regret switching residency

[cbcd]

So I switched from Internal Medicine to Psychiatry after my intern year. I starting thinking about switching after my first 2 months of IM, then halfway through the year decided to go for it. I was always interested in Psych and was hating IM internship, and it seemed like the right thing for me at the time. I am usually very conscientious and make good decisions, so I had the full support of my family and friends and nobody really questioned my decision to make the change. I was thrilled to be accepted into the Psych program as a PGY-2 at the same hospital.

However, towards the end of intern year I started enjoying IM more and got excellent evaluations, and was already beginning to regret my decision to leave. Looking back now, I recognize many other factors that influenced my decision. IM residency is not easy, especially as an intern. I was constantly exhuasted, feeling overworked, and was dealing with a lot of personal issues at the same time. I thought changing specialties was the answer to my problems, without fully acknowledging all the other issues that were likely clouding my judgement. Now I see that I was drawn to Psych during my intern year largely because I needed to see a psychiatrist, not become one!

I have done a month of Psych now and have much respect for the field. However, I now remember why I didn't choose Psych as a career in the first place. I wish I could go back and finish my IM residency. I doubt this is even possible at this point but I wonder if anybody has heard of residents switching out a second time? I realize that this will make me come off as a total flake, but I also have to consider that it is my career.

Anyhow, any thoughts or words of advice would be greatly appreciated.

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[captfp001]

If you got great evaluations, it should not be a problem. Ask your old program to take you back. Otherwise, there are always open PGY-2 IM spots that are looking for qualified candidates.

Funding might be an issue though because you are scheduled for 3 years of GME and you will have used one of them in psych. But if a program accepts you, then they will have factored this into their decision making.

 

[deleted6669]

how about switching to a combined psych/family medicine? then you would get credit for the yr of psych.

 

[lowbudget]

I met a guy who did FM-Path-FM, but did the return at a different institution.

Funny you mentioned that while in Psych you were reminded why you didn't pick Psych in the first place. Do you think your return to IM will remind you of why you switched in the first place?

I dunno. I'm not you, but if it were me, I'd channel my energies toward being an awesome psychiatrist. Get training over with and move on with life. Sounds like that's what needs more attention at this point anyways...

 

[peppy]

Personally, I would suggest sticking with the psych program, finishing it up, and then if you really miss medicine maybe doing a fellowship in a psych speicalty that puts more emphasis on general medical issues like geriatric psychiatry (most geri psych patients have other medical comorbidities) or psychosomatic medicine.
It is unfortunate that the way our system is set up you often have to make a leap of faith on specialty choice before you are certain of what you want, so I understand how things like this happen, but I think that trying to find a niche in psych where your interest in IM can be nurtured would be more productive than switching again.

 

[cbcd]

Thanks to everyone for the advice. It's a shame that our medical system is so inflexible and forces us to decide on our careers at such an early stage.

I agree that it's probably best to stick it out and make the best of my new situation. I would also feel terrible to just ditch the new program that took a chance on me. At this point, I just want to finish residency and move on. If by the end of residency I find it's really not for me, there's always pathology...

 

[gutonc]

Thanks to everyone for the advice. It's a shame that our medical system is so inflexible and forces us to decide on our careers at such an early stage.

I agree that it's probably best to stick it out and make the best of my new situation. I would also feel terrible to just ditch the new program that took a chance on me. At this point, I just want to finish residency and move on. If by the end of residency I find it's really not for me, there's always pathology...

Actually...if, at the end of your psych, you decide you really do want to do IM, you will be a surprisingly hot commodity for IM programs. Med/Psych is an area that is sorely needed in most communities but there are so few people boarded in both that it's a buyers market.

I agree that you should just stick to something (Psych) for now and then decide later if you want to go back to IM. Good luck.

 

[michaelrack]

how about switching to a combined psych/family medicine? then you would get credit for the yr of psych.

