Selecting the Medical

Specialty That Is Right for

You
Jim Holliman, M.D., F.A.C.E.P.
Program Manager, Afghanistan Healthcare Sector
Reconstruction Project
Center for Disaster and Humanitarian Assistance
Medicine
Uniformed Services University of the Health
Sciences
Clinical Professor of Emergency Medicine
George Washington University

Questions to Ask Yourself As You

Are Deciding on a Medical Career
Specialty
1. Do I like diagnostics or therapeutics or both
?
2. Do I like predictability or unpredictability,
and can I deal with more than one case at a
time ?
3. Do I have any prejudicial dislikes of certain
kinds or ages of people ?
4. Do I need defined limits to what I need to
know ?
5. Can I work in a team environment ?
6. Do I have verbal communication
limitations ?

Questions to Ask Yourself As You

Are Deciding on a Medical Career
Specialty
1. Do I like diagnostics or therapeutics
(procedures) or both ?
If you dont have any manual dexterity, then
dont choose a procedural specialty
Pure procedural specialties : Plastic
Surgery, Orthopedic Surgery
Pure diagnostic specialties : Neurology,
Preventive Medicine, Rehabilitation
Medicine
Mixed procedural and diagnostic
specialties : Emergency Medicine, General
Surgery

Questions to Ask Yourself As You

Are Deciding on a Medical Career
Specialty
2. Do I like predictability or unpredictability,
and can I deal with more than one case at a
time ?
- If you dont like or tolerate unpredictability,
then you want to choose a clinic or office
based practice, such as Internal Medicine,
Family Medicine, or Pediatrics (perhaps
without hospital admission privileges)
- Specialties with unpredictability of patient
presentations include Emergency Medicine,
Trauma Surgery, and General Surgery
- Some specialties such as Critical (Intensive)

Questions to Ask Yourself As You

Are Deciding on a Medical Career
Specialty
3. Do I have any prejudicial dislikes of certain
kinds or ages of people (or do I want to treat
all types and ages of people) ?
For example, f you dont like kids, then
dont go into Pediatrics or Family Medicine
In Emergency Medicine you have to like to
deal with all types and all ages of people
If you dont have patience with the elderly,
then dont go into Internal Medicine or
Emergency Medicine

Questions to Ask Yourself As You

Are Deciding on a Medical Career
Specialty
4. Do I need defined limits as to what I need to
know & study ?
- Some people are very uncomfortable with a
specialty such as Emergency Medicine in
which the body of clinically important
information to know and study is essentially
unbounded
- So if you want defined limits as to the
knowledge base required for clinical practice,
then choose more focused specialties such
as Ophthalmology, Anesthesia,
Otolaryngology, etc.

Questions to Ask Yourself As You

Are Deciding on a Medical Career
Specialty
5. Can I work in a team environment ?
- If youd rather work solo, then pick an office
or clinic based specialty
- Emergency Medicine and Rehabilitation
Medicine particularly require close teamwork
with other department personnel

Questions to Ask Yourself As You

Are Deciding on a Medical Career
Specialty
6. Do I have verbal communication limitations ?
- If you dont like to or are not good at quickly
establishing rapport and verbal
communications with patients, then you
should choose Anesthesia or Radiology where
these aspects are not as important as in
specialties such as Family Medicine, Internal
Medicine, Pediatrics, and Emergency Medicine

Questions to Ask Yourself As You

Are Deciding on a Medical Career
Specialty
7. Is my final career goal a sub-specialty or
multiple specialties ?
- If so, you need to consider the base specialty
you will need to complete first before going
on to the subspecialty.
For example, you can enter Critical Care
Fellowships via Anesthesia, Internal
Medicine, Surgery, or Emergency Medicine.
- If you want to be certified in more than one
specialty then you can enter one of several
combined residencies : EM / IM, EM / Peds,
EM / FM, etc.

Questions to Ask Yourself As You

Are Deciding on a Medical Career
Specialty
8. Can I tolerate the humdrum and disagreeable
aspects of the specialty I have chosen ?
- This is often the most important question to
consider
- For example, if you want to be a neurologist,
then you must be able to tolerate patients
with chronic undifferentiated headaches
- Remember that in many surgical specialties
you will be doing the same limited number of
procedures over and over
- Also remember that in most clinical practices
you wont see the variety or severity of cases

Questions to Ask Yourself in

Deciding on an Academic Career
Versus Private Practice ?
Can I tolerate turning over care of my
patients to trainees ?
Do I prefer to do everything myself to make
sure it's done right ?
Do I want to listen to my spouse yell at me
for working twice as hard for half as much
money in academic practice as my medical
school classmates are making in private
practice ?
Do the rewards of teaching and scholarship
outweigh the extra political hassles of

Why Is Emergency
Medicine A Great Career ?
Nice mix of diagnostics & therapeutics
(procedures)
Wide variety of patients & medical
problems
Challenging
Benefits to patients & U. S. health care
are obvious
Core component of U.S. health care
system
Young, vibrant specialty ; many
practitioners have extensive interests

