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Oct 1, 2014
Resident [Any Field]
Hi all,

I'm sure there's a thread about this that could answer my questions, but a quick search didn't reveal anything.

I'm a Path PGY-1, and I'm realizing I most likely made a mistake. I do very much enjoy learning pathology and it's almost everything I thought it would be from my rotations in med school. But I've just been feeling really strongly that I'd rather be on the direct patient care side of things, however crazy that world can be (especially during residency/fellowship). I didn't expect to feel this way at all, but it's real. Enjoying learning is one thing, but I am not enjoying the actual practice of it like I thought I would, and I don't see myself enjoying it more once I know more and become more experienced. It's a great field but the microscopy and visual discriminatory process is simply not for me, and I am thinking I should have stuck with my first inclinations (IM --> outpatient practice). I know it's a hassle to switch, it's a burden to the others in my program, and I'm jumping into a specialty known to be a rough one at least during residency... but at least now I won't have to wonder whether I would have made a better pathologist (It's possible I'd wonder that after the switch...but I at that point I would force myself to stick to my guns...I can't keep switching my life away).

I have no idea how to navigate this switch to IM. Even though it would cost me time and it would be a year without an income, I would like to finish out this year and then apply in the match during next ERAS cycle. That way, I could somehow do rotations in IM wards, ICU, ER to refresh my clinical skills (haven't done a medicine rotation since the beginning of 4th year med school!). The alternative would be to jump into IM right after this year of path...which would save me time, but honestly I'd rather be adequately prepared to start residency so it doesn't absolutely demoralize me.

So my questions are:
1) When should I tell my PD?
2) When are contracts for a PGY-2 year usually signed (I'm guessing it varies by program...), and should I wait until then?
3) Would it be possible to do IM-related rotations during most of my interview/application gap year? How would that work? I never did any away rotations as a med student, but would it be a similar process? Would I have to pay for every rotation?
4) If I wanted to jump right into a PGY-1 after my Path year, does that mean I would have to apply now? I don't really want to--I need time to make sure I am sure, to make absolutely sure this isn't just a little buyer's remorse that will resolve itself.
5) One of the particular fellowships in which I am interested is competitive. If I was an upper middle tier type of candidate for IM to begin with out of med school, then what can I expect now? The same? Or is switching from another specialty a disadvantage? What can I do to ameliorate this? I've had good evaluations from my path rotations so far.

Thanks and good luck to everyone else in residency just trying to figure out what they want to do with their lives!
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Staff member
7+ Year Member
Oct 10, 2011
Resident [Any Field]
1) ASAP, so he can start looking for a replacement, especially if you're going through ERAS again. You are better off, IMO, not taking a 'gap' year, but rather apply this cycle or next year while still maintaining your path residency income.
2) Not sure, others can advise.
3) Contact your medical school (hopefully a US-based one) and ask them what the process is. They've likely had someone switch specialties. I don't know how much time you will have to do 'rotations' like a medical student again.
4) Yeah, you'd have to apply right now. Maybe finish out your PGY-1 and see if it is just buyer's remorse, then you can tell your PD at the start of PGY-2 (allowing him a full year to find a replacement for you)
5) Switching from a specialty is likely a disadvantage, but as long as you focus on matching at a location that at least HAS the fellowship of interest, you've set yourself up in a good position. Then you can be a rockstar during your residency and get great LoRs from the fellowship department for use at other places or stay in-house as a fellow at the same hospital.

Best of luck. It's tough to change specialties, but people do it much much more than what most people think.


No Meat, No Treat
Staff member
10+ Year Member
Mar 6, 2005
Attending Physician
You did a crap job of searching, AND you cross-posted.
50 points from Hufflepuff.
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