Help! To switch or not to switch?

[La Fiera]

Crap!!
I thought I had everything figured out for what I was going to do in medicine but it just seems that I am either getting cold feet, or I really wasn't that happy to begin with my first choice anyway. If you have any advice please let me know especially since it is so late in 4th year and I have no other LOR to go into different fields, and haven't started on a new Personal statement.

I was convinced that I would go into Family Practice, so much that I accepted a full 2 year scholarship from the NHCS to do primary care. The catch is, if you should go back on your comittment to the NHCS, you have to repay them 3 times the amount that they loaned you- which would end up being $300,000 + in my case. This may seem like a lot, but in actuality, its not as bad as it sounds because I would have ended up paying this much interest had I taken out loans from the government and private companies.

I wanted to go into FP because of the continuity, the generality of the conditions and patients (young, old, sick, etc) seen, the fact that FP's affect more people than any other health care specialty (I'm talking numbers). Also, I really like working with my hands, and the procedures that FP's can do in the clinic (eg excision of moles etc.) or in the OR- eg. c-section really attracted me. Most of all, I like the fact that FP's can work in small rural ER's because there is no one else to do it! I love the ED! Furthermore, it seems as you can do so many different things with FP, that are not available in other fields.

Here's the problem that I started thinking about the last few weeks. I thought about whether or not I would be happy in FP and I couldn't say that I would with certainty- I imagined coming into the office and dreading seeing pts with Diabetes and HTN everyday where all I would be doing was adjusting meds. Or evaluating a pt's social situation and trying to see how I could work with it- (I want to be a doctor, not a social worker). And in a recent clerkship I did in FP all I seemed to see was chronic pain and just the things I am dreading. So my question to you is this- should I stick with FP in hopes of eventually find a job in a smaller ER, or maybe as a hospitalist because this is what I have already applied to and had a few inerviews in (not to mention that I have a scholarship in)?

The other options:
ER:
Something that I have always really enjoyed, but ruled out earlier b/c of 1. the lack of continuity, and not knowing if you really did the right thing with the patient (unless you follow them through the hospital course) 2. knowing the 1st few steps of how to take care of a med or surg pt but then not knowing how to continue care. 3. the scholarship I got to do primary care

Surgery:
I love working with my hands and I am good at it. But I do not want to be slave for the next 5+ years and then some. I like my life, I like going out and persuing other interests. Furthermore, I don't like laparascopic surgery- somehow the fun got lost in it. I really like Trauma surgery- but again thats a good 6 -7 year residency, which I might not even be guarenteed to get! Furthermore, 8 hrs in surgery would probably destroy my little ADHD mind.

Medicine:
Surprisingly, I really liked the ICU. Its general, and the physiology behind the diseases that you see in the ICU is absolutely fascinating to me. I know I couldn't specialize in one organ- I would get bored for sure. The problem with Hospitalists is that it seems as all they do all day is scutwork- call everyone else involved and get paged and then write ridiculously long notes.

OB/Gyne:
The problem with this is that you don't get to see any male patients, and not too many kids. Not too mention that you are a slave during residency just like the surgeons, and your malpractice is ridiculous.

So. There it is. I am also afraid that I left considering changing fields a little too long. I really screwed myself with ER and Surgery, as they are competetive and have sent out most of their invites to interview. I'd also have to get more letters from who knows? On top of that My Step 1 score was at the national average, and my Step 2 a little lower than that, so I don't know how favorably they'll look upon that (I didn't put so much effort in as I was just aiming to pass- FP is the least competetive field of all and I hate tests)
Then again, I don't know if I should change, as I think I went into FP for the right reasons, and it will let me do international medine (such as Doc's without borders), and wilderness medicine. But doing ER and surgery especially, are also great for international medicine. Er is probably even better for wilderness med considering they have fellowships in it.
Anyway. If you have any suggestions please let me know!
Thanks alot everyone!

