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The Frightening Process of Switching Programs Midresidency

Op-Med is a collection of original articles contributed by Doximity members.

“I’ve decided to leave this program at the end of the year, and I’m going to re-enter the Match this cycle to apply to a different specialty.” 

I was sitting in front of my program director in his office. My heart was thudding in my chest, and my voice sounded distant. I clasped my hands and made an effort to maintain even eye contact. My program director was incredibly gracious and supportive. I didn’t know what speciality I’d be switching into yet. That was a problem to be solved later. At this moment, my decision to leave was driven less by a passion for a different specialty and more of a need not to be doing what I was currently doing. My program director agreed to write a letter of recommendation once I picked a new specialty, which helped me breathe a little easier. I left his office feeling like I had jumped off a cliff without a parachute. 

I had applied to pathology residency during my fourth year of medical school. After starting residency, however, I quickly realized that it wasn’t the specialty for me. Although there were aspects I did enjoy, I found that I missed the treatment and patient management side of medicine much more than I anticipated. By the time this realization crystallized in my mind, it was late August of my first year of pathology residency. I scoured the internet looking for helpful information on how to proceed with changing specialties and programs while already in residency. I exclusively found unhelpful and even contradictory information. Was I supposed to tell my program director immediately when I decided to switch specialties, or was I supposed to secretly search for an open position without telling anyone? Was it better to look for an open position on my own, or did I have to go through the Match again? What was the best way to navigate the rest of the year in my current program? Or should I leave my current program early? Was switching specialties and leaving my current program the right decision, or was it a foolish choice that could jeopardize my future career and everything that I had worked for? And on top of that, how could I push past the haze of panic and actually choose a new specialty? 

I was paralyzed with indecision. I texted a mentor from medical school, and she called me while I was walking to the subway on my way home from the hospital on September 1st. I huddled near the subway entrance while I unleashed my anxieties in a stream of consciousness. I was deeply unhappy in my current situation, but how could I leave my current program and switch specialties — who would take me? How would I go about it? I told her that I couldn’t make the change. I told her that I must make the change. 

During my soliloquy, my mentor remained remarkably calm. I suspected that this wasn’t the first time she had experienced a late-night conversation with a panicked trainee. She was upbeat, but offered few platitudes or words of comfort. Instead, she simply pointed out a fact, that the very same day that we were speaking was when the Electronic Residency Application Service (ERAS) started accepting applications for that year’s interview season. She told me that there was no right or wrong choice in this situation, that I was forging my own path, and that I now had a choice to make. 

She was completely right. The first decision I made was to rein in my thoughts. Once somewhat freed from the tyranny of anxiety and dread, it’s as if my body knew exactly what I wanted to do. In my moment of clarity, I sent an email that same night to my program director, asking for a meeting the next day. At the meeting, I told him that I would be re-entering the Match and leaving his program by the end of the year. And just like that, the step I had been so worried about taking was already in the past. 

The next few months were a flurry of emails, interviews, phone calls, and more emails. I spent hours crafting my personal statement, molding it from the inner emotional ramblings of someone on the brink of a mental breakdown to a piece of writing that resembled a coherent narrative. I repeatedly convinced myself that I wouldn’t match and that I wouldn’t have a residency spot the following year, and so I had to walk myself back from that ledge daily. I had numerous phone calls with other medical school mentors who offered advice, support, and letters of recommendation. Because of my indecision in picking a new speciality, I ended up applying to four different specialties. I watched my savings account dwindle as I submitted applications to over 100 programs. Because I submitted my ERAS application over a month after it opened, I spent hours sending emails to program directors and coordinators, asking them to take a look at my application. I walked a fine line between letting them know that I was genuinely interested in their program without coming across as desperate and afraid. The interviews themselves ran the gamut from the interviewer asking zero questions about switching specialties to asking me to justify my decision in intricate detail. I changed my rank list innumerable times. I knew I wanted a nonsurgical specialty with a broad range of subspecialty training options; given this, I ultimately decided to rank internal medicine programs the highest.

During this time, I was also searching for open residency positions. I quickly learned that, because pathology is so different from all other residencies, none of the training I had done in pathology would be transferable to a different program. Programs in other specialties were understandably hesitant to take on a new trainee who would start so far behind in the middle of the year. I also continued to go to work at the hospital while I went through the Match again. I felt like a pariah, but I was fortunate to have supportive co-residents who were willing to swap and cover shifts so I could attend interviews. 

During this whole process, time was my worst enemy. The days passed increasingly slowly as I approached Match Day. The idea of a possible future in which I did not have a residency spot the following summer led me to start meditating multiple times a day. I snapped at people who cared about me. I shut out friends and family who asked questions, because thinking about the entire Match process and my fears and anxieties caused unbearable levels of stress. When Match Day rolled around, I felt both numb and fried. And to my incredible relief, I had matched into internal medicine. 

Looking back now, I would give myself a few pieces of advice. I’d tell myself to stop looking for the “right” path, given that there is no one-size-fits-all approach to switching residency programs. I’d tell myself not to get in my own way — I spent so much time worrying, planning, and overthinking that I almost decided not to take the initial step that set everything in motion. Lastly, I would remind myself to trust my support network. Between medical school and my pathology training program, I had a remarkable cadre of people whose unwavering support was present every step of the way, and to whom I will be forever grateful. 

Have you changed specialties or residencies? Share your experiences in the comment section.

Hailey Roumimper is an internal medicine resident in Washington, DC. She is a 2023–2024 Doximity Op-Med Fellow.

Image by z_wei / Getty

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