Ortho switch to radiology

[Rocketsfan08]

Hey everyone,

I wanted to elicit some thoughts and ask for advice about potential ideas. I’m a PGY-1 at an ortho program on the east coast. It’s a place I really wanted to end up at while interviewing and was ecstatic on match day. Ironically, ever since I started I’ve become disillusioned with my career choice. While I loved the people during the application cycle, they behave completely differently within the strict surgical hierarchy (lots of infighting, sniping, social politics). I always enjoyed surgery but have now come to dread whenever we have add on cases during the day or on weekends. I was aware of the hours during my rotations, but the prospect of getting into the hospital at 4 AM for 4 more years and now realizing that senior resident life isn’t that much better is a tough pill to swallow.

I seriously considered going into DR this past cycle and was torn between the 2. I took a year off doing predominantly musculoskeletal imaging research and have always loved imaging. It’s difficult to say why I didn’t jump ship then (probably a combination of pressure from my mentors, “inertia” of planning on doing ortho all of med school, and concerns about the radiology job market), which in hindsight are all very poor reasons.

What are some potential avenues to making a switch? My now “home” DR department is very strong, and it’s highly unlikely that a resident leaves. Is it possible for a department to increase their complement to take on an additional resident? This would be a dream scenario since I wouldn't have to move my family again. Would it be possible to ask about this without talking to your home department first (I assume they would immediately talk). I am lucky in that I did well in school (260+ on Step I/II, all honors/AOA, ~15 papers) but I'm not sure how much this would help now that I'm no longer a 4th year student.

Would I have to reapply in the match? If I did that, would I match at a PGY-2 spot 2 years away and need to finish my PGY-2 ortho year before joining? Also, would my first ortho year count as an internship year (we have a combination of ortho, gen surg, trauma, rehab, and ICU rotations).

Thanks for any and all help.

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[GadRads]

You will have no issue switching into radiology, but you may have to go to a different program if a first year radiology resident is unlikely to leave your current institution.

 

[Cognovi]

Yes, your ortho year will count as internship year (source: ACGME radiology program requirements III.A.2.b).

It is possible to increase the resident complement and take you outside the Match but they would also need secure funding for that position, obtain support from the institutional GME office/committee, and file paperwork with the ACGME (eg, demonstrating there is enough case volume), all prior to the Match. The paperwork would have to filed with the ACGME by October 23, which is the agenda closing date for their January radiology review committee meeting.

If your home institution program can't accommodate, the most efficient route would be to find one of the small number (<30) of "R" positions in the match, in which you start the July of the match year. A very small number of these are at top tier programs.

Otherwise you would re-apply in the Match for a PGY-2 position to start two years from now. You don't have to do your PGY-2 year in ortho (you can do something else outside of medicine, like research or teaching or whatever entrepreneurial thing tickles your fancy). In fact I would check with the radiology program about their funding, since Medicare funding limits each resident to a certain number of total funded years of postgraduate training, particular to the specialty, which you may run up against if you spend essentially two years doing a prelim.

Final note - because it is a Match violation to resign prior to completing 45 days in your program, I would not make any declarations of intent to your current program for another week from now.

 

[odyssey2]

Can't give advice but I strongly support your decision

 

[Clean7795]

One of my old buddies made the same decision coming from general surgery and one of my old seniors was a neurosurgery resident. These switches do happen relatively frequently. On paper you're an excellent candidate, really what you'll need is a spot.

 

[guytakingboards]

You're a PGY1, so you've been an intern for a little over 1 month. From that alone, chill. Surgical intern year is hard. It takes a while to get a footing on the clinical side of the job but also the professional side of the job. It's also super easy to lose sight of why you went into a procedural specialty, because you're probably not operating much right now.

Yes, surgical intern year AND PGY-2 ortho year both suck (PGY-2 being the bulk of the call). However I would be highly shocked if PGY-3 and above years weren't significantly different. Maybe not from hours perspective (though i also don't believe ortho seniors are getting to the hospital at 4am), but when you're actually chief of service taking care of patients and doing the majority of the operations the hours are less terrible.

