How Are You Going About Deciding On Your Choice Of Specialty?

[thsc]

I'm currently interviewing for med. schools and am positive that I will hopefully get in somewhere. However, a huge concern of mine is choosing specialty. I know that I've got time before I need to worry about that, but lately, the closer I get to med. school and the more I come into contact with my friends in med., the more the reality is dawning on me. 

 

Two of my biggest interests in medicine were surgery (particularly plastic surgery) and radiology (probably interventional). Of course, I've got a lot of exploring to do within these specialties and others as well to determine how well they fit in with my personality and also whether I also would be interested in other specialties that I've not had any exposure to. However, even before the "choice" aspect of picking a specialty factors in, we need to consider other factors too: income, flexibility, job prospects. In an ideal world, these factors wouldn't matter, but the reality is, you can't simply choose a specialty based on how much you like it without thinking of these 3 things (at least that's my belief). That's where I have an issue. While I think I'd love surgery (and I may end up realizing that I don't), I don't want to deal with all the lifestyle and flexibility issues that come with it. Medicine is an important part of my life, but I don't want it to consume most of my life to the point where I have no time for other things. Additionally, there's also this issue of crappy job prospects right now for most specialties. So while I might find surgery or rads to be thrilling, and while they provide a solid income, at the end I feel that the bleak job and lifestyle prospects might ultimately deter me. 

 

On the other hand, I also don't want to choose family med because I don't find it interesting and I don't think I'd enjoy doing it (for several reasons), but family med offers great lifestyle prospects and flexibility. 

 

So my question is, how the hell do you decide? How do you balance these conflicting factors? It's driving me insane...

[ellorie]

I was lucky, because I came into medical school liking psychiatry, and just fell more and more in love with it as time went on - and it is flexible, has great job prospects and while it's not the highest billing specialty, you can make a good living, and I don't need more money than I know what to do with.

 

So I guess you know where my bias lies.

 

I think the big thing in medical school is finding mentors in your specialty of interest who can talk to you honestly about why they chose their career, the ups and downs, and their path to where they are today, both residents, who are closer to making the choice, and staff, who can look back on their choice and give the long perspective.

 

I think by the time you do clerkship, you get to know whether certain specialties are something you like/find interesting/would enjoy versus something you love so much that you'd do it no matter what.  The people in my class who are going into some of the really time-intensive or job-crunched specialties don't just like them, they love them and cannot see themselves enjoying or being fulfilled by anything else.

 

There are people who like everything, and I think that's where the considerations about lifestyle come into play.  Then there are people who really wouldn't be happy doing anything other than one specialty.  I'm like that, but I think I got lucky with which specialty.

[ralk]

Everyone's got their own strategy, but here's what my approach has been so far.

 

First, I made a full list of all the first-entry specialties. I started crossing off anything I was absolutely sure I didn't want to do. That wasn't too many specialties and virtually no big ones - if I had even the slightest inclination that I might fit into a specialty, it stayed on the list. Mostly this got rid of some fairly unique specialties that clearly didn't fit my academic interests or how I wanted to practice, lifestyle or job opportunities didn't factor in much. Pathology was the only main casualty. Anything eliminated from the list could be safely ignored. Anything left deserved at least a little attention.

 

Secondly, I made a shortlist of specialties I was very interested in. Everything counted in considering this list - subject matter, patient population, lifestyle, job availability. I put a rough order of preference on this shortlist too. Any specialty on this list I actively pursued additional information about, as much as I could get.

 

Over the last two years, I've been modifying these lists regularly. If there was a talk on a specialty on my long list, I went to it. A few specialties fell off the long list from what I learned from those talks, in most cases because I wasn't too keen on the specialty to begin with and what I learned did nothing to change that. Classes changed my lists a bit as well. Dermatology, for example, was on my original shortlist. Our Skin week changed that quickly - it's not even on my long list anymore. I actively checked out the specialties on my shortlist, and that provided a lot of insight. Spending some time in the OR and checking out some surgical events were very helpful. I liked these experiences, but I didn't love them. You have to love surgery to pursue it - too many hours, too few jobs, too much stress to make it worthwhile otherwise.

