Happiness is a perception, the requisite components of which are always being newly defined or changing as we progress through life. It really is a state of mind. Maybe that's a little too much Ghandi for the forum, but that's my personal philosophy. There is no perfect specialty, there is no perfect career for that matter. Hell, I don't consider there to be a perfect...much of anything, except certain beers, nude women and cigars, some of which can come close. I think burn out is a danger for any specialty.
Residency is tough, you work longer hours and endure an enormous amount of stress, but I really considering second guessing your residency choice to be dangerous for anyone, after all... what if you change residency and then it's not what you expected, and you regret your decision? Then, you've wasted valuable time and opportunity chasing after a mirage in the distance. Finish residency, try out different practice environments, work fewer shifts, find some new hobbies outside work, spend time with your family, etc.. I guarantee that you probably won't feel so burned out at that point. Weather the storm my friend, residency is not meant to be a cake walk.
I was a career changer, switching to medicine after a mid-life crisis. Is medicine what I thought it would be? Hell no, and some shifts in the ED are downright painful, but I still can't imagine a better fit for me personally, and you've got so much control over your lifestyle and work load after residency that I find "burn out" to be more of a psychological state than anything specific to emergency medicine.
EM is fun dude... You'll be an attending soon enough and when you find that sweet practice environment and are reading your pay stubs while on vacation somewhere, or out to dinner with no pager to worry about, you'll be in a different frame of mind. Personally, I have a lot of outside interests besides medicine which is why I picked the specialty in the first place, because it affords me indulgence in those interests, yet I still get the chance to make a difference in patient's lives.
I just really don't understand why people jump ship halfway through residency. If you're really that disenchanted, at least finish it out and only then consider something else. I think you owe that to yourself. It's really difficult to make a judgement call on how the rest of your life will be in EM from a resident's eyes only. After all, we have probably more control over our lifestyle, work load and practice setting than most other specialties. Will I feel any differently 20 yrs from now? Probably...but it's hard enough for me to plan 1 week ahead, much less that far. I was never any good at that "where do you want to be 10 yrs from now"... type discussion in the high school counselor's office. Hopefully 20-30 yrs from now I'll be on a tropical island, holding a stiff drink in one hand and surrounded by bikini clad women....hopefully without an ICD/pacer implanted so that if I do have a heart attack, I can go out with a smile on my face.
Just my 2 cents.
This advice certainly is powerfully worded; may I offer the counter view?
I started my residency in psychiatry before switching to EM but this is not to say that I loved psychiatry head and shoulders above all other specialties as a medical student. I loved many specialties (in the 8-10 week window that I had for them as a student). Many people debate specialties such as surgery and EM or IM and FM etc....
Also, the decision of a specialty is made based on the brief experiences a person has as a medical student which are colored heavily by the people, grades, and cases that happen to come during that time. Also, specialties such as EM can regionally very different.
If people begin a residency and after day in and day out of practicing the medicine begin to have doubts about their career it is very healthy to try and decipher why. For some people, it is simply because they are a resident and they are tired, but for many people it is because the specialty they chose is not what they expected for themselves.
If a resident waits to complete say ophthalmology before switching to emergency medicine, they will be many years removed from their obstetric knowledge, their internal medicine knowledge etc and will be at a real disadvantage in trying to get an EM residency and in performing well during it. This would be true of many specialties (psychiatry, optho, PM&R, etc.) and would be unique to the situation (I mean depends on the other specialty being considered).
Also, it is important to know that many medicare funding dependent graduate training programs lose money on residents who switch / start over later than their PGY 1 year and so it is also harder switch at that point. This is not all but it is a consideration.
Speaking from my experiences, I started residency in psychiatry and found that I truly enjoyed my off-service rotations more than my on-service ones. I was repeatedly told that it was likely intern blues but I felt like it wasn't. I hadn't had any exposure to EM as a medical student but did as a resident and liked it. You're exactly right that I had great fears that I might be switching into the wrong field, but I was pretty sure that psychiatry wasn't going to lead me to my bliss and so in some senses I had nothing to lose and only everything to gain. I can gaurantee I am better and happier person for the switch.
I also can tell you of someone else very dear to me who began disliking their residency very early on but told themselves it was residency only and stuck it out. Now they are in practice and remain unsatisfied but do not wish to switch at this point given how much time they have put into things and how far removed they are from other specialties.
And getting back to the Ghandi reference, happiness is in part what we bring to the table, but acceptance of something that is wrong for us is never something he would proposed. My understanding of him (as I have no personal contact other than sharing the same Indian blood), is that he was very introspective of himself, his ability to change his life and that of those around him, and of our people. He was unaccepting of british rule of India and sought aggressively to change it. He had dreams for his law practice but found an alternative purpose in life. I believe if he had stuck out his legal practice and then later decided to change into politics and helping the poor we (all of society) may be the worse off. My understanding of him is that he would advocate great introspection on the part of a resident and the never ending pursuit of improvement in ones life....which it sounds like some of these EM residents are doing.
The opportunity for regret is present for people no matter what they chose; it is there if you switch residencies and if you do not. It should not paralyze people from change if it feels like the right decision.
Just my 2 rupees (since we talked about Ghandi and all)
😉
TL
