So, I've been asked by my program to look for another specialty :(

[nsap102]

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This question is more for PD's and Attendings...

I'm a PGY-2 and quite frankly my program feels that I'm not cutting it. I've been told by a faculty member to start looking at other specialties. My PD hasn't said anything yet, but I have a meeting comming up in the next month or so, and the faculty member who told me to look for another specialty is confident that the PD will feel the same way. I agree with this assessment.

So, I'd like help with the following, if you please,
1. Going back to the begining how do you figure out what you're best suited for?
2. Is it ok to stay within the same university system? i.e. same university but different specialty... If so, can my PD help me out with this?
a. Given that it is a third of the way through
the year, can a specialty just open up
another spot?
b. How does a specialty open up another spot?
c. How does funding come into play?
3. Where can I find out about the different types of specialties out there?
4. If you're a PD have you had to tell a resident a similar thing? What was the out come? How do things like this progress?
5. Am I ostracized from the field of medicine?????
5. Any tips are appreciated.

 

[BlondeDocteur]

Not a PD nor an attending, but a quick question-- what specialty are you in now? No need to get specific, just the specialty.

Secondly, how competitive an applicant to that specialty were you out of med school? What realistically is open to you?

Thirdly, what do they have problems with? Your medical knowledge, your professionalism, your ability to stay calm in emergencies/crises/codes/the OR? Obviously transitioning from, say, internal medicine to pathology if they think your knowledge isn't up to snuff will be hard; going to path if your ability to handle crises or multiple patients is the problem won't be.

This sounds like they are telling you not only are you not going to continue at their program, they won't support your applications to any other program in your field. In other words, quite serious.

 

[nsap102]

Hey BlondeDocteur,

Thanks for taking an interest in my situation. To answer your questions:

I'm in a patient centered specialty. I'm not exactly sure what is open to me...but, radiology would not have been available to me out of med school.

In terms of problems, the PD is really not sure. He's a bit baffled about some of my evaluations. So far, the thing they keep getting me on is that they feel I don't see the big picture and that I fixate on the minor details too much. That's from the attendings who gave me concerning evaluations. In terms of seniors who I rotated during my extra months, one was concerned that I worked too slowly and wouldn't be able to manage many patients at one time. Another said that my level of organization needed to be better in order to do the job. The other two said that I have to learn to play the game...i.e. it's not ideal medical practice; it's about real medical practice. In real medical practice it's about managing patients at a fast and high quality pace. Interestingly, all of them said that my medical knowledge was probably at their level.

In terms of where I stand with my program, well my PD after seeing the evals says that if things continue the way they are going then renewal of my contract will come into questions eventually. Until that time I should strongly consider looking for another specialty. Based on what the PD has seen, he/she thinks that I should go into a specialty which is more focused...i.e. dealing with few organ systems.

My PD also mentioned that the program doesn't intend to leave me stranded. But when I asked him/her how much they can and want to help me, I didn't get much of a reply.

In terms of what I'm thinking, well, I'm under the microscope, so anything less than perfect will be dismissed as suboptimal preformance and this will no doubt be grounds for not renewing my contract eventually. I also fell that there is a bit of "group thinking" going on here in that one senior faculty member thinks one thing and so the rest are inclined to agree. That's my take on it. Either way, it's going to be increasingly difficult to continue on in this program. In terms of taking up this specialty at this program...well, I doubt that's going to happen.

So, that's why I'm asking the questions I outlined in the original post of this thread.

I'd appreciate any help with this.

Thank you

 

[DontTaseMeBro]

I am switching from one field to another for personal reasons. I have been in the residency game for a couple of years. In my opinion you are not in a bad situation yet. It seems that if you really want to continue in your field you can and now would be the time to make a move. Ive seen alot of residents in your situation, who have seem to become the target of staff for extermination for whatever reason. The ball is still in your court right now. Now you still have the power to find and switch to another training program in your field. You need a letter from your PD, even if its not dazzling, just supporting your leaving your current program/contract obligations etc. Then I would find 2 or 3 other letter writers some may be from your departemnt some may be from other docs in other departments that really like you and will say good things to support you. Then its as simple as finding another program that has an open spots there are numerous posts on how to do this. One resource I have used and that I can say is accurate is residentswap.com. My advice is that if you wanna continue in the field leave that program now before they termiate you and this task gets more complicated. You can always "sugar coat" whats going on, program wasent a fit, need to be closer to family..think of something other than I was not cutting it. In this senerio funding is not an issue youve still got your funding on track. If you decide to swtich fields..its gets more complicatied, you need to come up with a reason why your switching into that field (which may not even be where your heart is), and now you may have a funding problem although some programs may not care too much about this if they are well funded. You can go about finding spots inside or ouside the match depending on what your going for. However again if this field is where you heart is, I would not let anyone discourge you. Ive seen it happen at my old program year after year. Fine they want you out of their program....go find another one..while you still have a choice.

 

[NotAProgDirector]

1. Going back to the begining how do you figure out what you're best suited for?
2. Is it ok to stay within the same university system? i.e. same university but different specialty... If so, can my PD help me out with this?
a. Given that it is a third of the way through
the year, can a specialty just open up
another spot?
b. How does a specialty open up another spot?
c. How does funding come into play?
3. Where can I find out about the different types of specialties out there?
4. If you're a PD have you had to tell a resident a similar thing? What was the out come? How do things like this progress?
5. Am I ostracized from the field of medicine?????
5. Any tips are appreciated.

1. There's no magical way. Perhaps your mentor's / PD can help. I have unfortunately been in this situation with residents before. As an IM PD, I tend to ask them to consider:

A. Anesthesia -- This is often a stretch, as it's more competitive than IM. However, for residents where "scope of practice" is the problem, the focus of anesthesia is narrower and deeper. This is not to suggest that anesthesia is "easier" in any way -- it's just that the knowledge base to master is very different. However, if speed and organization are problems, this might not be a good option
B. Psych - if you like patient interaction but get overwhelmed by patient volume / complexity, then psych is often a good fit. The skill set for success here is very different. Census tends to be lower, and again the focus is narrower but deeper.
C. Pathology - Path is a totally different field. It's often "work at your own pace". That pace may be fast, but it's you against the clock. No patient interaction, which can be a plus or a minus. Very broad field.
D. PM&R - Physical Medicine and Rehab, your intern year would likely count towards this field, more narrow diagnostic field, also less competitive. Lots of patient contact rehabilitating disabled patients.

2. Yes, this is almost always your best option if possible.
A. Not exactly, but sometimes. Sometimes there are gaps due to another resident leaving, maternity leave, research candidates, etc. Also, a program could take you and then take one less in the upcoming match.
B. Leave that to the PD. You simply ask if it's possible.
C. Your medicare funding is fixed at the length of your current specialty. If you are at a "warm and fuzzy" institution, they will feel that your training is "their responsibility" and will deal with your funding issue.

3. Instead of worrying about "all of the specialties out there" I'd worry about which one's you have a reasonable chance at. I'd start with the four I listed above (with anesthesia being a long shot).

4. I've transitioned one resident to PM&R, one to psych, and one to path. Two decided not to accept my help (or were in denial, your choice) and ended up nowhere, one is currently trying to get into an FM program.

5. No, not yet. But what you do in the next 3 months is key. If your PD will help you, that will make all the difference.

 

[nsap102]

Hi,

I just wanted to say thank you so much for the input you have provided me with.

The information is highly valued, now I've just got to make the next move.