Switching to another specialty after PGY1

[socalresident]

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Hey Guys. So currently I am in an osteopathic pgy1 resident in the midwest. I really like the hospital, but since taking some of my EM rotations last year as a medical student, I realized I fit into EM more than IM (after matching into IM), but tried fighting the urges of thinking things over about my career path until recently when I realized that I won't be happy unless I am in EM. Though I do like the IM field, the EM field fits me better. I did 2 rotations last year in EM and loved them, I had a lot of fun, and was given more autonomy with patients at the one hospital than the other medical students since they were confident in my choices and orders. I got an awesome LOR for an ER attending and I never went through with applying to EM spots until very late and had a hard time getting any interviews since most of the programs had already finished the interview season. I am currently in a contract with this hospital (usually 1 year correct?) and I do not want to be that guy who tries to leave the program early for any reason and put more burden on the other residents. But I am considering leaving after PGY1 and trying to get into a PGY1 EM residency or PGY2 if possible (not sure if that is even a choice). I don't mind starting over as a pgy1, I know this is what I want to do and what will make me happy.

My question is, is it possible to leave a categorical IM residency after completing PGY1 to switch specialties. How do I go about doing that? Do I reapply through ERAS? I do not want to hurt the program I am in, I have considered just doing the 3 years at this hospital and reapplying after, but the downside is, wasting all those years (theoratically speaking if I want to just stick with EM afterwards). Also, I read on here that the contract is a one year contract mostly to aid PD in case they feel the resident is not a fit, they can let him or her go without penalties. Can they force you to sign into a second year position if they want to keep you?

I am pretty new to this idea and have no idea where to begin, or if I should even do it. I know the later would mean I would be depressed for 3 years doing something I'd rather not be doing.

Thanks

 

[mlw03]

please use the search feature. this is one of the more commonly discussed topics on SDN. the logistics of such a switch are apparently not easy, simple, or risk-free.

 

[Law2Doc]

Hey Guys. So currently I am in an osteopathic pgy1 resident in the midwest. I really like the hospital, but since taking some of my EM rotations last year as a medical student, I realized I fit into EM more than IM (after matching into IM), but tried fighting the urges of thinking things over about my career path until recently when I realized that I won't be happy unless I am in EM. Though I do like the IM field, the EM field fits me better. I did 2 rotations last year in EM and loved them, I had a lot of fun, and was given more autonomy with patients at the one hospital than the other medical students since they were confident in my choices and orders. I got an awesome LOR for an ER attending and I never went through with applying to EM spots until very late and had a hard time getting any interviews since most of the programs had already finished the interview season. I am currently in a contract with this hospital (usually 1 year correct?) and I do not want to be that guy who tries to leave the program early for any reason and put more burden on the other residents. But I am considering leaving after PGY1 and trying to get into a PGY1 EM residency or PGY2 if possible (not sure if that is even a choice). I don't mind starting over as a pgy1, I know this is what I want to do and what will make me happy.

My question is, is it possible to leave a categorical IM residency after completing PGY1 to switch specialties. How do I go about doing that? Do I reapply through ERAS? I do not want to hurt the program I am in, I have considered just doing the 3 years at this hospital and reapplying after, but the downside is, wasting all those years (theoratically speaking if I want to just stick with EM afterwards). Also, I read on here that the contract is a one year contract mostly to aid PD in case they feel the resident is not a fit, they can let him or her go without penalties. Can they force you to sign into a second year position if they want to keep you?

I am pretty new to this idea and have no idea where to begin, or if I should even do it. I know the later would mean I would be depressed for 3 years doing something I'd rather not be doing.

Thanks

Are you just a week into orientation week for first year? It's natural to have second thoughts, but I personally would probably give it more time before you decide to bail. You put IM on your match list for a reason, even if it was your fallback. Your contract is for one year, so that's what you have committed to do, so you of course can change if you can find a place that will take you. But there are plenty of things you won't like in every field, so don't get sucked into how great things were as a med student, where you are largely insulated from certain aspects of the job.

 

[BolderNewfy]

I went through this last year. I matched into IM, and was immediately unhappy. Intern year is a really difficult time. I can remember after the first week thinking "there is no way effing way im doing this"....I am still not sure I like clinical medicine at all.

My advice is this, dont make any quick decisions and try evaluate whether it is internal medicine itself you dont like, or if it is just being an intern working 80 hours a week. I was so completely exhausted from the hours and stress it was too difficult for me to determine if I was depressed and unhappy with IM or just burned out. Give it a few months and if after you have settled into things and you continue to feel unhappy then perhaps pursue it further.

One caveat: As the year continued I was still so tired and depressed from being overworked that I never really was able to make a decision. Its a terrifying thing to try and switch, the program director can ruin you. I was scared of giving up a sure thing, and possibly end up with no residency, and I waited until I already signed my contract for the second year. Now Im in a contract for PGY2, and the PD knows I dont want to be here, but is making me stick out second year. I anticipate a not pleasant year. SO Dont sign your PGY2 contract unless you are sure you are ok with being at that program another year. and dont wait until may or june to tell your PD that you have finally decided that if you want to leave.

Also it is difficult to separate what your life is like now, and what it will be like after residency. Try to imagine what your life will be like as a hospitalist doing your 15 shifts a month or working as a PCP versus working as an EM doc working your 15 shifts per month. Try to figure which you would like better. I was initially going to apply to EM as well but saw IM as a way to do shift work and have the option of just working as a PCP with a more normal schedule, but as I was exposed to real hospital medicine i realized there is no way in hell I am going to be ok with being a hospitalist (basically a permanent resident), and with the current health care system, I could never be a PCP (and see like 30 people a day and stay at the office till like 8 not getting paid to return emails, and check labs....it totallu blows)......anyhow, I empathize.

 

[Going]

If someone is in a PGY-1 in an IM residency and wants to go through ERAS for another residency, can they do so without the Program Directors Knowledge? In other words, will the PD be notified if s/he registers for ERAS?

 

[BolderNewfy]

As far as I know the PD wont be notified that you are applying but every program that you apply to will be notified that you were a PGY1 the previous year, and they will either call your old PD to ask them about you, or they will REQUIRE a letter from your PD basically saying you didnt suck, didnt leave them hanging, and wont kill anybody.

There is no real way to apply through eras without getting the PD involved in my experience. and really, I think it would be an extremely rare situation that you would be able to secure any type of residency position whether it be through the match or out of the match without your PD, or without you requiring his/her blessing. it blows but they got you good.....