considering re-entering match diff specialty....advise thanks!

[triathlondoc12]

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I am in a position now and honestly am having regrets about matching into my chosen field....I am a new intern in psychiatry and honestly this has been tearing at me since before the match... I had a difficult time deciding on a specialty at the end of 3rd year and honestly learned a lot about myself during the 4th year of medical school and about what I really enjoy and am looking for in my career in medicine.. I just started my intern year and I know it's very early, but I can just see ahead and don't really see myself being happy long term in the field. I was on the wards just the other day and at the end of a 15 hour day I didn't feel tired physically but just mentally exhausted from listening to the patients over and over throughout the day and night. it seriously was a whip... i just kinda hate feeling like a social worker and not really practicing medicine... i honestly don't feel like a doctor at all on inpatient psych... more like a person finding the homeless person a shelter after sobering them up a little...(I know not everything is inpatient, but it's more than just the environment, I really don't see myself as a fit within the personalities in the field either)
Here's my dilemma: choosing to re-enter the match this year vs giving it a true shot this year and re-evaluating at the end of the year. I have thought about things for awhile and originally wanted to give the program and specialty an honest shot for a year to see how things went and re-evaluate at the end and make a decision to stick with psych or re-enter the match. On the other hand, I feel like it may be better to go ahead and try to make the decision early on (this year in the next month or so) so that I can apply this cycle and not have to do a PGY-2 year in psych as well...(The reason is b/c of application timelines if I waited till next year i'd still have to complete the pgy-2 year before matching and starting the following one). Would u recommend doing so early on like say apply for eras this year and go ahead and talk to program director or give it a year and see? Plus wouldn't it be better to leave a program with a pgy2 open spot vs a pgy3? I don't know that's why I ask! Thanks everyone.. still keeping an open mind but just looking at a strategy just in case!

 

[Brigade4Radiant]

So in order to switch you need to know what specialty you want to go into. Many people feel what you are feeling Psychiatry has a higher attrition rate than general surgery.

 

[triathlondoc12]

of course. I didn't want to put the new specialty in the original message, but I pm'd you. I'd always heard the opposite about psych.... most people switching INTO it instead of OUT of it.

 

[splik]

you should discuss this as early as possible with your PD. It may be that you are unsuited to psychiatry but it could also be that your program is not a good fit for you. I am not sure how typical working 15 hrs on inpatient psychiatry is but that would be very unusual indeed and might be your first problem. I am also not sure why you are finding people shelters on inpatient psychiatry, this should be done by a social worker. Perhaps there are other things you dislike about psychiatry but what you are complaining about seem to be insititutional problems rather than issues with the specialty itself. I am also confused about why you are admitting patients just to sober them up. This isn't unheard of, but is not good psychiatric practice and again speaks to issues with your program and not psychiatry itself.

it's not that most people switch into psychiatry, but psychiatry is very welcoming of people from other specialties joining the fold. in contrast, switching out of psychiatry can be quite difficult. you're damaged goods now, people will be wondering what's wrong with you, so without glowing recommendations and a strong CV you will have a harder time ending up in a different specialty than if you were switching from a different specialty or entering as a med student.

 

[serimeri]

I don't know what program you are at but 15 hours a day is pretty extreme.

By the way, have you already started your PGY1 year, or are you a current intern who is finishing PGY1?

 

[triathlondoc12]

It was a call after I had done a shift. I don't see why someone would be damaged goods coming from psych but not damaged goods coming from another specialty. What does that say about psych? Lol. I'm a new intern

 

[serimeri]

It was a call after I had done a shift. I don't see why someone would be damaged goods coming from psych but not damaged goods coming from another specialty. What does that say about psych? Lol. I'm a new intern

Okay, that's not bad at all then. 16 hours is the maximum anyhow.

I think just go ahead and finish this year and see how you feel . You may end up liking Psych.

