Residents are leaving to pursue non-clinical options

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DrJosephKim

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Recently, I've been approached by many residents who wish to leave their program. Some have already left and they're looking for some job opportunities. Others are wrestling with the decision because they're not sure about their long-term career goals. When my wife was a chief resident at Penn, several residents left or switched to different residencies.

I'm curious - how often do you encounter residents who are serious about leaving? What type of advice do you give that's most effective in motivating them to stay in residency?

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Recently, I've been approached by many residents who wish to leave their program. Some have already left and they're looking for some job opportunities. Others are wrestling with the decision because they're not sure about their long-term career goals. When my wife was a chief resident at Penn, several residents left or switched to different residencies.

I'm curious - how often do you encounter residents who are serious about leaving? What type of advice do you give that's most effective in motivating them to stay in residency?
What kind of non-clinical options? I know a resident that left to do a PhD, since he couldn't stand practicing. Other than that, I would say it's pretty rare from what I've seen.
 
My experience is that people saying they want to leave is common, but I don't know anyone who has left residency voluntarily, without being thrown out. Also, people saying they are going to finish residency but don't want to practice is also common, but again I don't know anyone who has quit yet. People tend to come to the realization that there aren't many good options for paying 100-300k in student loans with the skill set most of us have (well trained to do medicine but not much else). The main options are to practice or go into bench research, but the latter is mainly an option for those who already had a research background or are feeling lucky/like good gamblers. This is because if you quit practicing for several years, it may be hard to go back to clinical medicine.
 
I've met very few residents who were serious about wanting to leave medicine.

In my med school class, there was one student who quit to become a elementary school teacher and I admired the hell out of her. She returned two years later.
 
I've met very few residents who were serious about wanting to leave medicine.

In my med school class, there was one student who quit to become a elementary school teacher and I admired the hell out of her. She returned two years later.

I know of at least 2 who quit medicine altogether. One graduated med school and went to law school; currently practices as a lawyer and never pursued a residency or step 3. The other quit a few years into residency and is now doing nothing having to do with medicine.

I do think that most people who say they want to quit medicine really just needs to switch specialties and find their 'niche', so to speak.

However, if someone REALLY doesn't want to be in medicine, it's probably best that they leave medicine. As hard to understand (especially with all the years of school and loans) as it is for most of us, it's not fair to patients to try to convince them to stay in medicine and be miserable.
 
However, if someone REALLY doesn't want to be in medicine, it's probably best that they leave medicine. As hard to understand (especially with all the years of school and loans) as it is for most of us, it's not fair to patients to try to convince them to stay in medicine and be miserable.

There are some physicians who love practicing medicine, but hate the stress of potential malpractice litigation with every patient they see. That's why a lot of physicians retire early or leave practice.
 
A lot of people go into medicine for the wrong reasons and without knowing if it is a suitable career. Too many people get on the "medical student train" early in their lives because that's what their parents want them to do or that's what they think they are supposed to do. But by the time they realize they have another calling in life or other goals, they are halfway through med school and hundreds of thousands in debt.

The best way to get fewer residents to want to leave medicine is to ensure that people entering medical school are sure about medicine as a career. Perhaps that means more people should be taking time off to do something else with their life and experience real life. Perhaps that means that med schools should give more weight to candidates who have done this self-examination.

Some people, however, just want to leave because they are depressed or don't know what they want. Oftentimes as they move on to the final years of training they discover they really do like medicine. It all depends on why they are having doubts and what kind of doubts they are. Each person is different. Some people are going to be depressed and want to quit any field they go into because they are always looking for one that will pay them $1 million a year.
 
A lot of people go into medicine for the wrong reasons and without knowing if it is a suitable career. Too many people get on the "medical student train" early in their lives because that's what their parents want them to do or that's what they think they are supposed to do. But by the time they realize they have another calling in life or other goals, they are halfway through med school and hundreds of thousands in debt.

Oh man, so true. Debt is easily the biggest factor that most people who hate medicine don't leave.
 
What non-clinical options are there for someone who hasn't finished a residency? I know one military physician who left residency and hands out basketballs at the gym.
 
What non-clinical options are there for someone who hasn't finished a residency? I know one military physician who left residency and hands out basketballs at the gym.

I know one residency drop out who is now working in a hedge fund in HK.
 
I wish I knew what non clinical options were possible without finishing residency. I'm not even convinced there are that many if you do finish residency. I've been out of my residency (without finishing) for almost 3 years and have found nothing. I've been working a moonlighting type job, and it's not a good long term solution.

