Path to Family

[jd1022]

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I need some advice on some life changes during residency. I feel that I need some reassurance that what I'm doing is right for me, and more importantly how to do this the best way possible. This is about switching from Pathology to Family Medicine residency.


I am an AMG who matched at a great program in Pathology (AP/CP) on the West Coast. After 2 years of residency in good standing, my wife's mother took ill. My wife moved to New York to take care of her, and thereafter, I took a leave to be with her for support. Her mother passed a year later.

Following that, my wife and I decided to change our lives a bit. We moved to Chicago, IL together. I planned to enter a Pathology program there as PGY3. My wife applied to Architecture school.

Entering a pathology program mid program was more difficult than I thought. Also, I heard it was difficult to get a job in the city and stay following residency. After thinking deeply about my values, my love of medicine, and the best way I can be a good supportive husband, I decided to switch residency to Family Medicine. Although for most people this is an odd decision, I am very comfortable with this choice. Family medicine is often considered the opposite of Pathology in every way. I think of it as another part of the spectrum of medicine, and that being adept in one area will only make me better at another area. It wasn't my first choice, but there are many enjoyable choices in medicine for me, each with its advantages.


The question is how to do this smoothly and diplomatically. My program director wrote an exit letter explaining my progress in residency, and reasons for leaving. I also have mentors in the program who would write my letters of recommendation to apply for other residencies. All of this was under the premise I would be pursuing the match in pathology. This was not possible for a number of reasons. Although I am comfortable and confident in my decisions heretofore, I can't help but feel a loss of pride looking up to them. I am attempting to scramble at this point, and it's difficult to explain why I would have given up a prestigious position for my current situation. I need to figure out how to say this to my mentors and colleagues:

1. What I've been up to for the past year
2. Why I changed residency
3. That I would be open to returning to the program in the future, but it is not best for me now
4. Request letters of recommendation, and for their support.

I have considered flying to the west coast to visit in person. They are a very open faculty. However, I don't have the money right now. So this will have to be e-mail or telephone, followed up with handwritten letters and a visit in the future.

P.S. Pathology is a small world. Residency in AP/CP is an even smaller one. If you know who I am, please do not spread rumors about me, but feel free to contact me or have others get in touch with me.

 

[Buzz Me]

Was the only reason you switched from Path to FM the future prospect of jobs? Or were there other reasons?

If all you had to go on was "well, I thought the job market looked kinda bleak for pathologists so I decided to switch to FM," well, that might be a little weak. But if there were other reasons - better FM job prospects in the city where your wife's family lives, for example - that might be different. If you're looking to be supportive to your wife and her family (and I totally understand and respect that), more power to you.

 

[jd1022]

Was the only reason you switched from Path to FM the future prospect of jobs? Or were there other reasons?

If all you had to go on was "well, I thought the job market looked kinda bleak for pathologists so I decided to switch to FM,"

Reasons why continuing Pathology is difficult
1) There are no accredited programs in Architecture for my wife in the area of my prior pathology residency
2) Entering as a PGY3 is difficult.
3) I have taken a leave from my program, so my position is not available for swap.
4) Starting over as PGY1 would mean the program would only be funded for my remaining 2 years. The last 2 years, they would have to find funding.
5) Not many residents leave programs in which they have good standing, and they like working with the faculty. Moving within the small world of pathology, program directors are skeptical of my enthusiasm.

Reasons to switch to Family Medicine
1) I am trying to continue medicine as a career.
2) Switching residencies this late in the game is a far shot. When looking at unfilled programs in the nation in the past 4 years, FM always has some unfilled programs in this area.
3) Just because I chose Pathology as my first choice in specialty, doesn't mean I would not enjoy another specialty, nor that I wouldn't excel at it. Since college, I have been proactive in clinic based care, and serving the underserved. I have worked for AIDScare, AIDShospice, AIDSoutreach, food banks, Meals on Wheels, ChildCareNetwork, Child Advocacy, Juvenile mediation, Lamin clinic volunteer in Africa, as well as numerous clinics serving the homeless. I received an outstanding recommendation on my family medicine clerkship and studied medical decision making including algorythmic and mathematical approaches. As we all know, medicine specialties do not exist separately on a continuum. They are all interactive. My background in pathology can only make me a better family practitioner; particularly, because most others do not choose this path.
4) After spending time in the hospital with my mother in law, I felt a huge disconnect from patient care. Lung cancer is something that I supposedly know a lot about. I've been to M&M conference, I've dissected or "cut in" many lungs after VATS or autopsy. None of this really helped me take care of my wife or her mom. She was at a teaching hospital, and her case was "extremely interesting." I remember coming for a morning visit, and the whole room was full of students trying to impress faculty. I was extremely upset that they had started these rounds without inviting family (myself being the only one whose first language is English). They were discussing several hypothetical procedures in front of her that left her very alarmed and needed my explanations. Not to mention the poking and prodding.

