You get the phone call of your dreams: you’ve been accepted to medical school! Now nothing will stand in your way of becoming a physician.
It seems like your life’s path is carved out for you—no longer will you wonder, “What will I be when I grow up?”
Now you know. The big decision is behind you. With a sigh of relief, you embrace your future.
And then—just when you thought the decisions were over—you find yourself with a gauntlet of decisions to make!
You start wondering, “What school should I go to? Where should I live? What clubs and interest groups should I join?”
These small-time decisions come and go, until finally you’re left with the elephant in the room:
What do I choose for my specialty?
It’s a big decision. So how should you go about making it?
My advice? Don’t take advice!
You’ll get a lot of guidance on what specialty to choose. Some will tell you to chase the money. And while future finances should indeed weigh into your decision to some degree, it shouldn’t be the primary driver of what your future holds.
Others will chime in, “You don’t want to be on call.” But you’ll soon learn that almost all specialties have some element of call to them, some more onerous than others.
“Just do what you love!” you’ll be instructed. But what if the thing you love is unattainably competitive for your scores, grades, and extracurriculars, or doesn’t mesh with some of the other things you have planned for the future (family, frequent travel, coaching, etc.)?
The people around you probably have your best interests at heart, but there’s no way they can make this decision for you. And their advice—no matter how sincere—won’t help you make the right decision.
Pro tip: The day-to-day work is what really matters.
There’s no substitute for spending time in a chosen field, and seeing if you enjoy the day-to-day. If you love the day-to-day, you’ll find a way to connect all the other dots. And in experiencing the daily flow of a specialty, you might quickly learn that the quest for your chosen field is as much of a “rule out” process as it is a “rule in” process.
How I Chose A Medical Specialty: A Process of Elimination
To give you a sense of how this can work, here’s some of my own considerations throughout the years in various specialties. The moments that were deal-breaking in particular rotations, and other scenarios that made me think, “This is for me.”
Trial #1: General Surgery
As a whole, the rotation was tough, as expected. Everyone tells you it’s going to be. There will be exceedingly early wake ups, pre-rounding on patients, and seemingly unending work until past dinner time.
But the day that closed the door on general surgery for me was an extensive, eight-hour lysis of adhesions in a lady who had about seven previous abdominal surgeries and multiple complex fistulas.
I spent the entire surgery with my hands on the patient’s draped legs, while my fellow medical students came in and out of the room, informing the chief of the happenings on the floor, and eventually, setting sail for home.
I continued to stand, trying to keep some conversation with the residents and attending, while they worked on countless hand-sewn anastomoses. I was captive in one spot with nothing to offer clinically.
Now, more than a decade later, the day still stands out in my mind as eight wasted life hours, come and gone, never to return.
Trial #2: ENT
I’ve written before about my fascination with this field. However, after spending enough time in the OR, I came to learn it was a fascination and respect for my mentor in the field, more than the field itself.
The otolaryngologist who took me under his wing was an accomplished surgeon, was amazing with his patients in the clinic, and was a research powerhouse, organizing dozens of projects across all levels of residents, fellows, and medical students. He somehow had time for everyone.
I told myself, I want to be like him. That must mean I want to be an ENT, right?
After I spent some days in the OR alongside him, I couldn’t take it. To me, we were watching screens of pink caves and slowly chipping away at tissue. Then we’d suction some blood and chip away some more nasal structures.
I’m sure my small medical student mind couldn’t wrap my head around the nuance of what he was doing. It was curing cancer after all. But the tediousness of the procedures made it completely unpalatable. I decided I would find a way to carry the qualities of my mentor to a different field.
Trial #3: Emergency Medicine
While I really enjoyed the day-to-day of this specialty, my life became a blur. The two days, two nights, and two off schedule over and over again made it nearly impossible for me to “catch up” on life. I always felt like I was treading water, and spent my time outside the hospital just trying to adjust instead of actively living my life.
I appreciated the traumas that came in, the algorithmic decision-making, and fast action necessary to thrive. But the nature of the ever-changing shift work was a complete deal breaker for me.
Trial #4: All Things Clinic (Family Medicine, Pediatrics)
Any specialty that had a large office setting component didn’t gel with what I was looking for. I realized my home was at the hospital. That’s where I could work on the most complex cases and reach out to specialists in multiple fields in order to take care of patients. I liked being in a large building, covering a lot of ground, and seeing lots of coworkers.
Trial #5: Internal Medicine
Ah, the purest of specialties, combined with the allure of hospital work. Would this be the one for me?
While I did enjoy the holistic approach to the patient, and getting to move all around the hospital, I couldn’t believe the amount of time I would spend sitting at a computer, reading notes, writing notes, placing orders, writing notes, checking labs, and then writing more notes.
I wanted to be closer to the front lines and spend more time with patients than could be achieved with a list of 15 patients. Combined with the time in front of a screen, I had to pass.
Trial #6: Anesthesiology (& Why I Chose It!)
Day one, I’m placing IVs. I get called to PACU and get to help with a post-op nerve block. Then I’m off to a cardiac OR to see the fine interplay of anesthesia and perfusion during cardiopulmonary bypass. Next there’s a call from the labor floor. I need to head up there and watch an epidural. Then I intubate and take care of this patient for the next couple hours.
It had everything I was looking for. I was in the hospital, and even better than that, the OR, where I feel most at home.
I never had to step foot in a clinic, and while I had to write procedure notes and preops, it wasn’t dominating my day.
I could think about things and then execute them on the fly. The work was mostly in the daytime, but the occasional overnight call was manageable. I liked all the people I was around, and I loved staying on my feet and keeping busy and dynamic all day long.
All in all, it just felt right. I loved the day-to-day of anesthesiology, so that’s the specialty I chose!
Final Thoughts
Along the way, you’ll have experiences in certain specialties that lead you to say, “No thanks.” And there will be others you have an ineffable attraction to. Try to experience as much as you can during your medical school rotations. And develop a sense of what each field is like on a day-to-day basis. If it fits, and is attainable, then you’ll know it’s time to go for it!
Looking for more of a clear breakdown and side-by-side comparison of each medical specialty? Find your path in medicine with the FREE Medical Specialties Breakdown Guide! Go beyond the data with qualitative insights from residents, practicing physicians, and med school tutors who have been in your shoes.
Or check out these other posts on the blog to help you pick your specialty:
