Need advice/to vent

[deleted984892]

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I don’t know what to do.
I originally wanted to be a plastic surgeon, and as there weren’t too many integrated programs at the time, I decided to go the traditional route of general surgery followed by fellowship.
I survived residency, but only barely. It was a difficult time, and I thought my overall unhappiness was a normal response to being a resident, as well as it not being plastic surgery (the field I thought I wanted). I passed the rotations, but I think that was due in large part to me being hard working and agreeable, not because of my surgical skills or knowledge. I would come home every day exhausted and unhappy, barely able to crack a textbook to read. Whatever I did read would not be absorbed. Again, I didn’t think anything was wrong since I was advancing through the program and was going to be a plastic surgeon. I somehow was able to match into a strong plastic surgery fellowship...

...where I struggled. I picked the wrong program, and ended up even more stressed and unhappy. I became incredibly depressed, completely tanking my confidence. I tried taking a leave of absence, but that did not help matters. I just became incredibly stressed and depressed again upon my return. I am now unlikely to graduate, and I don’t know what to do.

I have come to realize that I rationalized too much of my behavior as just part of residency, and not for what they really were: signs I was depressed and in need of a different career. I have been in survival mode for way too long. I don’t feel like I learned anything during residency, so I don’t think I can pass my general surgery boards, certainly not in this state. Furthermore, the thought of doing general surgery makes me cringe. I’m now on who knows how many psych meds, barely able to make it through the day, and have no real hope for the future.

I feel like I’ve wasted nearly a decade on the wrong field, but don’t know what the next step is. I won’t be board eligible in plastic surgery, I’m barely board eligible in general surgery, and I just want to be done with surgery anyway. I feel like I’ve lost so much of my basic doctoring skills thanks to the sleep deprivation and stress.
Part of me would like to do another residency in the field I should have gone into in the first place (I.e. EM). I enjoyed my time doing consults and on trauma mostly because of my interactions with the ED folks. I would be willing to go through intern year again, as it couldn’t be worse than I feel now. I’ve always liked research, so are there non-clinical jobs available? I am just so damn tired of wasting time on a field I never should have gone into in the first place, and so mad at myself for taking so long to realize it.

Sorry this turned into a rant, but I really don’t know what to do or to talk to about it.

 

[dpmd]

Sounds like the mental health issues are clouding your judgement. I doubt doing EM or any other job right now is going to magically change your whole outlook. You need to focus on working on your mental health before making any big career moves. Hopefully things are better before the decision gets made for you (losing board eligibility in gen surg).

 

[rokshana]

I don’t know what to do.
I originally wanted to be a plastic surgeon, and as there weren’t too many integrated programs at the time, I decided to go the traditional route of general surgery followed by fellowship.
I survived residency, but only barely. It was a difficult time, and I thought my overall unhappiness was a normal response to being a resident, as well as it not being plastic surgery (the field I thought I wanted). I passed the rotations, but I think that was due in large part to me being hard working and agreeable, not because of my surgical skills or knowledge. I would come home every day exhausted and unhappy, barely able to crack a textbook to read. Whatever I did read would not be absorbed. Again, I didn’t think anything was wrong since I was advancing through the program and was going to be a plastic surgeon. I somehow was able to match into a strong plastic surgery fellowship...

...where I struggled. I picked the wrong program, and ended up even more stressed and unhappy. I became incredibly depressed, completely tanking my confidence. I tried taking a leave of absence, but that did not help matters. I just became incredibly stressed and depressed again upon my return. I am now unlikely to graduate, and I don’t know what to do.

I have come to realize that I rationalized too much of my behavior as just part of residency, and not for what they really were: signs I was depressed and in need of a different career. I have been in survival mode for way too long. I don’t feel like I learned anything during residency, so I don’t think I can pass my general surgery boards, certainly not in this state. Furthermore, the thought of doing general surgery makes me cringe. I’m now on who knows how many psych meds, barely able to make it through the day, and have no real hope for the future.

