In a future doctor’s life, there are few
decision as important and nerve-wracking as deciding on a specialty. Everything from your life during medical school,
to your life in residency, to your life beyond residency are all dramatically influenced
by this singular decision. How much money will you make? How much time will you have for your family? Will you be burned out and miserable or will you love what you do? This is how you should go about choosing a
medical specialty. Dr. Jubbal, MedSchoolInsiders.com. We’ll cover the thought processes and practices
you should go through to ultimately land on a specialty that is best suited for you. But an important part of the decision making process
is hearing from other doctors and learning what drew them to their field, what they love
about it, and what they wish they did differently. For that reason, we’ve started an all new
series called The Insiders Scoop available exclusively on the Med School Insiders
blog, where we highlight individual doctors across various specialties. If you’d like to receive updates any time
a new specialty is featured, be sure to subscribe to our newsletter at MedSchoolInsiders.com/newsletter. Data from a 2018 survey conducted by the AAMC on medical student specialty choice revealed that over the course of medical school, most
medical students change their preferred specialty. Only a quarter of respondents indicated
the same specialty between matriculating and graduating. And I can identify with that statistic. I initially started medical school wanting
to go into pediatric gastroenterology but I ultimately switched to plastic surgery. I go over that journey and the process that
led to my decision in a video on my vlog channel. Link in the description below. Interestingly, students that had the highest
rate of congruence, meaning they did not change their specialty, chose orthopedic surgery
at 50.2%, pediatrics at 42.9%, and neurosurgery at 35.5%. I’m not quite sure what to make of those
numbers. What do you guys think? Let me know down in the comments below. We now know that the specialty you decide
on has tremendous immediate as well as long term ramifications on your life. We also know that most medical students end
up changing their mind over their 4 years in medical school. So where do we go from here and how can we
create a system to decide on the best suited specialty for ourselves? Most commonly, people refer to compensation
as a significant factor to help sway your decision. I don’t blame them, particularly when medical
students graduate with close to $200,000 in debt. I’ve covered the top paid specialties in
a previous video, including the factors that lead to certain
specialties being highly compensated and others less so. Link in the description below. While compensation is important, I would argue
that most physicians are quite comfortable, and compensation differences between specialties
will be far less important than other factors in helping you lead a happy and fulfilling
life. Therefore, compensation should NOT be a primary or even secondary factor in
making your decision. Other, more important factors to consider
include what type of relationship and interactions you want to have with your patients, the work-life
balance you desire, how much or little you enjoy performing procedures, the types
of patients you generally work with, and who your colleagues will be. Does the specialty excite and captivate you? Can you imagine doing this for the rest of
your life? Often times, medical students fixate on rare
cases or procedures that are particularly exciting in their field. However, it’s important to remember that
these zebra cases are few and far between. More importantly, determine whether or not
doing the bread and butter, meaning the things you are more likely to see day after
day, is something you can actually live with. We’ll now cover a systematic approach to help you narrow down a category or group of
specialties for you to deliberate on. First, what organ system or clinical questions
do you find the most exciting and stimulating? If you enjoy pharmacology and physiology,
anesthesia may be a good fit for you. If you love anatomy, like I did, then consider
a surgical specialty. If you are fascinated by the brain and how
it works, then neurology or neurosurgery are appropriate considerations. Next, assuming you plan to practice clinically, do you want direct patient care or indirect
patient care? Indirect patient care would include specialties
like radiology or pathology. Direct patient care would include most everything
else. Next, assuming you want to have direct patient care, determine whether you’d like a primarily
surgical practice, where the operating room is the focus of your day-to-day, or a primarily
medical practice, where procedures are relatively rare. Surgical specialty examples would include
general surgery, plastic surgery, orthopedic surgery, and the like. Medical specialties include internal medicine,
pediatrics, psychiatry, family medicine, and other less procedurally focused specialties. On average, these medical specialties emphasize patient
relationships and clinical reasoning, but will often require a high degree of patience. You can also opt for a middle ground, like
urology, dermatology, OB/GYN, or anesthesia that allow for a mix of both. Another important consideration when answering
this question is the level of patient contact and continuity that you prefer. Do you enjoy talking to patients and forming
