Unhappy in residency

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magendie

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I already posted this in the general residency forum but thought I might get some useful responses here too...

I am currently in my second year of neurology residency and am incredibly unhappy. I have felt this way for a while but I just attributed it to being overworked and sleep-deprived. However, I am now on a fairly easy rotation (8-4 pm hours, weekends off, no call) and still feel the same way. And it's not just that I am unhappy with residency in general, but I find that I no longer enjoy the practice of neurology. I find myself wondering during rounds why we are spending hours discussing trivial points that won't change the management of patients. I absolutely hate neurology clinic, especially the fact that I have to spend so much time talking with and examining the patients when I often don't have an answer for them and don't always have any treatments to offer them.
A little of my background and why these thoughts are bothering me so much... I majored in neuroscience in undergrad and specifically came to medical school with plans of becoming a neurologist. During my third year rotations, neurology was my favorite rotation and I had no doubts about going into the field. I didn't have exposure to certain other specialties such as dermatology and opthalmology until late in my fourth year unfortunately. I did do a short rotation in anesthesiology during my 4th year and while I enjoyed it, I was already set on applying to neurology residencies and felt that it was too late to change my decision. I applied and interviewed at many top programs and matched at a program fairly high on my list. I was unhappy during my intern year but this was expected since it was an internal medicine program at a very busy hospital with overworked residents.
I kept thinking that once I started neurology, I would be happy (despite the overnight calls and long hours). But it's quite the opposite, and I often fantasize about just quitting residency and never coming back. And I know that residency is only 4 years and that practice is often quite different, but even when I think about the future, I am disillusioned. Neurologists are one of the lower paying specialties and are often unappreciated in my opinion, given the amount of time that goes into making complex diagnoses and the amount of time we spend with each patient. I have been giving a lot of thought to other specialties given how unhappy I am in neurology. I've recently been growing much more interested in anesthesiology since I enjoyed it during my 4th year, and friends that are in anesthesiology residency go on and on about how happy they are. I also think that I would really enjoy the pharmacology that is involved with anesthesiology, not to mention that the lifestyle would be much more desirable in the future.
However, I have many concerns that prevent me from pursuing anesthesiology (or another specialty). I am not sure how one goes about switching specialties once in residency and really dread going through the match process again. In addition, I have been interested in neurology for so long that I'm worried that I'm making this decision too hastily. I don't want to make any decisions that I would regret in the future. I don't even know how I would begin the process of bringing my concerns up with my program director or what would be the appropriate time to do so.
So my questions for you all are:
1. How common is it for residents to switch specialties during residency and how difficult is it?
2. When is a good time to leave a program and to discuss this with a program director?
3. How long should I think about this given that I could just be experiencing "residency blues"?
Any advice or help would be greatly appreciated.
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I can't give you any advice regarding the professional aspects of your decision being that I'm only a medical student. Having been around the block a few times as a nontrad though, I can offer some worldly advice: All jobs have will have a some degree of "suckiness" and rarely will a job live up to the fuzziness, glitter, and glam that originally had one feeling positive about the position/choice in the first place (e.g. jobs, education, relationships, etc). I'm sure this is only magnified during intern year and especially PGY2 of neuro. COULD you see yourself being content with neuro? Any thoughts of a fellowship that could steer you to greener pastures? While it's not as easy as with anesthesiology or PM&R, neuro could lead to pain fellowship (http://forums.studentdoctor.net/threads/historically-neurolohy-friendly-pain-programs.1068894/). Ponder the possibilities.

Personally, I think you should talk this out with a therapist… someone who can remain as objective as possible with you. Maximize efforts to simply clear your mind if possible (MAKE time for exercise, sleep as well as possible, put the worries on the "back burner" so to speak). But do talk to someone. Wish you the best of luck. Hopefully someone with more experience in regards to the professional aspect of this situation can chime in.
 
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Also, I think you should bring this up w/ your program director sooner rather than later. Diplomatically, let him/her know that you are having some questions about your career choice. If they are worth anything, they will have a series of serious discussions with you about this rather than just try to "sell" you on staying in neuro (or, worse, getting defensive/arrogant about it).

