Switching again - has my ship sailed?

[PunkRockDoc]

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Hey everyone, I was just hoping to get some perspective.

I was the guy in 3rd and 4th yr who applied to three different specialties because I really had no idea what I wanted to do. I applied to pathology, psychiatry, and family medicine. It sounds like a weird combo, but here's some brief reasoning:

Pathology - My reason for med school in the first place was to do forensic path

Psych - My favorite of all my 3rd year rotations, and the one that I found easiest to sit down and read about (as in I enjoyed reading it and my mind didn't wander to other things)

Family - What I always pictured myself doing in the back of my mind

So, after 4th year rotations in psych (subI - got burned out in one month), path (liked autopsy, didn't like anything else), and family (subI - really enjoyed it), I decided on Family. I got into a really great program, and basically had a mental breakdown during intern year. My mind was all messed up, and my solution was that since I initially went to school to do forensic path, perhaps I was unhappy because i was not heading down the road that I initially sought. So I bailed out of family and started a path residency.

I'm now in my second year of path, and have found that I dislike most areas of path. I do find autopsy and forensics interesting, but I don't foresee that interest holding up when it becomes the only thing I do everyday.

Anyway, I should cut to the chase, because I'm rambling. I've been thinking about trying to switch back to family, but I feel like the ship has sailed on that option. I mean, I'm sure that I appear as a risky option considering that I would be leaving a second residency program. What do people think my chances may be of getting into another decent family program?

 

[NotAProgDirector]

What do people think my chances may be of getting into another decent family program?

I think you're asking the wrong question. Perhaps you should ask "What are the chances I'd be happy in an FP residency, given my history of a mental breakdown the first time". Only you can answer that question.

If you're a US grad with good stats, then I expect an FP program somewhere will take a look at you. You will have funding issues, as you'll have consumed all of your full GME funding time already.

 

[Winged Scapula]

Outside of the above excellent advice, you might be well advised to seek some psychiatric counseling on this issue.

While you assume your unhappiness is due to your career choices, it may be other hidden things are troubling you. Or perhaps your expectations (ie, real day to day work can be boring, in every field) are unrealistic.

Before embarking on yet another career which could be disastrous, I'd think long and hard about what happened during your intern year and whether or not you are doomed to repeat that unless you fix what the problems are/were.

 

[dragonfly99]

Agree with the above.
There are no "perfect jobs". I don't know if they'll take you back in to fp residency. Somebody probably would, but I'll bet it wouldn't be as good of a program as your first one. Can you blame them? They don't know if you'll stick it out.
Any job can be boring or hard or unpleasant from time to time. If you enjoy more people interaction, maybe you can look at pathology jobs that involve that. I mean, could you become a medical examiner or something, and interact with police, etc.? I really don't have a good idea of the pathology field, but would think you could find something you like within it. You've only got a couple more years of residency to do...

If you switch back make SURE family practice is REALLY what you want to do. In the real world it can be tough - there are multiple issues with dealing with insurance companies, business aspects, etc. as well as many demands from patients when you do primary care.

 

[peppy]

If I were you, I'd probably stay in Path. Even though Path is not your favorite thing in the world, at least you haven't been pushed into a nervous breakdown by it. It's better to finish a residency even if it's not your first choice than to become so stressed out you quit before you finish.
For most people, any job becomes boring and routine after you've been at it for a while.
If something is fun to do, they don't have to pay people to do it. 🙂

 

[PunkRockDoc]

Thanks for the insight everyone. I definitely expected it to be tough to switch back - I wouldn't blame anyone for being hesitant to hire me. I did forget about the whole funding issue. That's something that I still do not fully understand.

As for my other issues, I am getting some couseling to figure things out.

 

[Leukocyte]

PunkRockDoc,

I am sure you know this, the difference between Family Medicine and Pathology is HUGE! I mean MEGA MEGA HUGE! In fact they almost have nothing in common at all. One is hardcore hands-on clinical medicine with extensive patient contact....the other is, well you know. If you did not like FM the first time, why do you think you will like it this time?