A MD degree doesn't qualify you to do much other than be a doctor. Sure, some people have gotten consulting or business type jobs, I'm not sure how you do that without a business background. Same with research- that's not really an OJT thing. Blogging takes a lot of time to build up, and somehow you have to get traffic to the blog (something I haven't figured out how to do yet)

Sadly, I will have to try to pick a specialty that I think is tolerable and retrain. I can't imagine ever enjoying working in medicine, but I will have to at least to pay off the debt.
 
These types of threads are really interesting for pre-meds, as we see that our expectations may clash with reality somewhere down the road.

Despite the fact that I feel certain that I want to pursue medicine, I'm planning on taking at least one year off after undergrad before applying just to know what the alternative is like.

I'm curious about a couple of points you guys brought up....

There are some physicians who love practicing medicine, but hate the stress of potential malpractice litigation with every patient they see. That's why a lot of physicians retire early or leave practice.

It's hard to imagine this type of stress without having worked in health care.

Do even the "lower-risk" specialties experience this type of stress? And can't physicians expect insurance to reasonably protect them from suits... assuming that they know what they're doing?

I wish I knew what non clinical options were possible without finishing residency. I'm not even convinced there are that many if you do finish residency. I've been out of my residency (without finishing) for almost 3 years and have found nothing. I've been working a moonlighting type job, and it's not a good long term solution.

A MD degree doesn't qualify you to do much other than be a doctor. Sure, some people have gotten consulting or business type jobs, I'm not sure how you do that without a business background. Same with research- that's not really an OJT thing. Blogging takes a lot of time to build up, and somehow you have to get traffic to the blog (something I haven't figured out how to do yet)

Sadly, I will have to try to pick a specialty that I think is tolerable and retrain. I can't imagine ever enjoying working in medicine, but I will have to at least to pay off the debt.

Just out of curiosity... at what point in your training did you realize that you made a mistake? What did you learn specifically in school and residency that made you become disenchanted with medicine... despite your experiences as a premed?
 
Just out of curiosity... at what point in your training did you realize that you made a mistake? What did you learn specifically in school and residency that made you become disenchanted with medicine... despite your experiences as a premed?

It is a long and complex story. i actually was a nontraditional student. Always wanted to be a doctor but life got in the way. Finally went back to med school at age 38. Loved being in med school, and matched into my #2 choice in general surgery. I thought life was going to be great!

After that, it was just a long, slow process of becoming dissatisfied. You don't realize how little control you have over things as a doctor. There is a lot of utterly stupid bureaucracy in medicine. And as the government tries to take control, more and more paperwork is required to prove you are meeting government guidelines.

Then there are the patients. They are getting harder to deal with- more demanding, more and more unreasonable expectations, more often with an in-your face confrontational attitude.



Ultimately, I rarely felt any sense of satisfaction from being a doctor. I still liked the intellectual aspects, and enjoyed being in conference discussing cases, but I wanted nothing to do with patients, or even a lot of nurses. I was tired of the pager intruding on my life. (at first it seems cool or exciitng when you get paged, but after a while I found that, at 2 am, I'd really rather just smash the pager into tiny bits)

As I was trying to get a handle on my dissatisfaction and figure out what to do, I read an article by a CT surgeon who had a heart attack himself and had to have surgery, and then slowed down his practice afterward. He described my feelings perfectly: society expects doctors to engage in "altruistic self destruction".

Ultimately, it came down to this: I had to meet everybody else's needs on demand (patients, nurses, attendings...) but nobody cared if my needs were or were not met. Nobody cared if I have time to eat, sleep or pee. When somebody decides they want something from me, they want it right now. If they don't get what they want when they want it, there are often complaints.

It doesn't matter if it's 8 pm and I've been in the OR all day now I have to do evening rounds. I stop in on pt 3 (of 15) and the room is packed with family members who have arrived from out of town, pt is several days post op, and the family bombards me for 30 min with questions (that I've already discussed with pt's spouse, but God forbid they talk to their own family). I have to smile and take it because if the family isn't happy they will go to administration and complain. So I leave the hospital at 9:30 pm, having missed out on my plans for the evening, and haven't eaten dinner. I'm dead dog tired- my back hurts, my knees hurt, my feet hurt. I have to arrive at hospital at 6 am and do it all over again. I have to prepare a talk for conference in 3 days. I don't have time to make anything healthy to eat,. So i shovel in some crappy food while spending a little time working on my presentation and then fall into bed exhausted. Get up at 5 to repeat the whole thing over again.

Ultimately the pain/benefit ratio wasn't worth it.

Maybe you won't find that these things bother you. Part of the problem with medicine is that you really don't get a good idea of what it is like, or if you can tolerate that reality, until you've invested so much money that it's too late. The student loan debt can be a huge trap. I find I recommend going though med school as cheap as possible, and avoiding debt as much as possible. You can't know now how things will play out. Nothing is worse than feeling trapped in a job/career you hate because of student loan debt.
 
