Changing Specialties?

[Guest terminalprep]

I have a question that I've never seen addressed anywhere else (probably because it's that ridiculous), but I thought I'd ask anyway...

 

Once I picked a specialty (say, I chose Emerg Medicine, which I believe is a 2-year residency), and completed everything, would I be able to still practice Emerg on a part-time basis while doing a residency in another speciality? Can I eventually have two? I apologize if it's a stupid question... any help would be appriciated!

[Guest moo]

You won't be able to practice medicine on a "part-time" basis and do another residency simply because you will get burned out! Can you imagine working 80 hours a week during this second residency and then also working another 10-20 hours on top of this? It's not feasible.

 

However, you can switch specialties... just re-apply to CaRMs/NRMP and do another residency. I know of a doc who was an ER doc for 15 years before doing another residency in psychiatry.

[Guest Ollie]

If you reapplied to CaRMS to do another residency, would you match in the first round with new grads, or would you have to wait until the second round?

[Guest strider2004]

Ontario has a special reentry program that will let 20 physicians retrain each year in a spceialty of their choice. Of course, this is a competitive program and half of the docs want to do radiology.

I did meet one person who did FM+anesthesia and was going back to retrain in a the 5 year anesthesia program because he wanted to feel more comfortable with the more complicated cases. Yeah, he probably could work in walk-in clinics at night if he wanted to.

Some programs already let you do that after 2 years of residency (Alberta, manitoba, etc) because you can getr license after you write your LMCC part 2.

[Guest Ian Wong]

It is not that simple for either Canada nor the US.

 

Here's a previous thread that discusses this in some degree.

 

pub125.ezboard.com/fpremed101frm31.showMessage?topicID=196.topic

 

The bottom line is that for you to do a residency, you need to have funding. In Canada, the provincial government provides money to the post-graduate institutions, which can then use this money to pay for having residents (covers their salary, institutional costs, etc). In the US, the Medicare/HCFA branch of the government provides roughly $100,000 USD annually to each hospital per resident per year (again, covers their salary, plus a cut for the hospital, which is why hospitals in the US have a financial incentive to fill all their residency spots).

 

Once you match into a residency in either Canada or the US, you are allocated funding appropriate to the number of years it would take you to complete that specialty. Once you use up that funding, you encounter serious obstacles in terms of getting additional funding to do additional residencies. You might need an outside agent, like the military or an underserved community to put up the money for you to retrain, in exchange for a return-of-service agreement, where you in turn go to work for them. In the US, once you've used up that funding, then the program itself would end up bearing the cost of your residency, which obviously makes you a much less attractive candidate.

 

Emerg is also not a 2 year residency, but can be arrived at by either a 5 year FRCPC residency, or 3 year CCFP-EM (2 years of Family Medicine followed by a 1 year CCFP-Emerg fellowship). You may be able to make a small amount of money during residency by moonlighting, particularly if it's a slack specialty that you're doing the residency in, but not much more than that. The reason you don't hear this question coming up often is that most people would consider you insane for embarking on a second residency if you were already fully-licensed (unless you really hate Emerg that much, in which case you would have tried to transfer out BEFORE you finished the residency).

 

Once you've done ANY post-graduate education (even for a day), you are forever barred from entering the first round of CaRMS. Occasionally, there may be residency spots reserved for re-entry candidates (in other words, practising physicians who want to retrain in a different specialty. ie. one of the ENT residents at UBC was an Emerg doc beforehand), but these are few and far between.

 

Ian

[Guest UWOMED2005]

One of the psychiatry residents I worked with this past week has been a family doc for 15 years.

 

She was an internist for about 10 years before that.

