Switching out of general surgery

[Tablet PC]

I know there are plenty of threads about switching out, but I thought I needed to create a new thread to get some personal advice, and also to clear the air and accept my future.

I applied to orthopaedics after graduating medical school from a US med school and did not match. I accepted a preliminary surgery position far from home, and went through the match again, applying to both ortho and general surgery. I matched into general surgery at the program in which I did my preliminary year.

Now, as a PGY-2 general surgery resident (3rd year total, prelim 1, then categorical PGY-1), I have decided I do not want to do general surgery. I thought I could love general as I did ortho, but it simply was not the same and I am not happy. I did the work, covered my assigned calls, but it was simply an unfulfilling job for me. I talked to my program director and I will not be completing surgery there as a PGY-3.

What are my options other than finding random position openings? I know that the SOAP process is different (I did the old scramble) in such that only ERAS registered people can fill the unfilled residency spots until all of the SOAP cycles are complete. My dean from my medical school said that after 5 PM on Friday of Match Week, any unfilled residency spots become available to non ERAS registered people.

What are my options? My PD and faculty here are 100% behind me (a huge sigh of relief) in terms of using their contacts to help secure a spot in something I see myself doing (radiology, anesthesia, PM&R, EM). Am I more or less just picking up random programs at this point?

Also, unless I find a spot to initially transition into for July 1 2014, I am assuming my next best option is to go through the 2014 match progress while continuing to seek out available positions that open up from residency drop out/transfers. Are there any other recommendations?

My back up plan is to be a surgical hospitalist in the year off (which one of my faculty surgeons here is helping me arrange a small local hospital). Basically being a surgical house officer to admit patients. Need 2 years of general surgery and completion of all STEP exams, which I have done.

Another option would be to do research, again which my program here is helping me arrange (NIH stuff, etc). I also know some opportunities for ortho research but again, I do not want to limit myself to one specialty since ortho is incredibly tough to get into. I would sell my soul, live in my car, etc to have an ortho spot, but I understand that I need to find a specialty that I can do for a career. General surgery simply isn't it.

I just wanted to say this is the worst feeling of my life all over again. I went through not matching and I would never wish that experience upon anyone. I ended up in a specialty which I somewhat resented (being that I worked hard, pulled out all stops, and could not get my "dream" job) and tried, but failed to make it work for me. Now I am back to technically, not having a job. Being a preliminary resident was the toughest year of my life in which I had constant pseudo-depression from the huge amount of uncertainty regarding my career. I basically get flushed and feel my heart in my throat when I think about reliving that experience again. I hope I can one of the success stories on here and I appreciate any help and advice that people have.

Thanks everyone!

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[Law2Doc]

I'm confused -- why wouldn't you just apply for the next match, tell your program closer to that point you were unhappy with surgery, use up your vacation days to interview, and use the match, targeting a particular field you actually have interest in. Or at least talk to PDs in fields you are actually more interested in before making a change. Trying to jump to "anything" open after soap is just so poorly thought out. Makes me think theres more to your story that you are willing to leap before you look. Just seeing what's left over the Friday after match isn't a recipe for ending up in a better situation. The ROAD specialties and PM&R spots that somehow fall to soap aren't still there after match day -- they fill the first round of soap. We are mostly talking prelim spots and malignant or geographically undesirable noncompetitive spots by then. What you really ought to do, and you haven't given us the big picture of why you can't, is to keep your current residency, choose a single attainable target specialty, meet with the local PDs in that field to discuss what you need to do to get a spot, and then use the 2015 match. You will not be tainted goods because you will still be in a residency and just voluntarily making a change. Leaving the residency immediately makes PDs worry that you were asked to leave, or (equally bad) that you would leave their program too if it's not your dream job. So I suspect there is more to this story you aren't telling, but if not, you are playing it all wrong.

Start with what field do you want to go into? (and don't kid yourself with fields like derm, ortho, ENT, uro, optho -- it's rare to bail out of a plane and fall upwards). If the answer is "anything but surgery", then I suspect you won't be happy in any residency because you didn't do your due diligence -- they all have their own headaches in different ways. So ask yourself again. Then after this match is over start talking to the PDs in that field. And stay in your program until the next match or until a spot opens. Leaving before you have a suitable spot lined up only hurts you.

