Changing Specialties - how to do it?

[johncity]

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Hey Everyone,

I'm posting a question for my friend who seemingly had no knowledge of this message board (and here I thought everyone knew about SDN!).

He matched into a prestigious internal medicine program last week, but he is already having second thoughts about IM as a career. Basically he saved his pediatrics clerkships for 4th year, and as the interview process went on (he applied in Med and later added some Med/Peds and Peds programs) he found himself getting more and more interested in peds. When it came time to submit his ROL, he only had 1 straight peds program ranked and it was in a non-desirable location, so he set up his list based on strong med programs and matched to a great place in the northeast for IM. My question is this...

If he decides early on in his intern year (around Sept), is there a mechanism for re-entering the match and applying in Categorical Peds? He would be willing to repeat his intern year. Is this considered a match violation or are most program directors willing to let you out of a contract if you don't like the specialty? Apparently his future PD is very cool, young and nice, so he is hopeful. He has no plans of abandoning his program in the middle of the year or anything and is actually looking forward to the training, but he suspects that his interest in Peds may not go away and doesn't want to do a life of IM if his true heart is in Peds. Any advice you have is much appreciated. THanks and good luck to all.

 

[Blade28]

In general, once you're certain you want to leave, you'd talk to the PD and let them know that you'd like to switch to Peds at the end of your PGY-1 year. Yes, you'd have to go through the Match again.

It's not a bad idea for your friend to see how the intern year goes (might just be a case of "the grass is greener" syndrome), but if he's unhappy, Peds may very well be a better fit for him.

 

[johncity]

So is changing specialties a relatively common practice?

Is there any chance the PD at his IM program could simply say no?

And finally, will he need to get one of those waivers from the NRMP and could they deny it?

Sorry for all the questions!
His numbers were fine and he got interviews at most of the top-flight IM programs, mostly in the northeast and west coast. Obviously he doesn't have a choice at the moment, and he fully intends on going to his program with an open mind about Internal Medicine (I totally agree, he may love it), but he wants to make sure he has all his ducks in a row in case he needs to reapply for Peds. Thanks again for the advice.

 

[NotAProgDirector]

There is no match violation, no waiver needed. The match only requires that you start your residency -- you can resign any time you want.

He should contact the PD and mention this, as he'll want some flexible time in Dec/Jan for interviews if possible. There are many prelim IM residents who want a PGY-2 spot, so the PD will have no problem filling it. Completing the whole PGY-1 year would be best -- if not, he should tell the PD now before the schedules are made. For example, if I was the PD, I would schedule this intern for nothing in June, as he may need to leave early to go to a new program...

Speaking of that: Young, cool, nice, northeast -- wonder if it's me?

 

[chrisisinnocent]

Speaking of that: Young, cool, nice, northeast -- wonder if it's me?

He didn't say good looking so maybe not... 😀

 

[johncity]

Thanks for the timely and excellent advice. My buddy is much relieved to hear that the universe will not explode if he changes his mind and goes for peds. As far as whether you are his program director, I suppose you will find out soon enough if he approaches you! Unfortunately he swore me to secrecy so as not to get a bad reputation at the place he is starting. And seriously, thanks again.

 

[mlw03]

your friend is looking at at least 4 years of training if he switches, right? well, how about he tries to get into his current hospital's med/peds program (if it exists), or at least switch to a med/peds program. this would provide more flexibility after residency towards fellowship options and/or practice options and wouldn't cost him any more time.

 

[urheald]

OMG! A confused intern is every PD's nightmare. You are about to face a very difficult year, both physically and mentally, you want to be certain about your career goals!

Hopefully you would never have to be in the predicament in which, simply matching into a program to become a medical doctor is an honor and a privilege. But, if that ever came to be.... think about how lucky you would feel having matched at a "Top Tier Internal Medicine" program....albeit one that YOU applied to.

Nevertheless, this happens and you should not have to be in a specialty in which you don't have "strong feelings" for. So here is my 2 cents

I have a similar "friend" for whom I typically post questions, since anonymity for him is a big issue.

Regarding your issue, in my experience, as long as you, I mean your friend, can articulate during his interviews, the reason for his change of heart there should not be a problem. However, by articulate I also mean convince. One of the main issues for PD's interviewing a candidate who is switching fields, is to determine if the switch is out of your own volition.......or your former PD's. In other words, are you leaving on your own, or are you getting kicked out (poor performance, drugs, alcohol, Axis I or II psych issues, etc..) Since you obviously are not in that situation (yet), having not even matriculated yet, so you are in the more favorable category from the PD's perspective.

That being the case, in order to avoid having to deal with this issue at all, try to somehow document your desire to leave NOW. By that I mean, write letters or emails, or make phone calls to the peds PD's whose program's you would like to match at. Why? you ask......What may happen from your indifference toward IM, is subsequent poor performance and you would ultimately switch from being in the good category of field switchers to the bad category. So I would urge you to contact some pediatrics PD's now and let them know your situation. This way, if even your performance deteriorates, you have a consistent story ("I was disinterested from the start").

If you end up falling back in love with your wife (Internal Medicine) and pediatrics is just some office floozy, one time fling, then you have nothing to worry about.

Good luck and stay positive!

 

[DukeOfEarl]

I was in a similar situation where I left a specialty that I determined is not right for me. Here is my advice:

Make sure it is not "cold feet" and that you really don't want to do the specialty. I think your friend should do IM without making a decision right away, and see if he likes it. Of course internship is tough so don't let the workload, a holes, etc. make that decision, let the specialty speak for itself.

If your friend knows that IM is not right for him, then he should just take the honest route, and tell his program director that he is thinking about the change. Most PDs would rather have someone be honest with them about these things, and will respect you. If they are the type of PD that doesn't respect honesty and try to sink you for the rest of the year, you wouldn't want to train there anyway.

My advice to your friend is to finish the PGY-1 year and DO A GREAT JOB. Not finishing it makes you look like a quitter to other programs, even though that probably isn't fair. You will need most of what you do during your PGY-1 year anyway for other specialties. Sure, for peds, you will lose out on peds training, but you will gain strong IM experience in exchange. Make sure your friend works hard, and is not a "short timer" so to speak, because reputation is important in this field, and you need a strong letter to help you.

If your friend does these things, getting into peds shouldn't be a problem. It is how you handle the switch that matters more than the switch itself.

Good luck to him/her.