MS4. I think I chose the wrong field.

[IR_to_surgery]

MS4 here. Top med school, yada yada. I just finished interviewing for IR and I'm already having serious doubts about my choice. I want surgery.

I can get into the reasons why but my big question is what do I do from here? Match into prelim/IR and try to switch, match into a prelim only, not submit a rank list at all and reapply? Thanks.

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[Dr.LeoSpaceman]

What's led to this feeling? Why did you like IR? What is it about surgery that makes you think it's where you really want to be? Some experience after the application process? Not only might that help people here provide insight, but if you do consider switching you're going to need solid answers to those questions. Not only in order to match, but more importantly to know you are going to be satisfied with your ultimate decision.

But as for your question, I would have to imagine that matching into a prelim/IR spot (if possible) would be your best option. Yes, you may try switching, but better to be left with a known path to finishing residency if it doesn't work out. If you do prelim only and then don't match into surgery, it's unlikely you would match back into IR either. Then what do you do? Simply taking a year off after not submitting is probably the worst option. Unless you have something lined up now, it's going to leave you with a gaping hole on your CV.

 

[MaximusD]

MS4 here. Top 10 med school, AOA, yada yada. I just finished interviewing for IR and I'm already having serious doubts about my choice. I want surgery.

I can get into the reasons why but my big question is what do I do from here? Match into prelim/IR and try to switch, match into a prelim only, not submit a rank list at all and reapply? Thanks.

Take a vacation for a week or two and really soul-search. You’ve gotta be passionate about what you do but also be cognizant of the sacrifices you will make if you choose a field like surgery.

 

[doc05]

Switching specialties isn't necessarily the wrong move, but you need the right reasons. Surgery isn't better than IR, nor is it worse. But it's very different, and there are real downsides to a career in surgery.

I find that most ms4's have such limited experience that probably 5 or 6 different specialties would work out for any given person.

What are your reasons for the change of heart?

 

[Socram]

If you feel strongly about surgery, I would encourage to consider extending/deferring graduation for another year and reapplying.

Switching specialties is doable, but not easy. First, going to residency interviews will be much more stressful as you balance your 80 hr/week intern work schedule with travel and scheduling. You will likely be expected to use your day off, and may possibly need to use your vacation time to go on interviews.

Second, some programs may not consider you because you have use up a year of Medicare funding for your residency training and they will need to cover the difference.

https://members.aamc.org/eweb/upload/Medicare Payments For Graduate Medical Education 2013.pdf

See page 6, which also has an example more clearly explaining the situation.

Third, know that you may lose your advanced residency spot if you reapply. If you match into a surgery prelim year and a radiology advanced position, and decide to reapply as an intern you will first need a change of specialty waiver from the NRMP before you can reapply (before Dec 15th).

Requesting a Waiver - The Match, National Resident Matching Program

As it mentions, you are free to participate in the match, but the program is now free to recruit for the position, and they need only to find someone who would have completed a prelim year.

What types of programs participate in the Main Residency Match®? - The Match, National Resident Matching Program

Physician-designated radiology spots are far more competitive than advanced radiology spots, it will be very easy for your future program to fill this spot.

Despite all this, every year people are successfully in changing specialties. Consider a meeting with the Dean of Students if you have a good relationship with him or her.

 

[IR_to_surgery]

Thanks everyone. I really appreciate it.

What's led to this feeling? Why did you like IR? What is it about surgery that makes you think it's where you really want to be? Some experience after the application process? Not only might that help people here provide insight, but if you do consider switching you're going to need solid answers to those questions. Not only in order to match, but more importantly to know you are going to be satisfied with your ultimate decision.

But as for your question, I would have to imagine that matching into a prelim/IR spot (if possible) would be your best option. Yes, you may try switching, but better to be left with a known path to finishing residency if it doesn't work out. If you do prelim only and then don't match into surgery, it's unlikely you would match back into IR either. Then what do you do? Simply taking a year off after not submitting is probably the worst option. Unless you have something lined up now, it's going to leave you with a gaping hole on your CV.

Two solid reasons and a bunch of wishy washy ones. First, my then wife basically told me I couldn't do surgery because of the lifestyle. Which is ironic because IR is no derm. We are now thank god getting a divorce so lifestyle is no longer an issue at all. Second, I had an absolutely abysmal surgery rotation in third year but ended up having a fantastic experience last month in in January of my 4th year. The third year rotation wasn't just pimping or long hours. It was being the 5th or 6th person scrubbed into a case so I couldn't even see anything, I closed a patient twice the entire two months, was sent to clinic more than the OR... on and on. It was not representative of what the job is like.

