Choosing a Medical Specialty: Your Guide to Clinical Informatics Fellowships

Clinical informatics is no longer a niche interest—it is a rapidly growing, board-recognized medical subspecialty that shapes how care is delivered, documented, measured, and improved. If you find yourself wondering “What specialty should I do?” and you’re consistently drawn to data, systems, and improving workflows, clinical informatics may belong high on your list.

This guide walks you through choosing a medical specialty with a specific focus on clinical informatics: what it is, who thrives in it, what training looks like (including clinical informatics fellowship options), and how to position yourself for a future in health IT.

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Understanding Clinical Informatics as a Medical Specialty

Before you decide how to choose a specialty, you need to understand what clinical informatics actually entails.

Clinical informatics is the application of information science, data science, and technology to improve clinical care, population health, and health system operations. It sits at the intersection of:

• Medicine and clinical workflows
• Information systems and software
• Data analytics and quality improvement
• Policy, governance, and change management

What Clinical Informaticians Actually Do

Clinical informaticians are typically physicians who:

• Help design and optimize electronic health records (EHRs)
• Translate clinical needs into technical requirements for health IT teams
• Lead implementation and optimization of clinical decision support tools
• Work on data dashboards, quality metrics, and reporting
• Improve documentation workflows and reduce clinician burnout related to IT
• Participate in or lead digital health innovation (telemedicine, patient portals, apps)
• Support population health programs using data (e.g., readmission reduction, chronic disease registries)
• Navigate regulatory requirements (Meaningful Use, interoperability standards, data privacy)

They are often the “bridge” between frontline clinicians and IT departments—people who speak both clinical and technical languages.

Is Clinical Informatics a Primary Specialty?

Clinical informatics is a board-certified subspecialty, not a primary specialty. In the United States, you must first complete a primary residency (e.g., internal medicine, pediatrics, emergency medicine, pathology, radiology, etc.), then pursue clinical informatics training.

The implications for choosing a medical specialty are important:

• You are really choosing two things:
  1. A primary clinical specialty in which you’ll train and possibly practice clinically long-term
  2. A subspecialty focus in clinical informatics that shapes your non-clinical or hybrid career

That means your “What specialty should I do?” question should account for:

• What primary specialty aligns with your clinical interests and lifestyle
• How well that specialty pairs with your long-term informatics goals

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Clarifying Your Career Vision: Is Clinical Informatics Right for You?

Before you commit your career path to clinical informatics, you need clarity on what appeals to you and how you like to work.

Key Traits of Residents Who Thrive in Clinical Informatics

You’re more likely to be satisfied in clinical informatics if:

1. You enjoy systems thinking
   You naturally ask:

   • “Why is our workflow this way?”
   • “How could we redesign this so it’s safer or more efficient?”
   • “How does this one change affect the entire care process?”

2. You’re comfortable with technology and data
   You don’t need to be a software engineer, but:

   • You like learning new tools or platforms
   • You’re curious about databases, dashboards, or analytics
   • You’re willing to engage with technical teams and understand constraints

3. You like collaborative, cross-disciplinary work
   Much of the work is in committees, workgroups, and project teams:

   • Clinicians, nurses, pharmacists, and therapists
   • IT analysts, developers, and data scientists
   • Administrators and quality teams

4. You’re patient with change and complexity
   Health IT projects can be slow and political:

   • Changes may require months of governance and approvals
   • Not every technically “best” solution is politically feasible
   • You must tolerate ambiguity and incremental progress

5. You value impact beyond the individual patient
   If it energizes you to:

   • Improve care for thousands of patients at once
   • Reduce errors or streamline workflows for an entire health system
   • Translate data into policy or operational decisions
     …you’re aligned with the core of clinical informatics.

Reflective Questions: Choosing Medical Specialty with Informatics in Mind

Ask yourself:

• Do I get more excited about optimizing a care process than doing one specific procedure?
• When I’m frustrated with the EHR, do I think “I’d love to fix this system,” not just “This system is terrible”?
• Do I enjoy QI projects, dashboards, or data-driven presentations?
• Do I like explaining tech to non-technical colleagues (or vice versa)?
• Am I okay with spending a significant portion of my career at a computer rather than the bedside?