Finally, like most specialties, training is very different than practicing as an attending. Don't envision what you're doing now (either as an intern or working in the hallowed Ivory tower) is what you'll be doing in practice.

I'm a radiologist. I really enjoy radiology. But I totally understand orthopedic surgery is one of the last bastions of the old age of medicine: highly lucrative, highly respected, and not at the beck and call of corporate medicine.

 

[Miles Gloriosus]

RocketsFan08,

As an ortho i'd like to chime in. I would not give up hope so soon. You are only a month in. I agree 100% with the above poster.. Transitioning to a new city, new social circle and from med school to intern year can very difficulty no matter what speciality you do. Intern year and PGY-2 year are going to be hard. Unfortunately, any place is going to have some level of hierarchy, social sniping or social politics. This is not specific to ortho. I bet some radiology programs are like this way too.

I would give it some time. The reasons for switching from ortho to DR are not because you inherently didn't like Ortho...it sounds like you work hard but don't get much of the benefit. It will get better. I don't think that the ortho residents who are on sports, recon, hand, spine are rounding at 4AM. You are probably on the ortho trauma rotation which does require long hours even for the seniors on that rotation. I would not judge the entire residency purely on that. I would not jump ship to DR b/c you perceive it to be "easier." Those residents work hard too.

From your stats, you probably matched at a well known top program. Not to be harsh (sorry for sports analogy), but its like you got recruited to play football at Alabama and being surprised that Nick Saban was actually a hard a** when you got there. I bet the senior residents at your program are very well trained.

"A journey of a thousand miles begins with a single step."
"We do these things not because they are easy but because they are hard”

In the end, its up to you to make the decision to leave or stay. I would not bail just because you think DR residency is "not as hard."

 

[DarkHorizon]

Don’t do it. Stick it out, life get much better as a 3 and a 4. As a chief, it gets a bit stressful but you need the responsibility. Rads spots are dime a dozen, you’ll easily be able to get one. If you give up your ortho spot, you’re not getting it back.

 

[Dave1980]

What are some potential avenues to making a switch? My now “home” DR department is very strong, and it’s highly unlikely that a resident leaves. Is it possible for a department to increase their complement to take on an additional resident? This would be a dream scenario since I wouldn't have to move my family again.

Good luck. Radiology is a great field. Highly unlikely to happen at your current program but you definitely will be able to get a spot somewhere.

As hard as it will be I think you have to have an honest and open talk with your PD and just say that you want to finish out the year and be a great intern but that you think you made a mistake in choosing ortho.

 

[medradthrowaway]

I'd consider this very carefully and not make any rash decisions. Like the other poster said, you're not getting this ortho spot back once you let go, probably dozens of ppl lining up for your spot.

 

[Ask Jeeves MD]

Wait, people are recommending to "stick it out" for 5 years of a terrible lifestyle to get to the next 30+ years of slightly better lifestyle? That seems insane.

 

[guytakingboards]

Wait, people are recommending to "stick it out" for 5 years of a terrible lifestyle to get to the next 30+ years of slightly better lifestyle? That seems insane.

That's not what people are recommending/saying.

It's usually 2-3 years of terribleness in ortho and then it lightens up considerably. And afterwards is not just a "slightly better" lifestyle, its significantly better. There aren't many specialties where you can come out of training to a 10-fold increase in salary, ortho is one of them.

 

[medradthrowaway]

Wait, people are recommending to "stick it out" for 5 years of a terrible lifestyle to get to the next 30+ years of slightly better lifestyle? That seems insane.

People are saying that it's a rash judgement to make 2 months into your 5-year residency, especially when the first couple years of any residency will involve alot of scut work. His ortho spot is probably at a very desirable academic institution and I am sure there are lurkers on here hoping he drops it and will be gunning for his spot.

