Doing more than one specialty?

[lacrossegirl420]

I realize this may sound like a ridiculous question, but there were a couple specialties in med school I was really excited about and would love the chance of “experiencing” them during my life. I’ve already finalized my specialty choice, which I’m super excited about, but part of me will miss some of the other specialties that I won’t really get a chance to do after this.

Has anyone say practiced in specialty X for 10-15 years, then gone back to do residency in Y field out of passion and not for financial reasons or anything? I don’t really have any desire to settle down/have a family and would say I’m a pretty adventurous person, so doubt any of that “life stuff” people always bring up would really apply to me and I can stay flexible. I also have a lot of career interests outside of medicine.

Thanks!

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[JBM16BYU]

Changing your specialty or how you practice is not unheard of in medicine. Typically it is not by doing a second residency (mostly due to it not being paid for the standard way so the hospital you do a second residency in would have to secure funding for you). That being said, I know someone personally who completed IM residency and is now in the middle of dermatology residency.

More common way to switch specialities is by doing a fellowship. This can vastly change your way of practice or just give you extra skills without changing your practice too much. Most will do fellowship immediately following residency, but I know of some cases where physicians went back several years later to complete a fellowship and change their practice (more commonly in lesser competitive subspecialities such as geriatrics or hospice and palliative care).

Even without doing a second residency or completing a felowship, one can change their practice by changing jobs. Private practice to academics or vice versa. Outpatient to inpatient or vice versa. This may not always be possible, but something to consider.

It would be helpful to know what your finalized specialty choice is to help apply this more to you, instead of having to speak more in generics.

 

[LucidSplash]

10-15 years is right when you will hit your stride in terms of experience and mastery of your field. If you leave at that point to start in a completely new field, you’ll be giving up a lot of ground.

That being said I have a friend that was a sub-specialty surgeon and after about 8-9 years did a palliative fellowship and switched her practice to palliative. She found she got a lot of satisfaction and better QOL out of it. I can understand doing something like that if totally burned out.

 

[Drrrrrr. Celty]

This is one of the major issues within medicine where things are hyperspecialized.

But honestly after being a trained physician and having practiced to go towards being a resident again and having someone potentially 10 or 20 years my younger be yelling at me to do **** would be an unacceptable status. Further going from making >200-300k cleanly a year to doing skut work for what presumably with inflation is still 1/3rd of that is unacceptable and would affect me and my partner's lifestyle.

Simply put, choose right the first time. If you cannot choose then pick IM and have fellowship options.

 

[ChordaEpiphany]

This is one of the major issues within medicine where things are hyperspecialized.

But honestly after being a trained physician and having practiced to go towards being a resident again and having someone potentially 10 or 20 years my younger be yelling at me to do **** would be an unacceptable status. Further going from making >200-300k cleanly a year to doing skut work for what presumably with inflation is still 1/3rd of that is unacceptable and would affect me and my partner's lifestyle.

Simply put, choose right the first time. If you cannot choose then pick IM and have fellowship options.

Along with pay and hours, I think social status/hierarchy would be the biggest deterrent with this. The hierarchy within medicine is intense. I'd go as far as to say that the entire training structure is designed to disadvantage (and at times embarrass) the person one rung down on the totem pole. You can literally point to the reasons it becomes easier and easier to do the job with each level of advancement. Sometimes it makes sense for patient care, sometimes it's clear that superiors just don't want to be embarrassed and the environment is set up accordingly. It starts in M3 and just keeps going until you are an attending. Then all of a sudden your jokes are funny, your awkwardness becomes quirkiness, and your plans are always right.

Just going from being a senior grad student in a lab to being an M3 was a major shot to the ego. You swallow your pride and grin and bear it, but it's a very bitter pill. I can't even imagine being an attending and voluntarily going back to intern. I think the embarrassment would be worse than the hours and right up there with the pay.

 

[Tenk]

Usually when people go and do a second residency it’s because they are fed up with one or more aspects of their current specialty.

