Specialty Profiles

5 things students overlook when choosing a specialty

Whether you’re a first- or fourth-year medical student, choosing your preferred specialty is a major decision, but how do you determine what to practice? Learn how to choose a specialty with tips from an adviser who understands your mindset.

The AMA’s Specialty Guide simplifies medical students’ specialty selection process, highlight major specialties, detail training information, and provide access to related association information. It is produced by FREIDA™, the AMA Residency & Fellowship Database®.

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Surendra Varma, MD, is the executive associate dean for graduate medical education and resident affairs at Texas Tech University Health Sciences Center. Each year, he advises 40 to 50 medical students about their residency program applications.

When it comes to specialty choice, Dr. Varma said he’s noticed an interesting trend: Most students want to choose a specialty they genuinely enjoy, but often lack exposure to a variety of disciplines to make an informed decision.

“Unless they have a parent who’s a physician or they attended some kind of medical service trip, the majority of students entering school aren’t exposed to many specialties outside of the popular ones like pediatrics or primary care,” he said.

The Association of American Medical Colleges’ (AAMC) 2017 Report on Residents found that most medical students change their preferred residency specialty over the course of medical school.

This data is based on comparisons between the specialties students selected on the AAMC’s Matriculating Student Questionnaire, which students are invited to complete during the summer before their first year of medical school, and the specialties they later chose on the AAMC Graduation Questionnaire during their final year of medical school.

Dr. Varma said he understands why students often change specialties between each questionnaire, noting that it may be more productive for students to initially select their specialties after they matriculate and gain exposure to their options.  

So how can you learn more about specialties and find the best fit for you? Make sure you don’t overlook these important factors when determining what to practice:

Assess your skills—not just the amount of money you wish to make. While the lifestyle and pay associated with a particular specialty are important, students should also consider the skills required for the field. Avoid pursing a specialty simply because of its prestige or earning power.

For instance, “many people want to go into orthopedics or surgery, but what if you don’t have the skills to successfully perform a surgery?” Dr. Varma asked, noting that Texas Tech University offers a simulation center for students who wish to test their skills in a medical setting. Find out if your school provides similar resources, so you can take inventory of your strengths and weaknesses and choose a specialty that truly fits your talents.

Gain clinical experience in your preferred specialty. Shadow an attending physician in your field as much as you can. “The best way to do this is through an externship,” Dr. Varma said. However, if you can’t work one into your schedule, join specialty clubs at your school and take advantage of free talks and lectures to gain exposure to different disciplines.

“Most schools have a club for every specialty and people do more than just have lunch,” Dr. Varma said. “Physicians will come to club meetings and talk about their work and the lifestyle of their practice.”

Of course, you won’t have time to shadow every specialty; the AMA’s “Shadow Me” Specialty Series gives practicing physicians the chance to reflect on life in their specialty.

Research the culture and availability of your specialty. The popularity of specialties can shift based on each generation of medical students, which will impact job availability. Data suggests that factors such as gender may also affect specialty choice, so take the time to consult practicing physicians and advisers about the culture of different disciplines. This will help you develop a holistic view of the practice environment you may work in.

Choose a backup specialty. This one is hard for many students to accept, but it’s important, Dr. Varma said. While gaining exposure to your preferred specialty, it’s helpful to also identify a backup specialty you’d be happy practicing, especially if your primary choice is in a competitive field.

“We usually tell students to apply to 20 or 25 programs,” he said. In competitive fields such as orthopedic surgery and urology, students should consider how to strengthen their application to increase their chances of matching in the specialty. Test scores, experience in the specialty and strong letters of recommendation are all important pieces to consider.

You may also want to have a good idea of how competitive specialties are when you begin the residency application process.

Make your residency program application as authentic as possible. It’s counterproductive to research a specialty that uniquely fits you, only to submit an application that sounds similar to your colleagues. Besides focusing on your overall competitiveness in your class, choose credible physicians who can write honest letters of recommendation about your potential to excel in your chosen field, Dr. Varma said.

Also, don’t forget: The personal statement is a chance to show who you really are and why you’re the best fit for a specialty. “Please, don’t submit a cookie cutter essay about why you want to work in surgery,” he said. “Go from the heart.”