Selecting the Medical Specialty
That Is Right for You
Jim Holliman, M.D., F.A.C.E.P.
Program Manager, Afghanistan Healthcare Sector
Reconstruction Project
Center for Disaster and Humanitarian Assistance Medicine
Uniformed Services University of the Health Sciences
Clinical Professor of Emergency Medicine
George Washington University
Questions to Ask Yourself As You Are
Deciding on a Medical Career Specialty
ƒ 1. Do I like diagnostics or therapeutics or both ?
ƒ 2. Do I like predictability or unpredictability, and can I
deal with more than one case at a time ?
ƒ 3. Do I have any prejudicial dislikes of certain kinds or
ages of people ?
ƒ 4. Do I need defined limits to what I need to know ?
ƒ 5. Can I work in a team environment ?
ƒ 6. Do I have verbal communication limitations ?
ƒ 7. Is my final career goal a sub-specialty or multiple
specialties ?
ƒ 8. Can I tolerate the humdrum and disagreeable aspects
of the specialty I have chosen ?
Questions to Ask Yourself As You Are
Deciding on a Medical Career Specialty
1. Do I like diagnostics or therapeutics (procedures) or
both ?
ƒ If you don’t have any manual dexterity, then don’t
choose a procedural specialty
ƒ “Pure procedural” specialties : Plastic Surgery,
Orthopedic Surgery
ƒ “Pure diagnostic” specialties : Neurology,
Preventive Medicine, Rehabilitation Medicine
ƒ “Mixed procedural and diagnostic” specialties :
Emergency Medicine, General Surgery
ƒ If you won’t be happy unless you get to do big
surgical procedures, then go into a surgical field
Questions to Ask Yourself As You Are
Deciding on a Medical Career Specialty
2. Do I like predictability or unpredictability, and can I
deal with more than one case at a time ?
- If you don’t like or tolerate unpredictability, then you
want to choose a clinic or office based practice, such
as Internal Medicine, Family Medicine, or Pediatrics
(perhaps without hospital admission privileges)
- Specialties with unpredictability of patient
presentations include Emergency Medicine, Trauma
Surgery, and General Surgery
- Some specialties such as Critical (Intensive) Care have
clinical unpredictability but work site predictability
Questions to Ask Yourself As You Are
Deciding on a Medical Career Specialty
ƒ 3. Do I have any prejudicial dislikes of certain kinds or
ages of people (or do I want to treat all types and ages
of people) ?
ƒ For example, f you don’t like kids, then don’t go into
Pediatrics or Family Medicine
ƒ In Emergency Medicine you have to like to deal with
all types and all ages of people
ƒ If you don’t have patience with the elderly, then don’t
go into Internal Medicine or Emergency Medicine
Questions to Ask Yourself As You Are
Deciding on a Medical Career Specialty
4. Do I need defined limits as to what I need to know &
study ?
- Some people are very uncomfortable with a specialty
such as Emergency Medicine in which the body of
clinically important information to know and study is
essentially unbounded
- So if you want defined limits as to the knowledge base
required for clinical practice, then choose “more
focused” specialties such as Ophthalmology,
Anesthesia, Otolaryngology, etc.
Questions to Ask Yourself As You Are
Deciding on a Medical Career Specialty
5. Can I work in a team environment ?
- If you’d rather work solo, then pick an office or clinic
based specialty
- Emergency Medicine and Rehabilitation Medicine
particularly require close teamwork with other
department personnel
Questions to Ask Yourself As You Are
Deciding on a Medical Career Specialty
6. Do I have verbal communication limitations ?
- If you don’t like to or are not good at quickly
establishing rapport and verbal communications with
patients, then you should choose Anesthesia or
Radiology where these aspects are not as important as
in specialties such as Family Medicine, Internal
Medicine, Pediatrics, and Emergency Medicine
Questions to Ask Yourself As You Are
Deciding on a Medical Career Specialty
7. Is my final career goal a sub-specialty or multiple
specialties ?
- If so, you need to consider the base specialty you will
need to complete first before going on to the
subspecialty.
For example, you can enter Critical Care Fellowships
via Anesthesia, Internal Medicine, Surgery, or
Emergency Medicine.
- If you want to be certified in more than one specialty
then you can enter one of several combined
residencies : EM / IM, EM / Peds, EM / FM, etc.
Questions to Ask Yourself As You Are
Deciding on a Medical Career Specialty
8. Can I tolerate the humdrum and disagreeable aspects
of the specialty I have chosen ?
- This is often the most important question to consider
- For example, if you want to be a neurologist, then you
must be able to tolerate patients with chronic
undifferentiated headaches
- Remember that in many surgical specialties you will
be doing the same limited number of procedures over
and over
- Also remember that in most clinical practices you
won’t see the variety or severity of cases you saw on
inpatient services in medical school
Questions to Ask Yourself in Deciding
on an Academic Career Versus Private
Practice ?
ƒ Can I tolerate turning over care of my patients to
trainees ?
ƒ Do I prefer to do everything myself to make sure it's
done right ?
ƒ Do I want to listen to my spouse yell at me for
working twice as hard for half as much money in
academic practice as my medical school
classmates are making in private practice ?
ƒ Do the rewards of teaching and scholarship
outweigh the extra political hassles of academic
practice ?
Why Is Emergency Medicine A
Great Career ?
ƒ Nice mix of diagnostics & therapeutics
(procedures)
ƒ Wide variety of patients & medical problems
ƒ Challenging
ƒ Benefits to patients & U. S. health care are
obvious
ƒ Core component of U.S. health care system
ƒ Young, vibrant specialty ; many practitioners
have extensive interests outside of medicine
What About Primary Care Careers ?
