help-thinking of quitting residency

[daisy78]

I am an internal medicine intern U.S. graduate who has already done a year of preliminary medicine with original plans to do anesthesiology. I found out I was ranked high enough to match in anesthesia at the same program where I did medical school. However, since my husband was going to be a G.I. fellow in another state, I just did prelimnary medicine hoping to get into the anesthesia program at his institution when we moved. After completing my prelim year, I ended up taking 2 years off to do research in anesthesia at the new place and got rejected twice, so I decided to go back to internal medicine instead of wasting any more time. Even though I have done 1 year of prelim medicine, I am having to do 6 months of internship before becoming a 2nd year , since I have been out for 2 years. I have forgotten so much and am really worried I won't be able to be a resident in a few months. Additionally, I don't really like patient care too much, which sucks when I've pretty much geared my whole education and life towards becoming a doctor.
So, I am contemplating quitting and starting a family. Is this bad?

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[medicinesux]

my advice: What in the gahell?!?! I would not repeat another 6 months of intern slavitude! You already completed your PGY-1 (I am assuming satisfactorily) and I would tell this new program to screw off making you repeat 6 months. There are so many other programs out there who have PGY-2 slots available. Just call around and you will see. Though I don't blame you for choosing to stay home with the kids.

 

[Winged Scapula]

Isn't your husband finished with his GI fellowship now? Its not bad to consider quitting but its also not clear to me how much you've tried to get another position.

I can't say I blame programs for wanting you to repeat part of internship; its a common request when you've been out for so long. But if you really want to do anesthesiology, why are you looking at IM? Now that your husband has finished fellowship is it not possible to move?

Even if you can't find an anesthesia position, there are other specialties without patient care which would take your IM internship as time credited.

If you have truly considered all your options, and still want to quit and have the support of your family, then fine, but I have to ask...what will you do if everything falls apart? No one likes to mention this but what if you divorce, or your spouse dies? Do you have skills and training to find a job? Once you've been out of medicine even longer, the ability to get a residency radpidly drops. If you can support yourself some other way, that's great and ignore my suggestion to get back into residency, so you have a marketable skill.

It sounds like to me, on an anonymous BB, that you aren't considering quitting because you don't want to be a physician but rather because you feel frustrated and scared. Those aren't good reasons to quit. Are there other residency options locally if you can't move besides IM and Anesthesia?

 

[renogirl]

Think carefully. It will only be harder to get back into it later.


I quit my residency after my PGY1 year 10 years ago when I had a baby. It is 10 years later and I need to figure out what to do now that my kids are older (10 and 8). For me to get back into medicine at this point is almost impossible. If I can find a program to accept me, I have to repeat my entire PGY1 intern year again. I spoke with my old program director and he said it would be very difficult but not impossible. I can't apply to a large number of programs either. My family and I are committed to living in our town now that the kids are older and there are only 5 programs within an hours drive. The chances of this happening are pretty slim although I may be applying next month for the next match. Since I have to repeat PGY1, I may be changing from IM to something with less call.

I just wanted to give you that side of the story since not many people did what I did. Don't rush into any decisions but make sure you are considering 10 years down the road too.

 

[dragonfly99]

I'm afraid the repeating 6 months thing is fairly standard. Though they could have given you credit for the whole prelim year, if they wanted, it's kind of hard for them to trust someone as a PGY2 medicine resident (i.e. the one who supervises the intern and basically has final say over important decisions in the middle of the night).

I wouldn't make any rash decisions.

If you want anesthesiology, would your husband consider moving somewhere with you so that you could do that? If not, or you both don't want to move, maybe you should consider reapplying/switching to some other specialty that you like better. Pathology might like an applicant with 2 years of anesthesiology research. It seems that if you did research x 2 years in someone's anesthesiology lab, he/she should be pulling strings to help get you in the anesthesiology program at whatever med center you are in...
Also, you say you were ranked to match in a prior year at your former med school's anesthesiology program. Can you phone them, talk to them and see if there's any possibility they have a CA-1 spot for you there next year?
It seems it might be time for your husband to start sacrificing for you, as you have for him, but that's just my opinion. I've seen multiple posts on the internet about open anesthesiology spots...check Findaresident or Openspots.com, or even SDN here has had such posts...

Even if you decide to quit residency ultimately, it would probably be a good idea to stick it out the rest of this year...you may find medicine residency sucks a lot less after you become a PGY2 rather than an intern. Also, if you did a full 2 years residency you probably could get a state license in many states...and then you could moonlight to get money even if you choose not to continue with medicine residency.

 

[Leukocyte]

Additionally, I don't really like patient care too much, which sucks when I've pretty much geared my whole education and life towards becoming a doctor.

