Switch from Primary Care to DR?

[Syndonium]

Hey all,
I'm finding myself in a confusing spot and have been contemplating for weeks about this. Just wanted some thoughts and advise on how realistic this would be, and what pitfalls I should avoid.

So basically I'm a rising MS2 and thought I wanted to do primary care going into medical school, am in a extra curricular program that is giving me lots of exposure/experience this summer with it and I'm finding myself rethinking whether I want to do primary care the next ~40 years of my life.

I wouldn't say I hate it, but I don't think my personality is a great fit with the community of primary care and I keep finding myself thinking I want to do rads. The first physician I ever shadowed was a radiologist and I thought what they did was really cool, and even during MS1 I spent extra time studying how to interpret images because (spoiler alert) I sucked at it 😂

The primary care program I'm in has supported me financially which I'm eternally grateful for right now, but I wanted to ask thoughts on sticking with this program (it's 4 year so it continues until I get my MD) and working on rads on the side/take more time thinking if primary care is right for me, or just dropping out of that program now and focusing completely on rads. I should also say there are personal reasons why financially my family needs the money we got from this primary care program, so if I did drop out and had to return the money we'd be in a complicated situation.

Thanks!

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[cj_cregg]

It sounds like the first question is whether you want to do primary care and stay in this program or not, and then if not, you can figure out if the right fit is rads or something else.

What exactly are the consequences of dropping out of this program?

What does your program count as primary care and what kind of PCPs have you shadowed? Can you do an IM/peds residency then specialize? Can you do OBGYN or psych? If you've mostly been with one doc/one practice style, have you tried shadowing some others to see if there's another niche within primary care you like? Maybe FM with inpatient or sports medicine (which would have lots of ultrasound/procedures) or addiction med? Are the things you don't like about primary care related to being an employed physician, and maybe DPC would be something you enjoy?

 

[Syndonium]

Yes you are right about the question being whether I want to do primary care or not, and I have a rotation set up with a FM residency program and hoping that will give me a better idea, but I'm also worried about lifestyle since I have a family to think about.

The physician I have been working with is great, he's a FM physician and mostly outpatient with very little procedures, which has been good but I'm thinking it's hard to see myself doing that long term. I was super interested in DPC, still am, but lately think I want to do more inpatient work.

Basically I think I thought primary care was a good fit for me initially, but now I'm having lots of second thoughts. I'm more of an introvert, though I've learned to be extroverted when I need to be (which makes clinic something I think would exhaust me longterm). I also naively thought I could be the "expert at everything" in general practice, but realizing my limitations after MS1 and I really enjoy being able to know the exhaustive details of my subject area.

I obviously still need to think about other options more, but it would take too long to go over why rads is what I'm leaning to. My main question was whether I am screwed or not.

Our program is fairly new and so I'm not entirely sure of the consequences for dropping out. I also don't know if I should just pull the trigger now or if I could just continue in this program and come MS4 apply to rads and have any chance if I just continue finding myself straying away from FM.

 

[cj_cregg]

Yes you are right about the question being whether I want to do primary care or not, and I have a rotation set up with a FM residency program and hoping that will give me a better idea, but I'm also worried about lifestyle since I have a family to think about.

The physician I have been working with is great, he's a FM physician and mostly outpatient with very little procedures, which has been good but I'm thinking it's hard to see myself doing that long term. I was super interested in DPC, still am, but lately think I want to do more inpatient work.

Basically I think I thought primary care was a good fit for me initially, but now I'm having lots of second thoughts. I'm more of an introvert, though I've learned to be extroverted when I need to be (which makes clinic something I think would exhaust me longterm). I also naively thought I could be the "expert at everything" in general practice, but realizing my limitations after MS1 and I really enjoy being able to know the exhaustive details of my subject area.

I obviously still need to think about other options more, but it would take too long to go over why rads is what I'm leaning to. My main question was whether I am screwed or not.

Our program is fairly new and so I'm not entirely sure of the consequences for dropping out. I also don't know if I should just pull the trigger now or if I could just continue in this program and come MS4 apply to rads and have any chance if I just continue finding myself straying away from FM.

FM can be a good lifestyle specialty if you are efficient and intentional about your scheduling and contract - most offers I'm seeing these days are 4-4.5 day work weeks. Some, but not all, FM programs will also prepare you well for hospitalist work and there are some parts of the country where you can do traditional FM where you round on your own inpatients, which can be a nice mix if you're not someone who loves clinic. You are right that FM cannot be the expert in everything, but we can be experts at the bread and butter stuff and preventive care, and carve out a niche for a few specialized things if we have an interest (women's health, sports med, office procedures, whatever). And there are actually a lot of introverts in FM - I'm one of them! Clinic can be tiring but personally it's a little less tiring compared to casual conversation because there is a set "script" or outline to the conversation in a way. But obviously it may be different for you and your personality.

I think whether you're screwed will ultimately depend on what the consequences are for dropping out of the program (do you have to pay the money back? How much? Do you lose other benefits? etc), and the level of flexibility within the program (what if you do a IM/FM/peds residency then do a fellowship or become a hospitalist? are there other specialties they consider primary care that are a good fit for you?). I'd start by reaching out to your program and letting them know you're having second thoughts and figuring out what the next steps are if you want to leave the program.

 

[Syndonium]

FM can be a good lifestyle specialty if you are efficient and intentional about your scheduling and contract - most offers I'm seeing these days are 4-4.5 day work weeks. Some, but not all, FM programs will also prepare you well for hospitalist work and there are some parts of the country where you can do traditional FM where you round on your own inpatients, which can be a nice mix if you're not someone who loves clinic. You are right that FM cannot be the expert in everything, but we can be experts at the bread and butter stuff and preventive care, and carve out a niche for a few specialized things if we have an interest (women's health, sports med, office procedures, whatever). And there are actually a lot of introverts in FM - I'm one of them! Clinic can be tiring but personally it's a little less tiring compared to casual conversation because there is a set "script" or outline to the conversation in a way. But obviously it may be different for you and your personality.

I think whether you're screwed will ultimately depend on what the consequences are for dropping out of the program (do you have to pay the money back? How much? Do you lose other benefits? etc), and the level of flexibility within the program (what if you do a IM/FM/peds residency then do a fellowship or become a hospitalist? are there other specialties they consider primary care that are a good fit for you?). I'd start by reaching out to your program and letting them know you're having second thoughts and figuring out what the next steps are if you want to leave the program.

I appreciate the insight it's been reassuring. I double checked the details of the commitment I've made for the financial support of the program and outside FM-focused training/activities during medical school there is no commitment for where I do residency or that it must be primary care.

If I decide after clerkships MS3 to do something else will it be too late? It's good to hear FM can do inpatient, I want to do rural and know it's possible but all our experiences thus far have been almost solely outpatient.

Thanks a lot for your help.