Wishy washy reasons are I always saw myself being a surgeon, it's my dream, I won't be happy unless I do it, I should have dumped the wife earlier, so on.

I think I will go meet with my dean. He seems to have my back. I agree not matching this cycle leaves a gap in my CV. I have done a lot of research this 4th year but most of it is IR-related, not surgery-related.

Thanks again.

 

[DrfluffyMD]

Thanks everyone. I really appreciate it.



Two solid reasons and a bunch of wishy washy ones. First, my then wife basically told me I couldn't do surgery because of the lifestyle. Which is ironic because IR is no derm. We are now thank god getting a divorce so lifestyle is no longer an issue at all. Second, I had an absolutely abysmal surgery rotation in third year but ended up having a fantastic experience last month in in January of my 4th year. The third year rotation wasn't just pimping or long hours. It was being the 5th or 6th person scrubbed into a case so I couldn't even see anything, I closed a patient twice the entire two months, was sent to clinic more than the OR... on and on. It was not representative of what the job is like.

Wishy washy reasons are I always saw myself being a surgeon, it's my dream, I won't be happy unless I do it, I should have dumped the wife earlier, so on.

I think I will go meet with my dean. He seems to have my back. I agree not matching this cycle leaves a gap in my CV. I have done a lot of research this 4th year but most of it is IR-related, not surgery-related.

Thanks again.

I still occasionally think about being a surgeon. If you have any doubt, do surgery. Lifestyle is worse but the work can be more rewarding and challenging. You are also able to “take” procedures from other fields.

Definitely do a surgical prelim.

I think your option would be to do a surgery prelim and reevaluate how much you like surgery. Of note the surgery prelim experience is nothing like a real surgeon.

The IR fellowship experience is often not the real private practice Ir experience either.

 

[doc05]

Thanks everyone. I really appreciate it.



Two solid reasons and a bunch of wishy washy ones. First, my then wife basically told me I couldn't do surgery because of the lifestyle. Which is ironic because IR is no derm. We are now thank god getting a divorce so lifestyle is no longer an issue at all. Second, I had an absolutely abysmal surgery rotation in third year but ended up having a fantastic experience last month in in January of my 4th year. The third year rotation wasn't just pimping or long hours. It was being the 5th or 6th person scrubbed into a case so I couldn't even see anything, I closed a patient twice the entire two months, was sent to clinic more than the OR... on and on. It was not representative of what the job is like.

Wishy washy reasons are I always saw myself being a surgeon, it's my dream, I won't be happy unless I do it, I should have dumped the wife earlier, so on.

I think I will go meet with my dean. He seems to have my back. I agree not matching this cycle leaves a gap in my CV. I have done a lot of research this 4th year but most of it is IR-related, not surgery-related.

Thanks again.

You need more exposure to solidify your decision. you still haven't clarified why surgery is a better choice than IR. One "good month" of a rotation isn't enough. A lot of what we do is disappointing, and the residency experience is very demoralizing.

 

[Pir8DeacDoc]

That romantic view you have of surgery will fade fast. A good month on a rotation and "dream" of being a surgeon is like watching Top Gun and wanting to be a fighter pilot. Seems easy and cute in the movies but reality is far different. I'd be damn sure of what you want before you change course completely. You'll practice for 25 + years, make sure you get it right.

 

[deleted547339]

Thanks everyone. I really appreciate it.



Two solid reasons and a bunch of wishy washy ones. First, my then wife basically told me I couldn't do surgery because of the lifestyle. Which is ironic because IR is no derm. We are now thank god getting a divorce so lifestyle is no longer an issue at all. Second, I had an absolutely abysmal surgery rotation in third year but ended up having a fantastic experience last month in in January of my 4th year. The third year rotation wasn't just pimping or long hours. It was being the 5th or 6th person scrubbed into a case so I couldn't even see anything, I closed a patient twice the entire two months, was sent to clinic more than the OR... on and on. It was not representative of what the job is like.

Wishy washy reasons are I always saw myself being a surgeon, it's my dream, I won't be happy unless I do it, I should have dumped the wife earlier, so on.

I think I will go meet with my dean. He seems to have my back. I agree not matching this cycle leaves a gap in my CV. I have done a lot of research this 4th year but most of it is IR-related, not surgery-related.

Thanks again.

Just because you’re getting a divorce doesn’t mean lifestyle isn’t a consideration. You may have a wife and/or child in the future that may like to have you around more.

Also, remember that surgery isn’t just surgery. It’s also clinic and rounding and consults where you don’t operate. I’m not a surgeon so I can’t speak to what percentage of the average work week an attending spends in an OR, but it ain’t 100. As a Med student, it’s easy to view any specialty through rose colored glasses.

