Tuesday, September 4, 2012

50 Ways to Leave Your Residency

Some of you who are longtime followers of my blog may know that I started out in an internal medicine residency and quit for PM&R. Switching residencies? Not recommended. But entirely doable.

I spent most of my first half of internship being really, really miserable. I remember sitting in the call room during my ICU month, talking to my mother about how badly I wanted to quit and what my options would be if I quit. Every time my resident would say, “This patient is really sick,” my stomach would churn. In the very beginning of the year, I’d only dread call on the morning of a call. Then I started to dread it the night before. Then I started to dread it like five minutes after the previous call ended.

Then I started to wish a car would hit me on the way to the hospital so that I wouldn’t have to go.

I may have been a little (or a lot) clinically depressed, but the truth was, I just really, really hated internship. At the time, I think I hated it more than most people, but in retrospect, I’m not entirely sure.

One night in December, I got very sick during a call. The whole thing made me realize that I couldn’t live like this anymore. I hated medical school and now I hated internship. I couldn’t go through one more year of hating my life, hoping things would get better. I mean, what if I died tomorrow?

Nobody believed me at first. I’m not the kind of person who makes crazy decisions. When I start something, I tend to stick with it. I’m incredibly responsible. So when I told my family I was quitting my residency, they all said, “You’ll never do it.”

But even though it was a “crazy” decision, I’d never been so sure of anything in my life. I wanted out. So without any kind of back-up plan, I met with my program director and told him that I was leaving at the end of the year.

My father told me I was an idiot for doing that. I should have first sniffed out my options, not told anyone what I was planning. But, you know, I was already a quitter. I didn’t want to be a liar on top of that.

I was given a month to think about my decision, but I really didn’t need it. I knew I was leaving. My two options were to spend a year doing urgent care moonlighting or to follow my “dream” and land a PM&R residency.

There happened to be a PM&R residency in the same hospital where I was doing my internship, and I had rotated there as a fourth year med student. I had clicked with the attendings and the residents, so I thought I might have a chance. I contacted the program coordinator and found out that a PGY2 spot was open for the next year.

I went to talk to one of the residents at the program to get his advice. He said to me, “There are a few other people trying to get that open spot. If you really want it, you have to go meet with our program director and really suck up to her. Because you can bet that’s what the other people are doing.”

And I said, “If I were the kind of person who would do that, I wouldn’t be going into PM&R.” And I sure as hell didn’t do it.

An attending I had worked with named Dr. Lane wrote me a strong letter, and I also got a letter from my program director. I was told during my interview that they appreciated how I had been honest with my current program about my intentions. That was a golden moment during an otherwise somewhat mortifying experience during which time I had to take a tour of the hospital where I’d been working for six months, wearing my little interview suit.

A couple of weeks after that, I received an offer from that program and I happily accepted.

Obviously, I got lucky. If there hadn’t been a spot available at that program, there were no other nearby programs and I would have been screwed. Before I even got the acceptance, I found out that my spot in the IM program had already been filled by a woman who wanted to move to be closer to her family.

Do I ever have regrets? Yes, sometimes. But retelling this story, I remember how miserable I was, and I know it wasn’t even a decision—it was something I had to do. And I feel good about the fact that I did it the “right” way. I was honest and I didn’t screw my program over by leaving at the last minute. (Another intern left in June and DID screw everyone over pretty badly.) Someone else got a spot that they really wanted thanks to my leaving. I don’t feel even a shred of guilt.

And you know what? I actually liked my residency. You can’t argue with that.

33 comments:

  1. What regrets do you have? Do you mean now there are things in PM&R that are tough to live with on a daily basis? Or you think IM would have had more job choices, including part-time and no call, or something like that?

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    1. I currently work parttime and have no call, so it's not that. I think it's just a matter of wondering what it would have been like if I had chosen an IM residency that was better suited for me. I'm the sort of person who has a tendency to doubt all my decisions.

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  2. Did you ever realize that you are in the wrong career?

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    1. I don't understand the question...

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    2. Did you ever think medicine was the wrong career for you and felt strongly about it?

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    3. Certainly never strong enough to leave the field entirely.

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  3. You know what, I felt the same except with my CPA career. I did it for 5 years, every year hoping it would get better and it just got worse. One day, after talking to my husband and my parents I decided to just quit. With no back up, except a dream to pursue medicine. Even though I have no guarantee I'll make it in meds, quitting was the best decision I've ever made in my life. I don't even care if I don't get into medicine now (well, I won't care as much) because the want of it is what made me quit my soul-sucking job and as a result saved my marriage, my sanity and many relationships.

    Kudos for making the right choice.

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  4. Yep, felt the same way when I worked in consulting, and then later at the Industrial Supply Company from Hell. Some days I would start crying for no reason while driving to work. It was bad. Haven't felt like that ONCE since starting the post-bac, then later med school. Even though I've had some difficulties along the way, they've been nothing compared to the hell of those first two jobs.

    Glad you found something you like doing now! It's good to hear that it can work out even if you're miserable right now.

