How to Choose a Medical Specialty
Choosing a medical specialty is no easy task. You’re faced with this task as a third year medical student trying to look good on every clerkship while working long hours and often with only the view of what the specialty looks like from an academic perspective.
At one time, I thought I might enjoy pediatrics, but then I did a 180 and considered radiology. Somehow, I landed on anesthesiology, which I think was actually a great choice for me.
Today, we have a guest post from a psychologist who understands the process of choosing a medical specialty well. His brother went the medical school path en route to becoming a pediatric emergency physician, whereas today’s author, Dr. Shirag Shemmassian went the Ph.D. route.
He helps applicants matriculate to college and medical school via his business, Shemmassian Academic Consulting. We have no financial relationship to disclose, and he provided the following bio. Pretty impressive!
Dr. Shirag Shemmassian is a medical school admissions expert who has helped hundreds of students get into schools such as Harvard, Mayo, and UCSF, as well as top residency programs.
Growing up with Tourette Syndrome in a middle-class family, Dr. Shemmassian was often mocked by peers and teachers and discouraged from applying to elite colleges. Therefore, he taught himself everything he needed to know to graduate debt-free with his B.S. in Human Development from Cornell and his Ph.D. in Clinical Psychology from UCLA.
Dr. Shemmassian has been featured in The Washington Post, US News & World Report, and NBC, as well as been invited to speak at Stanford, Yale, and UCLA. He presents on topics including writing memorable personal statements, developing a unique extracurricular profile, and acing interviews.
How to Choose a Medical Specialty
When you were applying to medical school, the questions you needed answered were somewhat simple.
You likely asked things like, “What MCAT score do I need to get?” and “How many hours of patient exposure or research do I need to accumulate?”
Most applicants aspire to get in somewhere so they can pursue their dream career as a physician. That way, you can help people while making a good living in a respected profession.
Choosing a medical specialty is a bit more complicated. In addition to being four years older at the start of residency with new personal considerations, you must decide not only how and where to spend the next three to seven years, but also the lifestyle you’ll enjoy throughout your career.
Although the best medical specialties differ from person to person, I’ll offer five factors to consider when selecting what field to go into, in no particular order.
Consideration 1: Income Potential
Money isn’t everything, but it matters. Earning a higher salary may reduce the number of years required to achieve financial independence, allow you to pay back student loans faster, and spend more on the things you value.
So, which medical specialties earn the highest salaries?
According to the 2018 Medscape Young Physician Compensation Report, the top 5 highest paid medical specialties among doctors under 40 are as follows:
- Plastic surgery: $519,000
- Orthopedics: $424,000
- Gastroenterology: $354,000
- Otolaryngology: $342,000
- Emergency Medicine: $338,000
Here are the bottom 5:
- Pathology: $195,000
- Diabetes & Endocrinology: $189,000
- Pediatrics: $187,000
- Infectious Diseases: $186,000
- Public Health & Preventative Medicine: $132,000
The fourth most lucrative specialty, otolaryngology, came with $153,000 more in annual salary than diabetes & endocrinology, the fourth from the bottom.
While the Medscape Physician Compensation Report (which looks at all doctors, not just young ones) demonstrates that physicians across most specialties enjoy income growth over time, it also shows a similar specialty earnings pattern across doctors of all ages.
Over the years, annual income differences in the tens to hundreds of thousands, assuming reasonable saving and investing, can lead to more significant net worth differences, even after taxes.
Consideration 2: Opportunity Cost
Of course, residencies vary widely regarding years spent pursuing them. For instance, whereas an emergency medicine (EM) residency can last only three years, a plastic surgery residency lasts six years.
Those three years may seem insignificant but can lead to significant differences when it comes to earnings, ability to begin paying off loans, and so on.
