Can I quit FM Residency to move to Occ Med without problems?

[mcatwizard]

I have known I wanted to do Occ Med for years. I chose FM residency because I thought a full 3yrs of FM training would lend itself well to a career in Occ Med. that said, I have no interest in practicing FM and want to get on to Occ Med residency as soon as possible. I'm a PGY-1. Can I quit this program, work in wound care or occ med or something else not requiring BC for a year, and then apply to occ med without issues? Any opinions on this? Haven't spoken to PD about this but they know I've always been planning on OEM residency.

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[mcatwizard]

I have known I wanted to do Occ Med for years. I chose FM residency because I thought a full 3yrs of FM training would lend itself well to a career in Occ Med. that said, I have no interest in practicing FM and want to get on to Occ Med residency as soon as possible. I'm a PGY-1. Can I quit this program, work in wound care or occ med or something else not requiring BC for a year, and then apply to occ med without issues? Any opinions on this? Haven't spoken to PD about this but they know I've always been planning on OEM residency.

As a follow up, how will only having an intern year vs. completing a full FM residency with BC affect OEM employment opportunities long term?

 

[NotAProgDirector]

Occ Med is it's own, separate residency. If you've always known this is what you want to do, one might wonder why you didn't apply for it the first time?

In any case, Occ Med requires a PGY-1 elsewhere, usually starts as a PGY-2. You should absolutely complete your FM PGY-1. You would need to reach out to Occ Med programs to see if they have open PGY-2 spots to start in July. You could also just apply this year although it's very late. Worst case, you'd apply next year. You would either continue as an FM PGY-2 and apply, or you'd resign after your PGY-1, find something to do for a gap year or two, and apply in the match.

The main problem I see is if you don't get an Occ Med position. Then you have incomplete FM training, and getting back into a spot could be a real challenge.

 

[mcatwizard]

Occ Med is it's own, separate residency. If you've always known this is what you want to do, one might wonder why you didn't apply for it the first time?

In any case, Occ Med requires a PGY-1 elsewhere, usually starts as a PGY-2. You should absolutely complete your FM PGY-1. You would need to reach out to Occ Med programs to see if they have open PGY-2 spots to start in July. You could also just apply this year although it's very late. Worst case, you'd apply next year. You would either continue as an FM PGY-2 and apply, or you'd resign after your PGY-1, find something to do for a gap year or two, and apply in the match.

The main problem I see is if you don't get an Occ Med position. Then you have incomplete FM training, and getting back into a spot could be a real challenge.

I have some public health research and occupational medicine interest group experiences from med school, as well as having attended some conferences. Also have networked a bit with OM docs. Will those experiences help me secure an OM residency spot? I went into FM because I originally thought that practicing occ med with only a transitional/intern year prior to OM residency would limit my employment opportunities, but looking at job postings and people in the field, it seems like many are doing just fine without the extra two years of mostly unrelated FM training. Any folks in the field want to comment on the value of FM board cert in occupational medicine? Hoping im not making a mistake here but I'm obviously not loving my FM program, nor the location I'm in. If I can leave this program after finishing my PGY-1 and getting a license (and make 3-4x my resident salary while I wait for an OM residency spot) without hurting myself too badly in the long run, I think it will be worth the potential strife and awkwardness of leaving a categorical program. Obviously in hindsight I wish I would've applied for a 1yr internship but this is the situation I'm in now.

 

[DrMetal]

As a follow up, how will only having an intern year vs. completing a full FM residency with BC affect OEM employment opportunities long term?

Yes, severely so. You are much more employable (in general) as a primary care physician trained in FM. You'd be smart to train in FM first, then pursue OccMed as a second residency or do it via certifications.

Once you're a primary care physician, you can do OccMed (even if you didn't do the OccMed residency). You can get certifications in particular physical exams (DOT, FAA, etc), you can opine for insurance companies. And if you're trained in a primary care specialty, if you decide you don't like OccMed, you have something to fall back on. The same is not true if you're soley trained in OccMed.

 

[LucidSplash]

I can’t understand this rash of posters asking, essentially, “if I quit my job and leave it in the lurch for <not very good reason>, will this affect my ability for another job to hire me, given that I will need support from the old job to get the new job?”