long-term relationships? And if so, internal and family medicine provide
ample opportunity. Or do you prefer brief and efficient patient
interactions? If so, emergency medicine, anesthesiology, and many
surgical specialties are better suited for this preference. Now when I first started medical school, I remember
thinking that work-life balance wasn’t important. This is a common sentiment amongst pre-med
and medical students. However, by the time you reach the end of
medical school and have been put through the wringer, you begin to realize how important
lifestyle is. It’s easy to simply correlate challenging
or unpredictable work hours with higher rates of burnout, but it’s more nuanced than
that. On average, surgical specialties have much
more challenging hours than non-surgical specialties, but the burn out rates are not necessarily
higher in surgical specialties. The 2019 Medscape National Physician Burnout,
Depression, & Suicide Report provides data on the burnout rates across
various specialties. The highest rates of burnout are found in
urology at 54%, neurology at 53%, physical medicine & rehabilitation at 52%, internal
medicine at 49%, and emergency medicine at 48%. The lowest rates of burnout were found in
public health & preventive medicine at 28%, nephrology at 32%, pathology at 33%, ophthalmology
at 34%, and otolaryngology and plastic surgery at 36%. Factors that were cited as most contributory
to burnout include too many bureaucratic tasks, such as charting and paperwork, at 59%, spending
too many hours at work at 34%, and increasing computerization of clinical practice at 32%. An often understated yet highly important
factor is determining the type of patients and the outcomes you are most comfortable
with. Entering my surgical rotations, I felt drawn
to neurosurgery given my interest in anatomy and love for neuroscience, which is what I majored
in. However, the surprising lack of precision
in neurosurgery, but more importantly the poor outcomes of neurosurgery patients, turned
me off from the specialty. Consider the typical patients you will encounter
in your specialty of choice. The types of patients and interactions emergency
physicians face on a daily basis is far different from what the average pediatrician or orthopedic
surgeon would face. Lastly, there are a few considerations you should keep in mind, although these will likely
not be as important as those previously mentioned. First, assess your own skills. While most skills can be learned, there’s
also some benefit to playing to your strengths. On average, we enjoy things we’re good at. If you’re a klutz and particularly uncoordinated,
then procedural focused specialties may not be a good fit. Next, consider the competitiveness of a specialty. If you’re barely managing to get by in medical
school, then the chances of you matching into something like plastic surgery may be relatively
slim. That being said, I’m a firm believer that
the majority of one’s performance in college or medical school is dictated by their study
strategies, habits, and systems. If you’re struggling in college or medical school, our
team of exceptionally qualified and effective tutors at MedSchoolInsiders.com can help you
turn things around. We stand for results at Med School Insiders,
and our tutoring is a perfect example of this. Third, consider what type of activities you’d
like to engage in outside of clinical practice. Research, teaching, policy work? In most cases, this preference is more important
in determining your practice type, meaning private practice vs academic vs community,
rather than your specialty choice. Addressing the previously mentioned questions
should do a good job in narrowing down your specialty of choice. You now likely have only a handful of specialties
that you’re considering. But prior to pulling the trigger and committing
to one, however, it’s essential that you get clinical exposure. If it wasn’t for gaining clinical experience,
I would not have realized that gastroenterology was not a good fit for me. Make sure you shadow attending physicians
in your areas of interest as much as possible. Specialty clubs and talks from physicians
across various specialties are also a great way to gain exposure to different specialties. And our new series, The Insiders Scoop,
is another great way to gain insight in a particular specialty. Link in the description below. Once you’ve decided, the next step is making
sure you match into a desirable residency program in your specialty of choice. For this reason, it’s essential that you
make your residency program application as authentic as possible. Don’t fall into the trap of researching
a specialty and finding one you love, only to submit a residency application that sounds too
similar to your colleagues. The personal statement, letters of recommendation,
and soft parts of your application are just as important as your USMLE Step 1 and Step
2CK scores. If you need help with your residency application,
our team of advisors with real residency admissions committee experience can help. Visit MedSchoolInsiders.com to learn more. If you guys want to chat with me in real time,
make sure you’re subscribed with the notification bell enabled. I spend the first hour after a new upload
responding to your YouTube comments in real time. New videos every Saturday at 8AM pacific time. Thank you all for watching, let me know if
you have any additional questions, and I will see you guys in that next one.
