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How to Decide on Medical Specialty?

When you were a child and adults asked you what you wanted to be one day, your answer always came quickly and confidently – a doctor. But now you are actually in medical school and can’t decide on a medical specialty. Don’t worry – you aren’t alone. This is a common struggle for med students.

The one thing you are sure of is that helping people is what you want to do. But what specialty will suit you best? We are going to walk you through the process so you can find the best-suited option for you and your goals. Let’s get to it.

When Do You Need to Choose a Medical Specialty?

A decision about your specialty would ideally be made by the time you finish your third year at med school. This is when most students start preparing their residency applications. 

Throughout medical school, you will have many experiences, including volunteer activities, in the classroom, milestone life events, and interacting with mentors and other students. These experiences will normally assist you in making your specialty decision.

While every med school is different, below, we will take a look at what you can expect in each year of medical school.

First Year

Once you have adjusted to the rigors and demands of being in medical school, you need to think about how you are going to use the summer vacation. 

You can volunteer in a local clinic if you are interested in community health, or you can sign up for a service trip overseas if your passion is for global health. If you enjoy medical research, you can spend your summer helping in a lab.

There are many programs you can choose from to gain exposure in the specialties you may be considering or that will expose you to new options you had not thought of.

However, you can also take a break over the summer if you feel you need it. You can decompress and rejuvenate so you can return to med school for the second year feeling refreshed so you can make a rational and sound choice about a specialty over the next year.

Second Year

If you have done a program or any type of experience over the summer vacation, update your resume with these details. Typically, you will have many school-sponsored activities during your second year which showcase various specialties.

Residents, physicians, and program directors from different specialties will speak during these activities and events, allowing you the opportunity to ask any questions you may have. In your second year, you will also complete your basic science courses, allowing you to see where your passion lies.

Third Year

This is the year when the option of specialty will typically become more obvious if your heart hasn’t already been set on one. Third year is completely clinical, allowing you to get exposure to these core medical specialties:

  • Neurology
  • Surgery
  • Psychiatry
  • Internal medicine
  • Primary care
  • Pediatrics
  • OB-GYN

Additionally, you have six weeks to complete elective courses. You will also have more chances to connect with and talk to various physicians to gain more insight.

Fourth Year

Hopefully, by the time you start your fourth year, you will have decided on a specialty and residency program that you would like to apply to.

Your med school will likely have advisers who will assist you in preparing for the questions that will be asked at residency interviews. These typically occur from October to January. They will also guide you to learn more about your chosen specialty with clinical rotations.

What Are the Medical Specialty Options?

There are dozens of specialty options, but the main specialty options include the below:

  • Anesthesiology
  • Dermatology
  • Diagnostic Radiology
  • Emergency Medicine
  • Family Medicine
  • General Surgery
  • Internal Medicine
  • Plastic/Reconstructive Surgery
  • Neurology
  • Nuclear Medicine
  • OB-GYN
  • Ophthalmology
  • Orthopedic Surgery
  • Otolaryngology
  • Pathology
  • Pediatrics
  • Physical Medicine (including Rehabilitation)
  • Podiatry
  • Psychology and Psychiatry
  • Radiation Oncology
  • Urology

These are just some of the options, and each of these specialties has many sub-specialties that you can expand into.

Which Are the Most Competitive Specialties?

With the variety of specialties and the personalities of the many medical students, the popularity of specialties changes every year. But the most competitive specialties typically remain the same.

Here are the most competitive options when looking at medical specialties:

Dermatology – No two people have the same skin or conditions, which gives dermatologists new challenges each day. This is one of the highest-paying fields, with physicians earning an average of $419,000 per annum.

Emergency medicine – If you work well under pressure and would like to respond to various emergency situations, triage them, and stabilize them, working with other physicians in different specialties to offer the best treatment, then emergency medicine may be for you. Emergency medicine has an average salary of $353,000 per annum.

Orthopedics – Issues involving the muscles, bones, and joints can be very complex, and need to be dealt with by an orthopedic specialist to get patients back to normal. This is a large area of medicine and consistently features on the top-earning medical fields lists. Orthopedic physicians can look at earning around $482,000 per annum.

Surgery – Surgeons work hard to save lives and improve the quality of life with the technical skills and clinical knowledge needed to perform surgery. Because of the skills needed for this specialty, a surgeon can expect to earn an average of $362,000 per annum.

Psychiatry –  Similar to internal medicine, psychiatrists have the opportunity to provide continuous care to their patients. Psychiatry is a growing niche, with an increase of 16% expected from 2018 to 2028. The average income in this specialty is $239,000 per annum.

work of the surgeon in the hospital operating room

How to Decide on Medical Specialty

Now that you know the main specialty options available, take a look at the following consideration to assist you in choosing the right specialty for you.


The biggest consideration you need to keep in mind when selecting a specialty is your character, personality, abilities, ambitions, interests, passions, aptitudes, likes and dislikes, limitations, and task-management skills.

Consider if you are more hands-on in your skills or if you prefer solving complex problems with details provided. Do you like to fly by the seat of your pants in busy situations filled with challenges and uncertainty, or are you someone who prefers an ordered approach with time to consider the situation?

Knowing these traits about yourself will help you in choosing a specialty.


The main preferences to consider when choosing a medical specialty include the following.

  • Competitive level of the selection process – Have you got the skills base, knowledge, and experience to be selected for the specialty you want?
  • Contact level with patients – Do you want time to form and develop relationships with your patients, or do you rather want to see numerous patients each day? What type of patients would you prefer to treat?
  • Time taken and training schedule to complete residency – How many hours will you need to complete, how long will you have to train for, and what hours will you be required to work once you are fully qualified?
  • Do you like data and analysis? Do you enjoy researching?
  • Do you prefer structured work and simple care practices, or do you like fast-paced problem-solving?
  • Career progression – Are there opportunities to climb within the specialty and how far can you go based on each specialty?
  • Stress levels and management – Are you good at coping with stress? How will you cope in a medical environment? Can you work in high-pressure environments practicing acute medicine?

When selecting a medical specialty, you need to look at these factors:

  • Conditions of success
  • Requirements
  • Financial compensation
  • Personal benefits
  • Advantages and disadvantages
  • Career prospects
  • Opportunities for further development – career and education

Be honest and realistic about the strength of your skills and reflect this in your application. Some specialties are oversubscribed. Investigate the different competition ratios and see your likelihood of success in specific specialties. Keep in mind that the data is historic and doesn’t necessarily show the current status, but the information can make the process simpler for you.

Final Thoughts

Choosing a medical specialty is not something you should do lightly, and you need to make sure you really have a passion for the path you select. With the guide above, you should be able to decide on a specialty a bit more easily. We hope that your journey through medical school and residency will be smooth and that the challenges placed before you are those that you can solve. 

Good luck with your med school process and remember to enjoy it – it is an exciting time where you are exploring many specialties to find the one that suits you best.

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