Why I (Probably) Won’t Subspecialize in Sports Medicine (From a Med Student)

Something that might surprise you about medical school is the amount of shadowing hours med students log outside of their normal school schedule. This is the best way for us to get exposure to specialties/subspecialties we otherwise might not get much exposure to on our clinical rotations. We also have a better idea of what questions to ask at this point in our training, so it’s not quite as passive as the shadowing you might have done in high school or college.

My first shadowing experience was with a physical therapist when I was in middle school. The idea of taking care of athletes is what initially drew me to the healthcare field, and PT was the obvious path to get there (at least to 11-year-old me). But after shadowing a PT twice, I could tell you that I absolutely did not want to be a PT. Fast forward 15+ years, and my interest in caring for athletes followed me to med school.

Before I get into this next part, here’s some context for those of you who aren’t familiar with the timeline of medical training. Physicians complete a residency in their primary specialty after medical school. They can then pursue additional training in a subspecialized area of medicine through a fellowship. For example, becoming a neurosurgeon requires completion of a neurosurgery residency. If a physician wanted to become a pediatric neurosurgeon, they would have to complete a residency in neurosurgery, then a fellowship in pediatric neurosurgery.

Sports medicine is a subspeciality that many residencies can funnel into. Physical Medicine & Rehabilitation (PM&R) is one of those residencies, which is the specialty I’m pursuing. I saw a fellowship in sports medicine as an opportunity to focus my future practice on the musculoskeletal-side of PM&R. Since I wasn’t going to get much exposure to the field as part of my 3rd year rotation schedule, I decided to shadow a sports med doctor a few months ago.

I already had significant exposure to the clinic- and surgery-side of sports medicine from my clinical experience in orthopedics during my gap year, so I did sideline coverage for a college basketball game with the doctor I was shadowing. We talked about the advantages and drawbacks of the field, along with the business model behind taking care of sports teams.

The doctor I shadowed said one thing that shaped my perspective on subspecialization beyond just PM&R and sports. He said, “your subspecialty should be an upgrade to your primary specialty”. This might be obvious for subspecialties that don’t have as much flexibility in what they allow you to do your residency training in. For example, there are many subspecialties that require a residency in internal medicine, such as cardiology and gastroenterology. This is why most med students match into internal medicine even if they don’t plan on becoming a hospitalist or practicing primary care. Those subspecialities I mentioned are an upgrade to internal medicine because they bring in more money and (potentially) allow for a better schedule as an attending physician.

However, this advice is particularly relevant for those subspecialties that many residencies can funnel into. PM&R, emergency medicine, family medicine, pediatrics, and internal medicine can all lead to sports medicine fellowships (note: orthopedic surgeons can also specialize in sports, but this is a surgical fellowship that differs from what I’m talking about here). This means that med students have more flexibility in what they choose to do their residency training in and can still focus their practice on treating athletes down the line.

From my perspective as someone who wants to go into PM&R, a fellowship in sports medicine wouldn’t really be an upgrade unless there was no other patient population I would be happy treating. As a PM&R doctor, I’ll already be a specialist in neuromusculoskeletal medicine and be able to treat athletes as part of my normal practice. I’d also make more money practicing general PM&R than I would as a fellowship-trained sports medicine physician. That extra year of fellowship training while only making about $50k wouldn’t be a small sacrifice, especially when interest rates on federal student loans are as high as 9%.

Overall, the conversation I had with the physician I shadowed a few months ago gave me a ton of perspective. Most importantly, I’m more equip with the information I need to make an informed decision about my future in medicine. I would highly encourage anyone in any industry to talk to people who are actually doing what you want to do. You never know what you might uncover.

Be sure to check out my other posts! Feel encouraged to reach out here or on Instagram if you have any thoughts or questions!

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