Choosing a Sub-speciality after Residency

As you go through residency interviews, one of the questions that is frequently asked is what your plans are after residency and if you are interested in a subspecialty fellowship. This can be a daunting question as it is challenging to understand the nuances of the various subspecialties just after medical school and what your eventual interests will be after residency training. Of course, many physicians choose not to pursue further subspecialty training and instead focus on primary care or hospital medicine. For physicians training in Internal medicine and interested in a subspecialty fellowship, there is a vast menu of choices such as Cardiology, Gastroenterology, Rheumatology, Pulmonary and Critical Care among many others. Given the vast array of potential fellowships, it may be helpful to have a general sense of your interests before you attend residency interviews so that you can address this question with greater confidence. In my opinion, if you are undecided about subspecialty interests before residency training, it is perfectly fine to acknowledge that and to say that you would base your eventual decision on your interests and experiences during the first two years of your residency training.
 
There are several factors to consider in making a decision about pursuing a subspecialty fellowship. The most critical factor is your interest in that subspecialty, i.e., do you have a passion for that branch of Medicine?  This passion should be both for clinical practice in that subspecialty and also for research as most fellowships will require that you demonstrate both clinical and research interest. It can be very helpful to do clinical electives or clerkships during medical school to gain experience in that subspecialty and to see if it is a good fit for you. As you rotate through these electives, you should ask yourself whether you are going to be happy doing this for the rest of your life. It is also critical to seek out experienced mentors in your desired specialties and discuss the opportunities and challenges in that specialty and how they foresee the evolution of the field in the next 2-3 decades, which will be when you will be practicing. Also, speak to current fellows about their experiences and what made them choose that specialty.  If you are in your internship year and are trying to decide on a subspecialty choice, you may want to rotate through those specialties during your elective months and seek the advice of faculty and your program director.

If you are inclined to choose a specialty that is associated with interventional procedures such as Cardiology or Gastroenterology, you should assess whether that would be a good fit for you. Other factors to consider are the length of the various fellowships. Most specialties require a three-year fellowship after residency. Many specialties also offer additional one to two year advanced training following completion of the regular fellowship. For example, to be trained as a therapeutic gastrointestinal endoscopist, you would complete three years of Gastroenterology Fellowship and then an Advanced Endoscopy fellowship, which can range from 1-2 years.  Several other factors can influence your eventual decision such as competitiveness of the fellowship, job prospects, and work-life balance but your clinical and research interest should be the primary factors in your subspecialty choice. 

The USMLESarthi Panel

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