Should I Switch Specialties?

Rosalyn E. Plotzker, MD

Disclosures

March 22, 2016

"If I had known what I know now, I would have picked something else."

It begins as a small mental stone, washed over by a river of more pressing concerns. The undertow of hospital discharges, pathology results, blood cultures, consults, frozen computer monitors, the need for sleep or coffee or a pen that hasn't run out of ink yet—they all erode the thought away. But, for some residents, it persists or even grows. The downsides of being an attending become apparent. Optimism toward a future career is replaced with dread. Other ideas spring up: life in an alternative specialty; perhaps shifting to research, policy, or informatics; maybe leaving medicine all together. The stone—by now a formidable boulder—creates a disruptive ripple in the flow of daily resident life.

It's an increasingly common narrative. In the 1980s, approximately 10%-15% of residents changed specialties. Now, the Association of American Medical College numbers show that almost 30% of residents do not finish the residency programs they begin. Despite the inclusion of preliminary and transition spots, the data exceeded predictions at the time of analysis.

If you're reading this, you're probably debating a change in career path. It's an incredibly difficult choice that takes courage to even consider seriously; so good job!

Like any big decision, the hardest thing is deciding how to choose. This means weighing pros and cons, following your gut, asking outside advice, and so on. Everyone does this differently, and for better or worse, no one can make the choice for you. It's a personal process. It takes work. In case you feel stuck, here are a few strategies that might help.

Look Inward

Dig up the past.

Self-reflection is hard. Luckily, medical training requires everyone to write a manifesto every few years: the personal statement. By now, you will have two. Read them both, at least twice. Why did you apply to medical school? What about residency?

Move into the present.

Having read your manifestos, consider how your current program has met your expectations and where it fell short. Make a list! Can you nourish the good aspects of your training? Can you remedy the gaps?

Usually, unhappiness triggers doubt during residency. Across specialties, interns are frustrated by a lack of autonomy and difficult lifestyle. Scut work outweighs time with patients. Explore what makes you unhappy. Make another list!

Talk to you fellow house staff. They could have similar feelings and maybe even advice. You could ask attending doctors—who have trekked that difficult path and lived to tell the tale—if your current struggle is the nature of the beast or simply an aspect of the odyssey we call residency. As hard as it may be, reach out to your program leadership to discuss whether or not you should switch. Trust them. They are your allies. Also explore other residency programs, both within and outside of your field. Find out what is ubiquitous and what is unique to your field and to your program.

Look toward the future.

Unhappiness is a normal trigger for a career change, no matter the job. That said, you should switch toward a specialty, not away from one. What about your new specialty appeals to you? Your old manifestos are good springboards here too. Outline your dream job as a doctor on this different path. Be specific.

  • What is the setting?

  • How many hours do you work each week?

  • How much time is spent treating patients?

  • How much time do you spend with each patient visit?

  • What population do you serve?

  • Who are your colleagues?

  • Are there nonclinical aspects? What are they?

Finally, flip a coin.

Stay or switch? With so much to consider, it's difficult to see past the intellectual analysis of pros and cons. I'd never recommend leaving the decision to a game of chance. But note your reaction to the coin's prediction. It's a good exercise to test your gut feelings...and that should be a factor.

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