PGY3 - switch vs. second residency?

[drmasterofnone]

I am a current PGY3 in emergency medicine at a 4-year program and I am miserable.
All the things that I found to be perks of emergency medicine (shift work, procedures, taking care of critically ill patients, diversity of patients & presentations, etc) no longer seem to be appealing (no normal schedule, extreme stress, feeling like a master of none, overly reliant on consultants, etc). I am dreading that in a year and a half that I will be an attending and while I know I can push myself to work as an EP, I know that at most I could force myself to do a couple of years before transitioning out.

As a PGY1, I chalked up my unhappiness as being an intern, working a lot of hours, and being insecure. As a PGY2, I could blame tough off-service rotations and graduated responsibility. Now as a PGY3 with an improved schedule and a better knowledge base, I am confident that the primary problem is that I am unhappy with my career choice. This has been a shameful secret that only my partner and close friends know- I haven't told anyone in my program. In fact, what makes me so hesitant to admit that I no longer love emergency medicine is that I love my co-residents, faculty, and all the opportunities my fancy pants institution offers. I have thought about gateways out of emergency medicine through fellowships, but haven't found the one that quite appeals to me or that can fully allow me to not practice emergency medicine as a way to supplement my income. Going corporate doesn't truly appeal to me either. Surprisingly, I keep coming back to wishing I had pursued radiology instead (which I did rotations for in medical school and really enjoyed), but acknowledge don't often have vacancies and is fairly competitive. I think ultimately I do want to continue being a practicing physician, just not an emergency medicine one.

I am trying to figure out what options are available and looking to solicit advice.
- would I be able to vie for a PGY2 rads spot if a position opens up? (would rather not have to do a prelim year if it is an option)
- should I just suck it up and finish my program first and then reconsider applying (it seems like such a waste to not finish), or are my options better if I start this process as a resident?
- am I just super burned out and being a crazy person?

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[rokshana]

I am a current PGY3 in emergency medicine at a 4-year program and I am miserable.
All the things that I found to be perks of emergency medicine (shift work, procedures, taking care of critically ill patients, diversity of patients & presentations, etc) no longer seem to be appealing (no normal schedule, extreme stress, feeling like a master of none, overly reliant on consultants, etc). I am dreading that in a year and a half that I will be an attending and while I know I can push myself to work as an EP, I know that at most I could force myself to do a couple of years before transitioning out.

As a PGY1, I chalked up my unhappiness as being an intern, working a lot of hours, and being insecure. As a PGY2, I could blame tough off-service rotations and graduated responsibility. Now as a PGY3 with an improved schedule and a better knowledge base, I am confident that the primary problem is that I am unhappy with my career choice. This has been a shameful secret that only my partner and close friends know- I haven't told anyone in my program. In fact, what makes me so hesitant to admit that I no longer love emergency medicine is that I love my co-residents, faculty, and all the opportunities my fancy pants institution offers. I have thought about gateways out of emergency medicine through fellowships, but haven't found the one that quite appeals to me or that can fully allow me to not practice emergency medicine as a way to supplement my income. Going corporate doesn't truly appeal to me either. Surprisingly, I keep coming back to wishing I had pursued radiology instead (which I did rotations for in medical school and really enjoyed), but acknowledge don't often have vacancies and is fairly competitive. I think ultimately I do want to continue being a practicing physician, just not an emergency medicine one.

I am trying to figure out what options are available and looking to solicit advice.
- would I be able to vie for a PGY2 rads spot if a position opens up? (would rather not have to do a prelim year if it is an option)
- should I just suck it up and finish my program first and then reconsider applying (it seems like such a waste to not finish), or are my options better if I start this process as a resident?
- am I just super burned out and being a crazy person?

Finish...at least then you will be able to work as an ED doc or UC ( which may get you more regular hours)... and then contemplate another residency know that if you don’t get one, you can still work in medicine . The other is have you thought of a EM fellowship? Pain? Toxicology? Occupational medicine?Something that may give you the chance to tailor your job to something you would like.

 

[Food]

Have you considered critical care fellowship? 2 years and you could then do 100% of your time in the ICU. Granted - still high stress with relatively high burnout but perhaps more control over schedule and not as many abusive, despicable patients as in the ED. I think you could try for rads, would be down to specific programs to see how much credit they give you in terms of pre-lim.