For instance I have a friend who was FM/sports med who went back and actually did EM residency in my class. I also had an attending who was EM when I was a resident who went and did ophtho because he was sick of EM. Both are much happier with their change.

To do a second residency for fun or interest just isn’t worth it especially if you like an adventurous lifestyle because residency is the antithesis of that.

My advice: find a specialty that interests you and has shift work (ie you aren’t on call all the time or you have to manage an office or staff) that way you can work as much or as little as you need and enjoy your life to the max.

 

[Drrrrrr. Celty]

Along with pay and hours, I think social status/hierarchy would be the biggest deterrent with this. The hierarchy within medicine is intense. I'd go as far as to say that the entire training structure is designed to disadvantage (and at times embarrass) the person one rung down on the totem pole. You can literally point to the reasons it becomes easier and easier to do the job with each level of advancement. Sometimes it makes sense for patient care, sometimes it's clear that superiors just don't want to be embarrassed and the environment is set up accordingly. It starts in M3 and just keeps going until you are an attending. Then all of a sudden your jokes are funny, your awkwardness becomes quirkiness, and your plans are always right.

Just going from being a senior grad student in a lab to being an M3 was a major shot to the ego. You swallow your pride and grin and bear it, but it's a very bitter pill. I can't even imagine being an attending and voluntarily going back to intern. I think the embarrassment would be worse than the hours and right up there with the pay.

I became very disillusioned with the medical training system especially as I completed fellowship.

 

[mrbreakfast]

Short answer: yes, people do this. I know multiple people who completed a residency, worked for a few years, then came back to do a different residency. Almost as a rule, it is people who are not happy in their current field.

 

[operaman]

I’ve known a few of these. One was a fellow “intern” with me on an off service rotation and I found out later he’d authored a book I had to read in my own didactics. He seemed quite happy with his choice. Definitely a cost though, but he also didn’t seem to mind the status drop as he felt he had much to learn in the new field and also liked the relative simplicity of the resident role.

I think more commonly that people evolve their practice within their own field. Classically for surgeons this means operating less or doing less physically demanding or high risk procedures over time. Some docs get into the administrative side of things mid to late career. Others go part time and start a business or some other venture outside medicine. Academic docs leave for PP and vice versa.

I think that eventually everything in every field becomes somewhat routine. Doing your first central line is really fun. Doing your 3000th much less so. Same for any procedure or clinic encounter. Most still find their fields interesting enough, the others will adjust or augment their practice in various ways, and a select few go back and retrain. Those few are usually quite unhappy where they are such that minor adjustments won’t cut it.

 

[annoyedpsychiatrist]

Im a psychiatry attending but maybe fantasize sometimes about busting into the OR like Dr. Strange, performing a little neurosurgery here and there, then heading back to my office like "no big deal".

 

[Dral]

It's possible for sure. I'd say stick with something that has multiple opportunities within it though. Go all in and try to master it. Then pivot in your career within that area if you so desire. You have to close some doors to be able to open up others.

If you do switch, as others have mentioned, you'll be starting from ground zero. It takes years to get to that stride point in your field. I honestly wouldn't want to do that again.

For instance, unless you are a super super star, you'd likely never get to the point of giving talks or being an expert in your fields. If you are outside of academics (though being in pp does not exclude giving talks and being academically inclined), that might not matter.

Just some things to consider.

 

[Drrrrrr. Celty]

Im a psychiatry attending but maybe fantasize sometimes about busting into the OR like Dr. Strange, performing a little neurosurgery here and there, then heading back to my office like "no big deal".

I considered doing psych as a 3 year "fellowship" after I completed IM. But I decided I'd rather shoot my dick off than be a PGY2.

 

[Tangerine123]

The hierarchy within medicine is intense. I'd go as far as to say that the entire training structure is designed to disadvantage (and at times embarrass) the person one rung down on the totem pole.... It starts in M3 and just keeps going until you are an attending. Then all of a sudden your jokes are funny, your awkwardness becomes quirkiness, and your plans are always right.