Also, you might want to touch base with people in the Anesthesia program about your potential interest. Maybe you could work in some more exposure to that to determine if it's really what you want.
 
You should be able to get a radiology residency spot (neuroradiology would be a good transition from neurology).

Check out residency swap and contact programs that didn't fill. Also check the radiology forum aunt Minnie for sporadic vacancies.
 
magendie said:
I already posted this in the general residency forum but thought I might get some useful responses here too...

I am currently in my second year of neurology residency and am incredibly unhappy. I have felt this way for a while but I just attributed it to being overworked and sleep-deprived. However, I am now on a fairly easy rotation (8-4 pm hours, weekends off, no call) and still feel the same way. And it's not just that I am unhappy with residency in general, but I find that I no longer enjoy the practice of neurology. I find myself wondering during rounds why we are spending hours discussing trivial points that won't change the management of patients. I absolutely hate neurology clinic, especially the fact that I have to spend so much time talking with and examining the patients when I often don't have an answer for them and don't always have any treatments to offer them.
A little of my background and why these thoughts are bothering me so much... I majored in neuroscience in undergrad and specifically came to medical school with plans of becoming a neurologist. During my third year rotations, neurology was my favorite rotation and I had no doubts about going into the field. I didn't have exposure to certain other specialties such as dermatology and opthalmology until late in my fourth year unfortunately. I did do a short rotation in anesthesiology during my 4th year and while I enjoyed it, I was already set on applying to neurology residencies and felt that it was too late to change my decision. I applied and interviewed at many top programs and matched at a program fairly high on my list. I was unhappy during my intern year but this was expected since it was an internal medicine program at a very busy hospital with overworked residents.
I kept thinking that once I started neurology, I would be happy (despite the overnight calls and long hours). But it's quite the opposite, and I often fantasize about just quitting residency and never coming back. And I know that residency is only 4 years and that practice is often quite different, but even when I think about the future, I am disillusioned. Neurologists are one of the lower paying specialties and are often unappreciated in my opinion, given the amount of time that goes into making complex diagnoses and the amount of time we spend with each patient. I have been giving a lot of thought to other specialties given how unhappy I am in neurology. I've recently been growing much more interested in anesthesiology since I enjoyed it during my 4th year, and friends that are in anesthesiology residency go on and on about how happy they are. I also think that I would really enjoy the pharmacology that is involved with anesthesiology, not to mention that the lifestyle would be much more desirable in the future.
However, I have many concerns that prevent me from pursuing anesthesiology (or another specialty). I am not sure how one goes about switching specialties once in residency and really dread going through the match process again. In addition, I have been interested in neurology for so long that I'm worried that I'm making this decision too hastily. I don't want to make any decisions that I would regret in the future. I don't even know how I would begin the process of bringing my concerns up with my program director or what would be the appropriate time to do so.
So my questions for you all are:
1. How common is it for residents to switch specialties during residency and how difficult is it?
2. When is a good time to leave a program and to discuss this with a program director?
3. How long should I think about this given that I could just be experiencing "residency blues"?
Any advice or help would be greatly appreciated.
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Unforunately, minutia is what ends up on your board exams. I've never seen a case of Tangier's disease in my entire life and probably never will, but to this day, I at least know that if I see orange tonsils, it might be the case. So, belaboring minutia in residency can be annoying, but is a RITE of passage. It happens in other specialties too.

I think that if you seriously want to leave, doing it during your PGY-2 year would be a good time. Don't wait too late.

Remember, clinic can be enjoyable once you are out of residency and you are seeing your own patients. There are ways to make your job enjoyable once you are out of residency. The biggest mistake that you could make is choosing the wrong type of job.
 
