How To Pick A Specialty - A Follow-up

It's been a bit less than a year since I made this post about picking a specialty, where I described the approach I took to narrowing down my specialty choice. Now that I'm done the majority of clerkship and am coming around to a final decision, I figure now's a good time to follow-up on that post to reflect on where my approach worked and where it might have fallen flat.

At the end of second year, my list of specialties, in no particular order, looked like this:

Diagnostic Radiology
Emergency Medicine
Family Medicine
Internal Medicine
Nuclear Medicine
Obstetrics & Gynecology
Pediatrics
Physical Medicine & Rehabilitation

Now, it's a bit smaller and it has an order:

1. Family Medicine
2. Pediatrics
3. Emergency Medicine
4. Psychiatry
5. Radiation Oncology

Two things to mention. First, a number of specialties dropped off my list. Two fell off because of less-than-great experiences in clerkship (OBGYN, Internal Medicine). A few fell off due to attrition - I didn't necessarily have bad experiences with these specialties, but I had enough good experiences in other specialties to feel comfortable eliminating them. That's all in keeping with my original strategy for picking a specialty.

Secondly, and decidedly not in keeping with my original strategy, you'll notice two specialties that weren't on my list from a year ago. I had a really good experience in Psychiatry, which I wasn't expecting. I also had a great experience in Oncology, which I was expecting, but even then the rotation exceeded my expectations.

Many residents and clerks say that you really won't know where you stand on a specialty until you experience it. I'm inclined to agree.

Nevertheless, I think my approach still has some merit. My top three specialties are ones I was considering heavily prior to clerkship. The specialties that jumped onto my list aren't overly competitive - if I wanted to, I could still make myself a reasonably attractive candidate for these fields by re-arranging electives, doing side projects, etc. Eliminating a good number of specialties because of more superficial attributes (hours, patient population, job market) proved reasonably useful because at the end of the day, they still factored into my final ordering. Radiation Oncology, for example, fit my preferences extremely well. However, its job market is pretty bad and flexibility of location is rather limited. Despite defying expectations and making my short-list, it's at the end of that list and will not factor into my elective planning.

Still, I did give too my credence to reputation about specialties, Psychiatry in particular. It hit my goals for those lifestyle-focused parameters, yet I wrote it off prematurely due to perception of the practice rather than reality. I wish I had explored it more thoroughly in advance of clerkship. It's important not to pre-judge the actual practice of a specialty until you see it first-hand.