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HealthApril 29, 2020

A guide to changing specialties during residency

By: Heidi Moawad, MD

It's not a situation you wanted to find yourself in: realizing your specialty isn't the right fit. After all, changing specialties during residency requires a great deal of strategy and effort, not to mention potential disruptions to your training and your life.

The good news is that you have options  and allies to help you navigate them. Here's a guide to how to change your residency specialty.

Should you switch specialties?

When you know that a certain type of work isn't for you, it makes sense to switch into a specialty that is a better fit.

For example, the fast pace and the life-and-death decision-making that are an inherent part of specialties like emergency medicine, anesthesia and critical care can be too stressful for some physicians who prefer to take their time making decisions. As Current Opinion in Anesthesiology notes, the work involves chronic and repeated stress. That's fine for some doctors, but not for everyone. Similarly, the calm patience you need to have in psychiatry isn't right for everyone, either.

When the patient interactions that are typical of your specialty tend to put you on edge or make you resentful, your patients can lose out on the quality care they deserve.

Get more tips on how to know if transferring residencies is the right step to take here.

Finding support

Changing specialties during residency is a major move, both emotionally and logistically. As you start to consider your next steps, it helps to find allies who can guide you through the process. If you know someone who already has firsthand experience with changing specialties during residency, they can help put you at ease and provide helpful advice.

In addition, you may want to talk to your program director or another faculty member who is empathetic enough to see that you could still be a good doctor, even if in another specialty. You may need letters of recommendation with your application, and these faculty members can write letters for you.

It's also valuable to talk to faculty or program directors in the specialty you want to switch into. They may be able to give you some insight into whether the grass really is greener on the other side, so you can think through whether switching would give you what you're looking for. They can also give you an idea of the availability of open positions.

The application process

Switching from one residency program to another likely means applying outside the Match. You might want to apply to programs that have openings at the PGY-2 level or above, depending on how much of your first residency program you will complete before switching.

Begin by directly calling programs, locally and throughout the country, to ask if they are accepting applications for residency at the level you're looking for. You can also ask around to find out if any of your attendings, colleagues or former classmates know of any openings that might be a good fit for you. Some residents are able to find positions by inquiring about openings on physician social media groups.

You'll need to be prepared to send an application, your medical school diploma and your board scores right away. Once you apply, your application and interview schedule can be a bit unpredictable, with little notice for interviews and a nontraditional schedule when it comes to your contract offer and your start date. It's important to be ready for sudden developments throughout this process.

Keep in mind that you may need to get coverage from your peers in order to go to interviews. Be ready to repay that coverage for your colleagues so your requests won't lead to resentment or hostility.

Troubleshooting and other options

A smooth transition from one residency to another would be great — but it might not work out that way. You might have to leave one residency before your start date for another, or you might be so fed up with your specialty that you decide to leave before securing another residency offer. In the meantime, you can consider moonlighting if you have a state medical license. This requires completing one year of training and passing Step 3 of the USMLE.

You could also consider applying for a research job or a completely nonclinical position instead of moving into another clinical residency. According to Academic Medicine, the career of a physician investigator involves a number of challenges, but many MDs are driven to pursue that route because it also has its own set of unique rewards in discovering new paths that advance medical care. In addition, entry-level jobs for physicians in healthcare technology and in the pharmaceutical industry don't usually require completion of residency.

Even if you realize that you didn't get off to the right start in your residency, with persistence things will work out. Handle the transition with care and efficiency and you'll be pointed in the right direction.

Heidi Moawad, MD
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