A recent poll on the Doximity network shows that a fifth of physicians have changed their medical specialty at least once, underscoring notable fluidity within the profession.
Another 6% are considering changing their specialty, though the majority of physicians (73%) have not changed specialties or expressed an intention to do so.
Over the past year, rumblings have emerged of a “great resignation” in medicine — born largely out of job dissatisfaction and overwork during the pandemic — suggesting that as much as 20% of physicians are considering leaving their practice. For many, however, the impetus appears to lean more toward a great reshuffling than a great resignation; the desire to leave a practice is less about departing the profession than it is about finding the right practice or specialty in which to continue their career.
Among the nearly 4,200 physicians who participated in the Doximity poll, the trend is to seek out specialized fields, with dermatology, emergency medicine, interventional radiology, and anesthesiology all in the top five. As an example, 35% of dermatologists practiced in a different specialty before transitioning into dermatology, compared with 21% for family medicine and internal medicine, and 16% for general surgery.
Only one of the 10 most sought-after specialties, geriatrics, is a primary care specialty. The only surgical specialty in the top 10 is plastic surgery.
Physicians’ preference for seeking out specialized fields may have to do with a combination of relatively high salary and a moderate training period. Quality of life may also play a part, especially for those who pursue the so-called “E-ROAD” lifestyle specialties (emergency medicine, radiology, ophthalmology, anesthesiology and dermatology). Specialties such as interventional radiology and anesthesiology have reported greater average compensation than primary care. And prior surveys have found the potential to earn a higher salary to be a primary motivating factor for physicians who change jobs.
In contrast, despite offering the highest wages, surgical specialties are the least likely to have physicians from a different specialty join their ranks. The long work hours and stress associated with surgery may contribute to this trend, as might lengthy residency requirements. Only 10% of neurosurgeons and 8% of orthopaedic surgeons entered the field from another specialty. Residency can extend to as long as seven years for neurosurgery, compared with three years for dermatology and internal medicine.
The trend differs, however, for physicians who are “considering changing” their specialty but have yet to move forward with the decision. The specialties with the greatest percentage of physicians who are considering a change vary widely: thoracic surgery (22%), med/peds (15%), radiation oncology (14%), rheumatology (10%), geriatrics (9%), family medicine (9%), emergency medicine (8%), internal medicine (8%), and ob/gyn (7%).
Collectively, more than 8% of PCPs are considering changing their specialty versus 5% of specialists and 4% of surgeons. The roughly two-fold higher percentage for PCPs may stem from a variety of causes, such as the desire to seek further specialization as well as opportunities for higher pay.
Shorter residencies also provide PCPs with the chance to change specialties at an earlier age. Nearly 8% of physicians in the early to mid stages of their career (up to 15 years since their last training) are considering changing their specialty, compared with only 5% of late-stage physicians (more than 15 years since training).
Overall, the poll results loosely mirror physician preferences reported years prior in a 2002 JAMA publication, which listed many of the same specialties as desirable, including dermatology, geriatrics, endocrinology, nephrology, and infectious diseases. Even further back, a study from 1986 found that physicians who changed specialties were more likely to leave internal medicine, pediatrics, and family medicine, and enter specialized fields such as pathology and radiology.
Yet the percentage of physicians who change specialties pales in comparison to that of other clinicians — 54% of PAs and 41% of NPs and CRNAs have reported a specialty change over time. The wide gap across professions may reflect the difficulty physicians face in changing specialties, which generally requires a significant shift in scope of practice and at least several years of dedicated training. In comparison, PA and NP residencies typically require a much shorter period of training of 12 to 18 months.
Easing the process of transitioning between specialties for physicians may help address their concerns. In the case of Dr. Ron Ron Cheng, who began a neurosurgery residency before pursuing a career in urology, changing specialties is “a very decentralized process, not to mention a daunting task.”
“The practice of medicine has such a high barrier to entry … that there are probably lots of people who don’t feel totally satisfied with their specialty choice, yet see it as the path of least resistance,” he said. “Would the incidence of burnout be less if it was easier to change specialties?”
Dr. Jaskirat Bhatia, who is training as an internist, emphasized the importance of providing students with comprehensive exposure to specialties, reducing the likelihood they regret their choice down the line. “Medical students need more exposure to lesser-known and surgical specialties to better formulate an understanding of those fields and for those specialties to attract the right students,” he said. “The lack of exposure … may hinder students from matching with the best-suited specialty for them.”
Still another avenue for improving physicians’ experience may be to collaborate on enhancing the sustainability of their specialty — how it adapts to health care’s shifting tides and continuous developments. The wide range of measures implemented during the pandemic speak to this possibility, from adaptive responses in emergency medicine to improved workflows in family medicine.
For Dr. Kathryn Duplantis, a plastic surgeon who has seen her twin sister switch from internal medicine to sports medicine and her daughter from pathology to family medicine, the key has been more straightforward: finding a specialty that she enjoys, regardless of swings in salary and decreasing autonomy.
“I tell the residents that I teach to find a specialty that they will enjoy no matter how it changes through the years,” she said. “Go into a specialty where you have passion.”