Questions to Ask When Choosing a Medical Specialty
For medical students in the clinical years who have to name a specialty before residency applications open and want more to go on than which rotation felt best. The questions run in the order the decision tends to: what you are drawn to, what the daily work and the life of an attending are like, what training takes and how hard it is to get in, the money and the field's future, and ways to check a choice while you can still change it. The first and last groups are ones to answer yourself, and most of those in between are for the residents and attendings on each rotation, so carry a few onto the wards.
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The questions
Each question, and why to ask it
Your interest
Which patients and problems still hold my interest when the case is routine?
Why ask it
Every specialty's rare cases are fascinating, so judge each field by its ordinary ones: the tenth chest pain of the week, the well-child visit, the hernia. On each rotation, write down the three commonest reasons patients came in and ask whether you would read about them without being told to.
How much of my week do I want to spend doing procedures, and how much talking and thinking?
Why ask it
Treat it as a ratio and put a number on it, even a rough one. Then ask attendings for their real split, because two people with the same board certificate can have very different weeks: one mostly in the procedure room, the other mostly in clinic.
On which rotation did the hours pass fastest, and what was I doing at the time?
Why ask it
Name the activity and not the service: closing a wound, working through a differential, explaining a plan to a family. The same activity turns up in several specialties, so the answer can widen your list beyond the rotation where you first noticed it.
Do I like this specialty, or did I like the team I happened to be on?
Why ask it
One generous resident or one harsh attending can color a whole field for a student. Picture the same work with a team you found dull. If the appeal survives that, it belongs to the specialty, and a few days at a second site will confirm it.
Do I want to know patients for years, or solve the problem in front of me and hand them on?
Why ask it
Continuity and episodic care suit different temperaments, and most fields lean clearly one way. Ask an attending in each kind what they miss about the other. Their answer is usually the price of the field they chose.
How sick do I want my patients to be?
Why ask it
Some students come alive when a patient is crashing, and others think best when nobody is. Go back to the most acute hour you have had on the wards and to the hour after it. Whether you wanted another one like it tells you which end of the hospital to look at.
Which kind of patient do I still have goodwill for at the end of a long day?
Why ask it
Children, older adults, people in pain, the worried well, patients who cannot speak for themselves: each field has its regulars. Your patience at 5 p.m. is a better guide than your interest at 8 a.m., so notice who gets the tired version of you and who does not.
Do I want to be broad across many conditions or deep in a few?
Why ask it
Generalist fields ask you to be comfortable not knowing everything, and narrow ones ask you to enjoy repetition. Put the question to one of each: ask the generalist what they refer away, and the subspecialist what they no longer see.
Can I live with problems that never close, or do I need most days to end with an answer?
Why ask it
A scan gets read and an operation gets finished, while a chronic illness is managed for decades with no last page. Think about which unfinished business followed you home from rotations: the patient with no diagnosis yet, or the one who would be back next month unchanged.
What have the people who graded me said I am good at, and did I enjoy doing it?
Why ask it
Reread your evaluations for the comments that repeat from one rotation to the next: your hands, your notes, your calm in a rush, your way with a frightened patient. Being good at something and liking it are separate findings. Where they part company, take both to a mentor before you lean on either.
Which part of each rotation did I dread, and would that part still be there as an attending?
Why ask it
Pre-rounding at dawn and being graded belong to being a student, and they end. The clinic inbox, the long family meetings and the hours standing at an operating table belong to the specialty. Sort your dislikes into those two piles before you cross a field off.
Whose reasons am I using: mine, a parent's, a mentor's or my class's idea of what is prestigious?
Why ask it
Many classes carry a loud, unofficial ranking of which fields the strongest students are supposed to want. Imagine keeping your choice to yourself for a year, with nobody to impress or reassure, and see whether the same specialty comes out on top.
The work
What does an attending in this field actually do on an ordinary Tuesday?
Why ask it
Students mostly see the inpatient, teaching-hospital slice of a specialty. Have an attending take you through one plain day hour by hour, including the parts no student is shown: the message inbox, the phone calls to other services, the forms.
What are the bread-and-butter cases here, and are you tired of them?
Why ask it
Put this one to residents and attendings both. Whatever they list is what you would do thousands of times. An attending who still finds something in the routine case, a variation or a patient's story, is describing a field that has lasted for them.
Where does the work happen: on the wards, in clinic, in an operating or procedure room, or at a screen?
Why ask it
The room matters more than students expect, since you will spend a career in it. Check how the mix shifts after residency in this field, because training can lean far more heavily on hospital wards than practice does, or the other way around.
How much direct contact with patients is there, and what are the conversations about?
