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Thursday, July 28, 2016

MiM Mail: Intern Regretting Specialty

Hello MiM!

I love your blog! It's been amazing reading everyone's stories and I hope I can get some insight or advice. I am currently a FM intern at my desirable location because I am near both my and my husband's family. We have a beautiful 5 month old daughter who is the light of my life. Since the match I've been regretting my chosen specialty. I came out of medical school loving a competitive specialty and was too discouraged to go through with it and under family pressure to come home for the baby's sake. I thought I had to do what's right for my family and return home where we can get some help and my daughter could be in a loving environment. My husband is a teacher and wasn't happy at our med school location. He was over the moon about coming home I couldn't disappoint him... But now I regret everyday I'm in this specialty.

Things I like about FM is the variety such as derm, pediatrics, and psych. Things I don't like about FM is I hate chronic health conditions. I don't like to be responsible for managing diabetes with kidney failure and liver cirrhosis plus 30 medications. My personality is much suited for a more specialized area. I don't know what to do. I want to switch into something else but I have no idea what. I would love to do dermatology but it is so highly competitive that I doubt I would get in. I also don't think my family will be willing to relocate for me to pursue options to get in such as a research fellowship. Other areas I'm interested in is pediatrics, EM, and psych. I know I know it sounds like I should do FM but I just can't take the "bread and butter" of it.

General pediatrics sounds better to me then general practice because kids don't generally have so many chronic health conditions for me to manage and I love working with kids. I didn't consider it in med school because of parents but now I am one and totally get it!! EM also sounds perfect on paper but the lifestyle scares me (nights,weekends, holidays) high burnout rate, and life/death pressure. Psych was a great rotation in med school but I know how emotionally draining patients can be. Also none of these residencies are available in my hometown and would require moving. Should I do what's best for my family? Try and stick it out? Or ultimately try and pursue something that will make me happy? I'm so conflicted because I know moving would be hard on all of us :((( and I'm scared to make things harder on my husband and me.

Any insight or advice is appreciated! Thank you!

Sincerely,
Regretful Resident

15 comments:

  1. My advice would be threefold. First, remember that the beginning of residency is a difficult and stressful time during which almost everyone has doubts about their choice. Don't make a change this early on without giving it a lot of though and time. Second, remember that every field in medicine is going to have its downside. You may hate the chronic management aspect of family medicine, but you might also hate the shift work of emerg or the patients who never get better on psych. There really isn't a perfect career in medicine (or any other field).

    Finally, I would spend as much time as possible talking to family physicians and seeing what kinds of practices are available. In my experience, I've seen a huge variety of practices, including people who just do walk-ins (minimal chronic care), people who do only emergency medicine in rural communities, people who do only obstetrics or basic pediatrics. Where I live, at least, there are lots of ways to tailor a family medicine practice so that you are mostly doing the things that you're interested in.

    Good luck with your decision and with residency, whatever you may decide!

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  2. I second everything solitary diner said. I am a rural fm doing full spectrum. Because fm is so broad it can be tailored in many different ways. You just have to get through training. And you may even find after more of residency is under your belt that you don't mind the chronic diseases as much, since you will have more comfort and experience with it.

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  3. I agree with the above advice. I'm FM and love it, but not every single aspect -- I have my "favourite things" and things I grumble through, but the interesting thing is that it changes over time, with comfort and experience. There is a lot of opportunity to self-specialize in family med, either officially or unofficially. I don't know if this is an option where you are, but in Canada many family docs establish a focused practice (eg. women's health/OB, sports med, derm, chronic pain, etc.) and that might appeal to you.

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  4. I think FM has more flexibility out West in the US, but not sure people specialize to the same degree as they do in Canada.

    I can totally relate to the resentment/regret you feel towards your family for making you feel forced to make this decision, and the second guessing that you're doing. While on one hand it is early in your residency, and frankly residency sucks so you're normal to have misgivings, remember, your wants and desires are important too and your family needs to understand that. Many, many parents in medicine find a way to make everything work even if they are not living near extended family.

    I guess my bottom line is: If you want to change you can, and your needs are important too.

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    Replies
    1. Well said OMDG! I should note that in Canada it's not the majority who have focused practices, but it's definitely an option in urban centres, especially with our long wait times for some specialties (again, very different than the US I'm sure).

      Regretful Resident, it seems like it's a good time for you to keep information-gathering and see what options might be out there? Keep us posted!

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  5. I just started a Peds EM fellowship after 3 yrs of general peds, so I can relate to both pushing yourself into something because it felt like the best choice for family and also the dislike of chronic health issues! I agree about sticking with your FM residency for now at least. As the others said, there are ways to tailor your life later, including working exclusively at an ER or urgent care or to do more mental health management. General peds certainly has fewer chronic health issues overall, but there are still plenty with NICU grads and other types of chronic illness with kids living longer and more complex lives than they used to. I think it just takes time to get to know yourself -- finding out what you think you'll like versus what you actually end up liking. Prior to starting fellowship, I had a cush 8-6 primary care clinic job, but it was mostly boring from a medical standpoint and I still spent a ton of time after hours working on notes. Then you have a couple crazy hours after work to spend with the family and rush to fit in everything on the weekend. All that to say -- if you love what you're doing, crazy hours are worth it, and if you don't like it, even banker's hours don't make up for it. Good luck! No matter what you decide, the perspective and experience you are getting are very valuable -- both for your medical career and your personal life/soul searching!

