Thinking about switching specialties (peds to path) after intern year

[deleted614508]

I've been having doubts about my chosen specialty, namely I miss the scientific aspects of medicine and I feel like clinical medicine isn't right for me anymore (I feel like I barely spend any time learning about pathophysiology like in pre-clinical years and as of now will probably end up spending most of my time on EMRs)

Has anyone successfully made this transition after intern year? My problem is that I can't really do electives as an intern and I've only done shadowing in Pathology, not an actual rotation.

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[draker80]

A friend of mine had the exact same story, he switched to path from peds after his intern year. His only strength was that he had the support of his PD and they wrote him strong references.
Path programs will be curious on why you are switching, do you have issues with your current program? Or such questions.
So PD blessings on why you are leaving is a must.
A letter or two from path faculty won’t hurt of course. Usually they look at your application as a whole.
Good luck.


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[deleted50541]

Yes, one of the interns in my program did an internal switch from gen surg to path. This person was clearly miserable doing clinical medicine and had the strong support of our PD to make the transition.

Have you talked with your PD yet about what your options are? That's the best place to start.

 

[deleted614508]

No I have no issues with my current program, and I love the faculty and get along with them great, it's also my home program so they've known me since I was a med student. My main issues have really been with the specialty itself (more like the day-to-day of clinical specialties in general). I wish I had more established connections with the Path faculty though because I don't think they really know me all too well..


Do you know if that resident who switched had to apply through the match or was it like calling different programs?

 

[Spikebd]

Take your time and try to get into a good path program. It’s a lovely field, but it is more lovely when you’re at a highly-regarded program. There are laid back, highly-regarded programs. Those are obviously the best. Anyway, lots of people switch into path. It’s a nice, niche field. Lab medicine is pretty cool, even if few know what we do.

 

[draker80]

No I have no issues with my current program, and I love the faculty and get along with them great, it's also my home program so they've known me since I was a med student. My main issues have really been with the specialty itself (more like the day-to-day of clinical specialties in general). I wish I had more established connections with the Path faculty though because I don't think they really know me all too well..


Do you know if that resident who switched had to apply through the match or was it like calling different programs?

He did his Peds in Louisiana and matched in Texas in one of the top programs, he interviewed in home but liked the TX program more.
I believe the safest way is to ensure internal connections with your home program, and once you get more interviews you may weigh your choices.
It’s best to have an internal position guaranteed, the path people will feel more comfortable to talk to your peds PD if they wanted to know anything.


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[deleted614508]

He did his Peds in Louisiana and matched in Texas in one of the top programs, he interviewed in home but liked the TX program more.
I believe the safest way is to ensure internal connections with your home program, and once you get more interviews you may weigh your choices.
It’s best to have an internal position guaranteed, the path people will feel more comfortable to talk to your peds PD if they wanted to know anything.


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Thanks so much for your replies! Another couple of questions: do you know if that resident applied through ERAS again, or was it a separate process? and do you know if there were any funding issues (since Peds is 3 years vs Path 4 years?)

 

[draker80]

Thanks so much for your replies! Another couple of questions: do you know if that resident applied through ERAS again, or was it a separate process? and do you know if there were any funding issues (since Peds is 3 years vs Path 4 years?)

It was through ERAS, like a whole new application, and he started as a PGY1 in Path. Peds internship doesn’t count.
Usually most programs won’t have funding issues. I know some small community programs won’t be able to offer another PGY1 to someone who already did one.
I believe Path is a great field, and wish you best of luck. Just have a solid application without weak points that might implies you are not 100% into path.


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[Spikebd]

Thanks so much for your replies! Another couple of questions: do you know if that resident applied through ERAS again, or was it a separate process? and do you know if there were any funding issues (since Peds is 3 years vs Path 4 years?)

I expect funding issues will be on a case by case basis. My advice, send out some eras apps, like 15-20. See which programs bite.
Make connections in your home program. Don’t be afraid to ask for help. Most people want to help if they believe you’re being honest with them.

 

[deleted614508]

It was through ERAS, like a whole new application, and he started as a PGY1 in Path. Peds internship doesn’t count.
Usually most programs won’t have funding issues. I know some small community programs won’t be able to offer another PGY1 to someone who already did one.
I believe Path is a great field, and wish you best of luck. Just have a solid application without weak points that might implies you are not 100% into path.


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So I guess since ERAS opens in mid Sept, I should let my PD know before that time? Like right after the end of intern year? So I guess I need to stick it out in Peds for PGY-2 year as well..

 

[gutonc]

So I guess since ERAS opens in mid Sept, I should let my PD know before that time? Like right after the end of intern year? So I guess I need to stick it out in Peds for PGY-2 year as well..

Did you already sign your R2 contract? Tusually happens in March. If you have, you're bound by whatever the contract terms are (usually a 90 day out clause) and how much your PD wants to push it for you to stay. I would argue that if you're going to start PGY2 in a 3 year specialty, you might as well finish it and then do path if you still want to at the end. That way you've at least got something to fall back on if path doesn't work out.

