Changing Specialties During Residency? Here’s What to Consider First

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September 23, 2022
Choosing a specialty in medical school isn’t easy. You’re required to make a career-long decision from a series of brief rotations each spanning a couple of weeks to months and then hope you made the right choice. Most of the time, this works out, and your career path becomes everything you wished for. But sometimes—maybe more often than you might think—it doesn’t. If you find yourself in this second camp and wonder whether the trajectory you’re on is the right one, here are some things to know about changing specialties during residency and what to do next.

1. Identify what is motivating these feelings

It’s important to reemphasize how challenging it is to pick a medical field and that you’ve done nothing wrong if you’re now considering changing specialties during residency. The process of rotating through every specialty in medical school is long, and for any given specialty, you likely only interacted with a select group of individuals for a limited period of time. Furthermore, you may not have had the opportunity to spend time in certain fields like radiology, ophthalmology, or dermatology and understand what a career in these specialties is like. Once you start training, you of course learn more about your own field but also about others. You naturally may wonder if yours really is the best choice for you.

If you come to the conclusion that the path you’re on isn’t what you wanted, take a moment to breathe. Think about what you like and don’t like about your specialty and how long you will have to endure the less palatable parts. Even though residency is hard, it doesn’t last forever. This doesn’t mean that being an attending is easy, but it does mean that your day-to-day will change as you advance through your training and it may morph into the job you hoped for from the beginning.

2. Consider the career you truly want

If you’ve looked into the future and still have doubts about your field, reflect on what you do want with insights you’ve gained with time. Some questions to help guide this deliberation include:

  • Do you gravitate towards more or less acuity?
  • Do you like to work in inpatient or outpatient settings?
  • Which do you prefer: procedural work, cognitive work, or a mix of both?
  • Is your work-life balance sufficient, or do you need more time to spend time with loved ones?

The reality is you don’t even have to stay in medicine. Many non-clinical opportunities exist for physicians—this may not have been what you set out to do when starting medical school, but can be fulfilling all the same. There are many different roads you can take.

3. Talk to your family, friends, and mentors

This might be the most important aspect of all of this. Even though you’re the only person who can answer the question of what will make you happy, it’s not easy and you can (and really should) ask for help. Talk to the people around you including the trusted family, friends, and mentors who have supported you this far and will support you going forward. Being able to discuss what you want to do for your life’s work can be validating, help combat feelings of guilt, and provide perspective.

4. Evaluate your options

Once you settle on a new course, the final step is investigating the opportunities available to you. While not abundant, advanced training positions do exist. Engage with your mentors about how to identify openings since they may not be advertised and how to connect with those programs. You will likely be asked for a CV and cover letter detailing your narrative and why you want to make a switch, invited for an interview with the program leadership, and hopefully then accepted into your new job.

You should know you may have to be flexible. First, depending on how far into your training you are when making the switch, you might have to repeat a year or multiple years of residency since you are starting anew in a different field. Of note, internal medicine intern years are standard across many fields, so you may not have to add any additional time if you interchange during this first year of residency among specialties that require one. Second, options in your new specialty of choice may not be available in the city where you live, so you may be asked to relocate to a different city.

5. Find confidence in your decision

You control your future. If you need to change course, you should do so without feeling guilty or worrying about disappointing others. Changing specialties during residency can be frightening and requires a bit of bravery, but ultimately it will be worth it if you need to realign what you’re doing with what you want to do. Identify and engage with the support you have in your life, learn what options exist for your new career, and make the switch.


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By Michael Stephens, MD

FAQs

Get a little more clarification

How do I choose a PA specialty?
If you haven’t started PA school yet, try getting hands-on medical experience (like as a scribe or medical assistant) in a field that interests you to make sure it's the right fit. While going through your clinical year of PA school, reflect on your experiences during rotations:
 
  • What subject gets you excited just thinking about it?
  • Do you feel a sense of purpose at the end of the day during a particular rotation?

Keep in mind that a negative experience during a rotation, such as poor organization or preceptorship, doesn’t mean you shouldn’t pursue that specialty. Ultimately, being in a fulfilling role is what's important.

Learn more about different PA specialties with the Is this the right PA specialty for you? series.
How do I get my first PA job?
During a rotation, if you’ve decided you'd like to work in that particular field, there are a few ways you can get your foot in the door:
  • Make your interest in the specialty clear to your preceptor and any attending staff you work with.
  • Show your commitment to the specialty and your desire to actively participate. This will open up the conversation for recommendations on additional resources (like helpful textbooks), and it can give your preceptor time to contact colleagues who may be hiring.
  • Do your elective or preceptorship with the clinician or facility you would like to work at.
  • Consider joining professional associations for your specialty to network with other PAs and learn more about the field.
For other tips, such as how to tailor your CV and cover letter to a specific position and what questions to ask in an interview, read How to Get Your First Job After Passing the PANCE.
How can I become a cardiology PA?
During the clinical year, get an elective in cardiology and consider shadowing a cardiologist on your days off. Spend some time with the telemetry technicians to pick up on common ECG variations.

Read Is Cardiology the Right Specialty for You? for more info.

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