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Changing Residencies: Part 1

Updated: Dec 12, 2019

Some people enter medical school with a particular specialty in mind, and after matching blissfully spend the rest of their lives practicing in that very same field. Most, however, change their mind rotation by rotation, ultimately making up their mind during their third year. Have you ever worried about what would happen if you changed your mind? Or what would happen if you matched into general surgery, only to dream of another specialty? Keep on reading for part one of Dr. Reck's journey from surgery to anesthesia, and how it is possible to change residencies, and pursue the right specialty for YOU.

My husband has his MBA and works in the managerial world of computer technology. However, he has been along on this crazy journey I call medicine since the end of M1 year. He has endured it all, but from a different perspective. One thing he frequently comments on is the difference in job longevity between business and medicine. By longevity he doesn’t mean how long one is at one job or another (that is an interesting comparison as well, but I digress). Instead, he is referring to the fact that in the business world, his MBA opens all kinds of opportunities for him and he can work in different capacities at different companies. Compare this to medicine, where young medical students are forced to make a decision as a fourth year about what they want to do for the rest of their lives. While an MBA opens doors, a medical degree and specifically, completion of a residency, in a way shuts doors; an Anesthesiologist can’t suddenly become an Orthopedic Surgeon or vice versa.

This isn’t to say that once one chooses a medical specialty it is impossible to change career paths, but it is certainly very, very difficult. We all know of a few residents who have switched into different residencies after a number of years and there are rare stories of attending physicians who have given up their practice to pursue a completely new field years after finishing residency. However, these stories are few and far between.

Changing specialties is not easy, but it is possible.

I think most medical students actually do have a sense of what they want to do, or once they enter a residency are able to find a career path within the field by completing a fellowship or carving out a niche for themselves are thus don't need to go down the path of changing residencies. However, for a certain subset of people, the thought of staying within their field are unbearable, and it becomes necessary to make a change. I know this because I actually did it.

I went to medical school to become an orthopedic surgeon, ended up matching into general surgery residency, and now practice as an anesthesiologist. However, this was not an easy road and it was one fraught with angst and feelings of letting myself and others down. So, what do you need to consider when making the decision to switch?

1. Switch for the right reasons. Residency sucks. Period. End of story. Even if you love what you do, working 80 hours a week and taking frequent call is not that much fun. Make sure you are considering a career switch because you don’t like the field you are in and NOT because you don’t like residency. Because when you switch, you will still have two or more years of residency left to complete. Residency is unavoidable.

2. Make sure you LOVE the field you are switching into. Once you change fields once, it’s going to be almost impossible to change again. You chew up ACGME and federal funding every time you change your residency, which is one of the reasons it’s so hard to do in the first place.

3. Consider if there are career options within your current field that may be more appealing and easier to switch into. An example is if you are currently in an anesthesiology residency and you decide you want a more office based-practice. You could do pain medicine or potentially work in a pre-op screening clinic. There are often options out there within your field that may not require extra training or may require only a year of additional fellowship training.

If you do decide to make change residencies you need to have the support of a lot of people. Your current program must “release” you from their program, meaning it behooves you to be honest with them about what is going on. If you are lucky, as I was, they will be supportive and write you letters of recommendation. If they aren’t supportive, you will have a much more difficult time. In general, I would say most residency program directors are likely going to help you out as it is not beneficial for them to have someone in their program who doesn’t want to practice that field of medicine.

Check out Part Two of this post- my "switch" story.

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