Saturday, October 02, 2010


I'm almost done proofing the galleys for the book, and there's only been one part that has made me cringe--one part that frankly has always made me cringe--and that is the six or so pages in which I am explaining why I switched residencies.

Some background for the new kids, and a little explanation to the readership in general, since my residency switch is easily one of the most popular topics about which I receive e-mail: a long, long time ago, I was a medical student who didn't know what she was going to be when she grew up. So I thought I would go into Pediatrics, because I liked my Pediatrics rotation and I liked the residents and attendings that I worked with (read: they never yelled at me) and I thought kids were cute or at least easy to overpower. But about a year into my Peds residency, I realized that I had probably made the wrong choice. This is not a condemnation of the field of Pediatrics in general. Pediatrics is a fine and noble field populated with some of the best doctors with whom I have ever had the honor to work. But it is not for everyone, and as it turned out, it was not for me, much the same way that Orthopedics, Emergency Medicine, or Psychiatry are also not a good fit for my personality and interests. Basically, I thought I would be a good Pediatrician, and I was wrong. The field of Pediatrics did not fail me, I failed the field of Pediatrics. Luckily, I had a chance to correct that error, and I was able to switch from the Peds residency program to the Anesthesia residency program without too much fuss. And now you know the rest of the story.

However, reading over the few pages in which I detail the rationale of my switch, I keep feeling like I come off as a spoiled, squeamish ingrate. Like: Ugh, well-child visits, flu season, overnight shifts in the Peds ER? Get me the fuck out of here and back behind some surgical drapes, where I all my patients are unconscious and I can fastidiously rearrange syringes to my heart's content! And maybe the pages still read like that to me (after umpteenth rounds of revision--that was one of the more difficult parts for me to write, frankly) is because it all is to some degree true, and I just feel like it highlights some central failure of character on my part. Why couldn't I stick with Peds? Why couldn't I finish what I started? I love being an anesthesiologist, but does switching out of Pediatrics make me a quitter? Whenever I revisit the switch in my mind, no matter how much I know that it was the right decision, part of me thinks exactly that. You quit. You're a quitter. You left because it was hard, and then you found something else. Traitor.

(And then I push myself down, take off my own glasses and step on them.)

I am nothing but grateful for the two years of residency training that I received in Pediatrics. Those two formative years helped me become the kind of doctor that I am today, and provided a strong foundation upon which the rest of my training was built. I moved on, but I'm not ungrateful, nor do I bear any disrespect or animus towards the field of Pediatrics nor the people who took the time and effort to train me. Peds, I know from experience, is one of the most challenging specialties in medicine. But it's true, I just didn't want to be a Pediatrician anymore. And reliving that realization feels bad, like revisiting the breakup with your first serious boyfriend, or remembering the look on his face when you told him.

Has anyone else out there switched residencies? Switched careers? Was there any long-term guilt involved with that, even if it was the right decision in the end?


  1. I guess there could be. I'm a mid 30s career switcher from human resources to medicine. I'm currently a first year PA student, and you can bet if I was 10 years younger than I am I'd be in medical school. 10 years ago, I was pursuing my first grad degree; if you had told me then where I'd be today I would have laughed and laughed. However, here I am! My only regret is that I didn't figure everything out sooner. Sometimes you have to go through certain things in order to get to other ones. I do feel guilty about "throwing away the education", but I don't regret for an instant the choice I made to switch.

  2. Anonymous12:20 AM

    We judge ourselves not merely by our actions and words but by our thoughts. As rationally as we may explain things, as capable as we may be of convincing the world of something, anything, our own selves are the toughest juries and judges.

    Perhaps, a part of you thinks or may have thought that at least one of the reasons for the switch was not at all rooted in the altruistic idealism with which you believed medicine should be approached, but rather was derived from the pragmatic equation, which contained personal comfort, interests and lifestyle as variables.

    The mere fact that this realization gives you pause and serves as cause for angst is ample evidence that your altruistic idealism is still alive and well. The fact that your personal code of ethics makes the thought of being a quitter feel so uncomfortable should tell you that you are not guilty of whatever charges you are bringing up against yourself in your mind.

    I look forward to reading all the parts of your book. If I can ever bring myself to live below the Mason-Dixon line, I would love to meet you in person.

