How Risky is Switching Specialties?

[canttrackmensa]

Throaway account.

PGY 1 GS Resident here. I have been doubting my General Surgery decision ever since beginning of intern year and as I am getting ready to enter my PGY 2 year, I realize that I can't do this anymore. I'm at a newer program so there's a lot of growing pains. But I got to be in the OR a LOT. However, OR is not fun enough for me anymore.

I think this is due to many reasons. Two biggest being 1) I think that initial glamor of OR is fading away. I liked being in the OR and working with my hands, but it's definitely NOT enough to deal with all the baggage (hours, schedule unpredictability, abrasive personalities) GS comes with. 2) I want to see my family more and want to have more of a predictable schedule as an attending. I understand residency is hard and you get more control as an attending, but attendings don't have 80 hr work restrictions and many of them still work hard afterwards even if they are "family oriented." They still miss stuff and their spouse has to put up with it. Yes I am willing to work hard during residency, but the impression I get is that in order to be a good surgeon, you have to be willing to sacrifice family, friends, hobbies, sleep, etc even after residency.

So I'm thinking of switching specialties, and I read up a lot about them. GS has 20% attrition. Commonly switch to Gas, EM, Rads. It's difficult, but doable. Biggest concern is time off for interviews during residency.

But I feel like people haven't asked this basic question as much - how risky is it? Are there abundant cases where GS residents are left with no jobs after trying to switch specialties? As in are they are forced out of medicine completely? I have only heard many success stories of switching from GS to other specialties.

Obviously, if it's really risky then I guess I'll have no choice to push on and have a potentially miserable career for the rest of my life...

---

Members don't see this ad.

 

[NotAProgDirector]

IN general, if you were competitive enough to get a GS spot, you'll get a spot in another residency. You'll have a total of 5 years of funding, so that shouldn't be a huge issue. Once you announce your intentions, they may pull you out of the OR completely -- whether that's good or bad depends on your point of view. Spots might still open for this coming year, if you were flexible on location. What field are you interested in?

 

[gutonc]

IN general, if you were competitive enough to get a GS spot, you'll get a spot in another residency. You'll have a total of 5 years of funding, so that shouldn't be a huge issue. Once you announce your intentions, they may pull you out of the OR completely -- whether that's good or bad depends on your point of view. Spots might still open for this coming year, if you were flexible on location. What field are you interested in?

This is the key.

As aPD points out, you're probably going to be a reasonable candidate for a lot of specialties. What is it that actually interests you? As long as you're not looking at derm, or one of the surgical subs (ENT, ortho and Ophtho have pretty decent post-training lifestyles, Neurosurg and Vascular not so much), you're probably not at much risk of going unmatched. the bigger issue is how to get there from here. And the specialty you choose will influence that quite a bit.

 

[canttrackmensa]

IN general, if you were competitive enough to get a GS spot, you'll get a spot in another residency. You'll have a total of 5 years of funding, so that shouldn't be a huge issue. Once you announce your intentions, they may pull you out of the OR completely -- whether that's good or bad depends on your point of view. Spots might still open for this coming year, if you were flexible on location. What field are you interested in?

Thanks for the reply aProgDirector. I'm indifferent if they pull me out of the OR. Sure I'll be a little disappointed, but I don't mind doing scutwork for a year.

Location-wise, I'd be flexible as long as there's an urban area that is within <2 hour drive. I think this is being flexible enough.

Specialty-wise:
That's something I'm struggling with. I was the kid in medical school that loved all of his/her rotations. The only one I didn't like was my OMM rotation (story for another day). I like procedures, I like anatomy, Medicine was okay, I don't mind clinic, I don't like rounding a whole lot, Not a huge fan of calls but I don't mind taking them <4-5x/month; I don't mind working hard - as long as it is predictable and that work will not be my identity; I like working with friendly, happy individuals, not the gruff I'm a Navy Seal comrarderie builder personality (whatever that means); Money is not an issue at all.

Do my wishlist above correspond well with a particular specialty in your experience @aProgDirector?

Maybe Gas (it'll be nice to be in the OR without dealing with GS garbage. Don't mind playing second fiddle or getting yelled at by surgeon [being facetious here]) or Rads (rotated before in medical school - really liked due to the immense knowledge required and the cerebral challenge, but isn't it hyper-competitive like derm, opt, surgically specialty?) like many ex-GS residents? Or maybe FM since I did enjoy the prospect of developing long-term relationships with patients and the variety in patient type and care?