As in many other jobs and fields, and it's really cultural.

I'm doing residency in Europe. Hierarchy is mostly flat. It's not uncommon to disagree with attendings and tell them that you won't do something. A PGY5 has no "power" over a PGY1, and responsibilities are mostly equally shared. We use first names and drop titles when talking with each other and about each other.

I was recently in South Korea. Hierarchy is so important there. It's expected for your colleagues that are younger and less experienced to even pour drinks for you.

 

[LucidSplash]

As in many other jobs and fields, and it's really cultural.

I'm doing residency in Europe. Hierarchy is mostly flat. It's not uncommon to disagree with attendings and tell them that you won't do something. A PGY5 has no "power" over a PGY1, and responsibilities are mostly equally shared. We use first names and drop titles when talking with each other and about each other.

I was recently in South Korea. Hierarchy is so important there. It's expected for your colleagues that are younger and less experienced to even pour drinks for you.

Sure. But the vast majority of people on this board are US-based and will train and practice in the US. I’m not sure that comparisons to other countries is pertinent to the discussion for the vast majority of the people here.

 

[Drrrrrr. Celty]

As in many other jobs and fields, and it's really cultural.

I'm doing residency in Europe. Hierarchy is mostly flat. It's not uncommon to disagree with attendings and tell them that you won't do something. A PGY5 has no "power" over a PGY1, and responsibilities are mostly equally shared. We use first names and drop titles when talking with each other and about each other.

I was recently in South Korea. Hierarchy is so important there. It's expected for your colleagues that are younger and less experienced to even pour drinks for you.

I disagree with my attendings as a PGY5 fellow. Because at that point I honestly knew enough to be able to hold my weight. And I can absolutely put my foot down if I believe it's serious enough that I won't do it. All residents can do that too if they ethically think it's wrong. However you better have a good reason more than something fluffy like my feelings.

A PGY-1 disagreeing with me is likely because they have no clue what planet they're on and also then speaking the completely wrong language.

A big part of why I don't enjoy medical education is because people don't do their generalist jobs well ( including not understanding even basic things within the management of disease) and then have an opinion on my treatment plans. Ex. I had a resident tell me they're sending a person with uncontrolled A fib with a FT4 of 3.0 home irregardless home. I tell them can they at least rate control them first? And they tell me we will keep your opinion in mind. Last HR 138 on discharge.

Regarding the hierarchy. I don't personally have a hierarchy mentality. However if I am leader of the team I delegate things. So yes, as a Senior or Fellow. I can tell you to do things and correct you if you're wrong. As that is part of my job and how I keep patients safe.

 

[LucidSplash]

I disagree with my attendings as a PGY5 fellow. Because at that point I honestly knew enough to be able to hold my weight. And I can absolutely put my foot down if I believe it's serious enough that I won't do it. All residents can do that too if they ethically think it's wrong. However you better have a good reason more than something fluffy like my feelings.

A PGY-1 disagreeing with me is likely because they have no clue what planet they're on and also then speaking the completely wrong language.

A big part of why I don't enjoy medical education is because people don't do their generalist jobs well ( including not understanding even basic things within the management of disease) and then have an opinion on my treatment plans. Ex. I had a resident tell me they're sending a person with uncontrolled A fib with a FT4 of 3.0 home irregardless home. I tell them can they at least rate control them first? And they tell me we will keep your opinion in mind. Last HR 138 on discharge.

Regarding the hierarchy. I don't personally have a hierarchy mentality. However if I am leader of the team I delegate things. So yes, as a Senior or Fellow. I can tell you to do things and correct you if you're wrong. As that is part of my job and how I keep patients safe.

