Switching OUT?

[Sightless]

I am just getting into PGY-2 in Radiology after completing my IM intern year. The bottom line is I'm not enjoying radiology, and desperately miss the patients, active interventions, and the team aspect from intern year. I felt part way through my intern year that I had made a mistake going into radiology, but convinced myself to stick it out and at least get there and give it a chance(as there must be some reason I thought it was prudent to choose this over other specialties). So far my worst fears are being realized, in that I'm struggling to find any semblance of passion for it. I'm not looking forward to any part of the work other than going home.

I think the biggest challenge is the lack of direct feedback from the work; I knew when I comforted a hospice patient and their family, or made someone's pain more tolerable. I knew when the antibiotics and pressors were working and the patient turned the corner. I knew when I saw the girl get extubated and walk out of the hospital. I knew when I was in the airway or the vein. I know when I see the sats come up, get blood return on a line, see the DKA resolve on the lab work, start draining the pleural fluid, hear a thank you (or not), get a hug, shed a tear.

Conversely, I felt the panic when I couldn't get the airway or thought I dilated the artery. I knew when my bedside manner was off on a bad day and my interactions weren't great. I knew the fatigue when the 20th call for pain meds from the same 5 patients on night float... the frustration from entitled clinic patients who wanted ever increasing doses of narcotics and disability placards... the dread of needing to consult that one particular attending again... the helplessness of repeat admissions for non-compliant patients... the terror when witnessing rapid and severe progressive neurodeficits in a young mom, while the senior resident was coding someone else upstairs. Parts of it were terrible but honestly I miss those ups and downs.

I understand radiology is a whole different ballgame than a lot of specialties, and I am just getting started. I understand the learning curve is steep and maybe others have felt this way. Perhaps it gets better? I have the utmost respect for radiologists and am constantly in awe of the resident and attendings depth of knowledge and their ability to make a difference when speaking to the surgeons or floor clinicians about findings. Perhaps I am viewing my clinical experience with rose-colored lenses (for there were surely days when I wanted to smash the pager with a hammer), but I can't seem to shake the feeling that I belong on the other side of the phone.

FYI I don't terribly enjoy the prospect of IR even though it is going through big clinical changes. Turned off by the raw turf battles (which will be hard fought and necessary if it is to emerge as a newly minted clinical specialty), prospect of associated DR work, and superficial patient interaction... (I know some people cringe at managing the "whole patient", but maybe it turns out I'm into that?). I know for some it is the holy grail, but does not appear so to me. Granted I have even less IR experience as a resident than my extremely limited DR.

Is trying to switch totally foolish? Am I purely suffering from grass-is-greener syndrome? Would I look back in 5 years and regret it?

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[youngdoc8205]

I am just getting into PGY-2 in Radiology after completing my IM intern year. The bottom line is I'm not enjoying radiology, and desperately miss the patients, active interventions, and the team aspect from intern year. I felt part way through my intern year that I had made a mistake going into radiology, but convinced myself to stick it out and at least get there and give it a chance(as there must be some reason I thought it was prudent to choose this over other specialties). So far my worst fears are being realized, in that I'm struggling to find any semblance of passion for it. I'm not looking forward to any part of the work other than going home.

I think the biggest challenge is the lack of direct feedback from the work; I knew when I comforted a hospice patient and their family, or made someone's pain more tolerable. I knew when the antibiotics and pressors were working and the patient turned the corner. I knew when I saw the girl get extubated and walk out of the hospital. I knew when I was in the airway or the vein. I know when I see the sats come up, get blood return on a line, see the DKA resolve on the lab work, start draining the pleural fluid, hear a thank you (or not), get a hug, shed a tear.

