Photo thanks to Dr. Farouk via Flickr.

The Path to Specialization

Cortney Ikpe

In the field of journalism, you can pick a broad emphasis area, such as print or broadcast, during your higher education. Specializing is often an on-the-job process for writers, and a secondary degree in an interest area like environmental science or economics is by no means required.

If you try to practice psychiatry, on the other hand, without a specific degree, you aren't going to make it very far.

The medical field, like the neurons and capillaries it studies, branches out in some living fractal pattern. There are specialties within specialties, and probably specialties within those. With such complete stratification of career paths, it can be daunting to muddle through the options.

Pre-med programs for undergraduates are often strictly outlined. The Association for American Medical Colleges lists four requires one year of biology, physics and English, as well as chemistry courses through organic chemistry. Many undergraduates pursue a Bachelor of Science in biology or chemistry, often with a pre-med focus. Once specialization begins

Medical specialties can be divided into two main schools of thought: high demand, and top paying. By researching data from physician surveys, Forbes and federal websites, I’ve outlined the two lists below:

High-demand specialties (according to Forbes)

  1. Family medicine, especially those that deliver babies facilities.
  2. Internal medicine. Internists can specialize into sub-categories including sports medicine, oncology, immunology and nephrology.
  3. Psychiatry.
  4. Emergency medicine.
  5. Pediatrics.
  6. OB/GYN

These “high-demand” jobs are ranked by both the volume of patients seen and potential patients searching for these services. They are jobs with a lot of security because they provide what can be considered “primary care”, and can be located in a wide variety of locales such as urban, suburban and rural.

Health care provider shortage

The high demand specialties are especially needed in Healthcare Provider Shortage Areas. There are 6,000 primary care health care provider shortage areas, according to the U.S. Department of Health and Human Services. Dental shortage areas follow with 4,800, then mental health with 3,600. In these areas around the nation, people are not getting the primary care they may need, oral health and dental surgery are not available and mental health problems may be ignored.

There are many state and federal programs that incentivize working in HPSAs, one of which involves student loan forgiveness. By committing to work in an HPSA for two years, physicians can receive up to $120,000 toward student loan repayment.

Missouri’s dearth of dental health providers has left Mercer, Chariton and Shannon counties with no practicing dentists. A.T. Still University’s Missouri School of Dentistry & Oral Health in Kirksville has created a public health mission to help alleviate this problem: third and fourth year students will work in health centers in HPSAs. The school hopes this sort of preparation will encourage dental students to stay and work in under-served communities.

You can search HPSAs on the U.S. Department of Health and Human Services website.

Top-paying specialties

  1. Orthopedics is listed as the top-paying specialty on Medscape’s 2013 compensation report, which collected data from over 21,000 physicians across 25 specialty areas. Forbes also ranked orthopedic surgeons as the highest-earning physicians, with an average salary of $464,400.
  2. Invasive cardiologists are second on the list. Catheters, stents and other required fine-motor skills increase the salary, averaging just over $357,000.
  3. Non-invasive cardiologists follow closely behind. Many patients with a family history of heart problems or undiagnosed chest pain are first seen by a non-invasive cardiologist to detect whether or not invasive surgery is needed.
  4. Radiology is the fourth highest-paying specialty. Radiologic technologists run the image tests for X-rays, ultrasounds and MRIs. The images are “read” by the radiologist, who then diagnoses the patient and send them to another specialist for longer-term treatment.

The upside of a high-paying job is clear: a hefty paycheck. There are, however, downsides. Many of these specialties require extra training.

Further resources

The Association of American Medical Colleges published “The Roadmap to Residency: From Application to the Match and Beyond,” a comprehensive plan through the medical school journey.  It links to the AAMC’s Careers in Medicine webpage, which includes advice and assessment on potential matches between students and specialties.

The American Medical Association hosts FREIDA Online, which allows students to search potential fellowships by state and specialty, as well as statistics on graduate programs in a variety of specialties.

Advisors and mentors can also offer invaluable guidance. Medical school is a huge commitment of time, money and energy, but it is also full of people who want to ensure you follow your skills and passion into a field that fits with you.

It is your life, after all.