Author: Dr. Rohini

What Specialty Should I Choose? Which Specialty is The Best? How do I Choose My Specialty?

One of the most significant decisions a medical student will make is choosing of specialty for practice.  In a doctor’s life, there are few decisions as important and nerve-wracking as deciding on a medical specialty. The choice of specialty can impact a person’s life and influence every aspect of their life such as training duration, future pay and lifestyle.  

Many factors go into this decision making including individual strengths, personal goals and preferences, clinical interests, experience during rotations, length of training, earning potential and lifestyle considerations.  While all of these factors are important, ranking the decision-making criteria will ultimately depend on each individual’s priorities.

Unlike other professions, changing a medical specialty is an ordeal. Though it is not impossible it would require additional years of training.  It would be easier to make the right choice early.

While some medical students know/decide the specialty early on in medical school, most weigh their options over time and choose a specialty they are passionate about.  Some decide after completion of their preferred rotation.  There are some who change their minds several times before choosing the right specialty.

Factors to Consider When Choosing a Specialty 

A lot of medical students find it difficult to decide on the specialty that is best suited for them. Rather than being overwhelmed, here are some factors to be considered to help narrow down selection when choosing a specialty.

·     Curiosity and Interest

A doctor is likely to practice medicine for over 30 years. Hence, it is essential to think about the future and choose a specialty that you find interesting and can enjoy doing for rest of life / retirement.  The topics that you find yourself reading out of interest and curiosity is the most important of them all. Determine if a specialty excites and captivates you, and the day to day demands and procedures are something you can live with.  Consider what causes stress or boredom.  Pursuing a specialty that one has no interest in is likely to lead to disheartenment and burnout soon.  

• Skills and Strengths

An in-depth and truthful analysis of strengths, weaknesses, abilities, likes and dislikes will give an insight about the specialties that are most suitable for a person.  Specialties that match an individual’s skills and strengths would prove invaluable. A clinic setting would be suitable if one is predominately a people person.  Surgical or procedural specialty may not be suitable for a person who is clumsy with their hands. Avoid pursing a specialty because of its prestige or earning power.

• Surgical, Medical, or Mixed Preference

What a person enjoys and what they are good at go hand in hand. Hence it can be helpful to reflect on the subjects and rotations that one enjoyed the most during medical school. Consider how much or how little you enjoy performing procedures. Decide if you’d like a surgical practice where the operating room is the day to day focus or a medical practice, where procedures are relatively rare. One can also opt for a specialty that allows for a mix of both practices. 

• Lifestyle

Consider how each specialty may affect individual lifestyle goals. If lifestyle goals include spending ample time with family, travel, hobbies and sports, a specialty that is less stressful, having predictable working hours and rare emergencies is an ideal choice.  If a person is ambitious, is career driven and love the adrenaline rush in high-stress situations, a surgical specialty might be ideal.  

• Length of Training

Length of specialty training varies from 3 to 7+ years and depends on the choice of specialty.  Specialty training usually occurs between mid- 20s to early 30s, which is an important time of life when people start families, lifelong investments etc. If those things are important to you, you should think long and hard about choosing a specialty that required lesser training period. 

• Direct Vs Indirect Patient Care

While most people love talking with patients, examining them and providing direct care, some find interacting with sick people less appealing and may want to provide indirect patient care working behind the scenes. Indirect patient care would include specialties like radiology or pathology. Direct patient care would include almost every other specialty. 

• Level of patient involvement 

Study the typical patient population in the specialty you are considering and decide if you could thrive professionally in that type of patient-doctor relationship.  If one likes long-term relationships internal medicine and family medicine provide ample opportunities. If one prefers limited interaction emergency medicine and many surgical specialties are better suited.  One can also choose no patient interaction by becoming a researcher or faculty.

