Switching programs from 5 years Royal College to FM but afraid of regretting it

[ChangeToFM]

Long time lurker, first time poster. 
Currently enrolled in my second year of a 5 years specialty program and have been feeling a lack of interest and satisfaction in my program.
Tried to brush it off and it keeps coming back every 3 months.
I am now convinced I need to switch programs and it seems like family medicine is a great fit because it interests me, offers flexibility and would be a shorter training.
I have reached out to PGME and have discussed my options of which a transfer to family medicine seems possible.
I completed the form, was about to send the email but started feeling the fear of regretting it because of everything I'm hearing about how FM is a horrible grind.
No one has the answer for me but I was wondering if residents that switched out felt the same constant fear of regrets in the past? Does it go away?
I have colleagues that are telling me that leaving for FM would be like 'giving up' and 'settling down' to become 'just a GP'.
I have friends that are currently FM residents telling me that they are treated differently by staff while off-service because they are thought to be 'less smart' than specialty residents?
I don't know why FM is so negatively perceived and I am starting to wonder if it's reallly *that horrible*.
Some advices would help. 
Thanks Premed101!
 

[shikimate]

So I see a few different facets of your worry. It may be better to give us an idea of your current specialty area (eg. surg vs medicine vs diagnostic vs other).

1 - sunk time - 2nd year is still not too late, you'll get some credits for your residency. It's better to bite the bullet early than late. 

2 - giving up an area - I don't do FM but I've seen FM doing so many areas, some very esoteric, that wouldn't be considered traditional FM. So unless your residency is very specialized (eg. radiology, pathology), then there's probably some way for you to do something related to that area as FM.

3 - talking down FM - this happens to everyone. The hepatobiliary guys will trash talk the transplant guys and so on. Unless you are dedicated to run the academia hamster wheel, once you finish residency and start working outside of academia, nobody cares about prestige. Plus, when you bill for services prestige is irrelevant.

 

[backinschool]

@shikimate, I would love to know what are those "esoteric" areas of FM? I am very interested in FM, includind the less common areas of practice! Thanks so much1

[rmorelan]

19 hours ago, ChangeToFM said:

Long time lurker, first time poster. 
Currently enrolled in my second year of a 5 years specialty program and have been feeling a lack of interest and satisfaction in my program.
Tried to brush it off and it keeps coming back every 3 months.
I am now convinced I need to switch programs and it seems like family medicine is a great fit because it interests me, offers flexibility and would be a shorter training.
I have reached out to PGME and have discussed my options of which a transfer to family medicine seems possible.
I completed the form, was about to send the email but started feeling the fear of regretting it because of everything I'm hearing about how FM is a horrible grind.
No one has the answer for me but I was wondering if residents that switched out felt the same constant fear of regrets in the past? Does it go away?
I have colleagues that are telling me that leaving for FM would be like 'giving up' and 'settling down' to become 'just a GP'.
I have friends that are currently FM residents telling me that they are treated differently by staff while off-service because they are thought to be 'less smart' than specialty residents?
I don't know why FM is so negatively perceived and I am starting to wonder if it's reallly *that horrible*.
Some advices would help. 
Thanks Premed101!
 

medicine has this strange and pointless self inflicted punishment system - everywhere really - where doing less than the maximum is looked down on in some fashion until medicine is your entire life. I think they may have some cognitive dissonance related to it - "I am doing something hard and painful so it must be for a logical reason, therefore I should keep going. Anyone that isn't doing something that hard and painful must be inferior to me" - it never ends by the way - you see that within different fields, and between them all over the place forever.  Probably almost necessary mindset at times to keep people going in some fields but it is not wise. So in this case that breaks down into FM must be horrible because I decided not to do it and my longer and more stressful chose is just better .... because it just has to be. 

The thing is......not all pain is gain. Sometimes it just hurts for no reason. It is a hard lesson for many in medicine that in many cases you just have to stop doing hurtful things to yourself. That extends as well across your entire career, where there are an infinite number of stupidly painful things you can decide to do. 

