switching specialties?

[mules05]

I'm a categorical gen surg intern, thinking about switching to another specialty. Since it's late in the year, I think I need to talk directly to the program director in the specialty I'd like to switch to, rather than just applying through ERAS. I'm not sure who to talk to first, though- talk to the PD in the new specialty to see if a spot in their program might be a possibility? Or talk to my PD first to see if he can pull some strings? My hesitation is in talking to my PD before I know whether getting a spot in the new specialty is a possiblity- I'm worried that I wouldn't be able to get a spot, and that my current PD would have already given away my 2nd year gen surg spot, leaving me with nothing. Any advice? If it makes a difference, I'm in good standing in my program and would have no trouble getting a letter from my current PD, and the specialty I'd like to switch to is one where I'd need to repeat an intern year.

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[leagueelbow]

I'm a categorical gen surg intern, thinking about switching to another specialty. Since it's late in the year, I think I need to talk directly to the program director in the specialty I'd like to switch to, rather than just applying through ERAS. I'm not sure who to talk to first, though- talk to the PD in the new specialty to see if a spot in their program might be a possibility? Or talk to my PD first to see if he can pull some strings? My hesitation is in talking to my PD before I know whether getting a spot in the new specialty is a possiblity- I'm worried that I wouldn't be able to get a spot, and that my current PD would have already given away my 2nd year gen surg spot, leaving me with nothing. Any advice? If it makes a difference, I'm in good standing in my program and would have no trouble getting a letter from my current PD, and the specialty I'd like to switch to is one where I'd need to repeat an intern year.

1) Are you sure you've given it enough thought? Having been through a prelim surgery year myself, I know it's miserable but things can get better as you progress.

2) What are you planning to switch into? I think it complicates issues if you go from surgery to one of those uber-competitive fields as you already indicated, you could be left holding nothing.

3) All being said, I would speak with your PD first. Without his/her consent, switching won't be easy and some PD's would be offended if you looked elsewhere first.

 

[mules05]

1) Are you sure you've given it enough thought? Having been through a prelim surgery year myself, I know it's miserable but things can get better as you progress.

I've given it a lot of thought. It's been a very tough decision for me because I've actually been really happy this year- this isn't something that's coming from having a tough intern year or being burned out. It's more a question of looking at what I want to do long-term, and being unable to find an avenue to do that through surgery.

2) What are you planning to switch into? I think it complicates issues if you go from surgery to one of those uber-competitive fields as you already indicated, you could be left holding nothing.

Pediatrics. If I were to apply and go through the match I'd be a competitive candidate, but the problem is that it's late in the year, and I'm not interested in leaving the hospital I'm at right now, so I would be ranking only one program.

3) All being said, I would speak with your PD first. Without his/her consent, switching won't be easy and some PD's would be offended if you looked elsewhere first.

Fair enough. Our PD is very approachable and I can only imagine that he'll offer help, but I don't want to be the one with a non-renewed contract if a switch doesn't work out.

 

[ESU_MD]

changing specialities happens all the time. its not that big deal in the overall grand scheme of life. In fact, you are in good shape if you figured this out prior to wasting too many years doing something you dont want to do.

in real life though- your PD is gonna be really upset since he has alot of work to do now. but you have to let them know as soon as you can so they can get another person in time. of course you will be treated much differently in your program as soon as they find out your switching, but thats human nature. it happens all the time

 

[Winged Scapula]

Since you are limiting yourself to ONE program, what if your local Peds residency doesn't have a spot for you?

Obviously they can't promise you anything but you are eligible for a spot outside of the match. I frankly would talk to the Peds PD *first* and find out their thoughts. If they tell you there's no way they'll rank you (although I'm not sure why they would), then you have some thinking to do - do another year of gen surg, drop out and do nothing while applying for Peds, etc?

If you get some vague, non-commital but positive feedback from the Peds PD then its time to talk to your PD. Obviously this all has to be done within the next few days/week, given the constraints of the match. There are plenty of people out there who will take your spot but you want to give you PD enough notice to find someone quality.

 

[Buzz Me]

I don't understand - you love surgery but don't like the foreseeable future? Is it residency duration? Fellowship options? Lifestyle? Family/kids?

 

[mules05]

I don't understand - you love surgery but don't like the foreseeable future? Is it residency duration? Fellowship options? Lifestyle? Family/kids?