The PGY2 year in neurology is tough in every specialty, and neurology is no exception. You spend your time as a super-intern taking care of stroke, ICH, and seeing altered mental status in the hospital. There is not much to do for many of these patients and it can be very frustrating. I would argue, vigorously, that this is not what neurology is like, and some residencies make residents spend 2+ years in the inpatient environment. I was done with taking care of stroke by the middle of my PGY3 year. Unless you are somewhere with a lot of tPA cases and a neuro ICU, receiving a bunch of transferred stroke patients where the damage is already done is not interesting (in my opinion). You can sub-specialize into a field of neurology where you see clinic and have a lot to offer patients. Neuroimmunology, movement, headache, epilepsy, neuro-oncology all come to mind. These patients can be sick and recalcitrant to therapy, but you end up being the one with the knowledge needed to take care of them. Often that is being comfortable with the uncertainty that is always present when caring for patients with neurologic disease. You focus on the disease and possible treatments rather than the stuff that feels trivial as a resident (obscure anatomy, rare diseases etc). That stuff is important to learn, but it is not what matters the most. Depending on your situation, how much money you want to make etc., you can minimize call and exposure to stroke, ICH, and altered mental status consults.
 
Its not uncommon to feel the way u do . And unfortunately, I think, by the way u r describing ur situation - u wont be happy as a traditional Neurologist ! But theres still hope- if u like anesthesia u can go into neurocritical care, which basically involves taking care of Neurosurgical pre op/ post op and sick and complicated neurology/stroke patients and a lot of neurology people are going into it. If not, may be u could use some exposure to neuro subspecialties with some experts in their fields who love what they do . and trust me, once u know what u r doing in neurology- u are going to feel really good and confident, which u then transfer to ur patients, colleagues from neuro and other specialties. If u dont know what u r doing, u and ur patients both feel dissatisfied. Also most other specialties are slowly approaching dead ends, with few new things coming up as compared to neurology.
The Brain is and will always remain the biggest enigma and everyone knows we are far away from understanding it; and that is what makes our job as neurologists the best!!
 
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magendie said:
... I find myself wondering during rounds why we are spending hours discussing trivial points that won't change the management of patients. I absolutely hate neurology clinic, especially the fact that I have to spend so much time talking with and examining the patients when I often don't have an answer for them and don't always have any treatments to offer them...
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This is why I didn't go into neurology.
 
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magendie said:
...I am currently in my second year of neurology residency and am incredibly unhappy. I have felt this way for a while but I just attributed it to being overworked and sleep-deprived. However, I am now on a fairly easy rotation (8-4 pm hours, weekends off, no call) and still feel the same way. And it's not just that I am unhappy with residency in general, but I find that I no longer enjoy the practice of neurology. I find myself wondering during rounds why we are spending hours discussing trivial points that won't change the management of patients. I absolutely hate neurology clinic, especially the fact that I have to spend so much time talking with and examining the patients when I often don't have an answer for them and don't always have any treatments to offer them.
Neurologists are one of the lower paying specialties and are often unappreciated in my opinion, given the amount of time that goes into making complex diagnoses and the amount of time we spend with each patient....
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Several points to consider in neurology in general:
- The appreciation for the need of neurologists in a given hospital has increased which is reflected in the continual increase in compensation. This is contributed by near zero training in neurological evaluation in all other specialties and primary care. Any neurological symptoms can be frightening to non-neurologists. Hence the consults that we consider trivial or unnecessary.
- I would not worry about the amount of earning in neurology. Take a look at some actual job postings to get a realistic picture.
- Deeper knowledge leads to efficient (time & money) diagnosis and explanation for the patient without having to resort to blind shot-gun approach. Sometimes your knowledge of minute detail help in distinguishing between the two close differential diagnosis. Elegance. And knowing the diagnosis and prognosis alone sometimes can help patients.
- Knowing which treatment really works and how effective and what does not can save a lot of money and frustration in patients.
- new discoveries on the way. As mentioned above, we are far from fully understanding our nervous system.
- There is greater demand for neurologists.
- One can design one's practice in any combination one likes.

About your interest in neurology:
- If you had 1 hour of free time, would you rather read about neurological topics or anesthesiology texts? This is a great way to tell where your passion is.
- residency is far from true practice of neurology.
- PGY2 in neurology is often harder than internship. So much to read but so many patients to cover.
- many specialties have their own uncertainties. Nothing is guaranteed. Look at cardiology, radiology and the trend in anesthesiology.
- as you grow, you become much more efficient in history taking and examination. It does not have to be 60 min clinic visit for every patients. For return visits, 20 min is often plenty.
 
