PGY 1 OB thinking about switching specialty- too early?

[ranoutofnames]

Hello everyone,

I know this has been posted in the past, but the answers to my specific questions have been very varied based on my search results and I was wondering if I can get different responses if I posted my own thread.

Briefly, pgy1 obgyn in the northeast, recently realized that I don't love surgery or obstetrics enough to stand the high acuity, high volume, high stress and the personality of the field (really no offense to obgyns, just basically personalty differences). I am sure this isn't intern blues and I know life as an attending will be somewhat better than being a resident, but even then, I don't think this is for me. Been thinking of making a switch into psych, but my questions is,, is it too early for me to tell my PD? She barely knows me and has no obligation to be nice to me. I am not doing poorly in the program now, so no red flags.

Any advice in terms of time line of when to tell PDs, and when to start looking for spots would be helpful. Thank you so much!

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[grapefruit17]

What kind of hours are you putting in? I'm a psych intern. Def tough at times on our inpatient unit, can't complain hours wise, though it's tiring because there's 2 interns on inpatient at once and we alternate taking weekends. Still, I'm guessing ob gyn is worse though so I honesty don't blame you..

I worry tho that you could put a target on your back if you approach it the wrong way, and I think it may be difficult making the switch unless you contact programs and ask about available slots. My program has taken transfers before who joined us mid cycle.

Maybe it would be a good idea to find a faculty you trust and slowly bring up the issue with him?

 

[ranoutofnames]

What kind of hours are you putting in? I'm a p7sych intern. Def tough at times on our inpatient unit, can't complain hours wise, though it's tiring because there's 2 interns on inpatient at once and we alternate taking weekends. Still, I'm guessing ob gyn is worse though so I honesty don't blame you..

I worry tho that you could put a target on your back if you approach it the wrong way, and I think it may be difficult making the switch unless you contact programs and ask about available slots. My program has taken transfers before who joined us mid cycle.

Maybe it would be a good idea to find a faculty you trust and slowly bring up the issue with him?

Thanks for the reply. It's supposed to be 6 to 6, but lately its been 5 to 8 or 9. And we average out to work 12 hour shift every weekend but we have to do 24s so it's some weekends I am off both days so I am working 24's which really turns into 26 or 27 hours. It's not even the hours that are the problem, its what i do with those hours. I don't feel like I enjoy the feel as a whole. I find ob very rewarding but I am not intellectuall excited by the field, I have no interest in reading about interesting cases or look things up. I just go in every day and hope I don't get another ED consult. I don't think that's a good attitude and I really don't see myself lasting long if that's how I am feeling.

 

[IM2GI]

Give it a minute. Certainly you put a lot of thought into what specialty you applied to in the first place, and likely did extended rotations in OB/GYN before applying right? Intern year can suck no matter what the speciality. Avoid making sweeping conclusions this soon.

That said, all the ob/gyn residents I worked with as a med student were insufferable and seemed miserable, so maybe that is just how it goes the whole time?

 

[ranoutofnames]

Give it a minute. Certainly you put a lot of thought into what specialty you applied to in the first place, and likely did extended rotations in OB/GYN before applying right? Intern year can suck no matter what the speciality. Avoid making sweeping conclusions this soon.

That said, all the ob/gyn residents I worked with as a med student were insufferable and seemed miserable, so maybe that is just how it goes the whole time?

I appreciate your reply. You made a valid point. As far as I can see, the upper years are miserable at my program too but they truly love love love what they do and they think it's worth it, which is great for them, but I can't say the same for me. I don't want to spend my life working so hard at something just to look back and go,,wtf did I do with my life?

I did do two advanced rotations as a med student and at the time knew how hard they worked, but I guess what I think is worth it changed in the last couple of months.

I am only really thinking about talking to my pd early because I see that psych programs

 

[ranoutofnames]

Some psych programs that take pgy2 as transfers have deadlines in the fall (October to November ish)

 

[IM2GI]

I appreciate your reply. You made a valid point. As far as I can see, the upper years are miserable at my program too but they truly love love love what they do and they think it's worth it, which is great for them, but I can't say the same for me. I don't want to spend my life working so hard at something just to look back and go,,wtf did I do with my life?

I did do two advanced rotations as a med student and at the time knew how hard they worked, but I guess what I think is worth it changed in the last couple of months.

