Choosing
a Medical
Specialty

Preparations necessary to make an informed decision: As a first year or second year medical student you might choose to work in a medical or non-medical area or work in a research lab during the summer. You should also spend some time doing serious self-assessment: clarify thoughts you have had in your first year by talking with family, friends and physicians of various ages and specialties. Read about health care issues in newspapers and magazines and become a student member of a professional or specialty organization that offers student memberships and you will receive their journals. Listen to what family and friends are saying about your future career plans in medicine. Explore various specialty areas by establishing relationships with at least two mentors, who will take a professional interest in you. Take advantage of any opportunities to meet with them and share in their family and community life. Actively participate in the Mentor/Advisor Program. Pay attention to your grades and prepare well for Step 1 of the United Stated Medical Licensing examination, because some residency programs and specialities place great emphasis on scores in their consideration of applicants. Seek out faculty in your area of specialty interest about clerkships or electives at other schools or internationally.

During your third year of medical school, you should faithfully make notations, both positive and negative, about each clerkship you have completed. When an attending offers to write you a letter of recommendation, be sure to periodically visit with them so that will remember you when you are ready to request the letter. Attend any programs offered on specialty choice and residency planning, i.e. Residency Review Seminar for third year medical students and the annual Residency Fair are two great sources of information. Prepare your curriculum vitae for residency applications. Schedule electives, particularly in the specialty area you have chosen, at your earliest opportunity and arrange electives at other schools at least twelve weeks in advance in order to secure the dates that you wish to attend. Begin the preparation of your personal statement for residency applications by jotting down ideas or even preparing a first rough draft of why you have selected a particular specialty and your future plans. Speak with current fourth year medical students who have matched in the specialty you are considering, to obtain advice on the application process, residency program selection, electives to take and interviewing. By early summer you should write to residency programs to obtain information especially if you are interested in Ophthamology, Otolaryngology or Neurosurgery. Continue to pay attention to your grades and prepare well for Step 2 of the United Stated Medical Licensing examination, because some residency programs and specialities place great emphasis on scores in their consideration of applicants.

Resources On Choosing A Medical Specialty: Taylor AD. How to Choose a Medical Specialty, 2nd Edition. Philadelphia: W.B. Saunders Company, 1993 Iserson K. How To Get the Residency of Your Choice, 3rd Edition. Columbia, SC: Camden House, 1991 Miller LT, Donowitz LG. Medical Student's Guide to Successful Residency Matching. Baltimore: Williams and Wilkins, annual edition Glaxo Pathway Evaluation Program, Research Triangle, NC: Glaxo, Inc. AMA Directory of Graduate Medical Education Programs, annual publication Annual Board Review Issue. Resident and Staff Physician, May issue Annual Medical Education Issue. JAMA, September issue.

Characteristics of Generalists versus Subspecialists: Generalists like working with people; like variety in work activities; have a high tolerance for undiagnosed problems with multiple symptoms; and, want to be involved in patients' lives on a continuing basis.

Subspecialists like taking care of people; prefer a narrow scope of professional expertise; and, their satisfaction comes from action-oriented curative activities.

Characteristics of Types of Care: Primary Care: Focus of care is broad; the population served is small; types of problems are common; the type of care is continuous; the dominant practice base is community; the technology necessary is basic; and, the approach is as an integrationist.

Secondary Care: Focus of care is intermediate as is the population served; types of problems are uncommon; the type of care is episodic; the dominant practice base is the hospital; the technology necessary is complex; and, the approach is as a consultant.

Tertiary Care: Focus of care is narrow; the population served is large; types of problems are complex/rare; the type of care is discontinuous; the dominant practice base is a medical center; the technology necessary is innovative; and, the approach is by referral.

Ask Yourself These Questions: What was the reason for my interest in becoming a physician? What did I see myself doing in my medical career when I applied to medical school? What are my family members, friends and instructors telling me to do in medicine? What would be my ideal practice setting? What do I want from my career and how will I know when I achieve my goal? How do I define success? What can I offer to a specialty? What can I offer to the community where I will live? What goals, other than career goals, have I set for myself for the next five years? For the next ten years?

Answers to the questions above can be useful as you review all of the specialty choices that are available; as you prepare your personal statement and complete applications; and, in preparation for residency interviews.

Note: Excerpts taken from a presentation by Anita D. Taylor, M.A.Ed at the AAMC Annual Meeting in 1996.

All physicians must have residency training in a particular medical specialty, and many practicing physicians go on to specialize in a particular area of medicine. The most frequently entered specialties, as derived from National Resident Matching Program (NRMP) data, are listed below. You can click on the Specialty to view more detailed information.

Emergency Medicine

An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the prehospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization, and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.

Family Medicine

A family physician is concerned with the total health care of the individual and the family and is trained to diagnose and treat a wide variety of ailments in patients of all ages. The family physician receives a broad range of training that includes internal medicine, pediatrics, obstetrics and gynecology, psychiatry, and geriatrics. Special emphasis is placed on prevention and the primary care of entire families, utilizing consultations and community resources when appropriate.

Internal Medicine

An internist provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults, and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections, and diseases affecting the heart, blood, kidneys, joints, and digestive, respiratory, and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health, and effective treatment of common problems of the eyes, ears, skin, nervous system, and reproductive organs.

Obstertrics - Gynecology

An obstetrician/gynecologist possesses special knowledge, skills, and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary care physician for women.

Orthopedic Surgery

An orthopedic surgeon is trained in the preservation, investigation, and restoration of the form and function of the extremities, spine, and associated structures by medical, surgical, and physical means. An orthopedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries, and degenerative diseases of the spine, hands, feet, knee, hip, shoulder, and elbow in children and adults. An orthopedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.

Pediatrics

Pediatricians provide preventive health maintenance for healthy children and medical care for those who are seriously or chronically ill. Physicians trained in pediatrics are experts in emotional and behavioral assessment and can be powerful advocates for troubled children and adolescents. Pediatricians are often the first and best advocates for children who suffer the sequelae of increasingly prevalent psychosocial morbidities, such as homelessness, family violence, and substance abuse. In caring for children's physical health, pediatricians diagnose and treat infections, injuries, genetic defects, malignancies, and many types of organic disease and dysfunction. They work to reduce infant and child mortality, control infectious disease, foster healthy lifestyles, and ease the day-to-day difficulties of children and adolescents with chronic conditions.

Psychiatry

A psychiatrist specializes in the prevention, diagnosis, and treatment of mental, addictive, and emotional disorders such as schizophrenia and other psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders, and adjustment disorders. The psychiatrist is able to understand the biologic, psychologic, and social components of illness and, therefore, is uniquely prepared to treat the whole person. A psychiatrist is qualified to order diagnostic laboratory tests and to prescribe medications, evaluate and treat psychologic and interpersonal problems, and intervene with families who are coping with stress, crises, and other problems in living.

Surgery

A surgeon manages a broad spectrum of surgical conditions affecting almost any area of the body. The surgeon establishes the diagnosis and provides the preoperative, operative, and postoperative care to surgical patients and is usually responsible for the comprehensive management of the trauma victim and the critically ill surgical patient. The surgeon uses a variety of diagnostic techniques, including endoscopy, for observing internal structures, and may use specialized instruments during operative procedures. A general surgeon is expected to be familiar with the main features of other surgical specialties in order to recognize problems in those areas and to know when to refer a patient to another specialist.