 

[DrMetal]

I can’t understand this rash of posters asking, essentially, “if I quit my job and leave it in the lurch for <not very good reason>, will this affect my ability for another job to hire me, given that I will need support from the old job to get the new job?”

What's even more alarming is the rash of (I presume) young posters who are trying to avoid any traditional (and frankly, more meaningful) medicine (primary care, surgery) . . . and instead are trying to pursue these 'softball' specialties.

 

[LucidSplash]

What's even more alarming is the rash of (I presume) young posters who are trying to avoid any traditional (and frankly, more meaningful) medicine (primary care, surgery) . . . and instead are trying to pursue these 'softball' specialties.

Honestly, I don’t care if they want to do it. If there’s an open job position then it’s a physician job that needs to be filled. To each their own. But like, “dance with the fella who brang ya”. Or at least stay for the whole dance before trying to get a different date for a different dance.

 

[mcatwizard]

Yes, severely so. You are much more employable (in general) as a primary care physician trained in FM. You'd be smart to train in FM first, then pursue OccMed as a second residency or do it via certifications.

Once you're a primary care physician, you can do OccMed (even if you didn't do the OccMed residency). You can get certifications in particular physical exams (DOT, FAA, etc), you can opine for insurance companies. And if you're trained in a primary care specialty, if you decide you don't like OccMed, you have something to fall back on. The same is not true if you're soley trained in OccMed.

Obviously I'd be more employable because I could fall back on primarily FM jobs, but I don't want a primarily FM job. I'm wondering what the impact would be on employability for OM BC required jobs that are truly OEM - corporate medicine, clinical occupational medicine, environmental medicine, nonclinical OEM gigs, public health, consulting, medicolegal work, etc. I just want good OEM specific training, and spending 5 PGY years total (2 of them in mostly useless FM training) seems unnecessary for these roles as long as I go on to a good Occ med residency

 

[mcatwizard]

I can’t understand this rash of posters asking, essentially, “if I quit my job and leave it in the lurch for <not very good reason>, will this affect my ability for another job to hire me, given that I will need support from the old job to get the new job?”

Ok, going forward we will just happily waste years of our lives completing postgraduate training that may end up yielding little-to-no measurable benefit for our careers while being paid an LPN salary despite having six figure debt. Please try to empathize here - there's a reason the question is being posed. Obviously it's not ideal to leave a categorical program but in cases where it can benefit someone greatly - it's just a job. Theres nothing binding you to stay and with significant student debt in this economy people can't afford to waste years of opportunity cost

 

[Crayola227]

Honestly, I don’t care if they want to do it. If there’s an open job position then it’s a physician job that needs to be filled. To each their own. But like, “dance with the fella who brang ya”. Or at least stay for the whole dance before trying to get a different date for a different dance.

I originally read this as "dance with the fella who bang ya"

 

[Smurfette]

If I can leave this program after finishing my PGY-1 and getting a license (and make 3-4x my resident salary while I wait for an OM residency spot) without hurting myself too badly in the long run, I think it will be worth the potential strife and awkwardness of leaving a categorical program. Obviously in hindsight I wish I would've applied for a 1yr internship but this is the situation I'm in now.

So if you don't finish a residency, while you can get a medical license in most states after one year, it doesn't mean you will get a decent job. Without finishing residency, the vast majority of employers won't hire you and insurers may not work with you either. Your options tend to be limited to wound care, insurance physicals and prison medicine.

 

[Crayola227]

Yeah I mean I will say that if all the OM activities began in med school, we may have the not super common but could exist, person who just truly has a passion for OM and is not just using it as a parachute out of their first chosen specialty

This isn't ideal, but it does sound a little bit more understandable to me

 

[mcatwizard]

What's even more alarming is the rash of (I presume) young posters who are trying to avoid any traditional (and frankly, more meaningful) medicine (primary care, surgery) . . . and instead are trying to pursue these 'softball' specialties.

Shocking, I know, that young people are actually listening to the burnt out and jaded mid-career physicians overwhelmingly advising the next generation against spending a lifetime rotting in the OR or in PCP inbox hell. Especially with perpetually decreasing comp and autonomy across the board.

