Wanting to switch back into surgery

[arthurthenyancat]

Hey everyone I wanted to know what your thoughts were on my situation. I have a rocky course through residency and I know my situation is very bad. I was wanting to know the honest truth regarding what my options were.

In Med school I wanted to do plastic surgery. I was top quartile 240+ on both steps, and had research. I did a 4th year rotation in vascular and liked it more so I switched out of plastics and applied gen surg right as interview season began. I didn’t have many connections and programs were wondering why I was indecisive so that did me in. I didn’t match so I did a prelim year with the intention of reapplying to gen surg. During my first few months of intern year, I was adjusting like any intern, making the occasional mistake, not efficient, deer in the headlights, etc. I was put on a ton of rotations which were nonoperative as compared to my categorical intern counterparts. i Got depressed and frustrated because I thought I wasn’t adjusting well, and I had a lot of depression from not matching. I started seeing a psychiatrist who thought that If I liked the OR and ICU but felt as if surgery was causing me more harm in terms of my depression, anesthesia would be a good option.

I ended up applying for anesthesia as a result because because of this and had no self confidence. My PD supported me because he told my my health is important and if it means switching then that’s fine. However, as the year went on, I became better at interning, I started developing self confidence and I genuinely enjoyed what I was doing even though it was not operative. And at the end of the year, my schedule got shuffled around due to personelle changes and I did a lot more operating, which was really fun. Even the smaller things gave me enjoyment. I told my PD that I was starting to regret switching prematurely and he told me I shouldn’t have been so finicky. I agreed and said I’d give anesthesia a shot.

I ended up matching to a good anesthesia program, and I have been doing it for almost 3 weeks now but I still really wish I was doing surgery. I know I’m
Experiencing growing pains. I just don’t enjoy reading the material as much as I did gen surg. I Miss even closing skin and port sites in the OR. I even miss clinic and consults to change up my day. I know I haven’t given myself time to adjust. I know that I’m flip flopping again. But to my credit I have had regret about not dual applying last year for months. I’ve never been more sure of anything in my entire life. All the free time in the world can’t make up for not feeling satisfied at work and I definitely had that last year as my mood and confidence improved and I don’t have that this year. I know people will say give it time, but I’d take a general surgery spot again if I could, even a prelim spot. I just miss it all.

I did ok on my ABSITE (+70%) and passed step 3. I know my end of the year feedback was good and attendings and upper level residents enjoyed working with me. I just want to know how bad my situation is and what I can do about it. All the free time in the world, and weekends off don’t make up for the satisfaction I had at the end of the day when I was doing gen surg. I am getting more hobbies outside of work but it doesn’t make up for how much longing I have to do surgery again.

I fully expect people to call me out on flip flopping and needing to grow a pair and just stick to something cause I can’t do this back and forth thing. I know I will be burning bridges entirely and I can’t go back after this. I know my home program won’t take me back cause I’m used goods and not reliable. I just don’t know how to navigate this situation without screwing things over for myself cause I don’t have a plan in place.

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[Dr.LeoSpaceman]

How to navigate this situation is quite simple: Finish your anesthesia residency.

The fact that you say your home program won't take you back is concerning. That suggests to me that there is something more to that relationship, and if that's the case, I suspect you also can't count on a strong recommendation from that program. And bottom line is that if you try to apply without support from your Gen Surg prelim program, I think your chances are incredibly long.

 

[arthurthenyancat]

How to navigate this situation is quite simple: Finish your anesthesia residency.

The fact that you say your home program won't take you back is concerning. That suggests to me that there is something more to that relationship, and if that's the case, I suspect you also can't count on a strong recommendation from that program. And bottom line is that if you try to apply without support from your Gen Surg prelim program, I think your chances are incredibly long.

I haven’t talked to my old PD yet and I’m assuming they won’t take me back because I talked with friends and they said that if you flip flop its problematic cause they need someone who’s devoted and my actions suggested otherwise since I applied anesthesia and then said I wanted back in halfway through. I haven’t talked to my old program yet. I was thinking about reaching out to him soon but I didn’t know if that would be poor form a month in and not giving it time to actually settle in. Yes I’ve been steadfast since the middle of last year in regards to wishing I was doing surgery and regretting not dual applying but the optics just look really bad.

I am fairly certain my old PD would write me a letter of support because he was the one who told me to see the psychiatrist and was invested in my well being throughout the year. I do understand what you’re saying though. I just wish there were other ways about it to get to where I wanna go in the end.

 

[Dr.LeoSpaceman]

I am fairly certain my old PD would write me a letter of support because he was the one who told me to see the psychiatrist and was invested in my well being throughout the year. I do understand what you’re saying though. I just wish there were other ways about it to get to where I wanna go in the end.

