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Switching out of Rural Fm

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So I'm finishing my pgy-1 year in rural FM, and I'm finding that it just isn't the right fit for me. I've really tried to look at the positives and there are definitely some (getting to work anywhere, perks of small town friendliness) but there are certain things that I just don't think are for me. While some may like how broad family med is especially rural I'm finding that I am frustrated by how vast of subject matter you need to have is. I enjoy the acute nature of covering emerg, minus ortho presentations. In a odd sense the sicker the patient the most engaged I am. Clinic drives me crazy with the UTI's, coughs and rashes these are important but I get more excited about the STEMI or acute stroke.  Basically I'm wondering if I'm not more suited to a specialty with more acute patients like internal med with a ICU fellowship or general surgery. I did seriously consider general surgery when going through carms but was concerned with 1.) the job market 2.) being able to maintain the lifestyle at 50 ( not so bad in my 20/30's but tougher with a family and just getting older) 3.) I did a lot of electives in GS really liked the big open cases not the MIS stuff and surgery it moving towards minimally invasive as it should its better for the patient but I found it less appealing. In regards to internal, I really liked my internal blocks especially infectious disease and CCU. I also really liked how much teaching I got and did on internal. I'm not into research which made me think I was less suited to internal. But I have found that I really like to have med students and teach even as a first year resident I find having a learner really good for both my learning and I just enjoy getting to engage with them. 

 

I guess in summary I was hoping for some advice/thoughts. I don't come from a medical family and while there are wonderfully supportive its hard for them to truly get how tough residency and finding the right fit can be. Should I try and transfer to internal or GS. I've been thinking about it a lot and I'm hoping for some insight from others that have felt like they are/where in the wrong residency 

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Why did you not like MIS? Was it because you found it less engaging because you got to do less? Was it because you sucked at it when you got to try to do something? Did you find the view and anatomy disorienting?

There is no getting around the fact that surgical specialties are very demanding on you and your family. But staff life is better than the hell of residency, which is probably what you were exposed to most. 

As for internal, you can work as a community internist and never do any research. 

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If acute care has been of interest and you've enjoyed your time in emerg, why not try for the +1 in EM? Transferring may be an option, but if you're just coming to the end of PGY-1, you may running out of time for that to happen. Not saying you shouldn't explore that option, especially with what seems to be a decent interest in IM, but for FM residents the main time for that to happen is at the end of the PGY-1 year.

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Agree with ralk. You like the more acute cases rather than mundane outpatient stuff, so I think working in a rural ED would be more up your alley, or working as a hospitalist in a smaller community hospital. While you definitely seem to have an interest in internal medicine, you'll find transferring from FM to IM is difficult (much easier to go the other direction). 

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I'd finish your FM residency. Work one year and then reapply for reentry through the Ontario program. Concurrently I would take the USMLE examinations and apply to the states as a backup. Although you do enjoy acute care medicine, and Rural medicine does have a lot of that, it's not hyper specialized and you'll feel like you're flying by the seat of your pants most of the time, due to the lack of backup. I also figure that you will find small town life boring, considering your rural Family Medicine residency is not shaping up for you.

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