Specialty Popularity

After my little rant about how specialty competitiveness has influenced my thinking on what specialties I want to pursue, I got to thinking about what makes specialties more of less desirable to students.

The short list of factors is fairly obvious:
- Clinical activities
- Academic interest
- Lifestyle
- Job availability
- Money
- Non-clinical activities (research, teaching, paperwork, etc.)

Desired clinical activities, non-clinical activities, and academic interest really depend on the individual, but the other three factors are a bit more universal. Most people want to get a job easily in a location they want, to be paid well, and to work less than what most physicians end up working.

Right now, the highly competitive specialties are Plastic Surgery, Dermatology, Emergency Medicine, and Ophthalmology. Dermatology hits all three of those universally-desired characteristics. It pays well, jobs are everywhere, and it has a reasonable lifestyle. Emergency Medicine pays less and shift work isn't for everyone, but it also has good job availability and low hours overall. Plastics pays well, plus it has a better job market and lifestyle than most surgical specialties (though probably worse on both fronts compared to non-surgical specialties). Ophthalmology is a bit of an outlier - terrible job market, but the work load isn't horrible and the pay is incredibly high.

So, those highly competitive specialties largely fit the mold.

When we look at the more moderately competitive specialties, however, things start to change. Many surgical specialties remain reasonable competitive despite a complete lack of desirable jobs and a frankly horrible lifestyle. The pay is pretty good, however. OBGYN is in somewhat the same boat, trading a slightly better lifestyle and job market for a slightly worse salary in most parts of the country. Radiology has good pay, but the lifestyle is not what it used to be and the job market has not been great in recent years. Pediatrics has reasonable job opportunities and lifestyle, but low relative salary. Anesthesiology is about the only moderately competitive specialty that has a good job market, good salary, and good lifestyle.

Contrast this with the minimally competitive specialties. Family and Psychiatry have plenty of jobs and pretty good lifestyles, but generally low compensation. Internal Medicine is a bit more mixed and highly dependent on subspecialty, but overall lifestyle is decent, the job market is alright, and compensation is average-to-low (subspecialties with higher pay tend to have poor job opportunities). There are also a few small fields with poor job opportunities, good lifestyles and variable pay.

Interestingly, the most predictive factor for determining specialty competitiveness seems to be money. Only pediatrics and emergency medicine really break the mold, being more competitive than their average compensation would suggest. Lifestyle and job opportunities seem to matter to the extent that specialties of roughly equal pay are more competitive when they have these elements, but the correlation is much weaker.

Of course, personal factors matter, as does the relative number of positions for each specialty. Surgery is cool! There may not be jobs in many surgical specialties and an overall poor lifestyle, but students still want to do it. On the flip side, family medicine may not be competitive, but it sure is popular - it's just in such high demand from patients that there's little fight for family medicine residencies. Likewise, emergency medicine may be competitive simply because the number of residency positions is needlessly low.

Anyway, apologies for the rant - just needed to spell those thoughts out in writing.