thanks

[intern_for_life]

for everyone's help

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[DrMetal]

I started my intern year in IM after medical school but resigned before finishing the year to pursue pathology. I matched into pathology the following year and now am even more miserable and I want to do something with patients such as occupational medicine. I know these are major black marks now but is this still possible for someone like me? I am specifically wondering about the funding issues but also just curious what other advice people have to offer. I don't see a lot of information about occupational medicine and whether I can still apply for a Transitional Year for the next cycle after finishing 1 year in pathology and have a shot at clinical medicine the year after that.

What do you mean you resigned from IM, did you actually finish the intern year? You must've if you started path, which is typically starts at PGY2 (after some kind of PGY1, IM, TY, GS, whatever have you).

So you shouldn't have to repeat a PGY1 year if you already did one.

How far along are you in your path residency? What do you like about it? You must like something.

 

[intern_for_life]

What do you mean you resigned from IM, did you actually finish the intern year? You must've if you started path, which is typically starts at PGY2 (after some kind of PGY1, IM, TY, GS, whatever have you).

So you shouldn't have to repeat a PGY1 year if you already did one.

How far along are you in your path residency? What do you like about it? You must like something.

No, unfortunately I resigned during my intern year of IM because I thought I liked pathology which was more objective. I didn't realize how much time I would be spending cutting organs during residency which is the majority of my day. I am having a bad reaction to formalin and it's giving me a cough and irritating my lungs to the point that I am having trouble speaking. I do like diagnosing and looking at slides which is what initially drew me towards it.

Pathology no longer requires the intern year that it used to so I am actually still in my first year of pathology which is technically useless for clinical medicine.

I am really interested in occupational medicine but afraid I might be too late to do a transitional year and apply again. I wouldn't mind doing that though if it was a possibility. Just curious if anybody else made a switch to occupational medicine and if it worked out for them.

 

[DrMetal]

No, unfortunately I resigned during my intern year of IM because I thought I liked pathology which was more objective.

You wouldn't be 'switching'. You'd be resigning from your current training. Then you'd have to re-apply (probably too late this year) next year. OccMed still requires a formal internship of some sort, I think, so you'd have to a do a IM, TY, GS PGY1 year. BTW, OccMed isn't all that clinical (it's lots of administrative type medicine, some clinic, lots of work comp, etc). Know the belly of the beast before your jump in. That's probably the take home lesson here. It helps to know that you're allergic to formalin before going into path.

 

[intern_for_life]

You wouldn't be 'switching'. You'd be resigning from your current training. Then you'd have to re-apply (probably too late this year) next year. OccMed still requires a formal internship of some sort, I think, so you'd have to a do a IM, TY, GS PGY1 year. BTW, OccMed isn't all that clinical (it's lots of administrative type medicine, some clinic, lots of work comp, etc). Know the belly of the beast before your jump in. That's probably the take home lesson here. It helps to know that you're allergic to formalin before going into path.

I agree with what you're saying. I made some poor choices and do regret the initial resignation from IM. I am just trying to figure out if I still have a chance to do something which I can enjoy and not lose my health over. I will finish pathology if that is my only option left now but I would really like some advice on whether I should pursue a transitional year and then apply to occupational medicine after that year. I don't know how hard it is to get into a TY or occupational medicine after basically resigning from 2 residencies. I regret my decisions.

 

[ThoracicGuy]

I agree with what you're saying. I made some poor choices and do regret the initial resignation from IM. I am just trying to figure out if I still have a chance to do something which I can enjoy and not lose my health over. I will finish pathology if that is my only option left now but I would really like some advice on whether I should pursue a transitional year and then apply to occupational medicine after that year. I don't know how hard it is to get into a TY or occupational medicine after basically resigning from 2 residencies. I regret my decisions.

The safest option is to finish pathology and then do a second residency in something else if you find you really want something else. You may find by then that you are ok with path and find a job. If you finish path and go into something else, it gives that new program more confidence that you'll stick around rather than quitting when the grass looks greener on the other side.

