Choosing a Specialty

Ho Folks,

I wanted to post a few thoughts on choosing a specialty for those folks who are undecided or worrying about these matters.

1. Do not choose a specialty based on anticipated income, perceived prestige or family tradition. There are ten physicians in my family but only two surgeons (one of us is a Neurosurgeon and I am the General Surgeon). There is no way I could ever find happiness in a medical specialty. My cousin the neurosurgeon feels the same way. We are just odd-balls.

2. If you are not in medical school or have not done third year, you have little idea of the elements of practice for any of the specialties. Keep an open mind until you have a chance to do your various third year rotations.

3. Even though some specialties require early tracking (Dermatology, Neurosurgery, Orthopedic Surgery), you still need to do well in your medical school cousework for any specialty.

4. If you are a medical student, join several specialty interest groups as a first year student. If you are undecided, join medicine and surgery. After that, you can drop one of the other as you go about your studies and develop interests.

5. Either you are a surgeon or you are not. If you believe you have an interest in surgery as a first or second year medical student, join the surgical specialty interest group but wait until your surgery rotation third year to make any final decisions. If you hate long hours, if you don’t like procedures and if you are thin-skinned, you are not going to like surgery.

6. As you are doing your third-year rotations, ask your interns and residents how they chose their residencies and specialties. Ask attending physicians how they chose their specialties. Get as much information as you can about practice and training.

7. Your USMLE Step I score is going to generally determine if you are competitive for the most competitive specialties. If you score below the mean for your year, you are probably not going to be able to match in Derm, Optho, Neurosurgery, Anesthesia or any of the surgeries unless you are the son or daughter of the chairs of one of these departments. (After being part of the selection process for a fairly competitive residency program, I was very surprised to see how important that USMLE Step I score is.)

8.Your medical school will not guarantee a good USMLE Step I score or a slide into a competitve residency. Your performance at any medical school is important for successful matching and getting the specialty and residency of your choosing. (At my medical school Howard [considered a very low ranked school] we matched folks into Harvard, Hopkins, Stanford, UVA, and other competitive residencies and continue to do so). We also matched folks in Derm, Optho, Anesthesia, Orthopedics etc. If you do well in medical school and on USMLE Step I, you are in control of your fate. If you are attending a medical school that is affiliated with a hospital that does not have a liver transplant program and you have your heart set on being a transplant surgeon, don’t worry, you can still match in a good surgery residency and get a competitive transplant fellowship. Just do your best, no matter where you attend medical school.

9. As soon as you have identified your interests, start finding out as much as possible about residency programs of interest to you. During interviews, you are going to be asked about why you chose to apply to the program. You can get loads of info online so gather your information.

10. If you are interested in Neurosurgery, ENT, Neurology or Ophtho, there is an early match. For these programs, you have to go through the San Francisco match program with earlier deadlines. Make sure that you are familiar with the times lines here.

11.If you are totally undecided after third year, you may want to do a Transitional year (with plenty of variable electives) and go back into the Match after you get more experience.

12. If you are still at the pre-med level, don’t worry so much about specialty choice. Most students drastically change their interests when they get into medical school. Before I started medical school, I was sure that I would be in pediatrics. I continued to be interested in Peds right up until January of my third year when I scrubbed into my first surgical case. I was hooked from the first time I tied my first knot and I haven’t looked back. On the other hand, one of my classmates came in into medical school sure that he wanted to be a Neurosurgeon. He never waivered in his interests and he is now a PGY-3 here at Cleveland Clinic in Neurosurgery. He is the exception and not the rule.

13. Don’t believe everything that you hear about various specialties. Go with your own interests! There were rumors about CRNAs taking over Anesthesia but every anesthesia resident graduating last year from UVA had 20 job offers. There were rumors that mid-level practictioners would take over Family Practice but every family practice resident graduating last year had plenty of good job offers. If you have the interest and do well in your residency, you will find a job.

14. Choose a specialty because it interests you. You are the person who will get up every morning and see patients. Any specialty can be tailored to lifestyle. It is up to you to decide what is important in your life and how you want to practice. If you like 9 to 5 hours, Derm and Optho are going to be good choices. Most medical specialties have decent hours with minimal on-call after residency. Emergency Medicine and Anesthesia can be easily tailored to your lifestyle. On the other hand, with any surgical specialty, there are going to be times when you are operating all night. Surgery is never going to be a life-style specialty. The 80-hour work week for residency has nothing to do with practice as an attending. My attending physicians in General Surgery work far more than 80 hours each week.

Just some food for thought for those folks who are thinking about specialties and worried about making choices.


I love these tips/your posts are so informative - am saving the nuggets of wisdom!
thank you for posting!

Thanks so much for the in-depth points about choosing a specialty. I keep saying its pediatrics for me, after 18 years as a pedi nurse. I wonder, after reading your post, if that might actually change later as well. That’s 3 years down the road for me, so I won’t think about it too much yet. Your posts are always great.