I feel like I’ve wasted nearly a decade on the wrong field, but don’t know what the next step is. I won’t be board eligible in plastic surgery, I’m barely board eligible in general surgery, and I just want to be done with surgery anyway. I feel like I’ve lost so much of my basic doctoring skills thanks to the sleep deprivation and stress.
Part of me would like to do another residency in the field I should have gone into in the first place (I.e. EM). I enjoyed my time doing consults and on trauma mostly because of my interactions with the ED folks. I would be willing to go through intern year again, as it couldn’t be worse than I feel now. I’ve always liked research, so are there non-clinical jobs available? I am just so damn tired of wasting time on a field I never should have gone into in the first place, and so mad at myself for taking so long to realize it.

Sorry this turned into a rant, but I really don’t know what to do or to talk to about it.

Switching to another specialty and especially doing another intern year is not going to help.
Have they told you that you will not graduate? If not, how much of your plastics fellowship do you have left? Try to complete if you can but you still have completed a residency so you do have some options.
Have you been involved in research at either of the places you have trained? Talk to them to see if there would be a post doctoral spot available for you or if they know if there is someplace that is looking for a post doc (though generally these are more for PhDs or MD/ PhDs).
Do you have the option of doing an actual ED rotation? Working with ED people and being the ED person are not the same...I get consulted by the ED and it is not the same as actually working there.

Most importantly, you need to get your mental health in order...of your meds aren’t working, you need to talk to to your psychiatrist and get things adjusted...until that is stable, you really shouldn’t be making big life decisions.

 

[NotAProgDirector]

You still have lots of options. There are lots of "I've failed / am failing out of my residency and what should I do?" threads on SDN, but your situation is very different. You've finished a GS residency.

First, I think your mental health issues are affecting your self assessment. I expect you're much better in GS than you seem to think on this thread. GS programs tend to fail out people whom they think can't do the work. And you've gotten a plastics spot, so they must have written you a good letter. I understand that you might not like GS and may want another career, and that's fine. But don't undersell your surgical skills, or as others have mentioned you need to get your mental health under control before you make complicated life descisions.

Options:

1. Practice GS in a community setting. This is VERY different from being a resident. The surgical cases tend to be relatively basic, uncomplicated. The hours are much better. There might be no night surgery call, all urgent cases referred elsewhere.

2. Critical care -- it's a 1 year fellowship after GS. It's not ED, but it's similar and the training is much shorter.

3. You might be able to work in smaller community ED's with a GS resideny. They might be very happy to have someone trained in surgery in their ED to do evals and procedures.

4. Another residency isn't impossible. Ive taken residents who have completed other training who clearly decided that they made a bad decision and want IM instead.. It can be done.

 

[deleted984892]

Thanks for the suggestions. My mental health is clearly not as well controlled as it could be, which I am working on (yay lag tune before meds kick in... if they do so). Nevertheless, part of what is making the recovery so hard is not knowing what to do.

My program has been incredibly accommodating, but they have made it clear they won’t be graduating me. They haven’t fired me outright so that I can avoid that mark on my record, but I’ve basically been assigned the equivalent of desk duty until the end of the academic year. In theory this should give me time to read/study, but I am so spent by the end of the day I can barely function, let alone learn anything.

I have considered critical care, but as with other fellowships, there is an assumption of baseline knowledge I just don’t think I have. I haven’t really taken care of SICU patients since second year and I barely remember those rotations.

I do have a research background as I came from an academic GS institution. However, my understanding is that post-doc positions are more for the PhD crowd. I would love to do research, and was thinking of getting into the pharma/medical device world if that is possible. I just don’t know where to begin.

 

[Goro]

You still have lots of options. There are lots of "I've failed / am failing out of my residency and what should I do?" threads on SDN, but your situation is very different. You've finished a GS residency.

First, I think your mental health issues are affecting your self assessment. I expect you're much better in GS than you seem to think on this thread. GS programs tend to fail out people whom they think can't do the work. And you've gotten a plastics spot, so they must have written you a good letter. I understand that you might not like GS and may want another career, and that's fine. But don't undersell your surgical skills, or as others have mentioned you need to get your mental health under control before you make complicated life descisions.

Options:

1. Practice GS in a community setting. This is VERY different from being a resident. The surgical cases tend to be relatively basic, uncomplicated. The hours are much better. There might be no night surgery call, all urgent cases referred elsewhere.

