Advice to the Next Generation
Questions from Our Readers, Answers from Physicians
Question
"I heard that certain specialties are over subscribed while others desperately need doctors; also, certain areas such as diagnostic radiology seem to have been outsourced. I'm worried that my medical school education would be wasted in a field that is over-subscribed. Which specialties in the practice of medicine have the best job prospects?"
– Serene Chen, Harvard College
Answer
While it is true that some fields (surgical subspecialities, dermatology, etc.) are more competitive than others (internal medicine, pediatrics) when it comes to the relative number of applicants compared to available slots, in my experience I have found that when medical students apply for fields in which they have a sincere interest, they have had little difficulty in securing a residency spot. If you truly are fascinated by urology, you will end up choosing classes, rotations, and research experiences that will likely make you an attractive residency candidate and position you to ultimately having a successful career in that area.
– Jennifer Rodriguez Pippins, Senior Resident, Harvard Combined Internal Medicine-Pediatrics Program
It is difficult to say which fields will have the best job prospects, because there is a somewhat cyclical pattern to the supply and demand in the various fields, and by the time most of you finish medical school and residency training (which could be more than ten years from now), things may change somewhat. For example, in the early 1990s, there was a national shortage of primary care physicians, and med school graduates were encouraged to become primary care doctors. However, there currently doesn't seem to be as much of a push towards getting people into primary care.
Another example is interventional radiology, which has seen incredible growth as a field over the last few years because of the new procedures the interventional radiologists are able to perform. Biopsies of chest masses, drainage of abcesses and repairs of abdominal aortic aneurysms used to be entirely the domain of surgeons, but the interventional radiologists developed ways of doing these procedures by using radiologic guidance in ways that required little or no cutting into the patient. Because of this, income and job opportunities in interventional radiology have soared, but this trend may also slow down over the next few years as vascular surgeons, cardiologists, and other specialists learn how to do these procedures and begin to "take back" the procedures from the interventional radiologists.
Another thing that people consider when they think about which fields have the best prospects is what the lifestyle is like. There is a saying among medical students that for lifestyle, there are certain specialties that people ADORE (anesthesia, dermatology, ophthalmology, radiology/radiation oncology, ENT/Emergency med). The New York Times wrote an article last year about the national "brain drain", which is their term for the increased migration of top candidates away from more traditional fields such as general surgery and internal medicine, and towards fields which may have a better lifestyle. For example, in a recent graduating class at a top medical school, 38% of the class chose an ADORE field, while 27% chose internal medicine or general surgery.
On the other hand, the dean of students at Harvard Medical School points out that what your lifestyle is like depends not so much on the specialty you choose, but on the type of job you choose. Someone who chooses a specialty with a more gentle lifestyle, but who takes a high-pressured academic job or who signs up for an aggressive high-volume private practice may have a worse lifestyle than a neurosurgeon who joins a large practice with good coverage and sets a schedule so that he or she works only 3 days a week. For example, my chosen field typically has clinical hours that are not too extreme, but I hope to have an academic career, and therefore expect to work many total hours overall.
Because it is impossible to tell now what the "hot" fields will be, and because medicine is generally a secure field in which you should always be able to find a job no matter what specialty you choose, my advice is to really pick what you love, because you will have to do it and live it every single day of your career, which may span 40 years or even more. When you're on the wards as third and fourth year students, look around closely at the kind of work the attendings (i.e. those who have finished their training and are working full-time in the chosen careers) are doing and the type of people you would be working with if you entered that field and ask yourself if you could truly see yourself in that field and whether you would be happy there. The choice of specialty is something that's very hard to make before you've actually rotated through them and understood what they're really like, so I would definitely go into medical school with an open mind.
– Paul L Nguyen, Intern in Internal Medicine, Brigham and Women's Hospital and Resident Pre-medical advisor Leverett House, Harvard College