Changing specialties after practicing for a few years

[The kitchen sink]

has anyone changed specialties after practicing for a few years?

i.e. apply to a residency match again

I am contemplating a switch but do not know how to navigate this

Would love to hear any stories of those who have done this.

Thanks 🙂

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[gutonc]

has anyone changed specialties after practicing for a few years?

i.e. apply to a residency match again

I am contemplating a switch but do not know how to navigate this

Would love to hear any stories of those who have done this.

Thanks 🙂

It happens, but it's not common. A lot depends on from what to what and how competitive you would have been for the new specialty at the end of med school and how you can spin your story and experience (and get LORs) to support your application.

Details (if you're willing to share them) would be helpful. If you're not interested in posting publicly, the Confidential Consult forum is limited to vetted Experts who are mostly mod/admin staff and is not shared with anyone other than those individuals and not posted publicly at all.

 

[The kitchen sink]

It happens, but it's not common. A lot depends on from what to what and how competitive you would have been for the new specialty at the end of med school and how you can spin your story and experience (and get LORs) to support your application.

Details (if you're willing to share them) would be helpful. If you're not interested in posting publicly, the Confidential Consult forum is limited to vetted Experts who are mostly mod/admin staff and is not shared with anyone other than those individuals and not posted publicly at all.

Thanks for the advice. Maybe I will post on there.

I am a moderately competitive applicant who is considering switch to Psychiatry.

Have a change of heart and want to pursue this change. Life is too short to linger in a specialty that is not fulfilling, or only partially fulfilling.

I can PM you details if interested in hearing more. Or I’ll leave it to the experts in that forum.

 

[djo208]

I actually HAVE met multiple people who have done this, but I agree that it's not common. One of my prior psychiatry attending back when I was in training had been an emergency medicine attending for 10 years before he decided to do a psychiatry residency. I knew another doctor who had a health issue that precluded continued practice in her specialty, so she switched. I used to interview residency applicants and I can tell you that I certainly wouldn't have held this against anyone. I think if your story and reasons are both compelling and sincere, it might actually be considered a plus to programs that you have all that experience and have demonstrated that you can succeed. It certainly is not in and of itself impossible. I think the bigger challenge is taking a pay cut and being a trainee again rather than independently making the decisions yourself and having an attending salary.

 

[voxveritatisetlucis]

Too much money left on the table for most I’m assuming

 

[dozitgetchahi]

I actually HAVE met multiple people who have done this, but I agree that it's not common. One of my prior psychiatry attending back when I was in training had been an emergency medicine attending for 10 years before he decided to do a psychiatry residency. I knew another doctor who had a health issue that precluded continued practice in her specialty, so she switched. I used to interview residency applicants and I can tell you that I certainly wouldn't have held this against anyone. I think if your story and reasons are both compelling and sincere, it might actually be considered a plus to programs that you have all that experience and have demonstrated that you can succeed. It certainly is not in and of itself impossible. I think the bigger challenge is taking a pay cut and being a trainee again rather than independently making the decisions yourself and having an attending salary.

There was a pulm/CCM attending at my residency program who had done something like this. He trained first in FM, got done, worked as a PCP and hospitalist but realized he really wanted to be in the ICU. So he restarted as an IM resident, then did a pulm/crit fellowship.

That said, it would be a hard pill to swallow to go back to making peanuts as a trainee and working under attendings. I don’t think I could persuade myself to go back to that again.

 

[NotAProgDirector]

Looking at your post history, looks like your prior training was IM followed by PCCM.

Have you considered Pall Care? It's a much shorter training track than psych.

But yes, we've had people come back to IM training after completing something else, for all sorts of reasons. In Psych, you'd be able to apply for PGY-2 positions since you'd already have completed an internship - which will save you one year of training. The best way to find a pGY-2 position might be to apply for PGY-1 positions and point out in your PS that you're open to considering either if available.

 

[The kitchen sink]

Looking at your post history, looks like your prior training was IM followed by PCCM.

Have you considered Pall Care? It's a much shorter training track than psych.

But yes, we've had people come back to IM training after completing something else, for all sorts of reasons. In Psych, you'd be able to apply for PGY-2 positions since you'd already have completed an internship - which will save you one year of training. The best way to find a pGY-2 position might be to apply for PGY-1 positions and point out in your PS that you're open to considering either if available.

I have considered it but not interested in pall care.

The only other IM specialty i would consider is maybe Allergy/immunology, if I had to switch within IM.

