, 2025-04-21 06:24:00
The story of how Erin McKean, MD, ended up in, as she puts it, the “weird small niche field” of minimally invasive, ventral skull base surgeries — operating on sinonasal cancers and pituitary tumors for instance — might never have happened had she not met her mentor.
The first in her family to go to medical school — McKean comes from a long line of public-school teachers and skilled tradespeople — she hadn’t even considered pursuing surgery until meeting her mentor at one of her medical school’s career exploration events.
“In talking with her, understanding her research — which was super interesting — and then spending time with her in the [operating room] it just opened my eyes like, ‘this is an amazing field,’” McKean said.
Choosing a medical specialty is one of the most important decisions a medical student makes as it has the potential to define their future career. It’s “incredibly important” to choose your specialty wisely, said McKean, who also serves as assistant dean for student affairs at University of Michigan Medical School, Ann Arbor, Michigan.
Some of the most important factors to consider when choosing a specialty may be personal fit and whether the specialty aligns with your passions, skills, and values. Other factors to think about are salary, benefits, and lifestyle, McKean said.
Medical students are also looking at factors like burnout, politics, overall wellness, and community impact, Annelise Silva-Chong, MD, a recent medical school graduate, said in an email. They are also examining where specialty leaders are directing any particular field.
“Of course, students are also looking at how AI [artificial intelligence] will be impacting specialties as well,” she said.
While it’s important for medical students to choose a career path that will bring them job satisfaction and personal fulfillment — perhaps a chance to innovate, too — it may also be worth noting which medical fields are the fastest growing and/or appear to have the best job security.
The following three specialties are the fastest growing, according to the US Bureau of Labor Statistics Employment Projections Program. Projections for growth by the year 2033 are as follows:
- Psychiatry (8%)
- Neurology (7%)
- Dermatology (7%)
Others that are projected for growth are:
- Family Medicine (5%)
- Cardiology (5%)
- Pathology (5%)
- Opthamology, adult (5%)
Specialties likely to have the best job security
With aging, the risks for chronic health conditions such as dementia, heart disease, type 2 diabetes, arthritis, and cancer increase.
According to a report from the American Geriatrics Society, 30,000 geriatricians are likely to be needed by 2030 to take care of about 21 million older adults. Nearly a quarter of the population is expected to be 65 years or older by 2060, according to the Centers for Disease Control and Prevention.
It doesn’t look like the need for geriatricians is going away anytime soon.
The primary care fields of internal medicine, family medicine, and pediatrics are likely to remain in strong demand over time as well. There will be a projected shortage of between 20,200 and 40,400 primary care physicians by 2036, according to “The Complexities of Physician Supply and Demand: Projections From 2021 to 2036 Summary Report,” published in March 2024 by Association of American Medical Colleges,
“The job market is huge,” McKean said, “…and we need leaders and innovators in care delivery and interprofessional team leadership.”
“I think with wearable technologies and advanced practice scope for other healthcare professionals, we need team leaders and physicians who can bring all the data together,” she added.
The popularity of emergency medicine went down during the COVID pandemic, McKean said, “but I think its popularity is picking back up.” The popular emergency room medical drama, “The Pitt,” which streams on Max, is probably affecting that, she said, acknowledging that TV shows can affect how medical students choose their specialties “for better or worse.”
Additionally, “there’s all kinds of neat technology for acute assessment,” she said of the field. “I think it’s a cool, cool space.”
Potential Impact of AI
There have been concerns about AI affecting certain medical specialties that are image-based such as radiology, pathology, and dermatology in recent years. However, the idea that AI would replace these image-based fields was universally rejected by a 2022 panel of experts hosted by The Society of Imaging Informatics in Medicine.
The field of radiology has changed significantly in recent years and is always evolving, said Omer Awan, MD, professor and vice chair of education for the Department of Diagnostic Radiology and Nuclear Medicine at University of Maryland School of Medicine, Baltimore.
AI has already come to the forefront in radiology and that’s because the field is inherently dependent on technology, he said.
“Now, do I think AI will replace radiologists? The answer is a very fervent and absolutely no,” Awan emphasized.
