“What specialty are you going into?”

I’m often asked this question as a medical student.

It is a reasonable one, but an incomplete one. It assumes that the central career decision in medicine is to choose from a fixed list of 65 existing pathways, then progress within one of them. Yet healthcare is not simply a collection of specialties. It is a complex system of patients, clinicians, technologies, institutions, incentives, information, and capital.

A more fundamental question is therefore:

“How can you create value in healthcare?”

Clinical medicine remains one of the most meaningful ways to do this. A doctor can create deep value for individual patients through diagnosis, treatment, judgement, and trust. This is the foundation of medicine and the source of its moral seriousness. But the reach of clinical work is often constrained by time: one clinician can only see so many patients, make so many decisions, and operate within so many systems.

Clinical work creates profound value, but its reach is often limited by time. In healthcare, impact can therefore be thought of as:

Impact = number of people reached × value created per person

The traditional clinical pathway creates high-depth value, often at a one-to-one scale. Other pathways can extend that value across many more people.

There are five broad ways to create value in healthcare.

  1. The first is the clinical pathway: direct patient care. This remains the core of medicine. It is where trust is built, suffering is relieved, and decisions directly change the lives of individual patients.
  2. The second is the research pathway: generating new knowledge. Research changes what medicine understands, measures, and treats. Its greatest impact often comes when discoveries are translated into practice, therapeutics, diagnostics, or new models of care.
  3. The third is the technical pathway: building tools. This includes software, hardware, AI systems, drugs, devices, and infrastructure. These can raise the standard of care not just for one patient, but for entire systems.
  4. The fourth is the policy pathway: changing how healthcare is organised, funded, and delivered. In a world of finite resources, better coordination, incentives, and institutional design can create enormous value at population scale.
  5. The fifth is the media pathway: moving information. Healthcare is an information system as much as a biological one. Helping patients, clinicians, and organisations understand what matters can shape decisions far beyond the clinic.

The real opportunity is not simply to choose one pathway, but to combine them. Medicine plus technology can produce better clinical software. Medicine plus research can create translational biotech. Medicine plus policy can redesign care delivery. Medicine plus media can distribute credible health knowledge at scale.

This is why the traditional question feels too narrow. “What specialty?” implies a bounded game: choose from existing options and compete within them. “How can I create value?” opens a much larger space. By combining medicine with technology, research, policy, media, or capital, the combinatorics of impact expand dramatically. The focus shifts from predefined pathways to the problems that matter, the leverage available, and the combinations of skills needed to solve problems what existing systems cannot.

Personally, I think the best pathway is the one that most strongly points towards the technical pathway. Media can spread ideas, but sometimes lacks depth; research and policy can create enormous value, but often require pleading with institutions, funders, or decision-makers before anything changes. Building technology feels more direct: identify a high-impact problem, create something tangible, and test whether it improves care in the real world.

The future of healthcare will likely not be built only by people who move through established systems. It will also be built by those who understand those systems deeply enough to redesign them.

Clinical training should therefore be seen not just as a destination, but as a platform. The most impactful “specialties” in medicine may not yet exist. Cambridge should produce global leaders in healthcare; becoming a doctor should be the floor, not the ceiling.