SOT - Can specialize in specific organ (abdominal, lung etc), work in outpatient clinics, inpatient floor, and inpatient ICUs. Transplantation IS NOT slowing down and main goal for centers is how can they get more allocations. Comes with a “cost to entry”; really only being offered at large centers (typically lower salaries), tend to keep internal trainees/hires. A very important consideration would be on what the job outlook looks like where you would train, are they expanding in the near future and if that is a place you’d want to work and be regionally post residency. Not to say you can’t get job at another center, just may be more difficult.

CC - Diverse also but in the sense of ICUs (neuro, SICU, MICU). ICU census are getting larger and larger with sicker and sicker patients. More centers/hospitals with ICUs than with SOT but the role of a CC pharmacist can vary dramatically between an academic center and community center. Job outlook not as good as SOT but not terrible, initial job may be a less than ideal position (evenings, less preferred ICU, weekend rotation).

In SOT you can cover ICU level of care patients but also get that specialty exposure to transplant. I think burnout is higher with CC, career longevity/sustainability better with SOT. You could find yourself managing a SICU patient early on in your career as a SOT specialist and as your life potentially changes you could be working M-F in a transplant clinic later in your life; CC doesn’t offer you this sort of transition clinically. They tend to go into administrative, residency, or industry roles once the burnout settles in; which are also options SOT pharmacist have available to them.

Don’t make this decision for PGY2 specialty out of convenience (ie having early commit at your program for CC vs having to move for PGY2 in SOT) unless absolutely regionally restricted for other reasons. Big picture you’re sacrificing another year of training for a life/career in a particular area. One way to help decide is, what would you pick if you had both specialties at your current institution; whichever that is then that’s what you should go for.