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  5. OMDG - it is not always about the wrong field. It is sometimes more about your microclimate at your particluar job. I worked for the Big Clinic from Hell. Several women MD's around me broke out in tears at work on a frequent basis, men MD's expressed their frustrations in men-appropriate ways. I am thriving and happy in a different practice now. And most my ex-colleauges either left or thinking about leaving. And we all love and loved what we did. It's important to recognize what you can't take - your abusive boss, bad institution culture or being in that profession.

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    1. Couldn't agree with you more. In my case it was both the wrong field AND the wrong microclimate. Plus, I really wanted to do research.

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  6. It is never easy to leave something that you have worked hard for. For one thing, there is a lot of judging that happens. For another there is no way of knowing how things are going to turn out. When I did it (over 20 years ago) the "pain" of staying at the edge of the cliff was greater than the potential pain of finding out that there were rocks in the water below...
    As it turned out, there were rocks, but they were manageable.

    congratulations Fizzy, Old MD Girl, and Kasiunut on making a difficult decision.

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  7. I honestly love your stories about residency...I don't why it get so excited reading about the good AND bad aspects of it..but I cannot WAIT! Anesthesia here I come! :)

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  8. My Dear Dr. Fizzy, This post took me back to my IM internship. I had planned to do IM because I liked the residents when I was a student. I spent the entire internship year crying at a certain point in the road every night as I was leaving the hospital because I hated it so much. I went back to my med school program for OB(another internship) and then did a fellowship in reproductive med. Years later, after successfully building a huge private practice, I made another big change and sold it and my ridiculous house, and moved my family across the country to work in a hospital-based practice. Both decisions seemed rash to my friends and coworkers and both were absolutely the right thing to do. It's pretty simple: crying=bad. When you must find a way to change, you do.

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  9. It's great to hear things like that working out in your favour. Decisions around which residency to go into and where seem so final and irrevocable (and they usually are). But can I ask, why did you choose IM in the first place? It seems like you hated your clerkship rotation as well. I found the same thing with some of my med school classmates who went into IM when they never really liked it in the first place -- and IM was a first choice (not a back-up) for them.

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    1. Because it was more important to me live with my husband than to be in my dream specialty. That geographical area happened to be highly competitive, and I figured I liked IM well enough.

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  10. just wanted to say thanks for providing wonderful things to read while studying histopathology and pharmacology (MS1) You always make me smile!

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  11. Wow Dr. Fizzy. I've been at the same crossroads with my graduate program. Coming back to my apartment crying every night or crying while at school just don't seem like good things in the long-term. Thanks for being honest about your experience and I'm glad that things worked out for you. I'm still trying to figure things out here on my end, but it helps so much to know that I'm not the first one.

    And why is it that people always criticize you for making a rash decision??? The department I'm in has been trying to kick me out for 11 months, but now that I mention leaving, everyone says, Don't make a rash decision, Abigail!! You're going to regret it later. Ummm, yeah, that's why I didn't make this decision 11 months ago.

    Abigail

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    1. I was there in my grad program (Physics Ph.D.) It's a marathon. I definitely had days (and weeks, and months...) when I wanted to quit. If you have a good advisor, that's definitely the sort of thing you can discuss with him/her. If not, your peers can be a pretty good support group. At the end of the day, you do what you have to do... for me, it was "Damn the torpedoes, full speed ahead!"

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  12. This was a great story. My only quibble - since you write a lot of advice aimed at trainees - is why on earth did you avoid meeting with the PM&R program director. As a program director, I would expect anyone applying to transfer to make direct contact with me and explain why you are leaving the old program, convince me you aren't a flake, why my specialty is a better match, etc. Sure, blatant sucking up is best avoided, but a direct face to face (perhaps phone if its long distance) chat should be a priority for a trainee in that position.

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    1. That's a fair question. I already knew several staff members from my rotation, so I felt like it was well known that I wasn't a flake. Also, it may have made sense to meet with the PD if my interview didn't get scheduled so quickly. And during my interview, one of the interviewers was the PD. So meeting with her twice seemed unnecessary.

      In a different situation, I probably would have scheduled a meeting.

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  13. wow. those first four paragraphs sounded like they came right from my head. i had a nearly identical experience during internship, right down to daily crying, the stomach-churning with each complicated patient, the dreading of call, and the hope for a car accident. i also used to relish red lights on the way to work because it meant an extra 30 seconds before i had to arrive. there was a fellow resident who had a serious illness and had to miss 6 months of work, and in my darker moments i envied her! i lost about 20 pounds (that i didn't have to lose) and none of my clothes fit anymore. the worst part was it felt like everyone else was just coasting and i was the only one struggling. i was looking at alternative careers, residencies, etc, when i finally talked to one of my chiefs and my PD and found out that my struggles were far from unique in my program, and that help was available. i got help, got better, and realized that the field i chose and the program i chose really were the best fit for me, so i stayed. that was 18 months ago and i've been thriving ever since, but only with the support of my peers, my chiefs, and my PD.

    i think the important thing to realize is that when you're an intern or a resident, you are not alone! when i asked around, it seemed like half the people i asked had similar feelings, right down to the specifics (like loving red lights). isn't that weird?