2. Critical care -- it's a 1 year fellowship after GS. It's not ED, but it's similar and the training is much shorter.

3. You might be able to work in smaller community ED's with a GS resideny. They might be very happy to have someone trained in surgery in their ED to do evals and procedures.

4. Another residency isn't impossible. Ive taken residents who have completed other training who clearly decided that they made a bad decision and want IM instead.. It can be done.

To this list, add teaching

 

[calvnandhobbs68]

When you say "barely board eligible" for Gen Surg, do you mean you're getting close to the 10 year time limit? I wouldn't think this is the case....

If you mean skills wise, like the others have said, this is probably your depression talking. You managed to complete a residency (which means your surgical skills were likely somewhat good) and you matched into a plastics fellowship which, don't sell yourself short, is super competitive. You're really down on yourself right now but you're much more accomplished than you're giving yourself credit for. Are you doing any psychotherapy? Therapy will be very helpful to restructure your thinking and work through how you're feeling right now.

Being board eligible for Gen Surg, you have tons of options available. You might be able to get into medical devices, I don't know as much about how that goes. I agree with the posts above critical care or even working in an ED might be more enjoyable for you. Especially community EDs hire FM/IM docs pretty frequently and I think they'd be happy to have someone with a surgery background who wants to work in the ED. Community ED work will be wayyy less grueling than a surgery residency.

 

[Gastrapathy]

Maybe do the transition to practice fellowship to prove to yourself that you are a surgeon and then a low acuity practice like the VA? Give it a shot before you decide you aren’t capable

 

[MSTP18]

I am now unlikely to graduate, and I don’t know what to do.

Is this your assessment of you or the program's assessment of you? I remember prior to the 6 month residency committee meeting this year I was convinced that I was underperforming and way behind my co-residents in my skills. Turns out as far as the program was concerned I was exactly where they wanted me to be and sure, there we some things where I was behind my co-residents but other things where I was ahead of them.

 

[deleted984892]

My program was not huge on the feedback, but what little I did get was not positive. At this point, however, they have explicitly stated I’m not graduating. Not surprisingly, they don’t think I can handle the stress of the field. There was no chance of doing extra time, as “that’s not what our program does.” I did not pick the right program.

I appreciate all of the positivity, but I am not prepared to be a general surgeon. I made it through residency, but I think that had more to do with the fact I knew how to be a resident, not because I was developing into an independent surgeon. We didn’t get a huge amount of autonomy. Plus, they kind of wrote off my knowledge issues to the fact I was going into plastics, and the time in fellowship hasn’t exactly sharpened my GS skills.

More to the point, I’m not sure surgery is the right fit for me. I realize this is partially the depression talking, but it’s hard to justify the toll this whole process has taken on my mental and physical health. I have been in denial about how bad things were getting, and I was on such a clear path that I didn’t really ask myself if I was enjoying it.

 

[Piebaldi]

My program was not huge on the feedback, but what little I did get was not positive. At this point, however, they have explicitly stated I’m not graduating. Not surprisingly, they don’t think I can handle the stress of the field. There was no chance of doing extra time, as “that’s not what our program does.” I did not pick the right program.

I appreciate all of the positivity, but I am not prepared to be a general surgeon. I made it through residency, but I think that had more to do with the fact I knew how to be a resident, not because I was developing into an independent surgeon. We didn’t get a huge amount of autonomy. Plus, they kind of wrote off my knowledge issues to the fact I was going into plastics, and the time in fellowship hasn’t exactly sharpened my GS skills.

More to the point, I’m not sure surgery is the right fit for me. I realize this is partially the depression talking, but it’s hard to justify the toll this whole process has taken on my mental and physical health. I have been in denial about how bad things were getting, and I was on such a clear path that I didn’t really ask myself if I was enjoying it.

So you have completed a Gen surg residency, but won't be graduating from the Plastics program? Is that right? For one, as others have said, take care of mental health issues - your health and safety is paramount! Second you can always do a non clinical type of gig - that would be what I would do if I were you. You have to be board certified yes, but I would imagine that you can study for boards and pass them. You can do a non clinical advisor or review utilization type gig. I don't think more training will help - getting a job at a VA also I think is reasonable, as volume tends to be less and hours tend to be more forgiving. Critical care is hard core - I wouldn't recommend that.