Or psychiatry as I mentioned before.

 

[alina_s]

There are some programs that have PGY2 entry positions- U of Washington and UCSF come to mind, but you could search on FRIEDA. Most people entering my program in 2nd year were doing exactly what you want. One was from OB, one from ophthalmology, two from anesthesiology, one of the attendings from neurosurgery. It’s probably worth reaching out to programs nearby or programs in the area you’d like to be because positions can open up.

 

[mistafab]

I think of all specialties psychiatry is most open to 2nd career wave physicians.

Just understand it is very difficult to become a resident again. The rate of failure after matriculating to another residency is palpable. Doing call or overnights may not be possible to avoid. I personally know of a neurosurgeon turned to psych resident who dropped out of psych residency due to these kinds of factors.

If you choose to go this route, it does take a lot of open communication with potential programs, directly to the PD. They may fastrack you to PGY2, but you may be required to redo some rotations (or do additional neurology, for example). Some may start you back at PGY1 but allow you to skip medicine. SOme may not be able to have you skip medicine due to their program structure. You need details. You need a program large enough to accomodate, or small enough to be flexible. You'll need to talk to a lot of potential programs.

So I would pick out multiple programs, open direct lines of communication with the PD, and get nitty gritty into what the program would look like for you. Some programs dont require call period. Some require lots of overnights and call. You need to know this to improve the chance you don't fizzle out and leave.

 

[Top Gun]

has anyone changed specialties after practicing for a few years?

i.e. apply to a residency match again

I am contemplating a switch but do not know how to navigate this

Would love to hear any stories of those who have done this.

Thanks 🙂

It’s rare, but I’ve seen one or two instances of this. When I was a third year med student, one of the interns I was following had been a PM&R attending, but apparently got bored and decided to go back and do a surgery residency. And when I was doing my psych rotation, I spent a week on the substance abuse rehab unit. Rumour has it that my attending there had been a transplant surgeon, but then she went back and did psych. So it can happen, but I’m not sure how. I would have thought the Medicare funding for training you would have been used up after you graduated from the first residency.

 

[gulmohr]

Knew of one guy who did pediatrics, anesthesiology and EM. Was a few years ago so forget the order. Was working in a major academic program in the South.

Curious what's driving you to switch from PCCM to Psych. As one of the few medical specialties where you can fully work from home, it does have appeal.

 

[HemeOncHopeful19]

It’s rare, but I’ve seen one or two instances of this. When I was a third year med student, one of the interns I was following had been a PM&R attending, but apparently got bored and decided to go back and do a surgery residency. And when I was doing my psych rotation, I spent a week on the substance abuse rehab unit. Rumour has it that my attending there had been a transplant surgeon, but then she went back and did psych. So it can happen, but I’m not sure how. I would have thought the Medicare funding for training you would have been used up after you graduated from the first residency.

The whole Medicare funding thing is usually a non-issue and way overblown. Just like the “hurr durr funding was capped in whatever 1995 year” well if you go look at match data we’ve opened TONS of residency spots since funding was “capped.” Most hospitals have tons of unfunded spots that they just pay for themselves because residents are extremely cheap labor.

 

[Gonio5]

The whole Medicare funding thing is usually a non-issue and way overblown. Just like the “hurr durr funding was capped in whatever 1995 year” well if you go look at match data we’ve opened TONS of residency spots since funding was “capped.” Most hospitals have tons of unfunded spots that they just pay for themselves because residents are extremely cheap labor.

Correct. For many residencies, the Medicare funding issue is not an issue. The reduction of Medicare funding is not 100%. About 2/3's of Medicare payments are classified as "indirect" (IME). This is not affected. 1/2 is "direct" or DME. This partially affect but not fully affected by residents changing specialties, if at all. If someone starts a surgery residency then changes to family medicine after their PGY1 year, they could finish after 4 years, which is shorter than general surgery.

 

[OEM doc]

In Occupational and Environmental Medicine (Occ Med or OEM), it is actually pretty common to see this, in large part because people don't know about OEM until they have already finished another residency. It is an easier transition compared to many other (longer) residency programs. I would submit that it possibly the best option for somebody that is burned out on their initial specialty choice. Definitely worth a hard look. I'd recommend the below two resources:

The OEM Info Page - page specifically about transitioning into OEM from a different specialty
KevinMD article about a family practice physician that transitioned to OEM after years in practice

 

[Dral]

Preventive med is another avenue to explore.