 

Right now my shortlist is down to five specialties, with a pretty clear order of preference and only two of which require any real attention pre-clerkship. My long list isn't much longer than those five - only a handful of specialties I don't feel entirely confident scratching out of consideration but which I'm very unlikely to pursue. I was lucky enough to get my first choice of clerkship rotation order, which should allow me to adequately refine that list before having to pick electives.

 

Is this a good strategy? I have no idea, too soon to tell. But it has been great for stress management. It's so easy to become consumed with thoughts of which specialty is right for you and whether you're doing enough to prepare to match to those specialties. This let me stop worrying about a good number of specialties and to focus on a select few. Keeps things simple.

[CharmingHedgehog]

Wow, that's a very systematic and thorough way of approaching the selection process. Good for you! I wish I'd thought of something like that!

I picked the specialty I applied for because I really liked it during rotations, and confirmed my choice by doing 14 weeks of electives and still wanted to show up to work and learn. I didn't really have a list going in, and really don't have a back up that I would really enjoy either.

[thsc]

Everyone's got their own strategy, but here's what my approach has been so far.

 

First, I made a full list of all the first-entry specialties. I started crossing off anything I was absolutely sure I didn't want to do. That wasn't too many specialties and virtually no big ones - if I had even the slightest inclination that I might fit into a specialty, it stayed on the list. Mostly this got rid of some fairly unique specialties that clearly didn't fit my academic interests or how I wanted to practice, lifestyle or job opportunities didn't factor in much. Pathology was the only main casualty. Anything eliminated from the list could be safely ignored. Anything left deserved at least a little attention.

 

Secondly, I made a shortlist of specialties I was very interested in. Everything counted in considering this list - subject matter, patient population, lifestyle, job availability. I put a rough order of preference on this shortlist too. Any specialty on this list I actively pursued additional information about, as much as I could get.

 

Over the last two years, I've been modifying these lists regularly. If there was a talk on a specialty on my long list, I went to it. A few specialties fell off the long list from what I learned from those talks, in most cases because I wasn't too keen on the specialty to begin with and what I learned did nothing to change that. Classes changed my lists a bit as well. Dermatology, for example, was on my original shortlist. Our Skin week changed that quickly - it's not even on my long list anymore. I actively checked out the specialties on my shortlist, and that provided a lot of insight. Spending some time in the OR and checking out some surgical events were very helpful. I liked these experiences, but I didn't love them. You have to love surgery to pursue it - too many hours, too few jobs, too much stress to make it worthwhile otherwise.

 

Right now my shortlist is down to five specialties, with a pretty clear order of preference and only two of which require any real attention pre-clerkship. My long list isn't much longer than those five - only a handful of specialties I don't feel entirely confident scratching out of consideration but which I'm very unlikely to pursue. I was lucky enough to get my first choice of clerkship rotation order, which should allow me to adequately refine that list before having to pick electives.

 

Is this a good strategy? I have no idea, too soon to tell. But it has been great for stress management. It's so easy to become consumed with thoughts of which specialty is right for you and whether you're doing enough to prepare to match to those specialties. This let me stop worrying about a good number of specialties and to focus on a select few. Keeps things simple.

Thanks for describing your process. This is very thorough! 

 

Mind if I ask which 5 specialties you narrowed down to in your shortlist? 

 

Also, does income influence your decision even slightly? Perhaps I place too much of an emphasis or perhaps others don't put enough, but as a physician, depending on which specialty you choose, you enter a different range of salaries you can expect to bill for. Of course, I'm in no way suggesting that income should be a primary factor (or even top 3 for that matter), but I think it's reasonable to say that it should factor in to some extent. 

[ralk]

Thanks for describing your process. This is very thorough! 

 

Mind if I ask which 5 specialties you narrowed down to in your shortlist? 

 

Also, does income influence your decision even slightly? Perhaps I place too much of an emphasis or perhaps others don't put enough, but as a physician, depending on which specialty you choose, you enter a different range of salaries you can expect to bill for. Of course, I'm in no way suggesting that income should be a primary factor (or even top 3 for that matter), but I think it's reasonable to say that it should factor in to some extent. 

 

In no particular order, my shortlist is down to Radiology, Nuclear Medicine, Internal, Family, and Pediatrics.

