Unhappy, I need advice

[BolderNewfy]

---

Members do not see this ad.

Hello, I am finishing my PGY 1 in internal medicine. Been struggling all year but wanted to just stick it out just in case it was just the intern blues. But now Im getting ready to go into the PGY2 year and Im sort of freaking out at the thought of having to continue with internal medicine. I really dislike internal medicine, and I dont see myself practicing in this field. I would like to transfer into a psychiatry program. I got in the 230's on step 1 and 2. I am from one of the better caribbean schools. Any advice on how i go about doing this? I have to tell my PD really soon to give them time to find a replacement. One of the problems is that I have to tell my PD before I have another spot lined up so I may end up going a year with nothing. Also should I just apply for PGY 1 spots through the match in september or how do I try and get a PGY 2 spot. Please Help!

 

[belle54321]

Hello, I am finishing my PGY 1 in internal medicine. Been struggling all year but wanted to just stick it out just in case it was just the intern blues. But now Im getting ready to go into the PGY2 year and Im sort of freaking out at the thought of having to continue with internal medicine. I really dislike internal medicine, and I dont see myself practicing in this field. I would like to transfer into a psychiatry program. I got in the 230's on step 1 and 2. I am from one of the better caribbean schools. Any advice on how i go about doing this? I have to tell my PD really soon to give them time to find a replacement. One of the problems is that I have to tell my PD before I have another spot lined up so I may end up going a year with nothing. Also should I just apply for PGY 1 spots through the match in september or how do I try and get a PGY 2 spot. Please Help!

I am about to start as a PGY-2 in psychiatry after almost a 10-yr post-residency career in another specialty, so I can empathize with how you feel. I think if you think internal medicine is not for you, and psych is, then by all means change. However, I would say it is a little late this year to essentially "quit" your IM program as July 1 is looming large. You will need full support of your PD no matter what you do (you will need a lor from PD), and by giving him such short notice is not going to help you. My recommendation is for you to complete your PGY-2 in IM and apply for a PGY-2 spots for 7/2013 or at least start it and look for a off-cycle position starting 1/2013. There are a number of programs that regularly take PGY-2s-Stanford, Yale, Hopkins, etc. Obviously, you may be competing with AMGs switching from more competitive fields who are going thru the similar situations as you. I personally applied to one of these programs that didn't participate in ERAS, and the rest I applied for PGY-1 positions thru ERAS. Most of the programs that invited me for interviews actually interviewed me for PGY-2 spots. Some programs wanted me to start as PGY-1 as they didn't have any anticipated open PGY-1 spots. Also check the APA website under residents for any open spots.

In the meantime, get your CV, LORs, personal statements together as you will need them. If a spot opens up, then you will have them ready.

 

[clement]

I am about to start as a PGY-2 in psychiatry after almost a 10-yr post-residency career in another specialty, so I can empathize with how you feel. I think if you think internal medicine is not for you, and psych is, then by all means change. However, I would say it is a little late this year to essentially "quit" your IM program as July 1 is looming large. You will need full support of your PD no matter what you do (you will need a lor from PD), and by giving him such short notice is not going to help you. My recommendation is for you to complete your PGY-2 in IM and apply for a PGY-2 spots for 7/2013 or at least start it and look for a off-cycle position starting 1/2013. There are a number of programs that regularly take PGY-2s-Stanford, Yale, Hopkins, etc. Obviously, you may be competing with AMGs switching from more competitive fields who are going thru the similar situations as you. I personally applied to one of these programs that didn't participate in ERAS, and the rest I applied for PGY-1 positions thru ERAS. Most of the programs that invited me for interviews actually interviewed me for PGY-2 spots. Some programs wanted me to start as PGY-1 as they didn't have any anticipated open PGY-1 spots. Also check the APA website under residents for any open spots.

In the meantime, get your CV, LORs, personal statements together as you will need them. If a spot opens up, then you will have them ready.

it all depends..there is also the medicare funding issue where if you use up another year of the max 3 years you are given as a categorical medicine resident, then switch to psych as a pgy2, the psych program gets less funding and still requires 3 years of training from pgy2-4. I'm not sure how much programs care about this.
Also, i hear (perhaps incorrectly) that the "new" rules state even for pgy2 spots you have to apply through the match. maybe someone else knows...it is a bit late in the year, but if you have a spot lined up for sure and were OTHERwise in good standing at your program, there is no reason for a PD to give you a horrible LOR out of spite...Especially if you have some candidates willing to apply for your position that you have lined up (but that isn't always easy or necessarily your job to do, just would ease the situation).

