Considering switching from IM to Path

[abbeydesert]

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I'm supposed to start my PGY-1 year in Internal Medicine in a couple of weeks, but I seriously think that would be a major mistake. I've recently had a major change in life circumstances - I have two special-needs kids and my mother-in-law, who was supposed to be their caretaker when I'm at work, just died quite unexpectedly. There is absolutely no way my family can survive if I have to take overnight in-house calls on a regular basis. I have thought of deferring for a year, but I have no idea if I'll be in a position to be able to take overnight calls then, either. Soooooo...I'm looking at other career options. It seems that most of the other specialities, including things like preventive and occupational medicine, physical medicine and rehab, radiology, etc. all require a prelim intern year, which is not something I can do anytime soon given my family situation. So, almost by default, I'm thinking about path, since overnight calls there are few and far between (and typically taken from home, right?) However, I have never done a path rotation and I have no clue if I'd be any good at it. Also, I didn't do that well in anatomy, nor did I particularly enjoy it (not crazy about cadaver dissections- how often do you typically have to do these?). I did really enjoy my 2nd year path course. I chose internal medicine in part because of the intellectual challenge- it seems that path would provide that same intellectual stimulation, but with more benign hours, fewer live patients, and more lab work.
Perhaps these are the wrong reasons for considering a switch to path, but I am desperate and my options are really limited right now. Does anyone have any advice for me? How do I go about doing a path rotation if I'm no longer in med school? Who would I get letters from? Do I need to go do research or something like that to demonstrate a compelling interest? How do pathology program directors look upon applicants who jump ship from IM?

 

[bananaface]

If IM is where you ultimately want to be, don't settle for something that doesn't suit you.

Long term, you have to figure out alternative care for your kids. Explore your options and figure something out, either now or a year from now. One option is to find some quiet college student who is willing to take on some child care responsibilities in exchange for room and board. Education majors seem to be into this sort of arrangement.

Does your husband work nights?

 

[yaah]

Well, first off people do switch fields a lot. We have a former IM resident and a former surgeon in our program - although the IM guy actually finished his IM residency.

But switching to path because you won't have night call is probably ill advised. As I have posted, my hours on occasion in certain rotations can be up to 18 hours. Path residency can, at times, be more grueling than other specialties because of the kinds of things you have to do and the knowledge you have to acquire. If your family is your priority you have to do that. If doing a transitional/prelim year is "impossible" then you are probably not going to be an affective path resident, and may end up being somewhat of a burden on your other colleagues. It may sound harsh, but it is the truth. People are generally understanding with helping out colleagues in need, but there comes a time when you are expected to pull your own weight and not rely on the single folks to do all the objectionable tasks.

Anyone who wants to switch into a new field in the time course you are talking about (having not even started your actual field) is going to face a lot of questions from the path programs as to why you are doing this and what your motivations are - and lack of night call and more humane hours is unlikely to get them to bend over backwards to let you in.

In addition - it is kind of late in the year to hope to find a residency spot for the upcoming year which begins in two or three weeks. The best you could probably hope for is a spot for next year (2006-7), and if your other option is to defer IM for one year, why not just do that and think about your options in more detail?

 

[LADoc00]

Here is a cherry bit of advice because your story really touched a soft spot in me (all 1/10 of mm of it):

Apply to CP only to a program with a blood bank/transfusion medicine ACGME approved fellowship. Then you structure your training as such:
year 1: core CP I
year 2: core CP II
year 3: Tripartite elective split between TM, Chemistry and Coagulation/Hemostasis. (take CP board examination after year 3)
year 4: BM/TM (apply for tons of jobs as early as August year 4)
year 5: Take fall adminstration of BB/TM certificate exam, start new job usually 150s+ range.
Basically you sell yourself (all important concept) as a lab director with the ability to run a TM service and cross cover chem and coags. Dont expect this job to fall in your lap though, these gems are rare and you would have to hustle big time or face unemployment for months-years.

Explain your goal as wanting to practice CP with a BM/TM emphasis and do not mention family circumstances. Also realize that you will have to apply for a TON of jobs here, Im talking near 100+ because this is a very very small niche market. BUT, I can assure you: you will almost never be at the hospital later than 5pm, usually your workrounds wont start until 9am, you can leave the hospital at lunch and go home if neccessary, all call will be from home/no in-house, no weekends and no holidays (other than home call).

PS- Without knowing the particulars of your 2 (!) special needs kids, I would think you should see a genetics counselor if you planning on having more.