want out of IM, and into Path

[WCL1980]

I am in my first year of IM residency and it is getting very clear that I do not want to do this for much longer. I spent some time in path looking at my patients biopsies and have become very excited about the field and would like to switch.
the problem is that I do not know how to go about it...
i have no letters of rec, the match is going on as i write...
anyone know of a good way for current residents to leave their program and enter a new field. seeming more and more impossible to do without having to take a year off and all of that.

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[pathstudent]

I am in my first year of IM residency and it is getting very clear that I do not want to do this for much longer. I spent some time in path looking at my patients biopsies and have become very excited about the field and would like to switch.
the problem is that I do not know how to go about it...
i have no letters of rec, the match is going on as i write...
anyone know of a good way for current residents to leave their program and enter a new field. seeming more and more impossible to do without having to take a year off and all of that.

Smart move. Primary care and many of the I.M. subspecialties are for the birds.

Is there a path program where you are now? Go talk to the PD. If not, call the path advisor from where you went to med school. They'll help you.

 

[WCL1980]

There is no path where i currently am, I do not get the feeling that the PD would like to hear that I want out (i feel like if i said something, all that would happen is that the rest of my year would be terrible), and I went to a Carib school, so they provide zero help...hence...my predicament!!!!!

 

[2121115]

You said you spent time in pathology looking at biopsies. Just go talk to the pathologist there and ask them what you should do. They'll be glad to help and they will probably know people where they trained that can help you find a spot.

 

[malchik]

Look up programs' websites and see what application materials they ask for. Then send the applications out en masse. Since you are not coming right out of school, you would not be obliged to do the match. You're going to have to come up with some letters of rec somehow. I would consider taking a year off to do research in a path dept or something. That would give you time to get all of this stuff and also make sure path is the best fit. Spending an additional year to get this decision right is worth it IMO.

 

[tinablue]

My advice to you is to talk with someone in your program you can trust. Is there an attending you can approach to discuss the reasons why you don't like IM anymore? Is it because the hours, the stress, the sudden increase in responsibility, so on and so on? My own experience and many whom I speak to is that the first year of residency in any subspecialty is extremely difficult. Many, many people contemplate switching. When you are unhappy, an alternative may appear unrealistic attractive.

During my first two months of pathology residency, I was so stressed and felt so inadequate that I contemplated about switching to something more familiar like family medicine or internal medicine. After talking with friends and an attending that I trusted wholehearted, I slowed down, took a breather, and relaxed.

I don't want you to think that you know what pathology is all about by sitting in on a few sign outs. I don't want you to hastily switch only to find out later that this was also a mistake.

Please talk to someone you trust to carefully examine the reasons behind your dissatisfaction and ways to perhaps remedy those causes.

Best.

 

[zao275]

I don't want you to think that you know what pathology is all about by sitting in on a few sign outs. I don't want you to hastily switch only to find out later that this was also a mistake.

This is very good advice. One of our residents (who was very talented, BTW) decided to switch to IM. The resident changed their mind after only a few weeks of IM, and wanted back in to path, but there was not an available spot at that point. It was not a good situation, and it was very sad, because the person was really good and we all begged the resident not to leave. Anyway, moral of the story is to take the time to be SURE of what you want before you burn any bridges.

 

[peppy]

One of our residents (who was very talented, BTW) decided to switch to IM. The resident changed their mind after only a few weeks of IM, and wanted back in to path, but there was not an available spot at that point.

I've heard of this happening to other residents too. I think you guys are right that the best course of action is to finish out the year of IM and then do some path research to see if it's really what it appears to be.

 

[pathstudent]

Don't do the reserach. Int Medicine and all primary care and many of the I.M. subspecialties are for the birds.

 

[pathstudent]

Nice choice of words -- arguably specimens and corpses are really for the birds, but perhaps this is just the humor of pathology I had yet to encounter.

Hospital autopsy is a dying field. Surg path specimens are awesome. I just saw a primary jejunal melanoma that caused intussecption. Amazing. And the day before I just saw a man with a primary large small cell carcinoma of the breast that metastized to the brain. Awesome.

Primary care is for turkeys, and I think you have to be hoodwinked to go into it.

A) It is lame and involves filling out ****loads of forms.

B) You constantly defer to subspecialists

C) You can do 3 years and go into Peds, I.M. or F.P. or spend 4 years and do anesthesia and earn 2-3x as much out of training.

I know Obama wants to elevate primary care, but they could make that **** worth 600K a year, I still wouldn't do it. B O R I n G

 

[redapple123]

.................

 

[sirenomelia]

There's always a few spots left in the scramble if you didnt get stuff sent in time for the match so just have your CV and crap ready for the day after the match.

