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  • In a future doctor's life, there are few decision as important and nerve-wracking as

  • deciding on a specialty.

  • Everything from your life during medical school, to your life in residency, to your life beyond

  • residency are all dramatically influenced by this singular decision.

  • How much money will you make?

  • How much time will you have for your family?

  • Will you be burned out and miserable or will you love what you do?

  • This is how you should go about choosing a medical specialty.

  • Dr. Jubbal, MedSchoolInsiders.com.

  • We'll cover the thought processes and practices you should go through to ultimately land on

  • a specialty that is best suited for you.

  • But an important part of the decision making process is hearing from other doctors and learning

  • what drew them to their field, what they love about it, and what they wish they did differently.

  • For that reason, we've started an all new series called The Insiders Scoop

  • available exclusively on the Med School Insiders blog, where we highlight individual doctors

  • across various specialties.

  • If you'd like to receive updates any time a new specialty is featured, be sure to subscribe

  • to our newsletter at MedSchoolInsiders.com/newsletter.

  • Data from a 2018 survey conducted by the

  • AAMC on medical student specialty choice revealed

  • that over the course of medical school, most medical students change their preferred specialty.

  • Only a quarter of respondents indicated the same specialty between matriculating and

  • graduating.

  • And I can identify with that statistic.

  • I initially started medical school wanting to go into pediatric gastroenterology but

  • I ultimately switched to plastic surgery.

  • I go over that journey and the process that led to my decision in a video on my vlog

  • channel.

  • Link in the description below.

  • Interestingly, students that had the highest rate of congruence, meaning they did not change

  • their specialty, chose orthopedic surgery at 50.2%, pediatrics at 42.9%, and neurosurgery

  • at 35.5%.

  • I'm not quite sure what to make of those numbers.

  • What do you guys think?

  • Let me know down in the comments below.

  • We now know that the specialty you decide on has tremendous immediate as well as long term

  • ramifications on your life.

  • We also know that most medical students end up changing their mind over their 4 years

  • in medical school.

  • So where do we go from here and how can we create a system to decide on the best suited

  • specialty for ourselves?

  • Most commonly, people refer to compensation as a significant factor to help sway your

  • decision.

  • I don't blame them, particularly when medical students graduate with close to $200,000 in

  • debt.

  • I've covered the top paid specialties in a previous video,

  • including the factors that lead to certain specialties being highly compensated and others

  • less so.

  • Link in the description below.

  • While compensation is important, I would argue that most physicians are quite comfortable,

  • and compensation differences between specialties will be far less important than other factors

  • in helping you lead a happy and fulfilling life. Therefore, compensation should NOT

  • be a primary or even secondary factor in making your decision.

  • Other, more important factors to consider include what type of relationship and interactions

  • you want to have with your patients, the work-life balance you desire, how much or little you

  • enjoy performing procedures, the types of patients you generally work with, and

  • who your colleagues will be.

  • Does the specialty excite and captivate you?

  • Can you imagine doing this for the rest of your life?

  • Often times, medical students fixate on rare cases or procedures that are particularly

  • exciting in their field.

  • However, it's important to remember that these zebra cases are few and far between.

  • More importantly, determine whether or not doing the bread and butter, meaning the

  • things you are more likely to see day after day, is something you can actually live with.

  • We'll now cover a systematic approach to

  • help you narrow down a category or group of specialties for you to deliberate on.

  • First, what organ system or clinical questions do you find the most exciting and stimulating?

  • If you enjoy pharmacology and physiology, anesthesia may be a good fit for you.

  • If you love anatomy, like I did, then consider a surgical specialty.

  • If you are fascinated by the brain and how it works, then neurology or neurosurgery are

  • appropriate considerations.

  • Next, assuming you plan to practice clinically,

  • do you want direct patient care or indirect patient care?

  • Indirect patient care would include specialties like radiology or pathology.

  • Direct patient care would include most everything else.

  • Next, assuming you want to have direct patient

  • care, determine whether you'd like a primarily surgical practice, where the operating room

  • is the focus of your day-to-day, or a primarily medical practice, where procedures are relatively

  • rare.

  • Surgical specialty examples would include general surgery, plastic surgery, orthopedic

  • surgery, and the like.

  • Medical specialties include internal medicine, pediatrics, psychiatry, family medicine, and

  • other less procedurally focused specialties.

  • On average, these medical specialties emphasize patient relationships and clinical reasoning, but

  • will often require a high degree of patience.

  • You can also opt for a middle ground, like urology, dermatology, OB/GYN, or anesthesia

  • that allow for a mix of both.

  • Another important consideration when answering this question is the level of patient contact

  • and continuity that you prefer.

  • Do you enjoy talking to patients and forming long-term relationships?

  • And if so, internal and family medicine provide ample opportunity.

