PGY3 in Public Health & Preventive Medicine considering a transfer : advice needed

[Confused_Resident]

Dear PreMed101 residents and staff,

As title mentions, I am a PGY3 in Public Health and Preventive Medicine (PHPM) in a program on the West Coast of Canada.
I need your honest advice about a situation that I have been facing since the beginning of my PGY3.
Some context is required because not a lot of people are familiar with the residency in Public Health and Preventive Medicine (PHPM).

Context about why I chose the specialty : 
As a medical student, I hesitated between PHPM and family medicine (FM).
As a fourt year, I was exhausted and tired of medical school.
I picked a PHPM rotation and found it both interesting and relaxing, allowing me to work out, see my partner and cook.
I figured that the lifestyle was appealing and decided to only apply in that specialty.
It seemed interesting and some long meetings were tiring but less than being on call overnight so I thought that I would enjoy it eventually.

How my first PGY1-PGY2 went : 

Usually, the PHPM residency is 5 years long : 2 years of family medicine (FM) + 1/2 years of master's + 2 years of PHPM rotations.
My program doesn't include the family medicine component and is structured this way : 1 year of clinical rotations + 1 year of master's + 3 years of PHPM rotations.
As a PGY1, my year was entirely clinical and I enjoyed most of it but I did find the papwerwork in family medicine demanding.
As a PGY2, I completed a master's and it was fine but nothing that I was passionate about, I figured it's a necessary evil.

My current situation : 
As a PGY3, I started my rotations in PHPM and I have started feeling major regrets about the fact that I am not in the clinical world anymore.
I am in a good program with great support and colleagues, amazing lifestyle right now.
But, I have honestly found myself bored, frustrated about very long meetings and the lack of any form of 'action'.
Essentially, I feel like I am doing an office job that is not stimulating and I am feeling like I am not using my medical knowledge as much.
I miss patient contact.
I (surprisingly) miss the hospital.
I know that as a PHPM specialist without family medicine license, I am still allowed to work in specialized clinics such as STI/addictions but options are limited.

My dilemma :
I am not sure what to do right now.
Both options end up in a graduation in 2026.

• Option A :
  • Just finish residency in PHPM
  • Be done in 2026
  • Try to find a clinical niche as PHPM specialist without FM certification
  • Start working and earn staff salary of about 280K$ per year based on what I am hearing
  • Enjoy life outside of work
• Option B :
  • Apply for a transfer to family medicine
  • Be done in 2026 since I can only get 6 months of credit
  • Make approximately the same salary but have more 'doors' in terms of clinical practice.

What would you do in my shoes?

Thanks all

[Bambi]

If you can take the 'paperwork', I would go for Option B. For sure, you do not want to feel that you are stagnating professionally from the very beginning of your career.

[-D-]

Can you try to transfer to a PHPM program with family medicine built in, as option C? Would not be surprised if these programs have space to add a resident. Keeps your options open. 

[shikimate]

Recommend option B,  transfer to FM. If you wait until latter half of PGY3 it's likely going to be late. Better to bite the bullet now.

I wouldn't say the MHS degree was complete waste. A lot of FM gets into "side gigs" and it could come handy. You might even be able to build a hybrid practice of clinical FM + non-clinical work.

Also I noticed PHPM is not very competitive and usually have 2nd round spots. Say 10 years down the road you are tired of FM and want to give PHPM another shot, you can always apply again.

Also regarding the salary thing, I've seen FM bill anywhere from 100K to 900K, but I have never seen public salary of PHPM go beyond 400K. If you enjoy hospital work like you said, then you could make $$. The FM here who does hospitalist work + ER + FM make more than some surgeons lol.

[-D-]

On 10/8/2023 at 8:55 PM, shikimate said:

Also I noticed PHPM is not very competitive and usually have 2nd round spots. Say 10 years down the road you are tired of FM and want to give PHPM another shot, you can always apply again.

To clarify, are you thinking of the 2nd iteration of CaRMS? Once you are a licensed physician (ie FM), as far as I’m aware you are no longer eligible to apply via CaRMS even the 2nd iteration positions.

[shikimate]

7 hours ago, -D- said:

To clarify, are you thinking of the 2nd iteration of CaRMS? Once you are a licensed physician (ie FM), as far as I’m aware you are no longer eligible to apply via CaRMS even the 2nd iteration positions.

If that's the case, you can also apply to programs like this

https://www.health.gov.on.ca/en/pro/programs/hhrsd/physicians/reentry.aspx

[MGN]

I mean, at the end of the day, it is up to you to decide what you want to do. But let me tell you as me being a FM resident, FM is not a walk in the park either. The patient interactions can be quite draining - there is a lot of talking in FM, and all my fellow FM residents feel the same way. I am dying for less patient contact. Somedays you feel like a social worker, other days you feel like a glorified secretary. The medical part of FM is very straightforward and not very rewarding, and there is a lot of social stuff that most people don't like. There is also tons of paperwork too - referrals to be made, consult reports to be read, bloodwork to check on, all of which is unpaid. A lot of FM residents try to escape from FM by doing +1's. Just wanted to let you know that a significant proportion of FM residents are not entirely happy with their choice either, and are just in it for the lifestyle, which you seem to already have. I am sure if you asked surgeons, they would complain about being on call and being unable to find a job easily, and some may say "I wish I would have been a family doctor". So the grass is always greener on the other side I guess.