 

[EMThrowaway2020]

I am trying to figure out what options are available and looking to solicit advice.
- would I be able to vie for a PGY2 rads spot if a position opens up? (would rather not have to do a prelim year if it is an option)
- should I just suck it up and finish my program first and then reconsider applying (it seems like such a waste to not finish), or are my options better if I start this process as a resident?
- am I just super burned out and being a crazy person?

So I was an EM resident and I'm currently applying to rads.
1. You would be able to vie for a PGY-2 spot. your EM intern year would count (as long as you're in an ACGME-approved residency) so you wouldn't need to do a transitional year. There are only ~6 PGY-2 spots in the match this year so far - there are usually ~25. I anticipate more will open up but who knows with COVID this year. You could also match into a regular advanced spot which would start ~18 months after your app cycle. (e.g, if you matched this cycle you would actually start advanced positions after you finished your EM residency.)
- RE competitiveness: rads and EM are similar. If you have a good rads personality and you have good board scores + upper half of class grades you will have an excellent chance. You won't have any funding so don't expect invites from many community programs, but many academic places don't care.

As for crazy and burnout... IDK. You know what you're getting into with EM now. Just make sure you know what you're getting into with rads before you do anything irreversible. Why rads over urgent care or sports med? Talk about that with people close to you (but who don't work in your hospital).

 

[NotAProgDirector]

Agree with this last post. If you were competitive for a "fancy pants EM" spot, you'll be competitive for rads. Had you posted earlier, you could have applied this cycle for either PGY-2 Reserved (to start Jul 2021) or Advanced (to start Jul 2022). if you matched the former, you'd need to resign your current spot. YOu'd need some buy in from your PD to do that, as they might ask you to sign your PGY-4 contract before that. But it's almost certainly too late at this point, and you'd need some Rads letters.

So, you should get some rads experience now if you can. If you have elective time, use it for that. Maybe you'll be wildly happy in rads. Maybe you'll find it just as much, if not more miserable than EM. But you're in a position to find out.

Critical care fellowship is a great option. It's 2 years, but theoretically 1 clinical and 1 research year. Plenty of community ICU's are day only (with tele-ICU night coverage).

So: Spend the next 9 months exploring Rads and ICU. Once you decide which you'd rather complete you'll apply -- Crit Care is in the IM specialties match, so you would apply next July. Rads is in the main match, you'd apply in September. If your home program has either, consider looking there first.

Seems unlikely to me that this is burnout. Sounds like you never actually liked it.

 

[EMThrowaway2020]

But it's almost certainly too late at this point, and you'd need some Rads letters.

FWIW, I don't have a letter from a radiologist. No one has asked about that, but they have asked about my experience with Radiology. 1 letter from a rad and 2 from your attendings in residency will probably be fine.

 

[Redpancreas]

I am a current PGY3 in emergency medicine at a 4-year program and I am miserable.
All the things that I found to be perks of emergency medicine (shift work, procedures, taking care of critically ill patients, diversity of patients & presentations, etc) no longer seem to be appealing (no normal schedule, extreme stress, feeling like a master of none, overly reliant on consultants, etc). I am dreading that in a year and a half that I will be an attending and while I know I can push myself to work as an EP, I know that at most I could force myself to do a couple of years before transitioning out.

As a PGY1, I chalked up my unhappiness as being an intern, working a lot of hours, and being insecure. As a PGY2, I could blame tough off-service rotations and graduated responsibility. Now as a PGY3 with an improved schedule and a better knowledge base, I am confident that the primary problem is that I am unhappy with my career choice. This has been a shameful secret that only my partner and close friends know- I haven't told anyone in my program. In fact, what makes me so hesitant to admit that I no longer love emergency medicine is that I love my co-residents, faculty, and all the opportunities my fancy pants institution offers. I have thought about gateways out of emergency medicine through fellowships, but haven't found the one that quite appeals to me or that can fully allow me to not practice emergency medicine as a way to supplement my income. Going corporate doesn't truly appeal to me either. Surprisingly, I keep coming back to wishing I had pursued radiology instead (which I did rotations for in medical school and really enjoyed), but acknowledge don't often have vacancies and is fairly competitive. I think ultimately I do want to continue being a practicing physician, just not an emergency medicine one.