 

[KCShaw]

Hospital autopsy is a dying field. ...

HA HA, HO ho..hah..ho... hm.

 

[Euchromatin]

HA HA, HO ho..hah..ho... hm.

So hospital autopsies are not a dying field? I was under the impression from my very limited experience at my own program and from interviews that they kinda were.

I know a few places (U of Iowa, U of Vermont) have integrated the ME's office into large teaching hospitals. They seem to have motivated forensic pathologists who have convinced their clinicians that autopsies are a valuable quality assurance and learning tool, and not just another opportunity for lawsuits. These places also seem to have well trained bereavement staff that know how to counsel and educate the families' of decedents about when an autopsy is appropriate. However, I was under the impression that these places were the rare exception and everywhere else in the country hospital autopsy numbers were in sharp decline.

I'm not really a huge fan of doing autopsies, so I can't say that I would be thrilled if numbers really are going up, but I would be interested in any opinions/facts about this topic that KCShaw and our other forensics-bound members would like to add to the conversation.

 

[Euchromatin]

rewriting the Moral again ---

Moral of the story " A bird in hand is worth 2 in the bush".... in simple words.... complete 1 residency and after that if you want you can always do another. Atleast you would not risk anything ( except additional 3 to 4 years assuming you are not in your 40's while doing a residency)

I have to disagree a little bit here - I think wasting an additional 3 to 4 years of your time (especially 3-4 years doing an internal medicine residency, *shudder*) IS a big risk, regardless of your age. I think many of the other posters have made good points about being cautious. It is certainly important that you have enough knowledge and experience in pathology that you can be confident you really want to do it (and that this isn't just a "grass is always greener on the other side of the fence" scenario). However, if you've already made up your mind, I also think it would be pointless for you to suffer through an ENTIRE IM residency before switching. You could even try shotgunning programs with applications this fall and hope that one of the less competitive places might want to offer you a non-Match spot, or, as was previously suggested, you could try during the Scramble. Or wait for next year's application season.

 

[KCShaw]

So hospital autopsies are not a dying field? ...

Of course it's a "dying" field... death..autopsy..You only (hopefully) autopsy the dead.. so.. Dying. Humerus, like the arm, but with "o"'s.

That's all I was going for at the time.

On the less lively (haha, get it..lively, less, dying...) topic of the downward trend in numbers of hospital autopsies -- yeah, it's hard to deny that, at least since around the mid 1900's when hospital autopsy rates reportedly averaged around 50%. It's a money drain on hospitals, and JCAHO no longer requires hospitals to have a percentage of in-hospital deaths proceed to autopsy. Despite numerous articles addressing the utility of autopsies, the rate of missed diagnoses even in the face of modern diagnostic techniques, inaccurate death certificates, educational issues, etc., the modern focus on health care costs combined with the rise of family rights to a body and informed consent to perform an autopsy (among other things, such as pathologists having more surgical specimens with more staining & subtyping on each while not making money on hospital autopsies, for the most part) have led to the trend continuing.

I don't think it's dead/dying, but it has certainly faltered as a widespread method of education & quality assurance, and now seems to carry a stigma of uncouthness as compared to, say, a CT or MRI -- which are very good at identifying some things, but poor at identifying others.

 

[zao275]

I guess sometimes autopsy is performed on the living (supposedly):

http://www.reuters.com/article/idUSN149975820070917

Not sure why they would cut on his face though.

 

[KCShaw]

That was just a partial autopsy. Doesn't count. Besides, if they're alive it's either a "physical examination" or "surgery."

I've heard rumors of ME offices which do their own ECG to confirm death on every non-decomp, in the wake of similar...incidents. Some EMS organizations require a printout of a flatline before determining fact of death. This means we occasionally get decomposed remains with fresh ECG patches present. It probably isn't a bad idea in cold climates where hypothermia is a real problem, but generally it doesn't seem like it should be that difficult.. Right..?

My most stressful moments of internship were the first couple of times I had to pronounce death. Not because I was disturbed by the death, as they were all expected, but because I really, really didn't want to be wrong and all of a sudden they start mumbling to family when I walk out of the room. And of course, because they were expected deaths, we had withdrawn monitoring devices along with support devices, so no cheating with electronics. A couple of times I heard a heartbeat or a breath after the nurse indicated they were dead and just needed me to document. Sometimes they'll become apneic and/or bradycardic for extended periods, so it's not always THAT easy to do the old school way (no electronics). Substitute hypothermia, narcotics, or a head injury for chronic natural disease and I can see how life sometimes gets mistaken for death.