 

[DrOrthoSpineMD]

That's not what people are recommending/saying.

It's usually 2-3 years of terribleness in ortho and then it lightens up considerably. And afterwards is not just a "slightly better" lifestyle, its significantly better. There aren't many specialties where you can come out of training to a 10-fold increase in salary, ortho is one of them.

this is my experience as well.

Lifestyle wise: Intern year is ok. 2nd and third year suck. 4th year is amazing. 5th year is good but not as cush as 4th year. and fellowship (so far) has been pretty enjoyable.

 

[Ask Jeeves MD]

What is a lightened up schedule though? 6 to 6 with call and weekend rounding mixed in? And as an attending you are still working 10 hours more than rads every week but people do weird things for money i guess. Maybe the poster needs to reevaluate why ortho? Was is prestige and competitiveness of ortho? Not "wasting" a good application? Its very hard to judge just how demanding surgery is as a student because while rotations do have long hours much of that is focused on following a couple pts, standing in the OR, and doing minor tasks on the floor. And who cares if others are gunning for the spot? What others do/want shouldn't affect you.

 

[DrOrthoSpineMD]

What is a lightened up schedule though? 6 to 6 with call and weekend rounding mixed in? And as an attending you are still working 10 hours more than rads every week but people do weird things for money i guess. Maybe the poster needs to reevaluate why ortho? Was is prestige and competitiveness of ortho? Not "wasting" a good application? Its very hard to judge just how demanding surgery is as a student because while rotations do have long hours much of that is focused on following a couple pts, standing in the OR, and doing minor tasks on the floor. And who cares if others are gunning for the spot? What others do/want shouldn't affect you.

you really think every attending surgeon is working 6-6 every day?

 

[Ask Jeeves MD]

For residency

 

[Miles Gloriosus]

What is a lightened up schedule though? 6 to 6 with call and weekend rounding mixed in? And as an attending you are still working 10 hours more than rads every week but people do weird things for money i guess. Maybe the poster needs to reevaluate why ortho? Was is prestige and competitiveness of ortho? Not "wasting" a good application? Its very hard to judge just how demanding surgery is as a student because while rotations do have long hours much of that is focused on following a couple pts, standing in the OR, and doing minor tasks on the floor. And who cares if others are gunning for the spot? What others do/want shouldn't affect you.

As an ortho attending I work 8-5pm with 2-3 call days per month. It’s not that bad.

 

[CyrusHabs7695]

anybody care to comment on the huge variability ive seen in "lifestyle" of DR? Sometimes I read that its great, other times like now it sounds like its not that great.

 

[Rocketsfan08]

Some really fantastic, insightful responses here. Yes, I started with ortho trauma, which is the busiest service here (although joints and spine are also very busy, and residents are routinely in at 5 AM or earlier). Sports and hand are the lightest (- the replants). I’m probably at a more “hardworking” program than some others, although still very academic. As people have mentioned, it’s difficult to differentiate between intern blues/adjusting to being a resident vs. realizing that lifestyle might be more important to me than I previously thought (I recently had my first child, which definitely changed my perspective/gave me more thought). I also enjoy radiology, and the predictable hours are an additional positive on top of also liking the specialty. At the same time, the above posters are correct in that there are certain advantages to ortho: the job market is amazing and you can get a position in essentially any city in the country, compared to DR where many major metros are saturated and have heavy corporate monopolies.

I know it’s probably better to wait longer before making a decision. The only reason I’ve been trying to think about it more now is that ERAS is significantly delayed this year due to COVID, and if I somehow got a PGY-2 spot for next year, I could go straight through without losing any extra years, even with the specialty switch. If I wait until next year, and don’t get an advanced spot, I’d effectively lose 2 more years before even starting radiology, and funding issues would be more likely to come into play. I really appreciate everyone’s help.