We are not talking apples and oranges here. We are talking apples and kangeroos! Or more accurately comparing full-contact active duty Marines in full combat gear...vs...clean-shaven, clean-cut, aristocratic, academic warfare historians.😱 I just cannot imagine one deciding between these two fields.

Do you want to be an Air-Force Raptor pilot, or would you rather be an Aerospace scientist/engineer? You decide.

Good Luck.

 

[Faebinder]

People who have a difficulty choosing between pathology and family medicine are probably having difficulty deciding if they like to deal with patients or not. I don't blame anyone for disliking dealing with patients... some are out right evil spoiled regressed kids in an adult body.

 

[EC3]

As far as day to day work is concerned, pathology is better than most medical specialties, especially FM, in my opinion. Not only that, but path pays better per hour and has much less stress than many other fields of medicine. Path is a bit longer residency but it's so much better quality of life. Call is mostly home call so it's not like call is a big deal. And so what if you have to read an hour every night... it's much better than having to hear about grandma and her polypharmacy. The only reason to go into FM in this day in age is because you have an emotional desire to. FM pays beans compared to most other medical specialities and the amount of stress can be very high when you're expected to see 30 patients a day.

It sounds like you're burned out on work. If that's the case, you don't want to go back to FM; dealing with patients and their problems is super stressful, and even moreso if you don't want to be there. Pathology on the other hand is a magnificent specialty for those who tend to find clinical work boring, stressful, or burdensome. After you've learned pathology and become comfortable with it, there's really not that much day to day stress when compared to other medical specialties. Put on some therapeutic music and start signing stuff out. If you really want it cush, find a job where you don't have to gross and instead can just read... even if it pays $150K that's still on par with a good FM job and I guarantee you'll have less stress in your life.

If you're not going to like what you do, it might as well be sitting alone listening to music and talking with other clinicians (educated people) vs. having to put up a facade that you care and dealing with patients (most uneducated in regards to medicine). The difference is like hanging out with your parents or going over to the in-laws. And even if you don't like your own parents, chances are they're still more fun to hang out with than the in-laws.

 

[EC3]

PunkRockDoc,

I am sure you know this, the difference between Family Medicine and Pathology is HUGE! I mean MEGA MEGA HUGE! In fact they almost have nothing in common at all. One is hardcore hands-on clinical medicine with extensive patient contact....the other is, well you know. If you did not like FM the first time, why do you think you will like it this time?

We are not talking apples and oranges here. We are talking apples and kangeroos! Or more accurately comparing full-contact active duty Marines in full combat gear...vs...clean-shaven, clean-cut, aristocratic, academic warfare historians.😱 I just cannot imagine one deciding between these two fields.

Do you want to be an Air-Force Raptor pilot, or would you rather be an Aerospace scientist/engineer? You decide.

Good Luck.

Raptor pilot? Let's not get carried away...

FM is more like the guy who loads the planes into the elevator so that they can be brought up to the carrier deck. I'm sure it seems cool at first, but then you realize you work just as hard as everyone else but get paid crap and in the end you have to watch as your buddies fly and have fun while you're behind the scenes making it all possible.

 

[Leukocyte]

Raptor pilot? Let's not get carried away...

FM is more like the guy who loads the planes into the elevator so that they can be brought up to the carrier deck. I'm sure it seems cool at first, but then you realize you work just as hard as everyone else but get paid crap and in the end you have to watch as your buddies fly and have fun while you're behind the scenes making it all possible.

In my unopposed residency program, I certainly do feel like a Raptor pilot (we do almost everything here), BUT the G-Forces are making me so nauseous to the point that I want to puke.

Nice post (your earlier post) by the way!👍

 

[Winged Scapula]

Raptor pilot? Let's not get carried away...

FM is more like the guy who loads the planes into the elevator so that they can be brought up to the carrier deck. I'm sure it seems cool at first, but then you realize you work just as hard as everyone else but get paid crap and in the end you have to watch as your buddies fly and have fun while you're behind the scenes making it all possible.