Medicine also has this deep root fear of losing out problem too - particularly in picking a specialty. As if that one decision can somehow complete your life, and if you get it wrong you will be tortured for your entire career. Truth is people are vastly more adaptive than that and field has good and bad things. Other than radiology - radiology is clearly the best - particularly emergency radiology 

You do have to  of course really make sure you have explored things - and not care ultimately too much about what other doctors think about what you are doing. Prestige really does wear out very quickly - because no one really cares in the end, and that too is an endless hollow pursuit because it is all external validation. For the record the smartest doctor I know from my class - phd and everything - went into family medicine and she wasn't alone because it was a smart move, and how can a very broad area of medicine be anything other than challenging in many ways. 

The people you really need to be talking to is people in family medicine. 

 

 

[rmorelan]

18 hours ago, shikimate said:

So I see a few different facets of your worry. It may be better to give us an idea of your current specialty area (eg. surg vs medicine vs diagnostic vs other).

1 - sunk time - 2nd year is still not too late, you'll get some credits for your residency. It's better to bite the bullet early than late. 

2 - giving up an area - I don't do FM but I've seen FM doing so many areas, some very esoteric, that wouldn't be considered traditional FM. So unless your residency is very specialized (eg. radiology, pathology), then there's probably some way for you to do something related to that area as FM.

3 - talking down FM - this happens to everyone. The hepatobiliary guys will trash talk the transplant guys and so on. Unless you are dedicated to run the academia hamster wheel, once you finish residency and start working outside of academia, nobody cares about prestige. Plus, when you bill for services prestige is irrelevant.

 

even in academic medicine people stop caring quickly. Oh this guy thinks less of this guy.....who cares? Most people are just trying to get through the day doing good work and then going home. There are a few doctors that can never get out that superiority mind set - those people are not much fun at parties. 

[shikimate]

19 hours ago, backinschool said:

@shikimate, I would love to know what are those "esoteric" areas of FM? I am very interested in FM, includind the less common areas of practice! Thanks so much1

Sometimes the setting is unique. For example, a local correctional facility here was hiring FM. It's like 0.8 FTE so you get paid a fixed salary for this job and you are free to do whatever else outside of this job. I've read some articles online about doing cruise ship medicine to get free travel, although I personally don't know anyone in this route.

I've seen FM doing full time work for CMPA and Health Canada, just office type work, no patient contact. Of course I imagine in their off hours they might do some side gig like WIC or something. One FM I met a while back had background in chiropractic school so they do a lot of MSK injuries, rehab and stuff on top of regular FM. There was another FM doing specialized stuff with laryngology, like voice rehab for singers. 

[Intrepid86]

The duration of training should not be a major consideration. Those few extra years in a specialist program are a drop in the bucket of what will presumably and hopefully be a long career. Family medicine offers great flexibility. This flexibility also contributes deeply to the widespread shortage of doctors doing office family medicine. I suggest you think back to the reason why you didn't initially select FM as your first choice. Whatever path you choose though, there will always be something to like and something to dread. The grass isn't necessarily greener on the other side.

[shikimate]

Categorically false, every choice has an opportunity cost, and schooling/training/fellowship is no different.

Let's do a simple back-of-the-envelope calculation, ignoring factors such as "how much I love FM vs specialty xyz etc". Suppose one could be a FM making 300K net per annum, but instead opt for 5 years (3 extra years) of residency, at an average of 80K per year (as PGY3-5). That's a difference of 220K per year x 3 years. What would be the effect assuming 6% ROI, if that 660K was invested? The answer is >$4 million if t=30 years, >$3.5 million if t=25 years, and >$2 million if t=20 years.

Year 1 220K

Year 2 (220K)(1.06) + 220K

Year 3 (453.2K)(1.06) + 220K

Year 4 (700.392K)(1.06)

Year 5 (742.41552K)(1.06)

etc etc

Of course, some FM make a lot, some little. Some specialist make a lot, some little. It's very geography dependent. 

