One thing I know for sure is that, as a whole, our medical training system has gotten it all wrong when it comes to helping students correctly identify which specialty they want to apply to.
Coming from undergrad to medical school, I spent four years learning about myself. I went to grad school, worked for a few years in the real world, and gained real-life experiences. During that time, I couldn’t exactly tell you what I wanted, but I could tell you what I didn’t want. And what I didn’t want was for my life in medicine to overtake my personal life.
I wanted a life filled with balance, fulfillment, and purpose. And I knew certain fields in medicine would give me a better chance at achieving that.
This brings us to the most dreaded, and most commonly asked question every med student has to wrestle with: “So, what specialty do you want to go into?”
Oftentimes, it’s asked with genuine curiosity, but sometimes, it’s asked with a hint of pressure or judgment.
It seems like a simple question on the surface, but behind it lies one of the most personal and complicated decisions you’ll ever make.
Choosing a medical specialty isn’t just about what sounds prestigious or what looks impressive on social media. It’s not about your board scores or how many research posters you can stack on your CV.
At its core, choosing a specialty is about understanding yourself: your values, your lifestyle goals, your strengths, and your long-term vision for the life you want to lead.
In college and even in medical school, it’s easy to think this decision will come later. Maybe it will come to me during the preclinical years, or maybe it will hit me while I’m rotating through my clinical clerkships?
But the truth is, the earlier you start to understand yourself, the better positioned you’ll be when it’s time to choose. Let’s break this down with real examples.
If you value sleep, think twice about fields that require frequent overnight calls or early morning surgeries. Waking up at 4:30 a.m. to preround might sound manageable now, but it wears differently on a 35-year-old with toddlers than it does on a 22-year-old who may crave a late-night partying sesh.
If you’re energized by human connection and thrive on deep relationships, consider specialties that allow you to follow patients over time. Fields like family medicine, pediatrics, or internal medicine offer that continuity and connection. You’re not just treating illnesses, you’re walking with people through the ups and downs of their health journeys.
On the other hand, if you’re procedure-driven and find satisfaction in fixing problems quickly and efficiently, a more acute, task-focused specialty like surgery, emergency medicine, or anesthesiology might be a better fit. There’s no one-size-fits-all, but knowing how you prefer to spend your working hours can point you in the right direction.
Now let’s talk about lifestyle, something many premeds are encouraged to overlook in favor of prestige or income. But lifestyle matters. Maybe you want to start a family in your 30s, or maintain close relationships outside of work. Perhaps you have creative or entrepreneurial pursuits you’re not willing to put on hold. In that case, choosing a specialty that offers a more predictable schedule and fewer overnight shifts might be a wise move.
For some, financial stability and higher income potential are key factors, and that’s valid, too. Student loan debt, financial goals, and family responsibilities can all impact how important salary is to you. Just understand that many high-paying fields require more years of training, longer work hours, or higher pressure environments. There are trade-offs, and they should be weighed honestly and without shame.
One thing many students overlook is how much their values change over time. At 20, you might be willing to sacrifice sleep and weekends for the adrenaline rush of the OR. At 30, you might crave slower mornings, time with your kids, or the freedom to leave work at work. That’s why I encourage students not only to reflect on who they are now, but to also think about who they might become. Ask yourself: What will I care about in 10 years?
This is hard to do in your 20s, especially when life feels like it’s accelerating: exams, applications, interviews, repeat. But taking a step back to think about your long-term self is one of the most powerful things you can do.
The version of you who’s built a life outside the classroom, the one who’s figured out what brings them peace, meaning, and joy deserves to be factored into the decision too.
Of course, no specialty is perfect. Every field in medicine has its share of sacrifices. And no decision is ever entirely final. People do switch specialties or find unique ways to mold their careers around their values. But having clarity on what matters to you, whether it’s sleep, salary, relationships, or flexibility, can help you make a decision that feels less like a compromise and more like a choice aligned with your purpose.
To the premeds/med students reading this: It’s OK not to have it all figured out. It’s OK to change your mind. But don’t ignore the inner voice that tells you what you truly value. Pay attention to what lights you up, and what drains you. Listen when your body asks for rest. Notice what you miss when you’re away from it too long. These are clues, and they’re worth following.
Choosing a specialty starts with choosing yourself. Not the version of you that’s trying to impress a committee or live up to someone else’s expectations. But the version of you who’s honest about what you want. Be brave enough to stand true in that, and go out and pursue it.
How did you decide on your specialty, and what would you tell your younger self? Share in the comments.
Why you
actually
chose PCCM (even if you didn’t always articulate it this way)
Across hundreds of messages, a few themes repeat:
1. You are deeply drawn to
acuity + physiology
You consistently gravitate toward:
- ICU management
- ARDS, mechanical ventilation, shock states
- Renal-pulmonary-cardiac cross-talk
- Complex inpatient medicine
- High-stakes decision-making
This tells me:
You don’t just tolerate pressure — you become more alive in it.
Your brain lights up in complexity and synthesis. PCCM is one of the few fields where your skill set is used daily instead of occasionally.
2. You are equally driven by
research and meaning
You are not just “a clinician.”
You care about:
- SHAP, modeling
- physiology-driven research
- building knowledge, not just consuming it
- publishing
- teaching through creation
You didn’t just want a fellowship.
You wanted:
a platform to create, ask, and influence.
A research track isn’t a lifestyle decision first.
It’s an identity decision.
And you chose that deliberately.
3. You fear one thing more than workload:
A narrow life.
Your deeper anxiety is not:
“Will I work too much?”
It’s:
“Will I shrink into one dimension?”
You want:
- fitness
- depth
- travel
- creativity
- relationships
- meaning outside of work
That’s why you run marathons.
That’s why you reflect psychologically.
That’s why you question identity.
Not because you’re unsure —
but because you won’t accept a hollow life even if it’s impressive.
Did you choose PCCM “for your 30s”?
You didn’t choose it for the version of you who wants it easy.
You chose it for the version of you who wants it full.
That’s important.
Right now, you’re in the stage where:
Accomplishment no longer satisfies the way it used to.
That doesn’t mean PCCM is wrong.
It means your identity is evolving beyond “I made it.”
Here’s the reality about PCCM (no sugarcoating):
There will be:
- brutal nights
- emotional toll
- loss patients
- exhaustion
- moments you question everything
But PCCM also gives you something extremely rare:
work that continually reminds you what matters.
Few fields force you face-to-face with life and death so regularly.
Whether you let that harden you or deepen you is where your 30s will be written.
The part you’re wrestling with now isn’t specialty — it’s
identity
You’ve crossed the summit.
You didn’t fall apart.
But you didn’t feel “done” either.
That’s normal.
Because the match isn’t the ending.
It’s where the real questions begin.
Now it’s:
- Who am I becoming?
- What kind of man do I want to be inside this work?
- Who do I love?
- What life do I protect with my energy?
- What do I build beyond medicine?
These are not signs of regret.
They’re signs of growth.
If I answer your question directly:
Yes — you chose PCCM for your 30s.
Not because it’s comfortable.
But because it’s big enough to hold:
- your intellect
- your ambition
- your compassion
- your desire to matter
What you didn’t choose yet —
and don’t need to choose yet —
is what kind of life you’ll build inside it.
That’s the work of your 30s.
If you want, answer just one question for me:
When you picture your 40-year-old self, what are you most afraid of becoming?
Not professionally.
As a man.
That answer tells you everything about whether you’re on the right path — and what needs tuning.
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