11 Most Intellectually Challenging, Cerebral Medical Specialties in the US

Rheumatology, Pulmonology, Cardiology, Oncology, Hematology — the list of existing medical specialties is obviously quite extensive, but which are the 11 most intellectually challenging, cerebral medical specialties in the US, you may wonder?

Even though each of these medical residencies largely differs from each other, one major issue closely connects them — all of them are extremely demanding on so many different levels. Thus, ranking medical specialties by difficulty not as easy as it may seem. Persistence, life-long self-improvement in the chosen medical area and the ultimate combo of both theory and practice are the major components of the “how-to-become-a-good-doctor” formula. According to a number of esteemed US Medical Universities, the most difficult medical profession is considered to be a Neurosurgeon, while a Neurologist is depicted to be the most cerebral medical specialty. There is also a belief that the most prestigious surgical specialty is more related to clinical specialties, which are seen as more respected than sub-clinical and non-clinical specialties in the US.  However, some like to think (IM) some like to do (Surgery) and some like a combination of two (ENT).

According to the Medical University of Michigan, the most competitive medical specialties in 2015 are more closely defined in three categories: competitive (the hardest), moderately competitive and less competitive. These categories are meant to provide a general guideline, which means that the boundaries between them are not strictly fixed. Regardless of the category of competitiveness, any medical specialization program can be considered more competitive depending on other variables such as program location, prestige, etc. You can find more interesting info related to this topic by checking 10 Most Competitive Residency Programs in US and 10 Most Competitive Medical Fellowships in America.

When it comes to the relation between one’s intellectual capacity and the very difficulty of medical residency, there is an unwritten rule that one specialty may seem easy or go easy for someone while on the same time is enormously difficult for somebody else. Because of this, it was pretty tricky for us to establish one main criterion for our final rank. Therefore, we took into account the difficulty of training residency requirements, amount of other medical sub-specialty expertise and skills. Our team consulted the study titled “Assessment of Junior Doctors’ Perceptions of Difficulty of Medical Specialty Training Programs” published in the Journal of Vocational Education & Training. Even though this research paper was maintained in Australian Medical Universities, the methodology and resources are mainly from the US medical field, and the eventual results of this research are more of global than of local nature. We also consulted the AAMC Report on Residents and compared some distinguished analysis on question-answer forums, such as LetsRun and StudentDoctor in other to provide you up-to-date info about studying medicine in the US. Thus we ranked the specialties in that manner, with the most challenging on the top. So, without much delay, here it is — our list of most intellectually challenging, cerebral medical specialties in the US may start with the final countdown.

11. Family medicine

A family physician has to provide comprehensive and preventive care to the patients, regardless of their gender, age or type of disease. Medical treatment can also be preventive and carried out in a personalized manner. They engage in a broad range of clinical activities that occur in the office. Medical procedures like sigmoidoscopy, colposcopy and skin biopsy are all included in their basic medical capability. What makes this medical specialty so intellectually challenging is the fact that they need to know a great deal of something about every specialty as well as to know when and how to treat patients. Acute or chronic, preventive or specific – all of these medical services are identically important for a family physician. On our list of the most intellectually challenging, cerebral medical specialties in the US, family physicians rank on the 11th place because, after finishing medical school, residency training requirements last no more than three years for this medical residency. However, a great amount of basic knowledge from other medical specialty fields such as pediatrics, internal medicine, psychiatry, emergency medicine, etc., in order to become a family physician.

10. Medical genetics

This medical residency is considered to be both intellectually and practically challenging. Medical genetics ranks quite low on our most intellectually challenging, cerebral medical specialties in the US list because theoretical knowledge prevails over practical one. This includes studies and research about the inheritance and mapping disease genes, as well as their official diagnosis and medical treatment. Genetically-linked diseases are also in the domain of medical and therapeutic procedures. Prevention treatments are carried out through radiologic, cytogenic or biochemical tests. A medical geneticist manipulates and deals with a bunch of different screening programs for congenital errors of hemoglobinopathies, neural tube deficiency, and chromosome or metabolism abnormalities. Residency program last four years- the first two must have been completed in another specialty or its equivalent (such as pediatrics or internal medicine). This means that in order to become a clinical laboratory geneticist, medical students must complete a doctoral degree program, followed by at least two years of residency training. They also have to complete a 2-year fellowship program in clinical laboratory genetics and get ABMG specialty certification.