 

[rmorelan]

On 12/19/2023 at 10:12 AM, shikimate said:

Categorically false, every choice has an opportunity cost, and schooling/training/fellowship is no different.

Let's do a simple back-of-the-envelope calculation, ignoring factors such as "how much I love FM vs specialty xyz etc". Suppose one could be a FM making 300K net per annum, but instead opt for 5 years (3 extra years) of residency, at an average of 80K per year (as PGY3-5). That's a difference of 220K per year x 3 years. What would be the effect assuming 6% ROI, if that 660K was invested? The answer is >$4 million if t=30 years, >$3.5 million if t=25 years, and >$2 million if t=20 years.

Year 1 220K

Year 2 (220K)(1.06) + 220K

Year 3 (453.2K)(1.06) + 220K

Year 4 (700.392K)(1.06)

Year 5 (742.41552K)(1.06)

etc etc

Of course, some FM make a lot, some little. Some specialist make a lot, some little. It's very geography dependent. 

 

You have the right idea with some how sometime family medicine financially is a stronger choice than many give it credit for - you have to factor in the taxes on that 220K (which due marginal taxation matters as the average tax rate on that 80K is not the same as the 300K - although if you have a corporation that effect is blunted). You also quite often need an additional fellowship year for many non-family medicine fields so it is 4 years of "extra" trainee time often or even more (it was 5 for me). 

People love comparing the incomes of FM vs whatever ignoring the power of potentially a 3-4 year head start. 

Also in many specialities your ramp up to full salary is not a quick as family medicine - for instance for me as a staff radiologists my first year of practise was at 60%, and the following year was 80% of base salary - and then I got the group practise pay. It just further stretches things out. Plus again the marginal tax rates bumping at higher rates blunts things a bit. 

There are obviously some specialities that earn quite a bit - that blow this math out of the water but they are relatively few in number. Plus all the FM advantages are always going to be there (many fields don't have the same career length, and are harder to go part time later one with - if you can gracefully slow down at late stages it really impacts the need for retirement savings). 

I am still not sure all of this should be a major factor in selecting a career - only because being bored or frustrated for 50+ hours a week sounds worse that any cost difference. 

 

 

 

[1D7]

I am not in FM. Most of my old friends who did FM like the flexibility it offers them (many are doing a combination of things, like walk-in, hospitalist, ER, cosmetics, etc. on top of traditional family practice) and are content with their job. A few have given up traditional FM clinic (the ones doing ER/hospitalist work have more than enough work).

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I have friends that are currently FM residents telling me that they are treated differently by staff while off-service because they are thought to be 'less smart' than specialty residents?

Many off-service residents are not treated as well or with as many responsibilities. Some of it is bias, some of it is grounded in truth (i.e. you're less likely to study and practice procedures you're only doing for a month). This isn't unique to FM but FM has a lot of off-service rotations relative to on-service rotations.

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I have colleagues that are telling me that leaving for FM would be like 'giving up' and 'settling down' to become 'just a GP'.

They probably like what they do so they can't imagine leaving it. I would never leave my specialty for FM, general surgery, neurosurgery, OBGYN, neurology, or pathology. Doesn't mean these are bad specialty choices, but I enjoy what I do. Your colleagues had their reasons for choosing your current specialty and not choosing FM, so to some extent they may just not be able to relate to your situation very well.

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No one has the answer for me but I was wondering if residents that switched out felt the same constant fear of regrets in the past? Does it go away?

I have seen a few people switch and regret, not specific to FM though. I think what was common was that these decisions were made without really getting at the root cause of why they were unhappy. In those cases there was a 'grass is greener' mentality and allowing transient circumstances to affect judgment for a long term decision (e.g. several tough string of call shifts, minor dislikes about their training program, etc.). Some were just looking for any change at all.

That said, most people I've seen switch are content with their circumstances... you just need to know what you're getting yourself into and if you're going to get closer to what you want your future career (or future training) to look like.