Switching out of competitive residency

[deleted840740]

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[OnePunchBiopsy]

I've heard of integrated plastics to interventional radiology. Don't know the details, but spoke to the guy and he just told me plastics was not for him and he always had IR in the back of his mind.

 

[mimelim]

This is simply out of curiosity. I've seen posts of people switching residency fields for various reasons. Most are usually to equal or slightly less competitive specialties, such as from gen surg to radiology, IM to anesthesia, etc.

I'm wondering, has anyone made the switch out of something very competitive? Ex going from derm to peds, or neurosurg to neurology etc. What are some bizarre changes you have heard of?

IVS to rads
Competitive/academic GS to anesthesia
Plastics to IM
Ortho to IM

Those are the ones that I guess would fall into your category that I know of. Frankly, going to equal/less competitive specialties because there are simply tons more spots in that category.

 

[Foot Fetish]

Neurosurgery to family medicine

 

[Anti-PD1]

Neurosurgery to radiology.
Neurosurgery to neurology.
Neurosurgery to "insert specialty here"

Happens all the time.

 

[bashwell]

I know a girl who went from ortho to PMR.

 

[tiedyeddog]

Neurosurgery to radiology.
Neurosurgery to neurology.
Neurosurgery to "insert specialty here"

Happens all the time.

It isn't for everybody.

 

[aalamruad]

Neurosurgery to radiology.
Neurosurgery to neurology.
Neurosurgery to "insert specialty here"

Happens all the time.

What's the deal with this? Are nsg applicants just not getting enough exposure to the field during med school to know what residency will be like?

 

[WheezyBaby]

What's the deal with this? Are nsg applicants just not getting enough exposure to the field during med school to know what residency will be like?

Exposure isnt quite the same as experiencing, and you frankly can't experience until residency. Student rotations provide a flavor of it, but after living it for a year or three and still looking down at several more years of the same... I don't find it surprising there's attrition

 

[sloop]

I have less experience with people who have actually switched, but strangely there has usually been at least one upper level resident on most services I've rotated through that has confided to me that they wish they had done what I did and gone into psychiatry.

 

[ChrisMack390]

I have less experience with people who have actually switched, but strangely there has usually been at least one upper level resident on most services I've rotated through that has confided to me that they wish they had done what I did and gone into psychiatry.

Hm. Is this because alot of people who are interested in psychiatry don't go into it for whatever reason (prestige?) or just because the lifestyle of a psych resident seems very desirable to people toward the end of a more intense residency? Or something else?

 

[Anti-PD1]

What's the deal with this? Are nsg applicants just not getting enough exposure to the field during med school to know what residency will be like?

Not sure, I'm in the application cycle now.

The vast majority know what they are getting into. But there is a sliver of the pie, they would be excellent at anything they pursue: great stats, hard workers, good personality. The only thing is some of these folks have a hard time reconciling their constant need to achieve (because there's no achieving like becoming a neurosurgeon /s) and the reality that they are aware of, that neurosurgery is probably the most grueling residency program there is.

There are also some whose circumstances change in the first few years of residency. People get married, have kids, priorities change. Working 100 hours a week becomes less feasible when you can't even say goodnight to your loved ones.

I believe 80 percent going in complete residency. Kind of expected, considering everything.

The neurosurgeons on this forum could provide better insight. EDIT: just saw reply above.

 

[aalamruad]

In my limited observational experience, by far the most common reason for quitting surgery or a surgical sub is realizing that you don't actually like operating. This tends to happen around PGY2-3 when you start getting more consistent OR exposure.

How to prevent that attrition at the student level? I don't really know. Like you said exposure and experience are two different things.

Seems bizarre that one could love standing in an OR just observing for hours but not enjoy actually participating/operating. How is that possible?

 

[surgonc2017]

Some people get a lot of anxiety when they are the one doing the operating, particularly if you have an attending riding you about every little move you make.

Some people can't shake the feeling that they hurt someone when there's a complication from a procedure.


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[Foot Fetish]

As said above, it's different when you're the one operating.

A lot of students get sucked into thinking the OR is "cool" or get that adrenaline rush feeling with a big trauma or big case

Do you still get an adrenaline rush with certain cases after all these years of operating?

 

[Optimus-Prime]

I wouldn't say I get an "adrenaline rush" out of much of anything. It's not really my nature/character.

I just enjoy operating. Certainly there are cases I don't like very much (thankfully most of those are permanently in the rear view mirror now).

But take my upcoming week - I have a day of gallbladders one day, and a whipple another day. I'm looking forward to both for different reasons.

I think the things I take enjoyment out of during a case are probably very different than what interests the students.

Any thoughts on if there would be advantages of using flexdex for a whipple?

 

[tiedyeddog]

What's the deal with this? Are nsg applicants just not getting enough exposure to the field during med school to know what residency will be like?

It's not often a choice by the resident to leave... I'd guess a good deal are not given an option.

 

[aalamruad]

It's not often a choice by the resident to leave... I'd guess a good deal are not given an option.

You mean they're booted out of the program? Is that common?

 

[tiedyeddog]

You mean they're booted out of the program? Is that common?

More like a mutual "this isn't working". Not very common I would guess, I'm just speculating on the instances of this I personally know of.

 

[ACSurgeon]

There is something to be said about the cumulative effect of stress, fatigue, and limited time outside of work. You can live at the hospital for 1-2 months as a student but won't appreciate what the PGY 3-4 resident feels like until you're there.

Also, many traditional students are still in the academic/institutionalized mindset. It's different when you're getting to be in your 30's and real life things start to happen and priorities change.

Finally, as noted above, some residents will be pushed out of the program either by gentle nudging or outright being fired. I suspect the former is much more common, as it's less damaging to the resident and the program.

 

[ACSurgeon]

Seems bizarre that one could love standing in an OR just observing for hours but not enjoy actually participating/operating. How is that possible?

You're made to feel incompetent as a resident. When you combine this with your own type A personality and being critical of your performance at baseline, it's really messes with your head.

 

[Domperidone]

What's the deal with this? Are nsg applicants just not getting enough exposure to the field during med school to know what residency will be like?

If it hasn't already been said - lifestyle is another reason. in addition to burnout. Or cons just outweighing the pro's eventually.

I knew a general surgery trainee/resident in his final year, final few months. And then he switched to family medicine. Much to the dismay and shock of well, everyone in the department plus the anaesthesiologists. Essentially how he put it, he just couldn't take it for another day. He was done, he had enough of surgery and was in it long enough to make an 'informed decision' that it was not for him. To him it was not a waste of time, there was no question of..say the "life un-lived or unexamined". He wanted a better work-life balance and he couldn't see it getting better with time with surgery. Eventually the rush of the OR just wasn't enough. (I was one of his students at the time, and he used to tell me to enjoy being a student while I could

)

I've also seen a switch to peds from surgery.
kids just made that resident happier. If i remember it correctly. he got a peds surgical rotation rather randomly or by chance and realized he enjoyed that far more than surgery itself so he just switched altogether. No idea why he didn't realize that as student apart from what's been said by posters above. the experience as a working resident is different to being a student.

I used to read this surgical resident's blog. Now they're an ex-surgeon.
But I still read their blog. Shouldn't say used to.