THE ULTIMATE GUIDE TO
CHOOSING
A MEDICAL
SPECIALTY
Brian Freeman, MD
Resident in Anesthesiology and Critical Care
University of Chicago Hospitals
Chicago, Illinois
And Associate Authors
Lange Medical Books/McGraw-Hill
Medical Publishing Division
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a LANGE medical book

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For Rebecca
Without you, this book would never have been conceived. You are my
inspiration—each and every day—for all that I do and all that I hope to
achieve. Thank you for your love, for your never-ending support and
devotion, and for always being there with a soft “pet” whenever I need
one. I am yours forever.
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Internet Resources Guide . . . . . . . . . . . . . . . . . . . . . . . . . . Inside Front Cover
Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Part 1. Planning Your Medical Career
1. Choosing a Specialty: The Most Difficult Decision of Your Career 3
2. The Specialization of Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3. Ten Factors to Consider in Specialty Selection . . . . . . . . . . . . . . . 23
4. Personality Assessment: Are You My Type? . . . . . . . . . . . . . . . . . . 35
5. Finding the Perfect Specialty . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
6. Special Considerations for Women . . . . . . . . . . . . . . . . . . . . . . . . 59

23. Orthopedic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
John C. Langland, MD
24. Otolaryngology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
Daniel J. Lee, MD
25. Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
Lisa Yerian, MD
26. Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
Aaron J. Miller, MD
27. Physical Medicine & Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . 367
Vicki Anderson, MD, MBA
28. Plastic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Gregory H. Borschel, MD
29. Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Kathleen Ang-Lee, MD
30. Radiation Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
Stephanie E. Weiss, MD
vi CONTENTS
31. Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429
Derek Fimmen, MD
32. Urology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 443
Jane Lewis, MD
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .457
CONTENTS vii
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M. Jafer Ali, MD
Resident in Neurosurgery, Department of Neurosurgery, University of
Michigan Hospital, Ann Arbor, Michigan

Neurosurgery
Vicki Anderson, MD, MBA

Illinois
dlfi
Radiology
Brian Freeman, MD
Resident in Anesthesiology and Critical Care, University of Chicago Hospitals,
Chicago, Illinois

Choosing a Specialty: The Most Difficult Decision of Your Career; The
Specialization of Medicine; Ten Factors to Consider in Specialty Selection;
Personality Assessment: Are You My Type?; Finding the Perfect Specialty;
Special Considerations for Women; Combined Residency Programs; Options
for the Undecided Medical Student; Applying for Residency: An Overview of
the Match Process; Love and Medicine: The Couples Match; Top Secret!
The Ultimate Guide to a Successful Match; Your Medical Career Beyond
Residency; Anesthesiology
Jeremy Graff, MD
Resident, Department of Emergency Medicine, Alameda County Medical
Center, Highland Hospital, Oakland, California

Emergency Medicine
Danagra Georgia Ikossi, MD
Resident in General Surgery, Department of Surgery, Stanford University
Medical Center, Stanford, California

General Surgery
Jennifer Lamb, MD
Resident, Department of Internal Medicine, Stanford University Hospitals,
Stanford, California

Internal Medicine

Pediatrics
Andrew Schwartz, MD
Resident Physician, Mount Sinai School of Medicine, The Mount Sinai
Hospital, New York, New York

Ophthalmology
AUTHORS xi
Ian Tong, MD
Resident, Department of Internal Medicine, Stanford University Hospitals,
Stanford, California

Internal Medicine
Lisa Vargish, MD, MS
Resident, Family Practice Residency Program, University of California, San
Francisco and San Francisco General Hospital

Family Practice
Stephanie E. Weiss, MD
Chief Resident, Department of Radiation Oncology, The Sidney Kimmel
Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland

Radiation Oncology
Lisa Yerian, MD
Resident, Department of Pathology, University of Chicago Hospitals, Chicago,
Illinois

Pathology
Tomasz Zabiega, MD
Attending Neurologist, Joliet Pain Center, and Medical Director of Practice
Developers of Illinois, Inc., Joliet, Illinois

Career,” delves into the main issues surrounding the choice of one’s medical spe-
cialty. These 12 chapters provide everything you need to begin making this ma-
jor decision—how to research each specialty, what to do if you remain undecided,
how to apply for a residency position, and much more. This section is especially
Preface
xiii
Copyright © 2004 by The McGraw-Hill Companies, Inc. Click here for terms of use.
valuable if read early during your medical education. In Part 2, “Specialty Pro-
files,” a chapter is devoted to each of the 20 major medical disciplines, all fol-
lowing a similar format and exploring common themes. Interspersed throughout
the text are special inserts—“Vital Signs” and “The Inside Scoop”—that provide
easy-to-read factoids like salary information and match statistics.
AUDIENCE
Most readers interested in this book are current medical students—allopathic and
osteopathic, and those who attend medical school in the U.S. and abroad. But
you do not have to be a medical student in order to get something out of this
book. Many residents have second thoughts about their chosen specialty and wish
to change fields. In addition, pre-medical college students, as well as anyone con-
sidering medicine as a possible career, will find this book helpful.
FEEDBACK
For comments and suggestions about the book, you are invited to contact the au-
thor by e-mail () or by regular mail:
Brian Freeman, MD
c/o McGraw-Hill
Medical Publishing Division
2 Penn Plaza, 12th floor
New York, NY 10121-2298
Your feedback is invaluable for continuing to make this book a must-have re-
source for future medical students. If you have questions regarding specific areas
of medicine, you may e-mail the contributor of that specialty chapter. Their bi-