 

[ThoracicGuy]

It was a call after I had done a shift. I don't see why someone would be damaged goods coming from psych but not damaged goods coming from another specialty. What does that say about psych? Lol. I'm a new intern

You are a new intern. You've barely had any experience, certainly not enough to say Psychiatry isn't for you. You obviously thought it was good enough to try to match for it. Give it a try and some time. You may find you really do enjoy it.

 

[Gastrapathy]

Tell no one about your doubts until you've decided to act.

 

[triathlondoc12]

so what's the Right way to go about doing this? make sure it is 100% what I want to do and request an ERAS token from my old medical school and start prepping things like getting letters for the new specialty? (example writing the perfect personal statement) would letters from good docs from last year work too? or does everything have to have a 2015 date on them? once i have those things in place do i go and talk to my program director around the time before eras opens up so that i can be johnny on the spot the day it opens? also does anyone have any advice for getting permission to take off for interviews during intern year ? we have this weird policy where we cannot take a vacation day unless it's on an on-service month. hopefully the PD would be understanding and work something out but I can also see it getting hairy.... :/

 

[NotAProgDirector]

There isn't a simple answer. You can apply this year, match deadlines aren't until February so if you decide that you fall in love with Psych between now and then, you can always withdraw from the match and stay in psych (assuming your PD hasn't given your spot away).

Whether or not to tell your PD what you're doing is a question often debated on SDN. If you have an understanding PD, it's definitely the way to go. You're probably going to need to tell them to help arrange all the interview days anyway. You could apply only locally, which makes interviews easier to manage. If your PD is a jerk about it, then it can make the rest of the year miserable. Remember that if you drop out, it leaves your PD with an empty spot to fill -- the more time you give them, the happier they may be about the situation. Or the longer they will have to torture you.

 

[triathlondoc12]

Do other programs not need a recommendation letter from the current PD?

 

[mcl]

Do other programs not need a recommendation letter from the current PD?

Technically the letter from the former PD doesn't have to be issued until after the Match. To transfer a resident from one program to another, the ACGME requires a letter from the former PD to the new PD stating whether the transferring resident was in good academic standing and had achieved the required level of competency for his/her level of training. However, as the person reviewing applications, I wouldn't recommend a transferring-resident applicant to my selection committee for an interview for my program without having that letter in the ERAS packet. If there was a compelling reason to interview the person without the letter, I doubt we'd go as far as ranking without it. Why should the receiving program take the risk?

 

[triathlondoc12]

I certainly don't want to be in violation of the nrmp. I realize that I need to probably register for an nrmp waiver in order to even apply for the match this year right? by applying for the waiver am i basically signing my death warrant from my program? basically do i need to talk to the pd before i request the waiver or does the waiver contact them for me and gain permission, or does the waiver just make a decision on it's own and not even inform the pd ? i don't want to violate the nrmp at all so am being as careful as possible. also if applying for osteopathic residencies does it even matter since they're governed by the aoa or is there another waiver needed for this one?

 

[gutonc]

I certainly don't want to be in violation of the nrmp. I realize that I need to probably register for an nrmp waiver in order to even apply for the match this year right? by applying for the waiver am i basically signing my death warrant from my program? basically do i need to talk to the pd before i request the waiver or does the waiver contact them for me and gain permission, or does the waiver just make a decision on it's own and not even inform the pd ? i don't want to violate the nrmp at all so am being as careful as possible. also if applying for osteopathic residencies does it even matter since they're governed by the aoa or is there another waiver needed for this one?

If you complete your intern year, you do not need to get a waiver from NRMP so that's not an issue at all. In fact, as long as you complete (I think) 90 days of your current program, you're golden to just walk out the door dropping F-bombs along the way whenever you feel like it. I wouldn't suggest doing that, but you could if you wanted and not risk the wrath of the NRMP.

 

[koikisi]

If you complete your intern year, you do not need to get a waiver from NRMP so that's not an issue at all. In fact, as long as you complete (I think) 90 days of your current program, you're golden to just walk out the door dropping F-bombs along the way whenever you feel like it. I wouldn't suggest doing that, but you could if you wanted and not risk the wrath of the NRMP.