 

[NotAProgDirector]

I agree that your 1st priority is figuring out what you want to do. You seem to be certain that you'd love ortho, but hate GS. You need to explore why that is -- what it is about ortho that you really like that's missing from GS, and then figure out what other field you'd like. Because as a US grad who has done well in their GS training (per your report), someone will take a chance on you. But if you go into another field and then bail again, you'll find it increasingly difficult to get someone else to take a chance.

You are correct that on Friday spots will be open to anyone. However, there will be nothing left. There are so many reasonable applicants in SOAP, no program is going to wait until after SOAP to fill -- unless perhaps they know about you beforehand (which is at least partially a match violation on their part). And it's too late to register for the NRMP/SOAP, so you really have no options there.

Doing a hospitalist year is not the end of the universe, IMHO. You'll be submitting your ERAS application in September, and you'd just have finished your PGY-2 in June. This assumes that your performance has been fine, and that your PD is really supporting you. Basically, you want them to write you a letter that says that they would have happily promoted you to the PGY-3 level. With that and staying clinically active, I think you'll be fine for 1 year. During that gap year you should see if you can get experience in the field you're really interested in (perhaps in addition to being a surgical hospitalist). You should also see if you can do non-GS rotations with some of the rest of the time you have. Obviously you should see if your home program has any open spots for other fields that might interest you.

 

[IM2GI]

I agree that your 1st priority is figuring out what you want to do. You seem to be certain that you'd love ortho, but hate GS. You need to explore why that is -- what it is about ortho that you really like that's missing from GS, and then figure out what other field you'd like. Because as a US grad who has done well in their GS training (per your report), someone will take a chance on you. But if you go into another field and then bail again, you'll find it increasingly difficult to get someone else to take a chance.

You are correct that on Friday spots will be open to anyone. However, there will be nothing left. There are so many reasonable applicants in SOAP, no program is going to wait until after SOAP to fill -- unless perhaps they know about you beforehand (which is at least partially a match violation on their part). And it's too late to register for the NRMP/SOAP, so you really have no options there.

Doing a hospitalist year is not the end of the universe, IMHO. You'll be submitting your ERAS application in September, and you'd just have finished your PGY-2 in June. This assumes that your performance has been fine, and that your PD is really supporting you. Basically, you want them to write you a letter that says that they would have happily promoted you to the PGY-3 level. With that and staying clinically active, I think you'll be fine for 1 year. During that gap year you should see if you can get experience in the field you're really interested in (perhaps in addition to being a surgical hospitalist). You should also see if you can do non-GS rotations with some of the rest of the time you have. Obviously you should see if your home program has any open spots for other fields that might interest you.

Hospitals will hire a general surgeon as a Hospitalist? Never seen that. I would assume a medicine floor would be a rude awakening to someone with surgical training.

 

[gutonc]

Hospitals will hire a general surgeon as a Hospitalist? Never seen that. I would assume a medicine floor would be a rude awakening to someone with surgical training.

Read the post...he said a surgical hospitalist. Essentially a Gen Surg R2 who has an independent license and privileges.

 

[IM2GI]

Read the post...he said a surgical hospitalist. Essentially a Gen Surg R2 who has an independent license and privileges.

ahh I see it in the OP, whoops.

 

[Winged Scapula]

Point of clarification: there are true surgical hospitalists, typically acute care surgeons and/or intensivists employed by hospitals for surgical needs. These are BE/BC surgeons who have completed training.

What the OP is describing is a different breed; essentially someone to take call on surgical patients, evaluate patients in the ED, etc. They do not have hospital privileges, cannot take patients to the OR or admit them under their own name. I spent some time doing this as a moonlighting gig during residency and fellowship for private practice groups at a hospital that did not have a residency program. It did require an independent license but only so I could have a DEA # to write scripts when discharging patients.