9. Plastic surgery

A plastic surgeon is definitely one of the most competitive medical specialties. It deals with the repair, reconstruction, or replacement of physical defects, both of form or function. The skin, musculoskeletal system, extremities, breast, and trunk, or external genitalia are all included in this professional, plastic surgery medical field. Cosmetic enhancement plays an essential role in plastic surgery work. The plastic surgeons use cosmetic surgical techniques to both mend and improve long-term appearance and the outcome of reconstructive medical procedures. High professional knowledge, skill in the design and aesthetic eye is more than required. Another mere necessity for this medical residency is the remarkable ability in managing serious wounds and the usage of implantable materials. Tumor surgery is also included in this medical domain. Thanks to plastic surgeons, the development of new techniques such as liposuction and tissue transfer, has been rising. Vast knowledge of anatomy, physiology and pathology, and are of essential importance to this specialty. Basic medical and surgical knowledge, outstanding operative judgment, skills in technical issues, ethical behavior, and other interpersonal skills are also fundamental for a successful plastic surgeon. Even though innovative medical technologies are continuously emerging, plastic surgery takes part on our list of the most intellectually challenging, cerebral medical specialties in the US because this medical specialty is constantly reinventing itself. This specialty is the perfect place for creative problem solvers who enjoy thinking “out of the box.” Subspecialties involved in this medical area are microsurgery, craniofacial, oncology and others. Residency training requirements are about two years, requiring successful mastering in neurological surgery, orthopedic surgery, urology or otolaryngology.

8. Orthopedic surgery

Orthopedics ranks on our list of most intellectually challenging, cerebral medical specialties in the US. A medical specialty devoted to the diagnosis, treatment, rehabilitation, and prevention of injuries and diseases of the musculoskeletal system, orthopedic surgeons take care of both young and old — newborns with clubfoot, young athletes who need arthroscopic surgery and older patients with arthritis. Even though most orthopedists study general orthopedics in a private group practice setting, some might finish specialization in medical rehabilitation,  treating the foot, hand, shoulder, spine, hip, knee, etc. Others may become experts in pediatrics, trauma, or sports medicine. Surgery is all about teamwork — The American Academy of Orthopedic Surgeons is the world’s largest medical association of musculoskeletal specialists (24,000 internationally). The training program lasts five years; including a PG-Y 1 year (PGY-1 year of training must be completed in general surgery).

7. Psychiatry

The prevention, diagnosis, and treatment of mental, addictive, and emotional disorders are all in the domain of psychiatry. Many other subtypes of disorders, such as anxiety disorders, mood shifts, sexual or gender identity disorders, and adjustment disorders are also very important issues to deal with. Psychiatry on this most intellectually challenging, cerebral medical specialties in the US list denotes a highly educated specialist who can understand the biological, psychological, and social components of illness, and therefore he or she is eloquently prepared to treat the patient properly. A psychiatrists’ job also requires ordering diagnostic laboratory tests and  prescriptions of medications. They also need to know how to evaluate and treat both psychological and interpersonal patients’ problems. This also includes different types of anxiety disorders, bipolar disorder, schizophrenia and substance abuse as well. Private offices, community mental health clinics, hospital-based clinics, hospital consultation services are just some of the vast number of different settings where psychiatrists have to treat their patients in. What makes this medical specialty intellectually challenging is skillful management between adequate evaluation, supervision of patients and psychotherapy. As for residency program,  during the PGY-1 experience, the psychiatry resident has to become an expert in recognizing medical emergencies as well as in control of side effects of psychotropic medications, including specific drug consummation. Fundamental knowledge and skills in the domains of neurology, immunology, geriatrics, genetics, endocrinology, and pharmacology are also involved in the residancy training program.

6. Nuclear medicine

Nuclear Medicine physician treats diseases in a painless way. First of all, he/she can diagnose certain abnormality in an early-stage progression; therefore it can be treated sooner and more efficiently. Radiopharmaceutical medicine is based on a small quantity of radioactive substances that can be injected into a human body, inhaled or swallowed. These substances produce gamma rays, that can be followed with gamma cameras what further enables for nuclear medicine physician to see are there any potential abnormalities inside of patient’s body. The nuclear medicine specialist has to be familiar with the basic biologic effects of the radioactive substance, as well as the main and sub-principles of radiation detection and radioactive exposure. Residency program lasts three years while medical training includes successful completion of a transitional year program or a PGY1 program in internal medicine or surgery. Residency program lasts three years, while medical training includes successful ending in a PGY1 program related to internal medicine or surgery.

And now, let’s see the top five most intellectually challenging, cerebral medical specialties in the US.