 

[intern_for_life]

The safest option is to finish pathology and then do a second residency in something else if you find you really want something else. You may find by then that you are ok with path and find a job. If you finish path and go into something else, it gives that new program more confidence that you'll stick around rather than quitting when the grass looks greener on the other side.

Yeah, you might be right. I understand how wrong I am here. Just wondering if the funding would be an issue if I were to apply for the match this cycle for possibly TY spots. I'm not even considering residency programs anymore, I just want a shot at a TY and work my way up to occupation medicine.

 

[ThoracicGuy]

Yeah, you might be right. I understand how wrong I am here. Just wondering if the funding would be an issue if I were to apply for the match this cycle for possibly TY spots. I'm not even considering residency programs anymore, I just want a shot at a TY and work my way up to occupation medicine.

And then if you get in OM and decide you hate it? What's your backup? At that point, you can probably forget any training program and practicing as a doctor. You left once for the greener grass on the other side. Don't make the same mistake again.

If you quit now, that will make two programs that you couldn't even finish out the year in. That won't give anyone confidence in you to take you in their training program. Funding isn't even the concern here.

 

[NotAProgDirector]

TY's are actually reasonably competitive. They tend to be less intense than IM prelims so are preferred by Derm and other competitive candidates. So your chances of getting a TY seem not that great to me.

Prelim IM would be an option, theoretically then followed by Occ Med. But as others have mentioned, your frequent switches raise concerns -- you'd need to convince a prelim IM and occ med program that you were not going to just bail.

If you're having problems with formalin exposure, you should go see Occ Med. They will likely give you a respirator of some sort. Once you're done with training, you won't be grossing slides any more.

 

[deleted480308]

I agree with what you're saying. I made some poor choices and do regret the initial resignation from IM. I am just trying to figure out if I still have a chance to do something which I can enjoy and not lose my health over. I will finish pathology if that is my only option left now but I would really like some advice on whether I should pursue a transitional year and then apply to occupational medicine after that year. I don't know how hard it is to get into a TY or occupational medicine after basically resigning from 2 residencies. I regret my decisions.

Finish

 

[SunBakedTrash]

Consider CP only, then transfusion medicine.

 

[Mass Effect]

Why do you want Occupational Medicine? Really explore this. Do you know what it is? Do you know what an average day in the life looks like? You jumped into path too quickly. Don't do the same with OM. I would suggest you visit your own hospital's Occ Med to discuss how to work around the formalin for now and then over the next year, you need to really research Occ Med and if you still want to leave path, discuss with your PD, but not until you've done your homework.

 

[swamzi]

See a therapist and learn about yourself before many any drastic changes #mindfulness

 

[rokshana]

What do you mean you resigned from IM, did you actually finish the intern year? You must've if you started path, which is typically starts at PGY2 (after some kind of PGY1, IM, TY, GS, whatever have you).

So you shouldn't have to repeat a PGY1 year if you already did one.

How far along are you in your path residency? What do you like about it? You must like something.

Actually path is one of the few specialties that starts at pgy 1...no prelim year.

 

[rokshana]

No, unfortunately I resigned during my intern year of IM because I thought I liked pathology which was more objective. I didn't realize how much time I would be spending cutting organs during residency which is the majority of my day. I am having a bad reaction to formalin and it's giving me a cough and irritating my lungs to the point that I am having trouble speaking. I do like diagnosing and looking at slides which is what initially drew me towards it.

Pathology no longer requires the intern year that it used to so I am actually still in my first year of pathology which is technically useless for clinical medicine.

I am really interested in occupational medicine but afraid I might be too late to do a transitional year and apply again. I wouldn't mind doing that though if it was a possibility. Just curious if anybody else made a switch to occupational medicine and if it worked out for them.

And how is anyone going to take you now interest in occupational medicine? This will be the third specialty you have decided was “right” for you...why would any program think you are going to stick this out too?
Finish path residency and then if you want to, look into occupational medicine...or do a path fellowship that is more what you like...cyto path...transfusion medicine,etc.

