals are interwoven with these considerations. Keep in mind that the areas of medicine which maximize both salary and work-life balance (i.e., fewer overall hours and flexibility in choosing hours) tend to be far and away the most competitive specialties. Think dermatology, diagnostic radiology, and the like.
Lastly is work culture. This should not be overlooked when you’re asking yourself “Which area of medicine is right for me?” Try to look beyond the broad stereotypes of fields. Instead, speak with a variety of mentors in the field. Read about the types of interactions they have with patients and colleagues. This will help you understand a field’s work culture more deeply.
Professional Factors to Consider When Choosing the Right Area of Medicine
A decision would not be comprehensive without careful consideration of the professional and intellectual factors associated with distinct specialties. First, think about your preference for inpatient vs. outpatient medicine. Do you like being in the hospital, or would you prefer an ambulatory setting? Many specialties in fact involve responsibilities in both settings.
Next is the training timeline. Do you want to finish school as soon as possible and start working immediately? Family medicine, internal medicine, and pediatrics are all three years, assuming no further specialization. Pathology, radiology, dermatology, and many others are four years. Conversely, cardiothoracic surgery and neurosurgery are seven years.
Another important point is that training paths differ in their order. For example, most pediatric subspecialties begin with a residency in general pediatrics followed by a fellowship (e.g., in cardiology). However, child neurology is unique in that it is a combined residency program that you must apply to directly. There are other exceptions in medicine like this; be sure to do your research early in medical school.
Next, think about what types of skills and patient outcomes you think will keep you motivated throughout your career. For some, the opportunity to think about concepts and learn pathways might be sustaining, whereas others may value physical skill/technique to be more interesting.
On a similar note, do you want to directly observe acute improvements in your patients (e.g., emergency medicine), or would you prefer to know that you are having a long-term impact (e.g., general pediatrics)? This also relates to the types of relationships you want to develop with patients. An area like EM allows you to see tons of patients only once. In primary care like pediatrics you may develop lifelong relationships with patients and their families.
Special Consideration: Research and Leadership Roles
For those who enjoy research and leadership/administration, certain specialties lend themselves better to these activities than others. For example, internal medicine is an excellent field for those interested in clinical and translational research. Infectious is a great field for more basic research, for example in molecular immunology. Additionally, health administrators and leaders of hospitals/departments are typically not hyper-specialized. Leadership often benefits from a broad understanding of medicine and healthcare, which is generally more applicable to general practitioners or those with a moderate level of specialization.
New, Obscure, and Undervalued Specialties
According to the AAMC, there are more than 160 individual medical specialties in total. Many of these are hyper-specializations within a narrow area of surgery or medicine. However, among this list are several specialties that are newer, lesser-known, or highly undervalued for a variety of reasons. Consider researching and/or asking a mentor about one of the following specialties, as something you didn’t previously find interesting or know was a specialty could turn out to be an excellent fit:
- Forensic pathology: examination of people who died suddenly
- Toxicology: prevention, evaluation, and treatment of people exposed to drugs, chemicals, and biological/radiological agents
- Preventive medicine: health promotion and maintenance for individuals and populations
- Sleep medicine: evaluation and treatment of sleep disturbances and disorders
- Lifestyle medicine: therapeutic lifestyle/behavioral interventions to manage chronic conditions
- Developmental-behavioral pediatrics: evaluation and treatment of children with unique developmental, learning, and neurological disorders (e.g., autism, ADHD, genetic conditions)
- Clinical informatics: management and improvement of data and technology used in healthcare settings, including electronic health records and decision support tools; a fast-growing field as AI and analytics become more prominent throughout healthcare
- Addiction medicine: comprehensive care for people with addictions and related substance use disorders
- Geriatric medicine: focused care on older individuals, including prevention and rehabilitation; increasingly important as the US population ages dramatically
Choosing a specialty is one of the most important decisions you will make in medical school. Fortunately, there are a plethora of resources available to you, including physicians and students who have recently gone (or are currently going) through the process. Ultimately, it is a highly individual decision that will be based on a combination of personal and professional factors.
For residency advising or 1-on-1 medical exam tutoring, consider enlisting the help of Elite Medical Prep! Schedule a complimentary consultation to hear more about what we can do to help you succeed!