 

[Leukocyte]

Hello, I am finishing my PGY 1 in internal medicine. Been struggling all year but wanted to just stick it out just in case it was just the intern blues. But now Im getting ready to go into the PGY2 year and Im sort of freaking out at the thought of having to continue with internal medicine. I really dislike internal medicine, and I dont see myself practicing in this field. I would like to transfer into a psychiatry program. I got in the 230's on step 1 and 2. I am from one of the better caribbean schools. Any advice on how i go about doing this? I have to tell my PD really soon to give them time to find a replacement. One of the problems is that I have to tell my PD before I have another spot lined up so I may end up going a year with nothing. Also should I just apply for PGY 1 spots through the match in september or how do I try and get a PGY 2 spot. Please Help!

I was in the same situation, but in FM (not IM). To change programs, mid way, as an IMG can be risky....since there is no guarantee to get into a Psych program in the Match, and one risks "angering" their current PD if they did not Match. But, you do have a strong Step scores, so that gives you an advantage.

Option # 1 (the safest option for an IMG): Complete the IM residency. During your IM PGY-3 year, apply through the Match for PGY-1 Psychiatry spots. Eventhough you apply to PGY-1 Psychiatry spots, you will not start as a PGY-1. Programs will automaticaly start you as a PGY-2 Psychiatry resident (because you have already completed/will complete IM). Most likely, you will get multiple PGY-2 Psychiatry pre-match offers before the match.

(This is what I did, and I got multiple PGY-2 Psychiatry pre-match offers way before the Match). However, I decided not to take the pre-match offers and not go into Psychiatry beacuse I really just wanted to get out of clinical medicine all together. So I am now doing a second residency in Preventive Medicine (a non-clinical specialty...which is what I want).

Option #2 (a risky option for an IMG): Apply in this coming Match for PGY-1 Psych spots. You will NEED a letter from your PD, so he/she has to know. This can be risky being an IMG (but not all PDs are the same. If your PD is a nice/cool person, he/she might be supportive). However, if you did not Match in Psych it can feel awkward during the rest of your IM residency. Some PDs (if they are mean/nasty), might feel offened that you want to leave them, and might hold it against you.

(When I was a resident, I had a fellow resident who applied to Anesthesiology programs during match when he was PGY-2 FM resident. He did not match. He did get into some trouble with the residency program, and placed on probation, after he declared that he wanted to switch to Anesthesiology. However, he was able to graduate and finish his FM residency.)

Option #3 (Safer than option #2, but riskier than option #1): Quit the IM residency, and take a year-off during which you apply to PGY-1 Psych programs. It is still a very risky move for an IMG, and it is not reccomended.

My advice is to take the safest route (Option #1). It is tough, but it will be much easier to get into Psych residency this way. At least, that is the option that I took....after seeing my fellow IMG resident in FM go through so much trouble because he decided to switch to a different specialty midway.

Good Luck.

 

[psychattending]

Doing it without informing your PD or working with him/her, raises a lot of flags about an applicant's professionalism. For this reason a lot of programs will not even look at such an applicant. I would recommend that you talk with your current PD about your issues. PDs understand that people change their mind about their specialty and typically will work with the person to help them figure things out. Depending on the specifics of the situation, your PD might be willing to work with you to get you transferred to another program quickly. However, you should be prepared that it might take a whole year in order to do the transfer in an orderly fashion, especially if you want to go to a stronger program.

 

[BolderNewfy]

what I would like to do is inform my PD as soon as possible that I am unhappy and that I want to leave, but tell him that I will stay as long as he needs to find a replacement. Hopefully that shouldnt take the whole year. Then I will try and apply through ERAS for PGY 1 or 2 spots and then also try and get a PGY 2 out of cycle match. that way I dont have to complete a second year of medicine but dont leave my program short handed. Is this still quite risky? If So why? I dont like IM or this program. I dont think I can handle another year of medicine. 2 more months in the ICU, I swear I cant do it.....

 

[heyjack70]

My PD in psychiatry is great. The PD has helped psych residents transfer into other residencies, actually helping them find open slots. So for me I would not hesitate to bring this up to my PD; I would anticipate getting tons of support and actually probably get help via PD connections to locate an open residency spot in the specialty I'm interested in.

I have heard rumors that not all PD's are so awesome, so I think you really have to guage how much support you think you will get from your PD. If you think there will be negative backlash, I would consider sticking out the entire IM residency then applying to PGY 2 psych in your IM 3rd year.

