Second thoughts

[Distressedlad]

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A little background.
DO and a little older than most residents.
I did great on complex but average on USMLE.
I did not have a good third year and was not so sure of my level of knowledge and skills.
I was not sure of medicine either. I heard of pmr, applied and got in.
Have completed my intern year and during that time I realized that my medical knowledge and interests lie in medicine, specifically EM.
Now I am starting pmr and am really not happy.
I don't know much about pmr since I just did just one rotation in it. At thy time the fear my medical school put in us was that we had to match and that was the reason I picked pmr. In hind site, I would have been better off not matching and instead done intern year and reapplied.
However, whichever doc I talk to outside pmr, they only have good things to say about the profession. I am not sure if they know what a pmr doc really does or are they just being nice.
I am really confused at this point. Don't know if I should talk to my pd or just keep going.
Any people here who hve done this before, that is switching from pmr to ER?

 

[ThoracicGuy]

A little background.
DO and a little older than most residents.
I did great on complex but average on USMLE.
I did not have a good third year and was not so sure of my level of knowledge and skills.
I was not sure of medicine either. I heard of pmr, applied and got in.
Have completed my intern year and during that time I realized that my medical knowledge and interests lie in medicine, specifically EM.
Now I am starting pmr and am really not happy.
I don't know much about pmr since I just did just one rotation in it. At thy time the fear my medical school put in us was that we had to match and that was the reason I picked pmr. In hind site, I would have been better off not matching and instead done intern year and reapplied.
However, whichever doc I talk to outside pmr, they only have good things to say about the profession. I am not sure if they know what a pmr doc really does or are they just being nice.
I am really confused at this point. Don't know if I should talk to my pd or just keep going.
Any people here who hve done this before, that is switching from pmr to ER?

Why do you think it will be better doing EM? How competitive would you have been applying for EM as a senior med student?

 

[rokshana]

A little background.
DO and a little older than most residents.
I did great on complex but average on USMLE.
I did not have a good third year and was not so sure of my level of knowledge and skills.
I was not sure of medicine either. I heard of pmr, applied and got in.
Have completed my intern year and during that time I realized that my medical knowledge and interests lie in medicine, specifically EM.
Now I am starting pmr and am really not happy.
I don't know much about pmr since I just did just one rotation in it. At thy time the fear my medical school put in us was that we had to match and that was the reason I picked pmr. In hind site, I would have been better off not matching and instead done intern year and reapplied.
However, whichever doc I talk to outside pmr, they only have good things to say about the profession. I am not sure if they know what a pmr doc really does or are they just being nice.
I am really confused at this point. Don't know if I should talk to my pd or just keep going.
Any people here who hve done this before, that is switching from pmr to ER?

Have you actually had a year in pm&r or do you start tomorrow?

If you have already done a year and know that this isn't for you then talk to your pd if you are absolutely sure that this is not for you... Meaning that you are fine not matching into anything... While EM tends to be a bit more DO friendly you will have some red flags and a few years out...

 

[Distressedlad]

I am starting pmr. I did a rotation in ER during my intern year and loved it. What do you mean by "if you are fine with not matching into anything"
I would have been competitive as an ER applicant.

 

[rokshana]

I am starting pmr. I did a rotation in ER during my intern year and loved it. What do you mean by "if you are fine with not matching into anything"
I would have been competitive as an ER applicant.

are you looking at DO EM spots? Or ACGME ones?

realize even if you were competitive 2 years ago,
you are now 2 years out
you are a DO (unless you are talking about DO spots) EM is more and more competitive and there are plenty of US seniors applying that programs have their choice...

don't know about your step/comlex scores, but they should be on the higher side, not average
don't know if you have any SLOEs and if you have the ability to get them, but if you don't

just saying, you take a big risk with deciding to resign from a residency spot to the unknown...there is always the chance that you won't match into EM...you need to be damn sure that pm&r is not for you before you take that leap...meaning you have to ask yourself, will you regret leaving residency if you never match into another program (go through the threads, there have been many that discuss the difficulties of getting another spot).

if you do decide to jump ship, hopefully you are in good standing and your PD will be helpful...in general they don't want people who are unhappy and truly feel they need to be in a different specialty.