 

[Tablet PC]

To answer the first set of questions - I left because of a number of reasons. The call schedule is basically prohibitive of doing any kind of "off service" rotations in which I could do something like ER. There is no anesthesia program here (it's a small community program with IM, EM, Family, Psych, Ortho, Peds) so I may have to "leave" aka set up an away rotation. Because of significant savings I did during my prelim year (I thought I would have to move after that), I could survive if I had no salary for nearly a full year, assuming costs are equal or less than a standard resident salary (I basically have a full year's salary saved up). A preliminary surgery resident was nearly terminated 2 years ago for leaving too much to go onto interviews. I did not want to end up in not "good standing" with my program versus completing the PGY-2 year in good standing.

Winged Scapula basically sums up what a surgical hospitalist does. That would be the plan for a year which would free me from any type of in-house call/back up call I would do as a PGY-3. If I had to leave for an interview and leave my call hanging more than once or twice, I'd be on a short pathway to getting fired in the middle of my PGY-3 year.

I guess I don't have many options, assuming that most unfilled spots are filled during the SOAP and it's basically trying to find a program with an unexpected opening or expansion. I guess I will start planning for the next cycle of the match.

 

[Tablet PC]

I guess the other question I didn't answer - I know what I want to do, but I can be happy doing lots of things (hence why I listed a few like anesthesia, ER, etc). Stapling colons together then debriding wounds, then seeing the recurrent battery of non-operative bowel obstructions isn't for me. I didn't love general surgery, or vascular, or CT, or plastics, or really any GS specialty. GS love their job and I didn't, and if you don't love GS, you won't be happy doing it. I was at a program in which I had a constant stigma of wanting to do ortho despite how hard I worked or how well I did. Doing another year in GS in which it became official that I was leaving would just make a toxic situation worse.

Now it's about me moving on to another specialty and finding a spot. I did 2 intern years, and may potentially do a third! I don't mind that, as long as it's towards a goal, a career, not a job. GS was a job that I did everyday so I could pay my loans, and I hated it. I think as long as I am not doing OB/GYN I would be okay. Nothing against women's health and women's reproductive medicine, but I couldn't see myself doing OB/GYN.

 

[Law2Doc]

I guess the other question I didn't answer - I know what I want to do, but I can be happy doing lots of things (hence why I listed a few like anesthesia, ER, etc). Stapling colons together then debriding wounds, then seeing the recurrent battery of non-operative bowel obstructions isn't for me. I didn't love general surgery, or vascular, or CT, or plastics, or really any GS specialty. GS love their job and I didn't, and if you don't love GS, you won't be happy doing it. I was at a program in which I had a constant stigma of wanting to do ortho despite how hard I worked or how well I did. Doing another year in GS in which it became official that I was leaving would just make a toxic situation worse.

Now it's about me moving on to another specialty and finding a spot. I did 2 intern years, and may potentially do a third! I don't mind that, as long as it's towards a goal, a career, not a job. GS was a job that I did everyday so I could pay my loans, and I hated it. I think as long as I am not doing OB/GYN I would be okay. Nothing against women's health and women's reproductive medicine, but I couldn't see myself doing OB/GYN.

Again you are still saying you want to do "anything but GS" (or OB), and not really focused on one thing attainable that you actually do like. Every field has it's own negatives, and there are people out there who consider each of those a deal breaker. You need to figure out one thing you WANT to do, and why, rather than hope to jump ship to anything different, and maybe hate that too. You have told us what you don't like about GS, but it's not clear why you think you'd like, say, IM, FM, psych (ie things you could potentially get) better. (Let's put aside the ortho and ROAD specialties, I think that's too much of a longshot for you given your circumstances.)

 

[Gastrapathy]

So it was a "toxic situation"? Are you sure you will get a strong letter? You could do IM --> Rheum or FP --> Sports Med. PM&R. They are vaguely bone related. Or Anesthesia Pain. Or IR (there are some direct IR programs out there). I don't think you need to necessarily rule out competitive specialties but you better get it right this time (and don't tell anyone else about Ortho) and probably need to take a primary care spot if thats all you're offered.