 

Not all of these are likely to be my first choice come match day, but they may show up on my ROL. Most importantly (for my sanity), I feel like I'm set up to be a competitive candidate in any of these specialties at this point in time. That'll change a bit through clerkship and into electives though. I can stay competitive in Family and Nuc Med without much difficulty, but I'll likely have to make a choice between Rads, Peds, and likely Internal over the next year or so. Fortunately, I think I'm pretty well placed to be able to make that choice.

 

Money has factored into my decision, but it's been fairly low on my list of considerations. Everything I'm looking at should earn $200k a year, minimum, and that's enough for me. I come from a frugal family and I don't intend to change that. There's not much that I care about that I could do with $300k or $400k a year that I can't do with $200k, so anything extra is just a bonus. The job itself is the most important part to me, followed by work hours and job availability, then compensation. In extreme circumstances money would be a bigger factor - say if the difference was between $100k and $600k - but fortunately that's not the case. Radiology, for example, pays quite well, but that's not enough to make it a clear front-runner over the other specialties I'm looking at.

[thsc]

In no particular order, my shortlist is down to Radiology, Nuclear Medicine, Internal, Family, and Pediatrics.

 

Not all of these are likely to be my first choice come match day, but they may show up on my ROL. Most importantly (for my sanity), I feel like I'm set up to be a competitive candidate in any of these specialties at this point in time. That'll change a bit through clerkship and into electives though. I can stay competitive in Family and Nuc Med without much difficulty, but I'll likely have to make a choice between Rads, Peds, and likely Internal over the next year or so. Fortunately, I think I'm pretty well placed to be able to make that choice.

 

Money has factored into my decision, but it's been fairly low on my list of considerations. Everything I'm looking at should earn $200k a year, minimum, and that's enough for me. I come from a frugal family and I don't intend to change that. There's not much that I care about that I could do with $300k or $400k a year that I can't do with $200k, so anything extra is just a bonus. The job itself is the most important part to me, followed by work hours and job availability, then compensation. In extreme circumstances money would be a bigger factor - say if the difference was between $100k and $600k - but fortunately that's not the case. Radiology, for example, pays quite well, but that's not enough to make it a clear front-runner over the other specialties I'm looking at.

I suppose you've done a lot more research than I have so you're more aware of the job prospects. How is it looking for Radiology? 

 

That's something I am quite interested in but I've been hearing that the job market is terrible for Radiology at the moment. 

 

Secondly, can you provide some insight as to how you've made yourself 'competitive' for radiology? I'm sure there are many ways to do it, but I'm curious to know what one can do other than research to become competitive for a specialty like that. 

[ralk]

I suppose you've done a lot more research than I have so you're more aware of the job prospects. How is it looking for Radiology? 

 

That's something I am quite interested in but I've been hearing that the job market is terrible for Radiology at the moment. 

 

Secondly, can you provide some insight as to how you've made yourself 'competitive' for radiology? I'm sure there are many ways to do it, but I'm curious to know what one can do other than research to become competitive for a specialty like that. 

 

From what I can tell, Radiology is about middle-of-the-pack for job prospects and looks to stay there or improve in the next little while. There are competitive locations and subspecialties where jobs are tight, but no one seems to be doing fellowship after fellowship for a low-demand position. Nothing like some of the surgical specialties - a reasonably flexible person seems to be able to get a job without going to extremes. It's also a specialty with plenty of room for growth, as diagnostic imaging becomes more effective and cheaper. Terrible is not the word I've heard used for the current job market.

 

I came into med school with a background pretty heavy in diagnostic imaging, so in a sense I came in somewhat competitive for radiology to begin with. I've added to that with research, plus a few projects and initiatives in diagnostic imaging, mostly relating to education and/or skill development in imaging. I've also got one or two things on my CV that I think any program would like, so that helps. I'm not saying I'm set to match to radiology - the main stuff will come in clerkship and electives - but other than doing a PhD in diagnostic imaging, I think I've done about all I can to show interest and aptitude in diagnostic imaging. Funny thing is, despite having a CV almost tailor-made for Radiology, it's not top of my list right now, Pediatrics is - my main struggle right now is proving that I'm not meant for Radiology and Radiology only.