Like you, I also do not like patient care or patient interaction in general, and yet I am knee deep in the mother of all patient care/contact specialties...FM.
Yes it sucks...Sucks big time, especially that now I started hating anything that has to do with medicine to the point that whenever I see a hospital or a patient (any hospital or a patient even when I am in my car driving), I automaticly get nausea and get sick to my stomach. But my options are limitted, at least for now, and I am sucking it up (with great difficulty). I have no support system what-so-ever. If I leave now, I will end up home-less on the streets with a 200,000 dollar loan. In fact, before starting residency, I was almost home-less for a couple of months, and I have no plans to return to that state. It is the ONLY thing that is keeping me going. I am extremely depressed with no social life, no support system, no people to talk to, and doing something I absolutely hate...Every single day is a living hell, but I know bitching and maoning about it will not change the reality I am in. So I will close my eyes, take a deep breath, cover my nose and mouth and run, run as fast as I can through this hell that I am in. Yes, I can quit at any time, and get a job with my undergrad degree or even work at the local McDonalds here...but let us get real here. If I do this, quit and work at a McDonalds, or at any less paying non-physician job, my life will still be hell. A financial hell with a bad credit Hx, and a 200,000 dollars that I will never be able to pay.

You on the other hand seem to have many more options than I do. You are an American Medical Graduate. You have a support system, with a well-to-do husband. If you were like me (an FMG, with no support system), I would tell you to just suck-it-up. But you are in a much better situation. I say life and time are very valuable, so do what you love and enjoy in your life, if you can afford it. Why force yourself into doing somthing you know you hate, if you can actually afford not to do it? So you have to sit down and think really hard about YOUR priorities, and about what YOU love and ENJOY. You are the ONLY one who can answer your question of to quit or not to quit. You KNOW what you like to do in your live, what you enjoy doing. So go and do whatever makes YOU happy. Live life to the fullest (if you can afford it).

Good Luck.

 

[daisy78]

Thanks for your suggestions; I am fortunate enough to have no student loans, car note, or house note to pay. I satisfactorily completed 1 year of preliminary internal medicine, before wasting 2 years doing research trying to get into anesthesia before going back to IM. My husband is completing his 3rd year of fellowship currently and will do an advanced fellowship next year. I should probably just go ahead and finish IM, but it's painful. And, now with Hurricane Ike, everything is in disarray.

 

[dragonfly99]

Daisy,
if it helps at all to know, I found 3rd year of IM residency to be pretty easy, except for my ICU months. I did 2, but probably at most programs it would be one in your 3rd year.
Even the 2nd year is a lot better because you have interns to protect you from a lot of the inane nurse pages at 2a.m. Also, you probably only have maybe 60% as many call months as you did intern year. I mean, you'll probably have a couple months of clinic, one of ER and then at least 2-3 more of consult months in your 2nd year. Repeating 6 months of internship really sucks a big one, though.
If you do finish IM residency, after that you could just work the hours you want (i.e. Locum Tenens, work limited hours at an urgent care clinic, round at nursing homes, or some other laid back job) if you want. Without finishing some kind of residency, your job options will be much more limited.

 

[ozzie20]

Quit residency. Your husband is financially secure, and YES, you sure can get a job outside of medicine with your degree. Hell, go certify yourself in botox and do cosmetics. moonlight. Enjoy life by going on a vacation. You're already 2 years out, 3 years total, you could have been board certified by now. People are looking at this financially the wrong way. You can make a hell of a lot more money moonlighting at this point than by going into residency. And on the back end when you're ready to retire, that translates into approximately 1 million more $$$ if you invest properly.

"starting a family" is a blessing, not the consolidation prize. your work, the ability to finish a residency, is such a distant second to family its not even funny. Don't listen to the argument that finding a residency will be hard if you want to go back into it. Its not. IM has a 43% fill rate NATIONALLY. And its only going down with the whole health care crisis in america. A spot will be there in the future if you need to go that route. For the time being, forget that crap.

 

[NotAProgDirector]

You can make a hell of a lot more money moonlighting at this point than by going into residency.

This might be true, now. Many people who did not complete residencies in the past and figured that they could always find work are now finding that almost everyone is requiring board certification for any employment.

IM has a 43% fill rate NATIONALLY.

I have no idea what this statistic is referring to. The fill rate of IM in the match last year was 97.8%. The fill rate with US Seniors was 54% -- so if the argument is that you will always be able to replace an IMG, I guess that might be true.

But, let's not forget that allo med schools have increased their enrollment by 30%, and DO schools by 50-70%. It's predicted that in 2012 there will be just about as many US grads (MD and DO combined) as residency slots, assuming the latter remains flat.

A spot will be there in the future if you need to go that route.

Most programs will be very wary of bringing someone in for only a PGY-3, especially if they have had some time away from medicine. PGY-3's have the most responsibilities, back up everyone else, and often have lots of elective and other flexible time. If you break away from medicine for any protracted time, I think you could plan on repeating at least 6 months of your PGY-2, if not all 12.

 

[DrJosephKim]

Keep in mind that you may find many non-clinical opportunities where you can work from home or work part-time and keep a very flexible schedule. This way, you can remain productive, stay as busy as you'd like, and still feel like you're using your skills to improve healthcare on a population level.

