Choosing a medical specialty is frequently a stressful experience. Many students start medical school with a fixed expectation of what they will be interested in. Without fail, a large number of these students drastically change their mind during the four years of medical school. As you experience a variety of specialties you see different lifestyles, cultures, tempos, and proficiencies. Not only are these experiences dependent on the field, but also the individual programs and physicians you work with. It’s easy to love a specialty when you work with a gifted educator, and just as easy to dislike a specialty based upon a malicious program or individual. Yet dismissing an entire field based on a single interaction could prevent you from matching into a field which you may thrive in.
If you are not familiar with a specific field, or you enter medical school loving absolutely everything, it can be exceptionally difficult to narrow down all the different exciting specialties. The first step to picking your specialty is to shadow a variety of physicians; surgeons, family practitioners, hospitalists, psychiatrists, etc. Even if you have already started medical school, it’s difficult to know what is available without experiencing a wide variety of situations. The goal is to experience as many different fields and settings as possible. This may sound difficult, but once you shadow one physician, you should ask them to recommend one or two other doctors who may be open to shadowing. I recommend starting with your own family doctor, or if you are in medical school start with a faculty member. Once you’ve spent a day or two with them, ask if they have any recommendations for other physicians in different fields. You may be able to get two or three recommendations from each doctor, and since they were personally recommended, will undoubtedly provide a quality shadowing experience. If you aren’t in medical school yet, don’t forget to keep their contact information, you should put these experiences on your resume for medical school!
Once you have shadowed a wide range of specialties, you’ve probably found at least two or three that are appealing. I highly recommend spending a large amount of your free time actively researching these fields, as well as having prolonged shadowing experiences. Spending a few hours in the ER is completely different than spending a 12-hour overnight in the department, and it’s important to experience a specialty for a realistic amount of time. If possible, try to shadow for two days or shifts in a row. If you are a medical student, you should try to schedule your rotation as an ‘acting intern’ i.e. you are given the schedule of a resident as well as the same (supervised) workload. Many students, when they finally get to their 3rd or 4th year rotations, realize that the specialty which was fun to shadow is much different to work in. I highly recommend putting forth a large amount of time towards this during your 1st and 2nd years of medical school.
Now that you’ve invested time into one or two specialties, take a step back and evaluate what you are wanting—not just from your future field but also outside of medicine. There are many specialties which are very demanding, both in time and brain power. Many residencies are more than five years long. Some fields involve a large amount of ‘on time’ call when you may need to respond immediately, or will have to answer calls from the hospital. Every specialty has pros and cons, and you should evaluate the negatives of each field just as much as the positives. In addition to lifestyle, consider the USMLE data on each field. I would never have the test scores to match to a dermatology program, and it’s important to be honest with yourself about where you would be competitive.
Finally, if you are still stuck between different fields, consider using online aptitude tests, which tell you which fields would be most fitting by comparing your answers to the tendencies of physicians. Additionally, there are books available to help you make the decision. If, after all of these, you are still not sure, then you should go into emergency medicine. Not only is it far and away the best field, but you also get the most exciting 15 minutes of every other specialty!
Evan Kuhl is a PGY-2 emergency medicine resident at The George Washington University in Washington, DC. Evan is interested in the intersection of sports and medicine, and is an avid cyclist. His website, www.evankuhl.com, includes helpful tips for pre-med and current medical students.