This is the key.

As aPD points out, you're probably going to be a reasonable candidate for a lot of specialties. What is it that actually interests you? As long as you're not looking at derm, or one of the surgical subs (ENT, ortho and Ophtho have pretty decent post-training lifestyles, Neurosurg and Vascular not so much), you're probably not at much risk of going unmatched. the bigger issue is how to get there from here. And the specialty you choose will influence that quite a bit.

Thanks for the reply Gutonc. Not competitive or interested in derm, or surgical subs thanks goodness. Frankly don't want to hold the scalpel anymore. But yes absolutely if I were looking into switching into one of those specialties I would definitely go unmatched. Would rather stick with GS than be out of medicine.

 

[smq123]

Throaway account.

PGY 1 GS Resident here. I have been doubting my General Surgery decision ever since beginning of intern year and as I am getting ready to enter my PGY 2 year, I realize that I can't do this anymore. I'm at a newer program so there's a lot of growing pains. But I got to be in the OR a LOT. However, OR is not fun enough for me anymore.

I think this is due to many reasons. Two biggest being 1) I think that initial glamor of OR is fading away. I liked being in the OR and working with my hands, but it's definitely NOT enough to deal with all the baggage (hours, schedule unpredictability, abrasive personalities) GS comes with. 2) I want to see my family more and want to have more of a predictable schedule as an attending. I understand residency is hard and you get more control as an attending, but attendings don't have 80 hr work restrictions and many of them still work hard afterwards even if they are "family oriented." They still miss stuff and their spouse has to put up with it. Yes I am willing to work hard during residency, but the impression I get is that in order to be a good surgeon, you have to be willing to sacrifice family, friends, hobbies, sleep, etc even after residency.

So I'm thinking of switching specialties, and I read up a lot about them. GS has 20% attrition. Commonly switch to Gas, EM, Rads. It's difficult, but doable. Biggest concern is time off for interviews during residency.

But I feel like people haven't asked this basic question as much - how risky is it? Are there abundant cases where GS residents are left with no jobs after trying to switch specialties? As in are they are forced out of medicine completely? I have only heard many success stories of switching from GS to other specialties.

Obviously, if it's really risky then I guess I'll have no choice to push on and have a potentially miserable career for the rest of my life...

Have you considered some of the GS subspecialties, like breast or colon? They have more clinic and the hours are better, from what I understand.

 

[canttrackmensa]

Have you considered some of the GS subspecialties, like breast or colon? They have more clinic and the hours are better, from what I understand.

Thank you for the reply @smq123. You bring up a great point. Yes I did. Thought about bariatrics, breast, endocrine, colon. But I'm at a newer program that doesn't have a graduating class yet. No guarantees that I'll match into a fellowship program seeing that these specialties are not uncompetitive. What if I don't match? Then I'll be stuck with GS and I think I'll be extremely miserable. Even if I match, no guarantees that I'd be able to find a job that completely eliminates GS from my practice or the long hours/calls at a location I desire especially as a new grad. I hate the prospect of tunnel visioning into a particular niche specialty, and this suggest to me that I may be in the wrong specialty in general. But more importantly, I'm less enamored with surgery in general. I think that med student fascination of OR is dissipating, and it's just not that fun anymore.

So that's why I'm trying to compare the risks between my options. If it's absurdedly risky to switch specialty then I hedge my bet that a) I hopefully like one of those specialties b) that I can get one of these fellowships c) that I actually find a job that aligns with my career desires. But if switching is statistically possible, I want to give that a shot.

 

[fleetfox]

Seems like a switch to Family Practice makes sense for you. Regular hrs, not much call, should be able to get a residency spot.

If you truly don't like the OR, there's no way I'd gut it out thru a GS residency. As long as you're not confusing being over intern year with being over surgery altogether.

 

[gutonc]

I think Gas or EM, maybe FM or IM with an eye to PCCM, GI or Cards (the last 2 probably more competitive than GS in general) are the way to go for you. From Gas you can do stay there or do crit care or pain, both of which have a lot of procedures. You could also do rads followed by IR (or a combined DR/IR program). The good news is that, at least for Gas and Rads, you've already done the prelim year and could conceivably match directly into an advanced program that starts next year. Everything else will be "starting over" but you'll probably get a few months worth of credit in EM, IM or FM if you went one of those routes.

 

[ThoracicGuy]

Throaway account.