Some people are going to be depressed and want to quit any field they go into because they are always looking for one that will pay them $1 million a year.

Bingo! But that's true for most people (outside of medicine, especially), until they're old enough to wise up and face reality.
 
What a thoughtful post, notinkansas. "Altruistic self destruction" about sums it up. Wish I heard and realized the implications of that term before medical school. I hope everything works out for you!
 
I heard of an MD who worked for Kaplan writing questions and made a bundle.

Ultimately, I think the easiest road is to stay in medicine and just find a specialty and career that suits you. There are SOO many careers in medicine (dozens of specialties, research, academics) that unless you find something outside of medicine that really makes you happy, it's not financially worth it to leave.
 
great post, but i'm sure you realize you were in surgery hell, and not all of "medicine" is that bad . . .

Perhaps you are right. But it got to the point where I just didn't want to deal with people at all. (maybe because I was in surgery, maybe not) Looking at anesthesia- the idea of taking pts away from the family and knocking them out is attractive, but still being on call often involves being up all night doing cases. Radiology takes patients out of the mix, but I think I'd go crazy with everybody calling me for reads all night long on call. Pathology: might be OK in terms of dealing with others, but it seems like job market is getting saturated. It just seems to me that Americans expect their doctors to engage in altruistic self destruction. Right now I'm having a bit of a hard time figuring out what would be the least painful route for me.

Oddly, I do still want to have a skill that can be used for international volunteer work. It is gratifying to take care of people who don't have an entitlement mentality, and who have nowhere else to go, and who trust that you are doing the best you can for them, even if you aren't perfect. I don't think that attitude exists in America any more.
 
great post, but i'm sure you realize you were in surgery hell, and not all of "medicine" is that bad . . .

Well, I think that each field of medicine has its crap. While not all of "medicine" is that bad, I wouldn't say that there are parts of medicine that are a bed of roses with zero issues whatsoever.

The practice of medicine is, in many ways, changing, I think. Skyrocketing malpractice rates have something to do with it, as does the increasingly disturbing trend that patients are not "patients" so much as consumers. There is a plethora of information that is available to the lay public, but without a corresponding ability to interpret that information. Veteran nurses (some of whom are on SDN) have noted that there is an increasing sense among patients of entitlement and "I deserve." "I deserve to be totally pain free." "I deserve to live a long life without working to maintain my health." "I deserve antibiotics and narcotics because I know my body best." "I deserve to have a perfect outcome each time I have surgery or deliver a baby." "I deserve to have the doctors do EVERYTHING for me." "If I need a test, I deserve to have the test performed RIGHT NOW."

The thing is, sometimes people will have to learn to live with pain. Sometimes things go wrong even though the doctors and nurses did everything right. There IS a disease called "Your time on earth is up," and that's all there is to it. Antibiotics and narcotics have their dangers, and are not always the best things to give out. But trying to convince some patients of this is...well, difficult.
 
Well, I think that each field of medicine has its crap. While not all of "medicine" is that bad, I wouldn't say that there are parts of medicine that are a bed of roses with zero issues whatsoever.

There IS a disease called "Your time on earth is up," and that's all there is to it.

I'm not looking for a bed of roses with zero issues. I'm looking for something that has tolerable issues. Personally, I am having a difficult time tolerating the toxic attitudes that people bring. it's not just patients, though that is a big problem. People need to understand that we can't guarantee perfection and that, ultimately, the disease "your time on earth is up" has a 100% mortality rate.

Example of generic BS: got a call from a nurse today (while working my moonlighting job). Pt is post op day 3 from a big hernia repair. She normally has edema but it's worse after surgery (as we would expect- one retains fluid for the first few post op days then mobilizes it) The family members show up and become angry.

Somehow in the conversation with the nurse it is discovered that the patient isn't on her home HCTZ. However, there is no documentation in the chart that the pt is on HCTZ at home, nor is there indication as to what the dose might be. The family is angry and demanding that the pt be given home meds. I tell the nurse on the phone, that I will be happy to do that- all I need to know is the dose. Nobody in the family has any idea. So the daughter goes home and checks, and calls back. I get a second call from the nurse that as to what the dose is and by the way, the pt is on lisinopril too and the family wants that started. Fine. Both of these meds would have been included in the immediate post op orders if the patient had mentioned these meds when she came in for her preop evaluation and H&P.

Now the family will likely go around saying that those dumb ass evil doctors tried to withhold the pt's medication and that's why her legs swelled up so bad. The will not recognize that we can't order a home med if we don't know what the home meds are. When we ask you during your pre op H&P do you have any medical problems and do you take any medications- that would be a good time to speak up!
 