I am only really thinking about talking to my pd early because I see that psych programs

you wouldn't transfer as a PGY2 though, you would have to repeat your PG1 year, so essentially start over.

Psych and Ob are pretty different fields, so be sure before you do something drastic.

 

[ranoutofnames]

you wouldn't transfer as a PGY2 though, you would have to repeat your PG1 year, so essentially start over.

Psych and Ob are pretty different fields, so be sure before you do something drastic.

Yeah I am confused about that, I have read from this forum that one could potentially enter as pgy2 after finishing pgy1 in another field but would have to make up some rotations later on in lieu of elective time.

In either case, even if I do decide to leave, I wouldn't do it mid year, I intend on finishing out the year.

 

[IM2GI]

Yeah I am confused about that, I have read from this forum that one could potentially enter as pgy2 after finishing pgy1 in another field but would have to make up some rotations later on in lieu of elective time.

In either case, even if I do decide to leave, I wouldn't do it mid year, I intend on finishing out the year.

It's probably up to your theoretical new psych PD but not sure why they would give you credit for a year in a completely different field without much overlap.

 

[AdmiralChz]

You are what, 6 or 7 weeks into intern year? Absolutely too early to contemplate transfer, you probably don't even have wide exposure to the field in your training yet. Give it a few more months/rotations, see if anything piques your interest.

 

[IM2GI]

Yeah I am confused about that, I have read from this forum that one could potentially enter as pgy2 after finishing pgy1 in another field but would have to make up some rotations later on in lieu of elective time.

In either case, even if I do decide to leave, I wouldn't do it mid year, I intend on finishing out the year.

If its like most surgery fields, you also won't be doing many procedures your first year. It's gonna take some time to settle in and really see what your life would be like at the end of the rainbow.

 

[ranoutofnames]

Thank you for all your inputs! I started out on a relatively chill rotation where I mostly just do c sections to get the numbers and that rotation really required minimal administrative BS and that's when I realized that maybe I don't like the OR as much as I thought. I know it's really silly but it's hard to have known that as a med student when the exposure to doing anything real in the or is so limited.

 

[IM2GI]

Thank you for all your inputs! I started out on a relatively chill rotation where I mostly just do c sections to get the numbers and that rotation really required minimal administrative BS and that's when I realized that maybe I don't like the OR as much as I thought. I know it's really silly but it's hard to have known that as a med student when the exposure to doing anything real in the or is so limited.

They let first month interns do C-sections? Bananas.

 

[anonperson]

Hello everyone,

I know this has been posted in the past, but the answers to my specific questions have been very varied based on my search results and I was wondering if I can get different responses if I posted my own thread.

Briefly, pgy1 obgyn in the northeast, recently realized that I don't love surgery or obstetrics enough to stand the high acuity, high volume, high stress and the personality of the field (really no offense to obgyns, just basically personalty differences). I am sure this isn't intern blues and I know life as an attending will be somewhat better than being a resident, but even then, I don't think this is for me. Been thinking of making a switch into psych, but my questions is,, is it too early for me to tell my PD? She barely knows me and has no obligation to be nice to me. I am not doing poorly in the program now, so no red flags.

Any advice in terms of time line of when to tell PDs, and when to start looking for spots would be helpful. Thank you so much!

I finished an OB GYN residency in 2014 and then completed a fellowship just last month and am in private practice doing a bit of everything. I can say that life as an attending is much better than anything in residency and fellowship. Night and day.

I definitely had second thoughts throughout the entire process. I dual applied internal medicine and Ob Gyn to be honest and then decided to just go with Ob Gyn as I did enjoy doing procedures. Thought about quitting during my intern year and doing medicine or something.

I think the main thing you have to take into account is that life as a resident is tough. The personalities of the residents/attendings, the nurses, and the hours can create this perfect storm. I trained in Pennsylvania and the winters were absolutely brutal for me (originally from CA).

Life on labor and delivery varies significantly from life on outpatient rotations and operative rotations.

The other benefit is that in practice, you can tailor it however you life. More and more Ob Gyn physicians are mainly doing clinic and covering labor call and really don't operate otherwise and are bringing in healthy salaries. You can operate as much or as little as you like and with the various fellowships can triage your interests as well.

