ready to jump ship, and swim for path

[msi7]

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Well, after strongly considering path during my 3rd year of med school, I instead decided to pursue a different specialty. I'm doing a prelim year of medicine at this time. Unfortunately, this is definitely not what I want to do at all. Is it possible for me to make the switch now...am I too far into the year? Could I jump ship now and then apply for a path spot for next year? I'm just trying to figure out what my options are (do I have any at all?). Clinical medicine is not for me and this has become painfully obvious. As far as sucking it up and completing the intern year, I don't think that's going to happen.

 

[yaah]

Come towards the light! Avoid the suggestive and irrational pleas of the other side.

It is very uncommon for programs to take residents in the middle of the year, although it does happen. I am not sure how I would recommend finding one. I guess the best advice I would have is to plan on starting a program next year. People switch specialties all the time, and honestly I don't know how they look at candidates from other specialties and whether it is more important to keep working in the field that you dislike or to quit and spend all your efforts on applying for another spot. I would suggest, however, that it is best to not burn any bridges or make anyone upset - at least give notice. I have known of people who do both - some quit their residency after about 2 weeks, never to return, and go through the match the following year. Others last a couple of months, find another job and apply. Others keep working until they match at a new place. I would suggest talking to advisors and such but advisors are notorious for not helping much in situations like this. Perhaps if you feel comfortable contacting a few program directors of path departments and feeling them out.

I'm curious - what made you end up deciding NOT to pursue path after med school? Was in the clinical medicine syren and her hypnotic voice, calling you in and telling you how rewarding it was to take care of patients?

 

[b&ierstiefel]

Well, after strongly considering path during my 3rd year of med school, I instead decided to pursue a different specialty. I'm doing a prelim year of medicine at this time. Unfortunately, this is definitely not what I want to do at all. Is it possible for me to make the switch now...am I too far into the year? Could I jump ship now and then apply for a path spot for next year? I'm just trying to figure out what my options are (do I have any at all?). Clinical medicine is not for me and this has become painfully obvious. As far as sucking it up and completing the intern year, I don't think that's going to happen.

Gawd, I thought 2 months of subI's would be hard to stomach. But me doing a whole intern/transitional year...that's suicide waiting to happen.

 

[deschutes]

Gawd, I thought 2 months of subI's would be hard to stomach. But me doing a whole intern/transitional year...that's suicide waiting to happen.

What are subI's? another year of clerkships?

Day 1 of Rheumatology. For once I start a service, unruffled! I could maybe do a whole year of Rheum, especially if Tuesdays continue to start at 9:30 and the attendings keep taking us on one-hour coffee/samosa breaks, the darlings.

This probably belongs on the "Five More Days!" thread, but what the hey. The universe runs on organized chaos.

 

[b&ierstiefel]

What are subI's? another year of clerkships?

Day 1 of Rheumatology. For once I start a service, unruffled! I could maybe do a whole year of Rheum, especially if Tuesdays continue to start at 9:30 and the attendings keep taking us on one-hour coffee/samosa breaks, the darlings.

This probably belongs on the "Five More Days!" thread, but what the hey. The universe runs on organized chaos.

Subinternships are one-month rotations where a 4th year medical student "acts" as an intern "as much as possible." So apparently, we M4's would write orders (which have to be co-signed anyway), make frickin phone calls, fill out paperwork, dictate (argh!), etc. At University of Michigan, M4's have to do 2 subinternship months in either internal medicine, general surgery, pediatrics, or family medicine.

Rheumatology...I heard that's a pretty cush rotation. After my pathology month in September, my last month as a med student will involve doing nephrology consults. I can see myself coming up with all sorts of excuses to not go into work during this month. Hopefully I'll get even a few interviews in October...however, that is probably asking for too much 🙂

 

[yaah]

my last month as a med student will involve doing nephrology consults. I can see myself coming up with all sorts of excuses to not go into work during this month.

Just don't tell them it hurts when you pee. That sets off a chain reaction in a nephrologist.

 

[b&ierstiefel]

Just don't tell them it hurts when you pee. That sets off a chain reaction in a nephrologist.

I also will not tell them that there is blood in my urine.

 

[joedogma]

For the original poster...I doubt that you will be able to find any programs that would take you so late in the game but you can always try. I would suggest that you apply for next year but that you also finish your intern year. I believe that it is slightly unprofessional to quit a few months in especially if you don't have another position in another field. To quit simply because you "don't like it" is pretty weak. If you leave now, it is probably too late for the program to find someone else and the other existing interns will have to pick up your slack. Finish out your intern year, take step3, and start path in the fall. This is certainly not the end of the world and you will most likely be a better doctor in the end (and certainly not an inferior pathologist)...

 

[deschutes]

Subinternships.... So apparently, we M4's would write orders (which have to be co-signed anyway), make frickin phone calls, fill out paperwork, dictate (argh!), etc.