 

[ScubaV]

Sounds to me like you're making a bunch of decisions based on gut feelings and not actual research/experience. Did you do any rotations or shadowing in path before you switched? Have you done any for occ med? Do you realize that the grossing part of pathology is not the main focus as attendings (many/most do little or even no grossing) or that the grossing component generally decreases the further you advance in residency?

The last thing our field needs from a job perspective is just a warm body looking for a salary, but you would probably personally be best served by looking into CP fields like transfusion, hematopathology, molecular, etc. If none of that appeals then you're probably still stuck finishing residency before starting another one and coming up with real, concrete reasons as to why for both your own sake and to prove yourself to PD's in another field.

 

[intern_for_life]

Consider CP only, then transfusion medicine.

How do I switch to CP only? Can I reapply for a 1st year CP only spot?

 

[intern_for_life]

Yes. I agree with all of you. I made some really poor decisions because I never could figure out what I would be best fit for. I get what most of you are saying. I am looking for any options left other than me coughing through work everyday but if that’s all I can do now then so be it. My mistake was not sticking out IM and I am aware of that. Any other input would be much appreciated. Sometimes I learn new things after it’s too late so I’m trying to cover all bases.

 

[intern_for_life]

Yes. I agree with all of you. I made some really poor decisions because I never could figure out what I would be best fit for. I get what most of you are saying. I am looking for any options left other than me coughing through work everyday but if that’s all I can do now then so be it. My mistake was not sticking out IM and I am aware of that. Any other input would be much appreciated. Sometimes I learn new things after it’s too late so I’m trying to cover all bases. There’s always a possibility some other resident went through something similar to me and can share their experience.

 

[rokshana]

How do I switch to CP only? Can I reapply for a 1st year CP only spot?

ask your PD if you can just do CP...I know someone that was able to do that and finished a year earlier.

 

[wholeheartedly]

Yes. I agree with all of you. I made some really poor decisions because I never could figure out what I would be best fit for. I get what most of you are saying. I am looking for any options left other than me coughing through work everyday but if that’s all I can do now then so be it. My mistake was not sticking out IM and I am aware of that. Any other input would be much appreciated. Sometimes I learn new things after it’s too late so I’m trying to cover all bases.

Again, see occ health to deal with the coughing issue. Second, a good path residency should have grossing decrease in volume as you go. Have you talked to fellow residents about how the program changes through the years and what you can expect moving forward? What type of path residency are you at?

 

[SunBakedTrash]

How do I switch to CP only? Can I reapply for a 1st year CP only spot?

Assuming you are in an AP/CP residency, tell them you have a formalin intolerance and ask to drop AP and remain CP only. This is going to limit job prospects significantly so it really only makes sense if you are ok with transfusion medicine. The other CP fields are largely PhD driven, and heme/molecular are really best served by having AP training. If you are AP only, you will need to reapply.

 

[operaman]

OP you gotta finish something. Anything. Every residency sucks in the beginning. Nobody wants to be an intern forever because you’re doing the crap parts of the field. PGY2 in path is probably better than PGY1 in path, so maybe find a way to stick it out.

I wouldn’t look to Occ Med as your salvation. There’s a reason nobody wants to do it!

 

[medready]

I agree with a lot of the other posters. Since OP has left one program before completion and is considering leaving a 2nd program, this would worry me if I was a program director.

Do a rotation (if possible) or shadow an occupational Med physician. Occ med has a wide array of duties. Some do corporate/administrative, others clinical (physicals, work site evals, IME's, work injury eval/treatment...).

I disagree with the above comment saying "There’s a reason nobody wants to do it!" Every speciality has pros/cons but I actually enjoy working in Occupational Medicine (lifestyle is great with no call, no nights, no weekends). OP must find what aspects of medicine they enjoy doing before leaving current residency.

Either way, to apply to occ med you need to have completed formal residency training or at least have completed a pgy one year.