If you answer “yes” to many of these, clinical informatics deserves serious consideration.

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How to Choose a Primary Specialty If You Want a Career in Clinical Informatics

Since clinical informatics is a subspecialty, choosing medical specialty for your primary clinical field is still foundational. There is no single “correct” clinical background, but the choice shapes your opportunities and daily work.

Common Primary Specialties Among Clinical Informaticians

Clinical informatics fellows and leaders come from many specialties. Common ones include:

• Internal Medicine / Family Medicine

  • Strong fit for inpatient and outpatient EHR workflows
  • Broad exposure to chronic disease management, population health, quality metrics
  • Commonly represented in CMIO (Chief Medical Information Officer) pipelines

• Pediatrics

  • Focus on growth, development, and family-centered care
  • Important for pediatric EHR builds, weight-based dosing, immunization schedules

• Emergency Medicine

  • Strong insight into high-acuity, high-throughput workflows
  • Often involved in optimizing triage, order sets, and documentation efficiency

• Anesthesiology / Critical Care

  • Deep familiarity with monitoring, devices, interoperable systems
  • Strong candidates for perioperative and ICU informatics roles

• Pathology / Radiology

  • Highly digital specialties with early adoption of IT systems
  • Opportunities in image management, lab information systems, AI diagnostics

• Psychiatry

  • Nuanced documentation, privacy considerations, and longitudinal care
  • Key perspectives for behavioral health IT and telepsychiatry platforms

Strategic Considerations When Choosing a Clinical Specialty

When asking how to choose specialty with a future in informatics, consider:

1. Clinical Enjoyment First
   You should not pick a clinical field solely as a “stepping stone” to clinical informatics.

   • Informatics jobs can be competitive and systems-dependent
   • You will still carry a clinical role—often 20–60% FTE
     Make sure you would be satisfied practicing that specialty even if your informatics route delays or changes.

2. Breadth vs. Depth

   • Broad primary care specialties (IM, FM, pediatrics) expose you to many workflows and are often well-aligned with roles in EHR governance and quality.
   • Procedural or diagnostic specialties offer deep expertise in specific domains (OR, imaging, pathology) which can be highly valuable in targeted informatics roles.

3. Academic vs. Community Aspirations

   • Academic centers may favor backgrounds aligned with their institutional strengths (e.g., strong internal medicine department, data science group).
   • Community systems may care less about which primary specialty you trained in and more about your communication skills and operational understanding.

4. Lifestyle and Burnout Risk
   Your clinical workload, call burden, and schedule will affect:

   • Time available for informatics projects
   • Energy to pursue additional training, research, or leadership roles
     A specialty with a sustainable lifestyle for you is essential.

5. Alignment with Your Informatics Interests
   Ask which specialty best matches the domain you see yourself improving:

   • Population health and ambulatory chronic care → Internal Medicine / Family Medicine
   • ED throughput and triage systems → Emergency Medicine
   • Perioperative systems and devices → Anesthesiology / Surgery
   • Laboratory data and digital pathology → Pathology
   • Imaging AI and PACS → Radiology
   • Behavioral health IT and telepsychiatry → Psychiatry

There is no universally optimal match, but some combinations are more common and create natural synergies with typical informatics roles.

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Training Pathways: From Residency to Clinical Informatics Fellowship and Beyond

Once you’ve chosen your primary field, it’s time to understand the formal training structure for clinical informatics and other forms of health IT training.

Board Certification and Eligibility

In the U.S., clinical informatics is recognized by the American Board of Preventive Medicine (ABPM) and several other boards. To be eligible for clinical informatics board certification, you typically need:

• An MD or DO degree
• Completion of an ACGME-accredited residency in a primary specialty
• A valid, unrestricted medical license
• Completion of an ACGME-accredited clinical informatics fellowship or satisfaction of “practice pathway” criteria (now largely phased out in many cases)

Always check up-to-date ABPM and ACGME criteria, as rules and timelines change.

