Considering Switch: Rads->Surgery

[therealalextrebek]

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Title says it, I'm about a month into my R1 (PGY-2) and just don't like it. I had been really close to applying in surgery, but listened too much to the med student voices about '...cush lifestyle!..' '.....chill!....', and did rads instead, and now I'm missing patient contact more than I thought I would, and am just bored during the day and finding it hard to motivate to read, learn, progress, and am struggling looking down the barrel of knowing this is what it's going to be for the rest of my life.

For family reasons, I like the institution where I am, and would love it if I could just switch on over to the surgery side, but would I have to start as a PGY-1 through the match? I did prelim medicine. How common is inter-institutional program switching outside the match?

Or is there anyone out there who can talk me out of it...?

 

[Doctor4Life1769]

That's a first...

 

[gutonc]

You know the rule...or perhaps you don't, and that's your problem.

If you can't imagine being anywhere but the OR, do surgery. If you CAN imagine being anywhere but the OR, do anything BUT surgery. The OR is a glorious place for a small subset of those of us in medicine, for the rest, it's a 10th circle of hell that Dante couldn't even imagine. Figure out which group you belong to (you still have some time) and put yourself there.

Also, perhaps diagnostic rads just isn't your bag. Maybe IR, or a non-surgical (but interventional) specialty is. Again, if you were competitive for GS and Rads, you're competitive for a lot of other things (that may or may not be Derm-level). You're also only 1 month into residency so perhaps you need to just give it a little bit of time.

 

[therealalextrebek]

Ya, I'm certainly not making any decisions right now, but am wondering about the process because I haven't been able to shake this feeling, like from day 1, that I'm not where I should be.

Yeah, I've heard that one, and I can imagine being a lot of places, but I think it may be a little more complex than that. Right now I'm feeling that, either way, if I have to be doing something other than being with my family for n hours per week (n being 50-70), it should be something that is better suited to me/more enjoyable. I think it was hearing those sorts of med student catch-phrases that held me back from applying to begin with....

 

[doc05]

don't do it. stick with rads, you'll have a better quality of life as an attending.

 

[Brigade4Radiant]

Title says it, I'm about a month into my R1 (PGY-2) and just don't like it. I had been really close to applying in surgery, but listened too much to the med student voices about '...cush lifestyle!..' '.....chill!....', and did rads instead, and now I'm missing patient contact more than I thought I would, and am just bored during the day and finding it hard to motivate to read, learn, progress, and am struggling looking down the barrel of knowing this is what it's going to be for the rest of my life.

For family reasons, I like the institution where I am, and would love it if I could just switch on over to the surgery side, but would I have to start as a PGY-1 through the match? I did prelim medicine. How common is inter-institutional program switching outside the match?

Or is there anyone out there who can talk me out of it...?

Hmm switching to general surgery as a resident makes you less competitive. Also gen surgery as well as the surgery specialties are harder to switch into in general. You also didn't do a prelim year of surgery so how do you know you'll like it? Other than board scores how are you going to convince a PD that you are dedicated to gen surg?

 

[Winged Scapula]

1) Your preliminary medicine year will not count for any rotations toward a surgical residency. Therefore yes, you must start over as an intern.

2) You mentioned work hours 50 to 70; don't fool yourself. Those might be reasonable once you're in practice but do not expect to work less than 80 per week during a surgical residency.

3) If you like patient contact and feel you made a mistake, sticking it out and ending up in a career you don't enjoy, despite the better hours and money is attending, is ridiculous.

4) Your current program is likely your best shot. You can discuss this with your program director and the surgical program director and see if they have a preliminary internship position available starting ASAP. Many programs have additional nondesignated preliminary spots for which they can add someone on.

As others have noted you may have some difficulty convincing them you're committed to surgery but you wouldn't be the first one to have a change of heart.

Your other option is to go through the match
or check www.apds.org for open positions.

 

[auburnO5]

Don't be crazy...

Stick it out with radiology and just do an IR fellowship.

 

[calvnandhobbs68]

Gonna join the "just do IR" camp...you've already started your residency and your last two years will have meant essentially nothing if you switch at this point (it's not like switching from surgery to rads where at least you get to knock off the prelim year). How much surgery had you really done besides your third year rotation? I'm assuming you probably did radiology aways (or at least didn't do any extra surgery rotations fourth year). I do think the above "do it if you really love being in the OR" is true. Is there something that you particularly like about general surgery? I didn't really get that from your post...just that you don't like radiology as much as you thought you would.