 

Of course, the Rads residents (or soon-to-be residents) who hang around this forum will have a much better sense of what the job market's like and what people need to do to match to Radiology than I do - hopefully they'll chime in.

[mononoke]

I was lucky, because I came into medical school liking psychiatry, and just fell more and more in love with it as time went on - and it is flexible, has great job prospects and while it's not the highest billing specialty, you can make a good living, and I don't need more money than I know what to do with.

 

So I guess you know where my bias lies.

 

I think the big thing in medical school is finding mentors in your specialty of interest who can talk to you honestly about why they chose their career, the ups and downs, and their path to where they are today, both residents, who are closer to making the choice, and staff, who can look back on their choice and give the long perspective.

 

I think by the time you do clerkship, you get to know whether certain specialties are something you like/find interesting/would enjoy versus something you love so much that you'd do it no matter what.  The people in my class who are going into some of the really time-intensive or job-crunched specialties don't just like them, they love them and cannot see themselves enjoying or being fulfilled by anything else.

 

There are people who like everything, and I think that's where the considerations about lifestyle come into play.  Then there are people who really wouldn't be happy doing anything other than one specialty.  I'm like that, but I think I got lucky with which specialty.

I'm a little confused about why people say psych doesn't pay well, you still earn about $200k on average which is pretty good!

[ellorie]

I didn't say it didn't pay well.

 

I said it's not the highest billing specialty.

 

It pays well enough - but it's on the lower end of the pay scale for medical specialties.  I think psychs and paeds make the least - but don't quote me on that specifically.  And of course $200,000 of billings doesn't mean you take home $200,000, though psychiatry is lucky to have fairly minimal overhead.

[GrouchoMarx]

Everyone's got their own strategy, but here's what my approach has been so far.

 

First, I made a full list of all the first-entry specialties. I started crossing off anything I was absolutely sure I didn't want to do. That wasn't too many specialties and virtually no big ones - if I had even the slightest inclination that I might fit into a specialty, it stayed on the list. Mostly this got rid of some fairly unique specialties that clearly didn't fit my academic interests or how I wanted to practice, lifestyle or job opportunities didn't factor in much. Pathology was the only main casualty. Anything eliminated from the list could be safely ignored. Anything left deserved at least a little attention.

 

Secondly, I made a shortlist of specialties I was very interested in. Everything counted in considering this list - subject matter, patient population, lifestyle, job availability. I put a rough order of preference on this shortlist too. Any specialty on this list I actively pursued additional information about, as much as I could get.

 

Over the last two years, I've been modifying these lists regularly. If there was a talk on a specialty on my long list, I went to it. A few specialties fell off the long list from what I learned from those talks, in most cases because I wasn't too keen on the specialty to begin with and what I learned did nothing to change that. Classes changed my lists a bit as well. Dermatology, for example, was on my original shortlist. Our Skin week changed that quickly - it's not even on my long list anymore. I actively checked out the specialties on my shortlist, and that provided a lot of insight. Spending some time in the OR and checking out some surgical events were very helpful. I liked these experiences, but I didn't love them. You have to love surgery to pursue it - too many hours, too few jobs, too much stress to make it worthwhile otherwise.

 

Right now my shortlist is down to five specialties, with a pretty clear order of preference and only two of which require any real attention pre-clerkship. My long list isn't much longer than those five - only a handful of specialties I don't feel entirely confident scratching out of consideration but which I'm very unlikely to pursue. I was lucky enough to get my first choice of clerkship rotation order, which should allow me to adequately refine that list before having to pick electives.

 

Is this a good strategy? I have no idea, too soon to tell. But it has been great for stress management. It's so easy to become consumed with thoughts of which specialty is right for you and whether you're doing enough to prepare to match to those specialties. This let me stop worrying about a good number of specialties and to focus on a select few. Keeps things simple.

What was it about pathology that made you rule it out immediately?

[dmleo]

You won't fully appreciate anything about a speciality unless you have done clinical rotations as a clerk. You literally don't do anything even shadowing in pre-clerkship. My advice for you is get into med school first then worry about what speciality when you approach and are on clerkship.

 

 

It is really foolish to make up your mind about a speciality by reading about other people's experiences, because yeah you can get a sense of it, but their experience will never be the same as yours.