But at the end of the day, if you don't find the subject matter interesting, it's hard to be motivated. My advice would be as follows:

-Have a good support system
-Find enjoyment in activities/other people with your time off, even if it's just relaxing and watching TV
-Try not to get in the mindset where the work/patient is the enemy. It can be destructive to your well being where you dread coming into work and impact how one cares for patients. Try to go with the flow. If you end up staying late here and there, it just comes with the job for now. Remember this time will pass.
-Make sure to study/read-I found that the more I read and knew, the easier the job became, and the less stressful it became.

I'm an attending in private practice. Not my first choice in jobs as I wanted an academic job in my sub specialty in Southern California so I settled for a private practice gig. I live in a nice area in Southern California. Have a chance to build a sub specialty practice and I make a reasonable six figure income. Things tend to work out in the end.

I would also say that I would never ever re do my residency again and have talked with other Ob Gyn colleagues who have said the same thing.

If after the CREOGS in January you still feel this is not the right specialty, then make your move.

 

[mcl]

I finished an OB GYN residency in 2014 and then completed a fellowship just last month and am in private practice doing a bit of everything. I can say that life as an attending is much better than anything in residency and fellowship. Night and day.

I definitely had second thoughts throughout the entire process. I dual applied internal medicine and Ob Gyn to be honest and then decided to just go with Ob Gyn as I did enjoy doing procedures. Thought about quitting during my intern year and doing medicine or something.

I think the main thing you have to take into account is that life as a resident is tough. The personalities of the residents/attendings, the nurses, and the hours can create this perfect storm. I trained in Pennsylvania and the winters were absolutely brutal for me (originally from CA).

Life on labor and delivery varies significantly from life on outpatient rotations and operative rotations.

The other benefit is that in practice, you can tailor it however you life. More and more Ob Gyn physicians are mainly doing clinic and covering labor call and really don't operate otherwise and are bringing in healthy salaries. You can operate as much or as little as you like and with the various fellowships can triage your interests as well.

But at the end of the day, if you don't find the subject matter interesting, it's hard to be motivated. My advice would be as follows:

-Have a good support system
-Find enjoyment in activities/other people with your time off, even if it's just relaxing and watching TV
-Try not to get in the mindset where the work/patient is the enemy. It can be destructive to your well being where you dread coming into work and impact how one cares for patients. Try to go with the flow. If you end up staying late here and there, it just comes with the job for now. Remember this time will pass.
-Make sure to study/read-I found that the more I read and knew, the easier the job became, and the less stressful it became.

I'm an attending in private practice. Not my first choice in jobs as I wanted an academic job in my sub specialty in Southern California so I settled for a private practice gig. I live in a nice area in Southern California. Have a chance to build a sub specialty practice and I make a reasonable six figure income. Things tend to work out in the end.

I would also say that I would never ever re do my residency again and have talked with other Ob Gyn colleagues who have said the same thing.

If after the CREOGS in January you still feel this is not the right specialty, then make your move.

This is all excellent advice, for any intern really, but especially for one contemplating a change. But sometimes you just know when a specialty isn't the good fit you'd expected it to be. If that is the case for the OP, and if the OP has a sense that their PD is a reasonable sort of person, I'd recommend going ahead and having the talk. I've related my anecdotal experience before, but it's a good story: Many years ago, I had a resident who knew after his second rotation that he'd made a terrible mistake and was in the wrong field. He really wanted to do Family Practice. Meanwhile, ERAS had opened and I saw an application from someone who was already a resident in another specialty at my institution. Turns out, she was a Family Practice resident who had been scheduled to start intern year as the rotator in our department, and once she started she realized she had made a terrible mistake and had chosen the wrong field. We interviewed her on our first available interview date--everyone liked her and remembered her as a hard worker when on service with us. In the end, we just switched the two residents at the holiday break (no point in waiting until the end of the year), and both have gone on to personal and professional success. That could not have happened if both parties hadn't informed their PDs of their decision to switch specialties.

 

[BigRedBeta]

Is it the medicine (eg delivering babies) or the window dressing that is driving your displeasure? If it's hours or administrative or just the stress of being an intern, but NOT the actual *medical* stuff then I think it's wise to give it a bit more time. If you're finding that you don't like what you are doing for patients (or the patients themselves) then you need to change.

Is there a fellowship outcome down the line that appeals to you? I have a friend who is now a few years out of an REI fellowship, and I think if you would have asked her if she liked intern year or most of residency she would have emphatically said no. But it was means to an end an end to do what she really wanted to do. If the OR is not a draw, I guess that GYN Onc or reconstructive surg or urogyn are not options, but something else?