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Regarding neurology residency, can we talk about stress? How often can misdiagnosis or mismanagement of patients in neurology lead to severe consequences for patients? I'm assuming , aside from the vascular problems (stroke, hemorrhage) , GBS, Status epilepticus, Mysathensia crisis etc. In general, there are not many circumstances where you can kill a patient in neurology ( most problems in neurology are not extremely urgent requiring quick management decisions)?

Regarding being life after residency, Is it very doable to have a very outpatient oriented practice without many life threatening emergencies?
 
Neurologo said:
Several points to consider in neurology in general:
- The appreciation for the need of neurologists in a given hospital has increased which is reflected in the continual increase in compensation. This is contributed by near zero training in neurological evaluation in all other specialties and primary care. Any neurological symptoms can be frightening to non-neurologists. Hence the consults that we consider trivial or unnecessary.
- I would not worry about the amount of earning in neurology. Take a look at some actual job postings to get a realistic picture.
- Deeper knowledge leads to efficient (time & money) diagnosis and explanation for the patient without having to resort to blind shot-gun approach. Sometimes your knowledge of minute detail help in distinguishing between the two close differential diagnosis. Elegance. And knowing the diagnosis and prognosis alone sometimes can help patients.
- Knowing which treatment really works and how effective and what does not can save a lot of money and frustration in patients.
- new discoveries on the way. As mentioned above, we are far from fully understanding our nervous system.
- There is greater demand for neurologists.
- One can design one's practice in any combination one likes.

About your interest in neurology:
- If you had 1 hour of free time, would you rather read about neurological topics or anesthesiology texts? This is a great way to tell where your passion is.
- residency is far from true practice of neurology.
- PGY2 in neurology is often harder than internship. So much to read but so many patients to cover.
- many specialties have their own uncertainties. Nothing is guaranteed. Look at cardiology, radiology and the trend in anesthesiology.
- as you grow, you become much more efficient in history taking and examination. It does not have to be 60 min clinic visit for every patients. For return visits, 20 min is often plenty.
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This post is elegant. Bravo!
 
magendie,

You will end up doing Neurocritical Care and you will love it. When I was a neurology resident I was viewed as an outcast by all of my attendings, most of whom had various Autism-spectrum disorders, because I did not have the patience to sit through a 4 hour discussion about 81 mg of Aspirin vs 82 mg of Aspirin. Once you transition to Neurocritical Care, all the pontificating BS stops and people make quick, informed decisions that actually affect patients. Plus, you will be a true doctor, not just an arm-chair intellectual. I do wish that I had done anesthesia as a residency, but it does not matter once you are in Neurocritical Care.

Neuro clinic is the worst place on earth. Just try and be Zen about it and pound through the patients as fast as you can. You will rarely learn anything from the 6 patients with headache and the 6 patients with back pain that you see.

Use all of your elective time to do ICU rotations, Anesthesia, Procedure electives, and you will be happy. The benefit to most Neuro residencies is that the hours are good, so read-up on critical care issues and be academically productive.

FoodLovinMD
 
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FoodLovinMD said:
magendie,

You will end up doing Neurocritical Care and you will love it. When I was a neurology resident I was viewed as an outcast by all of my attendings, most of whom had various Autism-spectrum disorders, because I did not have the patience to sit through a 4 hour discussion about 81 mg of Aspirin vs 82 mg of Aspirin. Once you transition to Neurocritical Care, all the pontificating BS stops and people make quick, informed decisions that actually affect patients. Plus, you will be a true doctor, not just an arm-chair intellectual. I do wish that I had done anesthesia as a residency, but it does not matter once you are in Neurocritical Care.

Neuro clinic is the worst place on earth. Just try and be Zen about it and pound through the patients as fast as you can. You will rarely learn anything from the 6 patients with headache and the 6 patients with back pain that you see.

Use all of your elective time to do ICU rotations, Anesthesia, Procedure electives, and you will be happy. The benefit to most Neuro residencies is that the hours are good, so read-up on critical care issues and be academically productive.

