Another strange quitting scenario, need advice please

[MilesWell]

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So here goes, I'll try to make this quick. Would appreciate legitimate advice. This is likely going to sound nuts, but I assure you, I'm just a person who thought I was doing the right thing...

I started residency #1 right out of medical school. Wasn't convinced it was the best choice for me, but was a stable choice with lots of career options. Throughout year one, I dreamed of career #2...I really thought I wanted to do career #2. I completed my internship year, went through the match again, and was lucky to receive residency #2 at my first choice location.

Well, now I'm in residency #2 and I am in complete misery. I mean, the kind of misery I wouldn't wish upon my worst enemy. I very clearly made a huge mistake. Believe me, I am just as befuddled as you that I feel this way. I put everything into obtaining that second residency and now I feel like a complete idiot. I already informed my PD about how I was feeling. So far, it doesn't seem as if there is going to be any easy way out.
I am so unhappy that I am considering quitting even if it means I am not officially "let go" by residency #2, and even if it means I may never get another residency again...that's how crappy I feel about my life on a day to day basis.

So, the advice I'm looking for...Is there any hope of me ever getting back into residency #1? I would be willing to go anywhere, and I would be a 2nd year in that discipline. Is there any chance of finding a 2nd yr spot before June of 2011? And if so, realistically what am I going to do in the meantime..with my massive loans? a job? my apt? Can I moonlight? I've passed all 3 Steps and have an intern year completed already...

Obviously, lost and confused...and regretting my decision to switch.

 

[gutonc]

So here goes, I'll try to make this quick. Would appreciate legitimate advice. This is likely going to sound nuts, but I assure you, I'm just a person who thought I was doing the right thing...

I started residency #1 right out of medical school. Wasn't convinced it was the best choice for me, but was a stable choice with lots of career options. Throughout year one, I dreamed of career #2...I really thought I wanted to do career #2. I completed my internship year, went through the match again, and was lucky to receive residency #2 at my first choice location.

Well, now I'm in residency #2 and I am in complete misery. I mean, the kind of misery I wouldn't wish upon my worst enemy. I very clearly made a huge mistake. Believe me, I am just as befuddled as you that I feel this way. I put everything into obtaining that second residency and now I feel like a complete idiot. I already informed my PD about how I was feeling. So far, it doesn't seem as if there is going to be any easy way out.
I am so unhappy that I am considering quitting even if it means I am not officially "let go" by residency #2, and even if it means I may never get another residency again...that's how crappy I feel about my life on a day to day basis.

So, the advice I'm looking for...Is there any hope of me ever getting back into residency #1? I would be willing to go anywhere, and I would be a 2nd year in that discipline. Is there any chance of finding a 2nd yr spot before June of 2011? And if so, realistically what am I going to do in the meantime..with my massive loans? a job? my apt? Can I moonlight? I've passed all 3 Steps and have an intern year completed already...

Obviously, lost and confused...and regretting my decision to switch.

Assuming you left Residency #1 on good terms with your PD, you should be on the phone with him/her first thing tomorrow morning to discuss this. That's your best chance to get a 2nd year spot. There's no way to "Match" into a 2nd year position in a categorical residency but you could go through the Match again and start life over as a PGY1 (for the 3rd time). If you're lucky, your PD might let you move up halfway through the year.

But it's going to be difficult to find another PD to give you a 3rd chance since it looks like you are commitment-phobic.

 

[ANCAdoc]

What field did you go from and now into? At the time, what aspects about residency #2 made you want to do it? And now, why the change?

 

[turquoiseblue]

It depends on a few factors:

Whether you're a US grad
What your board scores were
What specialty residency #1 was

US grad with high board scores likely has the best chance of being able to get back in a previous specialty.

At least you stayed through intern year in residency #1, so maybe you can start applying to PGY2 positions in residency #1, (if it is IM you'll find very few PGY2, but i've seen them on findaresident.com...FP is more abundant) or even just reapply in the match for a PGY1 spot all over again (the biggest chance of getting back in).

