Best specialties for people with ASD?

[SnakeDiscovery]

Hi everyone! Currently thinking about specialties as an incoming M1 and I've been trying to look on forums to see which specialties tend to be accommodating for people with ASD. However, most specialties people tend to bring up don't involve patient interaction, like anesthesiology or radiology. I typically enjoy patient interaction and being around people but have poor experience with social cues and settling into a normal conversational tone. Are there any specialties that are suitable for people on the spectrum that still include patient interaction in their routine?

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[blameitonbaby]

Hi everyone! Currently thinking about specialties as an incoming M1 and I've been trying to look on forums to see which specialties tend to be accommodating for people with ASD. However, most specialties people tend to bring up don't involve patient interaction, like anesthesiology or radiology. I typically enjoy patient interaction and being around people but have poor experience with social cues and settling into a normal conversational tone. Are there any specialties that are suitable for people on the spectrum that still include patient interaction in their routine?

Path

 

[SnakeDiscovery]

Path

Can you do Pt contact w Path?

 

[Dral]

Generally no, but there are opportunities such as FNA or blood bank.

 

[LeaveNoTrace]

There are a few autistic medical students in every class. The ones with good grades and test scores are steered towards radiology; the ones whose grades and test scores aren't competitive for rads wind up in pathology. However there's autistic IM, FM, and even psych doctors out there. If you're awkward but technically competent...maybe try a surgical specialty or anesthesiology? There are ways to work on building patient rapport and communicating with people better.

 

[PathNeuroIMorFM]

I'm fairly convinced I've met a number of ASD surgeons and IM doctors...

 

[SnakeDiscovery]

There are a few autistic medical students in every class. The ones with good grades and test scores are steered towards radiology; the ones whose grades and test scores aren't competitive for rads wind up in pathology. However there's autistic IM, FM, and even psych doctors out there. If you're awkward but technically competent...maybe try a surgical specialty or anesthesiology? There are ways to work on building patient rapport and communicating with people better.

This is actually really encouraging, thanks!

 

[LeaveNoTrace]

1) Make sure you are competent. Unfortunately, autistic people get judged a bit more harshly, not only due to things like missing social cues but also due to things like flat or unusual affect and speech inflections. People can and do overcome this hurdle; however, if you want something that isn't FM, IM, path, or possibly EM you're going to want to be in the top half of your class or at least have scores in the top half. It's hard, but you'll want to be a bit better than your classmates and know your stuff in order to compensate for whatever bias - warranted or not - that you're likely to get. Subjective evaluations are a big part of your grades in medical school. It's not going to be terrible, most likely - you're going to graduate and have a job at the end of four years if you do your part. It just might mean that if you want something competitive, you're facing an uphill battle.

2) Work on anything that can be articulated, after you've got the academic stuff out of the way. You're consistently in the top half or at least very close to it on your pre-clinical tests (which lay the foundation for your shelf exams and Steps). You now need to work on building rapport and engaging with patients. There are some simple tools you can use for that: get on their level, don't stand over your patients. Use a clipboard to write things down if you need it. When you make eye contact, use it as punctuation or to get their attention. Same with tone of voice and inflection. You might have an autistic "accent", where your affect is flat and you start and stop words abruptly. Listen to how celebrities, politicians, and podcasters talk, and imitate them.

3) You're going to have to do some soul-searching here. The specialties you can get may not be the best fit for you. If you don't fail anything, aren't terrible in the interview, and are a US MD you have an excellent shot at FM, IM, or EM, autism or no. However: is that really the best fit for you? How good will you be at building patient rapport if you miss social cues? These things aren't so large that they'll mean you can't be a good FM doc; after all, you got past the medical school interview. And again - there are ways to compensate for this, although they're not perfect.

For now: If you have the money/insurance, see if you can see a speech pathologist that works with autistic people, preferably low-support-needs adults. If not, I'd suggest videotaping yourself and listening to yourself talk; odds are even if you're awkward as hell yourself, you can tell when others are awkward and thus if you yourself are doing a good job or not. Also improv/acting classes, maybe get a job as a barista if you can.

Good luck with everything.

Finally: if you aren't already, consider seeing a therapist; medical school is not easy and as @Goro says, can be taxing for even healthy people. I wonder what MDs like @IlDestriero or @NotAProgDirector think as well as adcoms like @LizzyM and @Moko. They've got to have let you in for some reason...

