Choosing a Specialty, a.k.a. “The Medical Student’s Conundrum”

When I decided to pursue a career in medicine, I had no idea what type of doctor I wanted to be; I just knew that I wanted to become one. Back then, my scope of medicine was rather limited. I was really only familiar with doctors I had either seen on TV or interacted with in person: family doctors, pediatricians, surgeons, and emergency physicians. Frankly, I could see myself in any of those specialties.

Fast-forward a few years to today, where I have just completed my first year of medical school and am beginning to think about residency – the postgraduate training period in which new doctors are trained in their chosen specialty. The good news for me is that I have some time before committing to the specialty I will be practicing for the next few decades of my life. Medical school is 4 years long, with the first 2 years (so-called “pre-clerkship”) being spent mainly in the classroom, and the last 2 years (“clerkship”) spent exclusively in the hospital. Applications for residency occur midway through the fourth year, so I still have some time before committing to the specialty I will be practicing for the next few decades of my life. Residency training ranges from 2 to 6 years, depending on the specialty and program chosen.

Throughout my first year as a doctor-in-training, my awareness of the possibilities in medicine has drastically increased. In the US, there are almost two dozen distinct specialty programs available for students to apply to through the National Resident Matching Program (NRMP), and that value nearly doubles after counting the various combined and integrated programs offered at many schools across the country. Barring some differences in program combinations, there is a similar variety of residency options offered in Canada through the Canadian Resident Matching Service (CaRMS).

The spectrum of specialties is quite extensive, and different students have different ways of classifying them. The way I see it, there are ‘medical’ specialties on one end of the spectrum, and ‘surgical’ specialties on the other. The ‘medical’ specialties include Internal Medicine and all of its sub-specialties, Family Medicine, Emergency Medicine, Neurology, Pediatrics, Psychiatry, Dermatology, and others. While some of these specialties involve certain procedures, they are mainly focused on the diagnosis and medical treatment of patients and demand considerable clinical reasoning. On the other hand, the ‘surgical’ specialties include General Surgery, Cardiothoracic Surgery, Orthopedics, Neurosurgery, Opthalmology, Otolaryngology, Plastic Surgery, Vascular Surgery, Obstetrics/Gynecology, and Urology. These are mainly procedure-driven specialties that demand a significant amount of technical skill in addition to sound clinical judgement. A third grouping I think of includes ‘diagnostic/perioperative’ specialties like Radiology, Anesthesiology, Pathology, and Laboratory Medicine. These are more unique fields that attract students with particular interests in them specifically.

So how are you supposed to decide what field to go into? The key to indecision is exploration. Choosing a specialty is kind of like buying a car. You think of the type of vehicle you want (truck, sedan, SUV, coupé…), do your research, then go out and test-drive all the makes and models you’re considering. In the end, you choose the one that fits you and your needs the best. The caveat in medical school is that there are core specialties you are required to “test-drive,” but there is ample room to customize your experiences and explore what’s best for you.

Career exploration starts early in medicine. While clerkship is the time for students to officially try out different specialties through structured rotations, pre-clerkship students at my stage get significant interaction with practicing physicians on a daily basis. Most of our curriculum is taught by MDs from the respective field pertaining to the course. Our clinical skills sessions are taught by doctors in simulated clinical centers using standardized patients (actors portraying patients with illnesses). In addition, medical students can do observerships with doctors in the hospital to see and participate in clinics and procedures. In Canada, first-year medical students are required to complete a rural rotation where students join physicians in the community for a week to experience the daily life of a doctor.

As nerve-wracking as choosing a specialty may be, it is important to remember that all of us will eventually become doctors, a title that brings with it the privilege of having significant impact on people’s lives in a multitude of ways. A piece of advice I hear over and over again from my superiors is to find a specialty in which you enjoy the day-to-day “bread and butter” cases, as ultimately if you are not happy doing what you do, you will not last long doing it.

CaRMS Program Directory: https://phx.e-carms.ca/phoenix-web/pd/main?mitid=1201#

NRMP/ERAS Participating Specialties & Programs: https://services.aamc.org/eras/erasstats/par/

AAMC’s Careers in Medicine: www.aamc.org/cim/