According to the American Association of Medical Colleges (AAMC), there are more than 120 specialties and sub-specialties in medicine today. For medical students in their clinical years, deciding on a medical specialty can feel overwhelming, especially as the residency application period looms. AUC’s Office of Career Advisement (OCA) works with students to develop a roadmap for the future and collaborates with each individual to understand career goals and values, and position students for the Match.
We sat down with OCA Advisor Ed Lopez to get advice on the specialty selection process and hear what students can do to make an informed decision.
When should medical students start thinking about a specialty or career path?
It’s never too early to begin thinking about different specialty options. For many medical students, selecting a specialty is a difficult decision—maybe the toughest decision you will face during medical school. And while it’s often not possible to “preview” a career as an anesthesiologist, family physician, surgeon or psychiatrist, you have to decide on a specialty with only your limited clinical experiences.
Some students are drawn to a particular field even before they step foot in a clinical setting. Others find each clinical experience so exciting and interesting that they struggle to determine which specialty is the right fit. While a single exciting rotation may sway you to a particular specialty, try to use multiple clinical and non-clinical experiences to arrive at a decision.
Maintaining a balanced approach to your clinical experiences, and seeking a greater understanding of the differences in specialties, will make the decision-making process easier. Your medical sciences faculty and the various specialty interest groups on campus are wonderful resources to explore the initial understandings of different specialties.
How can students use their clinical rotations to narrow in on a specialty?
Clinical electives can help you explore a specialty that you are merely curious about or that you want greater exposure to. If you are interested in a particular residency program, I’d suggest a visiting or “audition” elective to visit that program and allow them to get to know you. It could give you an edge when it's time for residency interviews.
As with all clinical rotations, students completing audition electives should strive to present themselves in the best light possible. If you wish to seriously audition for a residency program, it may be best to complete these rotations at the kinds of programs that are historically friendly to IMGs. A fantastic away rotation may help overcome some slightly underperforming USMLE scores or other weak aspects of your application portfolio. However, a poor performance would likely have an adverse impact on your chances of obtaining an interview with that program.
Regardless, always try to plan elective rotations as early as possible because strategic planning will allow you to assess your specialty interests and narrow down your ultimate residency selection.
What are some of the key things to consider when selecting a specialty?
- Why did you originally pursue a career as a physician? Are you still motivated by the same reasons?
- Which aspects of the profession most appeal to you? (e.g. intellectual curiosity, professional reputation, patient care, career lifestyle, etc.)
- What kind of lifestyle is right for you? (e.g. work-life balance, salary, continuity of care, patient interaction, pace or challenge of specialty, in-patient vs. out-patient, etc.)
- What kind of professional setting do you see yourself in: Academic vs. Community-based? Rural vs. big city?
- Which kinds of patient encounters do you want to seek out? Which do you wish to avoid?
- Competition for patients or practice locations and demand for certain specialties
- How do your strengths and weaknesses play into different specialties? In other words, is the specialty a good fit for you and are you a good fit for the specialty?
- Are you competitive for the specialty that you are interested in? Are your USMLE scores within the confidence range for the specialty?
What advice do you have for students approaching their fourth year who still haven’t committed to a specialty?
Whether set on a specialty or still uncertain, all students should actively seek mentors, especially if you have no prior exposure to a specialty of interest. Remember that everyone has been in this position and sought help so don’t hesitate to approach faculty, attendings, residents and fellow students with whom you have established some rapport. You may also want to seek out opportunities to observe care in a non-academic setting, such as shadowing/observing in a clinical setting.
Medical school, and especially your clinical years, are the time to be proactive about meeting physicians from various specialties. Simply put, don’t be afraid to solicit recommendations or introductions. Consider joining a specialty professional association and attend their national or regional meetings (scroll to the bottom of this article for a list of professional societies). This is a great opportunity to network and seek out greater professional connections. Many professional organizations offer free or discounted membership to medical students and nearly all of them host networking and educational events throughout the year.
If you are still struggling to find a direction, consider completing an emergency medicine elective rotation. On any given day, you could see cases ranging from blunt force trauma to appendicitis to psychotic episodes and you may be able to narrow your interests by process of elimination.
Try to identify common themes across your resources and outline pros and cons. No one can, or will, determine what is the right specialty for you. As with any other major decision in life, making this decision may come with a certain amount of doubt. However, if you are willing to honestly and objectively self-assess, you can make a decision with confidence.
How should students maximize their 4th year electives to benefit their residency application?
Seeking a greater understanding of the differences in specialties is challenging and requires a great deal of maturity, insight, and self-reflection. Residency training programs prefer applicants who maintain a balanced approach to clinical training. Our analysis of AUC graduates obtaining residencies in various specialties indicates that, on average, they completed eight weeks of sub-specialty elective rotations. The remainder of their elective rotations were in related systems. For example, many general surgery applicants completed rotations in radiology, cardiology, pulmonology, gastroenterology and neurology in addition to eight weeks of surgery electives.
Consider completing elective rotations in August, September, and October at hospitals where you intend to apply to residency programs. This can effectively serve as a form of ‘audition’ with that program and can provide new educational experiences that broaden your professional network.
What are some of the pitfalls to be aware of when applying for a competitive specialty?
The National Resident Matching Program® (NRMP®) and the AAMC maintain vast databases with valuable information related to residency and international medical graduate (IMG) applicants. Take the time to read these materials, especially the NRMP’s Results and Data in the Main Residency Match, Charting Outcomes in the Match for International Medical Graduates, and Program Director Survey, which all delve into the factors and characteristics that residency program directors consider when selecting applicants to interview. These reports also include the top US-IMG and Non-US-IMG friendly specialties, the number of positions offered in each specialty, and mean USMLE scores below which residency programs almost never grant interviews.
The AAMC specifically analyzes IMG match rates across all specialties. For example, nearly 40 percent of all internal medicine matches in 2017 were IMGs, as compared to fewer than 2 percent of all orthopedic surgery matches. Students applying to parallel specialties should consider finding the overlap of common elective rotations between them in order to maintain competitiveness for both specialty applications.
What career planning resources are available to AUC students?
Students should keep in mind that there is no definitive formula for matching into any specialty. Different sources may present inherently biased information, so information from a single source should not determine your choice. Try to get information from as many different sources as possible, including fellow medical students, senior medical students, residents, faculty advisors, department chairs, physicians in private practice, friends, and professional associations.
OCA assists students who are preparing for residency by advising on the application process and providing necessary documents to match-related organizations such as the NRMP and the Electronic Residency Application Service (ERAS). OCA maintains a comprehensive list of resources for students, including the Match Handbook, webinars covering a variety of topics, residency application assessment, and the Physician Match Advisor program. OCA also hosts residency application workshops at various affiliated clinical sites (we’ve held 10 in the past five months), participates in Transition to Clinical Medicine meetings, and conducts appointments on a one-to-one basis.
Outside of AUC, there are an overwhelming number of resources available regarding each medical specialty. The Association of American Medical Colleges, for example, maintains a resource called Careers in Medicine which helps students assess their interests, provides details such as salaries, lifestyles, types of patients and procedures and other characteristics. There are also a variety of professional associations that provide resources for medical students interested in applying to those specialties. The American Academy of Family Physicians maintains a section on exploring a career in family medicine while the Council of Emergency Medicine Residency Directors created their own Emergency Medicine Applying Guide.