    P.S. When my older son was a little over 4, he refused to go trick-or-treating, making the very logical argument that we already had more than enough good candy at home and it would be a lot more fun to see all the kids in their costumes come to our house than walk in the cold to get candy from the neighborhood adults. Almost a decade later he is on his way to being the world's best teenager and is an incredibly loving older brother, so rest assured, Cal (with or without trick-or-treating) is perfect!

  3. If you had stayed with paediatrics, you would have been doing a job you didn't want to do. You would have spent more time being frustrated, annoyed and unhappy etc. I'm sure you would have been a good paediatrician, but you recognised that you could be a *better* doctor in a different field, and made some pretty significant sacrifices to do so. Sometimes it's harder to admit you've made a mistake and start over, than to pretend everything's fine and keep going, despite your unhappiness. That's not failing at paediatrics, that's succeeding at life, and is ultimately better for you, your family, and your patients. I look forward to reading your book when it comes out.

  4. Anonymous1:00 AM

    You do what's right for you and what makes you happy. If people want to get offended over THAT, that's pettiness on THEIR part, and that's their problem, not yours. I am going from a stay at home mom into medicine, and I get some of those same kind of reactions, too. Like, "Being a sahm isn't good enough for you?" Or like I'm condemning ALL sahm's, but it's not that, it just didn't make me happy. Everything most happy sahm love, I hated. Everything most sahm hated, I also hated! :) Like being a dr wouldn't make most of them happy, having a very big career makes me happy. Do what's right for you. Explain the best you can, but no matter how nice you are about the decisions you make, someone is always going to be all too happy to judge you. You just kind of have to say, okay, well, your decisions are right for you and mine are right for me, and if you don't like it, you are the one who is going to have to deal with that!

  5. You're allowed to do what you like! You don't have to like everything and finish everything you start. One of the reasons I chose PA school was because I didn't want to choose. I want to come and go through specialties as I like. Do I sometimes feel like a quitter because I chose PA over med school? Maybe. But the more I go through my clinical year the more I realize this was the right decision. The only reason I would prefer over being a doc than a PA is the pay. But the pay aint shabby anyway. And as we all know, you're never allowed to think about the pay when working in medicine. You're doing God's work. That's payment enough, or something.

  6. Anonymous1:32 AM

    I switched fields, also from something else into anesthesia, and I am also far, far happier in anesthesia than I ever could have been in the other field. However, I have a lot of guilt about it as well. I was one of those med students who liked everything and couldn't choose what I wanted to do, and in the end kind of chose the "best of the wrong fits." I loved my field but never fully felt, in my heart, like it was the perfect one for me. However, I ran out of time to continue perseverating about the decision, and just went with it. I was a good student, but matched outside of my top choices, and that was when I started to feel like maybe the stars were aligning to tell me to re-examine what I really wanted. I took an anesthesia elective, LOVED it, and put the ball in motion to switch, and got a spot at a very desirable program in a very desirable locale for me, very easily. I also took that as a sign.
    However, when I tell people about my switch, and they immediately kind of smile and say, "oh yeah, so when did you see the light about your other field and realize anesthesia was the only way to go?" I feel uncomfortable, because the impetus for me to reconsider what I wanted out of my career came from something as petty (although devastating, at the time) was not getting what I wanted in the match. Like I said before, I genuinely think things happen for a reason, and things certainly worked out in the end for me; but I don't like when people think that it inherently means I hated my other field or I couldn't survive it. I am, in many ways, always going to have a little bit of the other field in my heart and in my practice, even though I am much more happy in anesthesia.
    Anyway that was long-winded, but yes, I understand guilt and not wanting people to get the wrong idea. In the end, I am extremely happy with where I am in my career, and I hope all of my colleagues have found a similar peace with theirs, and that we don't judge each other's decision-making, and are just happy for each other.

  7. Anonymous5:13 AM

    So, this probably isn't really *good news*, but I quit the phd part of my md/phd in 2001, and I nurturing had a guilt nightkare that woke me up from a sound sleep at 430 on my Sunday off. I'm not sure ill ever get over that "quitter" feeling. Maybe it's the pathological stick-to-it-ivenessthat got us into and through the ridiculous training process in the first place.