Read a few of leukocyte's other posts and you'll see how much he loves FM! 😉

BTW, is path *really* that unstressful? I would think the fear of making a mistake would make it a tad stressful.

 

[EC3]

Read a few of leukocyte's other posts and you'll see how much he loves FM! 😉

BTW, is path *really* that unstressful? I would think the fear of making a mistake would make it a tad stressful.

If you're ever unsure and unless it's a stat frozen, you can usually get an opinion from a colleague on the matter or even send it to an academic center for their opinion. It's basically only as stressful as you make it.

Clinical practice, on the other hand, is stressful in a way that's out of your control. Will people be mad at me today because they waited too long? Will grandma bring her grandchildren in and have them run around the room? Will the patient bring her husband with her to try and get him a free medical check? Is my patient going to show up today? Why is Mr. COPD still complaining that he can't breathe when he won't quit smoking?

Much of clinical medicine is a great facade, pretending to be calm and caring while you only have 15 minutes to solve their problem and fix their ailments and make a personal connection. In specialties like path, on the other hand, you can be who you are, you can dress how you like and as long as you get your work done correctly and timely, nobody else gives a crap what you do.

 

[ici_cute]

Hey everyone, I was just hoping to get some perspective.

I'm now in my second year of path, and have found that I dislike most areas of path. I do find autopsy and forensics interesting, but I don't foresee that interest holding up when it becomes the only thing I do everyday.

Can't you do GP Locum once a week and stay permanent in pathology? I'm really asking, coz I'm not familiar with the system.
Besides, if you grad in path, maybe you can find a job scope that requires your expertise, rather than sitting with the microscope in a hospital. You said forensic pathologist appeals to you before.
Best of luck!

 

[Leukocyte]

Can't you do GP Locum once a week and stay permanent in pathology? I'm really asking, coz I'm not familiar with the system.

🙄

You can do brain transplants if you want to, but there is (thankfully) something called privileges, mal-practice insurance, and law suits in this country. We do not unleash M.D.s without the proper training to do things, and perform procedures, they know little of. Now if you own your private practice, you can do whatever you want in your office...but if you screw up, and end up in court in front of a lawyer who discovers that you are a doctor who did not have proper/adequate training in what you did, then...well...good luck.

Do pathologists just jump in and deliver babies in your country?

Do Family Medicine doctors just go ahead and read frozen sections were you come from?
🙄

 

[Winged Scapula]

Can't you do GP Locum once a week and stay permanent in pathology? I'm really asking, coz I'm not familiar with the system.

As noted above, no.

First, the extensive system of locums work does not exist to the same extent in the US as it does abroad. Locums jobs are available but: they are usually for extended periods, require travel to a different city or state, and generally require being Board Eligible in the field. A true "GP" no longer exists in the US. It is possible to "moonlight" covering an Urgent Care or some other sort of facility for a day a week, but most of these places want something more than someone who has trained in Pathology with a few weeks of FM internship.

While you can be licensed in some states without completing a full residency, you will be able to get hospital privileges to admit and/or see patients, likely not get malpractice insurance and not be accepted on most insurance plans without finishing residency. Thus, what you are proposing...that the OP complete training in pathology and "moonlight" or do locums work as a GP/FP, is not feasible in the US unless he were to complete a second residency as a FP.

 

[PunkRockDoc]

Hey Everyone,

Thanks for the input. Everyone's resposnses are pretty much what I thought the situation would be. My plan right now is to try and stick it out through the path residency, and then head back to another specialty if I still feel the calling. In all honesty, part of my unhappiness likely lies with the fact that I am in a pretty crappy residency program now (check some of my posts in the pathology forum) that is light years away from the quality of the family program that I was in (by the way Leukocyte, I think you may have been a bit overly dramatic comparing FM and Path - there are more similarites than you think).

But, yeah, for now I'm going to try and ride it out. If the funding was different, I might try to switch, but for now I'll just deal.

 

[peppy]

After reading your posts about your program, I see now why you feel so discouraged about Path. It sounds like if you can stick it out long enough to get through this program you'll probably feel much better about things.