Feasibility of Psych-->IM transfer

[ktwd7]

I'm a PGY1 who applied to Psych and IM, and got into Psych in a fairly large city in Canada (prefer not to disclose due to privacy). I did have >2 interviews for both specialties. While the first two months so far (doing Psychiatry rotations) have been fine so far, I've been feeling somewhat unfulfilled-- I really miss the more objective side of medicine and having clear-cut diagnoses relating to pathophysiology, etc. It doesn't help that my rotation right now has an extremely light work load, to the point where there are days where I don't see any patients.

In light of all this, I've been slowly contemplating a transfer (but I still see this as a last resort). I was wondering if anyone could comment on the feasibility of a Psych to IM transfer? Is this even possible? Or would a Psych --> FM then GP hospitalist be more realistic?

Before I get flamed in the ensuing comments: yes, I know that my situation is all due to my own choices. I made what I thought was the best decision at the time when I submitted the rank list, but I can't help the way I feel right now. 

Thanks in advance for any input!

[BigM]

It's do-able.  Psych comes with 5 years of funding so you have the funding aspect on your side.  You would need to find a program that a. Has an open spot and b. is willing to take you.  One of the other things on your side is that IM is very large program, so the prospects of losing residents from the program and opening up a spot at some point are higher.  Do you know any program directors or have any connections you could use? Overall this transfer would likely be one of the easiest ones to make (maybe not as easy as a 5 year specialty to family medicine, but still pretty good).

The other question to ask is do you really dislike psychiatry?  Psychiatry has a lot of positive aspects (great employment prospects, reasonably good paying, many patients are really grateful, flexibility to work in any work setting you want, controllable work hours).  Is it possible that your desire for a field that is more objective is driven by a lack of comfort with your current clinical skills in psychiatry (you're new after all, its to be expected) and boredom caused by your current rotation?

[#YOLO]

do fm the nhospitalist...u can do a lot of psych hospitalist work too that way

[bearded frog]

Talk to people from the IM program at your institution. By far your greatest chances of success will be there. Talk to the program director, maybe try to do an elective with them as soon as possible. Otherwise talk to your PGME. There is a transfer process in place. If you live in a province with multiple schools its easier.

[ameltingbanana]

14 hours ago, BigM said:

It's do-able.  Psych comes with 5 years of funding so you have the funding aspect on your side.  You would need to find a program that a. Has an open spot and b. is willing to take you.  One of the other things on your side is that IM is very large program, so the prospects of losing residents from the program and opening up a spot at some point are higher.  Do you know any program directors or have any connections you could use? Overall this transfer would likely be one of the easiest ones to make (maybe not as easy as a 5 year specialty to family medicine, but still pretty good).

The other question to ask is do you really dislike psychiatry?  Psychiatry has a lot of positive aspects (great employment prospects, reasonably good paying, many patients are really grateful, flexibility to work in any work setting you want, controllable work hours).  Is it possible that your desire for a field that is more objective is driven by a lack of comfort with your current clinical skills in psychiatry (you're new after all, its to be expected) and boredom caused by your current rotation?

Echo the above - we've had a few 5 year residents transfer into our IM program through this process and it was relatively painless once they did a rotation or two and met with our PD and we had a spot available to my understanding.

I think the second paragraph is important to think about too - I had a buddy in psych who had similar concerns with psychiatry. He transitioned to doing more psych CL stuff where there's a lot of interaction with internal medicine-esque patients and found that quite fulfilling. We've had a fair few  "medical mystery" cases (e.g. mania with new white matter lesions found on CT/MRI - ended up being MS, neuroleptic malignant syndrome, confusion that turned out to be neuropsychiatric WIlson's, etc.) where psych CL was heavily involved in the diagnostic process. I do think in most fields you can build a niche for yourself that can make you happy.

Then again, I am planning on being a general internist and like a bit of everything, so that may be overly optimistic/easy to say for me.

[JohnGrisham]

On 8/20/2020 at 10:18 AM, ktwd7 said:

I really miss the more objective side of medicine and having clear-cut diagnoses relating to pathophysiology,

Sure doesn't sound like IM too me   So much grey area and "this is expert opinion, but theres no real evidence of why we do it". Teasing...mostly.

[ameltingbanana]

23 hours ago, JohnGrisham said:

Sure doesn't sound like IM too me   So much grey area and "this is expert opinion, but theres no real evidence of why we do it". Teasing...mostly.

Haha, 100% agreed. The further I go in IM, the more grey things get...

[ktwd7]

Thanks for the responses everyone. I totally agree, I think what I'm feeling is at least partly situational, and I definitely think with a few months more my opinion might change. That being said, it's nice to know that a transfer is not impossible!

[transfertransfer]

if you are still interested in transferring, let me know I'm interested in the opposite IM to psych switch