  8. Anonymous5:15 AM

    Not sure how 'just' got spell-checked into nurturing, but whatevs.

  9. jane doe6:53 AM

    Over here, our medical graduates don't pick a residency until a few years after finishing med school. I'd say the vast majority of people don't end up doing the thing they thought they'd do at the point of graduation. Changing one's mind - often several times - before settling for one path is totally normal and expected. Those of us who jump ship after starting a training program aren't uncommon, either. People tend to react with some surprise when it happens, but I'm yet to meet someone who reckons it equates to quitting.

  10. You feel bad because "good" doctors are supposed to like primary care fields, and "bad, selfish" doctors do things like derm and anesthesia.

    MD-PhD is my third career. The only guilt I have about switching (repeatedly) is that I often want to go back and thumb my nose at the people who made my life miserable during my first two careers, and we're not supposed to feel that way. I was actually fired from career #2. I sincerely doubt anything that dramatic happened to you during your "failed" peds residency.

    You're happy now. Embrace it.

  11. I think you're all right. The unspoken part of it all (in this entry, though I do talk about it a bit in the book) is that all the "good fit" issues aside, Anesthesia also offers a more comfortable lifestyle with better salary and flexibility, although admitting that even factored into things seems like blasphemy, and compounds the "traitor" feeling of leaving Pediatrics. I love anesthesia and would still do it of those things weren't true, but hey, it helps.

    It's just that old med school idealism alive and well: GOOD doctors don't CARE about things like MONEY. Like Atticus Finch, just pay me with a bushel of potatoes and goodwill, right?

  12. Different fields, but sort of similar story -- I switched from engineering into law, and felt a little like I was giving up even though it was purely out of personal preference. I was very involved in women in math/science/computer science groups in college and grad school, and hated that I was contributing to the statistics about women engineers leaving the field. I know there's no point feeling guilty since I made my choice, but I still do.

  13. I have no experience in the medical field, but I am a mom and I've done plenty of time in the trenches with pediatricians - some good and some bad. My thought is that some of those bad ones should have done some of the same soul-searching you did and picked a different speciality. It's not about quitting, but getting the right fit: for you and the patient.

  14. Wow Michelle, your most recent post really resonates with me. I too have a time in my past which upon reflection always makes me cringe... and that is the time during which I chose NOT to enter a highly competitive postbac premed program to which I had been admitted at the age of 28. The idea of medicine as a career occurred to me very early in doubt, if you could travel back in time and talk to my 8-year old self, she would have told you: "When I grow up, I want to be a pediatrician." And this aspiration has stayed with me, in some form, throughout my whole life. It's just that my path to a health care career has been a bit circuitous, having included stints as an elementary school teacher, marketing professional, and even a brief stint as a Hollywood assistant. Indeed, to quote a previous commenter, sometimes we have to go through certain things to get to other ones. And by the time I got back to medicine, I was approaching 30 and thoughts of the other things in life (marriage, family, etc) definitely played into my ultimate decision to pursue a career as a nurse practitioner instead of a physician. I'm currently in my second year of NP studies, and I while do have the occasional pang of, "Was this the right decision?", in the end I have to appreciate the intricacies of the road that led me to where I am today. And most of the time, I feel pretty darn good about where I am and where I'm headed.

  15. Anonymous11:37 AM

    It took me five years to admit that I wanted to switch fields, and five years later, I'm about to enter the final part of switching, and yes, I'm racked with guilt, still. I appreciate all of comments; for the first time, I feel less alone, less like a failure - Wellesley doesn't tell us that it's okay to waiver in one's career or to stop doing something that doesn't make us happy. I always feel like everyone else I knew has headed on a straight path following graduation and I'm the only one who wasn't quite sure/realized what I wanted late.

  16. Anonymous12:06 PM

    I did just the opposite. Started internal med, switched to anesthesia, and after a year thought I'd lose my mind. Frankly, I'm not that fond of surgeons. Been a practicing endocrinologist for 15 years. Love the patients, love my practice, and have even come to like surgeons. By the way, what is it with anesthesiologists and pens. I picked up a few of the pens you mentioned and thought "well, these are ok. They're just pens." The anesthesiologist husband however, has put a specific order in to get more of those "terrific pens". What is it with you folks?

