changing specialty--any advice?

[Chirurgus]

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I'm thinking about changing specialty 😕. I have thought about it on and off for the past year. Any advice from anyone who's successfully switched specialties during residency? I'm scared to even approach the idea of changing as it seems like it would be near impossible-- but thinking of staying in my current specialty for an entire career seems miserable. I feel hope again when I think I could change, but also feel guilty abandoning my current program (I love where I am, the people I work with, just not the demands of the actual specialty and the thought of doing this for another 30-40 years)

How did you decide you wanted to change?
Do you go through the match again?
How did your program director respond?
Any other advice?

 

[Qex]

The best idea is to finish your current specialty, if you're in a 3/4 year program. This way, you are not shorting your program, and you have time to decide exactly what you like about medicine, and what you don't. The last thing you'd want to do is jump into another program and find it isn't any better (or is worse!) than your current one.
The other benefit is you will be able to get board certified, and that will help to get some employment, if you have trouble getting into another program.

 

[tkim]

The best idea is to finish your current specialty, if you're in a 3/4 year program. This way, you are not shorting your program, and you have time to decide exactly what you like about medicine, and what you don't. The last thing you'd want to do is jump into another program and find it isn't any better (or is worse!) than your current one.
The other benefit is you will be able to get board certified, and that will help to get some employment, if you have trouble getting into another program.

This absolutely wrong advice. Are you even a resident or med student?

 

[tkim]

I'm thinking about changing specialty 😕. I have thought about it on and off for the past year. Any advice from anyone who's successfully switched specialties during residency? I'm scared to even approach the idea of changing as it seems like it would be near impossible-- but thinking of staying in my current specialty for an entire career seems miserable. I feel hope again when I think I could change, but also feel guilty abandoning my current program (I love where I am, the people I work with, just not the demands of the actual specialty and the thought of doing this for another 30-40 years)

How did you decide you wanted to change?
Do you go through the match again?
How did your program director respond?
Any other advice?

The sooner you decide that that's what you want to do, the better. If this is your intern year, make sure you aren't suffering from the 'intern blues'.

That said, if you decide you want to switch specialties, you need to figure out what you want to switch into. Once you've decided that, you need to let your PD know. Most PD's don't want to keep a resident that's miserable and will help you get into another program.

Depending on what you've already matched into, the funding clock has started, and the sooner you switch into another specialty, the more funding you retain, which is a consideration for residencies.

Good luck.

 

[Chirurgus]

Thanks for both your posts. I've definitely considered what if it is just "blues"? I have never really seriously considered switching specialties until recently. I've finished 2 clinical years (of 5 total) for a surgical specialty. I am in a research year now which I really like -- and I've come to realize I just don't miss the OR or the clinic at all, whereas it seems like my co-residents in their research time can't wait to get back into the OR. Obviously, I used to like it since that's part of why I picked surgery in the first place. That's what seriously got me thinking maybe I should switch to something else (like pathology?) or even out of medicine all together?

I've also realized it's more important to me to actually see my family than to take care of an emergency in the middle of the night -- which throws up a major red flag as to maybe I shouldn't be in surgery (or even medicine?) and I think this basic inner conflict is what's making me ask should I get out or is this just me just being burned out in residency?

 

[tkim]

Thanks for both your posts. I've definitely considered what if it is just "blues"? I have never really seriously considered switching specialties until recently. I've finished 2 clinical years (of 5 total) for a surgical specialty. I am in a research year now which I really like -- and I've come to realize I just don't miss the OR or the clinic at all, whereas it seems like my co-residents in their research time can't wait to get back into the OR. Obviously, I used to like it since that's part of why I picked surgery in the first place. That's what seriously got me thinking maybe I should switch to something else (like pathology?) or even out of medicine all together?

I've also realized it's more important to me to actually see my family than to take care of an emergency in the middle of the night -- which throws up a major red flag as to maybe I shouldn't be in surgery (or even medicine?) and I think this basic inner conflict is what's making me ask should I get out or is this just me just being burned out in residency?

If there is an aspect of medicine you still enjoy, I would consider switching into that specialty. Since your funding clock still has about three years left, you could switch into any of the IM, peds, FM, EM residencies and be fully funded.

If you have the luxury of walking away from medicine without a massive debt-burden and cannot find anything about medicine you like, walk away.

 

[Chirurgus]

"If you have the luxury of walking away from medicine without a massive debt-burden and cannot find anything about medicine you like, walk away."
--unfortunately the debt burden is an issue

 

[Sneezing]

Psychiatry. Become adept at psychodynamics and use them to 'surgically' identify and help excise the pathology of internal conflict in a persons life. Very mentally exhausting at times, calls can still be brutal during the 1-2 years, but very rewarding and more family friendly compared to others.