Why ask it
Contact can be frequent and brief, or rare and heavy: a pre-procedure talk, one conversation about a result. Find out how long a typical encounter lasts and whether the patient is awake for it. Then check that against how much of your energy on rotations came from the talking.
Does this specialty own the patient, or answer a question for the team that does?
Why ask it
Being the primary team means the discharge planning, the family and the 3 p.m. social problem are yours. Being the consultant means a narrower question and less control over what happens next. Think back to whether you enjoyed being the service that got called or the one that did the calling.
Do most patients in this field get better, stay the same or decline?
Why ask it
Fields differ in how often there is something to fix. What you want from attendings is their definition of a good result on a day when cure is not on offer, and a sense of whether that definition would be enough for you over twenty years.
What is the hardest conversation you have regularly, and how often does it come up?
Why ask it
Each specialty has its own: a bad scan, a complication to disclose, a parent who disagrees, a patient who will not change a habit. Anyone can get through it once. What you are weighing is whether you could do it every week and still want to come in.
What does this work ask of the body over a whole career?
Why ask it
Long hours standing, fine handwork, protective lead, a dark reading room and nights on your feet all add up. People who have done the job for decades can name what they changed to keep going: a stool, loupes, fewer nights. If your own health would affect the answer, raise it early with an adviser you trust.
Is there room in this field for research, teaching or running something, and who pays for that time?
Why ask it
If you want part of your week to be something other than patient care, find an attending who has that and learn how the hours are paid for: a grant, a title that comes with protected time, or their own evenings. If it is their own evenings, you have learned what that ambition costs in this department.
The life
What does call look like for an attending in this field, and how often does the phone really ring?
Why ask it
Home call with one page a night and in-house call with emergencies share a single word. Have them describe the last three times they were on: when the phone went, whether they drove in, when they slept. A doctor in a group of four and one in a group of forty will tell different stories, so collect more than one.
When something goes wrong at 2 a.m., does this specialty have to come in?
Why ask it
This sorts fields with true emergencies from those whose problems keep until morning. If the answer is yes, find out how many years into a career people are still getting out of bed for it, and whether seniority buys anyone out.
How predictable is a day: do you know at breakfast what time you will be home?
Why ask it
Hours and predictability are separate things. Plenty of people cope better with a long day that ends on time than with a short one that can blow up at four. Ask which of the two this field offers, and be honest about which you tolerate.
What do I want an ordinary weeknight to look like when I am forty?
Why ask it
Be specific: dinner at home, a sport, a child's bedtime, a research project, nothing at all. Then set that evening beside the attending schedules you have collected, and leave the resident schedules out, since those end.
What are the attendings in this field like at fifty and sixty?
Why ask it
Residents show you the training, and senior attendings show you where it leads. Watch whether they still do the work they trained for, whether they have cut back, and whether they talk about patients with interest. Ask one of them how the job changed with each decade.
Can this specialty be practiced part time or scaled back later, and does anyone here do it?
Why ask it
A policy that allows it tells you little, and a colleague who does it tells you a lot. If the department can point to someone on a reduced schedule, hear from them what it cost in pay, in standing or in the cases that come their way. If nobody can think of one, that is the answer for this department, though not for every employer.
How have people in this field managed a pregnancy, young children or a sick parent, in training and after it?
Why ask it
Go to someone who has done it, because the person who wrote the policy can only recite it. Listen for whether colleagues covered willingly or kept a tally. The written leave rules are set by each program and employer and by national law, so read the ones for the places on your own list.
Can I do this work in any town, or only near a large center?
Why ask it
Some specialties need a big hospital, expensive equipment or a wide referral base, and some are wanted wherever people live. If a partner's career or family ties you to one region, look at the openings there before you get attached to the field.
What wears people down in this specialty, and what do the ones who last do about it?
Why ask it
A named cause, such as the inbox, the overnight pages, the losses or the fear of being sued, is something you can weigh against your own temperament. 'It is a lot' is not, so ask what the last hard month actually consisted of.
Training
How many years is training in this field, counting the fellowship most people end up doing?
Why ask it
The length of the residency is published, and the fellowship is the part nobody prints. Senior residents know how many of their class are going on to one and whether jobs in the towns you would live in expect it. Add it up for the country you will train in, then work out how old you would be on your first day as an attending.
How competitive is this specialty, and where does my application stand today?
Why ask it
Your school's advising office can usually tell you how recent graduates with a record like yours fared, and that beats corridor rumor. Where the body that runs the match publishes outcomes by specialty, read those as well. Go while there is still time to act on what you hear, and request the plain version.
What do programs in this field weigh most: exam results, clinical grades, research, letters or visiting rotations?