Clinical Informatics Fellowship: What It Looks Like

A clinical informatics fellowship is usually a 2-year ACGME-accredited program. Key components include:

• Protected time for informatics projects
  Fellows often spend the majority (60–80%) of their time on:

  • EHR optimization and build projects
  • Decision support and order set design
  • Data analytics and dashboard development
  • Quality improvement initiatives
  • Vendor or internal IT collaboration

• Some ongoing clinical practice
  Most fellows continue part-time clinical duties in their base specialty (e.g., rounding on a service, outpatient clinic, ED shifts). This:

  • Keeps you clinically current
  • Grounds your informatics work in real-world practice
  • Maintains revenue to support the fellowship program

• Formal curriculum and didactics
  Topics typically include:

  • Health information systems and architectures
  • Clinical decision support principles
  • Data standards (HL7, FHIR, SNOMED, LOINC, ICD, CPT)
  • Data governance, privacy, and security
  • Workflow analysis and human factors
  • Project management and change management
  • Quality measurement and improvement
  • Research methods in informatics

• Scholarly activity
  Many programs expect:

  • Abstracts and presentations at informatics or specialty conferences
  • Manuscripts or quality reports
  • Capstone projects or pilots of new tools

Alternative Health IT Training and Experience Paths

Not everyone pursues a formal fellowship, especially mid-career physicians. Options include:

• On-the-job health IT roles

  • Physician builder, EHR physician champion, or medical director for IT
  • Participation in governance councils (order sets, decision support, documentation)
  • Progressive leadership into associate CMIO or CMIO roles

• Graduate degrees and certificates

  • MS in Biomedical Informatics, Health Informatics, or Data Science
  • MPH with a strong informatics or quantitative track
  • Health IT or analytics certificates

• Industry or vendor roles

  • Working with EHR vendors, digital health startups, analytics or AI companies
  • Roles may include product design, clinical strategy, or implementation leadership

These paths can complement or, in some settings, substitute for formal fellowship training, though for board certification an ACGME clinical informatics fellowship is increasingly standard.

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Positioning Yourself for Clinical Informatics During Medical School and Residency

Whether you’re still asking what specialty should I do or you’re already committed, you can start building a strong informatics profile now.

During Medical School

1. Electives and Rotations

   • Seek out rotations in quality improvement, population health, or health systems management.
   • If your institution has an informatics department or EHR optimization team, request a shadowing or elective experience.

2. Projects and Research

   • Join QI projects that leverage EHR data (e.g., sepsis alert optimization, note template redesign).
   • Work with mentors on retrospective chart reviews or database studies.
   • Present posters at informatics or specialty society meetings.

3. Skills Building

   • Learn basic data handling and analysis (Excel, R, Python, or SQL).
   • Familiarize yourself with the structure of the EHR and common clinical workflows.
   • Attend hospital IT or EHR training sessions with an eye for systems, not just basic use.

4. Networking and Mentorship

   • Identify faculty with informatics roles (CMIO, physician informaticists) and ask for guidance.
   • Join organizations like AMIA (American Medical Informatics Association) as a student member.

When applying to residency, you can frame your interest in choosing medical specialty by emphasizing both clinical interests and your desire to contribute to system-level improvement through clinical informatics.

During Residency

1. Choose Programs that Support Informatics Interests
   When ranking or selecting programs:

   • Look for those with robust EHR systems and active optimization work
   • Ask about physician builder programs, informatics committees, or data science groups
   • Inquire if any faculty hold clinical informatics board certification

2. Get Involved in Health IT Committees

   • Volunteer for roles as resident champions for the EHR, order sets, or documentation templates
   • Join hospital QI or patient safety committees that rely heavily on data and IT

3. Pursue Targeted Scholarly Work

   • QI projects with pre–post EHR interventions
   • Studies of workflow changes and their impact on outcomes
   • Collaborations with IT or analytics departments on dashboards or reporting

4. Develop Practical Technical Literacy
   You don’t need to become a software engineer, but physicians who stand out in clinical informatics often:

   • Understand basic database concepts (tables, joins, relational data)
   • Can discuss data standards and interoperability at a conceptual level
   • Are comfortable exploring simple data queries and visualizations

5. Prepare for Clinical Informatics Fellowship Applications

   • Maintain a clear narrative: why clinical informatics, and why now?
   • Keep an updated CV highlighting informatics-related roles and projects
   • Seek letters from mentors who can speak to your systems thinking and collaborative style
   • Research programs that align with your interests (e.g., data science heavy vs. implementation-focused vs. policy-oriented)

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Life After Training: Career Paths and Lifestyle in Clinical Informatics

Understanding what your future might look like helps you make a more confident choice now.

