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Changing Residencies: Part 2

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.

If you haven't read part one of this post, read it here: Part One

I switched from general surgery residency to anesthesiology residency after my intern year.

The back story: I went to medical school to become an orthopedic surgeon. I am not 100% sure why this was my life goal, but I suspect it had a lot to do with the fact that I was an athlete in high school and college. After going through a few knee surgeries myself, I liked the idea of helping athletes get back on the field. So, I set up all my third year rotations so that I’d have surgery at the optimal time, priming for a good grade and good letters of recommendation, because we all know orthopedics is notoriously difficult to match into. Then, I did my orthopedic surgery rotation and I HATED it. I didn't like the clinic, I didn't like pathophysiology, and I especially didn't like a lot of the procedures, especially the sports ones.

Next I had a crisis of conscience because now I had NO idea what I was going to do with my life. Not only had I geared myself up for a career in orthopedic surgery, but I had been so sure that's what I wanted to do, I didn't have an open mind during my earlier rotations.

While I had learned a great deal about medicine on my earlier rotations, I hadn't allowed myself to really explore them from a lifestyle standpoint. I neglected to ask the relevant questions to the residents and attendings I met to learn what their careers were like AFTER training.

So, how did I become an anesthesiologist? Well, it wasn't as simple as just doing the rotation and matching into it. I had my heart and mind SO set on becoming a surgeon that I didn't feel like doing anything else was going to make me happy. After my ortho rotation I did my general surgery rotation and was blessed with a great team and a great mentor. At this point, I still wasn't 100% convinced that I loved general surgery, but I figured at the very least, I KNEW I wanted to be a surgeon and general surgery residency would have a lot of fellowship options.

Fast forward to 3 months into my intern year and I was MISERABLE. Miserable for many reasons: I was an intern, I was working 80+ hours a week, I hadn’t made a lot of friends, my husband hadn’t found a job in the city we were living in and had moved back home so I was alone, I had no family where I lived, and I really, really disliked what I was doing. I plowed through internship for a while, convinced that it was just situational and once I got a better handle on actually being a doctor and made some friends, it would get better.

But, as you can probably guess, things didn’t improve and the fatal flaw in my situation was finally revealed one day when when I was talking to one of my fellow interns who was post call and had decided to wait around for another five hours post call in order to be able to do an appendectomy that he had admitted the night before. In my mind, I was thinking, “I wouldn’t do that, I just want to go home and sleep.”

And at that very moment, I realized that the issue was simply that I didn't love operating that much. And anyone who has ever considered a career in surgery knows that the number one piece of advice is that if you don't absolutely love it, do something else.

So, back to crisis mode. I did some crying, and some thinking, and some more crying. And some talking to friends, and some soul searching, and A LOT of research. I didn't feel like I had many options as far as what to do. Clearly, I needed to find a new residency spot, but in what? At this point, I was kicking myself a bit for being so closed-minded during medical school about anything other than surgery. Looking back, I can see that while having an idea of what you might want to do is good, its extremely important to be open minded because this is the time you have to explore fields that you may not know much about or ones that you think you know a lot about but really don't.

At any rate, the conclusion I came to was that I loved being in the OR, enjoyed procedural-based specialties, and didn't like doing a lot of clinic. In medical school I had enjoyed Anesthesiology and even considered it for a bit, but was so set on going into surgery that it wasn't really on my radar. However, when re-exploring things, Anesthesiology really seemed to fit what I was looking for in that it would allow me to still do the things I enjoyed in medicine while also allowing some of the work-life balance I desired.

I then reached out to an older resident and mentor within my surgery program and got some advice from her. She was able to direct me to a few other people to talk to, as I really wanted to make sure I was making the decision to leave surgery for the right reasons. Additionally, I also knew that I only had one chance to make this all right, so I wasn't taking it lightly. I talked to an another resident who had also made the decision to switch to Anesthesiology as well as a few attending surgeons that I trusted to get their opinions, viewpoints, and advice in navigating this tricky situation. In the end, I obviously decided that leaving surgery to pursue Anesthesiology was the right direction for me, that it wasn't just situational or residency that was the problem, it was actually the field of medicine I was in.

My next step was to talk to the chair of my surgery department. I knew I couldn't pursue another residency position without being released from my current program so I needed his approval to move forward. I was lucky enough to received complete support from my chair, to the extent of him offering to write me a letter of recommendation for my applications.

The rest of the story in a nutshell, is that I decided to apply only to Anesthesiology residencies that had PGY-2 positions open; having already taken time off between college and medical school, I did not want to prolong training any further. I ended up securing a PGY-2 position outside of the match fairly quickly and was able to concentrate on completing my intern year with a good knowledge base to enter anesthesiology residency as a PGY-2 and without taking any more time off.

As they say, hindsight is 20/20, and the things I learned are as follows:

1. Even if you "think" you know what you want to do when you enter medical school, go into all of your rotations with an open mind.

2. As medical student, ask lots of questions. Not just about medicine, but about life after residency. Medical student tend to worry about residency, and residents tend to worry about fellowship. But the truth of the matter is that training lasts 3-10 years and being an attending lasts 30ish years. Knowing what to expect as an attending is the most important. This will be reality for most of your life as a doctor.

3. Changing residencies is POSSIBLE but NOT EASY. If you decide to do it, make sure it is for the right reasons and not just because residency is hard. Talk to people you trust to help you make the right decision. And BE HONEST and UP FRONT. I am pretty sure my best move was scheduling an appointment with my chair and letting him know firsthand how I was feeling. Hearing things through the rumor mill is annoying and frustrating for all involved.

4. Don't feel bad about your decision. For a long time, I felt like I had let people down for deciding I didn't want to be a surgeon. Myself, my parents, my fellow residents, my mentor, my chair. I think the only person I was actually letting down was myself. Ultimately, I am the one who needs to live the life I chose and practice the specialty I chose. Being miserable in that field would have led to burnout. Everyone deserves to be happy and pursuing a profession that allows for this is imperative.

If you are a medical student or resident looking for career advice or who is struggling with what to do with your life, please feel free to reach out.

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