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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DOI: 10.1036/0071457135
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
7. Combined Residency Programs . . . . . . . . . . . . . . . . . . . . . . . . . . 71
8. Options for the Undecided Medical Student . . . . . . . . . . . . . . . . 81
9. Applying for Residency: An Overview of the Match Process . . . . . 87
10. Love and Medicine: The Couples Match . . . . . . . . . . . . . . . . . . . 109
11. Top Secret! The Ultimate Guide to a Successful Match . . . . . . . . 119
12. Your Medical Career Beyond Residency . . . . . . . . . . . . . . . . . . . . 137
Part 2. Specialty Profiles

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
Resident, McGaw Medical Center of Northwestern University, Rehabilitation
Institute of Chicago, Chicago, Illinois

Physical Medicine & Rehabilitation
Kathleen Ang-Lee, MD
Resident, Department of Psychiatry, University of Washington Medical Center,


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
John C. Langland, MD
Orthopedic Surgeon, Steindler Orthopedic Clinic, Iowa City, Iowa
Orthopedic Surgery
x
AUTHORS
Jonathan Long Le, MD

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

Neurology
xii
AUTHORS
Three years ago I was a confused third-year medical student, not having any idea

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-
ographical and contact information can be found at the end of each chapter.
ACKNOWLEDGMENTS
Many people helped make this book a reality. I first would like to acknowledge
my mother, Ellen, for all her guidance, love, and support throughout my life. I

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
Copyright © 2004 by The McGraw-Hill Companies, Inc. Click here for terms of use.
you decided on a career in medicine. Whether you were a college student, try-
ing to pick between medicine, engineering, or public policy or perhaps an older,

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.
Everyone knows that medical school has many rigorous demands: patient
care, lectures, rounds, examinations, and call schedules all compete for a med-

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).
Because of all the subspecialties, there are over 60 different kinds of doctors out

and the development of the colonoscope created gastroenterology. The list goes
on and on. Today, with nearly 60 specialties and subspecialties of medicine, nar-
rowing the choices down to one is more challenging than ever.
Clinical Clerkships Have Many Limitations
After making it through 2 hard years of basic sciences, medical students have to
complete a series of clinical clerkships (rotations). The purpose of this hospital
experience is twofold: (1) to acquire a basic fund of clinical knowledge in that
specialty, and (2) to explore whether or not that field of medicine may be one
you want to pursue. For the latter goal, clerkships prove inadequate for many rea-
sons. Most rotations only last from 2 to 8 weeks. During this short period of time,
medical students get limited exposure to that specialty. It feels more like an
overview or introduction.
Anxiety over clerkship examinations and grades takes both time and mental
energy away from focusing on the merits of the specialty. During a rotation, many
students spend more time studying for the test or worrying about their daily per-
formance on rounds instead of discussing the pros and cons of that specialty with
residents and attendings. When the clerkship ends, the evaluations and grades of-
ten subjectively influence a medical student’s final impressions. More often than
not, your enjoyment of a particular rotation does not correlate with what you re-
ally think and feel about that specialty. This usually happens because bad evalu-
ations from bitter residents or tough attendings leave a negative lasting impres-
sion, making a student less inclined to choose that specialty. Having a rough
experience in a single month-long rotation, however, should not influence your
decision. It is possible to have a bad rotation but still end up choosing that spe-
cialty for a career.
Most clinical rotations are completed within the setting of an academic med-
ical center or teaching hospital. Here you receive an unbalanced, biased view of
that particular specialty. The academic environment is vastly different than the
private practice setting of most doctors. Take the internal medicine clerkship, for
example. Most medical students spend weeks gaining internal medicine experi-