How to Choose the Right Medical Specialty

It’s the end of the third year; you have a pretty good idea of what you wanna do for the rest of your life. But you still have doubts. You ask yourself, “Do I really wanna do <insert whatever medical specialty> for the rest of my life? How can I be sure — especially since I have only experienced some of the specialties, not all of them?”

Welcome to the dilemma that all fourth year students have.

Personally, at the end of my third year, I did not yet experience ophthalmology, dermatology, orthopedic surgery, and emergency medicine. Basically, a huge portion fn the E-ROAD specialties.

So what do you do in this situation … You may like a specialty, but you’re not quite sure, because you did not get to try it out yet. The no-brainer answer is that you should try out whatever specialty you are interested in. For example, if you are interested in dermatology, then do a dermatology rotation. Duh!

But then you remember … you gotta do audition rotations too! All your peers are doing them. They stick to one specialty and worked their little butts off to impress as many residency program directors as possible. This way, they can get into somewhere competitive. And you don’t wanna be left behind.

So you basically have to juggle two potentially different balls:

  1. You gotta try out different specialties, so you can to determine what the heck you wanna do with the rest of your life.
  2. You gotta impress the doctors in your auditions.

Now it is very difficult to juggle the two balls. With ball #1, you want to explore. If you get exposure to a lot of different specialties, you are more able to determine exactly what you would really like. With ball #2, you want to focus and impress. If you do more auditions in a specific specialty, more program directors will know you. This will increase your chance to break into your desired specialty.

It is quite the dilemma. How do you know what you really like, while increasing your chance of getting into the residency you really wanna go to?

So back to my question … What should you do? If you are like most medical students, you basically pick a specialty and pray that whatever you’ve picked is the right choice. Let’s say you want to do dermatology. You’ve heard that you don’t have to work too hard and you make good money. Unfortunately, everyone else heard the same thing. And they’re gunning after your residency spot.

None of your third year rotations were in dermatology. So during your fourth year, you schedule as many dermatology rotations as you can. You wanna impress as many program directors as possible. And if the electives are not too bad, you’ll stick with dermatology. Since it is competitive and everyone else wants to do it … it must be the right choice.

But is it? If you’ve never tried ENT, orthopedics, or whatever other specialty, how can you rule them out?

You can’t!

What should you do then? Should you follow what most medical students do? Pick and pray? Follow the road to riches? Follow the road that offers the cushiest lifestyle? Or is there a better way?

Do Medical Students Really Love Medicine?

As a side note, I really question if medical students and doctors really like medicine. Do they enter the profession for love of the field? Or is it a means to an end — a stable job and a good income? If I am to guess, for most people, it is the latter.

That is why I think personal statements are the biggest load of horsecrap.  They say that they like to help people, that they wanted to do medicine all their life … But I do not buy that. The best way to gauge a person’s true passion is to see how he spend his free time? Does he spend it learning about medicine … outside the school’s requirements? Or does he go out party and get drunk?

Do not listen to what people say. Instead, examine what they do.

To further my point, take a look at family medicine. To me, family medicine is the very definition of medicine. You interact with patients. You prevent diseases. You cure diseases. You give shots. You can even suture. You can basically do anything and everything. Isn’t that the objective of medical school? To teach you everything? To produce more primary care doctors? The number of people going into primary care also increases the US News rank for medical schools.

However, right now, family medicine is basically the red-headed stepchild of the various medical specialties. Many of its residency spots go unfulfilled.

Why? Because the pay and the lifestyle sucks. Reimbursement is low. Paper work is high. And you gotta deal with more and more bureaucracy. But someone who truly loves medicine would still be willing to put up with all of that — just so he can fulfill his love of medicine.

I bet you that if family medicine offered more prestige, money, and lifestyle … you’ll have a sudden influx of medical students who’ll claim to love the field.

People who love medicine — rather than the prestige, money, and lifestyle — are rare.

I mean seriously … Who grows up wanting to be a dermatologist? You can just imagine what the personal statement will be like:

I had severe acne for all my life. It was unbearable. Kids made fun of me. I just wanted to end my life and escape from my miseries. But when I visited Dr. Whoever, he cured me of acne forever. It was the first time I felt accepted. Kids loved me. And I had hope for a bigger and better life. It was in 1st grade that I’ve determined to be a dermatologist. I can give other pimple-face kids the hope that I’ve had.

Wow, that seriously brought a tear to my eye. Someone gimme the Pulitzer Prize.

What I Would Do

Instead of juggling both balls and failing, I would focus on one of them. As established earlier, most people would focus on ball #2. But not me. I would focus on ball #1, and figure out what the heck I wanna do. I would try to find out what each specialty is like. And then, after experiencing as much as I can, I would choose something that I love.

You’re right … If you focus on getting a broad experience, you will not be able to impress as many program directors. Your chance of getting into a competitive residency may not be as good.

But look at the bigger picture. We’re talking about the rest of your freakin’ life here. Do you want to pick a specialty, just because it is popular, and pray that it will work out? Would you really sacrifice your happiness to follow the herd? Or would you rather experience a bit more and choose something that makes you happy?

