Switching specialties- too late?

[toby2]

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I am looking to switch from pathology to FM or EM. Most likely FM as I feel it would provide the most broad-based training as I plan to do a sports medicine fellowship afterwards. Unfortunately, I decided this 2 months too late to get into this year's match. I am in my PGY-2 year, and would like to switch in the next few months if I can find a vacant spot at a decent program. Worse case scenario, I could wait until 2008, but I'd obviously rather switch now. Anybody know a faster way to find vacancies than trying to e-mail or call all of the program directors?

Thanks!

 

[path15]

I am actually in the same boat - in a path residency and I think I want to switch to FM. I've looked into residency programs and all seem to only accept applications through ERAS which I think is already closed for this year. The AMA website posts vacant residency spots but the spots are usually for PGY2 and up. Becasue I made my decision late in the year too I think I will have to wait until 2008 - Just curious have you told your residency program that you are leaving? Wouldn't they need to know before they send their match list in?

 

[toby2]

Glad to know there is at least one other person in this situation. Nope, haven't told them yet. Have you?

 

[toby2]

The AMA website posts vacant residency spots but the spots are usually for PGY2 and up. QUOTE]

Where is this website? I am guessing even if they say PGY-2 and above, they would take an intern too. More than anything, they probably just need warm bodies to help with all the scutwork (which right now I am kinda looking forward to--but my attitude may change toward the wee morning hours of my 1st call night!)

 

[path15]

http://www.ama-assn.org/ama/pub/category/6920.html

that's the website - I haven't told anyone in my program yet mostly becasue I think its a long shot for a spot in July as I am geographically restricted due to my signficant other, also I'm not sure how they would react. I started AP/CP but next year I will CP only. The thought of doing another year isn't exactly the most appealing thing - How are you sure that you want to switch? Sometimes I wonder if I am just picturing greener grass...other times I can convince myself that it is definitely what I want to do...

 

[toby2]

http://www.ama-assn.org/ama/pub/category/6920.html

that's the website - I haven't told anyone in my program yet mostly becasue I think its a long shot for a spot in July as I am geographically restricted due to my signficant other, also I'm not sure how they would react. I started AP/CP but next year I will CP only. The thought of doing another year isn't exactly the most appealing thing - How are you sure that you want to switch? Sometimes I wonder if I am just picturing greener grass...other times I can convince myself that it is definitely what I want to do...

Thanks for the link. Not too many programs listing spots, but anything helps at this point. I am also switching to CP only for now as I'm looking into other options. I do have a strong interest in Transfusion Medicine, so worst-case scenario if I don't find a good FM program for July 2007 I will finish this year and do a TM fellowship.

The only thing I know for sure right now is that I do not want to be reading microscope slides the rest of my career. It's weird- I used to think it was interesting and stimulating, and then after a year I just started getting more and more bored with it. I'm sure if I was in radiology the same thing would happen reading CXRs and CTs everyday. It's gotten to the point where no amount of AP private practice money would convince me otherwise. I just want some variety, flexibility, and want to increase my options. Family Medicine (particularly a rural or unopposed program) offers the best broad-based training and would also allow you to relocate practically anywhere you wanted to. Plus for me it has the added bonus of sports medicine fellowships which is what I would do for sure after FM. I've thought about IM (only for a few seconds because I want to work with peds as well as adults), and EM (still think about, but in my opinion it is not as broad-based as a good FM program).

How sure are you of your decision and how did you come to it?

 

[toby2]

path15,

I found another link which looks pretty good and lists a lot more open positions. It costs $75 or $30 if you're already using ERAS.

http://www.aamc.org/students/findaresident/

 

[path15]

I haven't filled out an ERAS for this year becasue I thought ERAS was closed already? Is this not right?
I'm just curious, why would you do a TM fellowship after one more year of CP? Why not then do FM? I pretty much feel obligated to do another year at my program becasue I haven't told them yet and also becasue when I switch I want to get a good FM program which seems more likely if I go through the match.
I pretty much realized that I missed patient care when I was on a 5 month stint of AP rotations - I ended up taking a CP weekend call and a light went on, of course, this was january. I also realized that I enjoyed clinical medicine's knowledge base when I studied for step 3 of the boards - I loved it! Now, this is of course so totally different then the day to day grind of clinical medicine, which is why I think I have been so unsure.
I have no interest in AP either, and at first thought CP would be alright but the more I think about it the more I realize that I want something completely different. I agree that it would be nice to have job security pretty much anywhere in the country (not so with CP). I do regret not entering the match this year and I must say if a contract was in front of me for FM at a good program I'd sign it and screw my path residency -
But, alas another year (actually about 17 months).

let me know if you find any programs - what are you using for letters of rec? Will you get one from your PD?
Ultimately, I think what convinces me is that none of the other residenst that I talk to seem to miss patient care at all -actually, they repeatedly point out how they hate it -
and if worse comes to worse we could get boarded in both and then decide...