  17. Anonymous1:28 PM

    Much like CM above, I left the field of engineering (and felt guilty about being another woman leaving the field). I floated for years until I found my current career, which I LOVE: teaching high school mathematics...and engineering. It's much more fun and valuable to me to encourage young people to pursue careers in math and science, to hear them say, "OOOoohhhh!" when they finally understand a concept, than it would have been for me to continue as a dissatisfied engineer.

    I love my job. That is so important. I felt like a failure when I left grad school (materials science, which was not a good fit for me). I felt like a failure again when I "abandoned" my engineering job. Now, though, I feel like a success. I feel like my job is perfect for me. I feel like I'm helping people. I can't ask for much more than that.

  18. Anonymous3:42 PM

    Dr. Au, your post couldn't have been at a more appropriate time. It's October of my 4th year of medical school - my classmates are busy on away rotations, getting interviews, planning the next part of their careers in medicine. And I'm floating along pretending like it's not really happening. I loved all of my rotations as a student - pediatrics, ob/gyn, neurology, internal medicine, general surgery... I imagined myself doing all of those, along with anesthesia, ophthalmology, ENT... But in the end I just couldn't decide. I still can't. I have yet to really pick what I'm going into. I know it sounds like I should ask myself if I even really want to be a doctor... but I DO. I REALLY REALLY still do. I just don't feel ready to pick.

    It's just too hard to decide as a 25 year old with basically no work/life experience other than being a student. It's hard to consider factors like hours, lifesyle, etc as a single person, knowing that in 10 years you will have more people to think about than yourself. The whole 'choosing a specialty' process has been a little bit of a let down, and I feel like a 'failure' for not being able to commit to one field.

    Don't be hard on yourself for your decision to switch. You took the initiative to go after what you really wanted, and believe it or not that gives me hope as a student that maybe I will figure it out later too.

  19. It is your life . AT the end of the day-it is YOU who will have to contend with the intricacies of living it. As far as we know, we have one go round on this planet-might as well enjoy how you spend your time here.

  20. ummm...totally did not mean to capitalize the first word of the second sentence....

  21. As a former peds resident and current second year peds hem/onc fellow, and one who has read this blog since before your switch, it never - not even once - occurred to me to think of you as a quitter. What I actually thought was, "Oh, it's so good she realized what she really wants today before she spent ANOTHER year doing something she didn't really love!". And I thought you were really brave to switch.

    So... try not to feel guilty! If members of the pediatrics world are in no way offended, you don't need to feel guilty for it! :)

  22. Anonymous1:28 AM

    That's the great thing about medicine, isn't it? That there are so many fields for so many different types of people. Believe me, I am so grateful that there are people out there who want to be anesthesiologists...neurosurgeons...adolescent medicine specialists... So I don't have to do those jobs!

    BTW, I decided on my subspecialty (neonatology) late in my third year of peds residency. Sometimes we're just not ready to take the leap, and I that sometimes contributes to people making the 'wrong' decision too early on...

  23. Anonymous1:31 AM

    P.S. What I'm more interested in hearing about (i.e. more than your residency switch) is your decision to stay in Atlanta vs. moving back closer to NYC. Is that in your book, by any chance?

  24. Anonymous6:03 AM

    I'm a junior doctor in Australia, and here it is quite common and in fact encouraged that you explore different avenues before settling into a training programme. After my internship, I did a year of paediatrics, then 6 months of O&G and 6 months of anaesthetics and am still unsure of where I will end up! I am doing a year of adult medicine next year and will see from there. Anyway, the point is, changing your mind is not quitting! How are you supposed to know what you want to specialise in when you have only been a med student, and not a doctor?

  25. I switched from engineering to medicine after two engineering degrees and working for 10 years, I entered med school at 34.... had two kids in med school... originally thought I wanted to do ER, but changed my mind, now I'm a third-year anesthesia resident... will finish at 43... don't regret any of it!! You're not a quitter...