Bedside care is a beautiful process when done right.
During my residency, I have taken many opportunities to visit patients at the bedside. I have come to terms with the fact, that I don't play much of a role at the bedside as a practicing pathologist.

My intention is not to deceive anyone about my purpose. My primary goal is to be a good husband. When I began my residency, this was not a part of the picture. However I choose to continue my self-growth and career, I will honor it and perform to the best of my ability. The question is… how to do this right.

 

[Apollyon]

There was a guy I ran into while a resident who had switched from path to FM. He had graduated from my same college 3 years before me, had been a provost marshal (officer in the US Army military police) for years, then went to med school. I don't know how long he was in path before he changed out.

 

[jd1022]

There was a guy I ran into while a resident who had switched from path to FM. He had graduated from my same college 3 years before me, had been a provost marshal (officer in the US Army military police) for years, then went to med school. I don't know how long he was in path before he changed out.

Did he explain why he switched? And how he approached the switch?

 

[Apollyon]

Did he explain why he switched? And how he approached the switch?

I don't recall, to be honest. I finished residency 5 years ago. I was trying to recall his name just now, and only remember the first name.

 

[Buzz Me]

4) After spending time in the hospital with my mother in law, I felt a huge disconnect from patient care. Lung cancer is something that I supposedly know a lot about. I’ve been to M&M conference, I’ve dissected or “cut in” many lungs after VATS or autopsy. None of this really helped me take care of my wife or her mom.

You face an uphill battle, but I commend you for your perseverance.

I will note that the above does not compute. I'm sure you had good clinical training during med school - however, in general, being able to work with lung specimens during a pathology residency has NOTHING to do with dealing with newly-diagnosed cancer patients. Especially when you have to break the news to them, tell them about dismal prognoses, etc.

 

[Taurus]

FM is always looking for US grads to fill their spots. I don't see why you wouldn't get a spot. In the city you want, that's a different story.

 

[Captain Fantastic]

My wife was an attending General Internist for 5 years and just went back to retrain in Pathology. Interesting how the grass is always greener on the other side of the fence.

Good luck. Frankly, I'd schedule a meeting with the FM PD and put my cards on the table and see what advice I get.

 

[Sneezing]

I didn't read everything, but these days and the future of medicine, primary care is the future. You are a smart man. Best of luck.

 

[gschl1234]

I'm a bit confused. Are you currently in the middle of your PGY-3 (i.e. have you already started at your second pathology program) or are you still taking time off (completed PGY-1 and 2 at 1 program only)? It shouldn't be a big deal to switch if you will be entering your second program but if you've already been at 2 programs for pathology and now want to enter yet another program albeit in a different specialty, I can see how an FP residency director might be skeptical.

 

[lipomas]

Have you considered spending a year or two apart while one or both of you finishes training? Many many people do this and still have happy marriages. Or can she wait and apply for architecture school? I mean, there are lots of other options then trying to find a PGY-3 path spot in the same city as a quality architecture program. And then what happens when she can't find an architecture job? Do you switch fields then? You can't base your whole life on potential/possible job prospects. If you like path stick with it. If you don't then don't.

 

[cjw0918]

Sounds like you're not all that in love with pathology to begin with...I transferred to another path program (AP/CP) for my PGY-4 year and am currently doing a fellowship there. As much as I love my specialty, I sometimes wish I had done peds due to the HORRIBLE path job market and the increased flexibility in primary care with part-time jobs being available. If your heart is not in path, I say go for fam med. You will have many more options for employment in the future and more flexibility, which will allow more family time. Just be honest and let the chips fall where they may. Good luck.