Selecting a Medical Specialty

Written by on May 30, 2014 in Features - No comments

Overview

CutieWEBSo, how do you know what specialty is right for you? Most medical students decide during their 3rd and 4th year clinical rotations which specialty training to pursue. Students have to start applying to residency programs early 4th year and go on interviews during 4th year (usually December through February of their 4th year). The Residency Match occurs in the middle of March.

Many students already have ideas early during medical school about which specialty they may want to enter eventually. However, it has been found that about 70 to 80 percent of medical students change their minds while in medical school.

Use SDN’s Specialty Selector developed with residency expert Anita Taylor to find a residency matched to your personality.

Also, check out the list of specialties we have for more details on specific specialties and residency options.

Selection Factors

When considering which specialty is the right one, there are many important factors to consider:

1. Does the specialty interest you?
2. Could you do this for a living, rather than just shadowing or spending a couple weeks on a rotation?
3. Is the lifestyle what you want for yourself?
4. Are you fine with the hours worked by physicians in this specialty?
5. Are you fine with the compensation offered in this specialty?
6. Are you fine with the length of training for this specialty?
7. Are you fine with the intensity of residency training for this specialty?
8. Are you interested in Academic Medicine?
9. Is this specialty going to change significantly within the near future?
10. Are you competitive for the specialty?

Probably the most important factor on this list is specialty interest (item 1). Make sure you are truly interested in the specialty. Don’t choose a specialty just because it pays well or is the most prestigious. Physicians who are miserable in their specialties most often made decisions due to those 2 factors, rather than focusing on what they would have most enjoyed to practice.

Your medical career will most likely last a long time and you don’t want to be stuck in a specialty you hate. At the same time, realize that you can still change specialties even if you have already begun or completed residency once. So, it’s never too late. But it’s painful to start over again.

Also, spending some time shadowing or rotating in a specialty may give you a false impression, depending on where and who you rotate with. Often, your experience can be much better or worse than it should have been (what you would see if you were in practice yourself) and may influence your decision in the wrong direction, so keep that in mind.

Lifestyle, compensation and hours

This is probably one of the most important factors for most people besides the factor of liking the specialty itself. It is generally known that surgeons have longer work days and more call than most other specialties. Also, dermatology, ophthalmology and a few other specialties are known as the “cush specialties”, with little call, very good compensation and relatively normal work weeks.

You have to decide which of these factors are most important to you. The surgical specialties are typically the most intense with the longest hours (60 – 80 hours per week is not uncommon), the most call, but also the highest compensation and the most prestige. Many specialties with great work hours and little call are also often the ones which are less well compensated and least prestigious.

Realize that medicine, in general, is an intense profession. So, most physicians in specialties which are considered to have better work weeks quite often still work 50 hours or more a week. Most employers require the physician to work 40 hours per week doing direct patient care. Any extra paperwork, charting, etc. is considered extra work, so realistically, most physicians don’t ever work just 40 hours per week, although you can find some exceptions. As one physician put it: “40 hours in medicine is part-time.”

Certain specialties are extremely competitive and hard to get into because the offer a favorable compromise between compensation (still fairly high), time spent each week (relatively low) and call schedule (not very intense). These include Dermatology, Ophthalmology, Radiology, Radiation Oncology, Anesthesiology, Emergency Medicine, Pathology and some others for various reasons. These specialties (and a few more not listed here) offer a relatively decent lifestyle.

A rule of thumb for compensation is that the more procedures the physician does, the more he or she is paid. So, a specialty that just sees patients in the office (internal medicine, family medicine, pediatrics), prescribing medications and is involved in thinking, etc. is not as well compensated as one that actually does probing, scoping, cutting, suturing, poking, stabbing and mutilating.