 

[Distressedlad]

Recent article showed 30% of residents change their specialty. I do not see how if it was that difficult that we can have such a huge percentage of residents changing. My complex was 90% and my step was 226. I know that I will have been one year and a few months into training. Also I am mostly targeting new programs that are opening up. If you look at the SAEM website you will see that they are asking for applicants who may already I've a year of some other specialty.
Are there any people here with positive experiences?

 

[camedstudent23]

Recent article showed 30% of residents change their specialty. I do not see how if it was that difficult that we can have such a huge percentage of residents changing. My complex was 90% and my step was 226. I know that I will have been one year and a few months into training. Also I am mostly targeting new programs that are opening up. If you look at the SAEM website you will see that they are asking for applicants who may already I've a year of some other specialty.
Are there any people here with positive experiences?

Source on the 30%? There is absolutely no way that is true....I would put the true percentage ~5%. And most of those are US MD's....switching from something competitive (meaning their application is legit)>>>less competitive (like anesthesia, the most switched into specialty). And 226 is not average for EM, EM average 2 years ago was 230....and it has become a really hot specialty in the past few years because of reimbursements/lifestyle, so it's probably closer to 235 now.

 

[rokshana]

Recent article showed 30% of residents change their specialty. I do not see how if it was that difficult that we can have such a huge percentage of residents changing. My complex was 90% and my step was 226. I know that I will have been one year and a few months into training. Also I am mostly targeting new programs that are opening up. If you look at the SAEM website you will see that they are asking for applicants who may already I've a year of some other specialty.
Are there any people here with positive experiences?

can you give a link to that article...i suspect that many (if not most) of those switching were MD students not DO and many completed a residency and then did another residency after...if that many people were changing residencies during their residencies, it would be be more known and considered common...again review the threads on here and see how many people talk about how difficult it is to find another residency spot.

again, if you are looking for a DO EM spot, you may not have as many issues, but if you are looking for an ACGME spot, you will have hurdles to overcome...step (I and II) at 226 are on the lower end for EM and i take it no SLOE (even those new programs are still going to want them) and unless you find an unexpected opening, it will be 2 years since you graduated...

and i doubt there will be many that will give you a positive experience...not to say there aren't people out there with success in transferring to another program...but they probably don't post here that much...but there have been some people who have come back and updated their info.

 

[Law2Doc]

Yeah, no way it's 30%. Maybe you misread and it was 3.0%??

 

[Psai]

Recent article showed 30% of residents change their specialty. I do not see how if it was that difficult that we can have such a huge percentage of residents changing. My complex was 90% and my step was 226. I know that I will have been one year and a few months into training. Also I am mostly targeting new programs that are opening up. If you look at the SAEM website you will see that they are asking for applicants who may already I've a year of some other specialty.
Are there any people here with positive experiences?

Rofl

 

[mvenus929]

Recent article showed 30% of residents change their specialty. I do not see how if it was that difficult that we can have such a huge percentage of residents changing.

In my n=88 so far in my program, I know of 2 who have decided to switch, and one who has gone on to pursue a second residency. Out of my med school class (of 150ish), I'd estimate than once people started, maybe 1-2 switched out. Several changed their minds while applying the first time, either because they weren't competitive for what they were applying for, or their priorities changed through the season (or some combination thereof). So it's nowhere near the 30% you are suggesting.

 

[Distressedlad]

http://www.medscape.com/viewarticle/860491
Here is the article. According to it the number of residents that don't finish the residency they started in.
What is the huge deal between MD and DO switching. At the residency level after an international year it's pretty much blurry distinction.
I see so many threads on switching, so how is it not common. Most people don't come and give their feedback after they have done it, so we cannot say it is uncommon to do so.

 

[Distressedlad]

http://www.studentdoctor.net/2010/03/switching-specialties/
Another article 6 years ago.
All those who claim it is almost impossible base their argument on anecdotal evidence.
I am not arguing that it is a difficult process but it is very much doable and common.
I would appreciate it if some has done it and knows of the best way to approach my pd.
I have started at my program and it is a really good program but I am not feeling pmr. I enjoyed medicine and if I do not get ER then I would rather do family.

