Medical students are more likely than not to change their physician specialty preference during medical school, says a study published in the journal BMC Medical Education.
For the study, researchers used data gathered from surveys conducted following medical students’ second year of medical school and graduation. From the sample of more than 10,000 students, 56% changed their career choice between their second year of medical school and graduation.
Why preferences change
The survey data included questions that asked medical students about the relative importance of specific factors in career decision-making.
The list of factors that demonstrated an association with a higher likelihood of changing specialties were specialty competitiveness, compensation and work-life balance.
Factors linked to a lower likelihood of specialty preference change were the influence of role models and content of a specialty.
Now an internal medicine specialist at NewYork-Presbyterian Queens, as a medical student Charles Lopresto, DO, had designs on pursuing a career in ophthalmology. After taking Step 1 of the United States Medical Licensing Examination (USMLE) during the period in which the exam was numerically scored—which is no longer the case—Dr. Lopresto said that his scores made ophthalmology an unlikely possibility for him.
“That was my reality, where ophthalmology was a competitive specialty at that time that required a high board score, and I'm not the best test-taker,” said Dr. Lopresto, an AMA member.
About half of medical schools begin their core clinical clerkship rotations during the third year of medical school, meaning many students surveyed after their second year had limited specialty exposure.
As Dr. Lopresto explored where to pivot, his rotations proved to be a key data point.
“When I started clinical rotations, I fell in love with internal medicine on the second or third day that I was on the floors,” he said. “I found that having the clinical experience and being on the floors with the patients in the specific environment was a lot more useful for me to actually see what I was interested in than a preconceived notion that I had limited clinical experience in.”
An associate professor of medicine at Cooper Medical School of Rowan University in Camden, New Jersey, Elizabeth Cerceo, MD, co-authored the study on changes in specialty choice. She said the data should inform how faculty help guide students in their specialty selection.
"As educators, we must meet the needs of our students which means guiding them to careers they will find fulfilling and meaningful,” Dr. Cerceo said. “As physicians, we want to meet the needs of society and align our talented physicians with patients. This kind of medical education research is important to inform how we mentor our students through the four-years of their training."
Dive deeper:
- Future physicians: When's the right time to choose a specialty?
- The 11 factors that influence medical student specialty choice
- How to prep for a competitive physician specialty as an M1, M2
Where shifts occurred
The specialty toward which most students switched their choice between their second year survey and graduation survey was psychiatry, with a 172% rise in students preferring the field. Anesthesia (138%) and radiology (77.8%) also made major gains in student specialty choice.
The specialties that saw the biggest drops in student specialty choice were medicine-pediatrics (27.5%), neurosurgery (26.2%) and orthopaedics (24.8%). The latter two options are annually among the most competitive specialties.
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The specialty that remained the most consistent choice among students between M2 and graduation was also psychiatry. More than 70% of students who preferred psychiatry as second-year medical students listed it as their choice on the graduation survey. Other specialties that had high retention from the second year to graduation were family medicine (65.1%), anesthesia (58.5%), emergency medicine (56.1%) and pediatrics (56.1%).
Ultimately, whether students change their specialty plans or stick with their original choice, Dr. Lopresto emphasized that following passions is vital.
“Pick a specialty based on what clinical environment makes you excited to come to work every day, where you feel most comfortable, where you seem excited about all the cases that you're seeing, and where nothing seems like a chore,” he said.
“Sometimes, you have to pick the specialty based on if the least exciting part of the job is still exciting for you,” Dr. Lopresto added. “It may feel interesting to want to be a cardiologist, but having to be responsible for reading all of the EKGs [electrocardiograms] for all of the patients in the hospital might seem a little less interesting. But it's still part of the job. If you can deal with that element of the job, then maybe cardiology is right for you.”
Dive deeper:
- The road to residency starts in M1. Here’s how to begin navigating.
- Mastering M2: Top questions for your second year of medical school