 

[DarkHorizon]

Some really fantastic, insightful responses here. Yes, I started with ortho trauma, which is the busiest service here (although joints and spine are also very busy, and residents are routinely in at 5 AM or earlier). Sports and hand are the lightest (- the replants). I’m probably at a more “hardworking” program than some others, although still very academic. As people have mentioned, it’s difficult to differentiate between intern blues/adjusting to being a resident vs. realizing that lifestyle might be more important to me than I previously thought (I recently had my first child, which definitely changed my perspective/gave me more thought). I also enjoy radiology, and the predictable hours are an additional positive on top of also liking the specialty. At the same time, the above posters are correct in that there are certain advantages to ortho: the job market is amazing and you can get a position in essentially any city in the country, compared to DR where many major metros are saturated and have heavy corporate monopolies.

I know it’s probably better to wait longer before making a decision. The only reason I’ve been trying to think about it more now is that ERAS is significantly delayed this year due to COVID, and if I somehow got a PGY-2 spot for next year, I could go straight through without losing any extra years, even with the specialty switch. If I wait until next year, and don’t get an advanced spot, I’d effectively lose 2 more years before even starting radiology, and funding issues would be more likely to come into play. I really appreciate everyone’s help.

Again, a very hurried decision on your part, you just had your first child, have only been through one month of trauma, and being the last person in the hierarchy, you’re feeling the heat. Question is do you enjoy ortho? Do you want to nail femurs and tibias and do hips and knees or do you want to be in a dark room reading Imaging for the rest of your life at odd hours? This is an important question because residency is finite for a certain period of time. I would caution you to at least stick it out until the start of pgy3 year. Even an ortho spot at the worst program in a terrible city would be filled within a matter of minutes with hundreds of applicants lining up. If you give it up, you won’t get it back. You were obviously a fantastic student, You can always do radiology. Also, it’s not about the money, rads does well too, but I would just hate to be a radiologist, I would do ortho every time, it’s not even a question.

 

[DarkHorizon]

What is a lightened up schedule though? 6 to 6 with call and weekend rounding mixed in? And as an attending you are still working 10 hours more than rads every week but people do weird things for money i guess. Maybe the poster needs to reevaluate why ortho? Was is prestige and competitiveness of ortho? Not "wasting" a good application? Its very hard to judge just how demanding surgery is as a student because while rotations do have long hours much of that is focused on following a couple pts, standing in the OR, and doing minor tasks on the floor. And who cares if others are gunning for the spot? What others do/want shouldn't affect you.

Surgery lifestyle is definitely demanding but it’s not as bad as others say, especially in ortho where hospitalist are managing all your patients medically. Of course, as a surgeon you’re always available for the patients you operate on, that’s part of the game, but today I did 4 cases, started at 7:30 and was home at 3. Monday I did 3 cases and wasn’t home until 830. Wednesday was my day off. I did 9 hours of clinic on Tuesday and Thursday. I do ortho trauma. You take however long it takes to do the best possible you can do. Some times it’s long, but most days are pretty normal.

 

[solitarius]

Hey everyone,

I wanted to elicit some thoughts and ask for advice about potential ideas. I’m a PGY-1 at an ortho program on the east coast. It’s a place I really wanted to end up at while interviewing and was ecstatic on match day. Ironically, ever since I started I’ve become disillusioned with my career choice. While I loved the people during the application cycle, they behave completely differently within the strict surgical hierarchy (lots of infighting, sniping, social politics). I always enjoyed surgery but have now come to dread whenever we have add on cases during the day or on weekends. I was aware of the hours during my rotations, but the prospect of getting into the hospital at 4 AM for 4 more years and now realizing that senior resident life isn’t that much better is a tough pill to swallow.

So you're saying that 'social bro' vibe is just an act?

w - o - w

 

[deleted941485]

So you're saying that 'social bro' vibe is just an act?

w - o - w

That whole bro culture was a nightmare to deal with as a Med student. I liked ortho couldn’t stand the personalities. It was frat house mentality and they definitely screwed with the juniors