By Joe Dyton, WCI Contributor

Having no shortage of medical specialties to choose from is perhaps one of the biggest benefits of entering the medical profession. At the same time, that seemingly bottomless amount of choices might feel overwhelming to some aspiring physicians. After all, unless you enter medical school with a specialty in mind, how do you narrow down your choices to just a few, let alone one? What factors should play into this crucial decision—difficulty, salary, hours, and all of the above?

Keep reading to learn what questions to consider as you pick your medical specialty.


How Much Time Will I Be Studying This Medical Specialty?

The road to becoming a physician is a long one. You’re looking at about eight years of education between undergraduate and medical school. Then, you begin your residency, which could take between 3-7 years. Then, perhaps there's a fellowship for an additional year or even three.

Why is there such a wide range in how long training takes? Because the medical specialty you pick will dictate your residency/fellowship length. That brings us back to the initial question you need to ask—how long will you be studying this medical specialty? Perhaps the better question is: how long do you want to spend in your residency?

If you’re aiming to get your physician career going right away, you will want to explore medical specialties with the shortest residency timeframes. Primary care residencies are among the shortest—they typically take about three years to complete. These medical specialties include family practice, internal medicine, and pediatrics.

If you’ve had your sights set on a surgical career, however, expect a longer residency. Most surgical residency programs take at least five years to complete. For example, general surgery is a five-year program on its own. Meanwhile, surgical specialties—such as urology, orthopedics, and urology—involve a five-year residency plus a year of general surgery. Plastic and neurological surgery take closer to six years, along with that one year of general surgery.

It takes a long time to become a physician with an attending salary. If practicing as quickly as possible is the only factor driving your decision, your list of medical specialties is now a little bit shorter. But how much do you like the choices you’re left with?

That brings us to the next question to ask yourself when picking a medical specialty . . .

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Do I Truly Want to Make This Medical Specialty My Career?

picking medical specialty

Changing medical specialties during or after your residency isn’t impossible, but it’s also not easy. It takes years to gain expertise in a particular field; if you decide to switch, you’re adding more years of education to your career path. That’s why it’s great if you can pick a medical specialty that you think you’ll want to stick with for the long haul.

While you can’t predict the future, you hopefully know yourself well enough to determine what factors comprise an ideal working environment for you. Do you like fast-paced days, or are you hoping to keep your stress levels down? How many hours do you want to work a week? You have a fair amount of control over these factors based on the medical specialty you choose.

For example, psychiatry is one of the least stressful medical professions, according to Medscape’s 2022 Physician Burnout & Depression Report. The combination of good pay and reasonable hours makes psychiatry one of the low-stress specialties. It’s also one of the few medical professionals that offer flexibility—psychiatrists can treat patients from their own homes or their practice.

Dermatology, plastic surgery, ophthalmology, and orthopedics also rank among some of the least stressful medical specialties, according to Medscape. If you feel you handle stress well or you want a faster-paced medical career, check out some of the most stressful specialties, according to Medscape.

The emergency medicine specialty might be the perfect storm of stress and fast pace—you never know what ailments you’ll be treating on a given day. Emergency medicine is also a great specialty to make you think about what type of personal life you want to have as a physician. ER doctors work evenings, nights, weekends, and holidays (until you become financially independent, at least). If you think you want a more conventional work schedule, this might not be the medical specialty for you. However, it does have an excellent average income for a specialty with just a three-year residency.

Opting for a more stressful medical specialty could make for tough days at the proverbial office. Many of these fields top the stress level charts because of the high stakes involved—obstetrics and gynecology involve keeping pregnant mothers and their babies safe; neurology often deals with severe brain ailments; critical care yields a barrage of life-and-death situations; and the physician shortage in the urology field has made the specialty the most stressful job in the US.

This isn’t to discourage you from picking these specialties. It’s just important to know what your career and personal life could be like depending on which medical specialty you select. As you examine potential residency length and the lifestyle impact of your medical specialty choice, there’s another question you should ask . . .

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How Much Can I Earn from My Medical Specialty?

Salary should not be the only factor you consider when picking a medical specialty, but it’s still worth exploring. The reason you shouldn’t put too much emphasis on salary is because, as Dr. Jim Dahle, has pointed out,

“Even a poorly paid physician usually makes 2-3 times the average American household income. Living like a resident for a few years can wipe out the student loans.”

Plus, solely looking at a medical specialty’s salary might put you in a field that you don’t enjoy practicing. Take plastic surgery, for example. This specialty paid the highest average annual salary, according to a 2022 Medscape Physician Report. The combination of the high salary and low-stress rating is great, but your residency will be on the longer side (six years). If you want to go into plastics, that’s fine, but if not, is it worth it to enter a field you’re not interested in just because of the higher potential earnings?

It might turn out that your chosen medical specialty is the perfect storm of high-end salary, low stress, and a field you enjoy. If you find yourself having to choose between these factors, it might be best to lean into something that you enjoy doing.

“At the end of the day, medical students shouldn't make finances a top consideration in their choice of specialty,” Dr. Dahle said. “Medical training and the practice of medicine itself is too long and hard to do just for the money. You've got to love it, and that goes for each specialty as well.”


He has also said that you should “optimize for longevity.” The more you love what you do, the longer you'll be able to do it without burning out. Plus, practicing longer earns you more money, allows your savings to grow longer, reduces the amount of time you will be living off your savings, and even increases your Social Security benefit. But don't ignore income and lifestyle issues. You will care far more about your income and lifestyle 10 years out of training than you do as an idealistic MS4 choosing a specialty.


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