As a chief surgery resident I was consulted on a patient with what was clearly metastatic melanoma with Mets everywhere including a large mass causing tracheal deviation. Giant melanoma protruding from the back like a mushroom. We were consulted for biopsy. I was like sure, no problem, we can do that at bedside under local for safety. PGY2 medicine resident “running the service” wanted me to take to OR for lymph node biopsy as well. I told him no, given the situation, that wasn’t safe and not indicated given the clinical picture unless the biopsy of the primary lesion returned something unexpected. Told me “oncology always wants the most peripheral lesion.” I stared at him dead-eyed and in monotone told him the giant melanoma was the most peripheral lesion.

He then told me “Just take him to the OR and put him to sleep, it isn’t that hard.”

I told him if it wasn’t that hard, we’d let him do it, and I wasn’t endangering a patient for an unindicated procedure.

After doing the biopsy, I also then went straight to the program coordinator to report myself in case he decided to. 😂 But I never heard any pushback.

 

[Drrrrrr. Celty]

As a chief surgery resident I was consulted on a patient with what was clearly metastatic melanoma with Mets everywhere including a large mass causing tracheal deviation. Giant melanoma protruding from the back like a mushroom. We were consulted for biopsy. I was like sure, no problem, we can do that at bedside under local for safety. PGY2 medicine resident “running the service” wanted me to take to OR for lymph node biopsy as well. I told him no, given the situation, that wasn’t safe and not indicated given the clinical picture unless the biopsy of the primary lesion returned something unexpected. Told me “oncology always wants the most peripheral lesion.” I stared at him dead-eyed and in monotone told him the giant melanoma was the most peripheral lesion.

He then told me “Just take him to the OR and put him to sleep, it isn’t that hard.”

I told him if it wasn’t that hard, we’d let him do it, and I wasn’t endangering a patient for an unindicated procedure.

After doing the biopsy, I also then went straight to the program coordinator to report myself in case he decided to. 😂 But I never heard any pushback.

While I certainly will say that I've had times where the surgeons need my help for decision making. It's about a mutual discussion. But this is a specialist talking to a specialist. A generalist who doesn't really know the whole thing is not good enough.

I also think legitimately that with very sick patients the internal medicine team shouldn't really be talking to a surgeon and instead it should be the Hem/Onc specialist.

 

[voxveritatisetlucis]

It doesn’t make sense unless you’re independently wealthy. Residents and fellows make less per hour than Starbucks workers in most states these days so it would be hard for many to go back to.

 

[LucidSplash]

While I certainly will say that I've had times where the surgeons need my help for decision making. It's about a mutual discussion. But this is a specialist talking to a specialist. A generalist who doesn't really know the whole thing is not good enough.

I also think legitimately that with very sick patients the internal medicine team shouldn't really be talking to a surgeon and instead it should be the Hem/Onc specialist.

The point of the post was that hierarchy is different between specialties and service lines. It’s generally not a great idea for a PGY 2 to tell a PGY 7 to “just do X, it isn’t that hard”, across specialty lines especially. But the PGY2 felt entitled, even after it was explained to him why he was wrong, because he was the “chief of the service” talking to the “chief of the service.” Also probably because he was a male talking to a female and PGY2 in most specialties is peak Dunning-Kruger. He said something smarmy to try and push his weight around and got a response in kind.

Hierarchy has its place in medicine. But it’s all about context.

 

[Drrrrrr. Celty]

The point of the post was that hierarchy is different between specialties and service lines. It’s generally not a great idea for a PGY 2 to tell a PGY 7 to “just do X, it isn’t that hard”, across specialty lines especially. But the PGY2 felt entitled, even after it was explained to him why he was wrong, because he was the “chief of the service” talking to the “chief of the service.” Also probably because he was a male talking to a female and PGY2 in most specialties is peak Dunning-Kruger. He said something smarmy to try and push his weight around and got a response in kind.

Hierarchy has its place in medicine. But it’s all about context.

Agreed.

You should never tell a senior who has more experience than you, especially in a field you're not trained in to do something for you unless you really have a compelling reason.

It really comes off as you having a grasp and belief of superiority.