On Choosing A specialty

March 10, 2014   

The other day, I was talking to a junior medical student who is in the process of choosing his medical specialty. He asked for my perspectives on the different types of specialties he had in mind. I dutifully offered all the advice I could conjure up but most importantly, I told him to take his time and study all his options, as the process is lengthy and evolving. However, he told me he has done his deliberation and that he wanted to pursue Spinal Surgery. On further discussions, he told us the main reason he picked that field was that he wanted to become the first Somali spinal surgeon. I thought to myself, how about the best doctor? how about a good doctor? or even how about a decent doctor?

I have seen a lot of my country men make this mistake. Somalia is in dire need of professionals, and to meet public demand, incompetent and unqualified people are employed to fill the gaps, including doctors. The standard of care is poor to say the least. So we tend to compare ourselves to the standards back home rather than those set by international bodies. Everyone is happy if he/she passes the exams, and to some they can’t wait to pick up their degrees.

I think this is dangerous and will lead to a lot of tears. For one, you are picking yourself to fail. You will also waste a lot of money, not to mention time changing from one specialty to another in the future. However, the one thing that’s going for you is the opportunity you have picking up the right specialty for the right reasons. You get three years to experience different departments during your clinical clerkship and internship. Make use of that time. When I talk to Chinese residents and some attending doctors, they don’t really have a say which specialty they pursue, the university or their professors pick up for them.

Some things you need to look out for when picking up a specialty is:

Type of doctor

Generalist or specialist, surgeon or internist; Generalist tend to have broad medical knowledge covering variety of medical conditions, specialists on the other hand care for particular region of the body or specific area of medicine.

Intellectual content and clinical skills

DO you want to pursue cerebral area of medicine e.g Neurology or more hands-on area like emergency medicine or surgery? if you enjoy say anatomy, you will likely also enjoy radiology. Same for pharmacology with anesthesiology and physiology with cardiology.

Amount and type of patients

Woman are better obstetricians and pediatricians than men. If you like clean, go for something like Ophthalmology. If you can’t stand people, be radiologist or pathologist.


Almost all areas of medicine is demanding, especially when you are starting out. But you can choose the so-called lifestyle careers that leave room for other activities like raising a family or hobbies. However, be warned, these specialties are getting more competitive as everyone starts basing their decision on this factor.

Length of Training

This is important if you have family that depend on you and those with financial burden. Not all specialties are created equal, some like Cardiothoracic surgery or Neurosurgery may take up to 6 years of postgraduate training and others like Family Medicine may take as short as 3 years of training.

Other things to consider; I put these here because they are worth looking into but don’t base your decision solely on them.

Prestige and social status

You may be the first neurosurgeon in your city but after few years, better and more competent ones will come. You also shouldn’t base your decision what someone else thinks is prestigious. For example, When I was starting medical school, I used to think neurosurgery was cool place to be but after attending few surgeries, I wouldn’t want to be there. You sit there for 12 hours watching an operation on a skull. They interchange and the lucky ones get may be one hour of action. You spend the rest of the day worrying about if the patient will wake up.

Job opportunities

Some specialties are more competitive than others but you will have job security for life whatever specialty you choose. Worry about your training and depth of knowledge. You can teach, work with an NGO, start a private practice, go into research. You will have such a great number of options it would be almost impossible to list them all here.

Difficulty of specialty

Some specialties are perceived to be difficult than others, but don’t worry! the harder a specialty, the more time you get to train. Were you ever told you can do anything if you put your mind into it, this is true especially in medicine. If you sacrifice enough and put in the right time and effort, you can become anything.

Future income or Salary

I believe money isn’t the most important in the world. I also believe no one should sleep with an empty belly or go outside begging. A career in Medicine fulfill both of these, you will be able to afford a decent living experience for your family. However, if you think money makes the world go round, you are in the wrong place to make money.

NB The image above is our hospital’s surgery theater corridors. The quality is a tad bit low because I took on my iPad. I couldn’t find a more appropriate picture.

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