FoodLovinMD
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This is one of the most offensive statements I have ever seen posted. I think that you are definitely in the wrong profession, period. I am not going to speculate about your training but you seem to have sneaked through all the crappy admissions filters through the years. A physician who thinks that "_____" clinic is the worst place on earth? Radiology and Anesthesiology seem to be the two specialties where the patient contact is minimal, but through my rotations I found how important it was to be compassionate and to make a patient feel at ease especially just before they were ready to have some procedure they were scared to death about.

Certainly, you seem to have found your niche working with comatose patients who will likely have no idea who you are. But, watch out for the families and your colleagues because your true colors will eventually shine through...
 
Thank you everyone for taking the time to read my post and for all of the informative replies. I have definitely considered neurocritical care, although I worry about lifestyle and burnout in critical care. I've been thinking about this a lot over the past week, and I'm concerned that it may be too late in my PGY-2 year to switch. It wouldn't really give my program director time to find someone to fill a vacant PGY-2 spot. I still haven't spoken to anyone in the program about how I feel mostly because I want to be more certain of my decision before I say anything. On the one hand, I think I could just continue my neurology residency and hope that I find a subspecialty that interests me. However, on the other hand, I don't want to spend two more years being unhappy. It's obviously a difficult decision. I have no idea if I would be any more content with another specialty given my limited exposure to other fields and would hate to make any decisions that I regret. Any thoughts on if I should discuss my concerns to my PD this late in the PGY-2 year?
 
magendie said:
Thank you everyone for taking the time to read my post and for all of the informative replies. I have definitely considered neurocritical care, although I worry about lifestyle and burnout in critical care. I've been thinking about this a lot over the past week, and I'm concerned that it may be too late in my PGY-2 year to switch. It wouldn't really give my program director time to find someone to fill a vacant PGY-2 spot. I still haven't spoken to anyone in the program about how I feel mostly because I want to be more certain of my decision before I say anything. On the one hand, I think I could just continue my neurology residency and hope that I find a subspecialty that interests me. However, on the other hand, I don't want to spend two more years being unhappy. It's obviously a difficult decision. I have no idea if I would be any more content with another specialty given my limited exposure to other fields and would hate to make any decisions that I regret. Any thoughts on if I should discuss my concerns to my PD this late in the PGY-2 year?
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Life is too short to be unhappy. And if you are unhappy, you will end up making your family, colleagues and your patients unhappy as well. I hate to be that guy, but it seems to me you made a mistake altogether and I feel very bad for you not only because of the way you perceive the practice of neurology but also because you seem to have so many issues at this time that I can not picture you being happy practicing medicine at all. It also seems to me you really do not like patient care (hence anesthesiology and radiology). Those two specialties were once very competitive because of the lifestyle and the income but that is no longer the case. I am very familiar with both fields because of family members who have seen their incomes dropped and their lifestyles changed dramatically in the last five years. The top med schools in the country are hardly sending any one to Radiology residencies -which is shocking. Anesthesiology does remains more popular, but if I had even mentioned that in my house, I would have never heard the end of it.

You have two years to finish neurology, and you could do with that what you want. You admit not being very familiar with the other fields and it would be disastrous to switch to another specialty just to find yourself being unhappy again. You do not seem to "enjoy talking to patients" and now you are also "worried about the lifestyle of critical care" ?. I think you will be disappointed practicing medicine because your expectations are off, period. Have you considered teaching? How about a pharmaceutical company where you can run clinical trials?

My heart goes out to you. But, there is only one life as we know it. This one. So make sure to make yourself happy.
 
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It sounds like you are in front-loaded program like I was. The latter half of PGY-2 year was by far the most difficult time for me in all of residency. I came very close to quitting as well. I don't think you probably appreciate how overworked you've been for an extended period of time. One week of sleep on an easier rotation is not enough to recovery. You won't come out of the fog until a few months into your PGY-3 year. I am quite happy with my career despite struggling during that time. I will say I don't think I was quite as disillusioned as you seem to be; however, I think you may spring back more than you think.

