Saturday, March 27, 2010

How Do You Know It Is Time to Go?

As I was saying in my last post, now that things are set with my new career move, I feel more free to write about what occurred. It is my hope that writing about switching specialties will be helpful for someone out here. From what I saw, there is not much concrete information out there about switching. I think that this is because there is no formal process for switching fields and the experience can very different depending on one's situation. But I do know that I am in good company. Several of my medical school classmates have switched fields already, and my own program has several residents who came to pathology from other specialties. And two of my favorite medical bloggers, Scutmonkey and Panda Bear switched specialties. So it is not that uncommon.

The question above was the first one that I had to answer when this all begin. It is also one that has been posed to me by many people as I went through this process. Unfortunately, the answer is not a simple one. If it was, I probably would have made the decision a lot more quickly and spared my friends and family endless conversations about what the hell I should do with my career. {A huge thank you to all of you out there who stuck by me in this rough period.}

Anyway, it all begins when residency started. I was excited and thrilled to be at my top choice program in a wonderful location. At first everything was fine. Yes, it was a big transition from medical student to resident. And it was a huge transition from clinical medicine to the world of pathology. It hit me early on that something might be slightly off. Whenever I presented a case or gave a talk, I got feedback that I was doing such a great job of addressing the clinical issues at hand. To me this was surprising because I was just doing what I had been trained to do in medical school. When it came to the lab side of things, I was lost. Completely lost. But I was told this was to be expected, since we do not learn about the clinical lab in medical school, and that I would get better at dealing with lab issues in residency.

It hit me that fall that I really missed patient care. I had expected this would happen, since I had enjoyed a lot of aspects of clinical medicine and struggled to decide between pathology and peds/FP during my 4th year. But I had not really expected the feelings would be this intense. I spent tons of time reading through patient's charts when dealing with their lab issues. Also, I was studying for Step 3 and realized I was more interested in that studying than doing the reading I should have been doing for my rotations. My friends from medical school were all suffering as interns. But I found myself being a bit envious of what they were doing while I sat at a desk all day (of course I valued the sleep I was getting most nights). So I put some feelers out to my fellow residents and tried to find out of this was a normal part of the transition to pathology. It seemed like for some people it was something that had to be gone through. And maybe I would be more interested in the more clinically-oriented subspecialties in pathology, like Blood Bank, Hemepath, and Cytology.

I figured things would get better if I gave it more time and moved forward. As the year continued I saw how diverse of a field pathology is. Medical students usually get exposure to surgical pathology and maybe to autopsy. But the field is so broad and encompasses everything from running blood bank or microbiology lab to forensics to seeing patients in an FNA clinic all day. It is possible to have a career in pathology signing out only subspecialized surgical specimens or only looking at flow cytometry in a reference lab. I remembered being told when I was a medical student that medicine was so broad that everyone would find their niche somewhere. Pathology seemed similar. People found what they liked, did fellowships, and could try to mold a career to cater to their interests. I would find that, I thought. It would just take some time.

To be continued.