The Pitfalls of Choosing a Medical Specialty

  • /Reviewed by: Amy Rontal, MD
  • We talk often about the important factors to consider when choosing a medical specialty or residency program. Less often, however, do we talk about the common pitfalls individuals encounter on the road to residency. Below, we explore some of the most prevalent mental, emotional, and social traps aspiring residents should avoid in choosing their medical major:


    In medical school you are surrounded by stories of trauma and sleep deprivation. In fact, it becomes one of the metrics by which social status is achieved. There are specialties that bring you clout, such as Surgery and Internal Medicine. It is also common to hear these same specialties referred to as “real” residencies. You spend your Medical School Career with the mindset of pleasing people, from the residents on service to attendings from whom you hope to receive letters of recommendation. It is easy to forget to reflect internally on what will make you happy, especially when it may not gain the desired response from those around you.


    It is taboo in Medical School to say you are not interested in a specialty because of the hours or volume of call. It is easy to lose sight of what we embarked on this career to achieve — helping patients. Even if you are naturally gifted in a specialty, if you end up resenting your job, you will not be a strong healthcare provider. At 3am, when you are admitting a patient to the hospital or removing an appendix, you have to be completely invested in your patient without a strong urgency to simply complete the task and be relieved of your duties. It is good to know your strengths, but even more important to be honest with yourself about what will make you happy. A happy and passionate provider is what every patient deserves.

    1. FORGETTING THE “Bread-and-Butter”

    As medical students we were diverted toward the “zebra” cases and away from the “bread and butter.” This was great for solidifying obscure information that would be tested on the USMLEs and much more interesting than the 9th case of influenza. However it is a dangerous practice because we aren’t exposed to what the specialty honestly looks like as an attending. It is easy to fall in love with a particular niche of a specialty and lose sight of what your actual day-to-day life will look like. To be happy you have to pick a specialty where you like the “horses” too, because that is what you will spend the vast majority of your career treating.


    Most of the medical students I work with have 2 or 3 specialties they are trying to pick between. As scientific minded people we are trained to rely on data for all decisions. Thus, people make lists and devise scoring methods to decide between specialties. But in reality you can’t make this decision with numbers. No algorithm will be able to appropriately incorporate you passion for a field of medicine. If you put aside the numbers and, perhaps more importantly, other people’s opinions, you’ll more likely than not find that you already know what you are leaning toward. In all reality, more medical students aren’t exposed to enough specialties or subspecialties for a long enough period of time to make a definitive decision about how we would like to spend the rest of our lives. The best option is to tune out the noise, trust yourself, and follow your gut.


    Changing specialties after you have been working for years to tailor an application for a specific specialty can feel daunting and impossible. It is also easy to feel like you will disappoint your mentors when you change specialties. However, at the end of the day, all they really want is for you to be happy and it’s their job to guide you down the right path. I had a friend in medical school who last minute during 4th year, decided to change from Anesthesia to Ophthalmology. It was stressful, but absolutely the right choice for them.


    Personally, I didn’t realize (or really admit to myself) until I was a resident that I chose the wrong specialty. I felt embarrassed, guilty for leaving my co-residents short staffed, and overwhelmed by the idea of Matching again. All of these emotions kept me from taking action toward changing specialties for several months. Eventually I admitted how I felt and talked to my Program Director, who was supportive (as, again, their ultimate goal is to support you on a path to career success). Medicine is a demanding career and you are likely going to practice for a long time. Delaying your path to completion a few years is a small price to pay for enjoying the next 30 years of your life.