Specialty

If you're well into 3rd year and still don't know what you want to do, don't panic. This is very common.

Choosing a specialty can be difficult because you often need to decide with minimal exposure to specialtie besides the 6 core clerkhips.

Obviously this is very individual, but here is some general advice, and hopefully a short blurb on pros and cons from students who've matched into subspecialties.

This is a tough question, but remember that it's multiple correct answers! Most specialties have enough flexibility that you'll be able to design the kind of practice you want.

One very critical piece of advice:

DO NOT PUT TOO MUCH WEIGHT ON ADVICE ABOUT A SPECIALTY YOU'RE INTERESTED IN FROM A PHYSICIAN OUTSIDE OF THAT SPECIALTY!!! Often physicians stereotype other specialties, but acutally don't know that much about what the job is really like. Go to the source, and don't let stereotypes or critical physicians from other specialties changie your mind.

General advice
"Careers in medicine" will be introduced to you by student affairs (or google it). Their aptitude tests are ok, but I found this one to be better: www.med-ed.virginia.edu/specialties. Why? Because careers in medicine focuses on superficial activities of the specialty (eg, "do you like interpreting lab values,") while the Virginia test focuses on core values ("are you energized by working with people," or, "are you a thinker or a doer?" These tests will be more accurate at the end of your third year - until then you haven't had enough experience to know what you do and do not like.

Be careful not to let your perception of a specialty be colored by your relationship with one preceptor. Just because you loved your rotation with Dr. So-and-so doesn't mean you'd love practicing that specialty.

Use the core clerkships to figure out what aspects of medicine you like the most, then look for a specialty that is the right blend: eg, surgery will help you decide if you like procedures, but there are many other specialties that are procedure heavy.

Here are a few key things to think about:
 * Inpatient vs. outpatient?
 * Preventative / chronic disease vs. acute?
 * Long vs. short term relationships with patients vs. little patient contact at all?
 * Procedural vs. cerebral?
 * Diagnosic vs. treatment?
 * Shift work vs. primary responsibility for patients / follow-through?
 * Patients usually get better / good outcomes vs. end-of-life / managing disability?
 * Paid for high turnover vs. paid for spending time to solve the problem?
 * Specialize in one body system, vs. using knowledge from all systems?
 * Anatomical vs. physiological way of approaching disease?
 * Any particular M1 / M2 subject or system you excelled in or are passionate about?

If you simply cannot decide, consider choosing your general population and style of work (ie, women vs. children vs. adults and inpatient vs. outpatient vs. procedural) then choosing one of the major specialties: they all have enough subspecialties that you'll be able to carve out the kind of practice you want as you gain more experience.

Why I chose my specialty, and early advice if you're thinking about it
A complete list of specialties and their subspecialties is available here:

http://www.abms.org/who_we_help/physicians/specialties.aspx

ENT
Good option for those who love both surgery and medicine. Balance of clinic and OR. Lifestyle is more controlled and relaxed vs. general surgery. A very competitive specialty.

Internal medicine
Medicine is the broadest specialty, and within medicine you can find subspecialties to meet almost any style of practice you want, including procedure heavy and inpatient or outpatient specialties. The core of medicine is diagnosis and medical management: heavy on physiology, pathology, pharm, physical examination and diagnosis. In general internal medicine, the elderly are a large portion of the patient population, and you'll be managing complex cases with multiple comorbidities. Can be shift work, as in hosptialist or critical care, or 9 to 5 as in several subspecialties. Offers the best in-training support for research of any specialty, with numerous physician-scientist training programs and most residencies offering research rotations.

Electrophysiology
A very interventional / procedural specialty with lots of time spent in the cath lab, as well as outpatient clinic. Manage primarily arrhythmias, as well as common comorbidities such as CHF. Very technological specialty that is developing rapidly.

Critical care
Lots of physiology, especially cardiopulmonary. Intense attention to complex patients. Lots of minor procedures, although also very cerebral, problem-solving work. Usually shift work, hours can be very intense. Must be able to deal with end of life issues, stressed out families and frequent bad, as well as good outcomes.

Critical care can be approached from medicine (usually combined with pulmonology), anesthesiology (the PACU is just a specialized ICU) or surgery.

OB/GYN
It has been said that OB's are, "surgeons who like people." It's a very surgical specialty, but a unique balance of OR and outpatient clinic, including a significant primary care and preventive medicine component. Schedule is obviously crazy, but manageable by practicing in a large group with cross-coverage.

Ophthalmology
Another surgical specialty with a very significant outpatient clinic component and a more controllable lifestyle (night time emergencies happen, but are less frequent). Uses really only one body system at a hyper-specialized level of detail. Very competitive specialty.

Radiology
Emphasis on diagnosis and problem-solving: your job is to solve puzzles, rapidly and all day long. A general or private practice radiologist does a lot of "directing traffic" within medicine, and needs to be familiar with the pathology and workup for all specialties: because of this, they call themselves, "the doctor's doctor," ie, the doctor that physicians call on for assistance in difficult diagnoses.

Clearly an anatomical specialty, but a surprising amount of physiology is required to understand and interpret images. Contrary to the stereotype of the unhelpful radiology report, "I see x, please correlate clinically," radiologists are trained to read the clinical history and perform their own clinical correlations. You will need a strong understanding of pathology in all body systems, although in an academic setting you may be subspecialized in a few body systems (eg, chest: cardio and pulm; neuro: spine and head).

Little patient contact, although can be more than you might think depending on your practice. Also depending on your practice, a more social specialty than stereotyped: especially in academic radiology, radiologists share large reading rooms and discuss / collaborate on cases with one another and with referring clinicians.

Excellent lifestyle specialty, working basically an 8-5 shift plus some call, even in residency. Work is very mentally intense during the shift, with very little down-time during the day. Although compensation is likely to decline over the next few years, it is also likely to remain among the higher paying specialties. Less support for research vs. other specialties, but opportunities are still plentiful at the top academic programs. Training is 5-6 years: 1 prelim intern year (most do a transitional year; you will not be limited in future opportunities based on how you spend this year); 4 years general radiology; and most radiologists do a 1 year fellowship.

If interested, do an away rotation (UIUC has little to offer - most of our radiologists aren't very interested in teaching, though the IR team is great). Do this early to make sure you can be happy reading images all day, but at the same time, keep in mind that doing radiology is way more fun than watching someone else do radiology (which is like watching someone play a video game.) I recommend doing a few modules from here to see if you like the process of image based diagnosis: www.med-ed.virginia.edu/courses/rad/

Radiology is among the more competitive specialties. A great step 1 score is the single most important factor, but clincal service grades are also very important.

Interventional Radiology
An almost exclusively procedural specialty with less invasiveness and therefore less management of complications vs. surgical specialties. Traditionally IR did minimal rounding / following of their patients, but this is changing, and IR is becoming more of an independent, surgical-style service. Pays extremely well, but busier / longer hours vs. diagnostic radiology, but some IR docs are opening outpatient clinics for things like varicose vein ablations, with a more relaxed schedule.

IR is about to become its own separate residency track - training will be 3.5 years of diagnostic radiology (including a few IR rotations) plus 1.5 years of dedicated IR training.

Nuclear medicine
As its own specialty, NM was dying out, and is being absorbed by radiology. The rise of PET-CT (and on the horizon, PET-MR) in primarily oncology applications has revitalized the field as a subspecialty of radiology, and it is now one of the most rapidly developing specialties as new tracers and methods become available. Nuclear medicine is unique in its emphasis on functional imaging, superimposing physiology on anatomy.

A fairly relaxed specialty with very few emergent studies.