As it relates to a person’s occupation, a “niche” is defined as a place, activity, status, or employment for which someone is best suited.1 Finding one’s niche in medicine can be akin to choosing a specialty or identifying a space within a chosen specialty where a physician finds purpose and pride.
Given the nature of their work, physicians are more susceptible to high stress levels and burnout compared with workers in other fields.2 Because it allows physicians to create meaning in their medical practice, finding one’s niche may protect against burnout and other negative effects of work-related stress.3 This article will provide physicians with a framework for identifying and acting on their niche.
Identifying Your Medical Specialties
The first step in identifying your niche in medicine is to make an honest assessment of your passions and interests within the field. The American Academy of Family Physicians (AAFP) shares questions to consider when choosing a medical specialty, which is an essential step toward finding your niche.4 These and other relevant considerations are reviewed in the Table.
Table. Questions to Answer When Choosing a Medical Specialty
|Goals, Skills, and Values||What were your goals when you chose to become a physician? How have these goals changed throughout medical school, if at all? Which of your skills make you feel most prideful, and are they best suited for a particular specialty within medicine? Do you envision incorporating research into your practice? Is advocacy work important to you? Are you passionate about alternative or complementary medicine?|
|Physician-Patient Relationship||What do you value most about the physician role? What types of physician-patient interactions are most rewarding to you? Do you feel uncomfortable in specific clinical situations?|
|Daily Responsibilities||Do you have a preference for clinical visits vs surgical procedures or a combination of the two? What type of work-life balance works for you? Do you envision a slow or fast-paced lifestyle?|
|Income||What are your income goals? Do you have student loans to pay? If yes, do you have a payment timeline?|
|Location||Where do you see yourself practicing medicine? Do you prefer working in a community, academic, or hospital setting? What are the job opportunities in your preferred location in your desired specialty like? How saturated is the job market?|
|Residency||What duration of training is required for your desired specialty? What does a particular residency program train you to do?What are the differences between different programs within the same specialty? Is there potential for further training after residency? Is that okay with you?|
Answering these questions can help with choosing a specialty that aligns with your goals and values. Identifying physician mentors in your desired specialty is also essential. Mentors have a wealth of experience to share, including strategies for applying to residency programs, managing work-related stress, and setting personal and professional priorities.5
Because choosing a specialty is only the start of the process to define your niche as a physician, mentors can also support you beyond this decision. Within specialties, there are also subspecialties to consider for people who want to focus their practice on a specific aspect of medical care.6
After exploring your desired specialty or subspecialty, engagement with your community can help further explore your niche in the medical field. Your patients make up the majority of the community where you train or work. Understanding their priorities and concerns from their perspective can identify meaningful ways to integrate community health promotion into your practice.
Since exposure to new facets of the healthcare system and your community may spark unexpected interests, discovering and refining your niche continues as you complete your training and move into independent practice. Personal priorities may also change as you progress through life. The process of identifying a medical niche is highly individual, but having a framework like the one outlined above can help guide the process.
How Do You Act On It Once You’ve Identified Your Medical Specialty?
Putting your medical niche into practice typically begins with applying for residency. The residency application process can be grueling, but it presents several opportunities to ensure your choice of residency is the best fit for you.
Talking with people you meet while applying for residency — including current residents and program faculty — can offer insight into the environment and culture of an institution and community.7 Asking how they chose their current program and how they feel about the program will allow you to determine if their motivations and values align with yours.
When comparing different programs within your chosen specialty, it is important to compare them based on factors that directly affect the daily experience of residency training, as opposed to name recognition or prestige.7 These factors include location, curriculum details, interpersonal experiences with current residents and faculty, institutional values, and investment in community health. You should also consider these factors when applying for a fellowship once your residency has been completed.
Residency, potentially followed by a fellowship, is your first practical opportunity to self-assess the fit between you and your chosen specialty/residency program. Because of the extreme demands of residency and fellowship, physicians may experience burnout and question their career choices during this time.8 Signs of burnout include9:
- Feeling ineffective or meaningless at work;
- Low motivation;
- Lack of personal accomplishment;
- Emotional exhaustion;
- Depersonalization; and
- Feeling helpless.
If you experience signs of burnout, addressing them should be a top priority. Interventions to prevent and reduce burnout often require institutional action; however, there are a number that are within your control, including9:
- Engaging in effective self-care practices;
- Going to therapy to process trauma and learn effective mindfulness/coping strategies;
- Seeking advice and support from trusted friends, family, or mentors; and
- Defining and acting on your passions.
During times of stress and burnout, reminding yourself why you chose your particular medical niche can reconnect you to joy and motivation.9 However, difficult experiences times may also lead to changed perspectives and goals.