PGY 1 GS Resident here. I have been doubting my General Surgery decision ever since beginning of intern year and as I am getting ready to enter my PGY 2 year, I realize that I can't do this anymore. I'm at a newer program so there's a lot of growing pains. But I got to be in the OR a LOT. However, OR is not fun enough for me anymore.

I think this is due to many reasons. Two biggest being 1) I think that initial glamor of OR is fading away. I liked being in the OR and working with my hands, but it's definitely NOT enough to deal with all the baggage (hours, schedule unpredictability, abrasive personalities) GS comes with. 2) I want to see my family more and want to have more of a predictable schedule as an attending. I understand residency is hard and you get more control as an attending, but attendings don't have 80 hr work restrictions and many of them still work hard afterwards even if they are "family oriented." They still miss stuff and their spouse has to put up with it. Yes I am willing to work hard during residency, but the impression I get is that in order to be a good surgeon, you have to be willing to sacrifice family, friends, hobbies, sleep, etc even after residency.

So I'm thinking of switching specialties, and I read up a lot about them. GS has 20% attrition. Commonly switch to Gas, EM, Rads. It's difficult, but doable. Biggest concern is time off for interviews during residency.

But I feel like people haven't asked this basic question as much - how risky is it? Are there abundant cases where GS residents are left with no jobs after trying to switch specialties? As in are they are forced out of medicine completely? I have only heard many success stories of switching from GS to other specialties.

Obviously, if it's really risky then I guess I'll have no choice to push on and have a potentially miserable career for the rest of my life...

I do hope you realize that not every attending is putting in >80 hours a week. When you go out and get a job, particularly if you are in a group practice, you only round on your patients, not the whole team. Yes, you may take call on them, but you're just getting called on surgery patients and ER patients for the most part. Patients that are admitted to other services probably won't bother you much at night.

You do not have to sacrifice family, friends, hobbies, etc.

You decide how much you want to work. You want to work less, well you'll get paid less, but you can find jobs out there to do that.

In the end, you need to find what kind of work makes you happy. What job will you be willing to get up for in the mornings. If that's something other than surgery, great. But make sure that's what you want to do. Once you leave, you won't be coming back.

 

[deleted50541]

But I feel like people haven't asked this basic question as much - how risky is it? Are there abundant cases where GS residents are left with no jobs after trying to switch specialties? As in are they are forced out of medicine completely? I have only heard many success stories of switching from GS to other specialties.

Obviously, if it's really risky then I guess I'll have no choice to push on and have a potentially miserable career for the rest of my life...

Folks have already made a lot of good points, but I'll add my two cents as someone who was in a similar situation.

First year is a demoralizing grind no matter what specialty you do. Burnout was pretty high in my program and I was no exception. A number of my peers either transferred programs or switched specialties. I took a year off to do research and reassess my priorities after my second year. But I stuck with it and am in a better place now.

The ones who left surgery were clearly miserable and found little joy in operating. Most switched to anesthesia, two went to different GS programs to be closer to family, and another went into pathology. Of those I keep in contact with, not one of them regretted their decision.

So to answer your question, of course there's risk involved with deciding to switch specialties. But it can be done and successfully.

 

[NotAProgDirector]

I like procedures, I like anatomy, Medicine was okay, I don't mind clinic, I don't like rounding a whole lot, Not a huge fan of calls but I don't mind taking them <4-5x/month; I don't mind working hard - as long as it is predictable and that work will not be my identity; I like working with friendly, happy individuals, not the gruff I'm a Navy Seal comrarderie builder personality (whatever that means); Money is not an issue at all.

Do my wishlist above correspond well with a particular specialty in your experience @aProgDirector?

Maybe Gas (it'll be nice to be in the OR without dealing with GS garbage. Don't mind playing second fiddle or getting yelled at by surgeon [being facetious here]) or Rads (rotated before in medical school - really liked due to the immense knowledge required and the cerebral challenge, but isn't it hyper-competitive like derm, opt, surgically specialty?) like many ex-GS residents? Or maybe FM since I did enjoy the prospect of developing long-term relationships with patients and the variety in patient type and care?

Reading the above, I'm not certain if you're referring to residency, or eventual practice. I'm hoping the latter.

Assuming that, I think the answer is "anything". You could work as an anesthesiologist at a big center doing cardiac cases and be on call / working nights and weekends all the time. Or you could work at a small community center that does no emergent cases and have (essentially) no call at all. Same situation in most other fields, and "call" might mean covering rare phone calls at night with no chance of being called in.

