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How to Choose a Medical Specialty You Love

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by Alec Palmerton, MD in Residency
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Are you wondering how to choose a medical specialty you don’t hate in the future? Do you feel overwhelmed with the gravity of choosing what you’ll do for the rest of your career? Does the thought of committing to a residency without knowing exactly what you’ll be doing terrify you? Choosing a medical specialty can be scary and overwhelming. However, with a little bit of introspection and guidance, you’ll be able to create a plan for choosing your dream specialty. And the best news of all? You don’t have to spend hours shadowing to take the most important steps. Summary:
  • Choosing a medical specialty is more like a one-way door than a two-way one
  • As such, making the right decision is important, since switching careers is time-/energy-intensive
  • Knowledge of specialties is rarely the bottleneck for choosing the right field of medicine
  • Instead, the most important first step in choosing your dream specialty is to know yourself
  • Use the list of suggested criteria to consider what will be most important in your specialty search

Table of Contents

Reversible vs. Irreversible Decisions

Jeff Bezos has said that decisions are either essentially two-way doors (reversible choices) or one-way doors (irreversible decisions). So the first step to choosing well is to know what kind of decision you face. Many of us are high achievers who can grind through whatever task is put in front of us. We may employ phrases like, “I don’t want to close any doors.” Until now, our choices may have been designed to leave us with the most options. In other words, we’ve labored to maximize the number of two-way doors available. For many of us, the closest decision we’ve made that would close specific paths was choosing our college major. And even that barely counts – few majors prevent you from a particular career.
Choosing a Medical Specialty Is Often a One-Way Door
However, choosing a medical specialty is different. Yes, the door to switching to another residency is always open. However, the costs of making a medical specialty change rise substantially, including time, money/lost salary, and effort. Consequently, doing the best you can to choose the right specialty from the jump is critical.

How to Choose a Medical Specialty: Start with Introspection

Some people know their dream medical specialty seemingly from birth. (In my experience, these tend to be surgeons, particularly neurosurgeons). However, for the rest of us, this specialty choice is often a years-long process involving much introspection. “Introspection?!” I can hear you say. “I don’t want any of that touchy-feely stuff. I’ve got work to do!” You may be tempted to bury your nose in a book to study for your next exam. However, knowing where you want to end up is essential to maximize your chances of arriving there.
List Your Five Most Important Career and Personal Values
The most valuable and thoughtful exercise I found in choosing a medical specialty was: 1) List your life’s five most critical:
  • Personal aims, and
  • Career aims
Then 2) rank the various specialties from 1-5 on these goals. Note that this activity is deceptively simple. It is also a variation of the Buffett 2-list rule. For example, when I did this as a first-year med student, my list looked something like this:

Personal:

    • Family
    • Friends
    • Travel
    • Financial security
    • Personal growth

Career:

    • Teaching
    • Helping people find comfort/meaning in suffering
    • Research
    • Using/applying science
    • (I’m sure I had a fifth, but I can only remember four)
My spreadsheet looked something like this:
How to choose a medical specialty

Choosing a medical specialty starts with knowing yourself

Everyone’s Specialty Preference Chart Is Unique
The beauty of this exercise is that it depends entirely on YOUR values. What do you value most? That is what you put on your chart, which will necessarily look different than anyone else’s. In addition, you’ll notice that a lot of these things are subjective. For example, I chose a “4” for “Teaching” for anesthesiology because it had more exciting subject material than other specialties. However, someone else that is more anatomy-oriented may find that surgery fits their teaching goals much better. The key: know yourself first, and make your decision based on that.

Next Step: Know the Specialties

Once you know yourself, the next step in choosing a medical specialty is researching more about each field. Below is a list of items you can consider.

How to Choose a Medical Specialty: Life Inside the Hospital

Most of us start choosing our medical specialty by thinking about what our life in the hospital would be like. Here are some things you should consider.
Day-to-Day Life: Research vs. Clinical Care vs. Teaching
Know your ideal balance between research, patient care, and teaching. Some specialties skew much more heavily towards some activities over others. For example, radiation oncology skews heavily towards research, as does medical oncology. On the other hand, internal medicine is known for having a solid culture around teaching.
Patient Population
Knowing what kind of patients you want to interact with is critical. For example, most people early in training learn whether they prefer children vs. adults. Others like the entire spectrum. In my case, it had less to do with age and more with the situation. The philosophy behind Man’s Search for Meaning by Victor Frankl resonated deeply with me. Because I had found deep meaning through difficult times, I wanted to be in a position to help others do the same in my career.
Variety
Some of us prefer to do something new every day – or even every hour. Others like the focus of doing the same – or similar – things regularly. Similarly, some fields are known for their variety (e.g., emergency medicine). In contrast, others are relatively repetitive (e.g., the orthopedic surgeon focusing exclusively on knee replacements).
Optionality
People change their minds. Values change, and preferences evolve. Some fields make switching harder. For example, I was considering cardiology vs. medical oncology early in my training. I knew, however, that if I made the “wrong” choice and wanted to switch to the other field, it would be at least another 3 years of fellowship training. In contrast, anesthesiology fellowships were only one year; I could switch to another sub-field much more quickly.