Conversely, I felt the panic when I couldn't get the airway or thought I dilated the artery. I knew when my bedside manner was off on a bad day and my interactions weren't great. I knew the fatigue when the 20th call for pain meds from the same 5 patients on night float... the frustration from entitled clinic patients who wanted ever increasing doses of narcotics and disability placards... the dread of needing to consult that one particular attending again... the helplessness of repeat admissions for non-compliant patients... the terror when witnessing rapid and severe progressive neurodeficits in a young mom, while the senior resident was coding someone else upstairs. Parts of it were terrible but honestly I miss those ups and downs.

I understand radiology is a whole different ballgame than a lot of specialties, and I am just getting started. I understand the learning curve is steep and maybe others have felt this way. Perhaps it gets better? I have the utmost respect for radiologists and am constantly in awe of the resident and attendings depth of knowledge and their ability to make a difference when speaking to the surgeons or floor clinicians about findings. Perhaps I am viewing my clinical experience with rose-colored lenses (for there were surely days when I wanted to smash the pager with a hammer), but I can't seem to shake the feeling that I belong on the other side of the phone.

FYI I don't terribly enjoy the prospect of IR even though it is going through big clinical changes. Turned off by the raw turf battles (which will be hard fought and necessary if it is to emerge as a newly minted clinical specialty), prospect of associated DR work, and superficial patient interaction... (I know some people cringe at managing the "whole patient", but maybe it turns out I'm into that?). I know for some it is the holy grail, but does not appear so to me. Granted I have even less IR experience as a resident than my extremely limited DR.

Is trying to switch totally foolish? Am I purely suffering from grass-is-greener syndrome? Would I look back in 5 years and regret it?

I switched out of radiology into a surgical subspecialty and am now doing a fellowship and don't regret it one bit. I felt the same way as you about taking care of patients but I also really enjoyed DR and really went into the specialty to IR. I stuck it out for 2 years in rads but ultimately decided to switch. Not so much because I didn't enjoy it but because I couldn't see myself not being in the OR. To top it off I had tons of rads exposurd since my first year of med school so I knew what I was getting into. Bottom line is what you are experiencing is not that out of the ordinary. Rads in the first year is hard because you don't have a ton of knowledge and feel like you are "not helping". But the more you read (books and imaging) the more you will feel like you are doing something.

There is also the feeling of the subspecialist can read imaging better than the radiolgist, which is true in the most specific niches in academic medical centers e.g. a liver surgeon can read MRI of the liver in cirrhotic patients as well as the body fellowship guy or gal. However, even that liver surgeon has one or 2 radiolgists that they will discuss cases with and rely on.

I think september in your R1 year is a) normal to feel they way you feel if you enjoy clinical medicine and b) too early to make a decision of whether you like it or not

Even having made the switch I still think rads is a great field where you can do a lot of good. Look to some of your attendings and you will see that a fair number of them are the go to person for other docs many times during the day.

 

[redoitall]

Dude
I feel your pain. I am an MS4 and I lost sleep many nights over what specialty I will be picking. I was very hesitant between Radonc and Radiology and ultimately I picked Radiology after trying both. The structure of the Medical School curriculum is not always amenable to allow you to choose something you will like. Radiology was a tough choice because of the job market for one, and the need for a fellowship which adds an extra year. Radonc however had way too much patient interaction to the point that I found it quite repetitive, answering the same questions again and again. I won't mention the sometimes entitled patients that come in and think they deserve better care than every one else, treating students and resident like s***.
That said, radiology is also very repetitive, but I can chose the amount of patient contact I want. I also like the idea of having my "own space", away from all the craziness and paperwork that goes on in many specialties. I remember in IM seeing residents spending about 1h or so per day rounding on their patients, and then spending the rest of day typing notes, placing orders and filling paperwork.
I enjoyed radiology much more than radonc, and going in the morning, I felt differently. Radiology floats my boat much more, I can't really explain why.
Ultimately, if you really don't like something, I would do everything I can to switch into something you will like. I don't know how PDs view these type of switches, but they appear to be common. Your happiness matters. It's up to you to get it. I am not saying it is easy. But I firmly believe it is worth it.

Good luck.

