If you were a medical student today, how would you factor the effects of the Affordable Care Act into your decision making process about what specialty to go into?

Don't think about it in terms of what the ACA will mean.  If you do what every other doctor has been doing during the medical bubble (and we are in a long-term bubble that's bound to pop sometime) then the ACA will mean more insurance headaches if you do your own billing or pay staff to do billing, and that will be regardless of what specialty you pick. But ultimately, pick what you want to do based on what interests you most.  If you are most fascinated with the heart, go for that.  If you're most fascinated with the digestive system, go for gastroenterology.  Pick what you love to do, because the ACA headaches are going to be there no matter which specialty you pick. If you want to stay away from insurance headaches, then stay away from insurance altogether.  There is an increasing number of physicians practicing in concierge clinics.  See, for example, the http://surgerycenterok.com/, which operates on a cash basis, with prices much lower than what you can get with insurance.  These centers have excellent quality while maintaining bare-bones administration and very little billing overhead, allowing them to pass cost saving on to you. Another way to avoid insurance headaches is to work for an organization like Kaiser-Permanente, which offers its own "insurance" program where patients pay a fixed monthly fee for virtually unlimited access.  With no third-party billing and insurance, overhead costs drop a lot and the medical staff can focus on their patients instead of sucking as much money from insurance companies as possible.