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  6. How about specializing in adolescent medicine? On a quick Google search I saw that as an option in family med. Also sleep medicine, geriatrics or palliative care. It's certainly not uncommon to question your choice during residency though. And remember being an attending is different than a resident -you will have much more ability to tailor your practice. I recommend go with it for this full year, embrace it and all the extra help of being near family and then reassess. Good luck!

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  7. How about specializing in adolescent medicine? On a quick Google search I saw that as an option in family med. Also sleep medicine, geriatrics or palliative care. It's certainly not uncommon to question your choice during residency though. And remember being an attending is different than a resident -you will have much more ability to tailor your practice. I recommend go with it for this full year, embrace it and all the extra help of being near family and then reassess. Good luck!

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  8. How about specializing in adolescent medicine? On a quick Google search I saw that as an option in family med. Also sleep medicine, geriatrics or palliative care. It's certainly not uncommon to question your choice during residency though. And remember being an attending is different than a resident -you will have much more ability to tailor your practice. I recommend go with it for this full year, embrace it and all the extra help of being near family and then reassess. Good luck!

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  10. Thank you all so much for your advice. I've been getting some hurtful responses elsewhere so I really appreciate your kind words of encouragement. I think y'all are right. It's still early and I will try and give it my all this year and then reevaluate my feelings. Before my acceptance I never contemplated how difficult this would be for me. I thought I would be happy as long as everyone else was.. And I felt horrible for not being so and people thought I was being ungrateful. But I really am grateful for the family support. I just hope I can find joy in my field and medicine in general.

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  11. Hi I'm a MiM from Australia and longterm follower of this blog.
    Just wanted to send some encouragement that you're never 'stuck' in one specialty forever and the door is always open for change.
    I was 3.5 years into a 5 year EM program (our programs are 5 years long) and stuck with it for longer than I enjoyed it, mainly because I believed it was more family-friendly (can easily work part-time) and being an optimist thought things would improve over time.
    I changed to anaesthetics (I believe you guys call it anaesthesiology) this year and despite having to start from the beginning (of another 5 year program), I really love it. If we have another child during training, I will be in my late-thirties when I finish. I am working fulltime and have to jump through more exams and other hurdles. But I enjoy my work so much more and that has made a huge impact on the kind of person I am able to be when I'm with my friends and family (despite having less time with them overall).
    I realised along this journey that a job I don't enjoy that is family-friendly is not necessarily better for me, or my family, than a job I do really enjoy.
    Having said that, I had my family's support all the way and the specialty change did not involve moving house.
    Definitely not an easy decision and much soul-searching, advice-seeking and prayer may be needed to figure out what's best for you at this time. Keep discerning and best wishes!

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  12. I know FM trained physicians who practice in both Urgent Care and Emergency Department settings. I have also worked with doctors who have developed a real "niche" practice while working in a general family clinic--travel medicine, eating disorders, OB/GYN and adolescent medicine. I made the exact opposite move mid-residency (8 hours from family to 1.5 hours away), and I left a top-tier institution for a smaller, less recognized program. I know how much anguish goes into this kind of decision.

    The best advice I can give you at this point is to do a ton of talking with your spouse about how you're feeling, why you want to make a change, and brainstorm how you can work this out together. Good luck! Keep us posted.

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  13. I know FM trained physicians who practice in both Urgent Care and Emergency Department settings. I have also worked with doctors who have developed a real "niche" practice while working in a general family clinic--travel medicine, eating disorders, OB/GYN and adolescent medicine. I made the exact opposite move mid-residency (8 hours from family to 1.5 hours away), and I left a top-tier institution for a smaller, less recognized program. I know how much anguish goes into this kind of decision.

    The best advice I can give you at this point is to do a ton of talking with your spouse about how you're feeling, why you want to make a change, and brainstorm how you can work this out together. Good luck! Keep us posted.

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  14. It's important to know what you want, when to push through and when to walk away...
    Since it sounds like you aren't particularly sold on a specific different specialty, it's worth looking into some of the FM subspecialties (sports medicine comes to mind) and see if any of those strike a chord. Also, is the long term plan to stay where you are, or is that subject to change when you graduate? If staying where you are will be preferable when you are done training, too, then consider what is available in your area when looking at what you want to do when you are "done" (anything can change of course but it's good to have a plan). The nice thing about being an MD and in training is usually programs and offices will support you rotating in different locations; if there is something else you think you want to do, see if you can rotate there and if it really is what you like.
    My mom did change out of her internship (which I think may have been family medicine, or internal medicine, not sure) and went into derm; some of her fellow dermatologists similarly changed out of their specialties (one was path) but that was several decades ago and the path is much harder now. If you were sold on derm that might be the way to go, but if not, I wouldn't recommend it. I did know a FM-trained physician who ran a skin clinic once and did the things that dermatologists typically prefer primary care to do ie skin tag removal, wart sprays, etc.
    So there are ways and there are ways; go for what you want but check out if a total change of direction is really necessary right now, it may not be.

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