 

[Silent Cool]

Here's my take: you listed so many fields that you dislike that I am inclined to say, "Hey, they call it WORK for a reason." It's not supposed to be fun. It's work. Perhaps you have romanticized Ortho too much. That too is work--it ain't any more fun. Find something that you can TOLERATE, that you are good at, and that is lucrative. Do you think that GI docs love scoping buttholes every day? Seriously? GI is competitive because it pays major $$$. The (relatively) nice lifestyle those docs have, coupled with the major bucks they make, = competitive specialty. But don't kid yourself that they "enjoy" butt scopes. If GI paid the same as rheum, endocrinology, or allergy, the competition for spots would fall off a cliff. Maybe you don't care about major $$$ and, as such, buy into the notion that you need to "enjoy your work," but the rest of us have realized that work is rarely enjoyable and, at best, tolerable. You need to be good at what you do and practice your field with the highest degree of ethics. Jumping for joy when you get out of bed each morning is not a requirement. Those who tell you to seek such excitement everyday are sending you on a fool's errand.

Work after a time becomes....well....just work. If you hate it and/or if it drives you nuts....then don't do it. But if you can tolerate it then.....well.....stop thinking the grass is greener anywhere else and plow forward. When your training is complete you will have more flexibility WRT your procedures, work hours, etc..., so keep that in mind.

good luck.

 

[Law2Doc]

Here's my take: you listed so many fields that you dislike that I am inclined to say, "Hey, they call it WORK for a reason." It's not supposed to be fun. It's work. Perhaps you have romanticized Ortho too much. That too is work--it ain't any more fun. Find something that you can TOLERATE, that you are good at, and that is lucrative. Do you think that GI docs love scoping buttholes every day? Seriously? GI is competitive because it pays major $$$. The (relatively) nice lifestyle those docs have, coupled with the major bucks they make, = competitive specialty. But don't kid yourself that they "enjoy" butt scopes. If GI paid the same as rheum, endocrinology, or allergy, the competition for spots would fall off a cliff. Maybe you don't care about major $$$ and, as such, buy into the notion that you need to "enjoy your work," but the rest of us have realized that work is rarely enjoyable and, at best, tolerable. You need to be good at what you do and practice your field with the highest degree of ethics. Jumping for joy when you get out of bed each morning is not a requirement. Those who tell you to seek such excitement everyday are sending you on a fool's errand.

Work after a time becomes....well....just work. If you hate it and/or if it drives you nuts....then don't do it. But if you can tolerate it then.....well.....stop thinking the grass is greener anywhere else and plow forward. When your training is complete you will have more flexibility WRT your procedures, work hours, etc..., so keep that in mind.

good luck.

To be fair, I know quite a few GI docs who enjoy what they do.

 

[Law2Doc]

So it was a "toxic situation"? Are you sure you will get a strong letter? You could do IM --> Rheum or FP --> Sports Med. PM&R. They are vaguely bone related. Or Anesthesia Pain. Or IR (there are some direct IR programs out there). I don't think you need to necessarily rule out competitive specialties but you better get it right this time (and don't tell anyone else about Ortho) and probably need to take a primary care spot if thats all you're offered.

While I think OP could perhaps make a jump from GS residency to anesthesia or IR in a subsequent match if he stays on another year, I don't really see these as realistic landing points if the OP first jettisons from his GS spot. The competition for these specialties is still such that it wouldn't take much of a red flag to make the OP noncompetitive, and while it's fine to decide surgery is not for you, leaving surgery before lining up the next residency is too much of a red flag. I think there's probably more to the story here and PDs in competitive fields probably will too. IM and FP are the more likely options, but only if OP can really sell them on why that's a better fit for him. The "anything but GS" approach won't sell him.