So in the end, I (nor anyone) can tell you what to do. You need to find something you'll be happy with. You thought that was surgery, and it isn't.

If you're a US grad without baggage, then you'll get a spot in an equal or less competitive specialty somewhere. You would either enter the match again, or try to find an off cycle spot. All of this is much easier if you have a program at your current institution and the PD is willing to help you (even if you decide to move / they don't have room).

 

[CopaceticOne]

Specialty-wise:
That's something I'm struggling with. I was the kid in medical school that loved all of his/her rotations. The only one I didn't like was my OMM rotation (story for another day). I like procedures, I like anatomy, Medicine was okay, I don't mind clinic, I don't like rounding a whole lot, Not a huge fan of calls but I don't mind taking them <4-5x/month; I don't mind working hard - as long as it is predictable and that work will not be my identity; I like working with friendly, happy individuals, not the gruff I'm a Navy Seal comrarderie builder personality (whatever that means); Money is not an issue at all.

Unless you are already considering what is referred to as "mommy-track" job in anesthesia, you'll be doing way more call than 5x/month. Also, anesthesiology is anything but predictable - it is every bit as chaotic schedule as general surgery, but we deal with all surgical specialities.

 

[manny24]

Reading the above, I'm not certain if you're referring to residency, or eventual practice. I'm hoping the latter.

Assuming that, I think the answer is "anything". You could work as an anesthesiologist at a big center doing cardiac cases and be on call / working nights and weekends all the time. Or you could work at a small community center that does no emergent cases and have (essentially) no call at all. Same situation in most other fields, and "call" might mean covering rare phone calls at night with no chance of being called in.

So in the end, I (nor anyone) can tell you what to do. You need to find something you'll be happy with. You thought that was surgery, and it isn't.

If you're a US grad without baggage, then you'll get a spot in an equal or less competitive specialty somewhere. You would either enter the match again, or try to find an off cycle spot. All of this is much easier if you have a program at your current institution and the PD is willing to help you (even if you decide to move / they don't have room).

What do u mean by this: (even if you decide to move / they don't have room).

 

[NotAProgDirector]

I mean that if the local PD in the specialty you are interested in helps you, it will be much easier even if you decide that you don't want to stay at that location and want to move somewhere else, or if they don't have room for you so you must move somewhere else. Having a local PD help you coordinate all of this is very helpful.

 

[dpmd]

Residency is going to suck in many specialities so if what you are burned out on is residency itself then changing specialties isn't going to mke you happy. Sure, you can change to family practice and end up in an outpatient only practice, but at my residency those folks rotated with us and ob so it isn't like residency was a cake walk. On the other hand, if you suck it up and make it through then you might be able to find angig like mine where you get over 300k a year for part time work.

 

[manny24]

IN general, if you were competitive enough to get a GS spot, you'll get a spot in another residency. You'll have a total of 5 years of funding, so that shouldn't be a huge issue. Once you announce your intentions, they may pull you out of the OR completely -- whether that's good or bad depends on your point of view. Spots might still open for this coming year, if you were flexible on location. What field are you interested in?

Doesn't reapplying and matching through the NRMP reset your funding? For example, if you have 3 years of funding then you apply to a 5 year residency and successfully match. Then your funding would be 5 years instead of 3.

 

[smq123]

Doesn't reapplying and matching through the NRMP reset your funding? For example, if you have 3 years of funding then you apply to a 5 year residency and successfully match. Then your funding would be 5 years instead of 3.

No. The number of years of funding that you get is based on the FIRST specialty that you match into. It does not re-set.

Also, given that the poster that you're replying to WAS a program director, for several years, I would assume that he would know what he's talking about. 😉

 

[Raryn]

Doesn't reapplying and matching through the NRMP reset your funding? For example, if you have 3 years of funding then you apply to a 5 year residency and successfully match. Then your funding would be 5 years instead of 3.

No, it doesn't. The first categorical/advanced program you start determines your funding. The difference for an unfunded year is not that large though (you still get the majority of your funding) and for bigger institutions that have unfunded spots entirely, makes no difference at all.

 

[Southpaw]

Anesthesiologist here. It's impossible to fully know your personality and wants/desires out of life. it's also impossible for you to understand what you'll want out of life 10-20 years from now. If I were able to turn the clock back 10 years I'd do surgery. There are plenty of anesthesiologists, some on our forum at SDN, who'd make the same choices and do anesthesiology. Again, this all depends on you and who you are.

