Background: Choosing the specialization after medical graduation is a predicament for every student. The choice of specialty depends on various factors like social, economic, others influence and career related factors. The present study was designed to assess the preferred career choice among the medical students and factors influenced the career choice. Materials and Methods: It was a cross sectional questionnaire-based study done at Kamineni Institute of Medical Sciences, Narketpally, Nalgonda District. Students of 5th Semester, voluntarily and anonymously completed a semi-structured questionnaire consisting of demographics, prior education level, specialty choice questions and reasons for choosing specialty. Results: Out of 146 students, 109 students properly filled the questionnaires. The mean ± SD of age was 19.84 ± 1.41 years with male to female ratio of 1: 2.5. A total of 90.83% students belong to urban areas. Most of them (66.97%) were from state board of higher education. Parents of 17(15.60%) students belongs medical profession. Majority of the students opted for medical specialty (67.9%) as first preference followed by surgical (32.1%). None of them opted for pre clinical, para clinical and hospital administration as first preference. The reasons like income, life style and low stress had strong influence in preferring the specialty. Only few students preferred to work in government hospitals (27.5%) and rural areas (11%). Conclusion: The study reveals majority of students inclined towards clinical specialties. Reorientation of Medical Education is needed along with policy settings to attract doctors to the scarcity and high priority disciplines so that imbalances encountered would be minimal in future.