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[EctopicFetus]

Um im not trying to be rude or anything but you are screwed for this yr. Perhaps you should either take a yr off and reapply, try to scramble or do a prelim yr (they are taking apps still) and see if a 2-4 spot opens for next yr.

I think 90+% of programs are past their deadline.. Sorry to be the bearer of bad news.

 

[cowgirlcarrie]

Ectopic is right about it being a little too late. However, I wouldn't take a year off unless you feel like its necessary. I am a pedi intern applying to switch over to EM this year and although I discovered that I loved EM too late in the game last year, I don't regret doing a year of pedi. I think any experience that you get will only make you a better physician in the long run. You may run into some resistance from a few programs if you have prior training but I have in general found that some programs really embrace it and others are just ok with it. However, having said all of that, you need to make sure you are certain that you are changing to what you really truly love doing. Going through the match is pretty stressful and putting yourself back through it twice takes a lot of committment and dedication to the specialty you want to change over to. So I say go for whatever makes you happy, but make sure you are 150% positive you are making the right choice.

 

[kungfufishing]

Make absolutely certain you really enjoy EM and be honest with yourself about what your motivation is for choosing it. There are definitely programs out there that often view prior training as a plus (at least one such PD frequents this board) but I would think you'd need to demonstrate a realistic understanding of and commitment to the specialty.

 

[NinerNiner999]

I wouldn't say you are screwed yet. PD's are very reasonable people and a deadline is merely a date put forth by a program, not a hard and fast rule that must be adhered to. This is THE time if there ever is one to pick up the phone and directly call PD's. One of my good friends (and current classmate in residency) called every ED program while he was working as an anesthesiology resident. He did this well after the deadline to submit his applications and convince the PD's why he needed to be interviewed. He had over 12 interviews scheduled within his first two weeks of calling and matched without any trouble. BE PROACTIVE, get off the computer, pick up the phone and SELL YOURSELF. If you can't do that now, then you will never have the fire to be an ED resident (you can do it!)...

 

[La Fiera]

Thank you all for your replies!
I was actually surprised to find out that there are still quite a few good programs out there who haven't reached their application deadlines, so I am doing my best to complete the app. I managed to get a letter from an attending who really thought I should go into EM- which I really didn't expect! So as soon as I can get everything in, there is a glimmer of hope as to getting some interviews. My guts are telling me that I am doing the right thing by persuing this; so we'll see what happens!

 

[corpsmanUP]

I am in your same situation my friend! I scrapped the NHSC scholarship even though the payback was quite painful. Luckily I had some good investments before med school and I was able to pay them back without too much pain. My debt was about half yours because I go to a state school. Just make a badass personal statement, be honest, and then submit your one good EM letter. Have your old letter writers change their letters to take out any mention of FM if you can get it done fast. Its such a liberating feeling to be going into what you really love even if the payback sucks!! I can tell you this; the NHSC won't tell you about your scaled payback options but you can seriously negotiate such. If you do a google search of NHSC defaults you will see that many have paid back like a hundred bucks a month in residency and then as much as 5-7K per month after that for several years. As long as you can transfer the debt load to a later time when it hurts less, the debt is rather meaningless. Trust me, I have a buddy in his 3rd year of FP residency trying to find a NHSC site and they are all crappy. One offered him 60K per year in an inner city ghetto, but he is thinking of taking it because he wants a specific city. If you really love EM, you will be able to make up the loss in as little as 3-5 years and then you are out of the red and into the good life. I am so happy with my decision to abandon that unorganized governmental entity and to pursue the only specialty that I have ever really had a serious passion about. I liked FP, but as I got further and further in my education I realized that 3 years of FP residency for someone who had already been a PA in family medicine would be very unrewarding and less than challenging. Now I know I will be challenged, and I will look forward to going to work every day of my life. I go to my EM interviews so freaking excited about the profession that I literally have to force myself to stop smiling!! If you think you might feel like that, then go for it! Do not let anyone intimidate you!!

