Choosing a Specialty

Career Exploration Process
Use this site in conjunction with the Careers in Medicine Web page

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For a moment, when you get accepted to medical school, you may think that all of your career decisions are over. You are going to be a doctor! Of course, this moment is short lived, and you soon realize that a huge number of specialties exist, some of which you've never heard of. And there are other decisions - community versus academic practice, research versus clinical, urban versus rural versus international.

These decisions do not need to be made right away. A specialty choice isn't usually made until the beginning of the fourth year and other decisions may not be made until you finish your residency training. But we certainly don't suggest that you wait until the last minute to begin the thought process.

There are two basic steps in this decision making process:

1. Know yourself.

2. Know the specialties

The first step - self-assessment - can and should begin as early as the first year.

The Careers in Medicine Program, an online resource, offered by the AAMC, aids students in understanding their personality types, skills, interests and values. Students should be introduced to the website in the first year of medical school and then expand their use of it throughout their medical school career. These workshops focus on exploration of specialties, decision making, and implementation. If you scroll below you can walk your way through a simplified version of this self-awareness process.
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     Self Awareness Questions:

What drew me to medicine? What values attract me? What has guided my decision-making? How have right decisions been confirmed in my life? What cues alert me when something I am attracted to is not ultimately a right choice?

What do I value most in life?
What challenges have engaged me most?
Who have been my heroes, and role models? Why?
Who have I trusted for sound advice?

     Self Assessment Questions:

What do I enjoy? What are my interests?
What are my strengths?
What are my limitations?
What do I dislike?
What drains my energy or causes me discomfort?

      Career Aspiration Questions:

What do I see when I imagine my future practice?
What kinds of patients do I wish to work with?
What relationship do I wish to have with them?
What type of problems do I wish to work with?
How will I define success in my professional life?
How important are lifestyle considerations for me?
What competes with my professional interests?
How will I harmonize them together?

     Allowing my Values to Guide Me:

I take time to again reflect upon those values that have inspired and guided me throughout my adult formation, and have led me to a helping profession like medicine.

Can I name these values?

As I move now toward choosing the specific path my career will take, how can I best assure that this, my professional life, will embody or be consonant with these values?

Mindful of the many options available for me to choose or pursue, which will be most consistent with my truest self and deepest values?

Click here to further explore your professional values

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Considering the Options - Understanding Specialties 

Generalist vs. Specialist    

     Generalists:
     Like working with people
     Like variety in their work
     Willing to deal with uncertainty
     Engage a variety of common symptoms
     Seek continuity in relationship with patients
     Agile orchestration of managed care

     Specialists:
     Like treating problems
     Focus on narrowed range of less-common concerns
     Derive satisfaction from serving as consultants
     Focus on offering curative interventions
     Accept discontinuity in physician-patient relationships

Characteristics of Practice

     Primary Care:
     Front line care
     Broad focus on common problems
     Defined group of continuity patients
     Orchestrates the coordination of care
     Community based activity
     Low tech demands

     Specialty Care
     Referral based
     Episodic, discontinuity care
     Defined set of less-common problems, symptoms
     Consultant approach to wider population
     High tech demands more likely

     Tertiary Care or Research
     Referral care
     Narrow focus of activity
     Complex/rare problems
     Discontinuous care
     Academic center
     Innovative practice, high tech 
    
     Narrowing the Field

So what do I think?
Which specialties seem most attractive to me, and which fit best, not only with my career desires, but with my strengths and limitations?

     Exploring Programs

I now begin to look into programs within the choice of specialty I have made, to see which programs I wish to visit, audition at, apply to, interview with, and eventually rank or dismiss.

     Creating my Rank Order List

I must now weigh the upsides and downsides of those programs that seem reasonable to apply to in order to begin the process of ranking them.
Factors include:
      How attracted am I to this program?
      How attractive am I to this program?
      How competitive is the specialty is am considering?
      Am I at risk for not matching?
      Would I prefer matching at this program, or risk going 
      unmatched and scrambling for openings at unfilled
      programs?
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  [Materials adapted from AAMC's Careers in Medicine program, as well as the writings of Kenneth Iserson, and Anita D. Taylor]