 

[GadRads]

I think the key is to realize whether patient interaction is one of the most important things to you. Think about your priorities and make the best decision taking ALL work-related and non-work-related factors into consideration before making a decision. Think about your life at 45+ and what you envision.

The intellectual and procedural aspects of medicine interest me more than patient interaction even though I enjoy patient interaction at times. I also did not see myself in the OR, so I ruled out surgery. I did not care for OB or Peds. I liked psych but the dose of patient interaction with that kind of population was too much than what I would have liked, and it had little to no procedures.

I ultimately decided between radiology, rad onc and cardiology. I settled upon radiology after thoughtfully excluding other fields.

 

[GadRads]

That said, radiology is also very repetitive, but I can chose the amount of patient contact I want. I also like the idea of having my "own space", away from all the craziness and paperwork that goes on in many specialties.

I would rather read 20 chest X-rays than see a patient with COPD exacerbation for the 5th time, do the H/P, progress notes, and the other boring paper work involved. Besides, if you want more patient contact, you can do mammo or IR.

 

[iatros]

I think what you're going through is completely normal. I wanted to switch to surgical specialty not two months into R1. I'm glad I stuck it out.

 

[Taurus]

a liver surgeon can read MRI of the liver in cirrhotic patients as well as the body fellowship guy or gal.

As someone who did residency at a major liver transplant center, did a body fellowship, and presented at more body tumor boards than I care to remember, this is a laughable statement. There is a good reason why body imaging is at the core of radiology. It's hard and full of subtleties. So the surgeon sees the 5 cm HCC. Did he also pick up the portal vein tumor thrombus? Nope.

 

[youngdoc8205]

As someone who did residency at a major liver transplant center, did a body fellowship, and presented at more body tumor boards than I care to remember, this is a laughable statement. There is a good reason why body imaging is at the core of radiology. It's hard and full of subtleties. So the surgeon sees the 5 cm HCC. Did he also pick up the portal vein tumor thrombus? Nope.

Sorry, you're statement is more accurate of what I meant, it was 4 am when i wrotri meant in reference to a specific issue, ex: a general surgeon can spot an appy but will miss any other findings, because the surgeon only cares about the appy. The radiologist might also notice a lung nodule that turns out to be an early lung cancer that gets resected because the rads caught it. Everyone brings value to patient care, anyone who says otherwise is d#%*wad.

PS: far more people switch into rads than out

 

[rad2014]

As a radiology resident I understand where your coming from. I remember missing the days where you get the gratification of helping and taking care of patients. As an intern it's the first time you decision is changing management But you have to think long term here and if you are going to be satisfied with your career. No matter what field you go into things do become repetitive and that's actually a good thing. I feel in radiology even though things may become repetitive you never really know what's coming up next. Its a challenge and mentally stimulating to me to try and figure out whats wrong on imaging. Radiology is not a field for everyone, your not gonna get that satisfaction from patients in the sense families will not be thanking you. But trust me we make more of an impact then you think. I also moonlight where I see patients in a clinic setting and personally I'm thankful that's not my career. But to some people talking to patients empowers them and that's what they ultimately want. I enjoy talking to people and patients like me but i wouldnt want to make that my career. You have to decide on what you really want. Just keep in mind radiology is a self gratifying career where u may not get the accolades from patients and clinicians (because apparently everyone can read there own imaging,*not true even in the slightest) but in my opinion still beats the alternative. Its a mentally stimulating field with a procedural aspect without having to deal with clinics and long winded notes. Hope that helps. Ultimately do what's best for you and your family.

 

[tco]

I am just getting into PGY-2 in Radiology after completing my IM intern year. The bottom line is I'm not enjoying radiology, and desperately miss the patients, active interventions, and the team aspect from intern year. I felt part way through my intern year that I had made a mistake going into radiology, but convinced myself to stick it out and at least get there and give it a chance(as there must be some reason I thought it was prudent to choose this over other specialties). So far my worst fears are being realized, in that I'm struggling to find any semblance of passion for it. I'm not looking forward to any part of the work other than going home.

