Considering switching from EM to surgery

[a4959]

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EM PGY1, anchored pretty hard on EM during Med school. 6months into intern year, I've come to find that EM isn't and probably won't be a fulfilling career for me. I'm strongly considering starting the beginning process of going about switching into either Ortho or gen surgery. At this point I just know that I should have done surgery.

Sounds crazy I know, not sure why I'd want to put myself through this ,but I'm sure this has been done, although there is very few examples I can find. I'm aware of the financial implications institutionally a program may face by having to take on a declared 3 year program resident now trying to switch to a 5 yr program. Curious if there anyone that can comment on how that works and if there are ways around it.

Looking for any advice from program directors, people who have been there and done this or know people that have. Little background DO, step 1 usmle/comlex: 250+/750+ step 2 270+/800, most of my letters were in emergency medicine as Med student, but have one surgeon (a respected program director) I know from Med school that would write a letter and have developed relationships during my trauma rotation with surgeons at my program whom would probably put in a word/letter.

Tentatively the plan would be to finish my intern year and likely finish pgy2 then enter my pgy3 year as a surgical intern, that sounds horrible as I type it but long term I think it's right.

 

[NotAProgDirector]

It's probably too late to apply for GS this year. However if your current institution has a GS program, you could certainly talk to them. They might be willing to interview you for this year, and give you a chance of matching -- assuming that staying at your current institution is an option you'd like to consider.

The next option is SOAP. It's unlikely a categorical GS spot will be open in SOAP, but you never know. You would be very competitive for a prelim GS position with those stats. After completing a prelim GS position you'd need to either find a PGY-2 GS position (which is possible), or re-match into a categorical surgery PGY-1. To participate in SOAP you'd need to register for both ERAS and NRMP.

The third option is the one you stated above -- continue as a PGY-2 and apply to GS. There's no guarantee that your EM program is going to give you time to interview for GS positions.

 

[Moose A Moose]

If you switch into a prelim spot you're going to hate yourself for a long time.

Grass is greener, man.

 

[hamstergang]

6months into intern year, I've come to find that EM isn't and probably won't be a fulfilling career for me. I'm strongly considering starting the beginning process of going about switching into either Ortho or gen surgery. At this point I just know that I should have done surgery.

I would worry most about how you'd be feeling 6 months into surgery. How sure are you that it will be better for you?

 

[ThoracicGuy]

It's probably too late to apply for GS this year. However if your current institution has a GS program, you could certainly talk to them. They might be willing to interview you for this year, and give you a chance of matching -- assuming that staying at your current institution is an option you'd like to consider.

The next option is SOAP. It's unlikely a categorical GS spot will be open in SOAP, but you never know. You would be very competitive for a prelim GS position with those stats. After completing a prelim GS position you'd need to either find a PGY-2 GS position (which is possible), or re-match into a categorical surgery PGY-1. To participate in SOAP you'd need to register for both ERAS and NRMP.

The third option is the one you stated above -- continue as a PGY-2 and apply to GS. There's no guarantee that your EM program is going to give you time to interview for GS positions.

A fourth option:

If the op is going to finish his second of three years, go ahead and finish all three years and then apply. That way if surgery turns out to be wrong, there's always em to fall back on.

 

[gutonc]

A fourth option:

If the op is going to finish his second of three years, go ahead and finish all three years and then apply. That way if surgery turns out to be wrong, there's always em to fall back on.

I actually think this is the best option. An EM attending applying to do Gen Surg is going to be a more desirable candidate than someone fleeing EM after 2 years who may look a bit flaky.

 

[doc05]

I actually think this is the best option. An EM attending applying to do Gen Surg is going to be a more desirable candidate than someone fleeing EM after 2 years who may look a bit flaky.

an EM attending is not a "desirable candidate."

 

[doc05]

EM PGY1, anchored pretty hard on EM during Med school. 6months into intern year, I've come to find that EM isn't and probably won't be a fulfilling career for me. I'm strongly considering starting the beginning process of going about switching into either Ortho or gen surgery. At this point I just know that I should have done surgery.

Sounds crazy I know, not sure why I'd want to put myself through this ,but I'm sure this has been done, although there is very few examples I can find. I'm aware of the financial implications institutionally a program may face by having to take on a declared 3 year program resident now trying to switch to a 5 yr program. Curious if there anyone that can comment on how that works and if there are ways around it.

Looking for any advice from program directors, people who have been there and done this or know people that have. Little background DO, step 1 usmle/comlex: 250+/750+ step 2 270+/800, most of my letters were in emergency medicine as Med student, but have one surgeon (a respected program director) I know from Med school that would write a letter and have developed relationships during my trauma rotation with surgeons at my program whom would probably put in a word/letter.

Tentatively the plan would be to finish my intern year and likely finish pgy2 then enter my pgy3 year as a surgical intern, that sounds horrible as I type it but long term I think it's right.

do you have any good reason to switch into either ortho or general surgery? both are far more demanding than EM; would be very hard to convince any program to seriously consider you as a candidate.

 

[gutonc]

an EM attending is not a "desirable candidate."

Far more than an EM residency "dropout" would be.

 

[bashwell]

an EM attending is not a "desirable candidate."

I think @gutonc was saying an EM attending is a "desirable candidate" in comparison to someone who hasn't finished residency (EM).

