Having second thoughts

[secondguesses]

Hey guys,

I am a current MS-4 who matched into a categorical position in PM&R at one of the top programs in the country. Initially I was very excited with my decision to apply for PM&R, but recently I have begun to second guess myself. I am now actually having nightmares about how I might have made the wrong decision and may have ruined my life all together.

As a medical student I was also interested in Anesthesiology and Radiology but was talked out of pursuing them by my local attendings due to various reasons; possible economic hardships these fields will face in the future, lack of job market stability, personal distaste for the field, etc. Is there any possibility of me switching into one of these fields for my PGY-2 year? My stats should be competitive for these fields as well as I am in the top of my class with >240 step 1 and >250 step 2.

Or is it normal for me to be feeling this way before starting residency? Will my fears and nightmares eventually stop once I am in residency?

Any help or guidance is greatly appreciated as I am afraid to talk to anyone about this in person, especially my family.

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[j4pac]

If you matched to Mayo...let your PD know your intentions asap.

It's a tough decision to make. If you do not believe that you will be happy with PM&R, then perhaps you should switch as soon as possible. I think the question is whether or not this is the typical pre-internship anxiety that I believe all of us feel...or is this logical decision making? The second part of the equation is determining whether or not you could match into another program after bailing on your prior program. Yes...you have good scores, but you will also have a pretty ginormous red flag. I personally would rather take someone with lower scores who hasn't bailed on their prior program. The third part is determine the right way of doing it...if that is what you choose to do.

I would like to believe that doing your internship as planned is probably in your best interested. You could apply to Physician-only spots and slide right in next year. Your program probably won't miss you a whole lot because if you indeed matched to a top PM&R program, they know that they will fill through a physician only spot. I wouldn't anticipate going into the match without letting your program know that PM&R isn't for you. They need to know to open a Physician spot of their own. Programs looking to take you in will very likely ask for your current PD's recommendation anyway.

 

[QofQuimica]

It's hard to answer that question without knowing you and understanding your motivations for picking your specialty. It's possible that you just have cold feet now that intern year is about to start, and it is also possible that you picked the wrong specialty for the wrong reasons. I suggest that you speak to your advisor or another trusted faculty at your med school (not at your residency program!), preferably someone who knows you well, for advice. But if you really feel like you can't speak to anyone, then I would suggest seeing your match through. Clearly at some point you were enthusiastic about PM&R, so unless some major life-changing event has happened since the match, it's unlikely to be a scenario where you have "totally ruined your life" by going into PM&R.

 

[thebrightside]

I'm sure you are simply experiencing intern jitters. we all are

At least do not make any rash decisions during this phase. Starting out in PM&R and realizing it's not for you is a totally different applicant than someone who quits before they even began!

 

[NotAProgDirector]

Try PM&R. If you love it, you're all set. If not, then you'll have no problem getting a Rads or Anesthesia spot if you have a competitive application and have done well in your residency.

You have not ruined your life. You could switch after 1 or 2 years. It's not the end of the world.

 

[secondguesses]

Try PM&R. If you love it, you're all set. If not, then you'll have no problem getting a Rads or Anesthesia spot if you have a competitive application and have done well in your residency.

You have not ruined your life. You could switch after 1 or 2 years. It's not the end of the world.

Thank you for the advice. The more I think about it the more I worry, so I am trying to keep my mind occupied with anything else. Luckily, I will be exposed to PM&R, Anesthesiology, Radiology and of course IM during my intern year so that should help me decide if I have made the wrong decision.

If I do decide that I like the other fields much more than PM&R, when should I pursue switching residencies? If after October, I suppose I would have to re-apply during my PGY-2 year? Also I hear that getting funding for the residency can be an issue if I swap specialities due to Medicare only paying for X years, is this true?

 

[gutonc]

Thank you for the advice. The more I think about it the more I worry, so I am trying to keep my mind occupied with anything else. Luckily, I will be exposed to PM&R, Anesthesiology, Radiology and of course IM during my intern year so that should help me decide if I have made the wrong decision.

If I do decide that I like the other fields much more than PM&R, when should I pursue switching residencies? If after October, I suppose I would have to re-apply during my PGY-2 year? Also I hear that getting funding for the residency can be an issue if I swap specialities due to Medicare only paying for X years, is this true?

ARRRGGGHHHH!!!!

NO!

Carry on.