1
PLANNING
YOUR
MEDICAL
CAREER
Copyright © 2004 by The McGraw-Hill Companies, Inc. Click here for terms of use.
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Throughout their education, medical students never stop hearing these kinds of
comments. Starting from the moment of acceptance into medical school, these ques-
tions continue well into the final year of earning the MD. As they undertake the first
major professional decision of their career, medical students often struggle to come
up with a good answer. After all, it seems like just about everyone has a strong opin-
ion on the “best” specialty for a future doctor. That person could be an advisor, par-
ent, supervising physician, or even Aunt Betty at the annual family reunion. From anes-
thesiology to urology, there are over 60 specialties and subspecialties (Table 1–1).
How will a medical student make an educated decision?
“MD” REALLY STANDS FOR “MAJOR DECISIONS”
Medicine is a profession that requires overwhelming sacrifice and commitment.
You have to spend over $200,000 for four years of rigorous education, followed
by many long, tough years of on-the-job training. Like life in general, many im-
portant decisions line the road to becoming a doctor. Think back to the day when
1
CHOOSING A
SPECIALTY: THE MOST
DIFFICULT DECISION
OF YOUR CAREER
“Is it true that gynecologists have the worst sex lives of all doctors?”
“Are you going to be a neurosurgeon like your mother?”
“Why don’t you look into dermatology? It’s got easy hours and you’ll make good money.”
3

Psychiatry and neurology 1935
Radiology 1935
Surgery 1937
Thoracic surgery 1970
Urology 1935
Source: American Board of Medical Specialties.
Now, another career-defining challenge awaits. The medical school experi-
ence is more than just memorizing the arteries of the arm, holding retractors dur-
ing surgery, and learning how to use a stethoscope. Each and every medical stu-
dent has to go through four years of grueling examinations, sleepless nights on
call, and tough clinical rotations. Despite these hurdles, most medical students
see eye to eye on what is really the greatest challenge of all—choosing one’s med-
ical specialty. Figuring out what type of doctor to be is, in many ways, more dif-
ficult than deciding to become a physician. Once medical students settle on a
specific niche within medicine, they become more than just future doctors. They
start to take on a new identity—that of a pediatrician, forensic psychiatrist, en-
docrinologist, orthopedic surgeon, or interventional neuroradiologist.
The specialties themselves are quite diverse. Graduating doctors have the
freedom to choose from a wide variety of medical fields. Some are based strictly
on an organ system, like the brain (neurosurgery and neurology), the heart (car-
diology), and the male genitourinary system (urology). Others provide compre-
hensive medical care for specific population groups, such as women (obstetrics
and gynecology) and children (pediatrics). Another set of specialties share in com-
mon the fact that they are hospital-based services. Its members include radiology,
pathology, anesthesiology, and emergency medicine. Medical specialties can also
generally be divided into two main groups: primary care (long-term comprehen-
sive care) versus secondary/tertiary care (referral-based care). Generalist special-
ties like family practice, internal medicine, and pediatrics are considered primary
care fields. More specialized areas such as gastroenterology, dermatology, and car-
diothoracic surgery fall into the latter category.

panded to meet. Depending on the specialty, residency consists of 3 to 7 years of
additional formal training and study (under physician supervision). Medical
school only provides a broad clinical foundation. Residency takes it one step fur-
ther and confers the skills, knowledge, and experience necessary to practice med-
icine unsupervised in a given specialty. Being a resident physician is kind of like
working as an indentured servant. You work long hours for little pay and spend
many nights sleeping in the hospital. In fact, residency earned its name from the
old days when house staff physicians actually lived on hospital grounds, as resi-
dents.
Through the National Resident Matching Program, graduating medical stu-
dents may enter residency training in 20 different specialties. You actually have
even more options. Here is why. The American Board of Medical Specialties
(ABMS) recognizes 24 official specialty boards. But every year, statistical data
from the residency match show that nearly all medical students enter 1 of only
20 areas. What about the remaining four? Three of the specialties—medical ge-
netics, preventive medicine, and nuclear medicine—offer such a small handful
of residency positions (16 total in 2002) that few students really consider them as
options. The other disciplines—allergy medicine and thoracic and colorectal sur-
gery—are really considered subspecialties of internal medicine and surgery, re-
spectively. (Psychiatry and neurology both share the same specialty board, and
radiation oncology falls under the jurisdiction of radiology). In addition, students
6 PART 1 / PLANNING YOUR MEDICAL CAREER
may also select more than one specialty through the combined residency pro-
grams described in Chapter 7. Doing the math, these 14 available options bring
the grand total to 34 choices.
After deciding on a specialty for residency, many physicians later choose to
subspecialize further by obtaining a fellowship, which can last any number of
years. Subspecialties exist for nearly every specialty. Examples include rheuma-
tology or infectious disease (internal medicine), vascular surgery (general sur-
gery), pain management (anesthesiology), and retinal surgery (ophthalmology).