If you were to decide to switch residencies, better to do it sooner rather than later. It would be much better to transition between PGY-2 and 3 year than in the middle of a year. In that sense you would probably need to talk to your PD about it now to figure things out for the summer. Having said that, it doesn't sound like there's a clear residency you'd prefer over neurology. Unless you find one, probably best just to stick it out. I will also add as a side note that I find the discussions of salary on this forum comical. Most of the folks posting on this forum have never had a real job. To make any kind of argument about avoiding neurology because the salary is lower than some of the other specialties is a total joke. A low end starting neurologist's salary still puts you above 90% of the U.S. population. You will have plenty of money. Just try to figure out what will make you happy.

I agree with the other poster to think outside the box with regard to your future career. If you stick it out through the rest of residency and find you really do just hate patient interaction, there are many other options. You can can be a medical director at a medical device or pharmaceutical company, do research, etc. I've also seen a few people complete an entire residency, then go back and complete another one in a different field.
 
Hank Rearden said:
I will also add as a side note that I find the discussions of salary on this forum comical. Most of the folks posting on this forum have never had a real job. To make any kind of argument about avoiding neurology because the salary is lower than some of the other specialties is a total joke. A low end starting neurologist's salary still puts you above 90% of the U.S. population. You will have plenty of money. Just try to figure out what will make you happy.
.
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As I have stated in other posts, the doctors that seem to "boo hoo" the most about salary are the ones that have the most. Sometimes individuals get clouded and forget, as you have pointed out, that they make more money than the majority. The last thing anybody wants to do is be in a high paying specialty and be miserable.
 
You do not seem to "enjoy talking to patients" and now you are also "worried about the lifestyle of critical care"
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Brainbuff, while I understand what you are trying to say, you are making a lot of assumptions and incorrect conclusions regarding my posts. I did not say that I do not enjoy talking to patients in general; I just said that it is frustrating when I spend so long in clinic doing a thorough HPI and neurological exam when I am often not able to give them an answer about a neurological diagnosis. Or if I am, I don't always have treatments available (for patients with complex neuromuscular diseases for example). I did not mention anesthesiology as a possible specialty because of the lack of patient interaction; I mentioned it because I am interested in the pharmacology and procedure possibilities. And I never mentioned radiology; I know I would hate sitting in a dark room all day looking at images.

Additionally, I only said that I am worried about the lifestyle of neurocritical care because I have seen multiple studies stating that there are high rates of burnout in critical care physicians. It is still a field I am interested in and would like to explore further. My expectations in medicine are not off; I knew what this field was going to be like before going into it. While I appreciate the advice that you're trying to give, I think that your opinions might be completely different once you start residency and experience what it is like to be so overworked. Medical school is completely different.

I think some of the other posts are correct in that I am very front-loaded during my PGY-2 year so that could certainly be contributing to how I'm feeling. I've decided that I'm going to talk to my program director and just be honest. Thanks again everyone for your advice.
 
magendie said:
I just said that it is frustrating when I spend so long in clinic doing a thorough HPI and neurological exam when I am often not able to give them an answer about a neurological diagnosis. Or if I am, I don't always have treatments available (for patients with complex neuromuscular diseases for example).
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I had to get back in here because this statement is outrageously false. It is one of the oldest and most repeated cliches about neurology and tells me that you really do not belong in the field. I think that you made the right decision in talking to your PD. Just get out.

My grandfather (a proud neurologist) must be turning on his grave. He used to be teased back then with this one : "neurosurgeons turn people into vegetables, and neurologists just watch them grow.........". I do have to admit that I always thought it was pretty hilarious.:)
 
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I did not say that it is the case with all my patients, and I'm not going to argue with you. It's just frustrating when it does happen (and it does when you see as many complicated and advanced neurological diseases as you do at my program). I'm well aware that diseases such as multiple sclerosis, Parkinson's, and other neurological disorders do have medications that can change disease progression and quality of life. It's one of the common misconceptions that I defended to my peers when they did not understand why I wanted to do neurology. But then when I'm overworked and exhausted and seeing patients with advanced ALS or Huntington's, it's difficult to remain optimistic. Again, I think that your opinion might change once you're in residency.
 