You would have to formulate a really good personal statement in which you write about how you dreamed of the wrong specialty and want to go back to where you were before and how you would never make the same mistake ever again. Also, if you don't get anything in the meantime, do rotations in the specialty of choice or do research in the field of interest. those can help reinforce your love for residency #1.

Good luck in securing a position in residency #1!

P.S. you can get licensed , since you have step 3 and an intern year (if you are a US grad u can do this with one year behind you..u can only get into wisconsin if you are an FMG/IMG) [check fsmb.org on initial licensure], and get a job moonlighting doing h&p's somewhere or work for an insurance company, etc. some start up their own out of pocket pay practice. there are also jobs on cruiseships where you inject botox, pay pretty well 8 months at a time. not much, but something's better than nothing and they do pay better than most regular jobs out there. also there is this site: nonclinicaljobs.com/p/search-jobs.html where you can find some jobs for MD's.

 

[shopsteward]

If you drop out of a second residency, after having put so much effort into changing, the big question I would be asking is "do you actually want to work as a doctor at all?" (It's a question which has some sub-sets: for instance, your problem may be not that you don't want to work as a doctor, but that you do not want to be a resident.)

If you do want to be a doctor, then the most certain way of achieving that goal may be to stay with the residency you've currently got. But that is only do-able if you can make your current residency compatible with your mental health, so that you can cope personally and succeed professionally until the residency is completed. So I think your first action should be to work out whether there is a way to do that, and what help is available to do that (if there is help available this is not the moment to turn it down - talk to your family, to your own doctor, to the person provided by your program to be on the side of the residents (i.e. not the program director)). If you can complete your existing residency, you have options after that as to where your career as a doctor goes.

If you wanted to go for a second change in residency, I think you may have a pretty hard job persuading someone to take a chance on you over all the other people competing for a chance at that residency. You will I think need to be able to tell a coherent story which explains exactly why you want that residency, why your two previous residencies didn't take, and why there are no other concerns about you not completing this third residency (eg all the possible points about not wanting to be a doctor, not being able to cope with residency, not going to change your mind again, etc).

In order not to have an uncomfortable gap in your CV, you may also need to be able to get decent references from your current residency (either for your new residency application or for some other job), so you will need to keep them onside to that extent, at least.

Good luck with whatever you decide.

 

[lipomas]

If I was reading this as a program director my first thought would be that there would be a 90% chance you would flake out again if I took you back, or that you would be unable to complete your residency for some reason. So I would be very hesitant to take you back.

Thus, you have to address this. You have to show somehow that you are certain of what you want (not that you think this is the best of many bad options, or that you think you might be ok if you continued). You also have to decide what you want and stop wasting time hoping that things will magically become clear to you. If you have to take time off and start over, so be it.

 

[Rendar5]

2 questions you should consider:

1. Is it the residency that is making you miserable or a depressive disorder?

2. If you completed residency, would you love your field as an attending?

 

[Buzz Me]

Are you as sure about this third residency as you were about the second? Have you had decision-making problems like this in the past (choosing a major in college, changing test dates for MCAT/Step 1, deciding which field to initially go into during med school, etc.)? What exactly is the problem each time? The field you're in? The hospital/location? Your coresidents? Faculty? Lifestyle? Distance from family?

 

[JaggerPlate]

It depends on a few factors:

Whether you're a US grad
What your board scores were
What specialty residency #1 was

US grad with high board scores likely has the best chance of being able to get back in a previous specialty.

At least you stayed through intern year in residency #1, so maybe you can start applying to PGY2 positions in residency #1, (if it is IM you'll find very few PGY2, but i've seen them on findaresident.com...FP is more abundant) or even just reapply in the match for a PGY1 spot all over again (the biggest chance of getting back in).