 

[intern_for_life]

I agree with a lot of the other posters. Since OP has left one program before completion and is considering leaving a 2nd program, this would worry me if I was a program director.

Do a rotation (if possible) or shadow an occupational Med physician. Occ med has a wide array of duties. Some do corporate/administrative, others clinical (physicals, work site evals, IME's, work injury eval/treatment...).

I disagree with the above comment saying "There’s a reason nobody wants to do it!" Every speciality has pros/cons but I actually enjoy working in Occupational Medicine (lifestyle is great with no call, no nights, no weekends). OP must find what aspects of medicine they enjoy doing before leaving current residency.

Either way, to apply to occ med you need to have completed formal residency training or at least have completed a pgy one year.

Great advice, so do you think I should just apply for the TY spots for this cycle and figure out if occupational medicine is a fit for me? Or do you think I lost my chances to get another shot at TY year?

 

[rokshana]

Great advice, so do you think I should just apply for the TY spots for this cycle and figure out if occupational medicine is a fit for me? Or do you think I lost my chances to get another shot at TY year?

Good grief! Do you just want to keep repeating being an intern over and over?
He said do a ROTATION in occ med, not jump ship and do a TY year!Smh!

 

[Dral]

And how is anyone going to take you now interest in occupational medicine? This will be the third specialty you have decided was “right” for you...why would any program think you are going to stick this out too?
Finish path residency and then if you want to, look into occupational medicine...or do a path fellowship that is more what you like...cyto path...transfusion medicine,etc.

I agree with this. You say you like the slides/diagnosing. I'm sure you do realize that once out working, most pathologists do little to no grossing unless they want to.

If you want some patient contact, consider going with cyto and working in an FNA clinic (if you can find that set up) or doing transfusion medicine.

I do clinical medicine and pathology. I'd say that path is a little more 'objective' than the clinical realm, but there is still a lot of subjectivity to it. It's one of the things I wish more clinicians would understand...a lot of times, things don't just magically appear as a final diagnosis under the microscope. You may have realized that and are a little less satisfied with where you are. Unfortunately, you are running out of time on a career decision at this point.

You could also consider preventive medicine. Although again, really research it. I'm not entirely sure how easy it is to get a considerable amount of patient contact in that field if that's truly what you desire.

I get the idea of not being sure about things. I was like that in medical school and had a really difficult time deciding. It's exciting to have a bunch of doors open and consider all the things you can do. However, you really do have to self-reflect and go with a final thing and concentrate on it. I think there are a few superstars that can focus on multiple career goals and be a superstar at all of them, but most of us are better off deciding on something and focusing on it. If you haven't thought of it already, try researching all the end points you could reach and think of the best way to get yourself there. What I mean by that is, instead of thinking of IM vs pathology vs occupational med think in terms of 'intensivist who focuses on cardiology issues' vs 'cyto/FNA doc at an academic center' vs 'person who does workers comp exams' (sorry occ med, I'm admittedly ignorant to what you do).

 

[intern_for_life]

Just out of curiosity, does anyone know if a pathology intern year count if I were to apply to preventive medicine after 1st year. I understand everyone is saying I should finish pathology but I’m just researching all options. I am also curious if I finish my pathology intern year (which has no clinical medicine), if I would technically be a licensed physician and can possibly practice clinical medicine in an urgent care or something down the road?

 

[deleted480308]

Just out of curiosity, does anyone know if a pathology intern year count if I were to apply to preventive medicine after 1st year. I understand everyone is saying I should finish pathology but I’m just researching all options. I am also curious if I finish my pathology intern year (which has no clinical medicine), if I would technically be a licensed physician and can possibly practice clinical medicine in an urgent care or something down the road?

Some states only require a year of residency, but you would be a crappy doctor. Not good for patients

just finish

 

[Dral]

Since it's not a true intern year (as in prelim, TY, or first year of a clinical categorical program), I'm not sure it would count for either the preventive medicine intern year or to be able to do clinical practice.