Writing a letter is not equivalent to writing a strong letter and being your advocate. It's great that the PD was concerned about your well well being, and was active in trying to help you manage the issues you were facing. And in the end, it seems like things "worked out" if you're are now matched in a fairly competitive specialty. But know that regardless of what they say or the letter they write, there is a lot of informal discussion that goes on between PDs. I can 100% guarantee PDs from other programs will reach out to them regarding you given the non-standard situation. It's also the case that PD's aren't going to vouch for someone just to be kind. If there are concerns about your dedication and you're former PD perceives you as an attrition risk, they will communicate this to other programs. If that happens, you are going to be in a very tough spot.

 

[arthurthenyancat]

True. I figured that there would be some behinds the scene talking, and my situation is not favorable. I appreciate the honesty. Would you think it would be worth talking to him about this, or is it just a futile effort? I’d love to have any spot even if it means redoing a prelim intern year and proving myself but if it’s not advisable then I guess I’ll just hold off and try and finish out the next 3 years.

 

[ThoracicGuy]

True. I figured that there would be some behinds the scene talking, and my situation is not favorable. I appreciate the honesty. Would you think it would be worth talking to him about this, or is it just a futile effort? I’d love to have any spot even if it means redoing a prelim intern year and proving myself but if it’s not advisable then I guess I’ll just hold off and try and finish out the next 3 years.

Finish anesthesia and then reassess. At that point you may be able to look for pgy2 as well. Having completed a training program would help resolve some concerns that you just keep leaving programs. That would be a bigger red flag.

 

[SLUser11]

I strongly suggest that you stay in anesthesia. I hope you can appreciate how similar your current discontent is to the way you felt in early surgery internship a year ago. You will likely find anesthesia more enjoyable over time.

Just take a deep breath and give your current career choice a chance to succeed.

 

[arthurthenyancat]

I strongly suggest that you stay in anesthesia. I hope you can appreciate how similar your current discontent is to the way you felt in early surgery internship a year ago. You will likely find anesthesia more enjoyable over time.

Just take a deep breath and give your current career choice a chance to succeed.

Yes that’s what some of my close friends are telling me as well, and that it should get better with time. I wish I just didn’t give up on myself so early last year. I think things would have been different if I had the same self confidence and attitude then that I have now.

 

[HighPriest]

For whatever it's worth, man, I have periods of time where I wish I had done something else even now, and I finished residency over 5 years ago. But, there are a lot of things I really like about what I do, which is why I picked it in the first place. So I concentrate on that stuff. There are things that other specialties do that I still think are really freaking cool, but I don't get to do them. My point is: some of that never, ever goes away. Medicine is pretty cool. Other than obstetrics, everyone does one or two things that are pretty interesting, and unfortunately you can't do them all.

However, there is a huge stigma with indecisiveness, and for good reasons. One: you need to be decisive as a physician, especially in surgery. So signs of indecisiveness are frowned upon. Two: there's a huge shortage of physicians. no one wants to train a person who might just stop practicing a few years out because they're fickle. It happens too often already. Three: unless you're in a very big program, you're screwing over your co-residents every time you pack it in (beyond maybe PGY1).

Stick with it. You'll be happy you did. And if you aren't, it's only three years. You've already spent a whole year out of sequence, and you're talking about doing another. Tack one more on that and you're a board certified physician in a high paying specialty. You'll be surprised at how much of a difference that makes in helping you grow roots.

 

[doc05]

You're damaged goods. You won't get a spot in any surgery program, prelim or categorical. Stick with anesthesia and be thankful you've got that spot.

And please enjoy your free time. You will be better off in the long run.

 

[Psai]

Theres a person who switched out of a surgical specialty then changed their mind again and wanted to come back. He's not coming back.

 

[arthurthenyancat]

So even spots open that are outside the match are not looking promising at all given how I played things out? I guess I’ll just try and learn to like this. I reap what I sew. I appreciate the Honesty folks. Better to not give myself any false hope.

 

[AdmiralChz]

There are some fields that really frown upon flip-flopping with interest/non-interest. Surgery (and subs) are probably the least forgiving of all.

Be glad you have a spot - finish your anesthesia training. You can of course inquire about openings but 1) they are highly sought-after nationally and 2) regularly fill with strong internal prelim applicants.

 

[SpecializedSurgeon]

True. I figured that there would be some behinds the scene talking, and my situation is not favorable. I appreciate the honesty. Would you think it would be worth talking to him about this, or is it just a futile effort? I’d love to have any spot even if it means redoing a prelim intern year and proving myself but if it’s not advisable then I guess I’ll just hold off and try and finish out the next 3 years.

I would suggest you speak to your old PD. Worst case scenario he confirms what random SDNers are saying, but it’s more likely he’s familiar with your specific situation and can give better advice about what to do. He supported you when you were having trouble, why wouldn’t he do the same now?

 

[Man o War]

OP-
Have you considered a pain management fellowship after anesthesia? That will give you the procedural elements and patient interaction you say you miss. Anesthesia is by far the best path into procedural pain management.

 

[vhawk]

Isnt anesthesia residency like a 6 month program? Just finish that