Why I quit internal medicine for physiatry

Some of you may know that I started out in an internal medicine residency and quit for physical medicine and rehabilitation (PM&R). Switching residencies? Not recommended. But entirely doable.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“Fizzy” is a physician who blogs at A Cartoon Guide to Becoming a Doctor.

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  • CK

    Reading this makes me realize how lucky I am that I love my residency. I’m happy that this story has such a happy ending and you did what was best for you. That takes guts.

  • Killroy71

    Not being in the medical profession, I had to look up physiatry: “Physiatrists specialize in non-surgical physical medicine and rehabilitation for patients who have been disabled as a result of a disease, condition, disorder, or injury. They diagnose, perform thorough patient histories, treat injuries and conditions, and direct your expanded treatment team using non-surgical methods. Physiatrists focus on a personalized method of treatment to improve their patients’ quality of life — one that involves a comprehensive approach to expand the framework of resources at a patient’s disposal. As a result, a patient’s recuperation involves every aspect of their lives.” Which led me to wonder – why is that a specialty? Isn’t that what all (non surgeon) doctors are supposed to do? I’ve been laboring under a misapprehension. If PCPs aren’t doing this, what are they doing? Since I don’t have any medical conditions for which I require prescriptions, mine prescribes lots of screenings for which I have no clinical indications when I turn up for my annual visit. They are, of course, conveniently performed in her group’s practice and, even more conveniently, covered by my health insurance. Whatever – good luck, sounds like a very satisfying kind of medicine to practice.