How to Choose a Medical Specialty: Life Outside the Hospital (i.e., Lifestyle)

Unlike a college major, our residency choice significantly impacts our future lifestyle. While everyone’s decision tree will be different, these are some common characteristics people consider.
Hourly Salary: Weigh Time vs. Money
At a crude level, physicians are (well-compensated) wage earners; they trade time for money. As such, the salary – particularly the equivalent hourly wage – dramatically impacts your future lifestyle. No resource I know gives precise hourly wages for physicians. However, we’ve created estimates for the hourly wage between specialties. Admittedly, physician salaries vary hugely depending on the practice setting (e.g., academics, private practice, etc.). However, the broad trends pass the “smell test.” You can read more about the estimated hourly wage for medical specialties here.
Happiness and Burnout
One good way to see how happy/burned out you’ll be in a specialty is to look at how others in the specialty fare. Medscape’s well-known annual survey on physician burnout and depression is worth a glance.
Call Burden
Another thing that will affect your life outside the hospital is the call burden. Call schedules can vary a LOT based on what kind of group you are in. However, some specialties have more time on call in general.
Availability of Jobs in Places You Want to Live
Some people don’t care where they live, as long as they like their job. For you, that’s great! However, if you want to live in a particular geography – e.g., California or Manhattan – some specialties may work better than others. For example, one of the cardiology fellows at the Harvard-MGH program said, “if I end up working in a city I’ve heard of, I’ll be happy.” The implication was that it would be challenging to find a cardiology job in a major city, even coming from a prestigious training program. On the other hand, some specialties welcome many fresh faces every year. For example, I chose anesthesiology over cardiology because my wife – a violinist – would likely need to live in a major city if she wanted to play in a larger orchestra. As such, cardiology was less appealing to me since there were so few jobs open.

How to Choose a Medical Specialty: Path to Get There

Another criterion to consider in choosing a medical specialty is the “path to get there.” These criteria include:
Competitiveness
What if all you knew was each specialty’s call burden and estimated hourly salary? Could you tell me how competitive those specialties would be? In most cases, yes. One thing to contemplate when considering a specialty is how hard it will be to get there. While nothing is impossible, the path is undoubtedly harder for some specialties than others. For example, in 2022, more than 30% of US MD Seniors who applied in otolaryngology, orthopedic surgery, and plastic surgery did not match in their chosen field. While they can always keep trying again – and many will succeed – not everyone will want to face such steep odds. Similarly, if you are an IMG, some specialties are more or less welcoming. For example, otolaryngology – one of the most competitive fields, period – is notorious for not taking IMGs. In 2022, for example, no IMG matched into the field. For the most competitive specialties, see this article. And for the most IMG-friendly (and unfriendly) specialties, see this article.
Length of Training
Finally, you may want to consider the length of training. If you can’t wait to move on with your life, then a 7-year, intense neurosurgery residency (not including a fellowship) may not be for you. On the other hand, if you plan on having a 30+ year career, what is another few years on the front end? Like everything, this criterion will depend on the person – and in many cases, their life stage.

Concluding Thoughts

Ultimately, choosing a medical specialty is a profoundly personal – and complicated – decision. So often, people use heuristics like, “where is your tribe?” (where are people most like you?), or “choose the field where you love the best and can tolerate the worst.” While there are nuggets of truth to these schemas, the most important thing to remember is to know yourself. In fact, the introspection part is the hardest – and most overlooked part – of the process for many people. However, often you will find that when you’ve clearly defined your values and goals, choosing the specialty is straightforward. So put down your books, take some time, and think of what you want to accomplish personally and professionally. What criteria are most important to you in choosing a medical specialty? Which specialties are you weighing? Let us know in the comments!
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Cardiology is key for impressive USMLE scores. Master cardiology from a Harvard-trained anesthesiologist who scored USMLE 270 with these 130+ high-yield flash cards. You’ll be begging for cardio questions - even if vitals make you queasy.

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