Considering leaving medicine, please help?

[cdunphy199]

Hi Everyone,

I'm in a bit of a dilemma. I hope you can give me some advice. During my 3rd year of medical school, I realized that clinical medicine/mortality/morbidity caused me to develop incredible anxiety, panic disorder, and an arrhythmia 2/2 to the anxiety. Being on wards makes me hyperventilate and brings on this feeling of impending doom. I have worked incredibly hard (board scores in the 250s) and it is heartbreaking that I cannot seem to cope with medicine. I have rotated in and considered non-clinical specialties as well but they haven't put me at ease either. I'm leaning towards leaving medicine for good but my advisors have recommended that I somehow finish residency so I can support myself and have more doors open in the future, but I am not sure if I will cope very well. Please give me some advice based on your take on this situation. Should I somehow finish residency (such as IM) or is it reasonable for me to look for an alternate career despite having to start from the ground up?

Thank you so much for reading.

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[bashwell]

Hi Everyone,

I'm in a bit of a dilemma. I hope you can give me some advice. During my 3rd year of medical school, I realized that clinical medicine/mortality/morbidity caused me to develop incredible anxiety, panic disorder, and an arrhythmia 2/2 to the anxiety. Being on wards makes me hyperventilate and brings on this feeling of impending doom. I have worked incredibly hard (board scores in the 250s) and it is heartbreaking that I cannot seem to cope with medicine. I have rotated in and considered non-clinical specialties as well but they haven't put me at ease either. I'm leaning towards leaving medicine for good but my advisors have recommended that I somehow finish residency so I can support myself and have more doors open in the future, but I am not sure if I will cope very well. Please give me some advice based on your take on this situation. Should I somehow finish residency (such as IM) or is it reasonable for me to look for an alternate career despite having to start from the ground up?

Thank you so much for reading.

Do you have any debt or other financial concerns?

Have you discussed all this with your school counselor or a psychiatrist (e.g., for medication if needed)?

 

[shopsteward]

Are you getting any treatment for this anxiety? I think you should explore the options for treatment, not necessarily so that you can white-knuckle your way through an IM residency but so you can understand your issues and manage them better.

Are you still a third year? That gives you a little time to consider your options, taking into account how your treatment is going.

 

[Waraba]

People follow the paths they're on for different reasons, and without knowing some additional information it seems it would be difficult to offer any specific advice. For example how much debt you have, how do you prioritize things like salary, service, job security, and how interesting a job is. If your anxiety is more rooted in the area of performance evaluations then I assure you that you may suffer this same thing if you were in the business/tech world or in academia. I think this is also true of social anxiety as well, since almost every endeavor involves dealing with people. You have invested a lot of time, energy and money in this. Take care before you bail out only to find that the grass is not greener on the other side...

 

[TraumaLlamaMD]

Can you take a research year and explore a bit to see if a transition into research-based medicine is better for you?

 

[thxleave]

If you have all federal loans, and don't mind working insurance, try applying to the state government. A lot of state governments have self-funded insurance, and have departments dedicated towards running the insurance company. You'll be an analyst (not a consultant) without any residency, but pay is alright.... ~45k starting off, caps at ~60k unless you get upgraded a tier (it isn't hard to upgrade a tier). Which leads to ~55k starting up till ~70k after 5 years. Not bad money for a chill job. Also the value of a pension in this low return rate investment world is estimated to be worth another 30k (only if you live till age 55 to reap the retirement benefits). Don't forget the PSLF is another increase of your income for 10 years until it's forgiven.

I left medicine, since I can't handle my brain going 100% everyday. Sometimes I want to turn off my brain and go to auto-pilot till 5 pm. I like life outside work more then I liked work itself. I don't like helping people (well I used to). After a while in the rotations, I see these people as a body that needed to get out of the hospital or clinic ASAP to reduce the list count. I never felt that spark where "hey I helped someone", it's more like.... Maybe the patients should stop doing meth and feel entitled to being treated every freaking month for CHF.

Being a medical student felt cruel and punishing to me, and I honestly dreaded the thought of residency. None of the stuff like pimping, or yelling, or criticism will ever be allowed in the office.

The only downside is all the free time you have after you leave medicine. So yeah, finding a career outside of medicine is possible with MD no residency. PS I also have a Carib MD (SGU). So it'll probably be even easier for you.

PS: As for anxiety problems. I had the same feeling, until the I started my job. Now life is super chill.

 

[cdunphy199]

Thank you all for responding. I do have some debt but my family is willing to help with it considering my situation. I am a 4th year currently making me pressed for time. The anxiety comes from being around sickness, death, seeing people unresponsive, making life-death decisions for someone else. Even outpatient medicine began to bother me half way through my clinical year. I have not seen a psychiatrist yet because I'm worried about medication dependence but I understand that I probably should do so. Some background about me: I have an undergraduate degree in business and I enjoyed it and did really well, I used to be a risk taker and enjoyed challenges in life, I worked really hard, was very patient and believed in myself. All of that changed a year and a half ago, I have become incredibly indecisive, a nervous wreck, an extreme worrier. I am beginning to think I am no longer the person I once was, and I don't know how this anxiety will affect a new career either. I hate that this is what it has come to but I don't know what else I can do apart from leaving.

 

[Waraba]

Did you enter the match? If so, what specialty?

 

[cdunphy199]

Yes, applied to IM. With the intention of getting a non clinical job in pharma or admin post residency.

 

[colbgw02]

Do you know what it was about "non-clinical" specialties that gave you anxiety?

 

[cdunphy199]

After shadowing a radiologist, I found the isolation and the dark room to be contributing to my mood issues. Otherwise I think it would be a better fit for me than most other specialities out there. Pathology did not interest me and also the bad job market is not encouraging, and Anesthesia again goes into the critical care territory. I appreciate all of you taking time to hear me out and offer advice, thank you so much.