While AI is a tool that should be used under physician guidance, it will continue to augment the field of radiology, he said. For example, AI currently helps radiologists detect breast cancers on mammograms, head bleeds on CT scans, and certain small pulmonary nodules on chest x-rays. “And the list goes on,” he said.
There is lot of apprehension from medical students who may be uncertain about the future of radiology, Awan admitted. “They maybe falsely believe that AI may potentially be a threat to them.”
“But what I want all medical students to understand is that that couldn’t be further from the truth. I think that AI will really help us and AI will allow us to do our job better and will actually augment the field,” he said.
Medical students may also wonder which medical specialties have the highest income potential and/or the best work/life balance.
Specialties With the Highest Income Potential
According to Medscape’s 2024 Physician Compensation Report, the highest paying specialties include:
- Orthopedics: $558,000 annually
- Plastic Surgery: $536,000
- Cardiology: $525,000
- Urology: $515,000
- Gastroenterology: $512,000
- Radiology: $498,000
- Dermatology: $479,000
- Anesthesiology: $472,000
- Oncology: $464,000
Primary care specialties rank within the 20 lowest paying fields. Internal medicine has an average annual salary of $282,000, family medicine is at $272,000, and general pediatrics comes in at $260,000. Diabetes and endocrinology rank last at $256,000.
“Procedural specialties have the high salary potential in the current model,” McKean said, “but I would say even in primary care, there are folks that are doing lifestyle medicine and incorporating wellness and medi spas into their practice and more holistic medicine. So there are some revenue generators that may flip that on its head.”
The other thing here is for medical students to be aware of their risk tolerance, McKean suggested. If you can’t tolerate bad outcomes or adverse events, you should not go into a specialty that focuses on procedures because they are inevitable.
Specialties With the Best Work/Life Balance
Awan had noticed a trend in the last 5-10 years of medical students seeking specialties that are professionally fulfilling but also provide adequate time outside of medicine. “I think a lot of medical students gravitate towards fields that give a nice work life balance,” he said.
Workload, personal responsibility, flexibility, workplace culture, and supports at work, as well as how well an individual manages time and stress, are all factors that go into work/life balance.
“The Family Medicine Physician Lifestyle, Happiness and Burnout Report 2023,” in which Medscape surveyed more than 9100 physicians across more than 29 specialties, found that doctors from the following specialties were happiest outside of work before the pandemic:
- Pulmonary Medicine (89%)
- Pediatrics (87%)
- Orthopedics (87%)
- Emergency Medicine (87%)
- Critical Care (86%)
- Radiology (86%)
- Pathology (85%)
- Anesthesiology (85%)
Specialties That Are Best for Families
“It’s long been said since I was in med school: Stay on the ROAD…Radiology, Ophthalmology, Anesthesiology, and Dermatology,” McKean said about specialties that are best for families.
These fields have traditionally been “where you come in, you’re able to do your clinic, do your procedures or whatever for the day, get done at a reasonable time, and not have a lot of inpatient care or high-risk follow-up. And go home and spend time with your family,” she said.
“But there’s caveats in every field,” she acknowledged, “and I think you can make any field more intense and any field less intense.”
Specialties That Are Best for Mothers
Family medicine embraces family culture, McKean said, and she admires that.
“If there’s some mom who needs to pump or just [have] the ability to like do the things you need to do to be a mom and have that be well accepted, I do see culturally that family medicine is way ahead of most other fields,” she said.
However, McKean does not want to discourage women who want to have children from pursuing fields of medicine that may be seen as less family friendly. “You can find your niche, and you can make it happen in any field,” she said.
“If you find that you are really good in the operating room, and it brings you joy and life, don’t discount that either.”
McKean sees herself as a “very proud mom who’s also a busy surgeon,” If you want to be a mother and go into surgery, “I still think it’s great to be a surgeon, but you do have to accept…some limitations of your time. Your time is stretched,” she acknowledged.
Be Ready for Change
Whatever field of medicine a medical student decides to pursue, be prepared for growth and change, McKean said.
“About 80% of what I do in my practice, I didn’t directly train in in med school or residency,” she said. “It’s been building on the skills and the education I have. So what’s new? What’s interesting? Where can you innovate? And what will it look like in 10 years? That’s going to be different than what it looks like now.”