I think the biggest challenge is the lack of direct feedback from the work; I knew when I comforted a hospice patient and their family, or made someone's pain more tolerable. I knew when the antibiotics and pressors were working and the patient turned the corner. I knew when I saw the girl get extubated and walk out of the hospital. I knew when I was in the airway or the vein. I know when I see the sats come up, get blood return on a line, see the DKA resolve on the lab work, start draining the pleural fluid, hear a thank you (or not), get a hug, shed a tear.

Conversely, I felt the panic when I couldn't get the airway or thought I dilated the artery. I knew when my bedside manner was off on a bad day and my interactions weren't great. I knew the fatigue when the 20th call for pain meds from the same 5 patients on night float... the frustration from entitled clinic patients who wanted ever increasing doses of narcotics and disability placards... the dread of needing to consult that one particular attending again... the helplessness of repeat admissions for non-compliant patients... the terror when witnessing rapid and severe progressive neurodeficits in a young mom, while the senior resident was coding someone else upstairs. Parts of it were terrible but honestly I miss those ups and downs.

I understand radiology is a whole different ballgame than a lot of specialties, and I am just getting started. I understand the learning curve is steep and maybe others have felt this way. Perhaps it gets better? I have the utmost respect for radiologists and am constantly in awe of the resident and attendings depth of knowledge and their ability to make a difference when speaking to the surgeons or floor clinicians about findings. Perhaps I am viewing my clinical experience with rose-colored lenses (for there were surely days when I wanted to smash the pager with a hammer), but I can't seem to shake the feeling that I belong on the other side of the phone.

FYI I don't terribly enjoy the prospect of IR even though it is going through big clinical changes. Turned off by the raw turf battles (which will be hard fought and necessary if it is to emerge as a newly minted clinical specialty), prospect of associated DR work, and superficial patient interaction... (I know some people cringe at managing the "whole patient", but maybe it turns out I'm into that?). I know for some it is the holy grail, but does not appear so to me. Granted I have even less IR experience as a resident than my extremely limited DR.

Is trying to switch totally foolish? Am I purely suffering from grass-is-greener syndrome? Would I look back in 5 years and regret it?

I'll just say that I was in a similar situation to you. I seriously considered switching to medicine during my intern year because I felt that I was proficient at it. However, you have to remember that essentially all of our training gears us up for a medical or surgical specialty. Radiology is a different beast.

I don't care what anyone says, R1 year sucks. Residents at our program say it's awesome because no one has expectations of you, but that's exactly why it sucks. No expectations, no one feels you know anything (because you don't), no one cares about your opinion, your reports suck and take forever to write because you don't know the vocabulary, you don't know the anatomy, you don't know the pathology. There's a huge learning curve.

So far, R2 year has been a lot busier, but a lot better. I realize that I learned a lot during first year, and continue to learn every day. However, there's times (such as overnight call) when you know the most about general imaging in the hospital (assuming you did your job and learned as much as you could during R1) and you can actually help patients. Clinicians, especially the ER, call you to ask for your help, and you're the only one there to answer the call. It's a great feeling to be needed. It's an even better feeling to be correct a lot of the time, and to pump out your reports in a reasonable time because you understand the basic format/language used.

I'm hoping R3 and R4 are even better.

 

[Puff-of-Snow Sign]

For those reading this thread who have yet to start a residency, I'll add my 2 cents about choosing a specialty here...

I'm unconvinced that there's one perfect specialty for most people out there. I think I could've been pretty happy in a couple of different fields (ortho or sports med, for example). Each one would have their downsides, but I bet I'd be pretty happy overall. For radiology, it's the relative paucity of patient interaction that gets to me some days. But then I do a day/week on interventions, arthro, fluoro or some other "patient-facing" service and that feeling goes away for a while. Like tco, I'm a little way into R2 at this point and each month seems a little better than the last as far as my overall confidence and job enjoyment are concerned. I finally feel like I know some things about radiology, though I'm even more aware of how much I don't yet know.