 

[ozzie20]

But, let's not forget that allo med schools have increased their enrollment by 30%, and DO schools by 50-70%. It's predicted that in 2012 there will be just about as many US grads (MD and DO combined) as residency slots, assuming the latter remains flat.



Most programs will be very wary of bringing someone in for only a PGY-3, especially if they have had some time away from medicine. PGY-3's have the most responsibilities, back up everyone else, and often have lots of elective and other flexible time. If you break away from medicine for any protracted time, I think you could plan on repeating at least 6 months of your PGY-2, if not all 12.

I seriously doubt if you increase the amount of USMD's by 30% that no residency slots will open up. If that's the case, good news for you and me, cause the population of the US keeps going up, and the amount of docs stay the same = more business for each doc.

When I said you'll always have a spot if you want to go back in, I was referring to a PGY1 spot. Sorry for the confusion, should have made that clear.

 

[Winged Scapula]

When I said you'll always have a spot if you want to go back in, I was referring to a PGY1 spot. Sorry for the confusion, should have made that clear.

Unfortunately, that is not true.

Many programs will refuse to accept applications from people more than 5 years out of medical school or training. If she waits much longer, she will not be able to get back into a residency and while cosmetics/aesthetic procedures sound great:

a) she has to be licensed as a physician to purchase some of the equipment and materials; otherwise, she needs to join a practice with someone who is
b) in this economy, people are choosing not to spend their discretionary income on aesthetic procedures, so the market is tight
c) as an unlicensed physician, she will not be practicing at the cream of the crop spas/practices and her duties will be no more than any aesthetician with much much fewer years of training

 

[dragonfly99]

Agree with programdirector on this one.
There aren't many good clinical jobs at all for someone who hasn't done an entire residency. Trust me - I'm an internist, and I know. There may be moonlighting opportunities (if you find the right ones, if you know people, etc.) but those generally aren't great long-term jobs. If you want to do clinical medicine, you really need to finish some sort of residency, whether it's IM or something else. The insurance companies and gov't are cracking down to such a point that folks with just a license, but no finished residency, or a residency but no board certification (and board certification, not just finishing a residency, is really the standard for what's expected to practice clinical medicine currently) are going to have a hard time practicing. In internal medicine, even the good moonlighting jobs (the ones that pay well and in which you aren't just a glorified intern doing H and P's) require a completed residency, and some prefer that you have passed the internal medicine boards.

I participate in Sermo, an online physician community, and there are posts on there frequently from people who never finished a residency and are now wondering how they can,
a) finish residency and/or
b) get a real clinical job
because they are either out of clinical medicine entirely or stuck in some dead end job, like being a prison doctor (not that it's always a dead end job, but certain jobs like that could be) and then getting notified that even the aforementioned dead end type physician job is going to be taken away from them in favor of "more qualified" candidates because of their not having finished a residency.

If you decide you want to quit clinical medicine, that's fine and I am sure you are a smart person and could pursue other work opportunities, either using your MD or not, but it's unlikely you'll ever make close to the money you'd make as a practicing board certified IM doc. You just can't see the light @ the end of the tunnel at this point, but in my mind it would be better to stick it out x 2 more years. At that point, you can do whatever the heck you want - have 2 kids and just work part time at an urgent care, get a part time hospitalist gig/job sharing, whatever. I just hate to see someone give up without carefully thinking about it and getting all the facts.

Maybe you're just in the wrong specialty? You could use your 1 year of medicine and maybe switch to psych, physical med/rehab, etc. It's just a thought.

 

[daisy78]

Thanks, you guys for all of your thoughts. I've thought about it long and hard and know that if I quit now, I will most definitely regret. I have passed all three USMLE's and never had to retake any of them. I have seen people a lot dumber than me make it. I have suffered from depression since high school and haven't really seeked appropriate tx(only took SSRI), and I am afraid that this is probably contributing to my pondering quitting residency. That, and regretting that if I had just stayed and finished residency where I started at the same instiution where I did med school, I would be finished by now like many of my classmates. Instead, I went against family advice and moved with my husband wasting 2 years of life doing research(not a primary interest) and now am behind.

 

[Winged Scapula]

Thanks, you guys for all of your thoughts. I've thought about it long and hard and know that if I quit now, I will most definitely regret. I have passed all three USMLE's and never had to retake any of them. I have seen people a lot dumber than me make it. I have suffered from depression since high school and haven't really seeked appropriate tx(only took SSRI), and I am afraid that this is probably contributing to my pondering quitting residency. That, and regretting that if I had just stayed and finished residency where I started at the same instiution where I did med school, I would be finished by now like many of my classmates. Instead, I went against family advice and moved with my husband wasting 2 years of life doing research(not a primary interest) and now am behind.

Thanks for the update daisy.

I'm glad you have reconsidered quitting but please don't think that you wasted the last two years of your life. You made a choice to move with your husband, something that many, if not most, would do. It was a tough decision and even if you now think it was the wrong decision, it is not a final one.

Best of luck to you.

 

[ozzie20]

points well made by winged and the previous poster. Its hard to predict the future, and I guess the best way would be to future proof by finishing the residency.