Switching Specialties During Residency

“Don’t leave. There are miserable people in this world, and then ones more miserable than the others. My assessment is that you’re in the second category.”

Although it has been more than a decade since I resigned from my ophthalmology residency after completing my PGY-2 year, I still remember this particular attending physician’s words and how they reverberated in my consciousness. I was terrified at his prophecy. Earlier that week I had requested a meeting with my residency program director and informed him that I intended to switch specialties. It was a painful meeting, almost as gut wrenching as disappointing a supportive parent. He tried hard to talk me out of it, reminding me of the endless opportunities being an ophthalmologist would provide. My Chairman asked sincerely if I didn’t want to help restore patients’ vision, and reminded me how hard I had worked to get my position in the first place.

Resigning was the most difficult professional decision I had ever made. The reality is that I knew I had to leave when I realized I went home every single day after the clinic, or the operating room, or after a busy on-call day - and would Google any viable escape options. I simply couldn’t shake the feeling that I had made a terrible mistake by choosing the wrong specialty. Ophthalmology itself actually wasn’t the problem. The residency itself wasn’t particularly grueling, I was in a city I loved and surrounded by smart and interesting people, and it was overall nice being part of a specialty where you could sometimes see immediate results.

The real issue was that I had chosen the wrong specialty for myself. I chose a specialty based on a few short electives in medical school and a year of research in a mouse lab at the NIH. I also had romanticized performing life altering surgery in far off lands. Finally, I cringe to admit this now, but I also chose based on some twisted logic of what I believed I deserved based on my academic performance. I should have instead chosen a field after carefully meditating about the day-to-day work of a decades-long career (and not the highlights). The result was that I found myself battling despair, and it became somewhat of a self-fulfilling spiral downwards. I finally decided to act after a mentor in a different specialty perfectly framed the potential consequences: “F*** it – worst case scenario you lose a few years. In the grand scheme of things - big deal!” She was right, and the discomfort I experienced was the price I had to pay to get on my own personal correct trajectory. 

Here is my advice for others considering a life-altering career change.

Be Careful Of The Opinion Of Others

My family thought I was insane. To outsiders it seemed I had invested four years of college, four years of medical school, a research year, and fought hard to win a competitive residency spot in Manhattan. They thought I was throwing away a lottery ticket or euthanizing the golden goose. My mentors tried to tell me things would be much better after training. That wasn’t the issue. I just realized too late that I wanted to do something else entirely. It’s vital to remember that seeking advice and guidance is good - but ultimately no one can make the decision for you because you’re the only one it will have long-term and perhaps permanent consequences for.

You Are Not Unique

At the time, it was agonizing to think I was the only one in the world throwing away a “competitive” residency spot. Once I made the move however, I realized that a new co-resident had left anesthesia, another ENT, and a third had changed from radiology. No one talks about their career pivots, but undoubtedly others have faced the same challenges you have. The more colleagues you talk to, the more diverse career choices you will find. Obviously some people don’t even complete a residency, while other physicians complete residency and then go into non-clinical fields. You have many options that can lead to a fulfilling career.  

Have A Plan

If you do want to continue in another residency, don’t do what I did and resign without having a solid plan in place. I casually contacted some internal medicine program directors around NYC but informed me sadly there were no open spots. I decided to resign anyway and figure I would just reapply through the match. Luckily a spot outside the match opened up at the last minute and I was able to stay at the same institution. If it had not - I’m not even sure I would have met the deadlines to successfully reapply. 

Don’t Burn Bridges

It’s important to be honest and professional towards your current program. The healthcare world is a small community and your reputation will follow you. I gave my program a full four months notice, fulfilled all my on-call responsibilities, and even politely answered questions while they were interviewing and wooing my replacement. Also, FYI I occasionally still have to explain the strange one year ophthalmology position on my CV to this day and have the old program ‘certify’ that I was in good-standing - I believe no one speaks badly about the process of my resignation. 

Remember That No Job Is Perfect

Fast forward to me being an internal medicine hospitalist for over a decade. The flexible schedule has allowed me to spend time working internationally, I have lived and worked across five states, and I’ve found my place in the hospital (versus the clinic). Despite all of these positives – not every day is rainbows. Far from it. Like many colleagues I’m frustrated about documentation burdens, bureaucracy and the Sisyphean task of attempting to be a compassionate and competent physician in our dysfunctional healthcare system. One thing I can say for sure… I don’t go home daily and Google my escape options.