 

[mlw03]

I've seen it go both ways, and the advice I would offer is be darn sure before you do it. The grass is not always greener on the other side. I'm a pathologist, so I'll say that switching into path is something I saw in residency from a few people, one of whom hated it and had decided to leave 3 months into the residency. The lack of patient contact is a big difference for most folks, although a research year is a decent simulation. You said you're a surgeon, and this could be an advantage if you do switch into path and decide to subspecialize in the area you'd previously been a surgeon for. A GU pathologist who'd done two years of urology would have a lot of insight into the true importance (or lack thereof) of all the minutiae that goes a biopsy or resection pathology report. I have no clue if you guys really care about something being pT2b or pT2c, but you certainly do. If you're thinking about pathology you need to do at least a 1 month general surgical pathology rotation, to decide for yourself and to show programs you have some idea what you're getting into.

 

[BADMD]

This is a tough issue. If you really want to switch, you have to start moving so that you can identify a program and get rolling. You may have to enter as an intern as you may not get a year's credit in the other specialty from surgery. It is far to late to attempt to enter the match. Before you do anything, you have identify what you would want to switch to.

Can you identify a "safe" member of the faculty that you can talk to about this? You have to be careful who you may talk to, but if you can find someone, that may help crystalize your thoughts.

Leaving medicine is very tough for a half trained physician. While there are some opportunities, realistically, medicine is a trade and the training isn't that transferable to other occupations.

 

[Buzz Me]

The sooner you decide that that's what you want to do, the better. If this is your intern year, make sure you aren't suffering from the 'intern blues'.

That said, if you decide you want to switch specialties, you need to figure out what you want to switch into. Once you've decided that, you need to let your PD know. Most PD's don't want to keep a resident that's miserable and will help you get into another program.

Great post, and highlighted exactly what I would have said.

Make sure you're not going through the typical intern or junior resident "blues" that happens in the winter. That's often when the grind gets to you, and it's cold, and you've just worked through Thanksgiving/Christmas/New Year's without seeing friends/family. And the novelty of being called "Doctor" has long since worn off.

Ask yourself if clinical medicine is right for you - do you really enjoy being in the lab, away from patients that much? Or do you just not miss the tough workhours/lifestyle of a surgical specialty, and would rather do something less intense?

Agreed that it will be tough to continue if you don't want to come in at night to deal with sick patients...I mean, no one likes being pulled away from your family, but what makes people stick it through a surgical residency (Gen Surg or any busy subspecialty) is that they love operating so much they'll put up with everything else.

 

[belle54321]

Switching specialty is not common, but not unheard of.
Also, I know you seem to be interested in pathology, but just to let others know that psychiatry is probably one of the few residencies that are quite open to people from other specialties. Many programs will take on PGY-2s. The ABPN gives PGY-1 credit to anyone who has completed a year of ACGME program regardless of the specialty. When I interviewed this year, I met an attending (she just graduated last year) at a top program that switched as a PGY-2 after 5 years of General surgery. Funding issues can be a concern, but it seems like some programs will overlook that if you are a compelling applicant.
PM me if you have some specific questions as I have some experience.

 

[CerealBox]

Hi Chirurgus, I recently switched specialties... and it was definitely not as horrible or difficult as I imagined it would be.

First, I discovered that it actually is common. A lot of people change their direction after they actually start practicing medicine and realize what actually interests them the most... or when people start having families and rethink their need for life work balance. The more I talked about my evolving interests and desire to switch residency programs, the more people I met who either had done the same or seriously thought about it.

Telling my program director was the scariest, but he was actually extremely supportive.

Also, I applied with every intention of going through the match again, but ended up taking an out-of-match spot.

My other general advice is to talk to as many people as possible, and to not feel guilty at all about pursuing the best direction for yourself and your family. Good luck!!

 

[dragonfly99]

I think in order to help the OP, we need to know what aspects of the lab he/she likes, and whether he/she misses seeing patients at all. Nobody likes call, b/c it sucks...or at least few people like being on call. But did you/do you always hate clinic, hate the ER, hate the inpatient floor, hate consults too? If you like seeing patients OK but don't care to examine them, but like talking to them, perhaps psych would be good.
If you just want cushier hours and to do some procedures, fp actually doesn't suck that bad...at most places they have a lot of outpatient months and don't take much call. They tend to do few ICU months. They do have a few rotations as interns where they get their tails kicked, but not as much as IM, surgery or ER interns.

ER is a decent specialty if you want controlled hours, but don't mind working hard when you ARE there. They do have some sucky months as PGY1/2, such as surgical rotations, but you might get credit for months you've already done. My impression of ER is that you may end up working nights for the rest of your career, at least on occasion. Someone has to staff the ER, even at night....