 

[rokshana]

http://www.medscape.com/viewarticle/860491
Here is the article. According to it the number of residents that don't finish the residency they started in.
What is the huge deal between MD and DO switching. At the residency level after an international year it's pretty much blurry distinction.
I see so many threads on switching, so how is it not common. Most people don't come and give their feedback after they have done it, so we cannot say it is uncommon to do so.

if you think that there is no difference between an AMG and a DO, you will soon find that out if you decide to switch...

anecdotally, in my program, 2 people didn't finish the residency...it was not by choice, so that 30% may not necessarily reflect just voluntary choices...

 

[hallowmann]

Source on the 30%? There is absolutely no way that is true....I would put the true percentage ~5%. And most of those are US MD's....switching from something competitive (meaning their application is legit)>>>less competitive (like anesthesia, the most switched into specialty). And 226 is not average for EM, EM average 2 years ago was 230....and it has become a really hot specialty in the past few years because of reimbursements/lifestyle, so it's probably closer to 235 now.

30% may be a bit high, but estimates I've heard have been somewhere in the range of 10-20%. I'm sure that in stronger programs the attrition is lower. Some specialties also demonstrate significantly less attrition than others. GS and OB/Gyn have historically had high attrition. I imagine IM and FM are probably significantly less. Sometime ago, I mentioned an article about GS attrition and it being 20%. At the time everyone replied with "no way", then I found a study showing it and most recanted. I don't know if I could find it again, but if I do I'll post it.

I personally know a number of physicians that have either switched in mid-residency, switched after deciding on something else during a TY, or redone a different residency.

http://www.studentdoctor.net/2010/03/switching-specialties/
Another article 6 years ago.
All those who claim it is almost impossible base their argument on anecdotal evidence.
I am not arguing that it is a difficult process but it is very much doable and common.
I would appreciate it if some has done it and knows of the best way to approach my pd.
I have started at my program and it is a really good program but I am not feeling pmr. I enjoyed medicine and if I do not get ER then I would rather do family.

By you have started, do you mean you started yesterday? I really think you should give it a little more time to make your decision. It would be one thing if you realized it early in your TY, but right at the end is kind of a problem. Either way you're going to have to finish out this year (or at least that would be best). If I were you, I'd wait a few months to make a decision. Really look at PM&R, give it a chance, then decide. Don't talk to your PD until you're certain. It'll help if you can develop a good relationship with your PD in the meantime (and otherwise be an impeccable resident).

Its a very difficult process, and is not the type of thing you can do easily, and honestly you really have to expect for things not to work out, because they honestly might not. That's why everyone is telling you to be reaaally sure before you throw away your residency.

I would also like to say that the articles you posted are including people who started pre-lims, TYs, and other non-categorical internships who went on to do some other categorical program. That absolutely inflates the percentage above real numbers, because most of those people didn't really have a program to leave in the first place.

I really doubt there are a ton of PM&R residents jumping ship. Like I said, most people that I know that jumped ship mid-residency were in GS, OB/Gyn, and I know a couple who were in Anesthesia. All of those switches were from a more competitive program to a less competitive one. You're talking about doing the opposite, which undoubtedly is harder.

Again, give it a couple months and if you still feel this way, talk to your PD. Good luck.

 

[BobBarker]

Do PM&R then do pain. Total no brainer!

 

[Law2Doc]

http://www.medscape.com/viewarticle/860491
Here is the article. According to it the number of residents that don't finish the residency they started in.
What is the huge deal between MD and DO switching. At the residency level after an international year it's pretty much blurry distinction.
I see so many threads on switching, so how is it not common. Most people don't come and give their feedback after they have done it, so we cannot say it is uncommon to do so.

Not finishing the residency they started in is not the same as changing specialty, which is what you initially posited.
Nobody is saying its not potentially "doable"or not "common", just that it's nowhere near a third of all residents. From personal experience it's more like 1 a program every couple of years and it's disruptive as heck. You'll find almost nobody out there who was in a residency class where a third of the people changed or left. Do you realize what a disaster that would be to the call schedule? And how impossible it would be to staff overnights? Many of us saw a lot of disruption just by a single person leaving our residency class (and not even for a different field), and are having a lot of trouble fathoming what a program would do if it lost 3-4.

