Thanks for your question.I'm a psychiatrist - I completed residency training at a nationally respected US program. I had initially intended on doing a neurosurgery residency but bailed last minute out of lifestyle concerns. However, I can't shake the idea that neurosurgery is the right career for me, as evidenced by the fact that I read Greenberg before bed despite it's complete irrelevance to my current responsibilities or career endeavors. Now I'm 6 years out from medical school and considering going back. I'm in my early 30s and considering a major career change with a huge cut in wages for 7 years, etc. I've thought about this ad nauseum and I'm still here considering this. But is it even practical to think a psychiatrist's application would be considered for neurosurgery residency? I know there's no way to know without applying, but I've heard concerns from others that ACGME won't pay salary for a resident who has already matched and completed a separate residency, so the training program has to eat that cost and this makes a candidate such as myself much less appealing for a training program. Any thoughts on the above would be greatly appreciated!
It's a difficult decision. A career change in you early 30s is absolutely okay. It will most-likely have a lifetime earnings impact, but it's unlikely that you're going to be destitute. If you're able to practice into your mid to late 60s, I'd argue it's better to do something you enjoy for the next 30 years -- even if there's some short-term pain involved.
Unfortunately, what is going to make this potential transition difficult is residency funding (as you noted). Medicare caps payments to each hospital for resident training (the cap is based on the number of residents in the program in 1996). Additionally, Medicare will only pay full-fare for a physician's initial residency (up to 5 years). If a physician wants to do another residency, Medicare only pays 50% of the rate. That means a lot of residency programs don't want to take a physician that generates 50% when they could get a newly graduated physician at 100%. But if a residency program has an unfilled slot, they would rather take a doc at 50% than get 0%!Here is a detailed description from the AAMC on how Medicare payments work for Graduate Medical Education.
Before going further, I'd recommend getting in touch with each residency director and briefly state that you've been in practice and are looking to change to neurosurgery. Program directors are often dealing with many unique personnel issues and they may have visibility of options within their program that might not be available otherwise.
Hopefully this provides you some guidance. Let me know if you have other questions!