Why ask it
It differs by specialty and shifts over the years, so the lore of students two classes ahead can be out of date. A program director or a resident who applied recently will know. Whatever they name is where your remaining months should go.
How different is residency in this field from practicing it afterwards?
Why ask it
In some specialties the training years are far harder than the career, and in others the career is the harder part. Put the same question to a senior resident and to an attending a few years out. A career that lasts decades should not be chosen, or avoided, over a few years of training.
If I decide late, what would it take to be a credible applicant?
Why ask it
Take this to the specialty's adviser at your school and come away with a list: which letters, which elective, whether research is expected. Students do change course late and still get a place, but how workable that is depends on the field, and you want the judgment of someone who reads applications.
What is my parallel plan if I do not get a place in this specialty?
Why ask it
Settle it before you apply, not after. A straight-talking adviser will say whether to add a second field, apply to more programs or take an extra year, and which of those the application system you are using makes practical.
Does this training keep doors open if my interests shift?
Why ask it
Some residencies branch into many fellowships and styles of practice, and others are narrow from the first day. If you are torn between two interests, ask whether one training route reaches both, through a fellowship or a combined program, and whether that route exists where you would apply.
Which residents in this field seem content, and what do they have in common?
Why ask it
Look across every team you have worked with. Perhaps the content ones love the operating room, or the patients, or the puzzle. If you share their reason, that is encouraging. If they all love something you merely put up with, take note.
Pay and outlook
What does this specialty pay where I would want to work, and how much does it vary by setting?
Why ask it
Published surveys give ranges, and the ranges are wide: academic or private, employed or owner, city or rural. A recent graduate working in the setting you picture can tell you what an offer looked like. Treat any single figure as local.
What will I owe when I finish, and how does this field's pay sit against it?
Why ask it
Get your own figure from your school's financial aid office, since an average is of little use here. Have the same office go through which repayment or forgiveness arrangements you could qualify for: those turn on the lender, the employer and the country, and they can change the sum a good deal. Do that before the debt rules a field in or out.
Would I still choose this work at the pay of the field I am passing over?
Why ask it
Money is a fair reason as long as you know how much of the decision it is carrying. If the answer is no, go back to the lower-paid specialty you keep returning to and run its numbers properly before assuming you cannot afford it.
How are doctors in this field usually employed: by a hospital, in a group, on their own or by the shift?
Why ask it
The arrangement decides who sets your schedule, how you are paid and how much of a business you would be running. Attendings in the region you would work in are the ones to tell you, and the older ones can say which way it has moved since they started.
Where is this specialty heading over the length of my career?
Why ask it
Ask several people and distrust anyone who sounds certain. New treatments, other professions taking on parts of the work, software that reads images or drafts notes, and changes in how care is paid for all come up. Listen for what the attending thinks only a physician in this field will still be doing.
How is the job market for people finishing training in this field right now?
Why ask it
Final-year residents and fellows are the freshest source. They can tell you how many offers they had, how far they had to move, and whether anyone added a fellowship mainly to get the city they wanted. A market can look different by the time you finish, so use it as one input.
Testing it
Which elective or sub-internship would test this choice hardest, and can I fit it in before applications are due?
Why ask it
Pick the rotation where you would work most like a first-year resident in that field, even if another has kinder hours. Look at the calendar now, because places fill and the deadline stays put. Your school's scheduling office knows what is still open, and an adviser in the field can say how late a rotation can fall and still produce a letter.
Have I seen this specialty outside the teaching hospital?
Why ask it
Academic practice is one version of a field, and it is not always the one most graduates end up in. A day or two in a community hospital, a private office or a rural practice can confirm a choice or undo it. An attending you got on with is the person to ask for an introduction.
Have I given a fair look to a field I never rotated through?
Why ask it
Required rotations cover only part of medicine. Depending on your school's curriculum, specialties such as radiology, pathology, anesthesiology or rehabilitation medicine may get little or no required time. A few days of shadowing early in the clinical years costs little and can add a name to the list.
If you were advising me, which other fields would you make me look at before I committed to yours?
Why ask it
Attendings know their neighbors: the specialties that share their patients, their procedures or their temperament. The names they give are often fields you have not rotated through, and the reasons they give show what they think the core of their own work is.
Among the people in this department, do I feel at home or like a visitor?
Why ask it
Sit in on a conference, or in the workroom at the end of the day, and notice what people joke about, complain about and admire. Feeling at home is a fair signal, with two cautions. One department is not the whole specialty, and the fit to look for is in how people think and work, which you can share with a room that looks nothing like you.
What did I think of the field at the end of the worst week of the rotation?
Why ask it
Keep two or three lines each Friday during an elective. Interest that is still there after poor sleep, a difficult team and a run of dull cases is the kind to build on. Enthusiasm recorded only on the good days tells you about the good days.