 

[Law2Doc]

http://www.studentdoctor.net/2010/03/switching-specialties/
Another article 6 years ago.
All those who claim it is almost impossible base their argument on anecdotal evidence.
I am not arguing that it is a difficult process but it is very much doable and common.
I would appreciate it if some has done it and knows of the best way to approach my pd.
I have started at my program and it is a really good program but I am not feeling pmr. I enjoyed medicine and if I do not get ER then I would rather do family.

A third if the 20% or so attrition in surgical programs doesn't equal a third of all residents changing specialties (i.e. The number they gave was 75 out of 1000+) -- that's more like 7-8%. And that was the highest percentage of all those fields listed. We are talking single digits here.

 

[Raryn]

Last time I looked at the data, it was highly specialty dependent. IM attrition was c. 5% over 3 years. General surgery categorical programs were c. 20% over 5+ years. The highest of any field was Psychiatry at ~25% over 4 years.

Edit: and quick google fu brings up this paper that has the below figure with annual rates of attrition. Note, that the attrition rate includes residents who quit, get fired, change programs within the same specialty, or change specialties. The only data in the paper with the proportion of who is who is for ob/gyn, which state that 30% of the attrition was for specialty changes.

I think that the overall average length of training in residency is just over 4 years (given that all the largest specialties are 3 years), so likely the overall attrition rate for everyone over the course of a residency is somewhere in the mid-teens. If we use the 30% attrition leading to specialty change listed for ob/gyn as a reasonable estimate, that puts the number of people who change specialties right around 5-6%, which fits with our anecdotal data. But if anyone has better numbers, I'm certainly open to them.

Mean (± SD) Annual Attrition Rates of Residents in Clinical Specialties

 

[Distressedlad]

To law2doc, the article does not state exactly what the 30% is but it was in follow up to the 10% noted in earlier years that actually changed specialty. Look at Sdn and you will see tons of posts regarding switching specialties and that just in the recent month. If so many people are posting here on Sen, when many people in the medical world do not even come here. By extrapolating, I can assume the figure would be in the teens to twenties not single digits. Anyways I am actually not looking to argue with a bunch of people who nothing about the process but profess to be gurus here. All I am looking for is people who have been through this and know how to approach the subject.
I do not understand all the negativity especially from law2doc, very pathetic argument, when I do not even know you or would be applying to your field.
Also why are there so many posts just here on sdn about switching specialties, it's simply because the process is kind of not the best. I understand the cons also of allowing everyone to switch when they want but the fact that when you 're applying while in medical school, there are times when your first choice of specialty has very few spots and that was the only thing that motivated you to get into medicine in the first place. This is what happened to me. I applied pmr because I realized that it would be impossible to get into what I wanted.

 

[Psai]

To law2doc, the article does not state exactly what the 30% is but it was in follow up to the 10% noted in earlier years that actually changed specialty. Look at Sdn and you will see tons of posts regarding switching specialties and that just in the recent month. If so many people are posting here on Sen, when many people in the medical world do not even come here. By extrapolating, I can assume the figure would be in the teens to twenties not single digits. Anyways I am actually not looking to argue with a bunch of people who nothing about the process but profess to be gurus here. All I am looking for is people who have been through this and know how to approach the subject.
I do not understand all the negativity especially from law2doc, very pathetic argument, when I do not even know you or would be applying to your field.
Also why are there so many posts just here on sdn about switching specialties, it's simply because the process is kind of not the best. I understand the cons also of allowing everyone to switch when they want but the fact that when you 're applying while in medical school, there are times when your first choice of specialty has very few spots and that was the only thing that motivated you to get into medicine in the first place. This is what happened to me. I applied pmr because I realized that it would be impossible to get into what I wanted.

😕

That's not how extrapolating works. There are over 30k residency positions per year and that's just in the match. You're trying to tell us that nearly 10k residents (based on 30%) switch specialties per year and yet no one seems to know that many people who did it? I'm going to go ahead and trust my anecdotal evidence over your "published data".

