Help! Switching into PGY 2 from PM&R

[sdnuser001]

Hi guys, I am a PGY2 in PM&R and have recently been regretting my decision to pursue this field. I was torn between PM&R and psychiatry in medical school and now after more recently starting the PM&R part of my residency have all but confirmed that I am a better fit for psychiatry. I have just found out of a PGY2 spot that is opening in July of next year from my home med school which is also in my hometown. The PD is definitely interested in me but obviously I know there are no guarantees. Now, my current PD is reasonable and would probably support my decision BUT I was on remediation these past 3 months for scheduling a double call shift without telling the administrator and just found out that I got a nasty evaluation from my first PM&R rotation of the year that was excessively harsh. I am unsure how this will play out and am hoping to meet my PD as soon as possible.

I have a couple questions:

1. Assuming I can convince my PD that this eval was not typical of my work ethic (which I truly believe, but will also admit that there were certain things that I could have been better on in this past rotation) would he/she be able to still write me a letter of good standing if they decide to extend my remediation? Of note, the evals from the other two attendings I worked with on this rotation would in no way be nearly as negative but also probably not glowing either. But in any case, if they put me on probation (which I pray won't happen) I should probably assume that getting a letter of good standing would no longer be a possibility?

2. I would ideally apply to this one program in the area that I want to be (as I am very depressed and homesick in my current location) but would still be committed to finishing my current PM&R program should for some reason I not be accepted to this PGY2 spot. If I can relay this to my PD and emphatically state that I am still equally passionate about my current field and program (minus location) would there be any way that I can apply for this PGY2 spot and continue with my current program should it not work out? Or would I automatically be forced into not renewing my contract for third year and subsequently losing my spot in residency if I don't get into the psych program?

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[hfzballer11]

I'm in a similiar boat. I'm currently a PGY-2 in PMR switching to anesthesia. I was honest with my PD and told them in August. I applied on ERAS and am going to finish the year here. If I don't match then I will scramble. Although it hasn't been explicitly stated, I think my contract for 2019 will not be renewed, as the program will ideally have already found a replacement by Match Day.

 

[kabooya]

What is it about PM&R that turned you guys off so much?

 

[RangerBob]

A lot of people that go into PM&R are interested in the outpatient/MSK side of things and get a bit burnt out by what is a typically inpatient-heavy PGY2 year. Granted, most don’t burn out till ~March. I actually felt PGY3 was tougher-I found inpatient so much more relaxed and less stressful. Different strokes for different folks.

There is almost no way to hold onto your position if you want to go for the psych position. If you want your PD’s blessing you will need to commit, and they will replace you. If you’re not going to commit to staying there, why would they renew your contract? It’d be unfair to the program and your co-residents-if they did hold your spot and you hen got the psych position, now they’re left with no one and your colleagues have to pick up the slack.

Psych is also getting more competitive. If I were a psych PD I’d look very cautiously at a resident who is leaving their primary field, had to remediate, and has a poor eval. It’s fairly rare to get poor evals in PM&R because we tend to be quite laid back and easy going, so that would be a red flag to me.

I would tred very cautiously here. If you truly won’t be happy in PM&R, and I trust you’re grown up enough to know so I won’t question your judgement, then you need to go all-in for psych. That means applying to a boatload of psych programs, including PGY1 positions (most psych programs won’t take PGY2s, but there are a few that will and will give you credit for intern year, though you may have to do a few extra neuro rotations and have fewer psych electives so you can fit in the psych rotations you didn’t get in intern year).

You will need a LOR from your current PD as well as intern-year PD. Any future PD will want their input.

I do not know what your chances of getting into psych are, as I know it’s gotten more competitive. It would be worthwhile for you to post on the psych forums for some opinions.

Ok-I said I wouldn’t question you, but I sort of will, as I had the exact same thoughts as you (I also was interested in psych, but went into PM&R, and questioned my choice too on a rough rotation). Ask yourself if psych is what you really want, or are you just unhappy in general right now and not necessarily unhappy with your specialty choice. There is a reason you chose PM&R—ask yourself if that reason was really incorrect. It’s easy to think the grass is greener on the other side. Just about every resident questions their choice-probably multiple tones on average. Personally I think I would’ve loved psych, but I realized I love PM&R more.

Just remember you’re talking about the rest of your life-if psych really will make you happier, then go for it. It’s much easier to find a job in psych-they’re in high demand and little supply. You can work almost anywhere you want other than a few saturated areas.