Can I Still Change Specialties After Residency?

Geoffrey A. Talmon, MD


June 02, 2009


Once I start practicing in the "real world," can I still change specialties if I feel that I made a mistake? Or will I be stuck in that career, no matter what?

Response from Geoffrey A. Talmon, MD
Assistant Professor, University of Nebraska Medical Center, Omaha, Nebraska

A friend of mine during residency had switched to pathology after being a rural family physician for many years. When I was a frustrated intern, I often asked him why he had chosen to go back to residency; his wife had a successful career, his children were all in elementary school, and he had already "paid his dues" as a resident. He said that in his previous practice, he was confident in handling common problems but often referred complex and interesting patients to specialists. Over time, he discovered that making one difficult diagnosis was more fulfilling than treating 10 patients with hypertension. Now in a pathology practice, he reiterates that although the move was initially hard for him and his family, he has found tremendous professional and personal gratification in his work and does not regret the switch.

The perceived dogma is that being a physician represents a state of terminal vocational choice. Although it is not uncommon for residents to change specialties, many doctors believe that it is "too late" to alter their career path after entering practice, partly due to their substantial investment in training. Few (if any) residency programs broach the topic with their trainees. Practicing physicians may be reticent to discuss a partner's departure from their practice, even if the change had nothing to do with group dynamics. A lack of information perpetuates the notion that doctors are stuck with their initial career choice.

The reality is that changing one's specialty is not unprecedented. In fact, as more Generation X'ers and Millennials populate medicine (with the increased tendency to job-shop), switching specialties likely will become even more common. Because there are few studies on this phenomenon and because mentors may be difficult to find, you may feel as though you are going where no one has gone before.

For obvious reasons, making the decision to try a new field after being in practice is substantially more complex than when one was a resident. Re-entering training (with the attendant staff-resident hierarchy) may be less palatable. Relocation to a teaching hospital in a larger city may be necessary, placing strain on spouses with careers and families with older children. Further, the switch will engender a substantial salary decrease for several years, which may require special financial planning or a lifestyle change. Obviously, the concept requires careful discussion with and assistance from your family.

Despite all of these potentially contentious issues, the ultimate factor to consider is your long-term happiness. Many other physicians have made these situations work, sometimes through their own creativity.

Which new specialty to enter may or may not be obvious to you. Perhaps you have always had a "second choice" in the back of your mind since medical school. Regardless, it is important to consider several issues: What is the primary source of dissatisfaction with your current specialty? Which aspect of medicine interests you more? For example (as with my friend), you may find that you enjoy diagnostic challenges more than urgent care or health maintenance. Perhaps emergent care provides greater stimulation than long-term treatment of chronic illnesses. Do you want to do more procedures than your current specialty involves? Perhaps your most serious concerns lie with work hours and scheduling. Whatever the reason, this decision represents a substantial psychosocial investment, and it is imperative that the new field you enter is professionally and personally satisfying.

Much like the first time you sought a residency, research is important. Spend time talking to multiple people from different types and sizes of practices about their experience and views. Specifically, determine the employment outlook and potential practice settings that would be available when you have completed training. To this end, it is beneficial to get a feel for the future of the specialty: What issues will you face in practice (economic liability, political pressures, the impact of mid-level practitioners, etc)?

Length of training is also a consideration. Starting a 1- or 2-year fellowship is obviously less complicated than starting a 6-year surgery residency. Note that residencies may be willing to grant exemptions from a preliminary or intern year due to your experience, so be sure to inquire.

When applying to training programs, be prepared not only to justify your decision but also to demonstrate that you have a good comprehension of the specialty and the previously mentioned issues associated with switching. Most program directors with whom I have spoken see the benefit and value of having an "uber-experienced" intern on service and on the educational team. Their primary concern is to maximize the training of the candidate and their contemporaries. Directors wish to ensure that you are making an informed, contemplated choice and are prepared to accept being a trainee again. Be certain to explicitly articulate your reasons for changing, and ask interviewers whether they believe that their program will provide what you are seeking. This reinforces to each person that you understand precisely what you want.

One benefit of being a "nontraditional resident" is that you may be exempt from the traditional application process. This allows you to receive offers and accept a position outside of the Match, which affords a modicum of flexibility, as it is possible to enter residency at a time other than July 1.

Once in training, continue to critically evaluate the new specialty that you have chosen. Taking into account the special challenges that are part and parcel of being a resident, is this new path giving you what you expected? Do not hesitate to discuss any perceived issues with your program director as soon as possible. Their advice is just as applicable to you as to traditional first-year residents.

In summary, the process of changing specialties after residency is more complex than it is during training, but it likely will become more commonplace in coming years. Research is the most powerful tool to help you make informed decisions. The psychosocial and financial ramifications are not insurmountable, and the increased satisfaction may be worth the cost.


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