You would have to formulate a really good personal statement in which you write about how you dreamed of the wrong specialty and want to go back to where you were before and how you would never make the same mistake ever again. Also, if you don't get anything in the meantime, do rotations in the specialty of choice or do research in the field of interest. those can help reinforce your love for residency #1.

Good luck in securing a position in residency #1!

P.S. you can get licensed , since you have step 3 and an intern year (if you are a US grad u can do this with one year behind you..u can only get into wisconsin if you are an FMG/IMG) [check fsmb.org on initial licensure], and get a job moonlighting doing h&p's somewhere or work for an insurance company, etc. some start up their own out of pocket pay practice. there are also jobs on cruiseships where you inject botox, pay pretty well 8 months at a time. not much, but something's better than nothing and they do pay better than most regular jobs out there. also there is this site: nonclinicaljobs.com/p/search-jobs.html where you can find some jobs for MD's.

Botox on a cruise ship!!?? That sounds freaking awesome.

 

[MilesWell]

Thanks to all of those who replied to my post and didn't completely flame me. I know my scenario sounds ridiculous...but just to clarify a few things...

I am a US grad with above avg board scores and grades. I did have a little trouble deciding which field to go into from med school. Medicine vs. surgery. I am currently in a surgery residency which is making me miserable beyond misery...I am close to family and friends, so that is not the issue. I did not completely hate my intern year, which was medicine, but truly thought I would be happier as a surgeon. I wanted to be more hands on and truly thought I was missing the OR. Of course, now that I switched, I feel I made a huge mistake. I feel like I was much better at medicine, and the thought of working as a surgeon for the next 30 years is now an impossibility for me.

Of course I feel like a complete fool and realize how this may not be correctable, but I can't continue doing something that makes me this unhappy every day. I am not clinically depressed, I even went to the hospital counselor at the request of my PD, but I feel like I will be if I stay in this mess.

In general I am a very hard worker and my Chairman even complemented me on being a great intern (even after I told him I was quitting),,,At this point, I am so stressed that I don't feel like I am going to make it through the year, even though I know the best thing is to fulfill my obligation and stay for the contract.

I am not commitment phobic and I DO want to work as a physician, but I realize how flaky this makes me appear. Still struggling, and don't know how to make this right. Just want to go back to working in IM, finish my last two years and possibly do critical care since I really enjoyed it last year (and it seems like a good mix of medicine with small procedures and higher acuity).

I know that leaving now will leave me jobless for a while and I am terrified about student loans etc...but I just want out so badly...Not sure how to bow out gracefully or what to do at this point. The program is fantastic, I just don't belong in it.

 

[peppy]

You could try switching into Anesthesiology and then going on to Critical Care from that.
You can plausibly claim that you struggled between medicine and surgery because of your attraction to the acute issues/small procedures stuff and that now you've come to the epiphany that anesthesiology is the path to your true love. I suspect that you would get more decent programs to consider you going that path than trying to switch *back* into IM (though I do think you could get into IM again due to the sheer number of programs out there and the fact that many aren't that competitive).

 

[generalist]

Doesn't sound that strange from where I am sitting. There are currently 4 residents in my program who have done the medicine-surgery-medicine dance (5 if you count my chief who just graduated). Two even took time off between internships to start a family. My only suggestion is to figure out what lured you to surgery and how your reality has differed from that. Some aspects you can change, some you can't. Some things you get used to; some get better after internship or residency. But I would say if you have considered everything and still want out, then make it a clean break (i.e. no trying to finish out the year). Only reason I say that is because from the moment my aforementioned co-residents above announced their intention to leave their old programs, their lives became infinitely more unpleasant. Best of luck.

 

[dragonfly99]

Internal medicine is not that competitive. You will be able to get back in somewhere decent as long as your old IM program director, or your new surgical one, doesn't say something bad about you. Can't you just go back to your old IM program? Or switch to IM at the end of this year at your new hospital?