 

[Groove]

I'm in EM and we steal a few surgery residents every few years. That seems to be one of the "on the list" of specialties that disillusioned surgery residents consider among their first line of specialties. The commonalities would be that you get to do surgical procedures and use your hands, just not nearly as extensive or long, but with the same instant gratification. You still get to 'save lives'. It's a tremendous amount of variety and you aren't stuck in an OR all day as your hustling about on full thrusters. It's stressful, it's draining, but no call, lots of flexibility and good pay. As someone else said though, "no call" can be a bit misleading as the ED is open 24/7, 7 days a week. You will work weekends, days, nights, evenings, holidays for the remainder of your life. Alternating schedules and circadian disruption is very difficult on your body. 2 days off "not on call" as your transitioning from days to night or vice versa is NOT fun and definitely doesn't feel like a real day off. It's jarring on your body and I usually feel like I've been clubbed on the head and hungover when I'm in between switches. It probably lowers my life span by quite a few years, but then again... so does the stress and work of surgery I would gander.

Hey, if you don't like the OR, then you don't like the OR, period. Unfortunately, if that's how you really feel, surgery is not for you, so get out while you can still use the remainder of your GME funding. Try to figure out what you really enjoy and talk to people in other specialties that pique your interest.

I personally love EM, but then again, I'm biased. Just don't forget that there is no panacea specialty. We all have our strengths and weaknesses. Everyone is prone to becoming disillusioned by their specialty/career. You have to make a conscious effort to focus on the things you enjoy and minimize the things that you don't. This is a second career for me. My first was based on one of my life long hobbies. I became disillusioned and it stopped being fun. I don't regret my decision as I made it for other reasons, but in hindsight... I see the commonality and temptation towards the path of "disillusionment" in just about any career. It has helped me tremendously on "bad days or bad months" as I look at the grand picture and remember why I did this and focus on the positives while minimizing the negatives. If you can't do that in surgery, then pick something that you CAN do it in. It's very easy for me to do that in EM.

Our ex-surgery guys seem very happy with their decision and I've never known one to ever go back to surgery or leave EM after "coming over to the dark side of the force" so to speak...

 

[bakre]

I am a second year trainee in EM. Its six year programmed here in England and I am lucky to be working in a big trauma center. I like EM but I feel I need more than just EM. I miss and wish if we could do EM theater, and a bit of clinic and office work.

I am probably in the same boat as you or some how similar situation like yours. I started to get bored of working in EM although one of the main reasons I joined EM is the variety in cases, but then after sometime it all feels repetitive and the environment is the same all the time the same shop floor.

I am also having serious thoughts these days about switching specialty to one that have the variety of medicine, surgery and emergency. When I think this way I consider obstetrics and Gynecology...If I switch to O+G I am not going to regret my two years in EM, I have learned a lot and matured a good clinician personality that will help me have more confidence in dealing with critical illness and minor injuries.

I feel I will have better life style when doing O+G and will be more family friendly for me. At least the hours, however they are long, are never anti social in O+G.

I have two of my colleagues trainee in EM switched to Anesthesia Residency and one considering progression as ICU doctor last year. I have never seen someone switching from EM to Surgical specialty. I agree its usually the opposite. Its very strange, I have another friend switching from Acute Medicine to EM and I know A girl changed her career after completing General Practice to O+G. Switching specialty is NOT RARE as many may think. You just need to be sure that you are not going to regret it it. "A good way to help knowing what best career that suits you, is to close your eyes and and try to see your life in 5-10 years from now" our career adviser say. This trick never worked with me, if I close my eyes longer than a blink I sleep.

I am still consulting and making my research because I know its a big decision..I am sorry if this post was not helpful, but its for you to know you are not alone.

Regards

 

[LucidSplash]

I feel I will have better life style when doing O+G and will be more family friendly for me. At least the hours, however they are long, are never anti social in O+G.


Regards

England must be opposite land compared to the US if these things are true.

 

[samsoniter]

To OP: have you considered radiology? It seems like a specialty that could give you much of what you want, as in no clinic, minimal pt contact, more family friendly hours....also you have a degree of freedom to shape your practice...i.e if you like procedures you can do IR.
Just a thought (and perhaps a shameless plug for radiology).
In any case good look, I know that switching specialties is more common than people think!

 

[peri0829]

to the OP, what did you end up deciding to do? I find myself in a similar situation...

 

[drkristy85]

Thanks for both your posts. I've definitely considered what if it is just "blues"? I have never really seriously considered switching specialties until recently. I've finished 2 clinical years (of 5 total) for a surgical specialty. I am in a research year now which I really like -- and I've come to realize I just don't miss the OR or the clinic at all, whereas it seems like my co-residents in their research time can't wait to get back into the OR. Obviously, I used to like it since that's part of why I picked surgery in the first place. That's what seriously got me thinking maybe I should switch to something else (like pathology?) or even out of medicine all together?

I've also realized it's more important to me to actually see my family than to take care of an emergency in the middle of the night -- which throws up a major red flag as to maybe I shouldn't be in surgery (or even medicine?) and I think this basic inner conflict is what's making me ask should I get out or is this just me just being burned out in residency?

Putting your family before your job is normal. This makes you a human. Most doctors feel this way (more and more nowadays). You should not feel guilty. It is only human to want to be with your family rather than a patient. When you are at work, you are at work taking care of patients. But everyone needs time of with their family.