Choosing a future medical speciality is considered one of the most critical challenges for undergraduate students worldwide. The present study assessed the influences and factors related to medical students career choices in Saudi Arabia. The study was designed in a cross-sectional manner to collect data from all undergraduate medical students and interns in the Kingdom of Saudi Arabia for 5 months, starting from September 2021 and ending in January 2022. The questionnaire was completed by 1725 medical students and interns aged 18 to 30 with a mean age of 24.2 ± 4.6 years, and 64.6% were females. In all, 50.4% of respondents reported that they had received advice from others on their chosen speciality, and 89% of respondents indicated that they were interested in working in a specialized field after graduation. The most influencing factors for choosing medical specialities are job safety, creative ability, dealing with a variety of patients and monthly income (69.6%, 63.7%, 62.4%, 58.9%), respectively. Additionally, the study showed that gender plays a significant role (
P
= .001) for medical students and interns in their choice of speciality, whereas pediatrics was the top choice for female students (12%), and medicine was the most popular choice for male students (14.1%). A student’s lower grade point average, the lower average monthly income of their family, lack of working relative in the healthcare field and absence of advice about future specialities are all significant predictors for stopping specialities endeavor. Our study concluded that students career choices depend on different factors, including gender based preferences and that their specialized preferences did not change considerably prior to or after graduation. Further studies are required to analyze the factors influencing student and intern speciality preferences in their early clinical and career years.