 

[rokshana]

To law2doc, the article does not state exactly what the 30% is but it was in follow up to the 10% noted in earlier years that actually changed specialty. Look at Sdn and you will see tons of posts regarding switching specialties and that just in the recent month. If so many people are posting here on Sen, when many people in the medical world do not even come here. By extrapolating, I can assume the figure would be in the teens to twenties not single digits. Anyways I am actually not looking to argue with a bunch of people who nothing about the process but profess to be gurus here. All I am looking for is people who have been through this and know how to approach the subject.
I do not understand all the negativity especially from law2doc, very pathetic argument, when I do not even know you or would be applying to your field.
Also why are there so many posts just here on sdn about switching specialties, it's simply because the process is kind of not the best. I understand the cons also of allowing everyone to switch when they want but the fact that when you 're applying while in medical school, there are times when your first choice of specialty has very few spots and that was the only thing that motivated you to get into medicine in the first place. This is what happened to me. I applied pmr because I realized that it would be impossible to get into what I wanted.

think about it...if this was "so common", then wouldn't you have had someone "with experience " have come on here and posted their experience? after all if 30% of the residency pool have changed residency, there would be quite a number of people posting on sdn who have had that experience, yet...crickets....

and now the truth comes out...you didn't apply to your first choice for whatever reason, and now are regretting it...

look, if you came on here to have people tell you what you want hear (that YEAH!!! its ok for you to ditch the residency you have to pursue a flight of fancy and that you will have NO problems in doing this), then you are very new to sdn and came to the WRONG place...you put out a question here you are going to get everything from sympathy to ridicule...and need to realize that you need a thicker skin and take the information here for what its worth...as psai pointed out, if there were 10,000 switches going on a year, it would be more known...not completing the residency and voluntarily switching are not the same thing.

 

[Raryn]

To law2doc, the article does not state exactly what the 30% is but it was in follow up to the 10% noted in earlier years that actually changed specialty. Look at Sdn and you will see tons of posts regarding switching specialties and that just in the recent month. If so many people are posting here on Sen, when many people in the medical world do not even come here. By extrapolating, I can assume the figure would be in the teens to twenties not single digits. Anyways I am actually not looking to argue with a bunch of people who nothing about the process but profess to be gurus here. All I am looking for is people who have been through this and know how to approach the subject.
I do not understand all the negativity especially from law2doc, very pathetic argument, when I do not even know you or would be applying to your field.
Also why are there so many posts just here on sdn about switching specialties, it's simply because the process is kind of not the best. I understand the cons also of allowing everyone to switch when they want but the fact that when you 're applying while in medical school, there are times when your first choice of specialty has very few spots and that was the only thing that motivated you to get into medicine in the first place. This is what happened to me. I applied pmr because I realized that it would be impossible to get into what I wanted.

30% specialty change of the ~15% attrition rate is right around 5% of the total # of residents. Unless you have better data, that's the rate I'm going with.

 

[Law2Doc]

To law2doc, the article does not state exactly what the 30% is but it was in follow up to the 10% noted in earlier years that actually changed specialty. Look at Sdn and you will see tons of posts regarding switching specialties and that just in the recent month. If so many people are posting here on Sen, when many people in the medical world do not even come here. By extrapolating, I can assume the figure would be in the teens to twenties not single digits. Anyways I am actually not looking to argue with a bunch of people who nothing about the process but profess to be gurus here. All I am looking for is people who have been through this and know how to approach the subject.
I do not understand all the negativity especially from law2doc, very pathetic argument, when I do not even know you or would be applying to your field.
Also why are there so many posts just here on sdn about switching specialties, it's simply because the process is kind of not the best. I understand the cons also of allowing everyone to switch when they want but the fact that when you 're applying while in medical school, there are times when your first choice of specialty has very few spots and that was the only thing that motivated you to get into medicine in the first place. This is what happened to me. I applied pmr because I realized that it would be impossible to get into what I wanted.

You only see posts on SDN from the single digit percentage that are jumping ship. The 90+% who don't have no reason to post about it. Those of us who have been through residency can assure you we didn't see a third of our class depart. And can also assure you how disruptive that would be to a call schedule if that wasn't a rarity.

 

[hallowmann]

Last time I looked at the data, it was highly specialty dependent. IM attrition was c. 5% over 3 years. General surgery categorical programs were c. 20% over 5+ years. The highest of any field was Psychiatry at ~25% over 4 years.

