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changing residency

I was gonna write about something else but then I noticed that someone got to my blog using the google search terms:

how to change out of my shitty fucking internal medicine residency

Dang.  It’s not that often I hear an internal medicine resident describe his/her residency as “…shitty fucking…” and it harkens back to some clinical rotations I’ve been on, which I would have described similarly.  You can’t help but feel bad for anyone who is that miserable in their residency.  It is unclear to me whether this was someone who just matched into this residency or is already there and just miserable.

This is unfortunately a not-so-uncommon thing–that residents regret their field of choice.  Residency is miserable enough to begin with–the abuse, sleep-deprivation, malnutrition, lack of free time, etc–but having to force yourself through that without even the motivation of enjoying your field must be hell.  So what are the options for someone who hates their residency?  It depends on the stage of the game.  If you just matched and signed/mailed in your form committing to your intern year, then if you ever want to practice medicine again, you had better do that intern year.  The good news is that many different residency programs will accept an internal medicine internship (similarly for a general surgery internship).  So for those incoming interns who are regretful of their choice, use that first year to apply to another specialty–preferably one that will accept your intern year so you don’t have to repeat it.  I know one guy who had to repeat his intern year.  Ouch.  That hurts me deep inside just thinking about it. 

For residents who are already in residency, there are few if any time-efficient options where all of your previous residency years would count towards your new residency of choice.  In fact, most of the time it’ll only be the intern year that can be applied toward another residency.  In this case, you’re just gonna have to suck it up.  Either finish up what remains of your residency or accept the fact that you will be losing a few years (although on the flip side, you will be more experienced than your counterparts). 

In either situation, I think you have to be open with your program director because if there’s one thing I’ve noticed that will get you black-listed for life in medicine it is leaving people in the lurch.  Sometimes program directors can be really helpful in finding something else or in the transition.  And any help that you can get is welcomed because switching residencies is an uphill battle.  Everyone is allowed to make mistakes but somehow this fact is lost in the desire of most programs to avoid any shake-up amongst their housestaff (including hiring a resident who has a history of switching residencies).  How well one will be accepted at another residency after switching will otherwise be affected by a number of other factors including the rationale for switching residencies (this better be damned good), previous academic track record and whether anyone is still willing to vouch for the resident.

Switching residencies is no joke.  It takes a lot of diplomatic maneuvering and will ultimately bring lots of grief for you.  But at the end of the day, you can’t do something that’s gonna make you miserable everyday for the rest of your life.  To switch or not to switch, pick whichever route will involve the least pain for you. 

If any readers are going through this now, please comment on what (if any) kind of approach has worked or not worked.

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