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deleted862527
Is this common? I am curious about this.
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deleted862527
Switch specialties
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It is very rare. It requires doing a second residency, or a second fellowship in the case of switching from one sub-specialty to another within internal medicine (e.g. switching from gastroenterology to nephrology). Most people would not devote another 2-3 years to training unless they really felt it was a better fit than what they were already doing. I do recall someone who switched to psychiatry and did a psych residency.... it is quite unusual to make that leap.
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Ive done rotations with people who have done it.
One went from a PM&R residency to FM and other from general surgery to FM. The preceptor went from obgyn to FM. (All switched residency programs)
isnt there like a 1 in 5 turnover in surgery?
One went from a PM&R residency to FM and other from general surgery to FM. The preceptor went from obgyn to FM. (All switched residency programs)
isnt there like a 1 in 5 turnover in surgery?
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It is not common, but it happens.
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It’s actually pretty common but it is not the norm. Common in the sense that I almost guarantee you will meet one or more people during your residency that switched specialties.
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So it depends on the field where you start with and we somewhat suffer from a lack of data - which is better for some fields than others. For the best example, roughly 18 percent (so almost 1 in 5) of general surgery categorical residents do not complete their general surgery residency. Of those residents, approximately 20% stay within general surgery, and 80% (so ~15% of the total) go to a different field with anesthesia being the most common.
For internal medicine, >90% (I think it was around 94%, but don't quote me on that) of residents finish their IM program. Pediatrics has a similar attrition rate. The remaining 5-10% presumably have a mix of people who try to find a different field or a different program in the same field.
The highest attrition rate that I'm aware of is Psychiatry, with >25% of residents not completing the program. I am not sure if that includes people who leave their general psych program early to "fast track" into child psych (and when I've looked it up in the past have been unable to answer that question).
You can see some of the raw numbers in the ACGME Data Book (PDF warning) but it isn't spelled out so clearly. Some of the relevant portion:
I don't know what exactly defines "withdrew" "dismissed" "transferred" or "unsuccessfully completed program" but all of those could potentially be people who tried a different field afterwards (or not). Subspecialty residents are typically fellows, so we won't count those. Probably shouldn't also count those residents who died - that brings up a full attrition rate of 1900 residents who didn't complete a program for whatever reason not including death, from a total population of 111,758 active specialty residents in the same year - that's an overall attrition rate of 1.7%/year. With the average length of a residency program somewhere around 4 years, the best overall estimate I could give is an attrition rate of ~7% for the overall population (which fits with what my gut says, so I'm going with it)
You can try to calculate specialty specific numbers using the table in the data book, but it's way more effort than I'm willing to expend.
Regardless of how you measure it though, the vast majority of people complete their initial residency program. Some proportion do quit (or get fired) and then attempt to do a different field, but that number is certainly <5%. In addition, some proportion of people who complete an initial primary residency do go back and do a second one - but that number is also very small. Most of the time people find another role within the same field - either through further training (i.e. a fellowship) or just a different job. Say, a primary care doctor can become a hospitalist. Or work for a nursing home. Or do insurance physicals. Or work for an insurance company reviewing claims. etc.
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Wow! Thank you for such a thorough review.
I was curious. I once heard of a pathology resident switch to E.R. Do interviewers view switching residencies unfavorably? I honestly would suspect they would but I don't know.
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In many cases, it is hard to do. It is particularly hard to switch "up" to a residency that is longer than the one initially started. This is due to Medicare payments to residency programs. If you start in a 3 year residency (med, peds, etc), then Medicare is only going to pay the hospital for 3 years of training. Many programs would have to take a loss financially if you switch into a longer residency than you initially start. (Some programs are at large hospitals "over the cap", so they take a loss anyway on some residents, so those programs can accept you without losing any more than they are going to lose). Complicated. Of course, if someone switches from a 5 year surgery program TO a 3 year EM program after one year, there is no financial loss for the program.
I am in Emergency Medicine at one of these large hospitals "over the cap" so we do get people switching into EM from all kinds of specialties. We have had residents from neurosurgery, urology, orthopedics, IM, pediatrics, gyn, surgery come to our program - but they essentially start out as interns, though they might get a couple of extra months of electives as credit for their time in other residencies. And they have to have done well in their former program and get a great evaluation from their program director. Years ago, we had a resident leave to do anesthesia, but have not had a resident leave our program in more than 10 years. So we have accepted no transfers, within or from outside our specialty, in many years.