P.S: If you want something like Derm or ENT that's nosebleed-competitive...I hate to deliver bad news so early, but you're climbing a huge mountain with extra rocks in your backpack. You're going to want to seriously consider backup specialties if you're going for that. FM, IM, Path, and EM should all be very realistic for you, however.

 

[LizzyM]

Neurology, neonatology, trauma surgery, critical care medicine. With some exceptions, the patients aren't talking and social cues are less important but you are interacting with living (and, we hope, still breathing) people.

 

[LeaveNoTrace]

Forgot about neuro! There's a stereotype of lots of autistic neurologists, and it...isn't entirely without merit. That's a possibility too, and residency interviewers might be slightly less biased/suspicious as well.

 

[SnakeDiscovery]

1) Make sure you are competent. Unfortunately, autistic people get judged a bit more harshly, not only due to things like missing social cues but also due to things like flat or unusual affect and speech inflections. People can and do overcome this hurdle; however, if you want something that isn't FM, IM, path, or possibly EM you're going to want to be in the top half of your class or at least have scores in the top half. It's hard, but you'll want to be a bit better than your classmates and know your stuff in order to compensate for whatever bias - warranted or not - that you're likely to get. Subjective evaluations are a big part of your grades in medical school. It's not going to be terrible, most likely - you're going to graduate and have a job at the end of four years if you do your part. It just might mean that if you want something competitive, you're facing an uphill battle.

2) Work on anything that can be articulated, after you've got the academic stuff out of the way. You're consistently in the top half or at least very close to it on your pre-clinical tests (which lay the foundation for your shelf exams and Steps). You now need to work on building rapport and engaging with patients. There are some simple tools you can use for that: get on their level, don't stand over your patients. Use a clipboard to write things down if you need it. When you make eye contact, use it as punctuation or to get their attention. Same with tone of voice and inflection. You might have an autistic "accent", where your affect is flat and you start and stop words abruptly. Listen to how celebrities, politicians, and podcasters talk, and imitate them.

3) You're going to have to do some soul-searching here. The specialties you can get may not be the best fit for you. If you don't fail anything, aren't terrible in the interview, and are a US MD you have an excellent shot at FM, IM, or EM, autism or no. However: is that really the best fit for you? How good will you be at building patient rapport if you miss social cues? These things aren't so large that they'll mean you can't be a good FM doc; after all, you got past the medical school interview. And again - there are ways to compensate for this, although they're not perfect.

For now: If you have the money/insurance, see if you can see a speech pathologist that works with autistic people, preferably low-support-needs adults. If not, I'd suggest videotaping yourself and listening to yourself talk; odds are even if you're awkward as hell yourself, you can tell when others are awkward and thus if you yourself are doing a good job or not. Also improv/acting classes, maybe get a job as a barista if you can.

Good luck with everything.

Finally: if you aren't already, consider seeing a therapist; medical school is not easy and as @Goro says, can be taxing for even healthy people. I wonder what MDs like @IlDestriero or @NotAProgDirector think as well as adcoms like @LizzyM and @Moko. They've got to have let you in for some reason...

P.S: If you want something like Derm or ENT that's nosebleed-competitive...I hate to deliver bad news so early, but you're climbing a huge mountain with extra rocks in your backpack. You're going to want to seriously consider backup specialties if you're going for that. FM, IM, Path, and EM should all be very realistic for you, however.

Thank you so much! This was very helpful. I'm trying to practice with people at my work to be more socially sensitive and change the way I talk. I think I'll stick with videotaping and rehearsing since I need to set up therapy in the first place.

 

[SnakeDiscovery]

Forgot about neuro! There's a stereotype of lots of autistic neurologists, and it...isn't entirely without merit. That's a possibility too, and residency interviewers might be slightly less biased/suspicious as well.

Thank you!

 

[SnakeDiscovery]

Neurology, neonatology, trauma surgery, critical care medicine. With some exceptions, the patients aren't talking and social cues are less important but you are interacting with living (and, we hope, still breathing) people.

Thanks a lot!

 

[Moko]

Neurology, neonatology, trauma surgery, critical care medicine. With some exceptions, the patients aren't talking and social cues are less important but you are interacting with living (and, we hope, still breathing) people.

I can't speak to the other specialties, but do disagree slightly for critical care medicine as being able to read the room is especially important. While there is less interaction in general, each interaction tends to be more intense and with much higher stakes. Intensivists also frequently have goals of care conversations with patients' loved ones on one of their worst days, and being able to connect with healthcare decision makers will make a difference in their decisions and the way they remember that moment.