That is exactly why I think every person in America needs to have a portable, accessible electronic record that they can take from doctor to doctor, clinic to hospital, and we don't have to rely on patients' poor recall ("oh, I take that small white pill, I don't know the name"). There really should be no need to complete histrories on anyone--just updates with new information as they occur. It would save so much interviewing time and frustration.
 
Right now I'm having a bit of a hard time figuring out what would be the least painful route for me.

If if you ever figure that out, please do me a favor and send a PM or post on here. I hope you figure it out before September (for my sake :p ).


Oddly, I do still want to have a skill that can be used for international volunteer work.

Me too! If not surgery, would family medicine provide the best skill set internationally?
 
I know one military doc with one year of internship under his belt who after his commitment was up, decided to pursue an MBA. Big factor probably was that he had zero debt.
 
Bingo! But that's true for most people (outside of medicine, especially), until they're old enough to wise up and face reality.

Yes, I know, but the problem is that these people somehow think that if they picked a different career they would be happy, unlike in medicine. When in actuality if their career path diverged in college and they decided on an MBA instead, they might now be working 110 hours/week on wall street and wishing they had gone to med school instead. It's the "grass is always greener on the other side" syndrome. It is very easy to idealize careers and specialities which we have less experience with and knowledge of.
 
Yes, I know, but the problem is that these people somehow think that if they picked a different career they would be happy, unlike in medicine. When in actuality if their career path diverged in college and they decided on an MBA instead, they might now be working 110 hours/week on wall street and wishing they had gone to med school instead. It's the "grass is always greener on the other side" syndrome. It is very easy to idealize careers and specialities which we have less experience with and knowledge of.

The grass is always greener. But, out of all the friends I have in finance and consulting, not a single one says they wish they had gone to medical school - especially not considering the changes that are happening and will continue to happen in the next decade or so.

But, even if a financier did want to go to medical school, he/she would most likely be able to do it (flash their Ivy credentials, take the MCAT, and make up a story about hating business and wanting to make a difference in the world). Going from medicine to finance is damn near impossible without ridiculous hookups. You could probably count on one hand (I only know one) the number of physicians in respectable IBs, HFs, PE, VC, etc.
 
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There are so many reasons why physicians choose to leave, but let me list a few so that people don't make any quick assumptions:

  • Financial gain (we can't deny this)
  • Improved work/life balance (even at the cost of lower income for some)
  • Disability (yes, doctors can get disabled, but in many cases they can continue to work and still collect disability - depending on the type of insurance you purchased)
  • Instability (you may not be disabled, but you may be impaired for a variety of reasons)
  • They find new opportunities (if you're an entrepreneur and you identify a huge opportunity, why not?)
  • To have a blended career (30% clinical, 30% non-clinical, 30% at home)
  • To work from home (if you're working virtually, then you can work from anywhere in the world)
  • Burn out (yes, it happens to everyone. I hope you can bounce back)
  • Rising malpractice premiums (especially true if you've been sued several times)
  • Emotional drain (if you're working in hospice, geriatrics, or oncology, then you're faced with death all the time. how would you handle that?)
  • To travel the world (some love to travel, so why not travel on the company's budget? jobs in sales, consulting, or media. Where do you think Sanjay Gupta's been?)
  • To experience international health (many international public health jobs with the WHO)
  • Government benefits (medical officer jobs with the FDA, the NIH, etc.)
Of course, there are also those who simply wish to avoid the smell of gangrenous wounds and colostomy pouches.
 
There are so many reasons why physicians choose to leave, but let me list a few so that people don't make any quick assumptions:

  • Financial gain (we can't deny this)
  • Improved work/life balance (even at the cost of lower income for some)
  • Disability (yes, doctors can get disabled, but in many cases they can continue to work and still collect disability - depending on the type of insurance you purchased)
  • Instability (you may not be disabled, but you may be impaired for a variety of reasons)
  • They find new opportunities (if you're an entrepreneur and you identify a huge opportunity, why not?)
  • To have a blended career (30% clinical, 30% non-clinical, 30% at home)
  • To work from home (if you're working virtually, then you can work from anywhere in the world)
  • Burn out (yes, it happens to everyone. I hope you can bounce back)
  • Rising malpractice premiums (especially true if you've been sued several times)
  • Emotional drain (if you're working in hospice, geriatrics, or oncology, then you're faced with death all the time. how would you handle that?)
  • To travel the world (some love to travel, so why not travel on the company's budget? jobs in sales, consulting, or media. Where do you think Sanjay Gupta's been?)
  • To experience international health (many international public health jobs with the WHO)
  • Government benefits (medical officer jobs with the FDA, the NIH, etc.)
Of course, there are also those who simply wish to avoid the smell of gangrenous wounds and colostomy pouches.

