Choosing Your Specialty

By January of the 3rd year of medical school, most medical students have had rotations in 3-6 medical specialties (out of the 145 specialities in medicine).  With what feels like really limited knowledge, they have to decide on their specialty and move forward.  They apply through the NRMP in the summer, interview at training programs in the fall, and in March go through “the match” to find out where they will train.

I started off believing that if you pay close attention, you will find the specialty that is “right” for you.  Cal Newport, in his book So Good They Can’t Ignore You: Why Skills Trump Passion in the Quest for Work You Love, calls this the “Passion Hypothesis”.  The “Passion Hypothesis” states that “the key to occupational happiness is to first figure out what you’re passionate about and then find a job that matches this passion”

I moved past the “passion hypothesis” as the sole way to choose a medical specialty when I realized that there were other variables like debt and family obligations that were important, too.

Here’s where I am now….

There may be a few people who have a lightening bolt hit them and know instantly what specialty they should go into, but they are few and far between.  Most people gravitate in a direction without a clear destination i.e. more medical than surgical, more procedural than not, more or less direct patient care, children vs. adults.  At some point they pick a specialty that is in their “zone” of interest…. and then they worry that they haven’t seen enough specialties or they may be making a bad choice.

“The more I studied the issue, the more I noticed that the passion hypothesis convinces people that somewhere there’s a magic “right” job waiting for them, and that if they find it, they’ll immediately recognize that this is the work they were meant to do. The problem, of course, is when they fail to find this certainty, bad things follow, such as chronic job-hopping and crippling self-doubt.” – Cal Newport

Here’s where it gets interesting.

What Cal Newport explains in his book parallels what I have seen in the happiest physicians I know, regardless of their specialty.  We have all seen the chief resident or seasoned attending light up when they learn something new at 2am, or when the complex diagnosis becomes clear with steady, deliberate investigation.   Cal Newport calls this the “craftsman mindset”.  It’s the process of devoting yourself to deliberate practice in order to master your field.  When you adopt the “craftsman mindset”, the passion follows.  Or, as Cal Newport summarizes it “working right trumps finding the right work.”

If you want to love what you do, abandon the passion mindset (“what can the world offer me?”) and instead adopt the craftsman mindset (“what can I offer the world?”) – Cal Newport

As I’ve thought more about it, I have also begun to wonder if picking a specialty isn’t somehow similar to how we choose the important relationships in our lives.  You may fall head over heels in love with another person or slowly realize you have met the person you want to spend you life with – but either way, the real relationship comes with time and “practice”.

One other thought, if you are currently struggling with your specialty choice.

There are no bad choices.

All the specialties in medicine are noble and important.  It’s a privilege to serve others… and we need all the specialties to be able to do it well.  Take the plunge.  Make the best choice you can and then devote yourself to being a craftsman in that field.

Cal Newport video from

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 “We are here to add what we can to life, not to get what we can from life.” – William Osler