 

[Raryn]

Thank you for the advice. The more I think about it the more I worry, so I am trying to keep my mind occupied with anything else. Luckily, I will be exposed to PM&R, Anesthesiology, Radiology and of course IM during my intern year so that should help me decide if I have made the wrong decision.

If I do decide that I like the other fields much more than PM&R, when should I pursue switching residencies? If after October, I suppose I would have to re-apply during my PGY-2 year? Also I hear that getting funding for the residency can be an issue if I swap specialities due to Medicare only paying for X years, is this true?

On the list of things that may be issues, funding is very low down. It's a very complicated matter and not really worth considering.

 

[ThoracicGuy]

Thank you for the advice. The more I think about it the more I worry, so I am trying to keep my mind occupied with anything else. Luckily, I will be exposed to PM&R, Anesthesiology, Radiology and of course IM during my intern year so that should help me decide if I have made the wrong decision.

If I do decide that I like the other fields much more than PM&R, when should I pursue switching residencies? If after October, I suppose I would have to re-apply during my PGY-2 year? Also I hear that getting funding for the residency be an issue if I swap specialities due to Medicare only paying for X years, is this true?

Not accepting people because of funding is mostly a way to let you down easy without just telling you no.

 

[secondguesses]

That is good to hear. Any advice on timing? If after the first 4 months I realize I made the wrong decision, should I attempt to get a waiver and reapply? Or should I wait until PGY-2 and basically waste a year? Thank you all for all the help so far! It has been a great help knowing that I do have options and I haven't totally screwed myself.

 

[NotAProgDirector]

If you matched into a categorical PM&R program, then you won't need a waiver at all. You honored your match commitment, and you can apply to anything you want.

If you matched to Prelim and Advanced, then you'll need a match waiver for the Advanced. As long as you apply before Jan 15th and state a change of specialty as the reason, the waiver is automatic.

You're thinking about it wrong if you think of it as "wasting a year". Spending 1 year sorting out what you want to do for the rest of your life isn't a mistake. It's a good plan. Don't force a timeline. Try out the program you've matched into. If you have a prelim year, try to get some PM&R time with some electives. Or do electives in other fields you might be interested in. Even if it takes 2 years to settle out, it's still a good investment in your future. Sure, you could make more money more quickly by picking the "right" training right at the beginning. But happiness is priceless.

 

[Bronze Medal]

If you matched into a categorical PM&R program, then you won't need a waiver at all. You honored your match commitment, and you can apply to anything you want.

If you matched to Prelim and Advanced, then you'll need a match waiver for the Advanced. As long as you apply before Jan 15th and state a change of specialty as the reason, the waiver is automatic.

You're thinking about it wrong if you think of it as "wasting a year". Spending 1 year sorting out what you want to do for the rest of your life isn't a mistake. It's a good plan. Don't force a timeline. Try out the program you've matched into. If you have a prelim year, try to get some PM&R time with some electives. Or do electives in other fields you might be interested in. Even if it takes 2 years to settle out, it's still a good investment in your future. Sure, you could make more money more quickly by picking the "right" training right at the beginning. But happiness is priceless.

This is a great reply.

 

[secondguesses]

If you matched into a categorical PM&R program, then you won't need a waiver at all. You honored your match commitment, and you can apply to anything you want.

If you matched to Prelim and Advanced, then you'll need a match waiver for the Advanced. As long as you apply before Jan 15th and state a change of specialty as the reason, the waiver is automatic.

You're thinking about it wrong if you think of it as "wasting a year". Spending 1 year sorting out what you want to do for the rest of your life isn't a mistake. It's a good plan. Don't force a timeline. Try out the program you've matched into. If you have a prelim year, try to get some PM&R time with some electives. Or do electives in other fields you might be interested in. Even if it takes 2 years to settle out, it's still a good investment in your future. Sure, you could make more money more quickly by picking the "right" training right at the beginning. But happiness is priceless.

Thank you! Yes, I did match into a categorical program. It's good to know I won't need a waiver. I'm assuming I would need a letter from my program director or chair if I decide to change. Is this correct? Also is there a listing of physician only residency spots?

Thanks again for all the help everyone. The nightmares have stopped and I feel better, much better about my current situation!

 

[gutonc]

This is a great reply.

As is the custom from aPD.

 

[gutonc]

Thank you! Yes, I did match into a categorical program. It's good to know I won't need a waiver. I'm assuming I would need a letter from my program director or chair if I decide to change. Is this correct? Also is there a listing of physician only residency spots?