Hmm. But I'm a third year. And I did that from Day 1 of my first rotation. Not that I'm any good at it! 😳 Bloody learning curves.

Rheumatology...I heard that's a pretty cush rotation.

It is, Andy, it is! 2 half-days out of 3 so far - and that's not counting the pitstops for Rice Krispies squares! I've actually had the time to work on ERAS 😀 These 2 weeks of Rheum may be the only way I'll get any IM reading done... and start knocking the 77 Essential Diagnoses of The Internal Medicine Clerkship off my reading list.

my last month as a med student will involve doing nephrology consults.

Join club. I did ID, am doing Rheum, will be doing Nephro. The three aspects of Internal that I know the least about. I hope to know something about acid-base by the time 4 weeks of kidneys are over....

 

[b&ierstiefel]

Hmm. But I'm a third year. And I did that from Day 1 of my first rotation. Not that I'm any good at it! 😳 Bloody learning curves.

Some of my classmates said they did it too. I just chose not to be all that eager (which is ironic, because when I was on Internal Medicine rotation, I was actually thinking of going into that field..haha)

It is, Andy, it is! 2 half-days out of 3 so far - and that's not counting the pitstops for Rice Krispies squares! I've actually had the time to work on ERAS 😀 These 2 weeks of Rheum may be the only way I'll get any IM reading done... and start knocking the 77 Essential Diagnoses of The Internal Medicine Clerkship off my reading list.

Yeah, consult and outpatient months are great for getting some studying done. I'm glad Rheum is treating you well. too bad you're only on rheum for only 2 weeks.

Join club. I did ID, am doing Rheum, will be doing Nephro. The three aspects of Internal that I know the least about. I hope to know something about acid-base by the time 4 weeks of kidneys are over....

I still know diddly-squat about ID, rheum. Worked in a nephro lab for my PhD (well actually, we did work with renal cell lines and my boss was a trained nephrologist). Acid-base is made to be way too complex in lectures than it actually is when you're evaluating patients. The main distinction especially in an inpatient unit is whether an acid-base derangement is acute (no compensation) or chronic (compensation). They try to make it tricky by talking about triple acid-base disorders. Of course, the only "triple acid-base disorder" I've encountered was in a young asthmatic/DM patient who was in DKA. Oh well, the more you look at ABGs, you'll get a hang of it...it's not rocket science like it may seem at first.

 

[deschutes]

Some of my classmates said they did it too. I just chose not to be all that eager.

I didn't actually have much of a choice. Week 1 of Peds the junior and senior rez were tearing around like headless chickens. The order to march was "Why don't you go and admit this patient." - and not the question "Would you like to go see this patient?"

I only got an "At Expected Level" anyway. Note to self: Not Peds.
Junior resident said "Pathology? Not a people-person, are you." Note to self: Not Peds.

Acid-base is made to be way too complex in lectures than it actually is when you're evaluating patients.

I figured it can't be that hard - just like Abx there must be some pattern that I haven't seen.

I now know that metabolic acidosis is the most common imbalance encountered. Had I known that in my first two years, I would've spent my time studying it instead of the other three.

 

[b&ierstiefel]

Junior resident said "Pathology? Not a people-person, are you." Note to self: Not Peds.

I've heard this again this month. I had to give an oral presentation on treatment and staging of lung cancer to all of the medicine teams. I was introduced as the subintern who was interested in going into pathology. After the talk, an intern came up to me and said the same thing.

God damn, the next person who says this to me is gonna get smacked. I'm gonna go to the nearby Kroger's and buy a couple can's of whoopass! They got a special, buy 2 and get the 3rd free. I'm gonna start bringing them to work everyday.

 

[b&ierstiefel]

Perceive the way of nature and no force of man can harm you. Do not meet a wave head on: avoid it. You do not have to stop force: it is easier to redirect it.
- Master Kan

Comment: Pathology? Not a people-person, are you?
Response: I like people, *look in eye* most of them.

Comment: I wouldn't want to be your patient!
Response: You are welcome on my table at any time.

Comment: I bet your patients don't talk back to you.
Response: Sometimes *look in eye* silence is best.

Comment: You see dead people.
Response: I also *look in eye* see foolish ones.

ect...

Touche Crepitus. I like these ideas...got any more?

 

[deschutes]

Brilliant. I promise to sally forth and deploy those missiles when I am an MD. But right now, silence is best... and not always that hard to do.

Failing which I resort to internal monologue. Fools, all of you. and etc.

 

[deschutes]

Comment: Pathology? Not a people-person, are you?
Response: I like people, *look in eye* most of them.

Crepitus! What about:

in the context of residents dropping out of programs...
"Dropping out? Of path? Why, because they had to do 2 autopsies instead of 1? Hahahaha I'm so funny! etc."

Subtleties are lost on this one. 😡