 

[clement]

what I would like to do is inform my PD as soon as possible that I am unhappy and that I want to leave, but tell him that I will stay as long as he needs to find a replacement. Hopefully that shouldnt take the whole year. Then I will try and apply through ERAS for PGY 1 or 2 spots and then also try and get a PGY 2 out of cycle match. that way I dont have to complete a second year of medicine but dont leave my program short handed. Is this still quite risky? If So why? I dont like IM or this program. I dont think I can handle another year of medicine. 2 more months in the ICU, I swear I cant do it.....

I would check on the viability of "out of match" pgy2 spots still being the case. I have heard mixed things re "new rules" that definitely say no "pre-match" for pgy1 and perhaps no "out of match" for pgy2 spots, but that doesn't make sense since some pgy2 spots come up after the match is over and would HAVE to be out of the match.

If your PD is a nice person, it is always helpful...But the limiting factor is that we are less than 3 weeks away from July 1 and this could make even nice PDs unhappy. They would likely have to find an off-cycle person, someone who took a year off etc even if you offer to stay longer. Staying for the full year might mean limited interviewing time and acgme/medicare funding issues as you are funded for a total of 3 years for IM (since that is the residency you started in), where as psych requires 3 more years from pgy2-4.

 

[BolderNewfy]

so thats it. man that is really devastating. so basically Im stuck working 80+hour work weeks with one day off for 3-4 months at a time doing work that makes me physically ill for at least the next year.....and at that point i will have finished my second year of IM residency which limits my funding, and would make a switch to a field I can tolerate even harder. If I finish IM residency I will never, ever practice in that field. Maybe I should just walk away from medicine altogether. I have serious philisophical issues about our approach to allopathic medicine.

At the end of it all, I have a doctor of medicine degree, owe about 1/3 of a million dollars, and the only job available to me now is worse than being unemployed.....speechless.....

 

[peppy]

What is your relationship with your PD like? If you've had a good relationship with them, I think if I were you I'd try talking to them about how you're unhappy in IM and see what options they're open to. It's something you need to talk to them about sooner or later anyway, so I'm not sure if there is any benefit to waiting to break the news. While there ARE unreasonable malignant PDs out there, I think that many are normal people who can understand that sometimes a specialty isn't right for a resident.
Yes, there may be a benefit to staying in the program longer, so I'm not saying to tell them you're resigning July 1st, but I'm talking about just telling the PD your intentions and seeing if they are willing to offer any support or help.

You might want to try private messaging the poster Masterofmonkeys. He resigned from his psych program and the last that I heard he was going to look into work at urgent cares and such while taking a year away from residency. Maybe he can tell you how his experience with that has been to help you decide if that's a road you'd want to take. Resigning and having a gap year IS a risky path, but if you truly feel like you can't tolerate IM anymore, maybe it would be better to leave on your own terms than get forced out of the IM program due to performance issues.

As for the funding issue, while I do think that can be an issue, I don't think it's automatically going to sink you. Even though I had lost a year of funding when I applied for PGY-1 psych spots, only one of the many places I interviewed at mentioned it at all. I did match high on my list even though they knew they wouldn't have full funding for my last year. It's also NOT uncommon in psych for people who have actually completed residencies in other specialties to end up going into psych, and obviously those people will have burned their funding. I know that my program has in the past accepted people who were full fledged attendings.

 

[clement]

so thats it. man that is really devastating. so basically Im stuck working 80+hour work weeks with one day off for 3-4 months at a time doing work that makes me physically ill for at least the next year.....and at that point i will have finished my second year of IM residency which limits my funding, and would make a switch to a field I can tolerate even harder. If I finish IM residency I will never, ever practice in that field. Maybe I should just walk away from medicine altogether. I have serious philisophical issues about our approach to allopathic medicine.

At the end of it all, I have a doctor of medicine degree, owe about 1/3 of a million dollars, and the only job available to me now is worse than being unemployed.....speechless.....

Peppy is right, the funding things may not be an issue for some programs (i.e. not all programs rely as heavily on medicare funding stuff because they have money coming in from other places).

I think with all of this said, you are not trapped and can apply for psych. A gap year would not have been the end of the world had you informed your PD 6-7 months ago, with, say, a game plan to do psych research that year, because that would give your PD time to replace you and increase your odds of a good letter from him/her.

