Every medical student dreams of having that “Aha!” moment where you instinctively realize your future specialty. Unfortunately, it never seems to be as simple. That moment is often insidious and occasionally tainted with self-doubt.
That being said, here is advice on choosing a specialty — based on experience: that of my classmates, physicians, residents, faculty, family and friends.
1. Don’t expect to know your specialty coming into medical school.
Some students enter medical school with a clear calling on what they wish to pursue. It’s perfectly okay to have that direction, but it’s also okay if you don’t. Do not be afraid to say, “I don’t know.” You are not required to know your specialty choice up front — but if you’re one of the lucky few that always had a clear vision on your specialty, kudos!
Be aware of your personal biases and try to avoid limiting yourself to a certain field. You will quickly find that your experiences as an undergraduate are innately different from working as a medical student on the wards. The whole objective of medical school is to be a part of new experiences that will shape you as a future physician. Embrace the uncertainty. Don’t fear the unknown.
2. Think about what you enjoy doing.
It is time to start seriously considering what you like and dislike about the many facets of medicine. Looking at the potential list of dozens of medical specialties, it’s very easy to be intimidated.
What aspects of medicine do you enjoy most? Do you like working with patients in the inpatient or outpatient setting? What type of patients? Young, old, sick, healthy? Do you prefer to work from a distance? What kind of relationship do you want to have with your patients?
Do you see yourself as working mainly in the operating rooms? Do you like using your hands more, your mind more, or a balance between the two? Consider if you like being in the hospital, the clinic, or prefer a mix of both settings.
What about procedures? Do you like fast changing environments and patient conditions? Or, do you prefer to have lower acuity patients with long-term conditions and illnesses? Do you like being a patient’s first contact when they are admitted to a hospital, or do you prefer to know every answer in a very specific manner?
More importantly, where do you see yourself in ten years?
Your answers will change as you have new experiences. Don’t expect your early impressions as a first year to remain set in stone throughout your years of training. Exposure will mold your interests in unexpected ways.
3. Explore career choices early.
This is perhaps one of the biggest hurdles for a medical student to face. Not only will you be bombarded with exams, assignments and deadlines, but you will be urged to explore specialties and make your decision as early as possible. Personally, I found this utterly terrifying.
You see all those emails for specialty interest group talks? Go to them. Join clubs and explore fields — even if you don’t know for certain whether you would enjoy that specialty. Pursue extracurricular activities that interest you. Avoid stretching yourself too thin; do not over commit. Care about what you do. It will show — even if you don’t end up going into that specialty.
Talk to your advisor and make sure you have a healthy balance of school and non-curricular related activities. Medical school is strenuous, and you have to look out for yourself and your fellow classmates. Don’t forget to prioritize your family and those who matter to you. Medical school burnout is a real phenomenon, and we as future physicians can be pretty awful about prioritizing our own health.
4. Find your niche.
It is one thing to choose a specialty, it is quite another to find your career. Many people don’t realize that your future will involve a lot more than just being a physician in your field.
Sign up for mentoring opportunities that your school may offer for first and second year students. This can be through a formal program, or through interest groups providing shadowing opportunities with attendings. If you are unsure where to start, start by meeting with your advisor. Talk to your school’s clerkship director for your rotation of interest. Email senior residents and ask if you can spend an afternoon working with them. Talk to your classmates and see how they are getting exposure. Many schools offer longitudinal courses that involve early hospital experiences. Talk to your preceptors and professors — they are fantastic mentors. Even if they are not in the exact field you want to explore, they will probably know whom you should contact. I do not say this lightly, but this step requires effort and persistence. You need to be proactive if you want the opportunity to explore some specialties.
5. Do you like research? Pursue it. Don’t like it? Don’t do it.
Depending on your eventual field, your research experience may or may not play an important role in your residency match. The types of research opportunities available are immense: bench work in a lab, clinical trials, studies in the humanities or social sciences, global health and health care management. Find out what types of research are available around your campus, and whether you think you would find it to be a worthwhile pursuit for you.
If you do decide to pursue research, here is my advice: show initiative, be attentive and act professional. Ask questions. Do your work. If you find yourself dreading your time in the lab, consider your other options. Life is too short to do things you dislike. Recognize this early.