[ralk]

What was it about pathology that made you rule it out immediately?

 

1) Subject matter. My educational background has very little overlap with pathology, so to pursue it I'd have to essentially start from scratch. I love learning new things, but don't have much interest in the fields of science that support pathology, and I'd rather build off what I've already learned.

 

2) Patient contact. Pathology basically has none and that's very high on my list of considerations. That's a big part of what's holding me back from the Imaging specialties, despite my imaging-heavy background - in Radiology you can have a fair bit of patient contact if you tailor your practice that way, but it takes a while to get there and we're still not talking about the same level of patient contact as there would be in something like Family Medicine. I worked as a health care practitioner before starting med school, and I know that patients are what get me up and going to work in the morning - heck, even these two years of pre-clerkship have been tough for me without patient contact.

 

You won't fully appreciate anything about a speciality unless you have done clinical rotations as a clerk. You literally don't do anything even shadowing in pre-clerkship. My advice for you is get into med school first then worry about what speciality when you approach and are on clerkship.

 

 

It is really foolish to make up your mind about a speciality by reading about other people's experiences, because yeah you can get a sense of it, but their experience will never be the same as yours.

 

I completely agree that you shouldn't settle on a specialty until clerkship, but some decisions can be made beforehand - and some decisions must be made beforehand.

 

Clerkship doesn't expose you to every single specialty, especially some of the smaller or more unique specialties. You often get a choice to get exposure to some of these smaller specialties, but that's the thing - you have to make a choice. For example, I won't have any exposure to Ophthalmology next year. I had to make a decision about how I felt about that specialty without having experienced it during clerkship. That's where crossing things off my long list came in handy. Yeah, I might have scratched off a specialty that was a great fit for me without really knowing what it was like, but that was going to happen anyway.

 

Secondly, there are factors that clerkship experience can't change, yet still matter. Neurosurgery is going to involve long work hours and limited job opportunities, whether I love it in clerkship or not. Those factors require sacrifices I'm unwilling to make, so why bother worrying about it? I'll save my efforts for specialties that better fit what I want from life - in my career, and out of it.

 

Lastly, clerkship is not the same as residency or practicing. It's as close as we'll get before having to make our choices, but it's not the same. Surgery's probably the clearest example of that. Even in the most permissive clerkship program, you're not going to get to do what surgical residents or consultants do. Individual experiences in clerkship also aren't necessarily representative of the specialty as a whole - a particularly good or particularly bad preceptor can influence clerkship experiences significantly. Other people's experiences can provide some perspective on that - essentially giving a larger sample size than the limited clerkship exposure, which can be as short as 2 weeks for some specialties. We're all making our specialty choices with incomplete information, even after clerkship. I don't think it's foolish to draw on other people's experiences, I think it's unavoidable.

 

Again, I don't think any specialty should be finalized as THE choice before clerkship. I've got a shortlist precisely because I want to use clerkship to help make that final decision. But clerkship can't answer everything about all specialties, and it's fairly late in the game to start narrowing down the options.

 

As I said, everyone's got their own approach, and your approach works for you. It wouldn't work for me - too much uncertainty, too many variables to consider when figuring out what pre-clerkship opportunities to pursue. If nothing else, what I did helped simplify things in my own, helped keep stress about my future specialty to a minimum. We'll see if I feel that way in a year or so after some time in clerkship, but I feel confident about where I stand right now.

[Laika]

In no particular order, my shortlist is down to Radiology, Nuclear Medicine, Internal, Family, and Pediatrics.

 

A little OT, but why are you considering the direct entry for NM at all?  I knew a NM PD who strongly advised people not to apply!

[ralk]

A little OT, but why are you considering the direct entry for NM at all?  I knew a NM PD who strongly advised people not to apply!

 

As I said, I have an imaging background - which included some NM exposure - so it's a fit that way. There's some interesting stuff in the field. I'm fully aware of the downsides of pursuing NM though, including its downright horrible job market. It's very unlikely to be my first choice, but since I'd rather do it than be unmatched at this point (and it's incredibly easy to match to it), it could easily end up on my ROL, if only as a last-ditch back-up. That's why it's on the shortlist.

