Unmatched predicament

[12345678910123]

Hi everyone,

 

So I went unmatched to a highly competitive sx speciality last year. Was completely broken about it. After much reflection this year I realized  that FM actually appeals more to me. It’s quicker, the residency will be way more chill, I’ll have tons of flexibility to carve an interest of what I like, I can have choice to a greater extent of where I do residency than the sx specialty. And I’ll get a job where I want while also having time to focus on my hobbies.. 

 

What is holding me back to the sx specialty are two things:

 

1. Justification of effort. I did do a lot of ECs in the sx speciality and feel like I HAVE to apply to this speciality again because I did so much work ..  on top of this everyone continuously sh*** on FM, so it makes me feel like I’m being an idiot considering ranking FM above this speciality. 
2. Considerable AVERAGE pay difference. However, I’m very efficient, and have a very entrepreneurial mindset, so feel like I will find a way to make a very good income in FM through OHIP and non OHIP ways

 

Would really appreciate anyone’s thoughts :) and I think for anyone who goes unmatched in the future or just went unmatched last cycle, this is a good example that when you really reflect on things, there’s a lot that can make one happy!  And I think it all happens for a reason 

[frenchpress]

1a. Sunk-cost fallacy.
1b. I also think a lot of people shit on family medicine because they are unhappy in their own choices to do something else. For every unhappy family doctor you find out there, I can find you an unhappy specialist. There are plenty of happy family docs, who are often happy in part because of the same things you mentioned - flexibility, shorter training, portability, more time for your life, etc. 

2. There are lots of ways to make money in family medicine. Assuming you don’t have astronomical spending habits, you won’t starve, and you’ll probably do pretty well. 

See if you can find some mentors in your city who like family med to reach out to. Sounds like you already made up your mind, but they may help you make peace with it. 

[1D7]

It doesn't really matter what other medical students think. It's an immature thought process to look down upon another specialty for their training length/difficulty, and that fades during residency anyway. Plus you won't be seeing most of your former classmates in residency much.

I find it common students over-invest their ego into a certain specialty identity during the clerkship/match process. Making decisions based off of what you've done so far is part of the ego-identity problem. I would recommend letting go of that and approaching your situation honestly as to what you would really be happy with 5 & 10 years down the road.

 

[Andrew]

Family Medicine is awesome after the FEB2023 LFP Payment model in BC and it's only going to get better. (Move to BC, AFAIK OHIP has a ridiculous payment model). Re-apply to your Surgical but don't be sad if you get FM.

I went unmatched in 2013 for a surgical specialty and ended up with FM just like you. I'll share with you some thoughts 10 years later:

To this day, I'm still angry about the whole thing but what helped me move on is a few things.

1. First, things tend to get better over time just naturally, as you get older, as you (not sure if you're married or whatever), get married, if you have kids, so many things will come into your life that you just forget over time. I would say the first 3-5 years maybe I was angry about the whole thing. Now it's 10 years out, I kind of don't care anymore. I had a lot of energy up until now (I'm 39) and at 39, I don't have the same energy or motivation so I kind of actually prefer the relaxed life of family medicine. When you're young, you think "I'll be a surgeon all my life", but in actuality, I think everyone hits a wall where they feel OLD and that's the point where the path of FM pays off.

2. My Residency preceptor told me "everything happens for a reason", I know this sounds deterministic, and I'm not religious (but for instance, if you are Christian you might find it easier to get on board with this). Here's how I reflect upon that: I couldn't see it at the time, but perhaps not going into Surgical Specialty has been a blessing for me. Once you accept that it's easier to move on.

Let's compare the two paths:

- I got into Surgical Specialty say U of T or whatever, I grind my ass off for 5 years, then go to the USA to do fellowship  for another 2+ years then I try to return to major Canadian city to work in a teaching hospital as attending, my life is forever chained to the hospital and doing call. I probably won't meet a quality girl during this time, and even if I do, I have to drag her around with me when I move.

-Instead I got Family Medicine, I did 2 years, but the Residency was pretty easy compared to Surgical, once I graduated, I worked hard including weekends for the first year but quickly decided the money wasn't worth it. I then had a lot of free time to cultivate hobbies: playing sports, working out, eating right, not doing any call (full night of sleep), going on vacations, dating girls etc.