I like being a surgery resident- this year has been great. However, while in med school I was heavily involved in a free clinic seeing mainly children. I thought I loved surgery enough to give that up; at this point, however, I've realized that I miss seeing children in a primary care setting and that while I love procedures, being in the OR no longer holds the same appeal for me. I've spent a long time trying to find a way to be involved with underserved populations and to deal primarily with children through surgery. Unfortunately, due to the lifestyle of surgery, there's little to no time to be involved in outreach. In addition, if you offer care to the underserved as a surgeon, you're unable to provide the long-term care that this population requires. The closest things I could think of in surgery were either peds surgery or just peds critical care, both of which offer the opportunity to work with kids, but with those you're subspecialized and less able to do any outreach. On the other hand, I've also thought about doing trauma/general surgery at a county hospital, where you get the care for the underserved populations, but a)few kids and b)I don't like trauma. So, long explanation, but the conclusion I've come to from all that is that I'd be limiting myself in one way or another from what I'd really like to do by continuing in surgery.

 

[smq123]

Obviously they can't promise you anything but you are eligible for a spot outside of the match. I frankly would talk to the Peds PD *first* and find out their thoughts.

Given the timing, would there be any benefit/disadvantage to emailing both PDs at the same time?

However, while in med school I was heavily involved in a free clinic seeing mainly children. I thought I loved surgery enough to give that up; at this point, however, I've realized that I miss seeing children in a primary care setting and that while I love procedures, being in the OR no longer holds the same appeal for me. I've spent a long time trying to find a way to be involved with underserved populations and to deal primarily with children through surgery.

mules05 - That sounds like a very valid reason to switch out of surgery, and I wish you the best of luck.

However, is the peds residency program at your current hospital "outreach friendly"? Or do they have a reputation for churning out future PICU/cards/neonatology fellows who do a lot of research? As you're already aware, each program has a different culture, and the one at that particular program may not focus heavily on community outreach.

I can tell you that, even as a resident in a primary care field, it's hard to find time to do outreach. It's easier than it is for surgery, clearly (particularly because it's actually built into our curriculum), but it's still a time crunch. I can't imagine what it would be like if I were at a place that had less of a focus on community outreach. Have you talked to the peds residents at your hospital to see if their program's culture is compatible with your goals?

 

[Winged Scapula]

Given the timing, would there be any benefit/disadvantage to emailing both PDs at the same time?

My concern would be, "what's Plan B". Say mule approaches both PDs and the Peds PD says "no spot for you" and Surg PD says "since you want to be a pediatrician so badly, I'm not renewing your contract". If he truly only can stay at his local program and won't apply elsewhere, I'd speak to the Peds PD first to see if its a possibility at all. Otherwise he risks losing his Surg spot. If mule doesn't care and is prepared to take a year off (ie, if his surgery contract isn't renewed and he doesn't find a position for next year), then it probably doesn't make any difference.

mules05 - That sounds like a very valid reason to switch out of surgery, and I wish you the best of luck.

However, is the peds residency program at your current hospital "outreach friendly"? Or do they have a reputation for churning out future PICU/cards/neonatology fellows who do a lot of research? As you're already aware, each program has a different culture, and the one at that particular program may not focus heavily on community outreach.

I can tell you that, even as a resident in a primary care field, it's hard to find time to do outreach. It's easier than it is for surgery, clearly (particularly because it's actually built into our curriculum), but it's still a time crunch. I can't imagine what it would be like if I were at a place that had less of a focus on community outreach. Have you talked to the peds residents at your hospital to see if their program's culture is compatible with your goals?

Good points above.

I'd venture that being a surgeon is an excellent way to treat underserved populations. As a matter of fact, some of most active surgeons I know doing things like MSF are pediatric surgeons - doing congenital hearts, faces, urogenital anomalies, and run of the mill things like hernias. I know other surgeons doing local outreach and education in terms of safety/trauma avoidance. I think it a fantastic way to serve your interests.

Quit surgery if its really what you want to do but I'm not sure I'm convinced that you can't do what you are looking for.

 

[JackADeli]

I'm a categorical gen surg intern, thinking about switching to another specialty...

I've given it a lot of thought. ...It's more a question of looking at what I want to do long-term, and being unable to find an avenue to do that through surgery...Pediatrics...

I don't understand - you love surgery but don't like the foreseeable future?...

I like being a surgery resident- ...while in med school I was heavily involved in a free clinic seeing mainly children. I thought I loved surgery enough to give that up; ... I miss seeing children in a primary care setting ... I've spent a long time trying to find a way to be involved with underserved populations and to deal primarily with children through surgery. Unfortunately, due to the lifestyle of surgery, there's little to no time to be involved in outreach. In addition, if you offer care to the underserved as a surgeon, you're unable to provide the long-term care that this population requires...

...I'd venture that being a surgeon is an excellent way to treat underserved populations...

Quit surgery if its really what you want to do but I'm not sure I'm convinced that you can't do what you are looking for.

Being a surgeon to an underserved US community often has some of the most lucrative employment offers... You can also be a surgeon to underserved and NOT accept income if you want to serve more from the heart... Further, there are numerous organizations that beg for surgeons to travel abroad, volunteer, provide true "rural surgery" care.... I think there is a rural surgery organization in USA... do a google search.