That 30% 30% 30% option sounds pretty good to me!!
 
If if you ever figure that out, please do me a favor and send a PM or post on here. I hope you figure it out before September (for my sake :p )


Me too! If not surgery, would family medicine provide the best skill set internationally?

Actually, that's what I am leaning toward. The program in my city is affiliated with Shoulder to Shoulder (Google it, interesting program and a number of FM programs have affiliation) and has an international health track, so I could go on a couple volunteer trips even during residency. I've met with a couple faculty with the local program and they are willing to entertain an application outside the match. The idea of losing control of my life for residency again is a bit unpalatable, but they do seem to have a decent system here so that call isn't too frequent. I'm not sure how I would feel about working as FM doc in the US, it certainly wouldn't eliminate a lot of the patient and bureacracy related BS that drives me bonkers. But I hope that being able to go on short volunteer trips would help me get though the crap.

I wish that I was able to do some business that would generate the income I need and pay down my debt, but I don't have any skills that allow that. So it looks like I'll have to work as MD at least until my loans are paid. And that is the main problem with medicine, if you don't like it- it is hard to get out.
 
Me too!! How to achieve that is the question...

I'm getting my MHA and really interesting in consulting, doing some management, etc, while balancing clinical practice. I'm very new to the game, so we'll see how well my ideas hold up, how logical it all it, etc.
 
This is kind of far out there but not impossible - but if you have any talent with writing you could break into the movie/tv entertainment industry by writing treatments or screenplays and shopping them around. Or you could use your medical background and offer your services as a consultant for writers working on projects that are medical in nature. We have all seen shows where implausible "medical-type things" happen probably because the writing team didn't consult with an MD.

Side note:
Senor Chang the Spanish teacher on the show Community (real name Dr. Ken) - he was a practicing physician and did stand-up comedy on the side until he hit it big. That guy is hilarious.
:laugh:

Spoiler alert - recent episode of Community (s01e23 modern warfare)
My favorite scene :D

[YOUTUBE]http://www.youtube.com/watch?v=bv0anibardo&feature=related[/YOUTUBE]
 
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This is kind of far out there but not impossible - but if you have any talent with writing you could break into the movie/tv entertainment industry by writing treatments or screenplays and shopping them around. Or you could use your medical background and offer your services as a consultant for writers working on projects that are medical in nature. We have all seen shows where implausible "medical-type things" happen probably because the writing team didn't consult with an MD.

Side note:
Senor Chang the Spanish teacher on the show Community (real name Dr. Ken) - he was a practicing physician and did stand-up comedy on the side until he hit it big. That guy is hilarious.
:laugh:

Spoiler alert - recent episode of Community (s01e23 modern warfare)
My favorite scene :D

[YOUTUBE]http://www.youtube.com/watch?v=bv0anibardo&feature=related[/YOUTUBE]

That Dr Ken guy is a baller. He was an IM guy while working on his comedy routine. I think trying to do some entertainment stuff with a medical background is a decent idea. Probably very saturated, but if you could find a manager to get you gigs as a consultant, spokesperson, etc, you'd probably do great.

Funny story, I shadowed a doctor who went to Western University in Pomona, CA, and one of his classmates was finishing up some sort of entertainment classes at USC during the same time, bumped into a guy who was starting a medical show, and ended up getting a job as the medical expert/consultant (something along these lines. The timeline may be messed up, it was a while ago when he told me this). Long story short, the show, called "ER," turned out to be a pretty big hit, and I'm sure the guy did well ;)

I'd love to get involved with something like that.
 
Um, yeah, but you have to be willing to be seen on the big screen naked with your weiner hanging out, like Dr. Ken.
 
I'm assuming the resident air freshener has seen "The Hangover", however I doubt it was watched on the "big screen" since most people go to the movie theater with friends and loved ones.
 
Recently, I've been approached by many residents who wish to leave their program. Some have already left and they're looking for some job opportunities. Others are wrestling with the decision because they're not sure about their long-term career goals. When my wife was a chief resident at Penn, several residents left or switched to different residencies.

I'm curious - how often do you encounter residents who are serious about leaving? What type of advice do you give that's most effective in motivating them to stay in residency?


I have encountered quite a lot of them at the graduation level in India . A good number of them opt out after finishing the grad's level and opt either for MBA/HA or they sit for civil services ,nowadays .
 
I'm assuming the resident air freshener has seen "The Hangover", however I doubt it was watched on the "big screen" since most people go to the movie theater with friends and loved ones.