I know hindsight is 20/20, but unless you really had an overwhelming reason to leave, you would have really done yourself a favor by finishing out your 1st year of IM when you were there.

My opinion is that if you stay in path, to finish out both AP and CP. Jobs are tough enough to find in path, you don't want to limit yourself imo...unless you are following a position you already know is available to you when you finish. I think people who are laser focused on CP from the start can do it (CP only) since they seem to have their end game career objectives in mind going in. You don't strike me as laser focused about your career, so again, if I were you, I'd probably do both AP and CP.

For how all over the place you are, it makes me think for a second you're trolling us or something. lol.

Anyway, good luck in moving forward. I'm sure you'll end up with something fulfilling.

 

[smq123]

For how all over the place you are, it makes me think for a second you're trolling us or something. lol.

It makes me wonder if the OP truly wants to be a physician.

A family medicine PD told me once that he occasionally got residents who would come to him discussing a specialty change. When he would try to find out which specialty they might prefer, though, they’d have a hard time picking one (or have a hard time pinpointing exactly what about family medicine they disliked). Eventually they’d come around to the realization that they just didn’t want to be doctors at all. Most of them admitted that they’d been “strongly encouraged” to go to medical school by their families. I’m not saying that this is the case with the OP, but it does make me wonder.

 

[intern_for_life]

No

Since it's not a true intern year (as in prelim, TY, or first year of a clinical categorical program), I'm not sure it would count for either the preventive medicine intern year or to be able to do clinical practice.

I know hindsight is 20/20, but unless you really had an overwhelming reason to leave, you would have really done yourself a favor by finishing out your 1st year of IM when you were there.

My opinion is that if you stay in path, to finish out both AP and CP. Jobs are tough enough to find in path, you don't want to limit yourself imo...unless you are following a position you already know is available to you when you finish. I think people who are laser focused on CP from the start can do it (CP only) since they seem to have their end game career objectives in mind going in. You don't strike me as laser focused about your career, so again, if I were you, I'd probably do both AP and CP.

For how all over the place you are, it makes me think for a second you're trolling us or something. lol.

Anyway, good luck in moving forward. I'm sure you'll end up with something fulfilling.

No, I wish I was trolling. Just looking for a restart tbh so I get a year to figure something out while learning something.

 

[ThoracicGuy]

No
No, I wish I was trolling. Just looking for a restart tbh so I get a year to figure something out while learning something.

Your chances for get a TY aren't great. Your chances of ending up without ANY training and no future job prospects as a physician are high if you pursue this path.

 

[Dral]

If what smq says is true, I would consider preventive medicine, but I would still strongly recommend finishing pathology first. If you don't like pathology your first few years out (remembering that the first few years as an attending in basically any field will be a little tough), then you may consider going back for preventive (or finding something path related that is not actually practicing AP/CP).

The tough part is, that many pathologists end up doing at least a fellowship or two before they even start practicing.

Sorry, you're in a tough spot. Just really stop and think of what your end game goals are and try to go from there. It's a trite interview question, but ask yourself "Where do I see myself in 10 or 20 years?"

 

[NotAProgDirector]

Just looking for a restart tbh so I get a year to figure something out while learning something.

There is no such thing. No TY is going to take you, especially without a plan going forward. And the funding issues mentioned in your first post are going to make finding a catagorical spot more and more difficult as your training progresses.

 

[deleted367183]

Just wanted to add that I am a PGY-2 in pathology. First year sucked a lot. This year is better.

 

[Mad Jack]

Just out of curiosity, does anyone know if a pathology intern year count if I were to apply to preventive medicine after 1st year. I understand everyone is saying I should finish pathology but I’m just researching all options. I am also curious if I finish my pathology intern year (which has no clinical medicine), if I would technically be a licensed physician and can possibly practice clinical medicine in an urgent care or something down the road?

Doubtful, as most programs require a year of clinical medicine and some require that a certain number of months be in primary care fields. You'll be expected to do clinic competently at many programs from day 1, which you simply don't have the training to do at this point.