Do not do this. I am in a miserable program as evidenced by my few days so far, and I am still committed to being a good intern and finishing this year.

Everyday you are in a program will be in your record, it will open up a series of questions. If you felt so strongly about not going into your chosen specialty, you should have done the waiver prior to starting.



NO PROGRAM will ever take you if you start your intern year and just quit. PLEASE DO NOT DO THIS! YOU ARE AN ADULT, YOU SIGNED A CONTRACT FOR 1 YEAR WHEN YOU STARTED THE RESIDENCY, please I implore you, finish 1 year, then leave if you don't match or its unbearable. OP, please don't put your current residents in a shamble with the call schedule and your PD in a difficult spot. This will bite you in the rear.

At the very least, you can apply for a license in most states and work as a GP, so you can help pay back your loans.

Transferring or quitting is not an option people should ever look into.

Your plan needs to be sticking around from July1-July 1 of next year.

 

[gutonc]

I wasn't suggesting doing this. Just pointing out that it's not a Match violation to do so.

 

[thoffen]

The first thing I would do is talk to my upper level residents about what you are feeling so you can understand it better and hopefully use it to your advantage. This is not an uncommon way to feel about what you are doing, but expecting not to have a different set of grievances by switching specialties is naive -- as is expecting you to know that psychiatry is not for you after 4 days of inpatient experience. Depending on the setting, psychiatry can be highly medical, and you may be the only physician around to treat someones blood pressure/diabetes/chest pain, or be diagnosing lupus, cancer, etc. in a very vulnerable population. Why not take a different angle and ask your colleagues how to get more medical experience in the confines of your residency? RE: burn-out with listening to problems, playing social worker, etc. this is vital counter-transference that you need to understand to take good care of your patients. It may be that you need help setting limits or an avenue to express frustration with the crappy social options available for our patients, or even that you have a covert disdain for patients who see you as a source to get housing, disability, etc. None of these are your burden. You are not the patient. You have the potential to make peace with this separation and your role with partnering with patients to better health. Explore that before giving up on it.

 

[triathlondoc12]

oh I would definitely not just walk out on my program. I am absolutely committed to finishing intern year... what I was wanting to know is do I have to apply for an nrmp waiver at all ? if i just want to re-enter the match and apply to another specialty while still doing my intern year. I would be up-front with my program about my plans and let them know before the match so that they could pick up a pgy-2 for my spot at the end of the year. basically I did not rotate in the specialty that i'm interested in until match month last year (march) I really felt for the first time in my clinical years that I had found something that I truly wanted to do as a physician. unfortunately by that time, rank lists and such had already been submitted and I accepted my fate.....I did another rotation at the end of the year in the specialty and I was even further convinced. I decided to go into psychiatry and intern year with an open mind and hope that things would change or that I would grow to love the specialty I chose, but it has not happened. I am giving it another month to see, but I also want to be pro-active in making a change. I don't fully understand the nrmp rules about having to submit for a waiver the february in advance... does that mean if you're planning to just not show up at your program? how does it work for those who are hard working, show up for every shift and give it their all, but just want to switch specialties? thanks!

 

[gutonc]

oh I would definitely not just walk out on my program. I am absolutely committed to finishing intern year... what I was wanting to know is do I have to apply for an nrmp waiver at all ? if i just want to re-enter the match and apply to another specialty while still doing my intern year. I would be up-front with my program about my plans and let them know before the match so that they could pick up a pgy-2 for my spot at the end of the year. basically I did not rotate in the specialty that i'm interested in until match month last year (march) I really felt for the first time in my clinical years that I had found something that I truly wanted to do as a physician. unfortunately by that time, rank lists and such had already been submitted and I accepted my fate.....I did another rotation at the end of the year in the specialty and I was even further convinced. I decided to go into psychiatry and intern year with an open mind and hope that things would change or that I would grow to love the specialty I chose, but it has not happened. I am giving it another month to see, but I also want to be pro-active in making a change. I don't fully understand the nrmp rules about having to submit for a waiver the february in advance... does that mean if you're planning to just not show up at your program? how does it work for those who are hard working, show up for every shift and give it their all, but just want to switch specialties? thanks!