 

[Dr.LeoSpaceman]

Critical care is hard core - I wouldn't recommend that.

Compared to what? Certainly not on the scale of someone who got through surgical residency.

I agree the OP needs to first determine if they are still interested in clinical medicine. If so, based on the posts in this thread, surgical critical care may be a good fit. Getting a job in a smaller ED (as others recommended) may be a way to transition to something like that while determining if clinical medicine outside of surgery is still in the cards.

 

[Piebaldi]

Compared to what? Certainly not on the scale of someone who got through surgical residency.

I agree the OP needs to first determine if they are still interested in clinical medicine. If so, based on the posts in this thread, surgical critical care may be a good fit. Getting a job in a smaller ED (as others recommended) may be a way to transition to something like that while determining if clinical medicine outside of surgery is still in the cards.

Critical care in my opinion is a highly stressful specialty. The name says it all. You are taking care of critically ill patients that can tank at any point. And those 12 hour shifts are brutal. Don't think the OP wants that.

 

[LucidSplash]

Critical care in my opinion is a highly stressful specialty. The name says it all. You are taking care of critically ill patients that can tank at any point. And those 12 hour shifts are brutal. Don't think the OP wants that.

Depends on what specifically the OP is stressed by. If it’s the OR and not patient management, CC is mostly just trachs and PEGs for procedures and otherwise lots of long rounding and tinkering. And it’s a bit more formulaic at the bedside, more so than some other sub-specialties. If caring for patients in general is what the OP can’t handle, then there’s no specialty in medicine they will feel comfortable in.

 

[Piebaldi]

Depends on what specifically the OP is stressed by. If it’s the OR and not patient management, CC is mostly just trachs and PEGs for procedures and otherwise lots of long rounding and tinkering. And it’s a bit more formulaic at the bedside, more so than some other sub-specialties. If caring for patients in general is what the OP can’t handle, then there’s no specialty in medicine they will feel comfortable in.

reason why I suggested maybe a non clinical physician role perhaps whether OP can use his knowledge in a non clinical fashion. Critical care in my humble opinion and I'm certainly far from critical care specialty wise, but I think is far more than PEGs and trachs. Remembering my once ICU rotation which I despised, i's a ton of management of every single thing on a patient. Stress doesn't even start to make it justice. And it would be even more training. Don't think OP wants more training.

 

[LucidSplash]

reason why I suggested maybe a non clinical physician role perhaps whether OP can use his knowledge in a non clinical fashion. Critical care in my humble opinion and I'm certainly far from critical care specialty wise, but I think is far more than PEGs and trachs. Remembering my once ICU rotation which I despised, i's a ton of management of every single thing on a patient. Stress doesn't even start to make it justice. And it would be even more training. Don't think OP wants more training.

Yes you’ve stated your opinion multiple times. I understand what you think about critical care. But these suggestions are not for you.

This is about the OP and the thoughts I post are to benefit the OP. So it depends on the OP’s source of stress as a surgeon. If it’s just operating, then the OP might do well in CC; a SCC fellowship is only one more year and easy to get. If it’s the overall care of patients, then I agree with you that a non-clinical field might be more appropriate.

 

[deleted984892]

I do appreciate everyone’s comments and suggestions. At this point I am so burnt out/depressed I don’t know what to think. In an ideal world, I’d take off a couple of months to get my head right and figure it out. I know I need to heal, but I also have bills to pay and mouths to feed. Plus, any time off would have to be explained to any medical board or hospital. Thus my amazing predicament.

I know I’m done with surgery. The OR holds no appeal for me, especially with general surgery. I just don’t know if I’m ready to walk away from clinical medicine. I picked the wrong specialty, but it’s hard to determine if I picked the wrong career.

 

[Piebaldi]

Yes you’ve stated your opinion multiple times. I understand what you think about critical care. But these suggestions are not for you.

This is about the OP and the thoughts I post are to benefit the OP. So it depends on the OP’s source of stress as a surgeon. If it’s just operating, then the OP might do well in CC; a SCC fellowship is only one more year and easy to get. If it’s the overall care of patients, then I agree with you that a non-clinical field might be more appropriate.

