So you’ve gone through your core clinical rotations as a 3rd year and now you need to think about choosing a specialty. You’ve done some rotations in the specialties you thought you might have liked, and they were.. ok. Perhaps you’ve even done the medical specialty aptitude test or something similar.

None of that matters.

You need to do some heavy introspection before you choose your specialty, and no one can tell you what fits you… except for you.

Choosing your specialty and its subsequent residency and sub-specialty fellowship will probably be the single most important decision you make that will shape your future, other than the choice to go to medical school. You CAN change your mind later… but that change of residency will be even a more important decision.

The first step is to be honest with yourself:

Do you:
like patients?
want long relationships with your patients or short interactions?
like procedures?
want to be in the OR, or do you prefer your procedures performed at the bedside?
need prestige?

If all specialties paid the some amount, which one would you chose?
If this specialty paid significantly less than it pays currently, would you still do it?

How much work is “too much work” for you?  8am to 6pm? 7am to 7pm? 6am to 10pm?
How much call is “too much call” for you? 4 weekday calls and 1 weekend a month? 8 and 2? q2?

Do you want a family? How soon?

Be honest with yourself and answer the above questions to the best of your ability.

Now the next thing to do is to discuss things with your mentor.

Hopefully who is in the same specialty as the one you are considering.

Some medical students have an “AH HA!” moment where they decide in their heads what they want to do, and can not see themselves doing anything else. Be careful. Doing your core or elective rotation in a specialty is not the same thing as the day-to-day responsibilities of that specialty. At the very least, you owe it to yourself to do a sub-I in a specialty that interests you. You should take on as much responsibility as your intern/resident will let you take on during that sub-I and pretend to be an intern. It is in your best interest to find out what the normal grind of that specialty is. Every specialty has its advantages and disadvantages, and you need to decide what is the best fit for you.

A common saying for those who want to do surgery is something along the lines of:

“Only do surgery if you can’t see yourself anywhere but the OR and want to devote all your time into getting back into the OR. If you can see yourself doing anything else, then you don’t want to be a surgeon.”

My wife and I both never had an “AH HA!” moment:

For me, I had an astute attending in the specialty I thought I wanted to go into straight up tell me that I would not be happy in her specialty, which was Neurology. She instead directed me to go into my current specialty, Radiology, and after doing a rotation in it, I decided she was right. And… I am very happy in my current specialty and could not imagine myself in any other specialty (and especially not hers). Listen to your mentors, they have experienced a lot, and at the very least they will make you see things from a different angle, or as in my case, show you where you really fit.

My wife was set on pediatrics from the beginning of medical school, and was planning to go into allergy/immunology. However, when she did her pediatrics rotation she was not happy at all. In fact, I would venture to say that she even disliked it more than any of her any other core rotations. However, she was still pretty set on doing pediatrics, claiming that she just didn’t like pediatrics because of that particular rotation. DENIAL is not just a river in Egypt guys… I convinced her to do a sub-I in pediatrics and she came to the conclusion that pediatrics just wasn’t for her.

After that experience she did some heavy soul-searching to find the one rotation she didn’t hate. It was the one specialty she never saw herself doing, but after some real introspection she came to the realization that it was the specialty she really enjoyed, psychiatry.  And… even now after doing residency and fellowship, she still comes home just about every day to tell me about a cool case she had. While she probably would have been a good pediatrician and a good pediatric allergist, I don’t think she would have enjoyed her nearly as much as she does psychiatry… and… she is extremely good at it.

TL;DR

Be honest with yourself.

Listen to a mentor who knows you well, preferably in the specialty you are considering.

Do a Sub-I to help you decide.

Life is short. Be happy.

-Sensei

Agree? Disagree? Questions, Comments and Suggestions are welcome.

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