The Match Waiver you're talking about is only for people going into advanced programs after a prelim year. In that case, if you want to change from (say) IM/Gas to IM, you request a waiver, it's automatically granted and the only way you get a Match violation is if you go back into the match for Gas again.

In your case, you're talking (prematurely...this being week 2 of intern year) about leaving Psych for some other specialty.

As long as you stick it out until Columbus Day (and honestly, if you only make it to Bastille Day, nobody will really care), you will have completely fulfilled your Match commitment, and no waiver will be required.

 

[koikisi]

my advice is to go in with your heart set on Psychiatry. Try and give at least 3 months before you make your mind. Really think this through.

It's really sad how unforgiving and political the graduate medical education system is. I don't want to see you end up with no residency spot.

 

[koikisi]

The Match Waiver you're talking about is only for people going into advanced programs after a prelim year. In that case, if you want to change from (say) IM/Gas to IM, you request a waiver, it's automatically granted and the only way you get a Match violation is if you go back into the match for Gas again.

In your case, you're talking (prematurely...this being week 2 of intern year) about leaving Psych for some other specialty.

As long as you stick it out until Columbus Day (and honestly, if you only make it to Bastille Day, nobody will really care), you will have completely fulfilled your Match commitment, and no waiver will be required.

45 days. So you have to make it to mid-August at least. Please think this through though. Don't do anything irrational, you may love Psychiatry.

My personal advice is to even try and do PGY2 (you'll get so much exposure) you may even feel that Psychiatry is your passion.

 

[hopefulophthalmology]

I was wondering what you ended up doing. I matched too in a specialty that requires a preliminary/transitional year and am finishing the year but unhappy to pursue my matched residency at this point. I am not applying for a waiver because it kind a late and so would start my pry2 but after that am unsure of my plans at this point. Did you enter the match or did you begin to like psych. Please share your experience for purposes of understanding my options and the process.

 

[gutonc]

I was wondering what you ended up doing. I matched too in a specialty that requires a preliminary/transitional year and am finishing the year but unhappy to pursue my matched residency at this point. I am not applying for a waiver because it kind a late and so would start my pry2 but after that am unsure of my plans at this point. Did you enter the match or did you begin to like psych. Please share your experience for purposes of understanding my options and the process.

Wait...you're about to finish your intern year and (I assume) are having 2nd thoughts about starting ophtho in July and maybe switching to something else. If that's the case, go back and read this post. Then this post. Then this other post. Put all that together and you've got the answer to your questions about options and process.

Spoiler

Yes, I know I linked to the same post 3 times. And that it's my post. And that it's a mere 3 posts above yours. But that's seriously the full and complete answer to your question.

 

[triathlondoc12]

I ended up switching specialties ! It is such a relief and even though I'm finishing my intern year in the specialty I'm leavjng, it makes each day sweeter knowing I'm a day closer to my goal. It took a lot of work and creative scheduling to get to interviews and such but I made it happen!


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[Lostin_space]

I ended up switching specialties ! It is such a relief and even though I'm finishing my intern year in the specialty I'm leavjng, it makes each day sweeter knowing I'm a day closer to my goal. It took a lot of work and creative scheduling to get to interviews and such but I made it happen!


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Congrats! What did you decide to switch into?

 

[bearintraining]

I ended up switching specialties ! It is such a relief and even though I'm finishing my intern year in the specialty I'm leavjng, it makes each day sweeter knowing I'm a day closer to my goal. It took a lot of work and creative scheduling to get to interviews and such but I made it happen!


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btw, how did your PD/program handle it?

 

[triathlondoc12]

I told my PD my plans as soon as eras opened and when I applied. I didn't want to keep him in the dark or do anything behind the program's back. My PD was extremely understanding and kept things hush with me until we knew for sure when I got the Monday "did I match" email.


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