Switching residency programs from surgery to psychiatry

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Today we discuss switching residency programs and how my friend made the switch from general surgery to psychiatry residency.

As a recent graduate from a surgical residency program, I still harbor psychic scars from the six years of training.  There were points where I seriously asked myself if I had made the right decision, and I thought about switching residency programs. Even now, a few years removed, I still get jarring flashbacks and cold sweats when I drive by the hospital where I trained.  

While I decided to stay the course and am now happily on the “other side” of medical training, there are many that decide to make a change.  Despite 80 hour workweek limitations, attrition from general surgery programs is still high. A comprehensive study in 2010 showed a 19.5% risk of a surgery resident leaving in any given year across all programs.  Of these, 62% switched to nonsurgical residencies, while only 13% left for surgical specialties.  

Switching residency programs

Previously, I told the story of a resident who quit her residency program and left medicine behind completely. This post has risen to become one of the most popular posts on my site, demonstrating the importance of this topic.

Today, I’d like to introduce you to a friend who made it through residency, but made a big change in the middle.  She completed two years of general surgery residency and then switched specialties to psychiatry. Currently, she helps patients with a variety of mental health conditions in her private practice in Los Angeles.  

I sat down and interviewed her about the decision and how she actually went about switching residency programs.  (We debated about revealing her identity, but in the end she chose to be anonymous.)

Interview starting

Can you tell me why you chose to go into general surgery during medical school?

I really liked the immediate rewards of surgery. For example, being able to fix something immediately with my hands, like removing cancer.  The intensity of the OR was a big draw as well.

I wanted to like the lucrative, easy careers, but I wasn’t as interested in them.  I briefly thought about OB/Gyn, but liked general surgery more. Interestingly, I had no interest in psychiatry during med school.

What did you like about general surgery residency?

I loved the feeling of being a female surgeon.  Honestly, I felt like a badass. In the beginning, I fed off the intensity of surgery residency and that feeling of being swallowed up by the hospital while on duty.  

I also enjoyed the teamwork element of surgery, especially in the OR.  I liked that there was a hierarchy within the team, and the surgeon was on the top.  

Finally, I liked the seriousness of surgery.  No one ended up in the OR unless it was critically needed.

What did you not like?

That same feeling of seriousness eventually wore on me.  I remember this complication when a 5th year resident drove a trocar through the aorta of a patient who was there for just a cholecystectomy.  At times, I felt scared at the acute level of responsibility in the OR.

I also hated working 110 hour weeks and not having time for anything else.  I assumed that life would get better as an attending, but I saw the attendings still spending at least one night a week on in-house call.  

When I saw that, I realized that general surgery wasn’t matching up with my picture of my future family life.

Did you have plans to do a surgical subspecialty?

Sure.  Early on, I was thinking about doing transplant surgery, but I quickly realized that wasn’t for me.  Later on, I thought about doing something like surgical oncology, but then I started having doubts about surgery overall.

When did you start having doubts?

It was at the end of first year.  I got the feeling that I just didn’t love the actual surgery as much as my co-residents.  As I became a second year and got to operate more, this confirmed that I just didn’t like operating as much as I thought I would.  I started to find it boring.  

What specialties did you consider switching to?

I considered a few:  emergency medicine, family medicine, and psychiatry.

But I noticed in particular that the psych residents seemed to absolutely love the subject material and were really happy in residency.  

What was the last straw that made you pull the trigger?

I had this realization that no one in my surgery program seemed to give a sh*t about me.  I decided that the program was malignant, and I wanted out.

So what concrete steps did you have to take to make the change?

I won’t say that switching residency programs was easy. First, I notified my program that I was applying to the match again.  Then I went through the whole application process again for the three specialties I was considering (family medicine, EM, and psychiatry).  I needed all new letters of recommendation and everything.

Ultimately, I withdrew my applications from everything except psychiatry. I was hoping for a second year position, but there was a chance that I would have to start over at intern year again.  

Eventually I got to choose between 3 programs and matched into a second year spot in another program in Los Angeles.  

It was a really crazy time for me. Within the span of a few weeks, I finished my second year of surgery residency, got married, and went to France for my honeymoon.  Then I got back to LA and started my psych residency right away.

How was psychiatry residency for you in comparison to general surgery residency?

There was a massive difference. I felt like a unicorn coming from general surgery, but the program treated me so well.

It felt like I was going to residency half time.  I worked 8 hour days instead of 12 hour days, and the program stressed the importance of mental health and self care.  My life opened up, and suddenly I had time for other things.

I was a little scared that I knew nothing about psychiatry to start, but the subject matter fascinated me and I picked it up quickly.  I loved all my new co-residents, and instantly felt more connected to them than my general surgery co-residents.

How have you found practicing as a psychiatrist in Los Angeles?

I absolutely love it!  I started a private practice in Brentwood so I can choose my own schedule. My practice is a simple fee-for-service model, so I don’t have to deal with the bureaucracy of insurance companies. 

My patients are fascinating.  I love learning their stories and their internal experience of the world. 

Recently, I have felt a little burnout, though.  I think it’s the nature of private practice medicine, where the more I work, the more money I make.  It’s hard to turn off that valve. I have a tendency to work a little too much, and that impinges on my personal life.  I’m still trying to find that balance.

Any parting words of wisdom?

It may appear like no one is switching residency programs, but people definitely do this. And more often than not, they’re infinitely happier after the switch. 

It’s definitely worth the heartache of making that uncomfortable change.

Interview ending

Conclusion

This year, over 20,000 fourth year medical students will use imperfect, incomplete information to choose their specialty of medicine.  On the basis of just a few months of rotations, these students must choose from one of over 120 medical specialties. After residency and fellowship, they might practice their chosen specialty for another 30 years before retirement.  

Many of these young doctors will struggle during their residency training.  I’d venture that most will struggle, and many will wonder if they made the right choice of specialty.  

But as my friend told us, there are more choices than just quitting medicine.  Switching residency programs and even your specialty are both viable options. Whatever you choose to do, know that you have the opportunity to change your environment to something that better fits your personality or lifestyle.

— TDD

Are you thinking of switching residency programs or specialties? Did you make a similar choice like my friend? Comment below and subscribe for more!

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