 

It's possible, but don't expect to get into plastics the second time around

[Guest Kirsteen]

Hi there,

 

On this topic, a good friend of mine's partner completed his anaesthesiology residency a good number of years ago. He's been practicing as an anaesthesiologist in Toronto for the past number of years. After feeling increasingly unhappy in this role, he's now set to begin a new residency in psychiatry in Ottawa this summer. An interesting point though: because this will be his second residency, he is required to, post-residency, complete two years of work in a rural area of Ontario. That was the first I'd heard of this policy. Is this unique in Ontario? :rolleyes

 

Cheers,

Kirsteen

[Guest Ian Wong]

You might need an outside agent, like the military or an underserved community to put up the money for you to retrain, in exchange for a return-of-service agreement, where you in turn go to work for them.

I bet you he's getting the funding for this second residency from the rural communities themselves. In return, he's going to have to practise there for a variable amount of time (basically, you then need to negotiate with them for how long the return of service will be, and usually 2 years is a good starting point). I had not heard that Ontario had a dedicated re-entry program in place, and perhaps this is how he found that spot? I'd be interested in hearing more if you ever tracked this individual down again. On that note, going from Gas to Psych? Pretty 180 degree turn-around there!

 

Ian

[Guest Kirsteen]

Hey there Ian,

 

I'll find out what program it is. I went out for some Indian with the two of them a week or so ago, which is when I found out about the two-year rural requirement. Although I failed to ask for any further specifics it sounded as though it was an Ontario-specific program as opposed to an Ottawa-specific, which was my initial hunch.

 

As to the switch to psychiatry, he'd had enough of the anaesthesiology life. In the downtown hospital, although he loved the teaching opportunities, the bureaucracy and huge number of hours ground him down. A few years ago, in an attempt to relieve the stress, he cut his hours back, and then finally decided to switch to a career over which he'd have a little more autonomy. He seems very happy with the choice, so apart from having to complete 90% of another residency, all's well.

 

Cheers,

Kirsteen

[Guest Shahenshah]

Hi Kirsteen,

 

I am curious as to why he would switch to pscyh for autonomy when he can possibly do a 1-yr fellowship in pain and have his own clinic etc...any ideas?..I am just curious about the anaesthesiology field and was trying to think why he would find it that frustrating?

[Guest UWOMED2005]

Possibly personality type, or maybe he just got bored of the same thing every day year after year. It's not that uncommon. A lot of the high paying specialty/sub-specialty work is fairly repetitive - when you're a med student putting someone under or doing a specific surgical procedure (for X amount of dollars) might seem like a great idea, but after 10-15 years of doing the same thing day in day out it might not seem as stimulating.

 

Interesting that this is the second doctor I've heard going back to do psych. I've found clinicians who have worked for years and have experience have way more respect for psych than med students deciding on specialties. I think it's because of the variety and challenge of that particular field, something med students might not think about as much.

 

That rural service thing makes sense with the ex-internist ex-GP resident I know. She has worked mostly in rural SW ontario communities so might be doing something similar.

 

Anaesthesia AND psych. . . now that would be a potent combination for pain clinics. For those of you who haven't work with chronic pain, inevitably chronic pain becomes a psych issue. . . not because people suffering from chronic pain are fakers/crazy, but because the stress caused by chronic pain inevitably leads to increased anxiety and/or depression. Depression and/or anxiety has a tendency to magnify our experience of pain - most of the physiatry chronic pain guys I worked with found anti-depressants were more effective in treating chronic pain than opiods or NSAIDs!

[Guest Elaine I]

Interesting topic - one of the ER docs that I know in Toronto just started a re-entry residency in dermatology. He told me that while he liked the ER, he was making the choice for lifestyle regions, ie: to get off shiftwork. I didn't ask too many questions about the re-entry residency (since I'm more concerned about first getting into med school!), but he did tell me that it was a shorter than normal dermatology residency.

 

Elaine

[Guest Kirsteen]

Hi there,

 

I think it's because of the variety and challenge of that particular field...

 

The above are definitely some of the other factors that he mentioned in his decision to enter psychiatry.

 

Additionally, his new residency (which begins in July) will take 4 years to complete. This is shorter than a traditional, new psychiatry residency since, I believe he was afforded one grace year since he did some time in a psychiatry residency straight out of medical school.

 

Cheers,

Kirsteen