I firmly believe that the right way to live out your life is to pursue happiness. Money and security could add to happiness, but are largely overrated.

As a whole, medical students are doctors are very conservative. There is a selection bias to admit students who are good worker bees — hard-working, focused (almost to an extreme), and rule-abiding. A lot of them have done the right things for all their lives. They did well in school. They did all the right things to pad their CV. And they sucked up to the right people to get their letters.

Very few of them are adventurous. I met a girl who graduated from college a few years ago. She is working in the doctor’s office and working in the labs doing research. Basically, her extracurricular activities are very similar to those of other medical school applicants.

I asked her, “How do you know you want to become a doctor? Have you done anything else?”

She basically responded that she thinks being a doctor is a good idea. This is coming from a person whose whole life is based around science. She has never tried anything else in her life. She didn’t go abroad. She didn’t work in another field. So basically, how could she really know she wants to become a doctor?

She is not an anomaly. Most medical students choose medicine exactly the same way as her. They think it is a good idea and plunge headfirst into it, without exploring what the rest of life has to offer. So it makes a lot of sense for them to choose residency the same way. They don’t explore all the specialties first. They pick and pray.

Medicine is much broader than you may think. You would be doing yourself a huge disservice by following convention.

Medicine Is Whatever You Want It to Be

So how do you define medicine? A no-brainer answer is to heal. You keep people healthy, and you get them to be healthy if they’re not.

Now I want you to go into more details. Give me some examples.

If you lack creativity, you can default to what is commonly accepted as traditional allopathic, Western medicine: general surgery, emergency medicine, internal medicine, psychiatry, and more.

But lemme ask you something …

Is that all there is to medicine? A bunch of specialties? A bunch of procedures, pharmaceutical drugs, and scientific articles? When patients wait 50 minutes to spend 5 minutes with the doctor, is that medicine? When uninsured patients get turfed to someone else, is that medicine? When doctors spend more time writing down notes than interacting with patients, is that medicine?

What about the guy who practices alternative medicine? Sure, there may not be scientific evidence to support that alternative medicine works. But there is evidence to support that placebo works. If the patient gets better from what is essentially placebo, is that medicine? If the unconventional healer provides sufficient time, empathy, and counseling, is that medicine?

My definition of medicine is anything that makes the patient better. Western medicine. Eastern medicine. Mainstream medicine. Alternative medicine. They all count. Anyways, once you get a medical license, you can practice any form of medicine you want. If you finished a family medicine residency, you can practice surgery if you want … and if you can find patients. I don’t know how comfortable you’d feel about going to that extreme. But you can have a primary care practice with an emphasis on weight loss. Or you can concentrate on treating the skin. Or you can do something completely that is totally unconventional. Some people opt to do alternative medicine (such as osteopathic medicine or even natural, holistic medicine). And why not?

As an osteopathic medical student, I’ve learned about osteopathic manipulative medicine (OMM). I think there is some benefit to it. But some of it seems like voodoo. But it does not really matter what I think. It is the belief of the healer and patient that counts.

There are doctors who operate a cash-only OMM practice and make as much money as a specialist, without dealing with all the hassle of accepting insurance. More power to them. The patients benefit, which is why they come back for the treatments. And the doctors benefit, by making good money.

I think one of my peers have a strong love for music. So he wants to combine music with medicine and create a music therapy practice. That is totally awesome. I wish him the best of luck.

When you become a doctor, I want to urge you to do what you like. If patients benefit, if you can support yourself financially, go for it. When you do something you love, you will get happier. You will provide a better service. Your patients will get healthier. Everyone wins.

Basically, choose your medical specialty based on your happiness. But before you can tell what you like and don’t like, you gotta experience different things. I wanna broaden your mind. You do not have to fit yourself into a mold. You do not have to be a cog in the medical business machine.

Ask yourself these 2 key questions:

  1. How do you spend most of your time?
  2. What do you enjoy doing most?

If you choose to think for yourself, you will feel liberated, but also a bit scared. When you are the captain of your own ship, when you determine the course of your life, you will reap all the rewards … and all the consequences.

If you choose to divert from the conventional path and go on the road less-traveled,  there will be time when things seem hopeless. Maybe money will be tight — especially when you’re first starting out. Maybe your peers will look down on you — until you wildly succeed. (Then they’ll look at you with envy.) Maybe you won’t know exactly what to do, because no one has done it before.

That is ok. All great things involve some kind of risk. If you take no risk and do what everyone else does, you’ll be like everyone else — average. Is that what you really want?

In closing, I want to encourage you. Be a great doctor. Do great things. And do not be afraid to soar.

If money was not an option, what type of medicine would you practice?

This article is part of the How to Survive Medical School series. Click on the link if you want more tips and hints about surviving academic hell.

Comments

  1. sasha cheng says:

    This is honestly the best thinh ever, thank you for saving me from the bottom of my heart.

  2. wow. thank you so much. your words were very helpful and inspiring!!!
    they have definitely impacted me.

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