Blanket statements suggesting that all OEM physicians (who have extremely varied career paths, mind you, and make a huge impact on both patients and populations) have less meaningful jobs than the surgeons spamming elective cases and PCPs grinding 6 minute appointments all day are not appreciated, but thanks for your contribution.

I'm not going to willingly enter more traditional fields that have alarming rates of job dissatisfaction just because "everyone does it." I have a passion for something off the beaten path (that happens to have one of the highest job satisfaction rates amongst all physicians) and I'm pursuing it. Why is this alarming?

 

[mcatwizard]

Yeah I mean I will say that if all the OM activities began in med school, we may have the not super common but could exist, person who just truly has a passion for OM and is not just using it as a parachute out of their first chosen specialty

This isn't ideal, but it does sound a little bit more understandable to me

This is why I'm hopeful that Occ med residencies will be able to look past leaving a categorical program. Occ med has been the plan all along, and I entered an FM residency with that goal in mind. I just realized sometime after starting that this is actually not an ideal means to my end

 

[Crayola227]

Shocking, I know, that young people are actually listening to the burnt out and jaded mid-career physicians overwhelmingly advising the next generation against spending a lifetime rotting in the OR or in PCP inbox hell. Especially with perpetually decreasing comp and autonomy across the board.

Blanket statements suggesting that all OEM physicians (who have extremely varied career paths, mind you, and make a huge impact on both patients and populations) have less meaningful jobs than the surgeons spamming elective cases and PCPs grinding 6 minute appointments all day are not appreciated, but thanks for your contribution.

I'm not going to willingly enter more traditional fields that have alarming rates of job dissatisfaction just because "everyone does it." I have a passion for something off the beaten path (that happens to have one of the highest job satisfaction rates amongst all physicians) and I'm pursuing it. Why is this alarming?

Lol because if no one takes the crappy jobs the world falls apart 🙃

Make all physician jobs great again

 

[LucidSplash]

This is why I'm hopeful that Occ med residencies will be able to look past leaving a categorical program. Occ med has been the plan all along, and I entered an FM residency with that goal in mind. I just realized sometime after starting that this is actually not an ideal means to my end

It’s less about the occ program overlooking you leaving your prior program than where you will stand with your prior program.

You’re going to have to find a way to leave, if you do leave, that leaves you in good standing with your current program. You will need them to a) write a positive letter for you (nearly universally needed when switching programs) and b)verify your training with them in a timely manner for the rest of your professional life every time you apply for a license or for credentialing at a new job.

 

[LucidSplash]

Ok, going forward we will just happily waste years of our lives completing postgraduate training that may end up yielding little-to-no measurable benefit for our careers while being paid an LPN salary despite having six figure debt. Please try to empathize here - there's a reason the question is being posed. Obviously it's not ideal to leave a categorical program but in cases where it can benefit someone greatly - it's just a job. Theres nothing binding you to stay and with significant student debt in this economy people can't afford to waste years of opportunity cost

It’s only beneficial if you’re sure you can get into an occ program. Listen to NotAPD here. Finish the FM program and then go do the occ med program. It’s a much safer choice.

And you’ll forgive me if I don’t see doing an extra 2 years of training as “wasting years” when you’ll be board eligible in a complementary specialty to occ med. And given my perspective that I did 9 years of training. At some point you look back and recognize that life continues while you are in training, it doesn’t just begin when you’re done.

 

[Crayola227]

b)verify your training with them in a timely manner for the rest of your professional life every time you apply for a license or for credentialing at a new job.

This. Don't underestimate the extent to which this can be weaponized and how much this can hurt you.

Believe it or not some programs will be very understanding. Not sure the vibe where you are. Definitely try to work this out with them. More notice is better.

 

[Crayola227]

Having the "fall back" of FM is worth the 2 yrs imho. My advice here has zero to do with judging you or what's best for your program.

 

[EthylMethylMan]

I have a passion for something off the beaten path (that happens to have one of the highest job satisfaction rates amongst all physicians) and I'm pursuing it. Why is this alarming?

I think the bigger point of confusion is why you didn’t apply to OEM residency if you knew for so long you wanted to do that. That’s the path the majority of those docs take. Most people can sympathize with the desire to pursue passion despite obstacles. I don’t think anyone commenting here is unaware of that. But ultimately you are where you are and you need to make smart decisions based on that. NotAProgDirector has the most practical advice. Being stranded as a doc with only PGY-1 training is a terrible fate. His advice has the best likelihood of success with the least chance of you being stuck with lots of debt and no money.