If you put Medicine as #1 in your life you'll be disappointed with FM. What I did was make room for everything else in my life (family/friends/hobbies) and I go to work and do what I deem to be a reasonable standard of quality/care but it's not the #1 thing in my life, and once work is done I don't take anything home with me. With this approach, Medicine becomes just another high-paying career like a lawyer or whatever.

3. Regarding the "satisfaction" with family medicine. Often times I feel the disrespect from patients and the pay wasn't that good in 2013 (but it is amazing in 2023), lately the pendulum has been swinging in the other direction, because there's a lot of media articles on CBC about shortage of GP's, talk of making FM a 3 year residency (because people seem to associate years with respect), lately increased pay etc, so things are actually looking up and now is probably a good time to be entering family medicine.

Regarding respect, a lot of people value "Doers" and not "Thinkers" and surgical applicants tend to think the same way, so it takes a while to adjust. In FM you're getting paid to think and not do, more like internal medicine. But its a lot lower level acuity/intensity, so there's a large element of psychiatry and soft people skills, not the pure thinking of Int Med. At the end of the day, you will still find patients that think you're a referral bot for specialists, but I minimize this by doing intake interviews and for the most part, the majority of my patients are reasonably pleasant. (don't be afraid to discharge patients you cannot get along with, I find the longer you keep them, the greater the chance they file a College complaint with or without merit, even a meritless complaint still forces you to write a response before it gets dismissed.

4. Regarding $$, after the LFP the pay is really good, the per hour or per time is pretty damn good I would say, even compared to Specialties. And of course, you have the opportunity to do Botox/Cosmetics, Travel medicine, private medicine (TELUS clinics etc), or maybe even open your own chain of clinics (although what I see in BC is that all FM clinics are being consolidated under 3 or more conglomerates WELL, TELUS, HighRoads(LondonDrugs), with Walmart/Superstore also looking into break into this area. The future of FM clinics is probably every clinic will end up being part of a large corporate chain of clinics.

You can use your extra time (FM has more free time vs Surgeries) to scout real estate and buy/rent properties, follow and invest in the stock market etc.

[shikimate]

I never wanted surgery but did an "easier" 5 year residency, but even then those were 5 very long, grinding years. I was fortunate enough to land a position without fellowship. I can't imagine spending another 1-2 years grinding away in academia. I actually applied to transfer into FM but was rejected; it might have been a blessing or curse, I can't say. I think the problem with the undergrad/med school stage is you've been stuck in academia for so long your life's "universe" is distorted. Once you get out and work in the community in a while your "universe" really expands. You can be busy beaver and make $$ or just sit back and dedicate time to other things.

No publication in 2 years? Nobody cares. Showing up to rounds in shirt and shorts? Nobody cares. Hoarding trinkets inside your office? Nobody cares. Bounce out of office at 2pm to go hunting? Nobody cares. When you tell regular people you are "doctor" at X hospital, they have the same respect for you whether you are IM, FM, surgery, rad, etc. That's the awesome life waiting for you once you leave the tight surveillance circle of academia. That's why I think FM is a great choice for a lot of people. You can leave ASAP. Or if you really want to stick around in academia, you can go back and do a PGY3 in something.

[Dice]

I just want to chime in as someone who was previously in a different specialty but got ill, had to leave medicine, and re-matched successfully to my first choice in FM, that I am very happy in FM. The efficient and entrepreneurial mindset will serve you well in FM. Also, if you haven't heard yet, FM is NOT going to 3 years after backlash so that is still a plus. I AM a Christian, so I believe like the poster above that everything happens for a reason. I bet you will be an excellent asset to FM, if you truly live each day as if it could be your last, being content if you were able to even help one person each day, not always looking towards the future, end of residency, better pay, etc. Blessings, OP.

[Curiousaboutapps1]

On 9/28/2023 at 6:10 PM, 12345678910123 said:

Justification of effort. I did do a lot of ECs in the sx speciality and feel like I HAVE to apply to this speciality again because I did so much work ..  on top of this everyone continuously sh*** on FM, so it makes me feel like I’m being an idiot considering ranking FM above this speciality. 

This is a common experience of a lot of people in medicine and beyond. So common, in fact, that it has its own name. It's called the "sunken cost fallacy". It's not a rational thought pattern. Recognize what it is and ignore it.