It's true. I actually watched it at home with your mom! :thumbup:
 
Recently, I've been approached by many residents who wish to leave their program. Some have already left and they're looking for some job opportunities. Others are wrestling with the decision because they're not sure about their long-term career goals. When my wife was a chief resident at Penn, several residents left or switched to different residencies.

I'm curious - how often do you encounter residents who are serious about leaving? What type of advice do you give that's most effective in motivating them to stay in residency?

Sorry DrKim, but what are these "non-clinical jobs" you vaguely post about?

I've read your blog, and the pickings seem awfully slim for a residency-trained MD without another degree such as an MPH, MBA, and appropriate skills. I don't see what an MD + res brings to the non-clinical table..
 
1990 IMG graduate. MS Neuroscience 1999, for 10 years work in research, worked hard to get GC through work and support my family back home, next year will be US citizen.
Passed step 1 and 2 10 years ago with low scores and attempts. Re-took all steps 2008-2009 Step 1 81, Step 2 86, Step 3 79, all first attempts. In 2008 3 months USCE and 2 US LOR's, 1 LOR from PhD supervisor.
In 2009 Applied 117 programs Psych/Neuro/FM/IM, not even one interview. Planning to apply this year Psychiatry/Pathology but not much optimistic about that.
Also applying to PA school this year, because I am not allowed to pass the exam without schooling. If I don't get any IV's I think I will quit applying and become PA if they take me (as they may not take me) One more good doctor will be lost for the 32 millions Americans soon to be insured.
I have put my life on hold for so many years to be a doctor in USA, struggling alone with visas and money, now when I want to at least have children I cannot even have that.
Decide wisely when you are leaving.
GL
 
1990 IMG graduate. MS Neuroscience 1999, for 10 years work in research, worked hard to get GC through work and support my family back home, next year will be US citizen.
Passed step 1 and 2 10 years ago with low scores and attempts. Re-took all steps 2008-2009 Step 1 81, Step 2 86, Step 3 79, all first attempts. In 2008 3 months USCE and 2 US LOR's, 1 LOR from PhD supervisor.
In 2009 Applied 117 programs Psych/Neuro/FM/IM, not even one interview. Planning to apply this year Psychiatry/Pathology but not much optimistic about that.
Also applying to PA school this year, because I am not allowed to pass the exam without schooling. If I don't get any IV's I think I will quit applying and become PA if they take me (as they may not take me) One more good doctor will be lost for the 32 millions Americans soon to be insured.
I have put my life on hold for so many years to be a doctor in USA, struggling alone with visas and money, now when I want to at least have children I cannot even have that.
Decide wisely when you are leaving.
GL
No offense, Nedi, but I don't think your situation parallels many of the posters on this forum. As an older IMG, many clinical, as well as non-clinical options are closed off for you (or at least severely limited).
I don't advise the younger, culturally American residents or medical students to leave medicine to go do bench work, but there are options out there. It isn't the end of the world if you leave medicine, but certainly do your diligence about the industry that you would like to enter. Don't leave until you're absolutely certain. Once you leave, the doors aren't opening back up at your whim.

And best of luck to you, man. I hope a PD somewhere would give you a chance. I personally have more respect for many IMGs than most AMGs. Moving to a different country to start over is tough. I don't know if I would have the courage.
 
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Nedi, I've worked with many people who have similar backgrounds and they've been quite successful finding jobs in the non-clinical world.

It's critical to possess strong leadership and communication skills so that you can be an integral member of a larger team. The jobs are out there. You need to know how to market yourself and leverage networks to get your foot into the door. Many people never even get an interview because they don't have well-written CVs.
 
It is a long and complex story. i actually was a nontraditional student. Always wanted to be a doctor but life got in the way. Finally went back to med school at age 38. Loved being in med school, and matched into my #2 choice in general surgery. I thought life was going to be great!

After that, it was just a long, slow process of becoming dissatisfied. You don't realize how little control you have over things as a doctor. There is a lot of utterly stupid bureaucracy in medicine. And as the government tries to take control, more and more paperwork is required to prove you are meeting government guidelines.

Then there are the patients. They are getting harder to deal with- more demanding, more and more unreasonable expectations, more often with an in-your face confrontational attitude.



Ultimately, I rarely felt any sense of satisfaction from being a doctor. I still liked the intellectual aspects, and enjoyed being in conference discussing cases, but I wanted nothing to do with patients, or even a lot of nurses. I was tired of the pager intruding on my life. (at first it seems cool or exciitng when you get paged, but after a while I found that, at 2 am, I'd really rather just smash the pager into tiny bits)

As I was trying to get a handle on my dissatisfaction and figure out what to do, I read an article by a CT surgeon who had a heart attack himself and had to have surgery, and then slowed down his practice afterward. He described my feelings perfectly: society expects doctors to engage in "altruistic self destruction".