Also, I know you have various reasons why you dislike FM, but @VA Hopeful Dr seems to be pretty optimistic about FM physician job opportunities and pay.

 

[comp1]

Goodness, finish the FM residency!! You WILL be able to find a job that you like.

 

[dozitgetchahi]

I can’t understand this rash of posters asking, essentially, “if I quit my job and leave it in the lurch for <not very good reason>, will this affect my ability for another job to hire me, given that I will need support from the old job to get the new job?”

These kinds of questions are as old as SDN. A very common pattern on SDN goes something like this:

Poster: “I want to do this really weird/crazy/potentially foolish thing in medicine!”

SDN: “That’s not a good idea, don’t do that.”

Poster: “But I think it’s a great idea! And I intend to do it no matter what you guys say!”

 

[dozitgetchahi]

Isn’t Occ Med one of these specialties where people start doing a primary care specialty like FM or IM, and then can dive into Occ Med like halfway through the residency or something? Or is that prev med that I’m thinking of?

Anyway, OP, if you want to switch specialties, you can certainly do it as long as you have everything lined up ahead of time. People change specialties all the time - it’s not as uncommon as you might think. I think what people are saying is this - don’t quit your current residency and just expect to match into a new one. Transferring residencies is different than just bailing out of your current residency and hoping to pick up another one later.

 

[RangerBob]

The quickest way to an occ med career is probably to finish your FM residency and get some exposure through your electives, maybe add some certifications if needed, but plenty of FM and PM&R docs go straight into occ med jobs.

Occ Med residencies are quite limiting--it's pretty much all you can do. I'd always encourage a med student interested in occ med to pursue FM or PM&R instead as they open many more doors long term. Personally I'm biased for the PM&R route...

 

[NotAProgDirector]

You can quit your FM position after one year, and continue in Occ Med. OM is 2 years (after the PGY-1), same length as FM, so there are no funding issues. If you really hustle and get lucky, you might be able to find an OM program with a PGY-2 opening for July 2025 -- you'd save a gap year, although likely have limited choice of programs as not many PGY-2 spots for July are likely open. If not, then you'd apply in the match for next year.

in the gap, you could try to work with just your PGY-1. You'll likely find that more complicated than you might think. People talk about wound care, the IHS, and other options but your choices will be severely limited with only a single PGY year. You can always get a job doing something else (i.e. non medical). Whether you can get a position in Occ Med doing something, I don't know.

Whether you can have the career you seek with only OM training is really up to you. if you complete FM and discover you don't like OM, you will have other options. If you complete only OM training, then you will not. But if you dislike FM and are as certain as you can be that OM is for you, then yes this is a reasonable path. If you were to let go of your FM spot and then not get an OM spot -- then you'll be in a real pickle. You can try to get an FM PGY-2 spot, which may be a challenge after a gap.

 

[shaggybill]

What's even more alarming is the rash of (I presume) young posters who are trying to avoid any traditional (and frankly, more meaningful) medicine (primary care, surgery) . . . and instead are trying to pursue these 'softball' specialties.

All due respect, what is and what is not meaningful for someone else is not for you to say. Focusing one's talents on the safety and health of the American workforce is not less meaningful than serving up a noncompliant diabetic another dish of medications. Softball specialties...seriously? That's just insulting. Without additional context, this comment sounds like the cantankerous grumpy old attending who wags his finger at his trainees for wanting to go home to their families at night instead of sleeping at the hospital like he does just in case something happens.

I think the bigger point of confusion is why you didn’t apply to OEM residency if you knew for so long you wanted to do that. That’s the path the majority of those docs take.

That's not entirely true. The vast majority of BC OM docs I know came into the specialty after having practiced EM/FM/IM for a while. Mostly for the reasons OP stated. They hated the grind of what primary care has become. And most OM programs are going to have plenty of faculty who transitioned into OM for those very reasons and will understand exactly where OP is coming from.