 

[path15]

I also thought about EM, but I really like out-patient medicine - and I'd like to see peds and adults too. I really miss interacting w/patients (which I thought would be a bonus of a path career). I also would like to do international work -
I guess if somebody asked me where do I see myself in 5 years I'd say hopefully going to the office to see patients -

I resent the need to sign our yearly contracts 6 months in advance (I already had to sign mine - it was tough - but I can't risk going unemployed b/c of my loans). The whole system seems rather user unfriendly.
Thanks for the website - it looks pretty good -

 

[Tn Family MD]

I mentioned this in another thread in the FM forum, but we have a PGY-2 in our program that did pretty much the same thing you two are talking about. A year and a half of path, then switched mid year into our program in FM here in Knoxville, TN. He is a fantastic resident and I am sure our PD would love to talk to any similar candidates that may happen to be out there. Make sure you check us out ASAP.

 

[path15]

Thanks Tn - I'm geographically restricted due to my signifcant other and I don't think he could get a job in TN, but otherwise I'd definitely check it out -

 

[toby2]

Thanks Tn! I would be interested in a program in Tennessee. Please PM me - I would like to talk with the resident who switched and find out how the process went.

 

[sandbtwmytoes]

I find it ironic that I was just telling a fellow resident how I wish I chose pathology. I’m in a general medicine residency and I despise it. Yes, some of it is do to being a resident, however many of the attendings (community and academic) I work with are miserable with their careers. There is little respect for what you do, you need to see 1 pt every 15 minutes to pay the bills and the demands are exhausting. Please think twice about switching. Every time I go to the path department to look @ slides, the pathologists are always so happy—they have career satisfaction. Sure, it must get boring looking at endless cuts of tissue, but you have to find a way to embrace it. Your job is very important to us medicine people, you know your patient by their cells & it’s just as important (and without the endless complaining from many patients). Ok, I’m still bitter over my residency choice, but every field has its downside & the grass is always greener somewhere else. However it ends up, I wish the best for both of you & hope you find a field that makes you both happy. Good Luck!!!!

 

[step1]

http://www.saem.org/saemdnn/Home/ViewByRole/Residents/ResidencyVacancyService/tabid/152/Default.aspx


Sounds like you prefer patient interactions in broad fields if you're thinking FM or EM. Nothing wrong if working on specimens all day doesn't float your boat.

For EM, you may have had to do a transitional year or EM focused internship to get a PGY-2 spot. Otherwise plan on starting as a PGY-1.

From a reimbursement standpoint, you should be fine because you are switching from a 5-year program to a 3-year program as a PGY-2. So I don't believe that puts you in the red-zone for medicare resident reimbusement to the hospital.

Good Luck😛

 

[step1]

You can also try the 2007 Scramble.

At this point, you may still be able to register through ERAS/NRMP (think they're still open)-
don't bother applying to programs and just let yourself go "UNMATCHED".

You will have the opportunity to see the Scramble list the next morning and go after it.

Your PS should be convincing of your committment to your change if this is what you feel is best for you. You may want to spend an hour a day or so wandering through the ED with a resident or see a few patients in the FM clinic (they would love you).

 

[path15]

Hi Step 1 - what do you mean medicare reimbursement red zone? if somebody does one residency and then decides to do another, they don't qualify for the normal salary?
Let's say somebody does PGY1-3 in pathology, then wants to do FM PGY1-3 -
the government won't pay?

 

[Winged Scapula]

Hi Step 1 - what do you mean medicare reimbursement red zone? if somebody does one residency and then decides to do another, they don't qualify for the normal salary?
Let's say somebody does PGY1-3 in pathology, then wants to do FM PGY1-3 -
the government won't pay?

Medicare or HCFA funding funds residents and their programs for the number of years that their original residency is.

That is, if you match into general surgery, you get 5 years of funding. If you choose after the 1st year to switch to FP, you still have enough years of funding left that the residency program wouldn't have to fund your salary without Medicare $$.

If you choose a second residency which is longer than the first, it can compromise funding but most programs don't make a big deal of this.

 

[Praying4EM]

I just wanted to not that if you do indeed try to register for the match this year, it's note true to not bother applying to any programs and just go "unmatched". Technically, in order to be eligible for the scramble, you must apply to at least one program through ERAS and then rank at least one program through the NRMP. Doesn't matter if you don't get interviewed, just pick a program, rank it, and then you will have access to the scramble.

 

[funkless]

Just out of curiosity....

As I understand it, a Path PGY-1 year doesn't resemble an IM/EM/FM intern year in the slightest, so how is it that you can slip into a PGY-2 position in IM/EM/FM without completing that traditional medical intern experience???

 

[step1]

For above post,

It depends on the content of your Path PGY-1 year.

-For IM residencies, ABIM is strict and asks that all rotations in the first year be under the direction of an IM attending. So if you took a surgery month for example, you would lose that month for IM internship credit.