  26. Canadian Jenn12:07 AM

    I had planned on getting my PhD and being a researcher/professor so that I could stay in school forever. I love school. However, after finishing my Master's degree, I felt burned out and decided to take a "short" break. I got a job with a (Canadian) federal granting council and now I give money to people who do research instead of doing the research myself. It is now eight years later, and I really don't see myself doing a PhD anymore. I really enjoy what I do, and I have to say--competing for funding in the academic world is TOUGH, especially now that I've seen it from both sides. I get a regular paycheque, which comes in handy for things like our mortgage and things for our three kids. Sometimes I feel like I abandoned my dreams and that I am wasting my talents, especially when I spend a lot of time talking to/meeting with grantees or people I know on our internal committees who do what I would have done, had I stayed in academia. However, I also know that our family life would be a whole lot tougher if I had stayed in academia and I don't honestly know if I would be as happy as I am right now. I thought I liked hard work and deadlines and my subject matter more than anything. Part of that was related to liking the idea of being seen as smart. But guess what? I like stability and regular income and being around for my kids. Most of my friends who stayed in academia had a hard time finding a permanent job (read steady income) and have no time for family. So it's a trade-off--yes, there is some long-term guilt (and I still have a lot of papers and journals I don't have the heart to purge yet) but I do think it was the right decision in the end.

  27. Anonymous4:38 AM

    The truth is, money and lifestyle are things EVERYONE does have to factor into their career choices. I don't think it sounds selfish at all. I wouldn't want you near my kid if you were miserable, thinking about your own kids and how you'd rather be with them. If that makes any sense. If you are happy in your lifestyle and what you do fits who you are and your life outside of work (yes, doctors ARE allowed to have them, haha) then you are going to be much more likely to do a good job when working on me or my loved one.

  28. I switched hit (is there such a term?) twice: once from being a practicing GP to an administrator in the public sector, then the second time, from working as an administrator to not working at all.
    These decisions to change gears were done after long & deliberate consideration, much tossing & turning, self-doubt, guilt & discussion with my significant other.
    I think the guilt set in when I went from working full time to not working at all - probably because of my self-imposed expectation of doing my share of bringing home the bacon.
    But end of the day, I had the support of my husband & found myself happy with the decision, less stressed, with more time to spend on other passions which previously, I did not have the time for.

  29. I've been a reader for a while and I think you did the right thing and for the right reasons. Don't beat yourself up about it. As someone else mentioned, if someone has an issue with that it is them who has the problem.

    I have done a few switches back and forth. I too thought I wanted to be an MD from an early age and let myself get weeded out as an undergrad. Went on to become a Systems Analyst. I was very good at that but didn't love it. In 2005 quit the job to do the postbacc and ended up getting into several medical schools and went to your alma mater for 2 months. But by then I had a newborn baby and I just couldn't be happy when I was away from her so I ended up withdrawing from med school and back at my systems analyst job (but telecommuting so I am always around). I feel terrible pangs of guilt every day. I feel like a quitter and like I didn't live up to my potential. Like I let down my community. But I had to do what I thought was right for my family. Unfortunately, hindsight is 20-20 and what I should have done was gone to med school just a year or two after undergrad, instead of 12. Oh well. Maybe in 5 years' time when the girls are both in school I will go back for PA or NP. I am sure there will be guilt feelings probably for the rest of my life.

    Just try to push them aside and enjoy day as best you can.

  30. Stacy D.5:00 PM

    I made a switch from ob/gyn to family medicine. I think I loved the idea of women's health so much that I kind of glazed over about the horrible lifestyle part, but once I was in it, I knew pretty quickly that it wasn't for me. I was miserable.

    Now I'm an intern again, in family medicine (the job so nice I'm doing it twice!!), and internship this time around is way more manageable. In a way, I think I'll end up being a "quitter" again... I'm not sure after I finish residency if I want to do any more patient care, and will likely end up in policy. But I these changes are normal for most careers, however, in medicine, we tend to get looked down upon for not being dedicated enough. For me, I was miserable enough in ob to not care that much about that.

    And if it makes you feel any better, you should know that you were an inspiration for my switch. I remember I thought it might be the end of the world at the time, but I've been reading your blog since before I started med school, and remembered that you switched specialties and seemed a-ok. So, thanks. And since then, I've met a ton of people who did the ob to family switch. We're just made to feel like it's not all that common, when actually it is.