For the OP, I will say that many skills in medicine can be learned and/or improved with practice. When I started medical school, I was very much 'behind the curve' when it came to the softer aspects of the curriculum (communication, reading cues, etc.) and lacked many of my peers' social talents, but my skills improved with consistent practice, and I'd like to think that I'm now on par, if not even slightly better, than my peers.. (or at least that's what my patients and their families tell me... though they can be telling everyone this!). Realistically, there is a functional 'ceiling' as to how much we can all improve, but I would not let your current abilities necessarily dictate your future if your current deficits are not severe.

You mentioned Anesthesia: you still do have patient interactions there (albeit much shorter ones) and even more so if you specialize in Pain Medicine. And for Radiology, my interventional radiology colleagues have their fair share of shorter patient interactions, which may be a good balance between no and 'too much' patient interaction. Just my thoughts.

 

[Angus Avagadro]

I can't speak to the other specialties, but do disagree slightly for critical care medicine as being able to read the room is especially important. While there is less interaction in general, each interaction tends to be more intense and with much higher stakes. Intensivists also frequently have goals of care conversations with patients' loved ones on one of their worst days, and being able to connect with healthcare decision makers will make a difference in their decisions and the way they remember that moment.

For the OP, I will say that many skills in medicine can be learned and/or improved with practice. When I started medical school, I was very much 'behind the curve' when it came to the softer aspects of the curriculum (communication, reading cues, etc.) and lacked many of my peers' social talents, but my skills improved with consistent practice, and I'd like to think that I'm now on par, if not even slightly better, than my peers.. (or at least that's what my patients and their families tell me... though they can be telling everyone this!). Realistically, there is a functional 'ceiling' as to how much we can all improve, but I would not let your current abilities necessarily dictate your future if your current deficits are not severe.

You mentioned Anesthesia: you still do have patient interactions there (albeit much shorter ones) and even more so if you specialize in Pain Medicine. And for Radiology, my interventional radiology colleagues have their fair share of shorter patient interactions, which may be a good balance between no and 'too much' patient interaction. Just my thoughts.

Excellent points. CCM docs have to interact with stressed and anxious families, many struggling to cope. Compassion and showing concern for their family member is paramount.

 

[mrbreakfast]

Neurology, neonatology, trauma surgery, critical care medicine. With some exceptions, the patients aren't talking and social cues are less important but you are interacting with living (and, we hope, still breathing) people.

Forgot about neuro! There's a stereotype of lots of autistic neurologists, and it...isn't entirely without merit. That's a possibility too, and residency interviewers might be slightly less biased/suspicious as well.

With the possible exception of psychiatry, there is no specialty that more involves long conversations with patients than neurology. The conversations are often challenging - on the inpatient side you often are breaking very bad news, and in general practice people will be referred to you for a myriad of symptoms, and you often have to tell them nothing is wrong, or break the news that they're functional. There is no conversation that requires "people skills" more, that I can think of, then explaining to a patient and their family that they can't walk, or fall down and shake, not because something is wrong with their body, but because it's in their mind.

As a side note: the idea that neurologists see patients who can't talk to them is inaccurate. Keep in mind most neurologists don't see hospitalized patients, and neurohospitalists who do actually see ED patients as a large percentage of their day.

The stereotype is that neurologists are weird, or neurodivergent, or whatever (which may be true) but not that they're autistic. There isn't a field in medicine you cannot do if you have ASD, but if you are worried about detailed conversations with people, just know that waits for you for the vast majority of neurological clinical encounters.

Source: academic neurologist who knows a LOT of other neurologists.


I will say the the majority of "on the spectrum" doctors I know seem to go into pathology, followed by psychiatry for some reason, but I also know someone who is definitely diagnosed as autistic and is a medicine hospitalist.

 

[LizzyM]

With the possible exception of psychiatry, there is no specialty that more involves long conversations with patients than neurology. The conversations are often challenging - on the inpatient side you often are breaking very bad news, and in general practice people will be referred to you for a myriad of symptoms, and you often have to tell them nothing is wrong, or break the news that they're functional. There is no conversation that requires "people skills" more, that I can think of, then explaining to a patient and their family that they can't walk, or fall down and shake, not because something is wrong with their body, but because it's in their mind.

As a side note: the idea that neurologists see patients who can't talk to them is inaccurate. Keep in mind most neurologists don't see hospitalized patients, and neurohospitalists who do actually see ED patients as a large percentage of their day.