Edit: and quick google fu brings up this paper that has the below figure with annual rates of attrition. Note, that the attrition rate includes residents who quit, get fired, change programs within the same specialty, or change specialties. The only data in the paper with the proportion of who is who is for ob/gyn, which state that 30% of the attrition was for specialty changes.

I think that the overall average length of training in residency is just over 4 years (given that all the largest specialties are 3 years), so likely the overall attrition rate for everyone over the course of a residency is somewhere in the mid-teens. If we use the 30% attrition leading to specialty change listed for ob/gyn as a reasonable estimate, that puts the number of people who change specialties right around 5-6%, which fits with our anecdotal data. But if anyone has better numbers, I'm certainly open to them.

Mean (± SD) Annual Attrition Rates of Residents in Clinical Specialties

Yeah, this fits what I was saying. 10-20% attrition across the length of the residency. I'm sure some of those people get kicked out, but wouldn't be surprised if many switch. It still only comes out to ~4%/year, which explains why very few people see this as a regular issue at individual programs, and why I've bumped into quite a few physicians that have stories about switching mid-residency. Its not extremely widespread, and significantly varies based on specialty and program.

 

[BoardingDoc]

http://www.medscape.com/viewarticle/860491
Here is the article. According to it the number of residents that don't finish the residency they started in.
What is the huge deal between MD and DO switching. At the residency level after an international year it's pretty much blurry distinction.
I see so many threads on switching, so how is it not common. Most people don't come and give their feedback after they have done it, so we cannot say it is uncommon to do so.

"Despite the inclusion of preliminary and transition spots, the data exceeded predictions at the time of analysis." So, they include the guy in optho who does a prelim in IM as not finishing in the same specialty? Or every single neuro resident? Or all the radiologists, anesthesiologists etc? Yeah, I'd say that adds up to about 30%.

 

[Winged Scapula]

"Despite the inclusion of preliminary and transition spots, the data exceeded predictions at the time of analysis." So, they include the guy in optho who does a prelim in IM as not finishing in the same specialty? Or every single neuro resident? Or all the radiologists, anesthesiologists etc? Yeah, I'd say that adds up to about 30%.

Thank you as that was my suspicion that they were including Prelim and TY.


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[Shikima]

What I'm not getting, initially OP cites that he's only done rotations. One rotation had more enthusiasm over the other, thus the basis of his claim for having cold feet and wanting to jump ship.

My recommendation, complete a year or 2 before you really say that the specialty is not for you.

 

[Distressedlad]

@Shikima. You make no sense at all. What?

 

[rokshana]

i get it...you did A rotation in PM&R and you did A rotation in EM...why do you think you will like EM any better than PM&R? Rotations are usually not truly representative of the specialty ...they just give a taste (and not necessarily an accurate one).

you are IN a residency right now...give it a few months, if by Nov-Dec you really don't think its for you then, you may want to talk to your PD at that time...bird in the hand though...

 

[Lostin_space]

Do PM&R then do pain. Total no brainer!

This! And I am one of those US AMG MDs who switched, I guess from a more "competitive" specialty to a PMR. But let me tell you the year I applied it was quite competitive and no easy task to get IVs at good programs. So I would warn OP that it's not that easy, and I certainly would not recommend switching the way I switched (did not tell my PD) but it was a really nerve wrecking situation to try to switch from a certain residency to a potential match in a different field, not to mention that as I found out, certain programs don't allow transfers. Pain is also awsome! and what I'm planning on going into. PMR has its issues like any other specialty, but the beauty of the field is that it is incredibly diverse and tons of different things you can do. Whether you like inpt., outpt, procedural, never want to touch a needle in your life, administrative, EMGs, sports, brain stuff, spinal cord, peds, etc, lots of options! Pay has also gone up so that's nice too and the lifestyle is not too bad.

As far as the % of those who switch, I know quite a few people who have switched specialties for all sorts of different reasons, both in my current and previous residency programs, and my understanding is that residency switchers are about 20% or so. I don't have stats on that but somewhere I've read. It's not *that* uncommon, just not super common.

 

[prone2xl]

DO here that just switched. Acgme to another acgme residency in a different specialty. Went into a more competitive specialty with longer training involved.


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