IR is a good gig. Just don’t make any rash decisions you could later regret. I would (personally) stay the course. If you do 1-2y of IR and hate it, you can always switch then and all you’ve lost is time. The Medicare funding thing is overblown. Yes, it’s an issue, but a lot of large institutions have unfunded spots. I know my site for residency and fellowship both do/did (both large, prestigious universities), they just shift it around to make sure all of their eligible spots are used on all of their eligible residents. Gen surg is roughly in the middle of the pack for match difficulty while IR is tough (which I’m sure is not news to you); given your credentials, you would likely be able to secure a very good surgical position after a year or two of IR if you change your mind, the opposite is not necessarily true. Plus, you will likely acquire some technical skills that may translate (think:vascular) and will certainly get a better anatomy foundation.

 

[IR_to_surgery]

Just because you’re getting a divorce doesn’t mean lifestyle isn’t a consideration. You may have a wife and/or child in the future that may like to have you around more.

Also, remember that surgery isn’t just surgery. It’s also clinic and rounding and consults where you don’t operate. I’m not a surgeon so I can’t speak to what percentage of the average work week an attending spends in an OR, but it ain’t 100. As a Med student, it’s easy to view any specialty through rose colored glasses.

IR is a good gig. Just don’t make any rash decisions you could later regret. I would (personally) stay the course. If you do 1-2y of IR and hate it, you can always switch then and all you’ve lost is time. The Medicare funding thing is overblown. Yes, it’s an issue, but a lot of large institutions have unfunded spots. I know my site for residency and fellowship both do/did (both large, prestigious universities), they just shift it around to make sure all of their eligible spots are used on all of their eligible residents. Gen surg is roughly in the middle of the pack for match difficulty while IR is tough (which I’m sure is not news to you); given your credentials, you would likely be able to secure a very good surgical position after a year or two of IR if you change your mind, the opposite is not necessarily true. Plus, you will likely acquire some technical skills that may translate (think:vascular) and will certainly get a better anatomy foundation.

Thanks again for your time.

Unfortunately the first 3 years of IR residency (after an internship) are DR years, exactly the same as the diagnostic radiology residents. So doing 1-2 years of IR would mean being PGY 5 or PGY 6 before trying to transfer which doesn't make a lot of sense. Adding on a surgery residency and fellowship after that would mean I could be up to PGY 15 before I would finish.

To the others, I get that there is clinic, rounding, OR time, and everything else make a surgeon. I'm not just drooling over the OR time. I know a month doesn't mean I should drastically change my life plans. And how does any med student choose surgery then? I have done about 5 months on surgery during my school which is more than some of my friends matching gen surg next month. But somehow they know and I can't know? I'm not sure how I have vastly less experience than them choosing a field.

To answer the question why surgery (in addition to what I mentioned above), I want to be able to do open surgical techniques, both because I think they are important and particularly so I can translate these skills abroad. Again, not having a spouse frees up my ability significantly to work abroad. Maybe it's a pipe dream, but I have spent several years abroad and know several languages. Other than very basic fluoro studies IR is unheard of in resource poor settings. Finally, I also feel that the reason why IR has "lost" so many procedures is because they are not clinically skilled enough to care for patients in the pre- and post-op settings. I enjoy that work to an extent and want to be clinically strong.

 

[Medstart108]

Thanks again for your time.

Unfortunately the first 3 years of IR residency (after an internship) are DR years, exactly the same as the diagnostic radiology residents. So doing 1-2 years of IR would mean being PGY 5 or PGY 6 before trying to transfer which doesn't make a lot of sense. Adding on a surgery residency and fellowship after that would mean I could be up to PGY 15 before I would finish.

To the others, I get that there is clinic, rounding, OR time, and everything else make a surgeon. I'm not just drooling over the OR time. I know a month doesn't mean I should drastically change my life plans. And how does any med student choose surgery then? I have done about 5 months on surgery during my school which is more than some of my friends matching gen surg next month. But somehow they know and I can't know? I'm not sure how I have vastly less experience than them choosing a field.

To answer the question why surgery (in addition to what I mentioned above), I want to be able to do open surgical techniques, both because I think they are important and particularly so I can translate these skills abroad. Again, not having a spouse frees up my ability significantly to work abroad. Maybe it's a pipe dream, but I have spent several years abroad and know several languages. Other than very basic fluoro studies IR is unheard of in resource poor settings. Finally, I also feel that the reason why IR has "lost" so many procedures is because they are not clinically skilled enough to care for patients in the pre- and post-op settings. I enjoy that work to an extent and want to be clinically strong.

I have some similar reasons to you and get where you are coming from, I would switch.