·     Expected salary

Often people consider potential income as a significant factor when deciding on choice of specialty. To help calculate future income, consider the cost of education, amount of loans, desired lifestyle, cost of living in desired area, and future financial goals. Keep expected salary in mind, but this should be a small consideration but not the primary consideration. Compensation differences between specialties will be less important than other factors for a fulfilling career.  If one can practice the specialty that they like as well as make the money they desire, that’s the best condition.  

·     Work environment

Some people enjoy the comradeship that they experience while working on medical teams. Some like to see their patients without the effort of others.  Consider the specialty that best suits your personality and needs.

• Physical limitations

Consider the physical limitations that would rule out certain specialties. Strength and stamina are necessary for some specialties but less so for others. Physician who can set their own working hours may need lesser physical stamina as compared to surgeons involved in long complicated surgeries.

• Social expectations and prestige 

The idea that any one specialty brings in more respect and prestige than another is just a personal attitude.   By setting aside external influences such as social prestige, other’s expectations and other’s view of your chosen specialty, you are likely to choose the right specialty suitable for you and be a happier doctor. 

Approaches to Choosing a Specialty 

There are different approaches for choosing a specialty. Some medical students project themselves into hypothetical career roles to choose their specialty. Some prefer to choose through the process of eliminating specialties that do not meet their predetermined criteria. Others choose based on their performance in examinations, which can indicate of how competitive they are for a specific specialty.   Regardless of the individual approach, all medical students should consider the above factors when choosing a medical specialty. 

Narrowing Your Options

Make a list of all suitable medical specialties. Cross off all the specialties that don’t appeal to you. After much deliberation, narrow down to a handful of specialties to consider. Ensure to research all specialties of interest and begin early. Rely on specialty program data for guidance, facts and figures.   Talk to people in the specialty you’re interested in and ask them about employment prospects, remuneration, working hours, vacation days and lifestyle. Get your own information and don’t rely on hearsay or gossip.

Choose based on your location

Choose your specialty based on the scope in your country of practice. If you are in India, don’t go by feedback from doctors in the west. For example, ENT is a great specialty in the US and one of the highest paid, whereas it is one of the worst specialties to pick in India because the pay is low and the job opportunities are almost nil. Are you going to settle in a tier 1/ tier 2 / tier 3 city? The scope of each speciality will vary based on that.

Choose based on how your prospects would change in the future with the rapid development of digital health and AI.

For example With AI coming up, AI will shake things up when it comes to jobs for doctors. The job scenario is already bad, it will become worse in many specialities, like radiology, internal medicine etc. check out the article: Will AI replace Doctors?

If you have a parent in the same speciality:

Blindly choosing the speciality one of your parents are in is probably THE BEST DECISION you will make for yourself. There are no jobs, it is impossible to find mentors, impossible to get hands on and almost impossible to start your own practice in today’s times. So if you have doctor parents or at least one doctor parent, choose a speciality they are in, it will make life easier. First generation doctors are really struggling.

SALARIES: HOSPITAL SALARIES OF ALL SPECIALITIES ARE THE SAME

Confirm Your Decision 

After you narrow down your specialty choice, confirm your decision.  Prior to committing to one, it’s essential to get clinical exposure as it’s possible to have misconceptions about specialties that one has not experienced first-hand. Internship provides medical students the opportunity to explore different specialty areas through structured rotations.  However medical students should also seize the opportunity to shadow doctors as often as possible to explore different possibilities. 

Get as much experience as possible of prospective specialties. Get involved, ask questions and seek advice from mentors. An important part of the decision process is learning from other trainees and consultants from the specialty you are interested in, what drew them to their specialty, what they love most about it, and what they wish they did differently. 

Selection of a specialty should be one’s own choice.  Don’t blindly pick a specialty based on someone else’s desires or to follow in someone else’s footprints. However, it will help to talk to people. The economy is dynamic and changes rapidly, so when you seek advice, seek advise from doctors who are are five to 10 years older than you since their advice would be more in tune with what is recent and the situation you would face. 

Remember, choose wisely, you are stuck with your specialty the rest of your life and switching is not going to be simple – but not impossible.

RESEARCH RESEARCH RESEARCH!