This is not about what I would do. This is based on what I have gathered from OP's needs/concerns. And if you look at the post OP made down below, you'll see just as I figured he's burned out, doesn't like/want to do surgery, and doesn't seem like he wants more training.

 

[LucidSplash]

I do appreciate everyone’s comments and suggestions. At this point I am so burnt out/depressed I don’t know what to think. In an ideal world, I’d take off a couple of months to get my head right and figure it out. I know I need to heal, but I also have bills to pay and mouths to feed. Plus, any time off would have to be explained to any medical board or hospital. Thus my amazing predicament.

I know I’m done with surgery. The OR holds no appeal for me, especially with general surgery. I just don’t know if I’m ready to walk away from clinical medicine. I picked the wrong specialty, but it’s hard to determine if I picked the wrong career.

Taking time off can be explained as “vacation.” Because that’s what it is. I’m taking a month off before I start my new job. It’s vacation. Taking a breather or a mental health break is also vacation, especially if you are taking the time to consider a career shift. Of all the things worrying you at this point, don’t let this be one of them. If you have the means, take the time. Hospitals, the ABS, state licensing boards will all be satisfied with vacation.

 

[dpmd]

This is not about what I would do. This is based on what I have gathered from OP's needs/concerns. And if you look at the post OP made down below, you'll see just as I figured he's burned out, doesn't like/want to do surgery, and doesn't seem like he wants more training.

Unfortunately it isn't as simple as saying "well I don't want to operate so I am going to do something else" when the only thing they are trained for is general surgery. Without any more training I don't see them having many job options (despite people thinking that getting an er job will be possible I am skeptical of this being true). A one year surgical critical care fellowship could in theory land a job with little to no operating though. Or, though the or holds little appeal in the way it was experienced during mental illness and while in residency (two things that make it worse than it can be) they might try being a general surgeon part time by doing some locums shifts or finding the right practice setting and see if they can tolerate it (several hundred thousand dollars a year plus therapy might go a long way towards contentment). Or if they have disability insurance they could use that while they get mental health treatment on a full time basis (if not they can try for state or federal disability but that gets more complex)

 

[IMGASMD]

To this list, add teaching

Had a general surgeon who became a anatomy lab instructor/professor, maybe as a gap, maybe he did something, maybe he’s taking a breather.

Gives you time and figure things out... if you’re into research, maybe your GS institution or med school will give you a year as post-doc. You’ll probably get paid as pgy-? though, definitely not general surgery money.

Go into equipment sales? Development? Get some rest first, get your head straight first. Reading your post was a little difficult, I think your thought process maybe a little off......

 

[deleted984892]

Get some rest first, get your head straight first. Reading your post was a little difficult, I think your thought process maybe a little off......

It was certainly a bit stream of consciousness, but overall seemed clear. I’m burnt out, dissatisfied with current career choice, and not sure how to proceed. It’s true I don’t have much training outside of Gen Surg, so don’t know where I’m supposed to go without further training. The question is whether to continue down this surgery road or try something else.

 

[IMGASMD]

It was certainly a bit stream of consciousness, but overall seemed clear. I’m burnt out, dissatisfied with current career choice, and not sure how to proceed. It’s true I don’t have much training outside of Gen Surg, so don’t know where I’m supposed to go without further training. The question is whether to continue down this surgery road or try something else.

What’s obvious is that you need a little break..... you have options, like what others have pointed out.

Also remembered, met a few surgeon who cannot/doesn’t want to operate anymore. 1. Came to this of the drape, more training but not hating life as much. 2. Got gigs managing SICU at night.

Good luck!

 

[dpmd]

It was certainly a bit stream of consciousness, but overall seemed clear. I’m burnt out, dissatisfied with current career choice, and not sure how to proceed. It’s true I don’t have much training outside of Gen Surg, so don’t know where I’m supposed to go without further training. The question is whether to continue down this surgery road or try something else.

I don't think we were unable to follow what you are saying. I think we just believe a huge part of why you feel as you do is due to your mental health and making decisions while deep in it will be bad for you long term. Is it possible you really dislike surgery or are so bad at it that you shouldn't do it? Sure. Is it the most likely thing? No.