I am in Emergency Medicine at one of these large hospitals "over the cap" so we do get people switching into EM from all kinds of specialties. We have had residents from neurosurgery, urology, orthopedics, IM, pediatrics, gyn, surgery come to our program - but they essentially start out as interns, though they might get a couple of extra months of electives as credit for their time in other residencies. And they have to have done well in their former program and get a great evaluation from their program director. Years ago, we had a resident leave to do anesthesia, but have not had a resident leave our program in more than 10 years. So we have accepted no transfers, within or from outside our specialty, in many years.
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I think it depends.
If you were a good medical student, got into a good primary program, and after a year of trying hard just came to the realization that it wasn't for you - you are at a disadvantage reapplying compared to a fresh M4 with the same credentials, but probably not a huge one. It really will depend on the recommendation you get from your initial program director. For example, you do a year of general surgery and just realize the OR isn't for you. The experience as a resident (even as an intern) is extremely different from the experience as a student, so it can just be an honest finding. If you then apply for EM, you'll probably find a place to take you.
On the other hand, if you were doing an initial year of something, were a borderline intern and eventually got fired - well, no program is going to take you without a letter from your old one, and that letter is probably not going to be a good one. You might still find a place to take you - but probably much lower quality of a program relative to what you might have had the first time around.
There is also the question of funding that's mentioned in the prior post - but the vast majority of the time it's no big deal. Every resident has years of funding that are linked to the duration of the program they initially started, and if you transfer to a different field there may be an issue with the hospital getting less money for you. It's actually not that much less money (it gets complicated with direct and indirect funds, but it comes out to ~1/3 less overall) and it may not be less money at all (if you transfer to a bigger program that has more residents than it has fully funded spots). A LOT of people misunderstand this (including some program directors!) but it is sometimes a concern.
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In terms of sub-specialty, do fellowships that overlap two specialties accept people from either route? For example, would a neuro-oncology fellowship accept both oncology fellows and neurology residents?
Generally not, but there are some exceptions. Neuro-onc is a neuro fellowship (although interestingly many older neuro attendings also trained in IM back in the day so there is a lot of overlap). I believe neuro-onc is also open to neurosurgeons. But peds surgery for example is obviously a subspecialty of surgery rather than peds.
Exceptions include sports medicine (PM&R, FM) and some female pelvic surgery programs (obgyn, urology), although some are uro-only because they include male reconstruction. There is also child neuro, which can be reached via peds or a specific child neuro residency.
Then there are some fields with completely separate training pathways that end up converging on similar areas in practice. Probably the most obvious is adult primary care, which is covered by IM, FM, and, to an extent, obgyn (insert EM joke here). More specialized examples include some spine cases (neurosurgery/ortho), certain specific surgeries (carotid endarterectomies by neurosurgery vs. vascular), and lots of endovascular procedures will overlap somewhere between IR, vascular, neurosurgery, and neuro, +/- interventional cardiology.
If you want to more know about specific specialties, just google the name of the subspecialty, click on some of the programs that come up, and see what the application requirements are.
Extremely uncommon. <5% for sure.
I know no one personally who has done it and I know of no one who did. It mainly seems to happen in surgical fields where people switch to non surgical specialties. I am not a surgeon so I have never seen this.
The more common scenario is people who complete one residency then go on to do a second in something else.
I know no one personally who has done it and I know of no one who did. It mainly seems to happen in surgical fields where people switch to non surgical specialties. I am not a surgeon so I have never seen this.
The more common scenario is people who complete one residency then go on to do a second in something else.
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So IM/Onc trainees can’t pursue a neuro-oncology fellowship?
A quick google search told me that a number of neuro-onc programs will consider heme/onc trainees "on a case-by-case basis." I have no idea how common this is. All the neuro-oncologists I have met or even heard of have been neurologists (or neurosurgeons, though most wouldn't call themselves such).
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Why would they want to anyway? A fully trained heme/onc doesn't need to do a superfellowship to treat neuro-onc problems - they already can. The only utility I can see in pursuing a neuro-oncology fellowship is if you are dedicated to neuro-oncology research and want to make triple sure you can fill that niche in an academic medical center.
Good question. I assume it's for the research aspect as well.
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There is an Anesthesiologist in my reserve unit who acted as an attending gastroenterologist in Canada for 4 years....decided to take the USMLE components, join the US army as a Canadian citizen and go in to his US Gas residency. He did that 15 years ago or so...so it might not be that easy now.