Finally, you can also do a lottt of other specialties that have patient contact besides surgery that don't require you working 80+ hours every week. If you really feel like you want to switch, keep an open mind about fields. Just because you feel that you shouldn't be in radiology doesn't necessarily mean that you should be in surgery.

 

[Doctor4Life1769]

1) Your preliminary medicine year will not count for any rotations toward a surgical residency. Therefore yes, you must start over as an intern.

2) You mentioned work hours 50 to 70; don't fool yourself. Those might be reasonable once you're in practice but do not expect to work less than 80 per week during a surgical residency.

3) If you like patient contact and feel you made a mistake, sticking it out and ending up in a career you don't enjoy, despite the better hours and money is attending, is ridiculous.

4) Your current program is likely your best shot. You can discuss this with your program director and the surgical program director and see if they have a preliminary internship position available starting ASAP. Many programs have additional nondesignated preliminary spots for which they can add someone on.

As others have noted you may have some difficulty convincing them you're committed to surgery but you wouldn't be the first one to have a change of heart.

Your other option is to go through the match
or check www.apds.org for open positions.

Generally I agree.
However, he'd be going from a straight shot path to radiology to an unknown status in gen surg. Prelim surg years mean nothing. They don't have to renew your contract. Hell, you guys have a prelim Year 2 as well. There's no guarantee he/she advances to PGY3 year. That's risky. If he wants patient care, he should just do FM and you get a whole lot of everything. Only 2 or so years and they may give him more credit towards intern year.

 

[Winged Scapula]

Generally I agree.
However, he'd be going from a straight shot path to radiology to an unknown status in gen surg. Prelim surg years mean nothing. They don't have to renew your contract. Hell, you guys have a prelim Year 2 as well. There's no guarantee he/she advances to PGY3 year. That's risky. If he wants patient care, he should just do FM and you get a whole lot of everything. Only 2 or so years and they may give him more credit towards intern year.

I agree. As a surgeon, I'm well acquainted with the issue of Prelim surgical residents.

However, he didn't ask if it was advisable, easy or the right thing to do. There's no reason he couldn't try and find a categorical surgical position; that would obviously be best. Prelim GS is going to be easier after the start of the year. Doing FM for someone "close to applying to surgery" is generally not advisable: he's already potentially made one wrong choice in Rads. FM isn't a substitute for GS.

 

[therealalextrebek]

I do like the operating, I did most of my electives in surgery and subspecialties (neurosurg, uro, ent, ortho) because i was that serious about it, plus DR as well as IR.

I realize that the residency is tougher (way tougher), but after how fast I feel that prelim year went by last year, I think it would go by relatively quickly.

Scheduled for IR soon, so I do think that will be a big decider.

As far as picking up a position, if a categorical were to drop from a surgery residency, do programs generally attempt to take another categorical person to take that spot (from prelims, IMG's, etc), or just cope with the loss?

 

[ThoracicGuy]

I do like the operating, I did most of my electives in surgery and subspecialties (neurosurg, uro, ent, ortho) because i was that serious about it, plus DR as well as IR.

I realize that the residency is tougher (way tougher), but after how fast I feel that prelim year went by last year, I think it would go by relatively quickly.

Scheduled for IR soon, so I do think that will be a big decider.

As far as picking up a position, if a categorical were to drop from a surgery residency, do programs generally attempt to take another categorical person to take that spot (from prelims, IMG's, etc), or just cope with the loss?

If a surgery program loses a PGY1 or 2, they will typically fill it in the next academic year with a current prelim. Most of the people that decide not to do surgery do end up sticking it out for the year, so the percentage that leaves in the middle of the year is quite low.

 

[Etorphine]

I put my vote in for IR. Plenty of pt contact in that specialty, and the pt contact is great. You just shoot the $%#@ with patients before and after the procedure, after they're rolled into the OR. IMO perfect amount of pt contact, less serious conversations in general, and you can joke around w multiple pts in a day. Pts are less stressed when getting a PICC line than having their tumor removed or appendix out, imo and from what I've observed.

 

[meister]

You just started radiology and know basically nothing at this point. You would be wise to give it some time before doing anything else you may regret.

First year of radiology is almost like being an MS3 again since third and fourth year of medical school, even internship, don't train you for it at all. It's not a good feeling but it passes once you start taking call and realize your work is important.