 

[manny24]

No, it doesn't. The first categorical/advanced program you start determines your funding. The difference for an unfunded year is not that large though (you still get the majority of your funding) and for bigger institutions that have unfunded spots entirely, makes no difference at all.

So, why do people mention years of funding as an issue if it's not a big deal?

 

[CopaceticOne]

So, why do people mention years of funding as an issue if it's not a big deal?

Because for some programs it is a big issue.

 

[Raryn]

So, why do people mention years of funding as an issue if it's not a big deal?

For two reasons

1) It's very commonly misunderstood, even by program directors but especially by applicants. The funding issue is pretty complicated and some people think being "out of funding" means you get $0.

2) For some programs, it does matter some. For large institutions where they're over their cap anyway it's irrelevant, but for newer institutions where everyone has a funded spot, if you're out of funding, the monetary difference (amounting to half of the DME portion of your total funding - you still get the full amount of IME) comes out to somewhere around $25k a year.

 

[ThoracicGuy]

For two reasons

1) It's very commonly misunderstood, even by program directors but especially by applicants. The funding issue is pretty complicated and some people think being "out of funding" means you get $0.

2) For some programs, it does matter some. For large institutions where they're over their cap anyway it's irrelevant, but for newer institutions where everyone has a funded spot, if you're out of funding, the monetary difference (amounting to half of the DME portion of your total funding - you still get the full amount of IME) comes out to somewhere around $25k a year.

Also it's likely a way to turn someone down to be able to give an excuse outside their control.

 

[hopefulgasman]

Anesthesiologist here. It's impossible to fully know your personality and wants/desires out of life. it's also impossible for you to understand what you'll want out of life 10-20 years from now. If I were able to turn the clock back 10 years I'd do surgery. There are plenty of anesthesiologists, some on our forum at SDN, who'd make the same choices and do anesthesiology. Again, this all depends on you and who you are.

I apologize in advance for opening Pandora’s box, but what are some of the reasons why you would leave anesthesia for surgery or another field in retrospect hypothetically speaking.

I understand that this is obviously personal and pertains to you.

 

[Southpaw]

I apologize in advance for opening Pandora’s box, but what are some of the reasons why you would leave anesthesia for surgery or another field in retrospect hypothetically speaking.

I understand that this is obviously personal and pertains to you.

I'd have picked different because as a medical student I didn't understand service specialties from those that aren't. Anesthesiology is a service specialty. If you're a hospital administrator we are a nameless face and easily replaceable. As an anesthesiologist I don't really have much say in whether I supervise or do my own cases as that's dictated largely by group setup and location (east coast tends to supervise, west coast has more MDs doing their own cases). As an anesthesiologist the midlevels of my specialty (CRNAs and AAs, but CRNAs hold the bulk of the marketshare) as a group are extremely politically active and vocal about their importance. It gets old, quickly. CRNAs also do better financially than any other midlevel specialty, by far, and still whine/complain about everything. It's nonsense.

As a medical student I didn't see the value in having your own patients. I've spent literal days of my life waiting on surgeons to show up to the hospital from clinic to operate on their patients (and yes, I know I know, all surgeons ONLY wait for anesthesia....). I also didn't see the value in having a clinic. Now I see great leverage in having the ability to leave the hospital completely if desired and do either just clinic work or operate out of an ASC. Or open/own your own ASC.

To do any sort of acuity in anesthesiology (as opposed to working out of an ASC) you work in a hospital and have associated call. That means you're working nights and weekends. You're also likely covering OB which tends to have a lot of work at night.

On the positives, overall I still enjoy my career, my income, the amount of vacation I take (I generally take 10-11 weeks of vacation per year), and my workload (I generally work 45 hours a week). All of my problems are clearly first-world problems.

Best of luck to you.

 

[deleted171991]

I think Gas or EM, maybe FM or IM with an eye to PCCM, GI or Cards (the last 2 probably more competitive than GS in general) are the way to go for you. From Gas you can do stay there or do crit care or pain, both of which have a lot of procedures. You could also do rads followed by IR (or a combined DR/IR program). The good news is that, at least for Gas and Rads, you've already done the prelim year and could conceivably match directly into an advanced program that starts next year. Everything else will be "starting over" but you'll probably get a few months worth of credit in EM, IM or FM if you went one of those routes.

Critical care doesn't have "a lot of" procedures, just BAD critical care.

A passion for surgery is almost a contraindication to a career in critical care.

 

[Sushirolls]

What no love for Psychiatry?

ECT is a procedure, you'll even get to work with anesthesiology.