Typical Roles for Physician Informaticians

Common positions include:

• Clinical Informaticist / Physician Informaticist

  • Split role between clinical practice and IT projects
  • Often focused on a service line or department (e.g., ED, ambulatory, ICU)

• Associate CMIO (Chief Medical Information Officer)

  • More leadership responsibilities and strategic planning
  • Oversees project portfolios, governance, and alignment with clinical goals

• CMIO / System CMIO

  • Executive-level responsibility for clinical IT strategy
  • Heavy involvement in vendor relationships, budgeting, and change management

• Medical Director for Documentation, Decision Support, or Digital Health

  • Focused areas such as decision support optimization, virtual care platforms, or clinical documentation integrity

• Industry and Vendor Roles

  • Medical director or clinical lead at EHR companies, analytics platforms, or digital health startups
  • Product strategy, user research, clinical safety oversight for software

Work-Life Balance and Lifestyle Considerations

Compared with many traditional clinical subspecialties, clinical informatics often offers:

• More predictable schedules

  • Fewer nights/weekends (though go-lives and major outages can be intense)
  • Less direct emergency call compared to many procedural specialties

• Hybrid clinical/administrative roles

  • Many physicians find satisfaction in a mix of patient care and system-level work
  • Potential for reduced clinical hours over time as informatics responsibilities grow

• Cognitive rather than procedural focus

  • Less physical wear and tear than procedure-heavy fields
  • Emphasis on analysis, communication, and leadership

However, this path is not stress-free:

• Go-lives, downtime events, and major EHR changes can be high-stress periods
• There is ongoing pressure to satisfy competing priorities (clinicians, IT, administration)
• You may feel pulled between your identity as a clinician and as an administrator or “IT person”

Understanding these realities is essential when asking yourself what specialty should I do and whether a clinical informatics career will fit your preferred work style and stress tolerance.

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FAQs: Choosing a Medical Specialty in Clinical Informatics

1. Do I need strong programming skills to pursue a clinical informatics fellowship?
No. Most clinical informatics fellowship programs do not require advanced programming skills. You should, however, be comfortable with technology and willing to learn basic data concepts. Familiarity with tools like Excel, basic statistics software, or introductory scripting (R, Python, or SQL) can be helpful and will make it easier to collaborate with technical colleagues, but deep software engineering expertise is not expected for most physician informaticist roles.

2. Which primary residency is “best” if I want to do clinical informatics?
There is no single “best” specialty. Internal medicine and family medicine are common because they touch many workflows and align well with health system roles. Emergency medicine, pediatrics, anesthesiology, pathology, radiology, and psychiatry also provide strong bases depending on the domain you care most about. Focus first on choosing medical specialty that you genuinely enjoy clinically and could practice comfortably, then layer clinical informatics on top.

3. Can I go directly into clinical informatics after medical school?
Not in the U.S. Clinical informatics is a subspecialty, so you must complete a primary residency first. While in medical school, you can pursue health IT training, informatics research, and electives that set you up for future fellowship, but your next formal step after graduation is residency in a core specialty.

4. What if my institution doesn’t have a formal informatics department or fellowship?
You can still build experience by:

• Joining QI or patient safety projects that use EHR data
• Becoming a resident champion for EHR or documentation initiatives
• Connecting with system-level IT or analytics teams (even if off-site)
• Seeking external mentors through regional networks, national societies (like AMIA), or virtual communities
  When it’s time to apply to a clinical informatics fellowship, programs will look for evidence of real engagement with health IT, even if your home institution lacks a formal division.

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Choosing a medical specialty is always a complex decision, and adding clinical informatics to the equation introduces extra layers—primary specialty selection, subspecialty training, and long-term hybrid roles. By understanding what clinical informatics involves, how it integrates with core disciplines, and what training and careers look like, you can make a thoughtful, strategic choice that aligns with both your clinical passions and your desire to transform health care at the systems level.