At the end of my first year of medical, I made a shortlist (year 1) of specialties I was considering. At the end of second year, I made another list (year 2) of specialties I was thinking of doing. Now, after finishing my third year and more importantly the clerkship year, I will present my thoughts on what my current specialty choices will be. There are some specialties I have gained a greater appreciation for while others that have fallen on my list. Here are my top picks, bottom picks, and some hidden gems.

Top 5

1. Internal Medicine
   This topped the list in first and second year, and I really enjoyed my medicine rotation despite how crazy/busy it was at times (a good sign?). I’m interested in the wide variety of practice, the different subspecialties and diversity of patients. I am about 70% certain I will rank it as my first choice for the upcoming Carms application.
2. Family Medicine
   Primary care has definitely jumped up quite a bit since the beginning of medical school. I never thought I would enjoy it as much as I do. I like clinics, having your own patients, continuity of care, preventative medicine and being the primary care giver. It’s an incredibly challenging field; you have to know everything about everything, and it’s definitely under appreciated. But you can tailor your practice or schedule to whatever is flexible for you. You’ll never be worried about finding a job. I am most likely going to apply to both Internal Med and Family Med, I know I’ll be happy with doing either.
3. Emergency Medicine
   Fast pace, high acuity, ability to make a difference quickly. What’s not like about the ER? I’m more open to the shift-work schedule now, still not liking the lack of continuity, but I’ve seen some docs have clinics to follow up patients they see in the ER too. If I was to do ER, I would probably go through the FM 2+1 route though.
4. Psychiatry
   Big mover. In first year, this was on my bottom 5 and now it’s moved to the top 5. This year, I enjoyed my psych rotation and gained a much better understanding of mental health. I may have also had some preceptor bias, but who doesn’t?
5. ??? - Couldn’t think of what to put here. The rest were either specialties I really didn’t like, or ones I didn’t care too much about. But it would probably one where I would talk to patients.

Bottom 5

1. Obs/Gyn – Definitely returned to the bottom 5 this year. Just way too much estrogen (the patients and the colleagues) for me. And the vaginal bleeding… oh make it stop!
2. Radiology – In first year, I seriously considered doing radiology. I did several electives and shadowed quite a bit. I know now it was never meant for me. I was attracted mainly to interventional radiology, a small subsection of radiology. But I don’t think I could ever do the bread and butter of sitting in a dark room, staring at a screen and interpreting films all day.
3. Pediatrics – I like kids, but perhaps they didn’t like me? I realized quickly I don’t handle crying babies and crying parents too well.
4. Pathology – They’re very good at using the microscope… not for me.
5. General Surgery – I actually liked the surgeries themselves and got to home my technical skills. The interventions they do are fascinating and there is satisfaction from fixing things. But the grueling residency + lifestyle afterwards, combined with a hierarchical ladder and the “surgical culture” ruled it out for me. And I only found it like this for general surgery… I had better experiences with subspecialty surgeries.

Hidden Gems

1. Anesthesia – Great lifestyle, interesting medicine, lots of procedures. If only I didn’t enjoy talking to patients as much… definitely recommend checking it out if you don’t know what it’s about.
2. Plastic Surgery / Urology / ENT / Ophtho – Subspecialty surgeries have it pretty good. Less grueling hours, interesting cases, cool toys, good mix of clinics and surgeries. If you’re interested in surgery, I would highly recommend you check out some of these subspecialty surgeries first! There’s a reason why they are so competitive.
3. Dermatology – Even though I still think the majority of their practice is just prescribing steroid creams, this year I got to see more of what dermatologists do. From small procedures to cosmetics to cancers, dermatology is actually a pretty neat specialty. Lots of medicine to learn and a great variety of things to see (it’s not just acne!). If it wasn’t its only specialty and was still in Internal Medicine, like the old days, I might have considered it more, but now-a-days it’s crazy how competitive it is to get into it.

That’s it for now. I’ll post about my clerkship year and my thoughts about my different rotations next!