 

[meister]

You sound to me like someone who really enjoyed the highs of clinical medicine. I would tough out the year but think long and hard before essentially completely abandoning that aspect of being a physician.

I had my doubts as an R1 as well since you don't know **** however I never once longed for a family discussion or a day in the ICU. Maybe others are different.

 

[RunningKing]

Know thyself.

You are a very different person than me.
I love the fact that I don't have to deal with obnoxious patients, ridiculous note writing, nurses (except in IR) and medications.
Radiology is full of problem solving, fun procedures, and has good hours too!

I can't imagine missing any of the stuff you named in your post, but if you Do, then you should probably switch. You are not a troll are you?

 

[LoveIR]

Also a pgy-2. Honestly I can't relate to what you're describing--I'm pretty excited to go to work every day and read studies, see all of the most interesting pathology, chat with my smart, interesting, co-workers, occasionally call a clinical team with an important finding, perform simple procedures and interact with patients then, etc.

I find that when I'm reading studies, even though I'm a first year and therefore know very little, it's totally engrossing. Blink and its lunch, blink again and it's time to go home. The learning curve is steep, but I can feel that I'm getting better every day.

I suppose I miss some of the highs of intern year you describe--the nice patient who got better, or running a good code. But those were few and far between, and the rest was brutal. Reading your paragraph about drug seekers, non compliance, and dying young patients I broke out in a cold sweat. And you didn't even mention the social work issues, prior authorizations, or writing endless, 90% pointless notes.

In short, I miss the rest of medicine very little, and enjoy radiology quite a lot. I think you'd be mad to leave radiology, but i agree with what other posters have been saying--what's a great fit for me may be less great for you. I will admit that I'm probably more introverted than you, so I don't NEED the team aspect and constant patient contact; maybe that's a key difference. Anyway best of luck finding what makes you happy.

 

[Bayonetwork]

I just applied to Rads as an MS4, my greatest fear is what the "grind" will be like. Every specialty eventually becomes repetitive but what is the repetitiveness in Rads like? What does the mental fatigue feel like, it it worse than the fatigue of working inpatient service? Do procedures break up time in the reading room well? Is it really an intellectually stimulating field or just intellectually demanding?
(Sorry for the post-ERAS submission anxiety of being forced to choose a specialty in a career (medicine) that wasn't what you hoped it would be as a naive pre-med/MS1)

 

[deleted116380]

The only field that makes sense to switch out of rads and into is EM. You get a wide variety of pathology with everything that walks in the door and you get the patient interaction you want. It's only 3 years of training unlike every other field (IM is 3, but most do 2-3 year fellowships) and you will get offers first year out of training making $300-$400/hr and they work about 1,000 hours a year. A buddy of mine is an EM attending and loves it.

 

[Bayonetwork]

Sightless, what are your thoughts on the content/learning curve for R2? Im not a fan of massive memorization of clinical facts with no concepts to relate them to. Is Rads residency learning like med school or more conceptual/intellectual/visual? Dare I say more enjoyable?

 

[Sightless]

OP

Sightless, what are your thoughts on the content/learning curve for R2? Im not a fan of massive memorization of clinical facts with no concepts to relate them to. Is Rads residency learning like med school or more conceptual/intellectual/visual? Dare I say more enjoyable?

Just an R1 so don't necessarily feel qualified to comment on how it feels over time. The R1 curve is very steep. As far as memorizing vs conceptual - you have your whole world of medical training to link your learning to. However, my suspicion is youll have put in real study time to track concepts in things like MR while looking at images, where as a first year I have just started out memorizing a few things while I continue to learn. I would say its a very visual (surprise) learning style, and it can be very intellectual in the tough cases. I enjoy when its a case where 2 or 3 attendings end up gathering around to discuss something, and find that slice or two that shows something unique, but those cases are rare.

