Specialty Choice
A NextGen Pathways in Medicine
Article
By Tavé van Zyl
You’re in the process of applying to medical school. You’ve submitted your primary application, having crafted the most compelling vision of yourself as a future leader in the profession. It has taken years – perhaps even a lifetime – to arrive at this moment, to have finally articulated your answer to the ultimate question of “why you want to be a doctor.” And it feels great now that you have done it. Now, as you leaf through the supplemental application, you suddenly halt as you read, “What specialty do you plan to pursue as a physician?” A mere month ago, you solidified your decision to become a doctor; how can you be expected to have settled on a specialty already?
While a question like this may seem premature and even unfair to ask of a student simply applying to medical school, it is not without a purpose. By impelling applicants to critically examine their interests and locate them in the context of a medical specialty, this question initiates an important exercise that will be helpful in the first year of medicine and beyond. This process is what prompted Dr. Glenn Gaviola, Chief Resident in Radiology at Brigham and Women’s hospital in Boston, Massachusetts, to first indicate he wanted to go into pediatrics. “I enjoyed working with kids. Throughout high school and college I did a lot of work with them: teaching, tutoring, and spending time with them in the hospital.” But when he ultimately had the opportunity to rotate on the pediatric service, Dr. Gaviola was surprised to find out that it was much different than what he had experienced as a pre-medical student. “As a pediatrician you end up working as much or even more with the parents of your patients than with the children themselves,” Dr. Gaviola explains. “A lot of time is dedicated to easing their anxieties, fears, etc., and this led me to reconsider my initial inclination.”
Dr. Glenn Gaviola, Chief Resident in
Radiology at Brigham and Women’s
hospital in Boston, Massachusetts
Indeed, it is not uncommon for students to enter medical school with an inherent preference for a certain area or specialty in medicine, shaped by high school and college academic, extracurricular or clinical experiences. But while past experiences and activities can inform, they should not dictate the decisions made when it comes to choosing a specialty.
How and when medical students choose their specialties
In many ways, choosing a specialty is like a higher-stakes version of choosing a major in college, and most medical students change their minds a few times before ultimately compiling their rank list of residency programs during their final year. This change over time is often due to the fact that, in medical school, students have the opportunity--and are in fact required--to experience a broad range of services before making their decision. “That is the good part about med school,” Dr. Gaviola points out, “Through your rotations you get exposed to aspects of medicine you never really thought about.” Furthermore, as Dr. Gaviola found during his time in pediatrics, rotations effectively challenge one’s preconceived notions about certain specialties. “The actual practice of medicine in a given specialty is often different than what you thought it was based on your past experiences as a pre-medical student.”
After pediatrics, Dr. Gaviola’s next prospect was Obstetrics and Gynecology because of its interesting blending of surgery and medicine. However, not long into his rotation he was prompted once again to reconsider. “My two advisors, both males in their fifties, confessed that if they had the chance to go back in time they would choose a different specialty,” Dr. Gaviola recalls. “Now that more and more women are entering the field, many patients prefer and consequently request women, and this is limiting the types of experiences male doctors can have.”
Ultimately, Dr. Gaviola’s interest fell upon radiology. At Harvard, where he attended medical school, it was a required rotation and it just happened to engage both his strengths as a visual learner and his enjoyment for hands-on work. “Radiology combined the intellectual aspect of diagnosis in medicine with hands-on work particular to the specialty.” What makes it even more attractive to Dr. Gaviola is that the field constantly evolves. “It is at a turning point, becoming more patient-oriented; it is also becoming increasingly prevalent and important in terms of minimally invasive surgery, with the advent of imaged-guided therapies such as percutaneous and endovascular treatment of certain types of abdominal tumors.”
Factors that influence specialty choice
The process of choosing a specialty is multi-factorial. Jennie Wei, a fourth-year medical student at Harvard Medical School, is currently in the process of applying to residency programs and has offered her perspective on this process. “Medical school is geared toward helping us find a specialty that we are passionate about,” Jennie explains, “but realistically, other lifestyle factors and the context of one's life play an extremely large part in the specialty selection process, independent of actual interest.” Location is one of these factors. According to Jennie, “as we start settling down in other aspects of our lives, location becomes much more important. Being around family and significant others, for example, takes on a greater importance.” Furthermore, perhaps unlike the process of choosing a medical school, “less emphasis is placed on which program is most prestigious, if that distinction can even be made.”
The people with whom you work during your rotation also exert a great impact on your perception of the specialty. Very often, it is their meaningful relationships and inspiring mentors and colleagues that ultimately influence students’ decisions more profoundly than the nature of the specialty itself. Other factors influencing specialty choice include the timing of one’s choice and the lifestyle and compensation associated with the specialty. Dr. Gaviola points out that the latter aspects are the least talked about, but nevertheless have a huge impact. Indeed, though no one admits the impact of salary, the most competitive specialties—Radiology/radiation oncology, Ophthalmology, Anesthesiology, and Dermatology—also happen to be among those that pay the best.
Ultimately, when it comes to ranking programs for the match, you will most likely find that your personal criteria, rather than generalized rankings, will more reliably indicate what will be the best residency program for you.
Insights into the Match process
The process of applying to residencies is very similar to the process of applying to medical school. The Match process is intricate, involving a significant degree of uncertainty, and often frustrating. Just like undergraduates applying to medical schools, fourth year medical students submit a general application including a personal statement and list of residency programs to a centralized collection service called ERAS (Electronic Residency Application Site, functioning like the AMCAS), which distributes their materials to specific programs. Students need not limit themselves in the number of programs they apply or in a particular specialty. After the interview process that occurs near the end of February, applicants submit a final rank list of anywhere between 1-50 programs, indicating their top choices for residency training. The Match system then initiates an iteration process that will ultimately match the rank lists submitted by programs with those submitted by applicants. Since some residency programs—such as those teaching Radiology/Radiation oncology, Opthamology, Anesthesiology or Dermatology—are more competitive than others and each year, there are applicants who do not “match.” These students find out two days before “Match Day” and have the option to scramble for a position that was unfilled or alternatively take a year off to do research and re-apply the following year.
While it is not required of the applicants, many advisors and Match veterans encourage them to limit their rank list to a single specialty. “You can imagine how weird it would feel going to Match day having applied to multiple specialties, not knowing if you are going to be a radiologist or a dermatologist,” muses Dr. Gaviola.
The Key to a Successful Match
According to Dr. Gaviola, early mentorship is the most important factor. The earlier you have a mentor who helps you choose your specialty and the earlier you get guidance from others who have been through the process, the higher the probability of attaining one of your top choices.
Faculty mentors are a great resource as they can offer students both academic guidance and access to a vast network of labs and clinical opportunities that might help them focus their interests and make progress towards their goals. Many medical schools organize official mentorship programs that pair faculty mentors with first year students.
Residents or final year medical students are another essential resource for mentorship. These mentors will have gone through the Match process recently and will be able to offer more immediate advice and pertinent details. Whereas the faculty mentor is often most helpful in terms of developing a plan for the next four years and beyond, resident mentors can offer helpful insights such as what they would have done differently given the opportunity to go through the Match process again.
Tavé van Zyl is Executive Editor for the Next Generation and a member of the Harvard class of 2008.