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    1. You really do feel like you're alone in feeling miserable when in actuality, most people are unhappy.

      But for me, I think it went deeper than just depression. I found very little that I enjoyed in internal medicine as a med student or an intern. The only thing I liked somewhat was working urgent care. It's possible I might have been happy in a different IM program, but I am 100% sure that the program I was in was a terrible fit for me.

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    2. yeah, i get that. when i was struggling i just felt i had to "get out" either by finding a different program, a different specialty, or a different career altogether. but some smart people convinced me that i shouldn't be making decisions like that when i was in such bad shape. i'm glad i waited and gave it another shot. i get that IM was a bad fit for you for a lot of reasons, i just thought it was interesting that the mismatch manifested itself in so many of the same ways. i'm glad you found your way.

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  14. I applaud you for this post, as it echoes a lot of the things I'm feeling now as an intern. only 3 months in and barely keeping my head above water. IM is not my career, as I'm going on to a different residency, which makes it difficult to feel passionate or enthusiastic about a field I'm basically forced to be in for a year. Basically I just wanted to say thanks - it's nice to know I'm not alone

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  15. I'm an MS3 and the experience you describe is exactly what I'm afraid of. I am learning towards choosing IM for residency but I don't know--I've had a rotation that was so bad I cried more than once...I don't know if I could handle a whole year of hating my life after these not-so-fun 4 years of med school. It makes me wonder if I should just forgo IM and do something else that sounds less painful--pathology? On the other hand, I don't want to count myself out of a career that is likely to be much better than the 3 years you have to put up with in the beginning. Decisions, decisions.

    Anyways, I wanted to ask you--why do you think the program was a terrible fit for you? What factors should we be looking into as we explore programs?

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  16. I have a very similar situation at the moment. I have an abusive boss, work almost 126 hours a week, infinite calls and a huge desire to quit. What's weird is that I use to love everything about medicine when I was a student. Now I cry on the way to the Hospital. Sometimes I even think about stealing some KCl from the farmacy and put an end to this crap. Still is nice to see I'm not the only one.
    Thank you so much for your post.

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  17. I must say I really appreciate your blogs especially this one. I have spent the first 6 months of my internship, attempting to convince myself that everyone hates intern year then I spent the subsequent two months realizing that a lot of my classmates in fact, do not hate what they are doing and once I began having thoughts similar to these (I quote) "I started to wish a car would hit me on the way to the hospital so that I wouldn’t have to go." I began questioning my choices. I rotated through the ER recently, I loved it. I realize this is not necessarily the avenue I wish to pursue but I craved working with adults. I miss it.
    There are a lot of "what ifs" and questions circulating around my head right now. Sadly, I don't think leaving is an option (IMG, who should be grateful she even got a residency in the first place) but I did want to let you know your stories inspired me and continue to enlighten me.
    Now although I am contemplating starting up on Celexa or Trazadone or the combination of some of spirits, I take comfort knowing I am not the only one that has felt this way at some point.
    In realizing you must get hit with a ton of e-mail daily, I am not expecting a response, I merely wanted to say thank you and let you know how your stories have left an impression with me.
    I'd like to leave you with this:
    Thank you.

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    1. :) its all just so true

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  18. Yup I'm only two months in and the only thing keeping me from quiting is the money I owe

    Frankly I don't think the program dieector will even care
    So goodby Downstate ! And thanks for the encouragement to leave

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    1. What field are you doing? And have you left the program?

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  19. Every day I walk outside and see a storm cloud I secretly hope lightning will just strike me dead. That's how my internship is going. Switching feels impossible at this point.

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  20. Hi I was reading that you changed residency programs and looked for PGY-2 openings. I'm not so happy in my current program, and also am engaged long distance. My fiancee could transfer his job to the the new city (Boston). I am on probation in my current program (basically got in the middle of a disagreement with two attendings, that really had nothing to do with me, but I think in order to pacify one of the attending's feelings, I was put on probation for 1 month, and will come off it in a week). I am interviewing with the other program in December. I have a couple questions:

    1. When should I tell my PD? I don't want them to think negatively of me, especially if I end up not even liking the Boston program.
    The Boston PD said he absolutely will not contact my program until he knows he wants to take me, AND I've spoken to my PD first to break the news.

    2. Do I have to tell Boston I was on probation if it's been remediated?

    Please advise, thanks.

    oh and p.s. my program is not exactly a happy, smiley friendly program. They've let many residents go in previous years, and are notorious for not renewing contracts over small things. I do not want to lose the spot I have.
    thanks,

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  21. This made me laugh, the first couple paragraphs were totally me med school CTU rotation. Needless to say didnt choose internal as a specialty. Now I'm in FM residency but still questioning medicine as a career even so we'll see. Good luck in your PM&R residency though! Seems like a good specialty

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