Toward the end of my Transitional Year Internship, I sat in the workroom of the medicine unit and thought to myself, “did I make the right specialty decision?” At that point in time, I felt more confident as a diagnostician and in my treatment plans. I survived numerous months of managing urban and underserved patients on the floor and intensive care units (most importantly, the patients under my care also survived). For nearly a year, I worked and learned alongside internal medicine residents. I felt like I was making a difference in my patients’ lives and was part of my program’s community. The thought of essentially being an intern again when I started my anesthesiology program made me cringe. Before I left my internship, I asked the internal medicine program administration if there was space to transfer back - just in case.
Currently, I’m in the last few months of my anesthesiology residency at Massachusetts General Hospital. I am proud of my specialty decision and feel honored to have the opportunity to provide reassurance, amnesia, analgesia and safe patient care for surgical interventions. I look back upon my internship fondly, but recognize that the culture and training in my specialty is a good fit for my personality and career interests. However, not every anesthesiology resident feels the same way. In the September 2018 JAMA article, “Association of Clinical Specialty With Symptoms of Burnout and Career Choice Regret Among US Resident Physicians,” 21 percent of second-year anesthesiology residents selected “probably not” or “definitely not” when asked, “If you could revisit your specialty choice, would you choose the same specialty again?” Initially, I was surprised by the results. We frequently see residents transfer into anesthesiology rather than out of it. Additionally, the study reports that anesthesiology was not significantly associated with higher relative risk of reported symptoms of burnout - so why did so many anesthesiology residents regret their specialty choice?
When I considered the cohort and specific time point in residency studied, I wondered if it had to do with the learning curve in starting anesthesiology practice. I wondered if they had reached that point in the year where the long, stable cases started to feel mundane. I wondered if the participants sat down to complete the survey after being in an operating room where communication had gone poorly. The second postgraduate year (PGY-2) in anesthesiology is often likened to starting internship again because our practice is so vastly different from what we are exposed to in medical school. During undergraduate medical education, students rotate through the “core” specialties: internal medicine, family medicine, surgery, pediatrics, OB-GYN, psychiatry. All of those specialties have certain commonalities such as a clinic and inpatients to round on. Operating room anesthesiologists have none of that. We provide direct patient care for a very specific procedural period, and then move on to the next patient. The care we provide during an operative procedure requires us to be a combination of physician diagnostician, proceduralist, pharmacist, respiratory therapist, and nurse all in one. Making the transition could be tough for some residents; perhaps because of this drastic shift in environment and roles, surveying residents at this juncture was just poor timing.
According to the Accreditation Council for Graduate Medical Education (ACGME), the number of residents that transfer programs is 1,044. Compare that figure to the 135,000 total active residents and fellows in ACGME-accredited institutions, we are looking at <1 percent of residents. Although this number does not tell us any information about the number of residents that transferred within the same specialty compared to those that transferred into another specialty, the data seems to imply that either it’s just too arduous to transfer residency programs or there aren’t that many residents that regret their specialty decision enough to do something about it.
When I was about to start my internship, I asked myself, “How do you know you’ve made the right decision?” I didn’t have a great answer then, but I subscribe to the same mindset that I had then - I’m happy with my decisions. Perhaps there’s no such thing as a right decision, but just one that fits. For those 52 anesthesiology residents that had specialty regret, I’d like to believe that with more time, the regret begins to abate with time. Either way, I’d love to see a follow-up study on specialty regret beyond residency.
Amanda Xi, MD, MSE is currently a resident at Massachusetts General Hospital (MGH) in Boston, MA and upon graduation will be continuing at MGH as a critical care fellow. She is an active blogger at her self-titled website and also active on Twitter (@amandasxi), Facebook, Instagram (@amandaeleven), LinkedIn, and Doximity. She is also a 2018–2019 Doximity Author.
Illustration by Jennifer Bogartz