How to Choose a Specialty

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I am often surprised by the specialties that people pursue, and how contented they are once they make their choice.  One faculty I know is a hard-core researcher, but started out life just helping to do research here-and-there.  Twenty years later, he’s a research professor without a PhD.  You would think it would be a deliberate decision, where they weigh the pros and cons and talk to mentors and friends and family.  In my experience, that is not the case.  

Most people seem to choose their specialty on their “gut”.  Sometimes they’ll have reasons for the choice, but it’s difficult to know if those are post-hoc rationalizations made to justify the decision or actual, genuine, well-thought-out reasons.  Understanding that most people probably won’t make a rational decision, here are some things I think you should consider when choosing a specialty.

  • Client contact.  How much do you want to interact with clients?  If the answer is “zero”, lab animal, pathology, anesthesia, and microbiology come to mind.  However, even that is a blithe answer.  In fact, pathology, anesthesia and microbiology’s clients are the other services and lab animal’s clients are researchers.  Everyone always answers to someone.  The advantage, from my point of view, is that your clients are well-educated, knowledgeable people.  If the answer is “I want my clients to love me!”, oncology comes immediately to mind.
  • Nature of busyness.  Everyone’s busy, everyone feels overworked.  So what’s the TYPE of busyness you like?  Would you rather have five referring veterinarians waiting for a consult call (internal medicine) or be harried trying to gather enough staff to help with a C-section (therio)?  Do you want to be go-go-go all day on a variety of different things (almost all), or be able to focus on one thing for a stretch of time (surgery)?  Do you want to have five reports to write up (pathology) or five student SOAPs to review (almost all)?  How do you handle stress, how do you like to work, and how do you want your day to run?  The discipline decides a lot of this.
  • Academia or private practice.  Most specialties can do either, but the relative proportion may differ.  For example, most anesthesiologists are still in academia, and most surgeons are in private practice.  For some disciplines, the choice may be between industry and academia (pathology, microbiology).  As a broad rule of thumb, academia is more likely to have more different specialists than private practice.
  • Brain vs. technical skills.  How much do you want to use your hands versus think about things?  Obviously, all disciplines have both, but the relative proportion differs.  In anesthesia, we have regional nerve blocks and catheter placement, but mostly use cognitive skills to handle problems.  In surgery, the majority of the problems are solved with surgery, which required significant psychomotor skills.  If you prefer to sit and think about things, internal medicine and E/CC may be good.
  • Salary.  Let’s be honest, a radiologist in private practice is going to make more than an equine internist.  If you have significant debts or other financial obligations, this may affect your decision.  We have this idea in America that you should follow your passion and, in general, I agree with that.  But, if you have alimony payments or want to buy a new BMW every two years, you may want to consider more lucrative disciplines.
  • Work/life balance.  Some disciplines have a lot of on-call.  Some require you to come in on the weekends.  Some you can do part-time from home.  I have done many a 2 am Sunday night/Monday morning colic to start my week off.  I can’t leave the town where I work for about half of the year because I am on backup call.  But I don’t have to go in every Saturday morning to examine hospitalized patients.  Each discipline has its own trade-offs with work/life balance.  Learn about them before deciding.

These are the most important things I can think of when you are deciding on a specialty.  At the end of the day, I believe you can be happy doing many different paths.  Don’t get too focused on a single discipline.

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