[fugacity]

I'm a little confused about why people say psych doesn't pay well, you still earn about $200k on average which is pretty good!

Actually 200k for a 5 year residency is pretty bad in terms of remuneration.  I am in the brain and behavior block right now, and let me tell you it can be a draining specialty from the little clinical experience I have had. 

 

I wonder if it is because of selective bias, but most people I speak to have lifestyle pretty high in terms of factors they consider for specialty training.  Might also be a west coast thing since there's so much you can do with free time .  As for myself, I don't think there is just this ONE SPECIALTY I need to get into - I like a few things and dislikes a few things.  I think what will decide for me is when clerkship rolls around, I can then get a real feel for it.  Certainly you can hear about it from other people, but experience is so subjective.  Medical school is nothing like what I heard about it as a pre-med, so I am taking everything I hear with a grain of salt.

[torontomd]

You won't fully appreciate anything about a speciality unless you have done clinical rotations as a clerk. You literally don't do anything even shadowing in pre-clerkship. My advice for you is get into med school first then worry about what speciality when you approach and are on clerkship.

 

 

It is really foolish to make up your mind about a speciality by reading about other people's experiences, because yeah you can get a sense of it, but their experience will never be the same as yours.

 

Ditto.  It is far too early to be thinking about choosing a specialty.  Also, by the time you will be looking for a job, the entire landscape may be different in terms of demand and pay.  I have no idea where you are from but at least in Ontario OHIP renegotiation means incomes are always in flux.  With that said, my general sense is that the whole field's HR planning isn't so great and there is probably an oversupply of specialists being trained right now (across all fields).  Slowly, more and more specialties are saturating and given the timing (i.e. lots of young staff in most divisions), in 10 years, unless youre a generalist it may be tough to be picky about job offerings.

[hkmedic]

I'm currently interviewing for med. schools and am positive that I will hopefully get in somewhere. However, a huge concern of mine is choosing specialty. I know that I've got time before I need to worry about that, but lately, the closer I get to med. school and the more I come into contact with my friends in med., the more the reality is dawning on me. 

 

Two of my biggest interests in medicine were surgery (particularly plastic surgery) and radiology (probably interventional). Of course, I've got a lot of exploring to do within these specialties and others as well to determine how well they fit in with my personality and also whether I also would be interested in other specialties that I've not had any exposure to. However, even before the "choice" aspect of picking a specialty factors in, we need to consider other factors too: income, flexibility, job prospects. In an ideal world, these factors wouldn't matter, but the reality is, you can't simply choose a specialty based on how much you like it without thinking of these 3 things (at least that's my belief). That's where I have an issue. While I think I'd love surgery (and I may end up realizing that I don't), I don't want to deal with all the lifestyle and flexibility issues that come with it. Medicine is an important part of my life, but I don't want it to consume most of my life to the point where I have no time for other things. Additionally, there's also this issue of crappy job prospects right now for most specialties. So while I might find surgery or rads to be thrilling, and while they provide a solid income, at the end I feel that the bleak job and lifestyle prospects might ultimately deter me. 

 

On the other hand, I also don't want to choose family med because I don't find it interesting and I don't think I'd enjoy doing it (for several reasons), but family med offers great lifestyle prospects and flexibility. 

 

So my question is, how the hell do you decide? How do you balance these conflicting factors? It's driving me insane...

 

What a naive statement. You're not even in medical school yet. And even if you say you've shadowed a family doctor before or that one of your parents is a family doctor, that doesn't even come close to what you'll experience as a medical student. I know people who were so dead-set certain specialties but after spending time in family medicine, they realize how amazing it can be. 

[ralk]

Ditto.  It is far too early to be thinking about choosing a specialty.  Also, by the time you will be looking for a job, the entire landscape may be different in terms of demand and pay.  I have no idea where you are from but at least in Ontario OHIP renegotiation means incomes are always in flux.  With that said, my general sense is that the whole field's HR planning isn't so great and there is probably an oversupply of specialists being trained right now (across all fields).  Slowly, more and more specialties are saturating and given the timing (i.e. lots of young staff in most divisions), in 10 years, unless youre a generalist it may be tough to be picky about job offerings.