I wouldn't announce your intention to leave surgery for a couple more months yet, but start quietly looking for ways to get an IM spot for next July. I do think you'll have to address the issue of whether you are flaky/indecisive, but I think your reasoning is actually O.K. IM residency can be painful, but fellowship is better...if you like procedures then do GI, cards or pulm/critical care.

Personally I think it would be a very bad idea to bail on your surgical internship part way through the year. It just makes you look flaky, like someone who can't honor his obligations. I know it sucks being an intern again, but quitting might make you look weak and immature.

 

[mTOR]

There are currently 4 residents in my program who have done the medicine-surgery-medicine dance

Welcome to the miserable hell that is a Surgery.

Boggles the mind how people aren't convinced by the epic suckage of the field when they rotate in it as a 3rd year. More power to those with skin thick enough to tolerate the day to day crap of a surg residency to follow their dreams.

Best of luck to the OP.

 

[maceo]

Thanks to all of those who replied to my post and didn't completely flame me. I know my scenario sounds ridiculous...but just to clarify a few things...

I am a US grad with above avg board scores and grades. I did have a little trouble deciding which field to go into from med school. Medicine vs. surgery. I am currently in a surgery residency which is making me miserable beyond misery...I am close to family and friends, so that is not the issue. I did not completely hate my intern year, which was medicine, but truly thought I would be happier as a surgeon. I wanted to be more hands on and truly thought I was missing the OR. Of course, now that I switched, I feel I made a huge mistake. I feel like I was much better at medicine, and the thought of working as a surgeon for the next 30 years is now an impossibility for me.

Of course I feel like a complete fool and realize how this may not be correctable, but I can't continue doing something that makes me this unhappy every day. I am not clinically depressed, I even went to the hospital counselor at the request of my PD, but I feel like I will be if I stay in this mess.

In general I am a very hard worker and my Chairman even complemented me on being a great intern (even after I told him I was quitting),,,At this point, I am so stressed that I don't feel like I am going to make it through the year, even though I know the best thing is to fulfill my obligation and stay for the contract.

I am not commitment phobic and I DO want to work as a physician, but I realize how flaky this makes me appear. Still struggling, and don't know how to make this right. Just want to go back to working in IM, finish my last two years and possibly do critical care since I really enjoyed it last year (and it seems like a good mix of medicine with small procedures and higher acuity).

I know that leaving now will leave me jobless for a while and I am terrified about student loans etc...but I just want out so badly...Not sure how to bow out gracefully or what to do at this point. The program is fantastic, I just don't belong in it.

are you kidding me? you should be able to find another medicine residency in a freakin afternoon of cold calling. not a problem dude really not a problem

 

[Buzz Me]

Internal medicine is not that competitive. You will be able to get back in somewhere decent as long as your old IM program director, or your new surgical one, doesn't say something bad about you. Can't you just go back to your old IM program? Or switch to IM at the end of this year at your new hospital?

What's going to happen to the OP's CMS funding? Will he/she be down to just one more year?

 

[gutonc]

What's going to happen to the OP's CMS funding? Will he/she be down to just one more year?

Yes, but CMS funding is not that big of an issue.

After your eligibility runs out, it goes from 100% DME*/100% IME* to 50% DME/100%IME. In practical terms, this means that CMS reimbursement goes from 100% of what you cost the program to 70-80%. In the grand scheme of things, not that big of a deal for a qualified applicant. And this is what all fellowship programs get for their trainees as well.

*DME = Salary + Benefits
*IME = Everything else it costs to train a resident which is roughly equal to your salary

 

[snowbank]

Interesting scenario. I agree spot on with most of the posts (esp. about sounding, though not necessarily being, commitment phobic, but also about contacting your PD of the first program as the best scenario, figuring out exactly what you want to say in interviews), and have some additional thoughts:

- Considered ophthalmology, with that nice balance of both medicine and surgery? Or GI fellowship after internal medicine?
- Sounds like you're an above average applicant with good scores and a hx of hard work, shouldnt be too hard to get good LoRs from ur 2 programs
- Sign up on residentswap and findaresident websites for random PGY2 vacancies that open up, and apply there. ERAS is only for PGy 1, correct?
- Calling up ur old programs is best: in my program, one resident got his wife into the program by scrounging around some add'l funding (stil not sure how that happened) but also - a prelim - who applied again for residency - didnt match - and asked PD to stay on as a categorical - and the PD agreed.