To pick out a few examples:

Dermatology – virtually no call, fairly high compensation, nice work week
Ophthalmology – virtually no call, very high compensation, nice work week
Emergency Medicine – no call, decent compensation, shift work
Pathology – virtually no call, fairly high compensation, nice work week
General Surgery – extremely long work week, lots of call, higher compensation, surgical
Otolaryngology – Head and Neck Surgery - longer work week, some call, very high compensation, surgical
Cardiology – extremely long work week, lots of call, high compensation, procedural
Anesthesiology – moderate to longer work week, some call, high compensation, procedural
Family Medicine – nice to moderate work week, some call, lower compensation – few procedures
Internal Medicine – moderate work week, some call, lower compensation – few procedures

Averaging all specialties and all practice types, the average physician earns approximately $240,000 per year in the United States. Surgical sub-specialties and some other (highly procedural) specialties like Cardiology can reach $357,000 or so per year, whereas most office based medical specialties such as Family Medicine, Internal Medicine and Pediatrics are closer to $175,000 or slightly more.

There is some great variation in pay depending on whether or not physicians work for themselves in private practice, are employed by a physician group, hospital or other organization, or work in academic or military medicine.

You have to decide how much time you want to spend at work each week vs. spending time with your family or doing other things and balance this with your interests and compensation.

Length and intensity of training

As is true for practicing medicine, the surgical specialties are also the ones which typically have the most intense and the longest residency training. Surgical residents have the longest work week and the most call, in most cases. Cardiology and some other specialties also have long hours and lots of call. Dermatology and a few others, again, have much less call and a much less intense schedule. General Surgery is notorious for having one of the worst and most intense residencies, but some of the other surgical subspecialties are not quite as intense.

Note that long hours and call schedules are not restricted to surgical specialties, however. Pediatrics, for example, and many other specialties, which do not have extremely long hours once in practice, can have long hours and lots of call during residency.

Academic medicine vs. private practice

About 50% of all physicians enter private practice, whereas the other half enters academic medicine or pursues other paths. Academic medicine involves teaching medical students and residents and doing research. Typically, compensation of academic physicians is only about 50 – 60% of the compensation paid to physicians in private practice. This is also similar to what the military pays its physicians.

Many physicians particularly like or dislike academic medicine for some of the same reasons. Private practice compensation is substantially higher, but there are also differences in the work itself. Obviously, research and teaching involvement are not usually part of a private practice career.

Also, the types of patient cases seen on regular basis may vary quite a bit. Being in a major academic center can provide a different set of patients. Often, academic physicians can sub-specialize more in a specific area of interest within their specialty and become a “super-expert” if they wish to do so.

On the other hand, academic surgeons may also see more variety and more difficult cases in their academic practice and stay current on all the surgical skills needed to perform many different surgeries. Once in private practice, several of these surgeries may be so rarely encountered that they no longer feel adequately practiced in the surgery and refer all of these cases to a larger academic center from then on.

Similarly, in Internal Medicine, the academic practice can be almost or entirely inpatient, whereas most private practice settings are mostly outpatient settings. Also, in the academic world, physicians tend to see many more interesting and complicated cases on a regular basis (because they have been referred to the academic center), which are rarely seen in private practice.

How competitive are you?

Certainly, your board scores, grades and a few more factors determine if you will be competitive for a specialty. Some specialties are very competitive because there are very few residency training positions available and because the specialties provide a nice lifestyle, good hours, good pay and little call, as previously discussed.

The average USMLE1 score is between 220 and 240 each year. The average for accepted residency applicants in the very competitive specialties is 240 and above. Since this is an average, there are also people who get in with average board scores.2

Generally speaking, you should not give up on your dreams or ideas of becoming a particular specialist just because you feel that you are not going to be competitive enough. Most students can get into the field they are interested in, but just like getting into medical school, they may have to make up for a lower board score and lower GPA with other activities to be competitive. Also they probably will have to apply to many more residency programs to get interview invitations.

Aptitude test and evaluation

During the 3rd and 4th year, most medical schools put together presentations and workshops to help students with the specialty decision making process. As part of these workshops, students work through various assessment tools which may help them focus on a list of potential specialties which may match their interests or personalities.

If you are interested in seeing which types of residencies you may want to consider or which ones may be a good fit for you now, you can visit the SDN Specialty Selector Application and take the online assessment quiz.

By Dr. Christian Becker
Previously published on the Student Doctor Network

Sources:

1 Physician Compensation Report 2013 http://www.medscape.com/features/slideshow/compensation/2013/public
2 USMLE (United States Medical Licensing Examination) http://www.usmle.org/bulletin/scores/

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