How to Start

Choosing a specialty may be one of the most difficult decisions you will ever make in your medical career. It would be easy if you could somehow transport yourself through time and preview your career as a family physician, surgeon, pediatrician or radiologist. Instead, you and other medical students must decide your specialty with the limited view you get from clinical rotations. Often, those first clinical experiences are so exciting and interesting you think you’ll never decide what is the right fit for you. A particularly exciting clinical experience might convince some to pursue a certain specialty, but most medical students weigh several options after many clinical and non-clinical experiences. Armed with a balanced view of each specialty and an awareness of your strengths and interests, you’ll find your way.

Making the decision begins with answers to questions that determine your personal and professional needs:

What were your original goals when you decided to become a physician? Are they still valid?
What do you value about the role of a physician? Is it the intellectual challenge, the ability to help others, the respect it commands from others, the security of the lifestyle, the luxury of the lifestyle, the ability to work autonomously? Which aspects do you value the most?
What type of doctor/patient relationships do you find the most rewarding?
What type of lifestyle do you envision for yourself (time for family, time for other interests, income level, etc.)?
In what type of community do you see yourself practicing and in what type of clinical setting?
What skills (interpersonal, analytical, technical, etc.) do you value the most in yourself and how does this affect your perception of the specialty or specialties to which your abilities are best suited?
Are there particular clinical situations or types of patient encounters which make you uncomfortable or to which you feel unsuited?

Answering these questions takes a great deal of maturity and insight. But be completely honest with yourself so you will be confident of your choices. You may find it particularly difficult to be frank with yourself about your own abilities. There is a danger of either overestimating or underestimating yourself, so get feedback from people who know you personally and professionally. Mentors are a good touchstone during this phase of the specialty choice process. As you begin to form some ideas of the career you would like to have, you’ll have new questions about specific specialties and their respective training programs. Take time to write down what you already know about each of the specialties in which you’re interested. Is the information you have accurate and complete? What else do you need to know?

With Regard to the Practice Characteristics of a Particular Specialty, What Do You Know About...

the type and degree of patient contact?
the type of patient treated?
the type of skills required?
the type of disease entities and patient problems dealt with?
the variety of practice options available within that specialty?
the type of research being done in that specialty?
the type of lifestyle afforded?

With Regard to the Residency Training Programs for a Given Specialty, What Would You Like to Know About...

the length of training?
the goals of training? (What does residency training prepare you to do?)
the availability of residency positions? (How many slots are available? What is the level of competition for those slots?)
the differences between training programs within the same specialty? (Are there geographic differences? Are there institutional differences?)
the potential for further training following a residency? (What are the requirements for subspecialty training or fellowship training?)

With Regard to the Overall Outlook for a Particular Specialty, What Would You Like to Know About...

the availability of practice opportunities? (How much competition is there for patients or practice sites?)
any current trends or recent changes in practice patterns for that specialty? (How has it been affected by the cost of professional liability insurance? By changes in Medicare reimbursement policies?)
any foreseeable additions to the repertoire of that specialty? (New technologies, new drugs or new techniques?)