 

[doglover919]

Once in an anxious state I've found that anything could set someone off and make them more anxious. For example I had a friend in high school who started getting anxiety. We used to always watch the show Supernatural together and she would have no problem but once the anxiety came about she could no longer watch the show as it greatly increased her discomfort. What I'm getting at is maybe outpatient med wouldn't usually upset you but since you're already anxious it does. I think once you can find a way to reduce your overall anxiety you should go look at radiology again and see if you like it any better. Best of luck to you I'm sure you'll get through this!

 

[Waraba]

Since you've thought about rads and path, have you considered psych? In your current state I think IM will be rough, although I realize it's too late now...

 

[cdunphy199]

You make a great point. If you were in my situation, would you take a gap year after graduation and then reassess residency options or would you start residency (for example at a community program which is OP heavy) and then maybe reassess after intern year and/or transfer to radiology?

 

[Waraba]

This is a tough question, and I don't feel comfortable advising you on it. On the one hand, you would be embarking on a new chapter of life, and you will be in a job, albeit (tough) training, where you will earn a salary. And this path will lead you to a place where you should have job security, flexibility, geographic flexibility, a good salary, and you'd be working in a field that should be at least somewhat personally rewarding, e.g. helping others and doing something generally non-boring. So I would be tempted to encourage you to not do anything which would limit your career options, and only work toward maximizing your career options. On the other hand I would not want you to get yourself into a situation you cannot handle and ultimately get yourself into a state where you might consider doing harm to yourself. Bailing out completely, taking a gap year, transferring programs/specialties, soldiering on - all of them have tough problems to overcome. IMHO your family/loved ones/close friends/colleagues, deep introspection, and maybe a mental health professional who sees you personally are the only ones who can really weigh in...

 

[NotAProgDirector]

I think it's critical that you get assessed. Maybe it's something medical -- hyperthyroidism, for example. Maybe it's anxiety. No way to know unless you get assessed. And if it is anxiety, there's a huge gap between being "medication dependence" and "taking a medication daily that controls my symptoms".

Given the timeline, my recommendation would be to consider a gap year. You don't even know if IM is the right field for you, and you want your health issues under control before starting a residency. You can ask your school if you can "split" your 4th year -- some allow you to do this as no increase in your tuition. You would then use the rest of this year to get assessed / treated, and explore other fields like rads, path, or other.

If that's not an option, then consider taking an LOA to get this assessed and treated. As you mentioned, you seem to have changed and it's not clear you could just go back to your old job and do well. A split 4th year is a better option, if possible -- especially if you can keep going to rotations while being evaluated / treated. Although during an LOA you could "get away" from medicine and see if your symptoms abate.

"Powering through" an IM residency with what sounds like disabling symptoms is not going to be easy. You could easily end up in trouble or in an LOA there. Better to try to address this now.

 

[Goro]

OP, I note that you didn't answer the questions of "Are you getting help?"

It's not a sign of weakness or a loss of face to get help.

 

[LucidSplash]

Agree with the comments above re: seeking help. Otherwise, did you consider PM&R?

 

[cbrons]

You shouldnt avoid the things that make you anxious.

Sent from my SM-N910P using SDN mobile

 

[Arcan57]

Sudden personality change needs evaluated as others have stated. Consider public health also, there are tracks for non-clinical MDs that are reasonable from a salary standpoint.

 

[QofQuimica]

Sudden personality change needs evaluated as others have stated. Consider public health also, there are tracks for non-clinical MDs that are reasonable from a salary standpoint.

Yeah, I was going to suggest preventive medicine as a possible option. Also agree with seeing a physician to rule out any non-psych etiology of this sudden anxiety, and a psychiatrist if no medical cause is found.

 

[Crayola227]

Without you receiving appropriate medical care, especially for any mental health issues, YOU SHOULD NOT BE MAKING LIFE CHANGING DECISIONS RIGHT NOW.

You needed to see a doc like yesterday. Go to your PCP or school wellness center. If after assessment they think you should see a specialist, take medication, or receive counseling, I would strongly advise you to seriously consider following their advice.

Because until you do this, ANY CAREER ADVICE WE OFFER IS MEANINGLESS.

GO SEEK HELP.

What would you tell someone who said, "I used to be this one type of person with these certain goals, and now because of my anxiety I don't feel like who I used to be, and based on that, I'm wanting to make major life choices, some of which aren't ego-syntonic but are rather driven by my untreated mental illness."

I hope you wouldn't offer job ideas.

The shouting is more meant for the well-wishers here.
I also don't mean to beat you up. Lord knows how many of us whilst in the mist of madness (mental illness) lost a little insight into ourselves.

Take solace that yes, even if nothing happens to change your issues, there is a path through this. In fact, you can probably do enough SDN search function research to figure out back up plans. Those always soothed my own anxieties so I understand you wanting them.

However, I think it's worth it to seek help and broaden your options. Don't let any potentially untreated illnesses narrow your horizons.

 

[Gastrapathy]

All good advice. Get help. Lots of lower intensity specialties with meaningful work. PM&R, Occ Med, Psych, etc. IM internship in 6mo doesn't seem like a good plan.

 

[deleted647155]

Wow, your situation sounds like mine word for word. I have a lot of anxiety dealing with morbidity and mortality in medicine, which is why I want to do outpatient medicine mostly, where most of your patients are healthy enough to ambulate.

In addition to the above mentioned specialties, have you considered dermatology or urgent care medicine (usually family medicine => urgent care medicine). Lower acuity, fewer hours, less stress, lots of time off in UCM.

 

[caffeinemia]

MEDICAL EXAMINER. The dead tell no tales. Supposedly.

 

[y123]

Research or consulting?