As an update, it has gotten slightly better a few months further in. Going through rotations and getting my legs under me a little more, has made the work more enjoyable. Did a procedure month and had some good patient/team interaction. While I am still very uneasy and still often think about switching to medicine (as hard as it is for some to fathom), I am riding this year out before I make any rash decisions.

 

[dahliadahlia123]

**Did you end up deciding to switch? Hope things worked out for you!

 

[tco]

The only field that makes sense to switch out of rads and into is EM. You get a wide variety of pathology with everything that walks in the door and you get the patient interaction you want. It's only 3 years of training unlike every other field (IM is 3, but most do 2-3 year fellowships) and you will get offers first year out of training making $300-$400/hr and they work about 1,000 hours a year. A buddy of mine is an EM attending and loves it.

If you've done two or three years of Radiology residency, your TAT could be, like, half of everyone else's. CXR is up? Negative, get out. Positive for subtle pneumonia, call medicine. CT A/P is up? Positive for appy - call surgery.

Man, you'd be an administrator's dream.

 

[DrfluffyMD]

I thought about switching to general surgery pretty often in the first and second years. Stuck it out and matched into IR. I am not ruling out dual training in gen surg or vascular surgery yet.

 

[Socram]

I started my first year of radiology, I feel like someone put me in time out.

 

[halwani]

OP



Just an R1 so don't necessarily feel qualified to comment on how it feels over time. The R1 curve is very steep. As far as memorizing vs conceptual - you have your whole world of medical training to link your learning to. However, my suspicion is youll have put in real study time to track concepts in things like MR while looking at images, where as a first year I have just started out memorizing a few things while I continue to learn. I would say its a very visual (surprise) learning style, and it can be very intellectual in the tough cases. I enjoy when its a case where 2 or 3 attendings end up gathering around to discuss something, and find that slice or two that shows something unique, but those cases are rare.

As an update, it has gotten slightly better a few months further in. Going through rotations and getting my legs under me a little more, has made the work more enjoyable. Did a procedure month and had some good patient/team interaction. While I am still very uneasy and still often think about switching to medicine (as hard as it is for some to fathom), I am riding this year out before I make any rash decisions.

I feel the same way, current R1. What did you end up doing? /how are you feeling about it?

 

[halwani]

I started my first year of radiology, I feel like someone put me in time out.

That’s how I feel… current R1. What ended up happening to you/ what did u choose? It’s just too hard to walk away from a gig this good tbh..

 

[halwani]

I'll just say that I was in a similar situation to you. I seriously considered switching to medicine during my intern year because I felt that I was proficient at it. However, you have to remember that essentially all of our training gears us up for a medical or surgical specialty. Radiology is a different beast.

I don't care what anyone says, R1 year sucks. Residents at our program say it's awesome because no one has expectations of you, but that's exactly why it sucks. No expectations, no one feels you know anything (because you don't), no one cares about your opinion, your reports suck and take forever to write because you don't know the vocabulary, you don't know the anatomy, you don't know the pathology. There's a huge learning curve.

So far, R2 year has been a lot busier, but a lot better. I realize that I learned a lot during first year, and continue to learn every day. However, there's times (such as overnight call) when you know the most about general imaging in the hospital (assuming you did your job and learned as much as you could during R1) and you can actually help patients. Clinicians, especially the ER, call you to ask for your help, and you're the only one there to answer the call. It's a great feeling to be needed. It's an even better feeling to be correct a lot of the time, and to pump out your reports in a reasonable time because you understand the basic format/language used.

I'm hoping R3 and R4 are even better.

Any updates on post grad life ? I felt the same way you all are describing but I miss clinical medicine more than I expected. Probably will do mammo. But any thoughts from the other end of training?

 

[halwani]

I think what you're going through is completely normal. I wanted to switch to surgical specialty not two months into R1. I'm glad I stuck it out.

How long does this feeling persist?

 

[halwani]

I started my first year of radiology, I feel like someone put me in time out.

I feel the same way, current R1. What did you end up doing? /how are you feeling about it?