 

[IM2GI]

Here's my take: you listed so many fields that you dislike that I am inclined to say, "Hey, they call it WORK for a reason." It's not supposed to be fun. It's work. Perhaps you have romanticized Ortho too much. That too is work--it ain't any more fun. Find something that you can TOLERATE, that you are good at, and that is lucrative. Do you think that GI docs love scoping buttholes every day? Seriously? GI is competitive because it pays major $$$. The (relatively) nice lifestyle those docs have, coupled with the major bucks they make, = competitive specialty. But don't kid yourself that they "enjoy" butt scopes. If GI paid the same as rheum, endocrinology, or allergy, the competition for spots would fall off a cliff. Maybe you don't care about major $$$ and, as such, buy into the notion that you need to "enjoy your work," but the rest of us have realized that work is rarely enjoyable and, at best, tolerable. You need to be good at what you do and practice your field with the highest degree of ethics. Jumping for joy when you get out of bed each morning is not a requirement. Those who tell you to seek such excitement everyday are sending you on a fool's errand.

Work after a time becomes....well....just work. If you hate it and/or if it drives you nuts....then don't do it. But if you can tolerate it then.....well.....stop thinking the grass is greener anywhere else and plow forward. When your training is complete you will have more flexibility WRT your procedures, work hours, etc..., so keep that in mind.

good luck.

False. Tons of happy GI folks that enjoy endoscopy.

 

[naus]

Anesthesia is a good option. I've met a ton of anesthesiologists who switched from general surgery, and don't know a single one who regretted the switch. And it's not that competitive nowadays. Since you were originally gunning for ortho, I assume you were a solid student in med school and just kind of fell through the cracks. It happens. Have a good recommendation from your program and you should be okay.

I asked some of those anesthesiologists what finally triggered their decision to switch, and this one guy told me a story of seeing how an old community general surgeon he worked with was still trolling the ED PACS system at 11 in the night to find a gallbladder to operate. Sounded miserable. My point is, the grass can actually be greener, don't listen to the guys above who say work is all the same. Some work makes you dread going in every day and just isn't worth it.

ED is also a good choice, but is more competitive and harder to find a spot without doing a couple of away rotations (hard for you to arrange while working).

 

[Law2Doc]

Anesthesia is a good option. I've met a ton of anesthesiologists who switched from general surgery, and don't know a single one who regretted the switch. And it's not that competitive nowadays. Since you were originally gunning for ortho, I assume you were a solid student in med school and just kind of fell through the cracks. It happens. Have a good recommendation from your program and you should be okay.

I asked some of those anesthesiologists what finally triggered their decision to switch, and this one guy told me a story of seeing how an old community general surgeon he worked with was still trolling the ED PACS system at 11 in the night to find a gallbladder to operate. Sounded miserable. My point is, the grass can actually be greener, don't listen to the guys above who say work is all the same. Some work makes you dread going in every day and just isn't worth it.

ED is also a good choice, but is more competitive and harder to find a spot without doing a couple of away rotations (hard for you to arrange while working).

The guys you know who made the switch from surgery probably were still in a residency when they made the switch, instead of bailed first. Totally different analysis.

I don't think anyone above said all work is the same or that the grass can't be greener. We suggested that jumping from a bad situation to "anything" was a bad game plan because blindly jumping over the fence doesn't necessitate it being greener. As a career changer I can assure you that you absolutely can find a better fit but only if you don't approach it with the attitude of change for the sake of getting out of a particular situation rather than having the focus on the target job.

 

[Silent Cool]

Enjoying GI isn't hard because the lifestyle is relatively good and the compensation is high. Take away those two things and fewer people would go into the field. I'm sure it's enjoyable with those two factors, but without them scoping colons all day would be much less appealing.

 

[Gastrapathy]

Jellly?


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[Law2Doc]

Enjoying GI isn't hard because the lifestyle is relatively good and the compensation is high. Take away those two things and fewer people would go into the field. I'm sure it's enjoyable with those two factors, but without them scoping colons all day would be much less appealing.

Again, I think you don't know enough GI docs. Last time I visited an endoscopy suite the guys were literally fighting over who got to drive the scope, like it was a video game. You see the same thing in Fields like urology, another field which doesn't play out as particularly glamorous. As hard as it may be to believe, even in the fields that seem less appealing to laypeople, there are plenty who would choose those paths even if the perqs weren't as good. There are lots of people in every field who genuinely like what they do, even if you personally may find it unappealing.