OP, you "can" get into Occ Med with just an intern year under your belt, but I honestly wouldn't recommend it. I'd at least finish PGY-2 and let your FM program know well in advance that you plan to apply to OM. You do need a letter from your PD, so you want to make sure you're in their good graces when it comes time to apply to ERAS, and you can most effectively do that by not surprising your PD at the last minute with your resignation letter. They need time to prepare for your departure.

While much of what you learn in FM residency does not necessarily apply to bread and butter occ med, you do need to be good at MSK, as well as some derm, infectious disease (appropriate abx, TB tx), vaccines, eye injuries, etc, so there is a lot to be gleaned from staying in FM at least through PGY-2.

What others are saying about having more options to fall back on if you have FM BC is technically true if the sky falls and you need to scramble for a job asap, but there is no shortage of jobs out there for docs who have BC only in occ med, and the training you get from OM residency will be plenty to make you a competent doc. But another year of FM residency will serve you very well, especially if during that time you can select electives that are relevant to the specialty (ortho, sports med, derm, EM/Urgent care, etc). Do some research on what types of workplace injuries/illnesses/exposures OM docs see and when you do your electives, make sure your attending knows what you are most interested in learning about.

 

[dozitgetchahi]

All due respect, what is and what is not meaningful for someone else is not for you to say. Focusing one's talents on the safety and health of the American workforce is not less meaningful than serving up a noncompliant diabetic another dish of medications. Softball specialties...seriously? That's just insulting. Without additional context, this comment sounds like the cantankerous grumpy old attending who wags his finger at his trainees for wanting to go home to their families at night instead of sleeping at the hospital like he does just in case something happens.


That's not entirely true. The vast majority of BC OM docs I know came into the specialty after having practiced EM/FM/IM for a while. Mostly for the reasons OP stated. They hated the grind of what primary care has become. And most OM programs are going to have plenty of faculty who transitioned into OM for those very reasons and will understand exactly where OP is coming from.

OP, you "can" get into Occ Med with just an intern year under your belt, but I honestly wouldn't recommend it. I'd at least finish PGY-2 and let your FM program know well in advance that you plan to apply to OM. You do need a letter from your PD, so you want to make sure you're in their good graces when it comes time to apply to ERAS, and you can most effectively do that by not surprising your PD at the last minute with your resignation letter. They need time to prepare for your departure.

While much of what you learn in FM residency does not necessarily apply to bread and butter occ med, you do need to be good at MSK, as well as some derm, infectious disease (appropriate abx, TB tx), vaccines, eye injuries, etc, so there is a lot to be gleaned from staying in FM at least through PGY-2.

What others are saying about having more options to fall back on if you have FM BC is technically true if the sky falls and you need to scramble for a job asap, but there is no shortage of jobs out there for docs who have BC only in occ med, and the training you get from OM residency will be plenty to make you a competent doc. But another year of FM residency will serve you very well, especially if during that time you can select electives that are relevant to the specialty (ortho, sports med, derm, EM/Urgent care, etc). Do some research on what types of workplace injuries/illnesses/exposures OM docs see and when you do your electives, make sure your attending knows what you are most interested in learning about.

I agree with all this.

If OP really wants to do OM, then they should get everything lined up to do OM.

 

[DrMetal]

Softball specialties...seriously? That's just insulting.

You only feel 'insulted' because there's some truth in what I'm saying. We all know what we're talking about here when I say 'Softball specialties'.

Sure, go ahead and treat that 33-yo Cluster B male/female for back strain that she incurred picking up boxes at work, 10 year ago, with another un-necessary round of physical therapy, narcotics, acupuncture . . .because you're too afraid to discharge her from your OccMed clinic, lest she write you a bad Yelp review and and get lawyers involved. This case x 100 per day = a typical OccMed clinic, that we only allow in our wonderful first world country.

If you can live with your conscience doing that for 30 years, go for it. It is true that there's a need for it, it is true that they pay physicians to do it, so why not?! Can't argue with that.

The rest of us will do real medicine and surgery.

 

[LucidSplash]

You only feel 'insulted' because there's some truth in what I'm saying. We all know what we're talking about here when I say 'Softball specialties'.