To the OP, I appreciate the desire to serve the underserved. I encourage you.... but please, do not suggest or imply that being a surgeon precludes service to this communities. It's not just naive... but naivity that insults. How much outreach one does as a surgeon is really up to you.

I just don't see this as surgery = NO outreach & pediatrics = large outreach. Actually I see this more like, "I want to be a primary care physician". That is fine and admirable. But, please do not cloud that decision in false ideas of inability to provide outreach, longterm care needs for underserved, etc.... I suspect your current position/situation is a result of such cloudy and misguided ideas... thus, you somehow convinced yourself you wanted 5 years general surgery residency even though your love was volunteer, free, pediatric outreach clinics.

JAD

PS: I know plenty of pediatricians with "worse" lifestyles then local surgeons... Often too busy meeting demands of clinic overhead to join the surgeons for the local shelter visit and volunteering...

 

[mules05]

Being a surgeon to an underserved US community often has some of the most lucrative employment offers... You can also be a surgeon to underserved and NOT accept income if you want to serve more from the heart... Further, there are numerous organizations that beg for surgeons to travel abroad, volunteer, provide true "rural surgery" care.... I think there is a rural surgery organization in USA... do a google search.

To the OP, I appreciate the desire to serve the underserved. I encourage you.... but please, do not suggest or imply that being a surgeon precludes service to this communities. It's not just naive... but naivity that insults.

JAD

I apologize if anyone felt insulted; all I was trying to do was answer a question that I was asked about my reasons for switching which, frankly, is no one else's business and irrelevant to the question I posted. My question was regarding the logistics of switching- not whether anyone thought I had valid reasons for wanting a change.

Further, if you read my post, my point is that I'm looking for a way to both work with kids AND provide outreach care- and that I miss several aspects of primary care. I'm well aware that there are many ways to serve various underserved populations through surgery- I even mentioned some above. No one is trying to say or imply that surgeons cannot or do not provide service to their communities in many ways. The fact that you jumped to this conclusion suggests that this is a touchy subject for you, though.

 

[JackADeli]

...The fact that you jumped to this conclusion suggests that this is a touchy subject for you, though.

Actually, outreach and/or the underserved is NOT a touchy subject for me. Those that know me and/or have had interactions with me on these forums have probably picked up what the touchy subject is.... It's folks that try to cover and cloud the decisions THEY make and choices they CHOOSE. You could be crying about psychiatry counseling for all anyone cares. The point is, for some reason, you loved the pediatrics and PRIMARY CARE and thought you could ~give that up for what exactly???? Now, you are asking about changing to pediatrics/primary care and trying to explain it by suggesting/implying/ and/or saying it's because you can not provide longterm care and do outreach as a surgeon. Long and short, it sounds like you chose residency poorly in the first place. You want to do primary care. Great, so do it. Start using some cold, hard reasoning without rationalizing your decisions. I think the rationalizing is what got you into surgery as opposed to primary care to begin with

I apologize if anyone felt insulted...

No apologies required.... Though I encourage a great deal more growth and honest analysis of reality....

...my point is that I'm looking for a way to both work with kids AND provide outreach care- and that I miss several aspects of primary care...

I got that... I think it came clear in your post and my response.

... No one is trying to say or imply that surgeons cannot or do not provide service to their communities in many ways...

I think you have stated and/or implied that surgery/surgeons can NOT provide outreach and/or longterm care for the underserved....

I like being a surgery resident... Unfortunately, due to the lifestyle of surgery, there's little to no time to be involved in outreach. In addition, if you offer care to the underserved as a surgeon, you're unable to provide the long-term care that this population requires...

Regards and best of luck.

 

[mules05]

Start using some cold, hard reasoning without rationalizing your decisions. .

Did you read the original post? I asked a simple question- talk to person A or person B first. Maybe I want to switch because I heard peds nurses are hotter than the surgery nurses. Maybe it's because I like the food in the cafeteria at Children's better than the University. The point it, it doesn't matter. What specialty I chose to start in and what specialty I ultimately become board certified in are my decision and mine alone. No one cares whether you think I have valid reasons or not. If you have no insight on the question at hand, feel free to ignore the thread. Thanks.

 

[JackADeli]

Did you read the original post? I asked a simple question- talk to person A or person B first....

Yes

...Maybe I want to switch because I heard peds nurses are hotter than the surgery nurses. Maybe it's because I like the food in the cafeteria at Children's better than the University. The point it, it doesn't matter. What specialty I chose to start in and what specialty I ultimately become board certified in are my decision and mine alone. No one cares whether you think I have valid reasons or not...

Now someone is feeling a little bit touchy. It seems you might care...

You CHOSE to provide rationalizations. Any of our business? No. Again, you CHOSE. Thus, I have chosen to point out your expressed, IMHO, poor thought process.

Regards, and best of luck.