One of the most common questions you are asked as a medical student and a junior doctor is what area of medicine you would like to specialise in. This question can also come up in medical school interviews. If you are applying to medicine in the UK, you won’t need to think about this when preparing for the UCAT. However, it would help if you had an answer prepared for your interview.

Some may find this easy to answer – like those who have had their heart set on becoming an orthopaedic surgeon before they could even hold a bone saw. However, others may still be uncertain after several years into practice. This guide is designed not to tell you which medical speciality is right for you but to outline the key considerations when planning your future training and career.

Consider what you enjoy about medicine

A crucial question to ask yourself when choosing a medical speciality is, “What job will I be happy doing for the next twenty to thirty years of my life?”

Medicine is a rewarding but arduous profession, and finding enjoyment in your work is key to remaining a happy doctor.

Reflect on your previous rotations to identify the parts of them you enjoyed. This knowledge can then determine which specialities most align with your preferences. Whether this is learning about the particular diseases you encountered, the nature and level of patient interaction, or the clinic or emergency department setting. Each speciality is unique in the experience and environment they offer – it is key to identify those that suit you best. 

Learn about what the speciality is like as a specialist

The experience of a speciality as a medical student or junior doctor is not necessarily indicative of the work of a specialist in that area. Much of a junior doctor's routine is generic and transferable across departments. To discover the true nature of a speciality, you have to look at the work the seniors do daily, as this will be the work you do for most of your career. Therefore, it is crucial to know what a career in that area really entails before making a commitment to train within it.  This also includes knowledge of the different training pathways and requirements. Such criteria are publicly available and generally found online.

Even if you do not have the opportunity to work in a speciality of interest as a junior, you can proactively gather practical information. You can ask speciality doctors in a specific area for guidance and arrange opportunities to attend clinics and experience days as extracurricular work.

Be proactive in your early years 

The experience of different specialities during initial post-graduate training varies by country. The initial two years of training (the Foundation Programme) provide six different rotations, offering a generally broad experience.

Your years as a junior doctor should be seen as a chance to explore your interests. The pressures of long hours and of being a newly-qualified doctor can make these years pass quickly. However, it is important to maintain awareness of the overall picture. You are a junior doctor, but also a speciality doctor and this time is important in shaping your future career.

Advance planning and proactivity can help you to maximise your experience. Examples include:

• Asking the senior doctors you work with if you can attend their speciality clinics
• Arranging ‘taster days’ – or experience days – within other specialities outside of your mandated rotations
• Seeking educational opportunities to attend conferences and other training days

All junior doctors should look to make full use of any allowance given for extracurriculars and career planning – it is time you are entitled to.

Utilising time out of training

Taking time out of training programmes is becoming increasingly common. Many junior doctors take the opportunity to undertake locum work before applying for further training. In the UK, this is colloquially known as ‘an F3 year’ – coming after completing the Foundation Programme.

Rather than a year out, this time can be seen as an opportunity to explore career interests before future medical speciality applications. You can use this time to improve your portfolio. Ensure you set goals and  plan this time – identify what you would like to achieve., Learn more about yourself and your career plans, and then take steps to meet those goals.

Not being contracted full-time allows the opportunity to attend conferences or arrange days in specialities of interest. Working as a locum also gives you a chance to broaden your experience by working in new specialities and in different hospitals and settings. This can also help you ascertain whether your previous speciality preferences were biased by enjoying time spent in a particular hospital or team. If you enjoy a medical speciality regardless of the environment, that suggests it is one to consider.

A year out from training also allows more time to make a decision about what speciality is right for you. Junior doctor training is rigorous and can fly by with little pause for thought. In addition, a year spent working at your own pace allows you to take stock and clarify your future ambitions.

Lifestyle

Work-life balance is a very valid consideration when choosing a speciality, which all vary in the commitment required. This encompasses:

• work schedule
• on-call responsibilities
• extracurricular requirements necessary for applications
• progression through training

Work is not all there is to life. Some people may choose to pursue a speciality that is less time-demanding and provides more sociable hours. Any reason for this is valid. It is your life, and if you do not want to work on-call shifts for the rest of it, then a career in emergency medicine or anaesthetics may not be for you.

Certain medical specialities are more competitive than others. Although this should not put you off applying, it is important to be aware of the competition and requirements. Areas such as neurosurgery are notorious for their competitiveness. With the substantial amount of extracurriculars required to be successful, you will likely have unsuccessful application attempts before being accepted onto a training programme. If going through several cycles of applications and undertaking a significant amount of extracurricular work does not interest you, then it may be that the most competitive specialities are not for you.

You can find out about the work-life balance and competitiveness of applications through online resources and speaking to people training in that medical speciality.

You can retrain

There can be a feeling of pressure to decide early the speciality you should commit to – but you have a long career in medicine ahead. It is important to remember that retraining is a possibility. Undertaking speciality training after having started or completed training in another area is more frequently and easily done than people may realise.

Re-training means more time spent in training and longer before reaching seniority.  However, it is more important to be happy with the destination than to get there quickly. Life circumstances and preferences can change, which may make another speciality more suitable. Furthermore, a speciality may not be what you expect once you begin training.

Changing your mind should never be seen as a failure. It is a decision made with your own best interests in mind. All medical training is valuable and transferable. Re-training does not mean you have wasted your prior experience and knowledge gained. It can even help you to become a more well-rounded doctor in your chosen field.

Final tips

The most important thing when choosing a medical speciality is that you do not need to decide right now.

Take the time to gather information by consulting senior doctors in specialities of interest, in finding ways to seek direct experience, and in evaluating what you want from a career. Make full use of the wealth of information offered by senior colleagues and the numerous crowd-sourced online platforms.

Remember also that speciality training is not a one-way ticket. Changing your mind after gaining new information or a change in life circumstances is entirely valid.  

Each person has their own priorities and preferences. Decide what is right for you! Separate the influence of others – especially on what fields are perceived as “prestigious”. Use your years as a junior doctor to learn about yourself as a person and a clinician. Choose the medical speciality that you think best matches you and will give you the greatest fulfilment long-term.