Hope this helps....

 

[dl2dp2]

are you kidding me? you should be able to find another medicine residency in a freakin afternoon of cold calling. not a problem dude really not a problem

I suspect any random spot that opens up might pose problems in terms of malignancy etc. On the other hand, even (perhaps especially?) the best programs often have people, sometimes in substantial number, dropping out after internship to go into alternative careers. If you want to go back to IM I don't think it'll be hard if you can suck it up for 2 more years.

 

[dragonfly99]

Make a list of IM programs you would like to join and start cold-calling them to see if they have any PGY2 openings. Even the good programs have things open up because sometimes or they decide to expand the residency, or someone bails out to do a research year, or switch to neurology or radiology, etc.

 

[turquoiseblue]

in addition to outside open spots, why not apply for ERAS/NRMP right now? it is going on as we speak.....that is the biggest chance to get back into a program....apply soon before it is too late...

 

[DrJosephKim]

There are too many variables in place. Was the first residency a competitive residency? Are you limited in where you can live? What types of letters of recommendation can you get?

 

[Luv2Cut]

MilesWell

I know you are miserable right now, but look at it this way, if you at least finish the year out it will be good for you. Trust me. Any kind of training you do help you even if you go to another specialty. You'll be known at the IM doc that did a year of a surgery.

In fact, I recall someone in my residency that did the same thing. This person was my assigned mentor (as a side note, I didn't see him much or get much advice but I know I can call on him if I needed anything even today). He was miserable in his first year of surgery and transferred to FM. Of course he repeated his PGY-1 in FM but he was a freakin' stud for procedures. He already had good numbers for most hospital procedures his classmates were working to get. He, in fact, designed his electives around critical care emphasis. When he finished residency he obtained privileges at a couple of hospitals in town and was a the "go to guy" in the ICU. If any of the IM docs, surgeons needed help in the ICU he was the man. He didn't go the outpatient FM track. He became a critical care hospitalist and he had the resume to back it up, all this from doing his year of surgery and transferring to FM.

You obviously are a smart person or you wouldn't be in surgery right now. Think of how you benefit your future IM patients. You will have performed or assisted a good amount of surgeries your pts will undergo. You have a leg up because you see it from the surgeons point of view. You are better equipped to manage your pt in their post-operative course if need be. Also, you'll learn to make an appropriate surgery referral. You won't be on of those docs that the surgeons curse because you sent them some BS consult. Take the blinders off and see what you got right now. Your sitting on a gold mine and don't see it.

I say stick it out and finish the year, its still early. Who knows you may "turn the corner" in a few months and see that maybe you were born to do this.

 

[medgrunt]

Dropped you a PM. write me - i want to know what developed in the end

 

[Top Gun]

I have a question. You previously did an internship in medicine, and now you're doing one in surgery. Are you sure that its the specialty that's making you miserable, and not internship? Internship sucks far beyond anything else you've ever had to do. As an intern, I was tempted to quit at least once or twice a day. Once you get into the second year, you begin to enjoy residency more. Maybe its not really surgery per se that's making you miserable, but rather being an intern. If that's the case, I would stick out the year. Once you become more efficient, you may find that you actually enjoy surgery, and will wonder why you wanted to quit in the first place.

 

[Bigbote]

I'm very curious how this turned out.

 

[gutonc]

I'm very curious how this turned out.

This thread was started 2 years ago by somebody who only has 2 posts (both in this thread). The likelihood that s/he even remembers doing so are slim so I wouldn't hold your breath for any sort of resolution.

Statistically speaking though, the answer to your question is "poorly."