The Medscape Residents Salary & Debt Report, last published in 2014, offers the following data:
- Average plastic surgery resident annual salary: $58,000
- Average emergency medicine resident annual salary: $54,000
After three years, the plastic surgery resident will earn $174,000 or $12,000 more pre-tax than the EM resident. However, because the EM resident will begin earning their attending-level salary ($338,000) after three years, here’s how their earnings will look at the end of year 6 post medical school:
- Plastic surgery resident: $348,000
- Emergency medicine resident/attending: $1,176,000
- Difference: $828,000
Of course, the plastic surgeon will be able to catch up and even surpass the EM physician’s career earnings during year 11 post residency.
However, the EM physician will have had seven to eight years—in their 20s and 30s—during which they could have paid down their loans more quickly, invest more, etc. Compounded over time, the numbers would add up.
Consideration 3: Interest in Day-to-Day Work
While finances are a major factor when choosing a medical specialty, you’ll of course want to enjoy what you do day in and day out.
AAMC provides a useful Clinical Rotation Evaluation questionnaire that can help you reflect on what you liked and disliked about your various M3 and M4 rotations.
If you disliked a meaningful aspect of a specialist’s work during a 2- or 3-month stint, those issues are likely to be magnified during your multi-year residency. The same may also be true for aspects you enjoyed.
There are also non-trivial differences regarding the percentage of physicians who would choose the same specialty. According to the Medscape Physician Compensation Report, specialty satisfaction ranges from 52% (nephrology) to 98% (orthopedics). Overall, only 62% of physicians would choose their specialty again.
Unfortunately, we don’t have data to help us explain why certain specialists would or would not again choose the same area. The takeaway, however, is to be thoughtful about what you see yourself doing for decades in most cases.
Consideration 4: Work-Life Balance
Most physicians I know would rather work to live than live to work. That said, one physician’s idea of good work-life balance will differ from another’s.
It’s not just the number of work hours you should consider when making your decision. You should also think about when you work.
Certain specialties like radiology, dermatology, pathology, and neurology offer predictable, controllable work schedules, whereas specialties like EM require shift work. While the total number of weekly work hours for a specialty like EM may be less than many other specialties’, you may have to switch between day and night shifts, which will throw off your internal clock.
Surgical specialties are often associated not only with long hours, but also early morning hours. It’s not uncommon to have to report to work as early as 4AM or 5AM to complete long procedures. If you’re a night owl, surgery may be a rough fit. Remember that the decision you make in your 20s—when you’re closer to your peak physical shape—will impact your middle-age years and beyond.
Medscape also publishes a Physician Lifestyle & Happiness Report that provides some insight on which physicians are happiest outside work. According to their survey, the happiest medical specialists are rheumatologists (65%) and otolaryngologists (60%), whereas the least happy are infectious disease physicians (46%) and neurologists (45%).
Although we shouldn’t infer any causal relationships from these data, I encourage you to ask various specialists about their work-life balance in addition to their professional fulfillment.
Consideration 5: Competitiveness of Medical Specialty
Residency match comes down to several factors, including medical school attended, grades, recommendation letters, residency applications, interviews, and USMLE Step 1 and Step 2 scores.
Unsurprisingly, the trend is that high-paying specialties (e.g., dermatology, plastic surgery, and radiation oncology) require some of the highest Step 1 and Step 2 scores, whereas lower-paying specialties like family medicine and pediatrics tend to be more academically forgiving.
You’ll have to apply realistically. If you have less-than-competitive stats for your desired residencies, you should either apply to more sites, sites in less desirable locations, or both. On the other hand, if you’re equally interested in less competitive specialties, you may prioritize location, work-life balance, and other factors.
Choosing a medical specialty is an incredibly personal decision. The five considerations clearly require value judgments and are meant to guide what will likely be an impactful decision for decades to come.
While it can be hard to block out others’ thoughts and opinions on what you “should” do, think deeply about what you want for your personal and professional life now and 10, 20, even 30 years from now.
Physicians, how did you choose your medical specialty? Are you happy with your choice? What additional criteria would you add?