HealthMay 01, 2020

When to choose your medical specialty

By: Heidi Moawad, MD

Choosing your medical specialty is a complex decision. You have to weigh a number of issues, including your interest in the work and the lifestyle of the field as well as job availability, income prospects and options for student loan forgiveness. Those factors take time to work through, and you shouldn't rush your decision.

Still, the question of when to choose your medical specialty can weigh heavily on you, and it's normal to worry about being "behind the eight ball" if your peers have already decided what they want to do. For most residency applicants, it's perfectly fine to take your time as you consider the different medical specialties throughout your medical school years.

But you can't spend too long pondering all these issues, since you do have a real deadline when it comes to choosing. For some specialties, making your decision well ahead of the "official" deadline is important, because you may need to build connections and start making a favorable impression as soon as possible.

When to choose your medical specialty

To apply for the Match in March, you'll have to send in your applications to residency programs during the fall of your fourth year. This is the deadline for when you have to choose your medical specialty.

When should you start the decision-making process? During your first or second year of medical school, it's a good idea to begin considering different specialties and shadowing doctors in a few different specialties that interest you. This can help you decide if a field could be a good fit for you. The earlier you start, the more time you'll have to weigh your options, and clinical rotations during your third and early fourth year rotations should help you decide for sure.

If you still can't decide in time for your residency application deadline, you can apply in more than one specialty. This approach makes the process more time-intensive, however, since you need to ask for multiple sets of recommendation letters. It helps to narrow down to one specialty unless you're unsure of your chances of getting into your first-choice field.

What to do once you decide

Once you decide on a specialty, it's important to learn about your future field and find out which programs you want to apply to.

For some very competitive specialties such as dermatology or neurosurgery, residency spots are limited. These specialties have traditionally been highly selective and usually place a strong emphasis on USMLE Step 1 scores. As this examination moves to pass/fail grading in upcoming years, it's difficult to say how the new system will impact students who are applying to highly competitive residencies.

It's likely that your letters of recommendation will play a greater role in your candidacy for residency, making connections with faculty more important than ever before. It's a good idea to get some shadowing experience during your first and second years of medical school so that you can make a better impression during your third and fourth year rotations.

What to do if you can't choose

Having a hard time choosing your specialty? This could actually be a good thing because it may mean you'd be happy with several different choices. Also keep in mind that building competence in something plays a strong part in whether you like it or not. According to Obstetrics and Gynecology, for example, the more exposure a student has to a specialty, the more likely they are to choose that field for the long term.

If you can't choose, take a moment and think about how you see yourself as a physician. Ask yourself the following questions:

  • Do you want to be a generalist or a specialist?
  • Do you want to care for acutely ill patients or patients who need health maintenance?
  • Do you prefer to do procedures or to write prescriptions?
  • Do you want to be a diagnostic expert, such as a pathologist or radiologist?

These questions can help guide you as you decide. If pathology or radiology sounds like a good fit for your personality, try rotations in those fields during your third year of medical school to figure out if that type of work suits you.

And if you know that you want to be a specialist but can't decide which type, consider applying to a three-year internal medicine residency, which is a prerequisite for most medical specialties (even interventional fields like gastroenterology). Or if you love outpatient primary care but want to be able to do procedures, consider family medicine, which is a field that gives you solid experience in primary medicine as well as the training to do procedures like Pap smears and deliveries.

Why you shouldn't stress too much

When I was in medical school, I often heard that each student needed to find the perfect fit as soon as possible to maximize their chances of getting into the perfect residency. Over the years, however, I've learned that it takes time to make the right choice. Whether you pick psychiatry or nephrology or radiology, you may realize many years down the road that you're better off concentrating on inpatient work, outpatient work or telemedicine within your own specialty.

I went to one of the top U.S. medical schools and my peers were highly sought after by prestigious residency programs, but I grew up in a community of foreign medical school graduates (FMGs), and my father is a foreign MD. I know many physicians who chose their specialty at age 10 and didn't have a choice when it came to residency specialty. They still had fulfilling, long careers in fields they never would have been in if given all the options.

Whenever you select a specialty that you would enjoy, you'll undoubtedly have to give up a few other things that you would have also enjoyed. Long-term career satisfaction is about making the most of your choices and options, not about looking back at the paths that you didn't take.

Heidi Moawad, MD
Lippincott® Medicine
Lippincott is a leading international medical publisher of professional health information for practitioners, faculty, residents, students, and healthcare institutions with a full suite of essential medical products, from books and journals to digital solutions.
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