Choosing a Specialty

Lately, the most pressing questions in my professional life have been a) which medical field to go into and b) how to get myself published. Part (b) is a topic for another post, but the choice of specialty question has been plaguing me for a couple of weeks now.

So far, I've narrowed it down to a few fields I think I'd be most happy in. Here's the list, in no particular order, with the training required for each:

1. Neurology (adult): 1 year preliminary medicine + 3 years' neurology
2. Child neurology: 2 years preliminary pediatrics + 3 years' child neurology OR 3 years pediatrics + 3 yrs child neuro
3. Pediatric rehabilitation: Same as child neuro, but put "rehab" in place of "neuro"
4. Adult rehabilitation: Same as adult neuro, but put "rehab" in place of "neuro"
5. General pediatrics: 3 years of pediatrics

So I think I'd be happy in any of these fields. The problems I have with deciding are related mainly to i) competitiveness and ii) scheduling 4th year rotations so that I have a good chance of doing well and getting a recommendation in my chosen field. Basically, I have two available slots, and I was hoping for a 'warm-up' rotation so that I could really do well in my 2nd one. I want to step it up my fourth year!

In terms of competitiveness, neurology and adult rehabilitation are not that competitive, but the 1st year -- preliminary medicine -- is. This is because everyone matching into the more competitive fields of Radiology, Ophthalmology, Anesthesia, and Dermatology (the ROAD to the good life, we call it) has to first do a prelimininary medicine year. These are the students with honors across the board, Alpha Omega Alpha (medical honor society), and great board scores as well as research in their field.

Child neurology and pediatric rehabilitation are not supposed to be competitive, but they have very few spots available each year, and so it tends to be that either you get interviewed/ranked at many programs or nobody ranks you (this refers to a complicated process known as "The Match", in which programs interview selected students applying in their field, and both rank each other so that a computer algorithm can decide who goes where).

What all of this means for me is that I have to take a cold, hard look at my scores, grades, research, and qualifications so that I don't under- or oversell myself when trying to find a position for residency. My record is that I come from a very good school, but my Step I is unfortunately quite awful, my Step 2 is quite decent, my grades are solid but nothing special, my research experience is strong but not PhD level, and I won't be a member of AOA. I do have gumption and passion and lots to give in terms of intangibles, though!

The other issue, of course, is whether I'd like to work with children or adults more. This is a huge decision and is, I think, the biggest 'branch point' in the above decision-making. I have written out lists of pros and cons, I have flipped coins, I've asked friends/families/advisors. I get different answers depending on my mood, the person I'm speaking to, etc. My mother even wrote out a flow chart analysis thing (it's so nice to have an MBA Mom with a great deal of patience for my ridiculous anxiety). Right now, I'm favoring the kiddos. And their parents. I really like parents. Parents are adorable. But we'll see!