You will definitely need a LOR from your current PD if you're applying again. If you approach him/her early to discuss this, and are completely committed to performing at the top of your game this year, you should be fine.

I agree with aPD that you should try to get some PMR electives/rotations early this year to make sure you're not just dealing with cold feet/nerves right now.

As for physician only spots, ERAS has them listed as (R) I believe.

Good luck.

 

[prone2xl]

Don't sweat it. I went through the same thing last year after matching to a different field and went into my intern year pretty much knowing that I would probably be re-applying through the match. It ended up working out great and I matched into my chosen field. Yeah, I wasted a year, but as prog director said, that's nothing in the grand scheme of things. For some, they know exactly what they want when they apply. For me, it took until the end of 4th year to know what I truly wanted. I think it's somewhat unreasonable to have to make that decision at the beginning of fourth year and wish everyone had to do a general intern year, but that policy changed awhile back. Best of luck to you and just know that anything is possible. Btw I switched into Rads!


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[Raryn]

Thank you! Yes, I did match into a categorical program. It's good to know I won't need a waiver. I'm assuming I would need a letter from my program director or chair if I decide to change. Is this correct? Also is there a listing of physician only residency spots?

Thanks again for all the help everyone. The nightmares have stopped and I feel better, much better about my current situation!

Assuming your PMR intern year counts (which it should), you'll be able to apply to R spots in the match (which start that same year as a PGY2), as well as A spots (which start the following year, giving you a 1 year gap you can utilize however you want). Another thing you can do, if there is a program in your new field of interest at the same institution, is set up a meeting with that PD and talk to them. Sometimes spots open up off-cycle and assuming you're a decent intern, better a known quantity than an unknown much of the time.

 

[secondguesses]

Assuming your PMR intern year counts (which it should), you'll be able to apply to R spots in the match (which start that same year as a PGY2), as well as A spots (which start the following year, giving you a 1 year gap you can utilize however you want). Another thing you can do, if there is a program in your new field of interest at the same institution, is set up a meeting with that PD and talk to them. Sometimes spots open up off-cycle and assuming you're a decent intern, better a known quantity than an unknown much of the time.

Thanks for the information! I will definitely take your advice into consideration. All the fields that I am interested in switching to are available at my program, and a community hospital near by as well. I'll see how it goes next year and reach out to the local PDs. The other specialties are quite competitive at my institutions, as it is a highly ranked institution, so I'm not sure what my chances would be.

Does anyone know how competitive the "R" or physician only spots are in the match? There don't seem to be too many either, looking at ERAS. None at my institution.

 

[secondguesses]

Do you think it would be a possibility to complete my internship then start as a PGY-2 in their categorical IM program?

 

[gutonc]

Do you think it would be a possibility to complete my internship then start as a PGY-2 in their categorical IM program?

If the PD wants to keep you, and has a spot for you...then yes. This is also the easiest scenario for you.

 

[Raryn]

Do you think it would be a possibility to complete my internship then start as a PGY-2 in their categorical IM program?

Start your program. If you enjoy it after a few months (no later than nov-dec), talk to your pd about it.

 

[MedicalDoctorV]

Way back in 2008 I was a prelim internal medicine resident and had matched to a PGY-2 spot in Ophthalmology at one of my top two programs... I too had a sinking feeling I had made a wrong decision.

It's normal to be nervous, it's not normal to go home every day and Google and escape-route once you start your categorical program.

That being said - you have to give it a chance. Find out if day-to-day practice is for you, and not the residency. What's more important is what your life will be as an Attending.

I decided that I didn't want that life. So, long story short- I gave my Optho PGY2 year a solid 8 months before I pulled the trigger and told my PD I wouldn't be returning. I finished out the year, they found a resident for the next year and I found an open PGY2 Medicine spot in the same city for the following July. I was prepared to reapply to the match because as others have put it - it's not wasting a year to find happiness. Luckily it didn't come to that.

Now I've been a Hospitalist Attending for 3 years and don't regret my decision (though my checking account may be poorer than if I were a super specialist).

PS. Re: Your Qn: "I was also interested in Anesthesiology and Radiology...Is there any possibility of me switching into one of these fields for my PGY-2 year?" There's always a possibility. Gather the facts, make up your mind and then take the leap. You'll find the path that others have taken before you.

 

[Distressedlad]

I matched pmr and now I am regretting not getting a waiver earlier on. If you have the feeling that I am experiencing then chances are that you will not like pmr. pmr has a decent residency life style but it's not medicine. I would advise getting out and not wasting time.