Almost done with residency but want to switch to PM&R

[ctsurgburner]

I'm in the back half of an integrated thoracic surgery residency. I've realized I don't want to live in the hospital. There aren't really options in this field or with my board certification (thoracic surgery, no gen surg boards) to go part time and I don't want to do locums work. And honestly, part of me is over surgery in general. I'd be ok not having to make critical life or death decisions on post ops in the middle of the night anymore. I don't need to make 800k and I don't need prestige, I just want a career that allows me to provide a comfortable life for my family and gives me the ability to enjoy life with them. PM&R always seemed interesting and drew my attention for a bit in med school before I decided to chase surgery. That said, I never had any rotations in the field so true exposure is limited. But I like doing procedures and would prefer being in the more subacute/chronic or outpatient setting. Turns out I don't hate clinic as much as I did as a med student. Seriously considering the switch to PM&R. Pipedream? Anything else I should consider before accepting my current fate?

---

Members don't see this ad.

 

[DrMetal]

I'm in the back half of an integrated thoracic surgery residency. I've realized I don't want to live in the hospital. There aren't really options in this field or with my board certification (thoracic surgery, no gen surg boards) to go part time and I don't want to do locums work. And honestly, part of me is over surgery in general. I'd be ok not having to make critical life or death decisions on post ops in the middle of the night anymore. I don't need to make 800k and I don't need prestige, I just want a career that allows me to provide a comfortable life for my family and gives me the ability to enjoy life with them. PM&R always seemed interesting and drew my attention for a bit in med school before I decided to chase surgery. That said, I never had any rotations in the field so true exposure is limited. But I like doing procedures and would prefer being in the more subacute/chronic or outpatient setting. Turns out I don't hate clinic as much as I did as a med student. Seriously considering the switch to PM&R. Pipedream? Anything else I should consider before accepting my current fate?

Don't be silly. Finish your residency. Be a surgeon. As an attending, you can call the shots, work as much or as little as you want. You're not going to 'live in the hospital', don't be so dramatic. You will certainly work in a hospital, but just consider that your place of work.

And most decisions are not 'life or death'. And if patients die, they die; they were most likely on that trajectory to begin with, rarely your fault. Document appropriately.

PMR is a bleak world. Mostly psychosomatic symptoms that we pretend to be real, treated with extensively un-necessary protocols (excessive PT, 'functional restoration programs', acupuncture), etc. It's a night and day different from CT surgery.

 

[ctsurgburner]

Of course it's different, that's the point. I'm over the high acuity patient population. I don't want to be 55 and coming in in the middle of the night to do a dissection. Even if it's once a month, that's more than what I want to do (yes I know, not every center does dissections but there will always be some sort of emergencies that require surgery). I don't want to play for such high stakes any more.

And while I may have been a bit dramatic, it's not quite so simple as "As an attending, you can call the shots, work as much or as little as you want." Most jobs whether they be academic or private require a certain level of productivity. In the private practice setting it can be quite high and in the academic world you have other responsibilities. Plus, even if it were this simple, I still wouldn't be escaping the above problems.

 

[DrMetal]

Of course it's different, that's the point. I'm over the high acuity patient population. I don't want to be 55 and coming in in the middle of the night to do a dissection. Even if it's once a month, that's more than what I want to do (yes I know, not every center does dissections but there will always be some sort of emergencies that require surgery). I don't want to play for such high stakes any more.

And while I may have been a bit dramatic, it's not quite so simple as "As an attending, you can call the shots, work as much or as little as you want." Most jobs whether they be academic or private require a certain level of productivity. In the private practice setting it can be quite high and in the academic world you have other responsibilities. Plus, even if it were this simple, I still wouldn't be escaping the above problems.

ok, fair points. how far along are you? coming in in the middle of the night aint so bad if you have the rest of the week off. Mid-week golf tee times are much easier to get.

 

[Centurion38]

What about Anesthesiology? You'd get credit for surgical internship. More adjacent to your current experience and pain is available (and currently easily obtainable) as a fellowship.

I don't think matching PM&R would be a problem either but general PM&R can buttonhole you into hospital or rehab facilities (with "call") and fairly limited clinic opportunities unless you do a sports/spine/pain fellowship.

General PM&R's- in general- don't do a lot of procedures. Perhaps joint injections. EMG/NCS.

Many aspiring surgeons leave the field to do Anesthesiology, whereas the jump to PM&R is certainly more rare.

Ultimately, a pain fellowship- from Anesthesiology or PM&R- might give you what you're seeking.

 

[NotAProgDirector]

Before you bail on T Surgery, you should explore being a surgeon at a community hospital. You may find the lifestyle is much more conducive. For example, we have some small community hospitals in our area that have GI docs there. But they don't scope at night. Ever. At all. They take no hospital call. if a patient shows up to their ED and needs urgent endoscopy, they get transferred to us. So you might be able to have a T Surgery practice that's M-F, elective cases only.

 

[ThoracicGuy]

Before you bail on T Surgery, you should explore being a surgeon at a community hospital. You may find the lifestyle is much more conducive. For example, we have some small community hospitals in our area that have GI docs there. But they don't scope at night. Ever. At all. They take no hospital call. if a patient shows up to their ED and needs urgent endoscopy, they get transferred to us. So you might be able to have a T Surgery practice that's M-F, elective cases only.

Only problem if the OP does cardiac surgery, then they will get the occasional aortic dissection that requires emergency surgery at night. I don't do hearts, so I have a much easier time with call. There's not many general thoracic emergencies that require an operation at night.

Now there are other options that the OP can do after being boarded, including running a vein clinic. There are CT surgeons out there that just do vein procedures now and that is purely M-F 8-5 work. But it just depends on what you want to do.

 

[ctsurgburner]

running a vein clinic

Can anyone elaborate more on this? I looked into it a little bit and saw ABVLM fellowships tied to a vein clinic where you do a one year fellowship and then are committed to one of their clinics for another three years. Anyone know anything about this, too?

 

[ThoracicGuy]

Can anyone elaborate more on this? I looked into it a little bit and saw ABVLM fellowships tied to a vein clinic where you do a one year fellowship and then are committed to one of their clinics for another three years. Anyone know anything about this, too?

I do some veins as a part of my job since my hospital wanted me to do them and I had capacity. It can be done as a sole job, but unless you get in with one of the big vein clinics out there, you'll have to do everything yourself. I don't know how good any of the deals are with these clinics.

 

[LucidSplash]

Working for a vein clinic tends to lead to doing a lot of veins, even if the patient doesn’t need their veins done. The reason for this is that the people who work for vein clinics are reimbursed based on the number of procedures they do. And if you only do one thing, and that one thing is the only way you make money, you tend to find a way to do that one thing on as many people as possible.

 

[operaman]

Another vote for finish the residency you’re in. You can always switch fields as an attending, but then you’d at least have the option to go back if you regretted it. Doing something before you finish cuts your options.

I work quite a bit with one of our thoracic surgeons here and she seems to have a really nice work life balance (no cardiac btw). If you only have a year or two left, maybe worth pushing through and seeing how attending life treats you before jumping ship.

And much easier to jump while making $800k in your gap application year!

 

[Slowpoke]

PM&R/Pain attending here. Grass is greener phenomena happened often in training for me. There are headaches of PM&R, just different kinds of headaches. It sounds like you're burnt out to me. If you continue to feel this way consistently, and for a longer period of time, feel free to PM me to learn more about PM&R. Agree with a lot of others here ---- finish your initial residency option if possible.

And also PM&R is not a "bleak world" as one poster mentioned, perhaps in his/her views.