As for dealing with your PD. Sure they don't owe you anything, but they also likely need you to be a contributor through the rest of the year. A miserable resident does a lot of damage to a program and is more than just isolated to you - it affects your fellow residents, the attendings, the admin staff and if you're particularly vengeful patients, nurses, students and more. Keeping your discontent bottled up doesn't let the PD help you.

 

[clausewitz2]

Yeah I am confused about that, I have read from this forum that one could potentially enter as pgy2 after finishing pgy1 in another field but would have to make up some rotations later on in lieu of elective time.

In either case, even if I do decide to leave, I wouldn't do it mid year, I intend on finishing out the year.

So transferring into a psych residency as a PGY-2 is definitely a thing. This is mainly because a)we have the fewest off-service requirements of any ACGME specialty and b) fourth year of our residency is almost entirely elective. This means there is a huge amount of slack to make up any rotations that the program thinks are critical/necessary to fulfill accreditation requirements.

Some relatively fancy psych programs have dedicated PGY-2 spots every year. More end up having PGY-2 slots come available.

Feel free to pm me with details on the geographical location you're trying to end up in and I can tell you what I know about the closest likely places.

 

[EasyRider]

Talk to some private practice ob/gyn doctors before switching.

80% of ob/gyn go into private practice after training.

What it appears like as a resident at a teaching institution is not the same as an attending in private practice. Private practice is more outpatient based than what you see now.

 

[J ROD]

Never too early to want to leave obgyn

 

[paradoxofchoice]

Hey man, this person was me and as cliche as it is, it gets better. I feel for you. I was miserable and convinced myself that I had made a terrible mistake in picking ob/gyn. We also worked very long hours. It wasn't uncommon to come in at 3-330 and leave at 7-730 pm for the first 4-5 months, and even by the end of the year, on some rotations it had only shortened by an hour. Sometimes, I would work straight for 3 weeks without a day off. Then do discharge summaries and clinic notes from home. These hours make you a shell of a person. I know what it feels like to not see the sun for 6-7 months of the year, to be so tired that if you read, you can't do notes and if you do notes, then you can't read, and sometimes your life is reduce to only these things. I remember being so miserably tired that by 2 pm, I would hope I would have a seizure or something just so I could get some sleep because I've already had a 9 hour day without a break, I would sob in the car on my way home. It sucks being an intern and being deathly afraid of every delivery, doubting your every cervical exam, nursing doubting every order, patients complaining "the doctor don't know anything" doubting every little thing from giving ibuprofen to woman with PLT 110 to is colace BID too much, etc.

The solution is keep your head down. Be calm. Realize that every one of your classmates feels the same. Figure out things you like outside of the hospital and do them. Then slowly, as you gained more knowledge and became more comfortable with management, things slowly ease up. The pressure eases up. You learn your style of note templates, make your own order sets. You make friends with your co-residents and nurses. You learn how certain attendings like their patients set up in the OR, what the instruments are called, how to properly use the bovie, tie knots, which suture to use where, etc. This takes years.

If you've decided to switch, realize that your program is small, they need you, and you are much less likely to be fired than, say, an internal medicine resident. Your program director likely wants you to be happy and will help you. A miserable you means miserable everyone around you. You also will need a letter from them. This might set you up to be seen as a "quitter" around your program, but it will be ok. It will only be a few months. Finish out the year, this give you time to apply for the match, and gives program time to find someone else. It's a little late to apply from ERAS. You will likely need to apply for whatever has replaced SOAP, this again means having LOR and a personal statement. Your best bet is going to be to talk to your own program director and the program director of residency you are interested in at your hospital. The other easier ones would be other programs in your city and your own medical school. Likely that this will be the easiest way to switch programs. The other option is to go speak to the GME director of residents or similar position for your hospital to see what other residency spot is available. My hospital told me that I would have to restart as a PGY1 if I switched because only two of my months could be used for an intern year in the field I was otherwise interested in.

 

[Menander's Bust]

They probably had this person doing 1st assist on the C-sections, not doing them solo. I’m a 3rd year medical student and I could easily do 1st assist on C-sections, in fact I did 23 during my obgyn rotation and was 1st assist in some stat sections on the middle of the night.