Int Med/psych combined would make more sense, but check out the ABPN web page first about restrictions regarding minimum # of years in one program and continuity clinic requirements. You may want to ask about this in the combined residency forum

 

[michaelrack]

Med/Psych is an area that is sorely needed in most communities but there are so few people boarded in both that it's a buyers market.

.

I am boarded in both and no one is offering me more $$ because of it. It's hard to do the combo in private practice- if you are in a psych group, your psych colleagues won't want to cover your med patients, and visa versa. Then they're billing issues- many insurance co have a mental health carve out and you would have to be credentialled with both their regular and psych plan (this is an issue more in some states than others).

Med/psych makes you more competitive in some fellowships, such as sleep. It can also help you advance in academics.

 

[michaelrack]

Personally, I would suggest sticking with the psych program, finishing it up, and then if you really miss medicine maybe doing a fellowship in a psych speicalty that puts more emphasis on general medical issues like geriatric psychiatry (most geri psych patients have other medical comorbidities) or psychosomatic medicine.
.

Don't make the mistake of thinking psychosomatics is a combo of psychiatry and internal medicine. It is 90% psychiatry and 10 % IM, in my opinion (I think it is an informed opinion, since I am boarded in Psychiatry, Internal Medicine, Psychosomatics, and Sleep Medicine)

 

[Sleepygator]

What is it about IM that you miss? Agree with Dr. Rack that it might be hard to do the IM/Psych combo at this point b/c of the continuity requirement. Agree with other posters that finishing psych is a good idea, rather than switching back.

 

[cbcd]

Thanks again for the interesting discussion and words of advice.

With regard to what I miss about IM, I enjoy working with hard findings - i.e. coming up with a differential, confirming a diagnosis with labs and other studies, and then being able to follow the results. Once I got more comfortable with medicine toward the end of intern year, I began to enjoy that aspect of it even more.

In Psychiatry, the approach is much more more subjective and intuitive and I do miss the hard findings and technical aspects of medicine.

 

[Faebinder]

Thanks again for the interesting discussion and words of advice.

With regard to what I miss about IM, I enjoy working with hard findings - i.e. coming up with a differential, confirming a diagnosis with labs and other studies, and then being able to follow the results. Once I got more comfortable with medicine toward the end of intern year, I began to enjoy that aspect of it even more.

In Psychiatry, the approach is much more more subjective and intuitive and I do miss the hard findings and technical aspects of medicine.

It's only as subjective and intuitive as you make it to be. You can change it to become more objective if you start applying neuropsychiatric scales on your patients. For example start running PANSS on your psychotic patients every 3 days, see how things are going. Is your treatment really helping? I agree psych requires more objectivity but that is slowly being changed IMO.

 

[cool c]

I am glad I came across your post. I am a new medicine intern. I am basically having the same thoughts as you. I couldn't decide btwn med and rads in med school and went with medicine. Now 2 months in, I am feeling like I made a huge mistake. I am considering switching, but after reading this post, I am wondering if I would regret switching. Knowing my personality of thinking the grass is always greener on the other side, I think I may have a similar experience as yours. Boy, that would absolutely suck. Sorry unfortunately, I don't have any advice for you, but your post has definitely made me wanna give medicine more time before I consider switching. Thanks

 

[dragonfly99]

dr coolc,
I don't think you should bail yet. The first few months of IM residency are always kind of crappy...they work you hard and you aren't yet comfortable in your role/decision making. It gets better by November or so. The thing about radiology is you'd have needed a prelim or IM year anyhow, so you aren't wasting the time, regardless of what you do. If you are thinking you want rads, can always wait until March or April, talk to your IM PD and see if you can get a leave of absence to do a research year in rads, or a promise to take you back if you can't get a rads spot. You might be able to find an open rads spot too, but those are few and far between. There was one guy in my IM residency who I think did rads after doing an entire IM residency, too.

 

[Top Gun]

How about finishing the psych residency and doing a fellowship in addiction medicine? Its sort of a mix between IM and psych.