6. Do some serious soul searching.
This is probably the last thing you want to hear, but it is very important. You need to make sure you choose a specialty that best suits your personality. If you plan to practice for several decades, it should be a career that you believe you can honestly love, and not one you’re pursuing for secondary gain.
Each field has a slightly different environment. Take a close look at what personalities are attracted to this specialty and see if you can see yourself getting along with those kind of physicians. Look for a field that aligns with your personal characteristics. I recommend the Careers in Medicine website. Keep in mind that your answers might change as you progress in your training.
You need to be realistic and start thinking about how you wish to see yourself ten or 20 years down the road. You need to know what you’re looking for in the next ten years. You need to know the good and the bad about your field choice. Don’t neglect your relationships and the things that matter most to you while you make your career choice. Evaluate work life balance. This is important regardless of gender.
7. Enter clerkships with an open mind.
Be enthusiastic about every learning experience, even the ones that are rough. As a third year, it is often easier to think about ruling out specialties rather than finding the one that is best for you. Try not to let that elimination principle stand in the way of you experiencing each rotation to its fullest.
Don’t discount a field at first glance based on what others say. You are wise enough to make your own deductions. Take time and analyze what you like. Work with other medical students and help each other out. A happy working environment makes rotations fly by and makes them more memorable.
Don’t taint a rotation with negative thoughts or complaints. Work hard and keep going. Third year is a powerful experience, even if you find that you don’t plan to pursue any of those specialties. Have fun, because this may be your only chance to deliver a baby, to dissect an eyeball or to scrub in on a liver transplant.
8. Talk.
Can’t figure out what specialty you want to pursue? Talk it out. Call your mother and have a heart to heart conversation while you do your laundry. Use your non-medical best friend as a sounding board and walk through your thought process. Having to explain why you like what you do is a great way to uncover what really draws you to the field, and a new perspective is always useful. Talk to your classmates, your upperclassmen and your advisor. It may feel awkward to talk about your feelings, but suck it up and just do it. Trust me.
Talk to residents and physicians, and ask what drew them to their field. I have received amazing advice and perspectives from the residents around me. They are the best source to tell you exactly what they like and dislike about their career choices. I like to ask every resident I work with about what attracted them to their field. I also try to ask them what they consider to be the worst part of their job. A resident once told me a valued piece of advice: when you think about a career, think about the most routine “bread and butter” case that you would experience. Do you think you can take care of that type of patient day after day without getting tired?
M4’s are another great resource. They are very honest and open about their own experiences. What better way to choose your field than to see how your peers made their decisions? Check out these M4 reflections from internal medicine, family medicine, psychiatry, surgery and obstetrics.
9. It’s okay to change your mind.
If you find yourself heading towards a career and you realize that you are having a hard time committing, be open and willing to look into other fields. It is better you discover this now, rather than three years into your residency in the wrong field. Meet with your advisor, talk to your school’s program director. Lay everything out and ask their opinion. You are not obliged to follow everything they say, but they are the best people to ask and will provide you with the most definitive answers.
10. Don’t panic.
This whole process is not an easy decision. Remember that your peers are going through the same process as you, and that you are not alone. If it gets to be a bit much, take a step away from the decision process, spend time doing things you love with people you care about, and then return to tackle the mighty beast. Don’t forget why you went into medicine in the first place.
How will I know I’ve made the right choice?
You will find what you love. Right now, everything may feel like an uphill challenge, but do know that you will emerge from this experience as a stronger and more confident individual. Realize that your love for your field will increase as you become more competent. Choose something you think you would truly enjoy doing.
Are you happy when you are in that field? When I found my specialty, eight hours would fly by and I’d still be rearing to go. Going to work didn’t feel like a chore. I missed being there on my days off.
It’s okay if the light bulb doesn’t suddenly flash on the first day you spend in your field. It’s okay to bump gently into your field. You’re in for a great adventure.
Good luck!
Editor Emeritus: Former Medical Student Editor (2013-2015) and Physician Guest Writer
University of Illinois College of Medicine
Jarna Shah is an CA-2 resident in anesthesiology at the University of Illinois at Chicago. She is interested in the development of medical education, mentorship, and healthcare. She is the Co-Editor-in-Chief of in-House (in-housestaff.org), a sister publication of in-Training. In her free time, she bakes ridiculous desserts, practices martial arts, and writes novels every November.