What About Primary Care

Careers ?
"Classic" primary care specialties include :
Pediatrics
Family Practice
Internal Medicine

The degree of governmental support for

these to the exclusion of other specialties
is waning
Usually do not include any trauma training
True "longitudinal" care in these may not
be practiced

Disadvantages of
Emergency Medicine As a
Career
You won't make as much money as in
cardiac surgery
Limited "longitudinal care"
No ability to pre-select patients
Usually spatially limited work
environment
Need to stay current in all fields of
medicine
Requires a lot of political skill (the art of
making other doctors actually do what
you both know is the right thing to do)

Unique Advantages of
Emergency Medicine As a
Career
Unlimited international development
opportunity
Relatively small number of academic
practitioners (easy to "rise to the top"
fast)
Control over, & predictability of, work
schedules
Potential for administrative
involvement in prehospital care
Interact with every other medical
specialty
Geographic flexibility

What Does the Future

Hold for Emergency
Medicine ?
"They may find a cure for cancer ; they
may find a cure for heart disease ; but they
will never find a cure for stupidity, so there
will always be accidents & a need for
emergency physicians "
Is currently an undersupplied specialty in
the U.S.
Is just beginning to develop in other
countries ; the U.S. is the unquestioned
world leader in this specialty

Important Principles to Remember

in Deciding Upon a Medical Career
Specialty
Does my chosen career mesh with my
personality ?
Does my chosen career match with my
significant others long term wishes ?
Can I stand the dull, humdrum, and
disagreeable aspects of my chosen field, and do
the interesting or infrequent exciting aspects
of my chosen field sufficiently make up for
these other aspects ?
(Seriously) : It is best to keep an open mind as
you are doing your third year rotations ; you
may find you really like a specialty you had not
had exposure to before

What Should I Do if I Still Cant

Decide on a Specialty Late in my
Third Year ?
If you can narrow it to two specialties : for your
first fourth year rotation take an acting
internship in one followed by a second acting
internship in the other, followed by one month
each of a rotation related to each specialty ;
prepare two different personal statements over
the summer ; make a final decision and apply to
only one specialty at the end of September.
If you still have no decision by your fourth
year : apply to transitional internships,
schedule rotations related to your specialty
interests early in the transitional internship,
then reapply to a single specialty the next year

My Recommendations for Students

Interested in Applying for E. M.
Residencies
Take E.M. elective early in 4th year, then take a
rotation that will buff your clinical skills such as
Surgical ICU
Then take second E.M. elective at another center
with an E.M. residency
Get 3 letters of recommendation from E.M. faculty
at these 2 places
Over the summer draft and edit your CV and
personal statement
Complete all NRMP application materials by
October
Take the time and expense to travel to any
residency that offers you an interview
Do an overseas elective in March or April while

Recommended 4th Year Electives for

Students Interested in E.M. (in
addition to the 2 E.M. electives)

Medical, Surgical, and / or Pediatric

I.C.U.
Outpatient Pediatrics
Outpatient Orthopedics
Anesthesia
Dermatology
Urology
Medicine or Surgery Subinternship
Plastic Surgery
Trauma Surgery

Fourth Year Electives NOT

Recommended for Students
Interested in E.M.

Radiology
Radiology subspecialties
Radiation oncology
Medicine subspecialties
Psychiatry
Rehabilitation
Oncology
Family practice

Additional Items to Consider to

Bolster Your Residency
Application
Get faculty to review your C.V. & personal
statement
Join several student interest groups
Do some public service projects
Do a decent research project(s)
Join AMSA, AMA, ACEP, SAEM, etc.
Become knowledgeable about current
affairs & political aspects of medicine
Develop some interests besides reading
& sleeping

What Should You Do if You

Apply to E.M. Programs & Don't
Get In ?
Don't reapply if you're actually a dork
If you are not a dork :
- Serve out your GMO time and then
reapply
Apply to transitional internships (these are
required for the PGY 2,3,4 programs
anyway)
Take a research position & reapply next
year
Analyze what was weak in your file and try
and fix or augment it
Work as an E.D. volunteer or in prehospital

Recognized Subspecialties of
Emergency Medicine

Toxicology
Pediatric Emergency Medicine
Sports Medicine
Palliative Medicine
E.M.S. (prehospital care)
Aeromedical Care
Critical Care
Note the first 4
Disaster Medicine
have official
International E.M.
subspecialty
certification
exams

How to Find Out More

Information on Emergency
Medicine Careers
Consult the unbiased Dr. Holliman and / or Dr. Burns
in the office anytime and shadow them when theyre
on clinical duty
Come to "Career Night" at Dr. Holliman's house
(party for students held twice a year)
Talk to the E.M. residents at GWU or Georgetown
Talk to the E.M. attendings at any of the local
hospitals
Join ACEP, SAEM, & the student E.M. Interest Group