ƒ "Classic" primary care specialties include :
–Pediatrics
–Family Practice
–Internal Medicine
ƒ The degree of governmental support for these to
the exclusion of other specialties is waning
ƒ Usually do not include any trauma training
ƒ True "longitudinal" care in these may not be
practiced
Disadvantages of Emergency
Medicine As a Career
ƒ You won't make as much money as in cardiac
surgery
ƒ Limited "longitudinal care"
ƒ No ability to pre-select patients
ƒ Usually spatially limited work environment
ƒ Need to stay current in all fields of medicine
ƒ Requires a lot of political skill (the art of making
other doctors actually do what you both know is
the right thing to do)
ƒ "Is practicing in a fishbowl"
Unique Advantages of Emergency
Medicine As a Career
ƒ Unlimited international development
opportunity
ƒ Relatively small number of academic
practitioners (easy to "rise to the top" fast)
ƒ Control over, & predictability of, work
schedules
ƒ Potential for administrative involvement in
prehospital care
ƒ Interact with every other medical specialty
ƒ Geographic flexibility
What Does the Future Hold for
Emergency Medicine ?
ƒ "They may find a cure for cancer ; they may find a
cure for heart disease ; but they will never find a
cure for stupidity, so there will always be accidents
& a need for emergency physicians "
ƒ Is currently an undersupplied specialty in the U.S.
ƒ Is just beginning to develop in other countries ; the
U.S. is the unquestioned world leader in this
specialty
Important Principles to Remember in
Deciding Upon a Medical Career
Specialty
ƒ Does my chosen career mesh with my personality ?
ƒ Does my chosen career match with my significant
other’s long term wishes ?
ƒ Can I stand the dull, humdrum, and disagreeable aspects
of my chosen field, and do the interesting or infrequent
exciting aspects of my chosen field sufficiently make up
for these other aspects ?
ƒ (Seriously) : It is best to keep an open mind as you are
doing your third year rotations ; you may find you really
like a specialty you had not had exposure to before
ƒ And certainly DO NOT pick your specialty based on how
much money you think you’ll make ! (there are a lot of
very unhappy rich doctors)
What Should I Do if I Still Can’t Decide on
a Specialty Late in my Third Year ?
ƒ If you can narrow it to two specialties : for your first
fourth year rotation take an acting internship in one
followed by a second acting internship in the other,
followed by one month each of a rotation related to each
specialty ; prepare two different personal statements
over the summer ; make a final decision and apply to
only one specialty at the end of September.
ƒ If you still have no decision by your fourth year : apply to
transitional internships, schedule rotations related to
your specialty interests early in the transitional
internship, then reapply to a single specialty the next
year
My Recommendations for Students
Interested in Applying for E. M.
Residencies
ƒ Take E.M. elective early in 4th year, then take a rotation that
will buff your clinical skills such as Surgical ICU
ƒ Then take second E.M. elective at another center with an
E.M. residency
ƒ Get 3 letters of recommendation from E.M. faculty at these 2
places
ƒ Over the summer draft and edit your CV and personal
statement
ƒ Complete all NRMP application materials by October
ƒ Take the time and expense to travel to any residency that
offers you an interview
ƒ Do an overseas elective in March or April while awaiting
match results
Recommended 4th Year Electives for
Students Interested in E.M. (in addition to the
2 E.M. electives)
ƒ Medical, Surgical, and / or Pediatric I.C.U.
ƒ Outpatient Pediatrics
ƒ Outpatient Orthopedics
ƒ Anesthesia
ƒ Dermatology
ƒ Urology
ƒ Medicine or Surgery Subinternship
ƒ Plastic Surgery
ƒ Trauma Surgery
Fourth Year Electives NOT Recommended
for Students Interested in E.M.
ƒ Radiology
ƒ Radiology subspecialties
ƒ Radiation oncology
ƒ Medicine subspecialties
ƒ Psychiatry
ƒ Rehabilitation
ƒ Oncology
ƒ Family practice
Additional Items to Consider to
Bolster Your Residency Application
ƒ Get faculty to review your C.V. & personal
statement
ƒ Join several student interest groups
ƒ Do some public service projects
ƒ Do a decent research project(s)
ƒ Join AMSA, AMA, ACEP, SAEM, etc.
ƒ Become knowledgeable about current affairs &
political aspects of medicine
ƒ Develop some interests besides reading &
sleeping
What Should You Do if You Apply to
E.M. Programs & Don't Get In ?
ƒ Don't reapply if you're actually a dork
ƒ If you are not a dork :
- Serve out your GMO time and then reapply
–Apply to transitional internships (these are required
for the PGY 2,3,4 programs anyway)
–Take a research position & reapply next year
–Analyze what was weak in your file and try and fix or
augment it
–Work as an E.D. volunteer or in prehospital care
where you will be seen by a residency program
Recognized Subspecialties of
Emergency Medicine
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Toxicology
Pediatric Emergency Medicine
Sports Medicine
Palliative Medicine
E.M.S. (prehospital care)
Aeromedical Care
Critical Care
Note the first 4 have
Disaster Medicine
official subspecialty
International E.M.
certification exams
How to Find Out More Information on
Emergency Medicine Careers
ƒ Consult the unbiased Dr. Holliman and / or Dr. Burns
in the office anytime and shadow them when they’re
on clinical duty
ƒ Come to "Career Night" at Dr. Holliman's house
(party for students held twice a year)
ƒ Talk to the E.M. residents at GWU or Georgetown
ƒ Talk to the E.M. attendings at any of the local
hospitals
ƒ Join ACEP, SAEM, & the student E.M. Interest Group