You can certainly try for this year in path but unless you resign your position, it will be hard to have time to interview (assuming in-person interviews are a thing this year). In the end, it's completely up to you, but if you don't have any path experience, you're going to need that first.

 

[deleted614508]

Did you already sign your R2 contract? Tusually happens in March. If you have, you're bound by whatever the contract terms are (usually a 90 day out clause) and how much your PD wants to push it for you to stay. I would argue that if you're going to start PGY2 in a 3 year specialty, you might as well finish it and then do path if you still want to at the end. That way you've at least got something to fall back on if path doesn't work out.

You can certainly try for this year in path but unless you resign your position, it will be hard to have time to interview (assuming in-person interviews are a thing this year). In the end, it's completely up to you, but if you don't have any path experience, you're going to need that first.

I might have to take the extra year, especially since my program doesn't allow for electives as an intern, I barely have any path experience except for shadowing as a student.

 

[deleted614508]

Did you already sign your R2 contract? Tusually happens in March. If you have, you're bound by whatever the contract terms are (usually a 90 day out clause) and how much your PD wants to push it for you to stay. I would argue that if you're going to start PGY2 in a 3 year specialty, you might as well finish it and then do path if you still want to at the end. That way you've at least got something to fall back on if path doesn't work out.

You can certainly try for this year in path but unless you resign your position, it will be hard to have time to interview (assuming in-person interviews are a thing this year). In the end, it's completely up to you, but if you don't have any path experience, you're going to need that first.

Regarding sticking it out for 3 years, I am considering that, but I'm worried my chances of matching to a residency after finishing another will be pretty slim. I don't know if that's true or not, but it's something I've been hearing a lot from others.

 

[doctorKAT]

Regarding sticking it out for 3 years, I am considering that, but I'm worried my chances of matching to a residency after finishing another will be pretty slim. I don't know if that's true or not, but it's something I've been hearing a lot from others.

It is slim because once you have completed one residency, programs know you can quit your 2nd residency anytime.

 

[Naruhodo]

I knew someone who switched for a peds program to path. In the end she became a pediatric pathologist and loved it.

 

[Perrotfish]

Regarding sticking it out for 3 years, I am considering that, but I'm worried my chances of matching to a residency after finishing another will be pretty slim. I don't know if that's true or not, but it's something I've been hearing a lot from others.

The issue is funding. Most residents don't realize that Medicare (or Medicaid or pediatrics) is both reimbursing your program for your salary and is also paying your program a 'tuition' for your education that is similar what you were paying in medical school. Unfortunately they are only willing to pay for that once, for a number of years equal to the length of the residency you initially matched into. So if you finish a residency in IM, and switch to path, you would need to convince the path program that it was worth taking you despite having to pay out of pocket. That's more possible than you might think but it is a negative.

Now one thing I haven't been able to ever get an answer to is whether that rule applies to pediatric residents who are funded by Medicaid, or if you would still have full medicare funding. @NotAProgDirector , do you know?

 

[NotAProgDirector]

That is a great question, and I have no idea.

To the OP: If you were a competitive peds applicant, then you'll do fine applying to Path. Although you'd use ERAS to get a path spot for July 2021, you could start looking for a spot to start July 2020. Chances are, some intern in a path program will be unable to start for any number of reasons. If you're geographically limited due to personal issues, that may limit your options. It might also be possible for your home program to host an extra path intern -- you never know unless you ask.

 

[kraskadva]

Just a couple of FYIs...

So I guess since ERAS opens in mid Sept, ...

It's been pushed back to Oct 21 this year bc all the med students have been pushed out of the hospitals for the past 3mo and we still have to finish up clerkships and scramble for limited audition rotations (most spots not available this year), so co2021 is a little behind on the timeline.

...(assuming in-person interviews are a thing this year). ...

They are not. All specialties and all governing bodies are insisting on virtual interviews this year.

 

[Laradd]

I know you are feeling now, as it is the cases that some of us experienceing but I know you'll get into it. It will just happen! Good luck!!!

 

[deleted614508]

Thanks for all the replies.. I will wait till after August to talk to my PD. In the meantime, I have 1 week of vacation coming up, should I use this time to approach the Path department and ask to shadow? And if I do that, should I not mention anything about planning to switch, since I haven't spoken to my PD yet?

 

[cthorburn]

Thanks for all the replies.. I will wait till after August to talk to my PD. In the meantime, I have 1 week of vacation coming up, should I use this time to approach the Path department and ask to shadow? And if I do that, should I not mention anything about planning to switch, since I haven't spoken to my PD yet?

It never hurts to ask. I would tell them you miss the pathophys side of things without explicitly saying you're planning to switch, at least until you talk with your PD.

If you aren't allowed to shadow(which I would consider unlikely), you can always try attending tumor boards - that will give you some path exposure and a convenient excuse to start a conversation with a pathologist.