Who knows me well enough to name a specialty for me, and have I asked them?
Why ask it
Residents who supervised you, a mentor, a partner or a close classmate have seen where you light up and where you go quiet. Ask them to name a field before you reveal yours. Their surprise at your choice, or the lack of it, is worth hearing.
If I am stuck between two fields, what am I afraid of losing with each?
Why ask it
It usually comes down to one thing: the operating room, long relationships, a certain kind of patient. Name it, then ask someone in the other field whether a version of their job keeps it. There is often one, such as a procedural niche inside a clinic specialty.
By what date do I have to decide, and what has to be in place by then?
Why ask it
Work backwards from the application deadline with your dean's office or adviser: letters requested, electives finished, exams sat, a statement written. Take this year's dates from the application service itself. A classmate's memory of last year's is how deadlines get missed.
Could I be content in more than one specialty?
Why ask it
Try it on a few attendings: would another field have suited them too? Those who say yes are telling you the choice has more than one right answer. When two specialties pass every test you set, a practical tiebreaker such as location or length of training is allowed to decide.
How to work through a specialty decision on the wards
Practical guidance for the conversation itself
Who to ask what
Answer the first and last groups alone, in writing
The questions under Your interest and Testing it are mostly for you, and they work best on paper before anyone else weighs in. Write a line or two for each after every core rotation while the memory is specific. By the end of the year you will have several entries to compare, written by the person you were that month.
Residents for the training years
Residents know what the next few years would feel like: the hours, the teaching, how the application went. They are a weaker guide to the career, because most have not lived it yet. Use them for Training and for the plainer questions under The life.
Attendings for the decades after
The work, the call that never ends with graduation, pay and where the field is going are attending questions. Try to ask one early in practice and one near the end of it. The younger one remembers the job search, and the older one has watched the specialty change.
Advisers for your chances
Whether your record fits a competitive field is a question for the advising office or the specialty's adviser at your school, who have seen how earlier classes fared. Residents and classmates will guess. Ask the person with the figures, and ask early.
Asking during a rotation
Pick the quiet moment
Rounds, a busy clinic and the middle of a case are the wrong time. The walk to the cafeteria, the wait for a room to turn over and the slow end of a call night are the right ones. One question in a quiet moment gets a longer answer than five squeezed between patients.
Say that you are still deciding
Students worry that admitting doubt will cost them on an evaluation, so they claim an interest in whatever service they are on. You can work hard on a rotation and still say you are weighing this field against one or two others. Many residents and attendings talk more frankly to a student who wants to know what they would be getting into.
Get a day, not a description
A general question about call or clinic invites a general answer. Asking how last Thursday went brings out the details you need: when the pager went, whether they drove in, what time the last note was signed. Most of The work and The life can be put this way.
Carry three questions onto each rotation
Choose three that matter for this particular field before the rotation starts and put them to everyone: an intern, a senior resident, a new attending, an older one. Hearing one question answered by four people at different stages shows you how the answer changes over a career.
Weighing what you hear
Compare attending lives with attending lives
It is easy to set a brutal residency in one field against a comfortable attending job in another. Line up like with like: training against training, and career against career. The career is the longer column.
Keep one table for the short list
Once you are down to two or three specialties, put them in columns and use the six groups on this page as rows. Fill each cell with something a person told you or something you saw, and leave it blank if all you have is an impression. The blanks are your list of people still to talk to.
Allow for recruiting and for venting
A department that wants good students will show its best side, and a resident at the end of a bad month will show the worst. Neither is lying. Collect enough answers that one mood does not decide it, and give more weight to people who describe both the good and the bad without being pushed.
Let the routine decide
When two fields are close, go back to the ordinary cases, the ordinary day and the ordinary night on call. The rare save and the dramatic operation will take care of themselves. The routine is most of the job, in every specialty.
Where the choice goes wrong
Choosing the rotation you finished last
The most recent service is the most vivid, and whichever one came just before the deadline has an unfair advantage. Your written notes from earlier rotations are the correction. Read them before you commit.
Crossing a field off over one bad month
A single team, a single site or a month when your own life was hard can sink a specialty that would have suited you. If a field fits on paper and the rotation went badly, try a second, shorter look with different people before you drop it.
Letting your scores choose
Strong results do not oblige you to apply to the most competitive field, and weaker ones do not always close it. Start from the work you want, then take the question of your chances to an adviser.
Waiting to feel certain
Many students never get a moment of certainty, and the deadline arrives anyway. Decide what would be enough: a second rotation that confirmed the first, three attendings whose lives you would take, a plan your adviser thinks is sound. When you have that, apply.