  • Or do you prefer brief and efficient patient interactions?

  • If so, emergency medicine, anesthesiology, and many surgical specialties are better suited for

  • this preference.

  • Now when I first started medical school, I remember thinking that work-life balance wasn't important.

  • This is a common sentiment amongst pre-med and medical students.

  • However, by the time you reach the end of medical school and have been put through the

  • wringer, you begin to realize how important lifestyle is.

  • It's easy to simply correlate challenging or unpredictable work hours with higher rates

  • of burnout, but it's more nuanced than that.

  • On average, surgical specialties have much more challenging hours than non-surgical specialties,

  • but the burn out rates are not necessarily higher in surgical specialties.

  • The 2019 Medscape National Physician Burnout, Depression, & Suicide Report

  • provides data on the burnout rates across various specialties.

  • The highest rates of burnout are found in urology at 54%, neurology at 53%, physical

  • medicine & rehabilitation at 52%, internal medicine at 49%, and emergency medicine at

  • 48%.

  • The lowest rates of burnout were found in public health & preventive medicine at 28%,

  • nephrology at 32%, pathology at 33%, ophthalmology at 34%, and otolaryngology and plastic surgery

  • at 36%.

  • Factors that were cited as most contributory to burnout include too many bureaucratic tasks,

  • such as charting and paperwork, at 59%, spending too many hours at work at 34%, and increasing

  • computerization of clinical practice at 32%.

  • An often understated yet highly important factor is determining the type of patients

  • and the outcomes you are most comfortable with.

  • Entering my surgical rotations, I felt drawn to neurosurgery given my interest in anatomy

  • and love for neuroscience, which is what I majored in.

  • However, the surprising lack of precision in neurosurgery, but more importantly the

  • poor outcomes of neurosurgery patients, turned me off from the specialty.

  • Consider the typical patients you will encounter in your specialty of choice.

  • The types of patients and interactions emergency physicians face on a daily basis is far different

  • from what the average pediatrician or orthopedic surgeon would face.

  • Lastly, there are a few considerations you

  • should keep in mind, although these will likely not be as important as those previously mentioned.

  • First, assess your own skills.

  • While most skills can be learned, there's also some benefit to playing to your strengths.

  • On average, we enjoy things we're good at.

  • If you're a klutz and particularly uncoordinated, then procedural focused specialties may not

  • be a good fit.

  • Next, consider the competitiveness of a specialty.

  • If you're barely managing to get by in medical school, then the chances of you matching into

  • something like plastic surgery may be relatively slim.

  • That being said, I'm a firm believer that the majority of one's performance in college

  • or medical school is dictated by their study strategies, habits, and systems. If you're

  • struggling in college or medical school, our team of exceptionally qualified and effective

  • tutors at MedSchoolInsiders.com can help you turn things around.

  • We stand for results at Med School Insiders, and our tutoring is a perfect example of this.

  • Third, consider what type of activities you'd like to engage in outside of clinical practice.

  • Research, teaching, policy work?

  • In most cases, this preference is more important in determining your practice type, meaning

  • private practice vs academic vs community, rather than your specialty choice.

  • Addressing the previously mentioned questions should do a good job in narrowing down your

  • specialty of choice.

  • You now likely have only a handful of specialties that you're considering.

  • But prior to pulling the trigger and committing to one, however, it's essential that you

  • get clinical exposure.

  • If it wasn't for gaining clinical experience, I would not have realized that gastroenterology

  • was not a good fit for me.

  • Make sure you shadow attending physicians in your areas of interest as much as possible.

  • Specialty clubs and talks from physicians across various specialties are also a great

  • way to gain exposure to different specialties.

  • And our new series, The Insiders Scoop, is another great way to gain insight in a

  • particular specialty.

  • Link in the description below.

  • Once you've decided, the next step is making sure you match into a desirable residency

  • program in your specialty of choice.

  • For this reason, it's essential that you make your residency program application as

  • authentic as possible.

  • Don't fall into the trap of researching a specialty and finding one you love, only

  • to submit a residency application that sounds too similar to your colleagues.

  • The personal statement, letters of recommendation, and soft parts of your application are just

  • as important as your USMLE Step 1 and Step 2CK scores.

  • If you need help with your residency application, our team of advisors with real residency admissions

  • committee experience can help.

  • Visit MedSchoolInsiders.com to learn more.

  • If you guys want to chat with me in real time, make sure you're subscribed with the notification

  • bell enabled.

  • I spend the first hour after a new upload responding to your YouTube comments in real

  • time.

  • New videos every Saturday at 8AM pacific time.

  • Thank you all for watching, let me know if you have any additional questions, and I will

  • see you guys in that next one.

In a future doctor's life, there are few decision as important and nerve-wracking as

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