Ultimately, it came down to this: I had to meet everybody else's needs on demand (patients, nurses, attendings...) but nobody cared if my needs were or were not met. Nobody cared if I have time to eat, sleep or pee. When somebody decides they want something from me, they want it right now. If they don't get what they want when they want it, there are often complaints.

It doesn't matter if it's 8 pm and I've been in the OR all day now I have to do evening rounds. I stop in on pt 3 (of 15) and the room is packed with family members who have arrived from out of town, pt is several days post op, and the family bombards me for 30 min with questions (that I've already discussed with pt's spouse, but God forbid they talk to their own family). I have to smile and take it because if the family isn't happy they will go to administration and complain. So I leave the hospital at 9:30 pm, having missed out on my plans for the evening, and haven't eaten dinner. I'm dead dog tired- my back hurts, my knees hurt, my feet hurt. I have to arrive at hospital at 6 am and do it all over again. I have to prepare a talk for conference in 3 days. I don't have time to make anything healthy to eat,. So i shovel in some crappy food while spending a little time working on my presentation and then fall into bed exhausted. Get up at 5 to repeat the whole thing over again.

Ultimately the pain/benefit ratio wasn't worth it.

Maybe you won't find that these things bother you. Part of the problem with medicine is that you really don't get a good idea of what it is like, or if you can tolerate that reality, until you've invested so much money that it's too late. The student loan debt can be a huge trap. I find I recommend going though med school as cheap as possible, and avoiding debt as much as possible. You can't know now how things will play out. Nothing is worse than feeling trapped in a job/career you hate because of student loan debt.

Wow. That is a great post. Thank you for writting what many surgeons wants to write and say but don't have the guts or the venue to do so. Honestly, they just don't want to do the big cases anymore because it's too much hassle and not enough reward. The truth is that more and more people feel this way, these days. I see it in their faces. Practicing medicine just isn't what it should be. Surgery is great in a perfect world, unfortunately, everything that you said brings it down to a level of servitude only. What the hell happened to respect in this world.
 
Just so you guys know, the way to deal with being bombarded with questions from family members is to just use as much medical jargon as possible, even things that don't apply. Start using obscure eponyms and occassionally lapse into memories of your childhood. When confronted, become angry and challenge the intellect of the people questioning you with obscure facts. In other words, treat the patients like residents are treated. It has been demonstrated to work and is ACGME approved. :thumbup:
 
I heard of an MD who worked for Kaplan writing questions and made a bundle.

Ultimately, I think the easiest road is to stay in medicine and just find a specialty and career that suits you. There are SOO many careers in medicine (dozens of specialties, research, academics) that unless you find something outside of medicine that really makes you happy, it's not financially worth it to leave.


I agree fully! One must complete a residency to shoulder the debt burden, regardless of weather or not you actually practice.....

And Thanks "notinkansas"....your post is actually a large part of why I chose not to do a residency........


Hello all.

My situation is long and complex so I'll abbreviate it A LOT, especially since it’s my first post.

I graduated from what most would consider a top notch US medical school in May, 2008. My life situation/circumstances were such that I decided to forego a residency, Sort of….

I started Medical school when I was 32, after multiple application attempts and 5+ years of research in academia (basic and pre-clinical) and the Biotech industry (Mostly Clinical Trials Management). I struggled quite a bit in Med School, but never failed a class or rotation.

Between 2nd year and my last year I met a women, got married, got a dog and had a child…..I half heartedly studied for step 2 and took it late in my 4th year….Ended up scrambling and finding out I failed Step 2 on the same day….Matched in the scramble in IM but didn’t know how I could retake the boards so quickly. Also, geographically it was going to be difficult. No work for my Wife. Finally, I was pretty disgruntled with the “Establishment” (see notinkansas' post)and really didn’t know what I wanted to go into……Seeing no other option I made a bad choice…….I decided I would go back into Biotech and start making money right away…

I think we all know what happened shortly after May of 2008…..The economy crashed….I have spent the last 2 years partially employed, both due to the economy and the fact that I’m not licensed/boarded. Places pretty much want only BE/BC docs…..I can get contract work making pretty decent money but contract work is hardly consistent and pretty damn stressful. Usually end up going into “broken” environments and being expected to fix things. You’re expected to do the impossible and get no respect while doing it…..Hey, Sounds like medschool (And probably more like internship)J

There’s more, but the bottom line is I really want to get back onto the treadmill. I’m starting to study again for step 2 but am pretty nervous about getting back into it…..Don’t really know where to start (except to study and take step 2)

I’m possibly very interested in the idea of doing a GMO tour in the Navy, or perhaps a transitional/prelim. On my list of interests are FM, Psych and Anesthesia (possibly PM&R or IM)……..Any advice/help/comments, etc. about getting back to becoming a real doctor, not a half a doctor would be very much appreciated….I’d be happy to discuss more details of my situation via email/PM with those whom I feel are trustworthy. Thanks in advance for your assistance.