 

[Gastrapathy]

Far more than an EM residency "dropout" would be.

You sure? Enough of a difference to be worth 2 years of earning attending pay?

 

[akwho]

You're a D.O. with an EM spot, and halfway done with intern year? I promise you a million dollars, that you will be significantly happier as an EM attending than a gen surg R3 in 2019.

 

[Gastrapathy]

You're a D.O. with an EM spot, and halfway done with intern year? I promise you a million dollars, that you will be significantly happier as an EM attending than a gen surg R3 in 2019.

But that's not the question. How will he feel in 2022-20xx.

 

[gracie369]

But that's not the question. How will he feel in 2022-20xx.

Those are the years he will feel depressed and wish he would have just stayed with EM.

 

[GonnaBeADoc2222]

Yeah. You don't want to make that switch,

 

[DrBowtie]

Far more than an EM residency "dropout" would be.

But the dropout is stuck and will finish the surgical residency regardless because otherwise they have no other options.

The full fledged EM turned surgery resident has far less to lose. After a particularly crappy call they can just say screw it and find an attending job quickly.

I'd say the dropout is less risky to finish the program.

 

[Winged Scapula]

Those are the years he will feel depressed and wish he would have just stayed with EM.

Really?

So you know the OP personally?

Can we stop assuming that being a surgeon is the worst thing ever? Some of us are actually happy!


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[Winged Scapula]

But the dropout is stuck and will finish the surgical residency regardless because otherwise they have no other options.

The full fledged EM turned surgery resident has far less to lose. After a particularly crappy call they can just say screw it and find an attending job quickly.

I'd say the dropout is less risky to finish the program.

Doesn't matter what the OP (or " dropout") thinks; I agree with others that in GS at least someone who has left other programs is seen as a flight risk. Better to finish EM unless he can get a position locally,


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[LucidSplash]

Really?

So you know the OP personally?

Can we stop assuming that being a surgeon is the worst thing ever? Some of us actually happy!


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Agreed! This phenomenon seems limited to GS, even. Including into the surgery forum. I don't think I ever see surgeons posting in the Gen Res forum or other specialty specific forums with unsolicited advice about choosing something other than surgery or switching out of surgery like "Ack! Don't choose EM! Shift work will make you miserable!" I don't understand why people are so intent on believing that all surgeons and surgery residents are miserable. The world needs all types and I'm happy there are those who are passionate about things that I don't want to do. When non-surgeons or their loved ones need a surgeon some day, don't you want there to be skilled passionate surgeons available?

 

[Arcan57]

Really?

So you know the OP personally?

Can we stop assuming that being a surgeon is the worst thing ever? Some of us actually happy!


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To me, EM >>> general surgery in terms of desirability. That may have factored into my decision to become an EM physician and not a general surgeon.
I can understand why physicians that have no interest in either specialty would compare the two and decide that EM (especially during training) has less objective suck than GS.
I do share WS's surprise that some of the posters are unable to imagine a person that would be happier doing surgery than EM, but matched into EM due to gaining an inadequate understanding in medical school of the specialty.

Life's too short to spend it working at a specialty for which you're unsuited.

To the OP: Jan/Feb of intern year is traditionally the low point of residency for EM (probably true for most other residencies also) for a variety of reasons:
1) Daylight is in short supply
2) Some of your peers may be starting to gain a superficial appearance of competence in the ED that exacerbates your feelings of incompetence
3) You've probably spent relatively little time in the ED
4) You've probably rotated through some surgical specialties and enjoyed your time on them.
5) You may be in the wrong specialty

1-3 are what they are and don't have any long term bearing on whether you're in the right specialty.

4 is somewhat unique to EM in that many of those rotations are a somewhat curated experience. Even working the same hours as that specialty's interns, the expectations are different for us being there a month versus the categorical intern who's competence as a PGY-2/3 is going to have a direct and continuous impact on the seniors'/chiefs' quality of life. We also tend to get shown more of the "cool" aspects of the specialty compared to the average floor scut monkey surgical intern experience. In a way this is not dissimilar (although the motives are different) to how EM curates it's med school rotation to make the specialty more broadly appealing than it actually warrants.

5 is the real concern and it's something that can be objectively difficult to figure out. I'd recommend making a list of what you perceive as the pros and cons of each specialty. Then you'll need to go through that list (possibly with a trusted neutral observer) and decide if those pros and cons are situational or are immutable. IF your list of cons for EM are things that never going to change (hate circadian rhythm disruption, dislike episodic care, can't refocus after interruption) and your pros about GS are things that will still be true as an attending and the pro/con for GS>>>>>EM then you need to look into changing specialties. If you find that what's bothering you now is unlikely to be a feature of your career in EM as an attending or that there's only a small difference between surgery and EM then stay put.

 

[gracie369]

Really?

So you know the OP personally?

Can we stop assuming that being a surgeon is the worst thing ever? Some of us are actually happy!


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Always include humor in the differential. I'm good but diagnosing depression 5 years into the future is still difficult. Glad that you are happy though.

 

[gutonc]

You sure? Enough of a difference to be worth 2 years of earning attending pay?

At this point, it's really 1 year.

The OP's not getting a categorical Gen Surg spot this year. And a prelim year is...well...a prelim year.