Sure, go ahead and treat that 33-yo Cluster B female for back strain that she incurred picking up boxes at work, 10 year ago, with another un-necessary round of physical therapy, narcotics, acupuncture . . .because you're too afraid to discharge her from your OccMed clinic, lest she write you a bad Yelp review and and get lawyers involved. This case x 100 per day = a typical OccMed clinic, that we only allow in our wonderful first world country.

If you can live with your conscience doing that for 30 years, go for it. It is true that there's a need for it, it is true that they pay physicians to do it, so why not?! Can't argue with that.

The rest of us will do real medicine and surgery.

I do not cosign this. The beauty of multiple specialties is that we can each do what we want. There’s clearly a need for this kind of position or it wouldn’t exist in the market economy. I wouldn’t want to do it but happy that there are positions for physicians who do. Because I’d rather it be a physician than an undertrained NP who is likely just to make the situation worse.

There is zero need for this kind of infighting.

 

[DrMetal]

I do not cosign this. The beauty of multiple specialties is that we can each do what we want. There’s clearly a need for this kind of position or it wouldn’t exist in the market economy. I wouldn’t want to do it but happy that there are positions for physicians who do. Because I’d rather it be a physician than an undertrained NP who is likely just to make the situation worse.

There is zero need for this kind of infighting.

I'm not even (entirely) saying don't do it (OccMed) . . . I'm saying (in response to the OP) finish your residency in FM (a good, strong foundation in Primary care), then pursue OccMed. If you have good training in a primary care specialty, the latter will be easier.

 

[LucidSplash]

I'm not even (entirely) saying don't do it (OccMed) . . . I'm saying (in response to the OP) finish your residency in FM (a good, strong foundation in Primary care), then pursue OccMed. If you have good training in a primary care specialty, the latter will be easier.

Yeah but the tone here is entirely different than the tone of your other posts here. Knock it off. It’s totally unnecessary. Other physicians and their chosen specialties are not deserving of your derision. There are plenty of other people masquerading as physicians who are more deserving of scorn. We should support each other.

I agree that at this point OP’s safest bet is to continue in FM and then do OccMed. But if they had chosen OccMed straight out of med school I think that’s fine too. The issue is at this point that if they jump ship from FM and then fail to get an OccMed spot we have someone who will struggle to be gainfully employed in an area they want to be in with only a year of FM residency. OP has the potential to be an expert in their field. We all know it’s very risky to leave a categorical spot without another spot in hand. If OP wants to do OccMed that’s fine but I’d hate to see OP end up like so many of the posts we see here with regrets in 5 years if they don’t get the OccMed spot.

 

[DrMetal]

Yeah but the tone here is entirely different than the tone of your other posts here. Knock it off. It’s totally unnecessary.

It's called an opinion. I can give an opinion regarding a topic, a medical specialty, a career path, etc. I can opine and state that I don't think a particular path is viable, worthy of your talents, your efforts, etc. Nonetheless it is an opinion, you're welcome to disagree and provide another point of view.

 

[LucidSplash]

It's called an opinion. I can give an opinion regarding a topic, a medical specialty, a career path, etc. I can opine and state that I don't think a particular path is viable, worthy of your talents, your efforts, etc. Nonetheless it is an opinion, you're welcome to disagree and provide another point of view.

You can provide an opinion. But derision and scorn for other specialties, and calling other specialties “not real medicine”, is unnecessary and only benefits those with less training than physicians who seek to supplant us.

There are physicians that deserve our scorn, to be clear. The ones that engage in fraud or harm patients due to their greed in the pursuit of that fraud. But a guy who just wants to do OccMed instead of FM? Come on.

 

[shaggybill]

Sure, go ahead and treat that 33-yo Cluster B male/female for back strain that she incurred picking up boxes at work, 10 year ago, with another un-necessary round of physical therapy, narcotics, acupuncture . . .because you're too afraid to discharge her from your OccMed clinic, lest she write you a bad Yelp review and and get lawyers involved. This case x 100 per day = a typical OccMed clinic, that we only allow in our wonderful first world country.

Ah, I see. You don't know what occ-med is. That makes more sense.

 

[OEM doc]

What a curious thread. There are two separate questions to address. The first is if it is generally a good idea, or reasonably necessary, to do FM or another residency before doing Occupational and Environmental Medicine (OEM) residency.

No.

