How to Choose a Medical Specialty

The 2024 Main Residency Match broke all prior records, with almost 45,000 medical and doctor of osteopathic medicine school applicants seeking a spot in their chosen specialty and roughly 94% matching with residency needs. It’s a mind-blowing feat, if you consider that there are over 200 specialties and subspecialties to choose from in the United States.

What considerations drove applicant decisions? Moreover, how were they able to sort through noise and discover their north star?

Specialty selection is a rite of passage, an experience unique to medical students, and one that can be as enriching as it is difficult.

“Specialty choice is one of the hardest things that any med student has to go through. Unlike in other fields where there is lateral movement, in medicine there is none or very little,” said Sahil Mehta, MD, founder of MedSchoolCoach, a premed and medical school admissions consulting firm, and an interventional radiologist at Beth Israel Deaconess Medical Center in Boston.

The key, experts said, is to stay the course and broaden the experience and exposure.

Open Minds Change Minds

One of the best things a med student can work on is how to keep an open mind.

“There’s a benefit to being open-minded starting off because expectations can quickly differ once you actually see the lifestyle, or how residency programs are, or even realizing what you want for yourself for the future,” said Tara Menon, a first-year med student at Virginia Tech Carilion School of Medicine in Roanoke, Virginia.

She said that some of her classmates who came in with one idea have already started changing their minds.

This isn’t unusual. Almost three quarters of students change their minds from the time they start medical school to the time they apply for a residency spot, according to findings from a recent Association of American Medical Colleges (AAMC) report. In fact, changing one’s mind indicates a willingness to really explore what you want vs assuming that your career direction is preordained.

“People should go into medical school having a sense of what they want to do but being open to being influenced; the environment they’re entering into is designed to give them exposure to things that they haven’t learned before, to stimulate them,” said Sanjay Desai, MD, chief academic officer at the American Medical Association.

“There is no specialty soulmate,” said Mary Halicki, director of the Careers in Medicine Program at AAMC. “Your job is to get a basic understanding of the profession and really understand yourself so you can make an informed decision that hopefully leads to a satisfying and fulfilling career.”

Desai agreed. “The only way to make a wrong decision is if you’re uninformed.”

Path to Self-Enlightenment

AAMC’ offers a broad range of resources to help students understand themselves and identify their interests and values.

“Every year, we ask students what their top factors were in their specialty decision,” said Halicki. “The top two, every single year over the past several years have been a fit with their personality, interests, and skills, and the content of the specialty,” she said.

This is the tack that Chelsea Johnson, a fourth-year medical student at the Philadelphia College of Osteopathic Medicine, Philadelphia, said she took.

“When I first got to medical school, I wanted to be involved with things that aligned with my interests: Working with kids and teaching and mentorship. So, I found opportunities that aligned with those interests.”

Now at the tail end of her interviews, Johnson said she hopes to grab a psychiatry residency spot. Her change of heart came during the third-year clinical rotation, when she realized that the conversations around mental health were more fulfilling than those around pediatrics.

“These conversations are important,” said Desai, who suggested that students seek out someone who is about 5-10 years out of school and into practice. “Ask how these doctors came to their specialty decision, what they like and dislike about their specialty, how they spend their time, and how their careers evolved as well as how they see them evolving.”

“One of the key pieces of advice that I give is that every specialty has some really interesting things and some really cool things. It’s really easy to get lost in those cool things, but the day-to-day of every specialty is what you actually have to enjoy,” said Mehta.

“What you really want to find is the specialty that has the mundane things that you are going to do every single day that you’re actually excited about,” he said.

Show Up, Reach Out, and Broaden Your Horizons

Every school has faculty members who are available to discuss and guide specialty decisions. At Virginia Commonwealth University School of Medicine in Richmond, Virginia, Carolyn Peel, MD, associate professor of family and population health and medical director of VCU Downtown Family Medicine, is one of four lead specialty advisors actively involved in the school’s Careers in Medicine Program. (She’s responsible for family medicine, pediatrics, psychology, and pathology.)

“If you have multiple interests, you can talk to multiple people,” she said. “There’s no barrier to the number of career advisors you could talk to, especially if you are on the fence and really uncertain about what you want to do.”

Clinical rotations are also important. “The one suggestion I would give to students starting their clinical rotations is to really show up every single day, be engaged, and learn as much as you can, even if you think that you’re not going to go to that specialty,” said Michal Ruprecht, a third-year student at Wayne State University School of Medicine in Detroit.

Regardless of the specialty you ultimately choose, you’ll pull insights and information from others, he explained. “For example, if you go into pediatrics, you’re going to be dealing with the youth mental health crisis. And so, what you learn on your psychiatry rotation can be super helpful.”

Both Johnson and Ruprecht have honed additional skills to help drive their ultimate specialty choice. Not only have they pursued health journalism on the side, but Ruprecht said that he’s also worked on research projects in global health and advocacy and is a board member of the Michigan chapter of the American Academy of Pediatrics. The latter provided him with an opportunity to speak with a member of Congress about legislation geared toward fostering children’s health.

Ultimately, the choice lies on inherent values, interests, and how you see your future.

“Choose something that makes you feel true to yourself, your personal values, your capacity for work-life balance, and how much that matters to you,” said Peel.

Mehta is co-founder of MedSchoolCoach. Desai, Menon, Halicki, Johnson, Ruprecht, and Peel had no relevant financial disclosures of interest.