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One of my friends and residency classmates realized that Neurology was not for her during our PGY2 year. Our program was brutal, and PGY2 was much harder and scarier than Internship, which I'm sure contributed to her unhappiness. But it wasn't just that...... Neurology wasn't for her, and I knew it even before she did. Like you, she did not like dissecting detailed physical exams and histories and working through complex problems. She wanted a straightforward exam, clear answers, proven treatments and easy endpoints.

So she went into cardiology instead.

She had done very well as an Intern at a different institution, before starting Neurology Residency. So she got in touch with the program director from her prior Internship hospital and talked with him about her change of heart, and he offered to take her back as a resident in Internal Medicine. Only then, when she had a clear plan, did she talk with Neurology Program Director about her unhappiness. She left at the end of PGY-2. It is ALWAYS better to leave at the end of a year, and to announce your plans before they start making the schedule for the coming year. And it's of course better to let your program know even earlier so they have a chance of hiring someone in your place.

So my friend left. And then our Residency became even more painful, as we were down another resident and our program didn't hire anyone to replace her. So I'll warn you... your classmates will not be happy with you. But you have to do what is right for you. I certainly didn't blame my friend. I was glad she figured it out early enough to transition without too much pain.

But I'll also say.... I know several people, including myself, that often strongly disliked residency and found much of it stressful and painful and awful. But residency and life after residency can be very different worlds. If there is any Neurology faculty member that you trust/respect and feel that you can go to and talk to about your doubts/ambivalence, I would consider doing this.... especially if they are in a field that you might consider doing a fellowship in if you could "imagine" staying in Neurology. Think about what field that would be, if you were forced to stay, and then go talk with someone. What do you have to lose, right? If you are really thinking about leaving...... make sure you exhaust all options.
 
I think u need to get the idea of not seeing urself( a neurologist) as a cliched doctor- diagnose something>> check 'uptodate'>> and give medicines; or see something on CTscan>>> cut it out or something else in between(this is just to make a point, and I know every field has its own awesome parts).
A neurologist has a different role- for patients, other doctors and (sorry for being dramatic ) for mankind. I wont tell u what, how and why . U shouldn't be brainwashed into liking something. I suggest reading some good books- "phantoms in the brain"; "reaching down the rabbit hole"; "the man who mistook his wife for a hat" - some that I would recommend. Dont give up without reading one of these and if they still dont pique ur interest(back)
- I'll confidently say u don't belong in neurology !!
 
807crash said:
But residency and life after residency can be very different worlds.
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I was going to stay off this discussion any more as I had pretty much put in my 2 cents. But the above remark comes up so damn much that I've finally gotten sick of it and had to comment.

Yeah, residency and "life after residency" (by which people usually mean being an attending) are different. You know why? BECAUSE RESIDENCY ENDS!!!!! And being an attending does not, until you either quit, retire, or die. The stuff you do as a resident is the stuff you will be doing for the next 30-40-50 years as an attending, only with more responsibility and no 80-hour work rules, and in many cases nobody to delegate scut-work to, and nobody (i.e, a supervising attending) to cover your a$$. Sure, you may get more efficient and develop a broader/deeper knowledge base over time, but at the end of the day neuro is still neuro and cardiology is still cardiololgy and psych is still psych, etc., so you damn well better like it. Because if you don't, you're gonna be miserable no matter how damn smart and efficient you are, and the last thing you or your patients need is for you to be a miserable and unhappy doctor.

It doesn't matter a rat's ass WHY the OP doesn't like neuro -- if he don't like it, he don't like it, and it's hubris for you all to sit here and tell him he's "wrong" and try to convince him that neurology is da bomb. HE's living this, HE's thought about it, and HE's the one who has to live his life.
 
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Was that really necessary?

Regardless, I think my post was helpful and directly answered all of her questions. I definitely hated the hours and stress of residency (this was before the work hours changes) and hated being forced into a schedule of seeing patients that were not what you necessarily the type you want to see. Yes, different stresses occur as an attending, and they are in some ways worse... and in some ways better.

