How to Pick a Medical Specialty Without Getting Brain Freeze

  • /Reviewed by: Amy Rontal, MD
  • Picking a specialty is hard as hell. You thought that the big decision was made – you are in (or about to go to) medical school, ergo, you will be a doctor.

    But the next big question at hand – what kind? How will you know if you are deciding right? Or choosing wrong? Because you work so hard and do so much complex thinking all day, here’s some food for thought in a simple DOs and DONTs format for your reading pleasure.

    DON’T pick based on the basic science.
    DO pick based on the day-to-day.

    I received this piece of advice from an esteemed Radiation Oncologist at my medical school. During career night, where students nervously mingle amongst attendings across all specialties, everyone was giving the same advice – the trite “Do what you love” that I am going to obligatorily mention at the end of the article. But a great insight was bestowed unto me by this attending.

    Let’s say you were a physics major, and you adore particle physics. Nothing gets you as excited as the spin of electrons and the basic science behind brachytherapy and gamma knife radiation. If, for whatever reason, you cannot sublimate the grief of treating cancer patients and their sometimes negative outcomes, then radiation oncology probably isn’t for you. If sitting on tumor boards and planning palliative radiation treatments for patients sounds miserable to you, then despite your fascination with the science, you should find a field where you find more enjoyment in the day-to-day.

    Maybe you love anatomy, abdominal pathologies, and trauma assessments, but can’t stand the OR. Surgery should not be in your differential. Think about (and talk to attendings and residents in the field to get a sense of) what their every day is like, and ensure it gels with your desires. If you love waking up early and can’t be outside the OR, then surgery or anesthesia might be right for you, even if your knowledge of vasculature or pharmacology is a little weak at this point.

    DON’T worry about board scores being “too high.”

    So you have the fantastic problem of having crushed boards. You are sitting in the 97th percentile, your grades are great, recommendations flawless. You could literally call your shot of what field you want to pursue, and easily match to a competitive program.

    But you want nothing more than to be a rural family doctor, delivering babies, handling emergencies, excising moles, talking contraception, and managing diabetes medications.

    Your desires are infinitely more important than your board scores. Don’t destroy your dreams because the chance of something more competitive is possible. A “more competitive” specialty doesn’t translate to a “better” specialty for your happiness.

    DO be realistic regarding your chances.

    If you are in the more common, tighter spot of board scores being lower than desired, then it does pay to do a reality check, and not put all of your eggs in an unattainable basket. With marginal test scores, below-average grades, and no demonstration of commitment to the field, it will be exceedingly difficult to match into orthopedics, ahead of the die-hards with stellar applications. While the advice to follow your dreams holds true, you absolutely must have a back-up plan. Ergo, if a competitive specialty is your dream, regardless of how board scores go, it is up to you to demonstrate dedication to the field, with research and any possible involvement you can. Earlier is better.

    DO consider the road ahead and how it fits into your life schema.

    This is a tough tenet that not everyone might agree with. One might say “If you want to be a neurosurgeon, forget about everything else in life and do what it takes (7 years of incredibly demanding training) to become one.” But what if that’s not in the cards for you? What if your spouse and child need more from you than a neurosurgery residency would allow? What if supporting your family of 5 on a resident salary for the better part of the next decade is entirely untenable without causing major strife at home? It is up to you to figure out what you can afford from a time and monetary perspective, and if you owe any of that time to anyone else. If you don’t have any serious ties or obligations, and the road ahead looks clear, by all means forge ahead with whatever your heart tells you to do.

    DO consider the financial aspect of things, but DON’T get hung up on them.

    Due to our societal norms, talking about compensation is generally vilified, especially in medical school. But it is an important thing that is involved in almost every decision that we make. It is important to have a look at your financial health, and make a decision that makes sense for you, especially if it is up to you to provide for a family. Please don’t misconstrue this or take it out of context; I’m not advising you to “go for the money.” But in the example above, if you and your spouse already have tons of loans, can you afford to defer your attending salary for 7 years, and put food on the table without causing yourself an inordinate amount of stress? Yes, the financial windfall will eventually arrive as you skyrocket into the 1%, but will a decade of mental turmoil be worth it?

    Your actual desires are far more important than the dollars and cents. Choose with your heart and not your balance sheet. But don’t dismiss the financial aspects of every decision you make, just because people don’t like to talk about it.

    DO what makes you happiest.

    Yep, there it is. You knew it was coming. The most common wisdom from the largest number of attendings has always been to do what you love. As you are going to spend the better part of your time and life devoted to a field, you have to enjoy it to maintain a decent quality of life. Go for whatever makes you happy, and what you think will continue to make you happy for years to come.