[robclem21]

9 hours ago, MGN said:

I mean, at the end of the day, it is up to you to decide what you want to do. But let me tell you as me being a FM resident, FM is not a walk in the park either. The patient interactions can be quite draining - there is a lot of talking in FM, and all my fellow FM residents feel the same way. I am dying for less patient contact. Somedays you feel like a social worker, other days you feel like a glorified secretary. The medical part of FM is very straightforward and not very rewarding, and there is a lot of social stuff that most people don't like. There is also tons of paperwork too - referrals to be made, consult reports to be read, bloodwork to check on, all of which is unpaid. A lot of FM residents try to escape from FM by doing +1's. Just wanted to let you know that a significant proportion of FM residents are not entirely happy with their choice either, and are just in it for the lifestyle, which you seem to already have. I am sure if you asked surgeons, they would complain about being on call and being unable to find a job easily, and some may say "I wish I would have been a family doctor". So the grass is always greener on the other side I guess.

I like this post. No medical specialty is "perfect". Every specialty has things about it that even its most passionate members dislike. The goal during medical school is to find a specialty where you love the bread and butter, and can "tolerate" the worst elements of that practice. For some people, that worst element is call, for others it's the many hours spent on unpaid paperwork, and sometimes things people hate the most are clinic, or early morning starts, or difficult patient populations.

To be honest, it sounds like you weren't quite sure what medicine was all about before starting medical school and this made you burnt out at the end of medical school. Therefore you had a hard time finding anything that you truly enjoyed, and so opted for something that gave you the most time out of medicine. Unfortunately, in medicine so much of our time and energy is dedicated to our work (especially if you want to make more money) that if you aren't remotely happy during the day, it will be hard to compensate for that with hobbies outside medicine.

You have said you dislike call, paperwork, and non-clinical work. The question is which one can you "tolerate" more to make it through your day, and which option might give you the most flexibility to find something you can tolerate. That might be option B, but that answer for you may be different from people here so aside from providing perspectives, the choice still needs to be yours because it sounds like you might be unhappy no matter where you end up to be honest.

[GH0ST]

Hi there! @Confused_Resident

First off always nice to connect with a fellow PHPM colleague. 

 

I think part of the perspective is how UBC structures their program ... it used to be where you do the MPH PGY 1 then go into clinical work which was very awkward... glad to see that's over I think 

 

I too have had periods of time where I feel a bit jaded, especially during this pandemic. I also can empathize with the relatively monotonous feel associated with meetings, but I think you also need to take that with a grain of salt as you're just starting on the PHPM journey. 

 

The first misconception people often have is that there's no ability to practice clinical medicine as a PHPM physician even if you don't have CCFP. Don't get me wrong... it is definitely a HUGE advantage to have your CCFP while doing PHPM (I personally did not apply to any program without PHPM+FM). That is simply not true. Although it's not the same conventional job as a medical officer of health, or a public health physician in a provincial health authority (think Public Health Ontario, BCCDC, AHS, WRHA, PHAC, CAF, etc) there's still many opportunities where you can try to tailor your practice. You DO NOT NEED TO BE A MOH FULL TIME. 

 

As an example, a PHPM physician that has a side practice in addictions medicine took a position briefly while at Algoma Public Health working as a consultant to help with COVID outbreak management. He wanted to have more flexibility than work MOH full time. There's so many opportunities for part time clinical work in addictions, inner city, STI, etc... 

 

A third option you didn't list is applying for occupational medicine as your fellowship (I'm giving it a shot personally). I love CD work but I also really enjoyed connecting with my patients and advocating for improved workplace mental health culture as well, paid sick leave, EAP supports, improving workplace policies etc... I'm thinking either working as a consultant with companies to instigate changes to workflow or at a Ministry of Labour while maintaining a clinical practice part time. If I don't get in no harm done as I can still work as a PHPM physician and do clinical medicine.

 

The other misconception is that the meetings are just boring... which to some extent it feels dry. That said, you're not at the level yet where you are leading teams or the one setting things up. I guarantee you that it's much better when you aren't just a passive participant listening to meetings vs your preceptor giving you a task like "establish a program X for this condition... or support the stakeholder engagement work to solicit feedback from community members, or develop a policy to be utilized for the organization. Soon you will be the one that decides who to meet, how to set things up and with some remote supervision, actually take more ownership of your work. You will also have opportunities to lead outbreak management meetings with many physicians, IPAC groups, and other community stakeholders who will defer to your guidance. You will get many interesting communicable disease consultations on diseases of public health significance that we'd never see in general practice (had a challenging one involving a monkey bite in Equador and thinking of potential pathogens while collaborating with public health veterinarians at the ministry, or Avian Chalmydiosis, or blastomycosis in a rural community). There's work on developing Ebola guidance and emergency preparedness. The point is there's so many other opportunities and most importantly, you will get opportunities to take more ownership and facilitate the process rather than just sit back and not know what's going on. It feels different when people ask you to provide guidance on what to do in a respiratory outbreak in a retirement home, or when you have to do media interviews or radio shows... the responsibility and the engagement is completely on a different level. 

 

Please take the time to speak to many preceptors and physicians experienced in PHPM first before you make a decision. I think part of the issue is that you're still so new to PHPM but not clinical medicine and so your perspective will be different. 

 

I would be happy to speak to you via PM. 

 

NOTE: I would not say the salary is the same... FM may be higher if you're a grinder and do lucrative side hustles, but PHPM has a different level of stability especially if you're a government employee with full benefits, retirement packages, etc. Many physicians have to find their own health insurance, think about how to invest in their own retirement... when you have an employer that you know won't be defunct that's a huge boon to security in my opinion... that said you have to decide what you value. 

 

- G 

 

[Confused_Resident]

Thanks to all of you members for taking the time to read my story and give me an opinion. It's sincerely appreciated. I will take a few weeks to think about it and explore some possible options. Will keep you posted ! :)