 

 

What a naive statement. You're not even in medical school yet. And even if you say you've shadowed a family doctor before or that one of your parents is a family doctor, that doesn't even come close to what you'll experience as a medical student. I know people who were so dead-set certain specialties but after spending time in family medicine, they realize how amazing it can be. 

 

These posts have a degree of truth to them, but are missing the point.

 

When people are on the cusp of getting into medical school or are in pre-clerkship, thoughts of what specialties might fit pops up constantly. Friends ask about it. Family asks about it. Instructors ask about it. Fellow students ask about it. When pursuing extra-curricular opportunities, interest in potential specialties matters, because some have more relevance to some specialties and there's only so much you can do. Lastly, I don't think I'm being facetious in saying it's a fairly important decision to make. Given these pressures, it's reasonable to want to devote a fair bit of thought to what specialty might be a good pathway.

 

It's fine to say "you don't know enough yet, don't bother thinking about it until later", but specialty choice is a nagging question hanging in the back of every medical student's mind, and most of us can't just ignore it for the several years between getting into med school and when we'll have to commit to a specialty. Having a process to approach specialty selection can help address that anxiety, even if it doesn't ultimately answer the question of what specialty to go for.

 

I agree, it's important to keep an open mind about specialties, because we all come in with misconceptions about specialties and the more we find out the better positioned we'll be to make those ultimate choices on specialty preferences. Yet, not all those misconceptions can be addressed, even by clerkship - every graduating MD will have a false perception of multiple specialties, sometimes including the one they're headed into. There's simply too much to each specialty to figure out in the relatively short amount of time we have to do it in Med School. I guarantee each of you dismissed specialties without fulling grasping what they entailed.

 

When faced with incomplete information, making naive judgments is a completely reasonable course of action, so long as those judgments are re-evaluated when that information becomes more complete. As you point out, hkm91450, even students heavily focused on a single specialty are able to do that re-evaluation when they gain a bit of extra exposure. It's entirely acceptable to be a bit naive at this point in the process. There's no need to be criticize someone because of it, everyone's naive at this stage.

[ellorie]

Like I said - I went to medical school to be a psychiatrist.  People told me I'd change my mind but I never wavered for a minute.  Sometimes you just know.

 

I think it's totally appropriate to have an idea of your interests/strengths/weaknesses going in, as long as you're not so completely fixated that you don't explore other options.

[A-Stark]

I think it's very difficult to figure out what you really like until you have a real taste of it in clerkship, and even then you don't *really* get a sense of things until you do it as a resident. And then that still is not entirely reflective of life as staff. But I do think that most people should/do have a very clear idea of why they like what they do once they become a resident. 

[fugacity]

I think it's very difficult to figure out what you really like until you have a real taste of it in clerkship, and even then you don't *really* get a sense of things until you do it as a resident. And then that still is not entirely reflective of life as staff. But I do think that most people should/do have a very clear idea of why they like what they do once they become a resident. 

... Soo crapshoot is the name of the game for Carms?  I think I would really appreciate a year of general rotation as a resident, and I don't even care about the extra year of training.

[A-Stark]

Many people do figure things out soon enough. Or else they make a sufficiently educated decision that things work out. Priorities do change, though, and it sometimes becomes more important that what you're doing is "good enough" and allows time for other things. 

 

It can be a crapshoot. Not absolutely inevitably a crapshoot though. 

[Lactic Folly]

The same could be said for going into medicine - that you don't really know what it's like until you're practising - yet here you are, having chosen to go to medical school. Inevitably, there comes a point when you have to make a decision based on the information available. A general rotation year as a resident won't expose you to all fields, nor will you be experiencing the field at the level of a staff person. As described above, an introspective, motivated, strategic person can make strides in determining what fields are likely to be most suitable to them in the long run, thus enabling them to make an optimal decision despite the finite time and experiences available as a medical student.

 

By the time I entered medical school, I had narrowed down the specialties to a list of 5, with 3 additional fields I knew little about and needed to find out more before ruling out. With additional electives/research/shadowing, I narrowed this down to 2 by the time I entered clerkship, which were the fields I applied to in CaRMS. Others will invariably have different experiences, but I'm in practice now and am quite happy with my career choice which was my #1 going into medical school.