Like many medical students or soon-to-be medical students, I suffer from periodic existential crises about what specialty I will end up going into when it comes time to become a resident.
Ok, "crisis" may be too strong a word, but choosing a specialty is arguably the most important decision of a physician's career, one which is largely irreversible, and so it's fairly anxiety-producing when the thought of "What kind of doctor should I become?" pops up. With some specialties being extremely competitive, that thought also gets mixed in with the fear of not getting the desired specialty when it's chosen. To help manage some of this anxiety, I started looking at my specialty choice in a semi-methodological way that, even if it doesn't give me a final answer, lets me feel like I have some control over my future.
I thought I'd share my process. It won't work for everyone, but I've found it helpful for my situation.
When I first got into medical school, I looked at every specialty. There are a LOT of them, particularly when you include sub-specialties that have their own unique features. However, it's the specialty that gets decided at the end of medical school, not the sub-specialty, so I figured I'd best start there. Here's the list of all direct-entry specialties in Canada:
Anatomical Pathology
Anesthesiology
Cardiac Surgery
Dermatology
Diagnostic Radiology
Emergency Medicine
Family Medicine
General Pathology
General Surgery
Hematological Pathology
Internal Medicine
Medical Biochemistry
Medical Genetics
Medical Microbiology
Neurology (adult)
Neurology (pediatrics)
Neuropathology
Neurosurgery
Nuclear Medicine
Obstetrics & Gynecology
Ophthalmology
Orthopedic Surgery
Otolaryngology - Head and Neck Surgery
Pediatrics
Physical Medicine & Rehabilitation
Plastic Surgery
Psychiatry
Public Health and Preventive Medicine
Radiation Oncology
Urology
Vascular Surgery
Wow that's a long list... How do you decide between 30 specialties?!
Well, the short answer is, you can't. At least, you can't make a truly informed decision - there's simply not enough time to fully explore every one of those 30 specialties while still being a competitive applicant to all of them. The good news is, making a fully informed decision isn't necessary and the final decision can wait. Most medical students settle on their eventual specialty sometime in Clerkship (3rd year for most students). A few figure it out earlier, in pre-Clerkship, and a few don't ultimately decide until 4th year, but 3rd year seems to be the most common. The majority of students match to their desired specialty and are happy with their decision, so that's quite reassuring.
Those two facts - that I can't (and don't need to) check out every specialty and that I probably won't make my final decision until Clerkship has led to the approach I describe now.
Basically, I started narrowing down the full list of specialties you see above you. This narrowed-down list became the list of specialties I could potentially enjoy practicing. Once a specialty was scratched off that list, that was it - that specialty was dead to me. Any crossed off specialty would be largely ignored. In the first year of medical school, I cut this list down to this:
Anesthesiology
Dermatology
Diagnostic Radiology
Emergency Medicine
Family Medicine
Internal Medicine
Neurology (adult)
Neurology (pediatrics)
Nuclear Medicine
Obstetrics & Gynecology
Pediatrics
Physical Medicine & Rehabilitation
Psychiatry
Public Health and Preventive Medicine
Radiation Oncology
Now that's a lot more manageable!
In my second year, I started crossing off specialties that had really failed to grab my attention despite a reasonable amount of exposure. They might have been fits, but they clearly weren't where I wanted to devote my energies. So, the list shrank a bit further:
Diagnostic Radiology
Emergency Medicine
Family Medicine
Internal Medicine
Nuclear Medicine
Obstetrics & Gynecology
Pediatrics
Physical Medicine & Rehabilitation
Going into Clerkship, that's where I stand, which makes the daunting prospect of choosing a specialty much more palatable.
In all honesty, I've probably cut down my list further than I need to for my stage of training. Again, most people decide their specialty in Clerkship, which has built-in clinical exposure to Family Med, Internal, OB/GYN, Peds, General Surgery, and Psych, so those can still be on the table for everyone. My program has mandatory short rotations through EM and Anesthesiology as well, which I believe is also the case for most programs in Canada, so those could stick around as well.
There's a reason those fields are mandatory training in Clerkship - besides giving an overall good grounding in medicine, last year about 83% of Canadian graduates matched into one of those 8 fields. Chances are you will match to one of these specialties too!
If there is a role for pre-Clerkship in determining your specialty, it's ruling in or ruling out those smaller specialties without built-in exposure in Clerkship. That's a much more reasonable goal than definitively locking down a single specialty early in the game!
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