Specialty regret among physicians rarely happens all at once. It tends to accumulate, Avani Patel, MD, who operates a concierge sports psychiatry practice in Mississippi, wrote in a recent article published by the American Medical Association.
Dr. Patel describes her experience of nearly marching into anesthesiology before withdrawing from the Match entirely to pursue a master’s degree, take stock of her interests and eventually land in psychiatry. Reflecting on her path she identified seven practices that help physicians avoid specialty regret.
1. Listening to other voices over their own
Dr. Patel spent much of medical school pushing aside her affinity for psychiatry after mentors warned her it would cost her career credibility. The cultural stigma around mental health, she said, compounded the pressure — particularly in the South, where she trained.
“I loved my psychiatry rotations. Not only was it something I was good at, but it was also interesting and intriguing. I was able to communicate with patients in a way that truly felt like a gift. But I still pushed that to the side, and I ignored it. I allowed the noise of other voices tell me ‘I can’t do this, because what if no one takes me seriously?,” she said.
2. Entering medical school with ‘blinders on’
Students who commit to a specialty before they’ve experienced clinical rotations can talk themselves out of the evidence in front of them, Dr. Patel writes. She said she was determined to become an anesthesiologist through all four years of medical school before eventually changing her mind.
“I wanted to have my own OR, and I couldn’t see anything else outside of that. Those were the blinders that I had on,” she said. “Most people who go into medical school tend to be type A personalities. It’s totally OK if you go into medical school having a plan that ‘I want to be this’ or ‘I want to do that.’ Be prepared and be open-minded in the sense that that may change.”
3. Not asking the right questions about how they want to practice
Specialty choice comes down to two fundamental questions that many students skip, Dr. Patel said: Do you want to do procedures? And how much continuity do you want with your patients? Physicians who don’t have clear answers before matching often figure them out further down the line in clinical practice when it becomes more difficult to shift specialties.
“I knew very early on when I rotated through that I was not meant to be a surgeon,” Dr. Patel said. “Some people are great with the procedural details, and that’s something that they enjoy. Other people may realize that procedures are not the way to go, and they want a different type of experience in addition to continuity in relationships with their patients.”
4. Avoiding competitive specialties out of fear
Some physicians settle for a less competitive specialty not because it’s the right fit, but because it feels like a safer bet, Dr. Patel wrote. She argues that if there’s any genuine interest in a more competitive field, incoming physicians should pursue it. The worst outcome is landing in a specialty with more training slots — not the one you wanted.
“If there’s any chance at all that you might be interested in something that’s more competitive, every single person would say: Aim for the stars,” she said. “It’s much easier to fall to a mid-tier specialty as opposed to one that’s much more competitive.”
5. Letting salary drive the decision
The debt load of medical school makes high-earning specialties an easy gravitational pull, Dr. Patel acknowledged the report. She said she sees it consistently in the students she talks to, with many being drawn toward surgery, gastroenterology or cardiology, regardless of fit.
“Don’t be blinded by what you could get from a specialty in terms of a monetary standpoint, because that will only last for so long when it comes to overall happiness,” she said. “When you compromise your happiness, you experience much more regret. And the burnout rate increases.”
6. Not thinking honestly about the life they want
Work-life balance, hospital-based versus outpatient practice, call schedules, the possibility of a family are critical factors of medical practice that shape daily life for decades. Physicians who don’t reckon with them during specialty selection often find themselves re-reckoning with them mid-career, Dr. Patel writes.
“You have to ask yourself: What do I want my life to look like in the future? How important is work-life balance? Is being in the hospital where I find my joy? Or does having more of an 8-to-5 format fit better?” Dr. Patel said. “One of the hard things is that everyone has different goals for what they want their life to look like in the future. And sometimes, it’s difficult to be honest with ourselves.”
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