Another thing, if you PM me, I'll give you my phone number and I can tell you about some EM programs that are less big name and more likely to interview you now. You will probably have to settle for a less than big name program, but who cares!!!??? If you are serious about doing this, the PD's will hear it in your voice and you will catch a few interviews just based on that energy! Go for it...my prediction is that if you do the application, and state in your personal statement EXACTLY how you saw the light and that you are SACRIFICING everything to do what you really love, that you will get enough interviews to match!! Don't just do an ERAS blanket send out to 50 programs because you won't get noticed. Instead be meticulous and pick the ones you think you can really get an interview at, and work toward them a few at a time. Try to review the CORDEM website and pick 5-10 per day that you think you can get an interview at and prioritize. Call even before you pay the money to apply and ask if they would be willing to consider an application submitted now knowing that you just learned what you really wanted to do. You will be surprised! Take a few sick days to get it done, and don't ruin your holiday worrying about it. And even if you lose a year...that is the worst case scenario. You do need to get on the horn NOW though with NHSC and tell them to place you in default, and then you can work out the payment plan. I kid you not, at your level of debt with them and their terribly high interest rate on defaulters, you stand to add $1,500 bucks a month in interest to your current debt! So lock in a payment plan now, and send them a certified letter telling them NOT to send you another freaking penny!!

Oh, and one last thing! If you can pay back this year's stipend and tuition back to July, including the other reasonable fees payment, you will not have to pay any penalties or interest on this year's amount!! I know the contract inside and out and feel free to ask me anything you need to know. I felt your pain earlier this year and you can ask anyone here, I was on the site as a newbie not 3 months ago begging someone to help me and tell me if it was too late to go into EM, what I really loved!! I had tons of encouragement and I want to do the same for you. G-luck and be fearless. 300K is a small house in many places and it might mean you can't afford that weekend condo at the beach when you are in the real world. Who cares? You are doing what you love! I'd do EM for 50K per year, but don't tell my future boss that!

 

[La Fiera]

Hi Y'all,
Thanks for all your support and advice, it really helped!
I got my application on ERAS, contacted a bunch of programs and have received 3 interview invites so far!!
I am so happy I can't stop grinning from ear to ear!

 

[La Fiera]

So, just to let anyone who was interested know what happened to me-
I matched in ER at my number 3- Lincoln Hospital in NYC, a great ER program and am super stoked. I had a whole bunch of people come up to me the day and night of match to tell me how worried they were about me, how brave I was for making the switch last minute, and my situation. So I wanted to pass this on, and give future med students in the same situation hope- cause I really didn't think that I had a chance! I ended up getting 14 interview invites (I applied to 23), went to 9 (only cause I couldn't fit in any more!), ranked 9, and matched at number 3.

 

[DeLaughterDO]

Congrats! It's heartwarming to see someone making good on what they want to do.

Best of luck!

jd

 

[JackBauERfan]

So, just to let anyone who was interested know what happened to me-
I matched in ER at my number 3- Lincoln Hospital in NYC, a great ER program and am super stoked. I had a whole bunch of people come up to me the day and night of match to tell me how worried they were about me, how brave I was for making the switch last minute, and my situation. So I wanted to pass this on, and give future med students in the same situation hope- cause I really didn't think that I had a chance! I ended up getting 14 interview invites (I applied to 23), went to 9 (only cause I couldn't fit in any more!), ranked 9, and matched at number 3.

great story, another win for the EM team! Now lets see if we can pull more folks in.

 

[EctopicFetus]

La Fiera is a stud in every sense. Saw her on match day I can tell you she was super psyched! Fiera have fun in NYC I did my 1 yr there and lets just say..... i had a lot of fun!

 

[waterski232002]

Awesome story... Congrats on the match!

 

[SouthernGirlie]

Wow... it's really encouraging to read this. Up until now I was completely die hard about Surgery. Then after long talk with EM resident today, I'm beginning to see a different light.