But now that's it's NOW, ultimately, it's good to have an open forum with your PD even at this point...It will relieve a lot of anxiety for you and most normal PD's will appreciate your honesty and the fact that you're giving them time to replace you. If you've never been in trouble at your program, then you are clearly in good standing and no one would try to screw you over. My guess is he/she will want you to stay the whole year and that it's to your advantage because you will NEED a good word/letter from this PD. There will be psych pgy2 positions open for 2013 ... and they are very used to taking people from IM, surgery, anesthesiology. Stay positive but make a convincing argument about why you like psych and what you could bring to the field.

 

[vistaril]

so thats it. man that is really devastating. so basically Im stuck working 80+hour work weeks with one day off for 3-4 months at a time doing work that makes me physically ill for at least the next year.....and at that point i will have finished my second year of IM residency which limits my funding, and would make a switch to a field I can tolerate even harder. If I finish IM residency I will never, ever practice in that field. Maybe I should just walk away from medicine altogether. I have serious philisophical issues about our approach to allopathic medicine.

At the end of it all, I have a doctor of medicine degree, owe about 1/3 of a million dollars, and the only job available to me now is worse than being unemployed.....speechless.....

wow....lots of points to make.

1) IM programs vary a *lot* in terms of the work load after pgy-1 year. I know IM residents at many programs who have a pretty light pgy-2 year and basically 7 months of electives(which they can spend doing research, very light outpt responsibilities, etc) their third year.....many pgy-3 at smaller programs with lighter work loads spend far more time moonlighting than working for their program. So you may want to consider switching to one of these programs with a lighter workload. They are often easy to switch into.

2) If you dont want to do general IM(and most people dont), do an outside of the box fellowship. What about allergy/immun? Very good schedule, and good money.

3) If you do end up staying in IM and finishing that residency, hospitalist jobs are 7 on-7 off. That's *not* a bad schedule, and they pay a little over 200k generally. Yes, your shifts are 12 hrs/each, but HALF THE DAYS you are off.

4) An addiction fellowship is maybe a good idea if you like psych. It's only a year, and you will be able to get a job where you are only doing addiction. This may be as the medical director of an inpatientn rehab with a full list of outpt suboxone pts for example.

iow, you're looking at IM with much too narrow a focus.

 

[BolderNewfy]

the program im at there is no way i am going to get a good fellowship. it is a small community program, allergy is one of the most competitive fellowships out there, no way i would get it. the fact that being a hospitalist being 7 on 7 off sounds good on paper till you actually do it. many hospitalists I see look miserable. You are seriously a permanent resident. it is 12 hours of pure hell. no way im doing that for the rest of my life. no damn way. Also my second year, is pretty similar to my PGY1, another 2 months in the ICU, 4 electives (and I have to take 6 overnight calls on my 4 elective months). it really is a horrible program.

Anyhow I told my PD. He was a total douche bag. said I have to finish PGY2. wouldnt even look for a replacement. I told him I would gladly stay until they could find a replacement, he said i am obliged to fisnish my whole second year. I am surprised he would want me to stay on as miserable as I am, and wouldnt even try to find a replacement.

 

[vistaril]

the program im at there is no way i am going to get a good fellowship. it is a small community program, allergy is one of the most competitive fellowships out there, no way i would get it. the fact that being a hospitalist being 7 on 7 off sounds good on paper till you actually do it. many hospitalists I see look miserable. You are seriously a permanent resident. it is 12 hours of pure hell. no way im doing that for the rest of my life. no damn way. Also my second year, is pretty similar to my PGY1, another 2 months in the ICU, 4 electives (and I have to take 6 overnight calls on my 4 elective months). it really is a horrible program.

Anyhow I told my PD. He was a total douche bag. said I have to finish PGY2. wouldnt even look for a replacement. I told him I would gladly stay until they could find a replacement, he said i am obliged to fisnish my whole second year. I am surprised he would want me to stay on as miserable as I am, and wouldnt even try to find a replacement.

well, I seriously doubt that your program is so horrible that allergy is completely off the table. Not sure such a thing is possible. Maybe not somewhere you would want to be, but if you applied to 2/3rds of the allergy programs in the country I bet you would get some interviews somewhere and probably be offered a slot in at least one....Unless you yourself arent a decent candidate outside the limitations of your program.

Also, why would anyone pick a community IM program with such a horrific schedule? Community IM programs are not difficult to slide into, and there are many that have pretty decent schedules....I could have pm'd you 5 in my area right off the top of my head that are very noncompetitive.

That said, even if you can't do allergy....there is always addiction. You *can* get an addiction spot somewhere, unless you have some *serious* red flags(and by serious red flags I dont mean low board scores and coming from a community IM program...I mean bad legal/ethical/professionalism stuff)