I am trying to figure out what options are available and looking to solicit advice.
- would I be able to vie for a PGY2 rads spot if a position opens up? (would rather not have to do a prelim year if it is an option)
- should I just suck it up and finish my program first and then reconsider applying (it seems like such a waste to not finish), or are my options better if I start this process as a resident?
- am I just super burned out and being a crazy person?

Its natural to feel this way from time to time. Only you can truly determine if its burn out or genuine career dissatisfaction. To me based on what you've written, it seems like the latter based on how long these feelings have been. I was going to suggest Sports Medicine Fellowship with EM shifts/Clinic transitioning to the latter as you move to retirement you said that doesn't appeal to you. In regards to Radiology does your EM residency get you PGY-1 radiology credit? They usually need an IM/Surgery intern year and EM only allows IM/Surgery rotations.

I think you should two things.

1.) If your program director is supportive ask them if you can be given some radiology electives during your time off. You're doing a 4 year EM program and are at a fancy (i.e. quaternary care institution I presume) so there will be radiology opportunities where you can work with to gain clinical experience and references. This will allow you to be a legitimate and not a fringe candidate for for Radiology C/O 2028 in ERAS 2022. This should be your safe plan. You won't be the most competitive applicant because of your non-traditional app but you would be perceived as a legit/solid applicant without red-flags. (Ask a radiology PD/aPD to ensure this is accurate). Funding will be really the only thing programs will see as a downside and per academic physicians on here, the funding can be worked around if a program wants to support you.

2.) Simultaneously contact radiology programs systematically and ask about openings PGY-2 openings for July 2021. Right now you will hear crickets because of ERAS/COVID, but the SOAP may be an opportunity. You're right that Radiology is competitive but you can never say for sure and your lack of red flags, clinical experience, and likely good future references may count for something. This way you may be able to salvage a year.
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If none of that appeals to you I really think you need to look harder at graduating EM. Options after that include working a few years in EM which will set you up well financially. I would also talk with those in your EM program. I find it hard to imagine that people in your 4 year program are all gearing up for traditional EM practice. I think a lot will be seeking administrative roles, fellowships, etc. and they would be the ones to best advise you in that area if you choose to stick with EM.

 

[Redpancreas]

Agree with this last post. If you were competitive for a "fancy pants EM" spot, you'll be competitive for rads. Had you posted earlier, you could have applied this cycle for either PGY-2 Reserved (to start Jul 2021) or Advanced (to start Jul 2022). if you matched the former, you'd need to resign your current spot. YOu'd need some buy in from your PD to do that, as they might ask you to sign your PGY-4 contract before that. But it's almost certainly too late at this point, and you'd need some Rads letters.

So, you should get some rads experience now if you can. If you have elective time, use it for that. Maybe you'll be wildly happy in rads. Maybe you'll find it just as much, if not more miserable than EM. But you're in a position to find out.

Critical care fellowship is a great option. It's 2 years, but theoretically 1 clinical and 1 research year. Plenty of community ICU's are day only (with tele-ICU night coverage).

So: Spend the next 9 months exploring Rads and ICU. Once you decide which you'd rather complete you'll apply -- Crit Care is in the IM specialties match, so you would apply next July. Rads is in the main match, you'd apply in September. If your home program has either, consider looking there first.

Seems unlikely to me that this is burnout. Sounds like you never actually liked it.

I really should read the subsequent posts before I give my whole rant. Lot of things in common with what I said OP.

 

[ortnakas]

Honest question from an IM PGY-3 (so if I’m wildly wrong ignore this post and tell me so): isn’t ultrasound a fellowship you can do after EM? Would that be an opportunity to do something radiology-like without starting over?

 

[EMThrowaway2020]

Honest question from an IM PGY-3 (so if I’m wildly wrong ignore this post and tell me so): isn’t ultrasound a fellowship you can do after EM? Would that be an opportunity to do something radiology-like without starting over?

Not all fellowships lead to a well-paying job. Tox, for example, won't make you more than a Fellows salary if it's all you do. All the Tox docs I know either do tons of research + teaching or work clinical EM shifts on top of their Tox stuff to earn their keep.

I don't think you can "just" do US. It makes you more competitive for academic programs, but it isn't it's own job.

I think Sports Med or something weird like doing survival and finding a job with the Armed Forces are the only ways to escape clinical EM. (well, and urgent care).