Sounds like you may need a break from medicine, from your response. No need to jump all over people trying to help the OP.
 
Great thread.
OP: Do you think you made a mistake entering medical school competely set on your speciality?
Just looking for advice. Hope this doesn't derail.
 
OP- from reading your original post, it sounds like you already know what you want! I mean, putting aside your reasonable concern about a "hasty" decision, the tone of your three questions speaks volumes:

"1. How common is it for residents to switch specialties during residency and how difficult is it?
2. When is a good time to leave a program and to discuss this with a program director?
3. How long should I think about this given that I could just be experiencing "residency blues"?"

The only "bone" you throw neurology is to ask how long is permissible to think about this! o_O

But to specifically answer your questions: 1. Much more than you think; 2. Ummm, no good time, but might as well have an honest discussion now; 3. Sounds like you've already done a lot of thinking- residency will get a *LITTLE* easier but neurology isn't going to change.

Do you have kids? A spouse/SO? If kids, you know, that's a tough move. If a spouse/SO, maybe a little less so. If not, the world is still your oyster! You didn't get kicked out of a program, and you're just leaving because you realized it wasn't for you?! C'mon- you're practically on easy street!

Anyway, it's been over a month- what happened?
 
Green Doc said:
OP- from reading your original post, it sounds like you already know what you want!
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I don't know about that. Do any of us know what we want? Personally, I find it difficult or impossible to dissociate my personal discontent with my surroundings.

This person says "I majored in neuroscience in undergrad and specifically came to medical school with plans of becoming a neurologist," and then says "During my third year rotations, neurology was my favorite rotation and I had no doubts about going into the field." But also says they question"why we are spending hours discussing trivial points that won't change the management of patients." And "I absolutely hate neurology clinic, especially the fact that I have to spend so much time talking with and examining the patients when I often don't have an answer for them and don't always have any treatments to offer them."

So here's a person who liked the thought of neuroscience, then hates the discussion of "trivial points" in patient care, presumably not speaking about correcting potassium. Neurology is full of disease modifying and highly effective symptomatic therapies. So it all just rings false, or at very least contradictory to my eye.

Anesthesiology is a fine and noble profession. But it is a field that's full of long, boring and early hours and trivial points.

I was a lot like Green Doc. I went to a terrific internship that filled me with purpose and vigor and a sense of competence, into a grueling, high ranking and soul sucking residency. Neurology was a second internship without the fun. It was full of idiotic IM residents who wanted to diagnose neurologic zebras at 2 AM, so they could cover themselves in morning report. And ER attendings who admitted one-in-every-5 UTI nursing home patients to neurology with stroke. It sucked. But I loved my co-residents. I still love them. I found mentors. And things got better. Then I tried to make things better for the next class. And now I'm unbelievably blessed every day. I have no doubt that neurology is the best fit for my brain. The burden of neurologic injuries creates opportunities for brilliant diagnoses and trials using pharm and device innovations.

But my brain is not the same as others. @Green Doc needs to reflect. It is unhappiness or is it neurology? In another context this would be determining depression vs. adjustment do or grief reaction. Is neurology a good fit? If not, then get the hell out! Become a happy person. You have to maximize your own happiness, no-one else will do it for you. But if this is just a phase, then stick with it.

Best luck.
 
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Hi,

So what happened magendie?

You sounded burnt out. When had your easy rotation started? Are you sleeping better now? How do you feel?

I have a solution for you: Read! Read basic science like you did in your neuroscience undergrad and it will all be much more enjoyable! You will enjoy teasing the details from the patient, making hypotheses and reading tests better. I can understand clinic would be less amusing than basic science, where we can actually control variables and retrieve data faster. But the opportunities are there. If you don't feel like reading at all about anything....you truly are tired. So rest first and then evaluate your mood and behavior.

Can you teach at your program? Maybe that will motivate you? I didn't hear you mention anything about your colleagues. Is it a supporting team? You could motivate the other residents to have a blog or an email list where you share cool info and build each other up.

Here I am wondering if I applied too late for Neurology interviews and you are wanting to leave...life's turns.

Hopefully you got at least a month of good sleeping before you decided!
 
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