5. Ophthalmology

An ophthalmologist is a specialist who treats and diagnosis eye-related illnesses and other vision disabilities. He/She must complete college and eight years of additional medical residency training. After this, an ophthalmologist is highly competent and licensed to perform visual surgery or to prescribe eyeglasses or contact lenses. There is also a subspecialist who completes one or two additional training years in medical fields such as glaucoma, cornea, pediatrics, neurology, plastic surgery, etc. which further allows the specialist to take care of more complex vision conditions.

4. Dermatology

A dermatologist ranks quite high on the most intellectually challenging, cerebral medical specialties in the US list — this doctor is trained to maintain the patients’ problems of the skin such as hair loss and scars, but also the skin changes, mostly associated with aging. Prevention and treatment of benign and malignant disorders of the skin, hair, and nails, as well as a number of sexually transmitted diseases. Dermatologists must have been highly experienced in diagnosis and treatment of skin cancers, melanomas, moles, and other types of tumors of the skin. Allergic and nonallergic skin disorders and infectious diseases of the skin are also included. Dermatologists have to carry out special training in dermatopathology and in some surgical techniques related to their medical residency. What makes this medical specialty so intellectually challenging is the fact that dermatologists see patients of all ages for various skin problems. They also have to know how to conduct biopsies and excisions and do surgery in order to remove benign or malignant cancers. Subspecialties include cutaneous surgery, pediatric dermatology, dermatopathology. It is positioned as very competitive medical residency, which training lasts at least four years.

3. Anesthesiology 

Anesthesiology is included in our top three most intellectually challenging, cerebral medical specialties in the US for a good reason —  it is the practice of medicine which involves the perioperative care of patients and the treatment of unbearable pain. As a hospital-based specialty, it is focused on both operative and post-operative patients’ medical care. The practice of anesthesiology involves a wide scale of patients regardless of age, illness, and sex. The specialist must also be expert in subspecialties such as pediatric, cardiac, neuro and ambulatory anesthesia. Critical care medicine and pain management are also included. According to some medical statistics, a great number of medical students interested in anesthesiology are those who enjoy physiology and applied pharmacology in the clinical background. What makes this medical specialty so complex is four years of residency training program (plus a Clinical Base (PGY-1) Year), as well as training in internal medicine or emergency medicine, pediatrics, some field of surgical specialties, critical care medicine, obstetrics and gynecology, neurology, family practice, or some combination of these.

2. Radiology

Radiology is one of our two finalists on the most intellectually challenging, cerebral medical specialties in the US list. According to American Medical Association statistics, 1.2 % of physicians specialize in radiology (compared with 16.7% who specialize in internal medicine). Generally, the radiologist is different from other physicians because he or she diagnoses diseases by obtaining and interpreting medical images by using x-rays or radioactive substances. Sound waves or the body’s natural magnetism are also used here. What makes a radiologist’s job so intellectually difficult is the fact that they must correlate medical image with other medical examinations and results. The second step is a recommendation for further medical treatments. Residency training requirements involve five years, including a PGY-1 year. The PGY-1 year must consist of training in internal medicine, pediatrics, surgery or surgical specialties, obstetrics and/or gynecology, neurology, family practice, emergency medicine, or any combination of these, or an ACGME or equivalent accredited transitional year.

1. Neurosurgery

Neurosurgery takes the very top of the most intellectually challenging, cerebral medical specialties in the US list. It is definitely one of the most difficult medical specialty to get into. It is said to be ‘more art than science.’ Generally speaking, this medical specialty is categorized as the most intellectually challenging surgical specialty that treats patients with disorders of the brain, spinal cord, and peripheral nervous system. It is estimated that nearly about 70% of patients treated by neurosurgeons have diseases of the spine or spinal cord. There are about 3,500 practicing neurosurgeons in the United States of which 500 are in teaching centers. Neurosurgery encompasses microsurgical techniques, treatment of brain tumors, and comprehensive reconstruction of the spine. Interestingly, neurosurgery became a surgical specialty just after the turn of the last century. In order to become a successful neurosurgeon, one should be a scientist and a clinician at the same time. However, one should also be prepared to make ‘life-or-death’ decisions on a daily basis. The residency program is as complex as this very specialty seems – six years of residency training program, involving a preliminary one year of training. The preliminary year of training must be in either general surgery or spent on gaining fundamental clinical skills in some other, related medical specialty. It is important to emphasize that neurosurgeon never works all by himself – he is just a one link in the chain. This implies work with neurosurgery residents, a scrub nurse, and an anesthesiologist.

So, what do you think? Do you agree with our listing of 11 most intellectually challenging, cerebral medical specialties in the US, or you hold your own opinion?