-For EM residencies: many vacant programs will request that you were enrolled in a categorical EM training program for the PGY1 year.
BUT
If you internship experience was broad- ie, it included months of some of the following: surgery, medicine, ER, Peds, OB-GYN, ICU, Ortho, then some programs might accept this to start as a PGY-2.

As an example, my internship was considered acceptable to some for EM PGY2 with: Trauma, SICU, MICU, Ortho, Med Wards, Cards, CT Surg, Neurosurg (nasty eh?)
but I choose to start as a PGY-1 because I believe this will make me a better Emergency Physician overall.

hope that helps

 

[step1]

FYI:
You can get partial credit.

Oftentimes IM/FM programs declare vacant mid-year PGY1 positions intended for graduating mid-yr IMGs (from intern attrition).

Most do not advertise their openings, you have to e-mail several different programs to see who has the spots.

 

[yaah]

I'm not sure why the two of you who want to switch are so hesitant about talking to your own current program director. What is your expectation, that you will somehow find a spot and get it all worked out, and then you will just inform them of your life change and that will be it? If you are going to try to switch programs and fields, people are going to want to know why, and your current program director is going to be one of the most important people. If you start off this hopeful transition with deception, why would they ever help you? No program director wants to keep someone around who doesn't want to be there, and especially someone who doesn't even want to be in that specialty. But if you don't even come to them, why are they going to help you out at all?

Program directors also have answers to many of the questions you are trying to ask people on here who may or may not be talking out of their ass, or working with supposition and heresay. Everything that has been said here makes sense to me too, but no one here is a program director (as best as I can tell).

Again, hoping that working completely through back channels and supposition is going to miraculously work out for you is a bit of a pipedream. It may happen, but not without the help of others.

 

[toby2]

I'm not sure why the two of you who want to switch are so hesitant about talking to your own current program director.

I have talked to my program director, who is hard-core AP and wants nothing to do with CP (which is kind of lame since a lot of the residents do have interests in CP). Among the possibilities we discussed were leaving path altogether for a clinical specialty, or switching to CP only and doing a TM fellowship. My impression after bringing it up was to not expect a lot of support from my PD.

 

[yaah]

My impression after bringing it up was to not expect a lot of support from my PD.

No offense, but you're kind of all over the place and don't really have a career goal other than, "I want to do something else, and I might like this so should I do that instead?" so that's probably part of his problem.

 

[marshmallows]

I have talked to my program director, who is hard-core AP and wants nothing to do with CP (which is kind of lame since a lot of the residents do have interests in CP). Among the possibilities we discussed were leaving path altogether for a clinical specialty, or switching to CP only and doing a TM fellowship. My impression after bringing it up was to not expect a lot of support from my PD.

even if they aren't supportive, he/she has to to understand that life is unpredictable, (people change, their lives change, their minds change, etc..) and you can't control everything.

 

[lilycat]

I just wanted to not that if you do indeed try to register for the match this year, it's note true to not bother applying to any programs and just go "unmatched". Technically, in order to be eligible for the scramble, you must apply to at least one program through ERAS and then rank at least one program through the NRMP. Doesn't matter if you don't get interviewed, just pick a program, rank it, and then you will have access to the scramble.

Sorry, but this information is not accurate, or at least it wasn't true last year. I changed specialties late in the game, was registered with NRMP, didn't submit a rank list, but still was able to participate in the scramble with access to the scramble list the day it came out. As long as you register with NRMP, you can participate in the scramble.

 

[Winged Scapula]

Lilycat is correct. I knew someone who had to drop out of the match because he didn't get his CSA exam done in time before the Rank Order List (a requirement for IMGs/FMGs). But since he had registered with the match, he was still able to get the scramble list when it first came out, contact a program where he had interviewed (which happened to have an open spot) and get a position. So as long as you register, you can participate in the scramble.

 

[toby2]

No offense, but you're kind of all over the place and don't really have a career goal other than, "I want to do something else, and I might like this so should I do that instead?" so that's probably part of his problem.

It's just the way my PD is (hardcore AP). On the other hand, I've talked to the dept chair and the director of CP, who are both much more supportive of residents switching tracks to further define their career. I'm REALLY glad to have them both in my corner throughout this process. In fact, the CP director switched to pathology after some training in internal medicine, and is thus very understanding and supportive of residents switching specialties if that's what it takes to find their career path.

 

[yaah]

Well, your PD probably shouldn't be the PD if he is like this. It's good that you are talking to others though, because the most important thing is to find out what is best for you and what you really want out of your career. It doesn't make sense to keep going if your heart isn't in it, and that is what the proper response from a PD should be. But I think perhaps he is responding to the fact that you are still expressing an interest in TM while still considering getting out of path entirely.

As I said, the PD has no real vested interest in keeping you there if you don't want to be there.