Please let me know if I should have started a new thread…

-Half a Doc
 
Perhaps you are right. But it got to the point where I just didn't want to deal with people at all. (maybe because I was in surgery, maybe not) Looking at anesthesia- the idea of taking pts away from the family and knocking them out is attractive, but still being on call often involves being up all night doing cases. Radiology takes patients out of the mix, but I think I'd go crazy with everybody calling me for reads all night long on call. Pathology: might be OK in terms of dealing with others, but it seems like job market is getting saturated. It just seems to me that Americans expect their doctors to engage in altruistic self destruction. Right now I'm having a bit of a hard time figuring out what would be the least painful route for me.

Oddly, I do still want to have a skill that can be used for international volunteer work. It is gratifying to take care of people who don't have an entitlement mentality, and who have nowhere else to go, and who trust that you are doing the best you can for them, even if you aren't perfect. I don't think that attitude exists in America any more.

thanks for the honesty, i really appreciate brutally honest posts like yours. what was your career before medicine?
 
Well, I think that each field of medicine has its crap. While not all of "medicine" is that bad, I wouldn't say that there are parts of medicine that are a bed of roses with zero issues whatsoever.

The practice of medicine is, in many ways, changing, I think. Skyrocketing malpractice rates have something to do with it, as does the increasingly disturbing trend that patients are not "patients" so much as consumers. There is a plethora of information that is available to the lay public, but without a corresponding ability to interpret that information. Veteran nurses (some of whom are on SDN) have noted that there is an increasing sense among patients of entitlement and "I deserve." "I deserve to be totally pain free." "I deserve to live a long life without working to maintain my health." "I deserve antibiotics and narcotics because I know my body best." "I deserve to have a perfect outcome each time I have surgery or deliver a baby." "I deserve to have the doctors do EVERYTHING for me." "If I need a test, I deserve to have the test performed RIGHT NOW."

The thing is, sometimes people will have to learn to live with pain. Sometimes things go wrong even though the doctors and nurses did everything right. There IS a disease called "Your time on earth is up," and that's all there is to it. Antibiotics and narcotics have their dangers, and are not always the best things to give out. But trying to convince some patients of this is...well, difficult.

ya people in the usa are so demanding of things. they aren't patients, they are THE CONSUMER, and they are now YOUR BOSS and if you dont do what THEY WANT, they will go at you with a vengence. it is really sad that is how things are.

what if TORT reform happened? could you see medicine changing?
 
FYI, i knew a guy during my undergrad who was a med student at my school.

I was shocked he was in med school. when i asked for his opinion and advice. he said he was looking to get a Dental degree when he was finished. talked to me about all the bull**** in medicine and the politics. he said he was going to try to get a shortened dental degree. i believe he finished up back in 2003 with medicine. i lost contact with him but am very curious if he went to dental afterwards.
 
FYI, i knew a guy during my undergrad who was a med student at my school.

I was shocked he was in med school. when i asked for his opinion and advice. he said he was looking to get a Dental degree when he was finished. talked to me about all the bull**** in medicine and the politics. he said he was going to try to get a shortened dental degree. i believe he finished up back in 2003 with medicine. i lost contact with him but am very curious if he went to dental afterwards.

The politics is something that was a surprise and mostly due to my nativity. I can't believe how much underhanded and vicious some of these doctors are to their own kind. It's really pathetic and sad. Everyone is out to protect themselves, there's no camaraderie and it is no surprise that these people are continuously getting their ass handed to them by the administration, the government and the nursing union. Sometimes I just want to grab some of these attendings who are in charge and just yell "Grow a pair, will you, you freaking pansy." But I have to be fair and say that the brave few who have spoken out and stood their ground were quickly disposed off by the ruling hospital administration. Again, that is mainly due to the lack of camaraderie within their circle.
 
that varies widely. I have seen such a lack of camaraderie, I've also seen wonderful brotherhood. Try somewhere else.
 
that varies widely. I have seen such a lack of camaraderie, I've also seen wonderful brotherhood. Try somewhere else.

Yeah right. We rotate through six hospitals. Seen a good deal of stuff. Mostly bunch of blowhearts. Wonderful brotherhoods is not the norm. Keep your advice. :cool:
 
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