    Just met a guy the other day who did neurosurgery, switched to general surgery, and is now an internal medicine resident. Once he finishes, he's planning on doing an Emergency residency. So, at least we're not THAT bad. :)

  31. Anonymous5:43 PM

    I'm a practicing veterinarian currently applying for residencies in pathology. After a few years in practice, I've discovered I don't really like talking to clients. I do enjoy the diagnostic process, so pathology is the way to go. It helps that the salary is much, much, better but I don't talk about that. :-)

  32. I'd rather be an OR patient with an anesthesiologist who WANTED to be there than visit a pediatrician who woke up each day with regret. Stop cringing.

  33. Well, I am joining this comment party late, but YES there is one thing thing that I try not to think about very often because it always makes me feel like a "quitter". It's funny because I've switched careers twice (architecture to art history; art history to medicine), and there are small pangs of guilt that go along with certain aspects of those big switches, but the "quitter" pang is from something much more insignificant: my decision to not finish my master's thesis and to instead take "comprehensive exams" to get my MA (same degree, just a different route). I had good reasons for doing so (in a nutshell, my advisor and I disagreed on a crucial point of my thesis, and I felt I wasn't going to be able to write it the way I wanted. Plus, I knew I was switching careers at that point, so the thesis wasn't going to be "necessary" anymore.) But it was also easier to take exams . . . like a lot easier. Even though I know I gained a ton of knowledge during those two years, and I did get about 35 pages into a thesis (and wrote a boatload of other papers and TA'd and generally worked my butt off!), it still felt like I hadn't really "earned" that MA - like I took the easy route out. I pretty much didn't want to acknowledge my graduation, but I'm glad now that my mom made a big deal about it. :) I still have a box with all my thesis materials in it. When we moved recently, I almost pitched it, but I think I might need to open it someday (perhaps with a bottle of wine close by) and confront those demons . . . just not yet. :)

    So yeah, if I can feel like a quitter over something like that, you would think the big career switches would have brought a mountain of guilt with them. Thankfully, that hasn't been the case for me. However, I'm realizing that often it's the particular audience that brings the guilt on. There are people from my past who would/do consider me a "traitor" for leaving a liberal arts field like art history for a scientific field (with an almost guaranteed higher paycheck) like medicine. And you know, I'm sure if I wrote book about my life and knew some of those people might read it, I might start cringing more about these choices. Ultimately, though, I am OK with everything for two reasons (1) I'm the one who has to deal with my life choices every day and (2) I'm so much happier AND I'm so much BETTER at medicine (and better fit TO medicine) than I was ever going to be with architecture or art history, so it becomes a non-issue. I'm also of the persuasion that a little bit of guilt is healthy - it's part of being human and means your heart is in the right place; but a lot of guilt is no good as it just eats you up. Hence, we have to find that balance in each of our lives . . . but good people probably always have a little bit of guilt about the road not taken, and that's just how it is. :)

    Thanks for sharing your life and thoughts with us - I can't wait to read the book!

  34. Anonymous1:22 AM

    Just started reading your blog at the advice of a friend. You are absolutely hilarious. I'm a radiologist that went into med school thinking I wanted to be an orthopod. Talk about traitor...bah hahah!

  35. Anonymous5:21 PM

    another 4th year medical student here. I have NO CLUE which specialty is the best fit for me. I have seriously debated family medicine, pediatrics, ob/gyn, surgery-> breast surgery fellowship, and ER. I am currently applying to ER because it is a little bit of everything, but am unsure if it'll be a good fit, and finally just made a decision. But I didn't submit my application feeling a sense of "oh my gosh this is my destiny!", it was more of a feeling of "wow, I hope I made the right decision". I think it is courageous to switch, and quit beating yourself up for it! Be happy that you found the right fit!

  36. Hi, several months late here. I switched from General Surgery to Pathology. I love (LOVE) Path, it really fits into my OCD personality and I enjoy learning an area of medicine that everyone else is happy not to spend too much time on. But I still feel like a failure when I tell people I quit surgery. Yup, I couldn't handle the ridiculous hours, the crazy personalities, and the fact that I had to make split-second decisions and be happy with them. Now I get to sleep, be myself without drama, and read about a diagnosis that I'm unfamiliar with....and I still feel like a big fat quitter every now and then. But I AM a Happier quitter, and a quitter that is much more pleasant to be around!