Matched into psychiatry but having second thoughts

[redbandit]

I was sure I'd want to do psychiatry over Internal medicine but during my application / ranking, I just felt rushed through things. It maybe have to do with the rotations I was in but I was never really able to give it much thought and kind of just ranked psychiatry higher than IM. However, after matching into psychiatry, I am having strong doubts. My question is: there are some programs with unmatched spots in IM that are still available, through the NRMP stats. Can I reach out to those IM programs, or is that a violation of the match? I would of course reach out to my PD, however, I want to wait bc I feel like it would be a conflict of interest and if I cannot obtain an IM spot, it'd make him / her think / realize I'm going through a residency I don't want to do.

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[MacDonaldTriad]

Even if your future PD has unmatched applicants on his/her list that they love, this isn't up to you or your future PD. The NRMP people are the only ones who can absolve you of your contractual obligation. They may be likely to let you go if y0u future PD is in favor of it, but they may not be and you will be expressing unhappiness before you have even worked a day in your new program.

The moral here is not to rank anything above something you would rather do. If your opinion is so fluid on this, perhaps reporting in and giving it a few months will work out well? Good luck, even sub-Is can be poorly representative of the field. You will not find much support for leaving the field from this forum. Most of us really like psychiatry.

 

[Mapplicant]

That sounds like a violation of the NRMP binding commitment.

It looks like there's a 45 day rule but NRMP does have a waiver that you must request from the NRMP first:

Useful link here: Match Participation Agreements and Policies |

"Programs and applicants are not authorized to release each other from their binding commitment. Once a party has matched or a position has been offered and accepted during the Match Week Supplemental Offer and Acceptance Program (SOAP), a waiver of the binding commitment may be obtained only from the NRMP.

....

Applicants who have matched to a program or who have accepted a position during SOAP shall not apply for, discuss, interview for, or accept a concurrent year position in another program prior to the NRMP granting the requested waiver.

...

The burden shall be on the requestor to demonstrate unanticipated serious and extreme hardship. For purposes of the waiver process, the term serious and extreme hardship means the significant and unexpected adversity that honoring a Match outcome would bear upon the requestor’s case."

Looks like it's up to you to demonstrate "serious and extreme hardship" if you were to honor the match results.

 

[MacDonaldTriad]

On the other hand, slavery ended in the US in 1865 and the NRMP tends to be soft unless you don't ask and just try and leave. Family health, a change in financial support, ...lots of things happen. You just can't ignore your obligation and you can't just say "because I don't want to". PDs actually give in fairly quickly. Who wants a Debbie Downer in their program (gender not intentional, just don't know a male equivalent saying).

 

[OldPsychDoc]

On the other hand, slavery ended in the US in 1865 and the NRMP tends to be soft unless you don't ask and just try and leave. Family health, a change in financial support, ...lots of things happen. You just can't ignore your obligation and you can't just say "because I don't want to". PDs actually give in fairly quickly. Who wants a Debbie Downer in their program (gender not intentional, just don't know a male equivalent saying).

Negative Ned.

 

[redbandit]

Yeah, I hate that I'm even considering the switching, since i haven't even started yet. I am just a little scared by it. I think I've somehow found comfort in IM, and just falling back on it.

 

[MacDonaldTriad]

The truth is we have little control over destiny anyway. Radical acceptance time, go with the flow, you may like it, the dye is cast and Cesar has crossed the Rubicon. Best of luck

 

[OldPsychDoc]

The truth is we have little control over destiny anyway. Radical acceptance time, go with the flow, you may like it, the dye is cast and Cesar has crossed the Rubicon. Best of luck

The Sorting Hat hath spoken...

 

[DJKitty]

Hi Redbandit,

I wanted to offer some reassurance that it is normal to be having second thoughts at this time. Prior to ranking/match day there was always the possibility to change to/from psychiatry/IM, but now your options of changing are pretty limited and you are in psychiatry for better or worse. I think just the fact of it seeming so "permanent" (although, not in actuality) can create these doubts in our minds, like "Am I really going to do this?"

It might be helpful to list your doubts here so that the forum can help and provide some reality testing (if necessary). Also, you might start browsing the types of careers after residency/fellowship that are available and see if something piques your interest. Psychiatry is so much more than what you are exposed to in medical school. You can work with children to the elderly, in all types of facilities/offices, providing many different services and incorporating other fields such as philosophy, medical ethics, and public health.

Good luck!