Adapting to Change
During your career, you may discover new passions or technologies that change the way you practice. You may even discover that your clinical focus or clinical work, in general, is no longer fulfilling for personal or professional reasons. Adaptability is key to navigating these changes and fulfilling your niche.
Although making big career changes in medicine can feel impossible, many physicians have moved through them successfully, and their experiences can provide guidance and inspiration. Bonnie Darves interviewed several physicians who for various reasons decided to pursue nonclinical work, either alone or in combination with clinical work, and published her findings in The New England Journal of Medicine (NEJM) Career Center.10
Heather Fork practiced dermatology for 10 years before deciding she wanted to help people in a different way through career coaching.10 She now runs The Doctor’s Crossing, a company dedicated to supporting physicians who are looking for a career change.
In her interview with Ms Darves, she encourages physicians to explore their interests within and outside of medicine if they are feeling unfulfilled.10 Taking inventory of your current circumstances and interests can help identify areas for improvement in your current role or illuminate an entirely new career path.
Yasmine Ali, a cardiologist, applied these principles to her career.10 When she was feeling unfulfilled after 10 years of cardiology practice, she looked to her interests for inspiration and decided to combine writing and preventive medicine in a new, gratifying career path. Now, Dr Ali is the president of LastSky Writing, LLC, a company that provides medical consulting and writing services, and runs a preventive medicine practice.
Hodon Mohamed, an obstetrician-gynecologist, has also combined clinical and nonclinical work to achieve a career that works for her.10 Along with working 2 clinical shifts per week, she also works as a medical director, in utilization management, and as a career coach. She finds coaching physicians particularly rewarding, noting that physicians often do not discuss their issues, and she enjoys helping them discover their passions.
Importantly, career changes such as these can take time to develop. Feliciano Yu is a pediatrician whose career has evolved over the past 2 decades from pediatric clinical practice to a full-time administrative role focused on informatics, care quality, and outcomes research.10 This evolution began as an interest in computers that led to Dr Yu obtaining degrees in both public health and health informatics. In his current role, Dr Yu feels like he is still caring for patients, just in a new way.
These are just a few examples of physicians who have successfully changed their careers. Their stories emphasize the importance of frequent and honest self-assessment of your job fulfillment and that the right niche in medicine looks different for every physician.
Be True To Yourself
Finding a medical specialty that aligns with your priorities and values is essential to long-term job satisfaction. In a field in which burnout may be becoming more commonplace, pursuing a medical career that feels purposeful and promotes your wellness is a radical and important act. You are not alone in this pursuit; look to friends, family, and mentors for support, while also remaining true to yourself and your goals.
Originally appeared on Dermatology Advisor
1. Niche. Merriam-Webster. Published 2019. Accessed July 27, 2023. https://www.merriam-webster.com/dictionary/niche
2. Berg S. How burnout in physicians compares to other professional degrees. American Medical Association. Published March 19, 2023. Accessed July 27, 2023. https://www.ama-assn.org/practice-management/physician-health/how-burnout-physicians-compares-other-professional-degrees
3. Kumar S. Burnout and doctors: prevalence, prevention, and intervention. Healthcare (Basel). 2016;4(3):37. doi:10.3390/healthcare4030037
4. Choosing a medical specialty. American Academy of Family Physicians. Accessed July 27, 2023. https://www.aafp.org/students-residents/medical-students/begin-your-medical-education/deciding-on-specialty.html
5. Fishman JA. Mentorship in academic medicine: competitive advantage while reducing burnout? Health Sci Rev. 2021;1:100004. doi:10.1016/j.hsr.2021.100004
6. Careers in medicine: specialty profiles. Association of American Medical Colleges. Accessed July 27, 2023. https://careersinmedicine.aamc.org/explore-options/specialty-profiles
7. Choosing a residency program. American Academy of Family Physicians. Accessed July 30, 2023. https://www.aafp.org/students-residents/medical-students/become-a-resident/choosing-residency-program.html
8. Nituica C, Bota OA, Blebea J, Cheng C-I, Slotman GJ. Factors influencing resilience and burnout among resident physicians – a national survey. BMC Med Edu. 2021;21(1):514. doi:10.1186/s12909-021-02950-y
9. Grimes PE. Physician burnout or joy: rediscovering the rewards of a life in medicine. Int J Womens Dermatol. 2020;6(1):34-36. doi:10.1016/j.ijwd.2019.12.001
10. Darves B. Outside the fold: exploring nonclinical work opportunities for physicians. NEJM Career Center. Published July 1, 2019. Accessed July 27, 2023. https://resources.nejmcareercenter.org/article/outside-the-fold-exploring-nonclinical-work-opportunities-for-physicians/