 

[Sightless]

OP -
Once every year or two I get a message asking me about my experience. Since this thread has already been necro'd, I'll post an update here for posterity.

I did switch back to IM and have been an academic hospitalist at a busy residency program for a couple of years.

Clinically, the highs are higher and the lows are lower in internal medicine. The days go by quicker but are more emotionally draining. I have days with lots of stress or difficult patients that sometimes make me miss the quiet but active pace of radiology. I have days where I'm responding to strokes, occasionally code blues, doing bedside procedures, and am right in the thick of it (which I enjoy). I have quiet days where I'm done with rounds early and am doing chalk talks or procedures with the residents (which I enjoy), or when on our private group service am free to prep lectures, work on research, take a long lunch, and spend some extra time with the complicated patients, really digging in to the case. Private hospitalist life is much more miserable, per my med school classmates, but I am a taking a decent salary hit for this QOL.

I had many friends at my radiology program tell me that radiology gets better with time, as the fish out of water feeling subsides. Hell, even my program director told me that she had her doubts her R1 year. There's likely an the area of the field you'll enjoy, given the time to develop some skill and let the jitters settle. The more you learn, the more helpful you are, the more satisfied you feel. My R1 classmates have now finished, or are finishing fellowships, and their starting salaries will be 2-3x greater than mine as an academic hospitalist (don't base your life on this but it bears stating explicitly). I could've pursued fellowship training in about the same time to narrow that gap.

I think I am more satisfied but not necessarily any happier for switching. "The grass is always greener" really rings true. There's things to enjoy and things that bring you down in any specialty. Now that I'm on the other side and have much more clinical experience - I can absolutely have seen myself enjoying a career in IR or neuroradiology, but I enjoy what I'm doing now. Overall, I would make the same decision based on the nature of the work, but reflecting back there was no wrong decision either way.

It will work out no matter what - just follow your heart, and don't buy anything you can't afford.

 

[cecumbowels]

OP -
Once every year or two I get a message asking me about my experience. Since this thread has already been necro'd, I'll post an update here for posterity.

I did switch back to IM and have been an academic hospitalist at a busy residency program for a couple of years.

Clinically, the highs are higher and the lows are lower in internal medicine. The days go by quicker but are more emotionally draining. I have days with lots of stress or difficult patients that sometimes make me miss the quiet but active pace of radiology. I have days where I'm responding to strokes, occasionally code blues, doing bedside procedures, and am right in the thick of it (which I enjoy). I have quiet days where I'm done with rounds early and am doing chalk talks or procedures with the residents (which I enjoy), or when on our private group service am free to prep lectures, work on research, take a long lunch, and spend some extra time with the complicated patients, really digging in to the case. Private hospitalist life is much more miserable, per my med school classmates, but I am a taking a decent salary hit for this QOL.

I had many friends at my radiology program tell me that radiology gets better with time, as the fish out of water feeling subsides. Hell, even my program director told me that she had her doubts her R1 year. There's likely an the area of the field you'll enjoy, given the time to develop some skill and let the jitters settle. The more you learn, the more helpful you are, the more satisfied you feel. My R1 classmates have now finished, or are finishing fellowships, and their starting salaries will be 2-3x greater than mine as an academic hospitalist (don't base your life on this but it bears stating explicitly). I could've pursued fellowship training in about the same time to narrow that gap.

I think I am more satisfied but not necessarily any happier for switching. "The grass is always greener" really rings true. There's things to enjoy and things that bring you down in any specialty. Now that I'm on the other side and have much more clinical experience - I can absolutely have seen myself enjoying a career in IR or neuroradiology, but I enjoy what I'm doing now. Overall, I would make the same decision based on the nature of the work, but reflecting back there was no wrong decision either way.

It will work out no matter what - just follow your heart, and don't buy anything you can't afford.

This is really helpful. Currently a R1 and going through something similar. Was it easy to switch? Did you go through the match?

Thanks