 

[redbandit]

Hi Redbandit,

I wanted to offer some reassurance that it is normal to be having second thoughts at this time. Prior to ranking/match day there was always the possibility to change to/from psychiatry/IM, but now your options of changing are pretty limited and you are in psychiatry for better or worse. I think just the fact of it seeming so "permanent" (although, not in actuality) can create these doubts in our minds, like "Am I really going to do this?"

It might be helpful to list your doubts here so that the forum can help and provide some reality testing (if necessary). Also, you might start browsing the types of careers after residency/fellowship that are available and see if something piques your interest. Psychiatry is so much more than what you are exposed to in medical school. You can work with children to the elderly, in all types of facilities/offices, providing many different services and incorporating other fields such as philosophy, medical ethics, and public health.

Good luck!

Thank you so much for the reassurance! I can't say how much that means to me! I was beyond conflicted in choosing between the two, and I had gone with my heart and ranked psychiatry higher. Some doubts I have:
-terrified of the constant verbal abuse I may potentially be on the receiving end of, from patients. On the flip side, being exposed to it can only make me stronger and will help me deal with future aggressive patients, with less fear.
-being worn down / mentally drained from being exposed to the above.
-(this I don't care about as much, but worth noting) some family members (naive) don't have much of an understanding of psychiatry, given our cultural background (Indian). I am trying my best to educate them on it, and telling them it was my choice, but having their approval would have made my choice more gratifying / fulfilling.

I will continue to feel that I made the right decision. My biggest fear is how the field can affect me as a person. I know I'm strong, but constant exposure to certain things can affect even the strongest. I have been bummed out all day today, and I really appreciate the positive feedback in the above post. Really means a lot

 

[FlowRate]

Worst case, you'll have some IM months to figure out what you really want to do.

 

[OldPsychDoc]

Thank you so much for the reassurance! I can't say how much that means to me! I was beyond conflicted in choosing between the two, and I had gone with my heart and ranked psychiatry higher. Some doubts I have:
-terrified of the constant verbal abuse I may potentially be on the receiving end of, from patients. On the flip side, being exposed to it can only make me stronger and will help me deal with future aggressive patients, with less fear.
-being worn down / mentally drained from being exposed to the above.

You say that like IM docs don't have to deal with verbal abuse.
At least after a few months with us you'll start to learn our secret Jedi skills for evading it.
You might get drained now and then, but if you have good colleagues you can vent to, you'll come through.

A long time ago, someone on here suggested that you imagine having gotten the letter saying that you'd matched into one of the IM programs you liked instead of Psych. What are you thinking and feeling now? Are you regretting not matching into psych? Dreading the living hell of IM intern scut? Wishing you were delving into the patient's internal conflicts, developmental crises, and defenses instead of their orifices? If you complete that exercise and still long to be an internist, plow on through your PGY1 year and start looking for a transfer spot.

 

[clausewitz2]

Thank you so much for the reassurance! I can't say how much that means to me! I was beyond conflicted in choosing between the two, and I had gone with my heart and ranked psychiatry higher. Some doubts I have:
-terrified of the constant verbal abuse I may potentially be on the receiving end of, from patients. On the flip side, being exposed to it can only make me stronger and will help me deal with future aggressive patients, with less fear.
-being worn down / mentally drained from being exposed to the above.

I think it is worth pointing out that most psychiatric practice settings are not forensic settings. This is important, because it means most psychiatric practice settings are not actually full of patients who are going to subject you to constant torrents of verbal abuse. It will of course happen sometimes, and probably fair to say it will happen more often than on a standard inpatient medical unit, but look - most psychiatric patients want something from you, even if it is just for you to help them get better.

 

[Candidate2017]

You say that like IM docs don't have to deal with verbal abuse.
At least after a few months with us you'll start to learn our secret Jedi skills for evading it.

Surgeons are the most powerful of the jedi. They can summon psych at will with one-liner consults like, "Crying".

 

[J ROD]

just a thought.....I may know an open Psy/IM spot

 

[redbandit]

just a thought.....I may know an open Psy/IM spot

That would be amazing and I'd prob sell my soul for a position. But how would I go about the whole issue with match violation?

 

[J ROD]

That would be amazing and I'd prob sell my soul for a position. But how would I go about the whole issue with match violation?

I have no clue about the match thing. This whole process is wtf to me. I feel like I am in servitude.

 

[redbandit]

I appreciate all the feedback. I do agree on the idea that I might be most fearful of the "permanent" aspect of things. I just need to get in the rhythm of things, and I am sure I will enjoy it and once again realize why I chose psychiatry to begin with!