Many people know that an important part of medical school is choosing a specialty — the field of medicine that you plan to practice for the rest of your career. However, fewer people know just how many different factors weigh on this decision. As my classmates and I navigate through third year, I thought I would share several of the factors that enter the balancing act:

Clinical interest: The simplest, yet most mysterious, factor. Each field deals with a very different range of health problems, and some medical students inexplicably end up developing a passion for helping patients within a specific field.

Relationship with patient: Some fields — particularly primary care – lend themselves to long-term relationships with patients that may last many years (and may even span multiple generations of family members). In many others, such as emergency medicine and surgery, you may only see a patient once or twice — but the interaction comes with the “instant gratification” of knowing that you have helped them immediately.

The personalities of colleagues: Each field tends to attract its own “type” of personality. Given the long hours and team-based nature of health care, it’s important to find people you fit in with and enjoy spending time with. Unfortunately, I also worry that our tendency to naturally self-segregate can be a barrier to entry for many otherwise qualified candidates in certain fields.

Work environment: Every specialty has its own balance between inpatient (hospital) and outpatient (clinic) medicine. Some people love the adrenaline rush of caring for the critically ill, while others are much more content thinking about a patient’s long-term goals in the setting of an outpatient clinic.

Opportunity for procedures: For many medical students, the opportunity to roll up their sleeves and get to work with their hands is the best part of the day. These students may find themselves interested in surgery, interventional radiology, dermatology or even cardiology.

Research and academic opportunities: Research and education are possible in any specialty, but certain fields, such as oncology and immunology, have burgeoning research opportunities with massive amounts of funding available and the possibility of much academic prestige. At Stanford, where many of us plan to enter academic medicine, and the opportunities for a successful research career can be very important.

Work-life balance and scheduling: It goes without saying that some specialties can be much more strenuous and life-consuming than others. You may love the thought of spending your work day in the operating room, but if family and friends are a top priority for you, surgery may not be the best choice down the road.

Compensation: I wish this weren’t a factor at all, but the reality is that with hundreds of thousands of dollars of medical school loans after graduation, going into a lesser paid field can potentially cause years of financial strain. Medical trainees forgo earning a full salary for about 10 years, which delays buying a house, having a family and saving for retirement. Specialists in private practice can make hundreds of thousands of dollars more per year than a full-time family practice doctor.

In summary, deciding on a specialty requires a great deal of time determining what our priorities are as we move forward with our careers. No career will ever be “perfect,” but I’m optimistic that each one of us will ultimately find a field that allows for a productive and engaging life both inside and outside of the workplace.

Nathaniel Fleming is a medical student who blogs at Scope, where this article originally appeared.

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