 

[Dave1x1]

Corpsman

If you're still on this forum, I'd like some info from you. I also took the NHSC scholarships starting my 2nd year in med school. At the time I thought it would be perfect, as I thought primary care was what I wanted to pursue. But now I'm finishing my 2nd year of residency and I know I DO NOT want to do primary care. As a matter of fact, I just matched in Cardiology today!
Can you pass on any tips/advice that you have for dealing with the NHSC? I know I'm in default and I will pay back the money, but I won't be able to during fellowship for 5 years.

Thanks for any advice that anyone has to offer

 

[corpsmanUP]

Corpsman

If you're still on this forum, I'd like some info from you. I also took the NHSC scholarships starting my 2nd year in med school. At the time I thought it would be perfect, as I thought primary care was what I wanted to pursue. But now I'm finishing my 2nd year of residency and I know I DO NOT want to do primary care. As a matter of fact, I just matched in Cardiology today!
Can you pass on any tips/advice that you have for dealing with the NHSC? I know I'm in default and I will pay back the money, but I won't be able to during fellowship for 5 years.

Thanks for any advice that anyone has to offer

You are actually in better shape than some of us because you have not defaulted yet. You will eventually pay the piper though my friend and there is no way around it, unless you can be creative. Being a medicine doc might help you if you would be willing to cut a deal with them where they would place you somewhere that would allow you to serve your obligation as a cardiologist. See, they will always allow you the option of serving down to the last second before they seize all your freaking assets. And as an IM doc with a new cards cert, the absolute worst case scenario is you have to take a general IM spot for a few years and do cards on the side. You only have to serve 36 hours a week as a general IM doc, then you could perhaps do something creative. Unlike you, I was in default the second I entered into an EM program and abandoned the whole primary care route. The problem though for you is that you are putting off the interest and penalties for a really long time. They won't turn off the interest no matter what from what I have read and learned. And its up to about 12% per year right now. So figure your triple damages, then the interest back to day one of med school and you could seriously be on a payment plan paying like many thousands a month for 30 years or more. You might just want to consider serving after your cards fellowship. They WILL give you that option as I have read it in the court transcripts of people like you. But how crappy is that to do general IM as a cards doc!!? But it might be worth it. The only thing they will do that they won't advertise is allow you to pay back in a scaled fashion while you are still poor, but recall, that you are not stopping the interest from accruing. It cost me about 188K for less than 60K of debt. It sure sucks but they have you statutorily in the end, which is better than any contract.

 

[bulgethetwine]

You are actually in better shape than some of us because you have not defaulted yet. You will eventually pay the piper though my friend and there is no way around it, unless you can be creative. Being a medicine doc might help you if you would be willing to cut a deal with them where they would place you somewhere that would allow you to serve your obligation as a cardiologist. See, they will always allow you the option of serving down to the last second before they seize all your freaking assets. And as an IM doc with a new cards cert, the absolute worst case scenario is you have to take a general IM spot for a few years and do cards on the side. You only have to serve 36 hours a week as a general IM doc, then you could perhaps do something creative. Unlike you, I was in default the second I entered into an EM program and abandoned the whole primary care route. The problem though for you is that you are putting off the interest and penalties for a really long time. They won't turn off the interest no matter what from what I have read and learned. And its up to about 12% per year right now. So figure your triple damages, then the interest back to day one of med school and you could seriously be on a payment plan paying like many thousands a month for 30 years or more. You might just want to consider serving after your cards fellowship. They WILL give you that option as I have read it in the court transcripts of people like you. But how crappy is that to do general IM as a cards doc!!? But it might be worth it. The only thing they will do that they won't advertise is allow you to pay back in a scaled fashion while you are still poor, but recall, that you are not stopping the interest from accruing. It cost me about 188K for less than 60K of debt. It sure sucks but they have you statutorily in the end, which is better than any contract.

Bankruptcy.

And move to Canada -- always need cardiologists there, and you could still live close to the border, I bet!