If you are fortunate enough to be exposed to OEM in medical school and want to pursue residency training in OEM, then you should absolutely apply to go directly from medical school into OEM residency. Just like any other specialty. OEM residency will teach you everything you need to know to be competent working in the field.

Don’t a lot of people in OEM have additional residency training or board certification? Sure. But this is mostly because OEM is so under the radar. They simply didn’t know about OEM coming out of medical school, so transitioned into OEM later in their career after being unhappy with their initial choice of specialty. Many of them, could they do it over again, would simply have gone straight into OEM and skipped the unhappy years in whatever they quickly became burned out in. I certainly know OEM physicians who went straight into OEM training from med school, and they are loving their life in OEM practice. One example is here.

Wouldn’t I be more marketable if I had dual training in OEM in another specialty? I suppose that all other things being equal, having completed FM or another residency in addition to completing OEM will look better on paper, give you a broader clinical skill set, and may set you up better for some jobs that look for this specific combination. But OEM training, as with any other specialty, is sufficient to stand on its own. The limited upside hardly seems worth the years of additional residency training.

Should I have FM training just in case, as a fallback plan? This is quite a ridiculous question. Sure, you would have a solid fallback option if you completed another residency first, but this would be true no matter what specialty you went into. Should general surgeons do FM residency first, just in case it doesn’t work out with general surgery, or they realize later on in life that they don’t really like general surgery? I strongly recommend to focus your efforts on picking the right specialty for you, the first time around. Which should be obvious to everyone. If you made a bad choice initially, then I would focus on getting it right the second time around. Make the shortest path to achieve your goals.

Wouldn’t having FM training make me a much better OEM doc? There is a common misconception among those who are not OEM-trained that FM has a lot of similarities and overlap with OEM. It doesn’t. Of course there is some overlap, but the two specialties are really apples and oranges. I personally know people that have gone into OEM after years in FM practice. Some think that their FM training and experience makes them a better OEM doc. A good example can be found here. I would say that most people tend to say this, though I believe there is a substantial incentive for them to think this way. Nobody wants to think or admit that they wasted years of their medical career. I do however, know some brutally honest ones who think that their FM training added nothing useful or was even a detriment, in the sense that they had to unlearn much of what they picked up in FM training in order to be a good OEM physician. I have personally seen physicians that tried to transition from primary care to OEM, without doing OEM residency training, and floundered.

You can absolutely find many good job opportunities in with residency training and board certification in OEM alone. I believe it would be accurate to say that transitioning into OEM is a good "fallback" option for unhappy FPs. However, since there are so few unhappy OEM docs to begin with, and a diverse range of plentiful OEM jobs available, FP is not a serious fallback option for those in OEM. Sure, some FPs out there probably dabble in OEM just a bit, maybe take a bottom-tier OEMish job that OEM-trained physicians would never take, and don’t like it. But it would be exceedingly rare to find somebody residency trained in OEM that willingly chose to go into FP (or back into FP). I know of none.

 

[OEM doc]

The second question is what should this FP resident do in this particular situation?

1. Finishing internship is an absolute must.
2. Some OEM programs may have "reserved" slots available for people to match directly into the PGY-2 year. You would have to check the NRMP listing to know for sure. Per the NRMP website, rank lists have to be finalized by 05 March. So, while it is very late in the process for this year, it may be conceivable if you really hustle (and get a little lucky).
3. Assuming it doesn't work out for this year, it would certainly be an option to apply for a "reserved" PGY-2 OEM slot next year, meaning you would leave your FP training a year early if accepted.
4. You could always complete FP training before going into OEM. I would be very wary of the person who tells you that you can just go into OEM practice on your own, without OEM training. While technically true, that is very unlikely to get you the kind of job you would want in OEM.
5. Like others have said, I would be cautious about leaving your FP program without a clear pathway for the future. You don't want to get stuck there and find yourself unable to get back into a residency program.

 

[OEM doc]

I'll add that there is a lot of inaccurate information about OEM on SDN, with a number of threads about OEM entirely consisting of posts from people not in the specialty. Probably the best source of information is The OEM Info Page. There are separate pages for topics like OEM job options, compensation, transitioning from another specialty, and what kind of doc is a good fit for OEM.