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.