The stereotype is that neurologists are weird, or neurodivergent, or whatever (which may be true) but not that they're autistic. There isn't a field in medicine you cannot do if you have ASD, but if you are worried about detailed conversations with people, just know that waits for you for the vast majority of neurological clinical encounters.

Source: academic neurologist who knows a LOT of other neurologists.


I will say the the majority of "on the spectrum" doctors I know seem to go into pathology, followed by psychiatry for some reason, but I also know someone who is definitely diagnosed as autistic and is a medicine hospitalist.

I stand corrected. The two neurologists I know best must be outliers, and I was thinking, in large part, about hospitalized stroke patients and others in ICU.

 

[LunaOri]

Please stop recommending that people with ASD go into pathology. While path has little patient contact, it requires a LOT of communication with other physicians, who can be quite demanding. Plenty of “odd ducks” in path, but folks who don’t communicate well, or who get super stressed out by talking with others, won’t be happy in pathology (the exception being in a reference lab, where you sit at a scope all day).

 

[LeaveNoTrace]

I will say the the majority of "on the spectrum" doctors I know seem to go into pathology, followed by psychiatry for some reason, but I also know someone who is definitely diagnosed as autistic and is a medicine hospitalist.

Radiology is competitive, so the autistic docs are steered into pathology instead. Psychiatry: wasn't nearly as competitive 20 years ago, and sadly mental health issues are more common for people on the spectrum. Couple that with a special interest in human behavior, and you have your autistic shrinks.

 

[LeaveNoTrace]

Please stop recommending that people with ASD go into pathology. While path has little patient contact, it requires a LOT of communication with other physicians, who can be quite demanding. Plenty of “odd ducks” in path, but folks who don’t communicate well, or who get super stressed out by talking with others, won’t be happy in pathology (the exception being in a reference lab, where you sit at a scope all day).

Tell that to medical school deans and advisors! I have a friend who's on the spectrum, rather awkward...and the student dean and advisors at his medical school steered him hard towards pathology. He likes it, though, so all is not lost...

 

[mistafab]

Path or rads is good. I had a friend with ASD flunk (nonpromotion) after pgy1 in IM due to poor performance despite being a smart / nice guy (240s/250s steps), He switched to path and is now thriving, a chief there in his last year.

Or, most specialties if your career is research-focused.

If primarily clinical - avoid psych, IM, most surgical fields, peds, obgyn at all costs. They require a lot of teamwork or communication face to face where if you struggle with that, you almost cant be good at the job.

many specialties can be friendly to research-focused careers. Mostly because people will tolerate you and youll be good at your research with a smaller sliver of FTE for pure clinical roles. Its really hard to be good at clinical work if you have ASD since so many specialties require significant interaction with teams or patients. For example - you need to be able to collect and interpret sublte cues in psych regularly or your patients will die. The toughest part of peds is parents, which requires good and often difficult communication. In the OR, if you dont communicate great with a team im honestly not sure you’ll complete your residency let alone be able to practice effectively. IM residency often requires alot of teamwork (juniors, seniors, students, nurses, etc) and patient family plus consultant management,

So my recommendation is to decide on a specialty that will be less of an uphill battle. Also, consider academic/research type work in medicine as many people are on the spectrum (believe me) at top places in medicine (believe me again)

 

[LeaveNoTrace]

If you're a guy - yeah, I wouldn't pick OB-GYN unless you're an excellent student and OK with going through hell and high water in order to practice. Even then, I'd advise against it. That's not an uphill battle you're talking about, that's a cliff you're trying to scale. We've kind of got the wrong parts for the job...not that there aren't male OB-GYNs and that some aren't good, but that's two strikes against you already.

See how your medical rotations go, to be honest. Communication in medical teams is a bit more standardized in some ways, and there are probably ways to be passable and compensate for deficiencies. I might be wrong for saying this; I'm only a graduating fourth-year...but you can get by if your communication skills are okay and you're a little awkward but compassionate and caring. What you can't do, is be a dumpster fire. You have to not be bad at communicating with patients and other healthcare professionals. Your rotation evaluations and attendings' comments will mean quite a bit. I knew a guy on the spectrum, wasn't straight, liked wearing nail polish...and he got solid evals from his OB-GYN rotation; his internal-medicine residents and attendings also liked him and felt he was good at building rapport with patients. It's too soon to call the ballgame at this point. Good luck, though. Do you want or like research? It's competitive, but if you're good at it it might be a good idea.

Finally: I'm agreeing with Moko here: there's definitely room for improvement. It is unlikely that you are truly terrible if you got past a medical school interview.