This past match cycle I successfully switched medical specialties from Family Medicine to Dermatology. 

Switching residencies is quite common but is seldom spoken about publicly. I had several mentors and fellow residents who also made the switch who guided me along the way. But I realize that not everyone has access to this network of career-switchers. 

My goal is to demystify the process. 

This is a multi-part series: 

Table of Contents

1. How I made this scary decision less terrifying
2. Realizing I was in the wrong specialty
3. How I told my program I was leaving & their reaction
4. The process of applying to a competitive specialty as a prior-year graduate
5. Why switching specialties resulted in a two-year gap and how I’m spending the time

Part 1: Making the Decision Less Terrifying

How do you make scary decisions less terrifying? Hint: these two simple charts:

How did I make the decision to switch from Family Medicine to Dermatology less overwhelming?

‍The decision to change residencies is daunting for two main reasons:

1. Time: Changing residencies resulted in a 2+-year training gap & delay
2. The Big What-If: There’s a chance you don’t match

How did I make this decision feel less overwhelming? By breaking down these daunting, existential questions (Am I wasting years of my life away? What happens if I don’t match?) into concrete yes/no questions. 

Time

Since dermatology matches as a PGY-2, and because I realized partway through intern year that I wanted to switch specialties, changing residencies would result in a 2-year training gap (FM intern year ended July 2024 and if I applied during the 2024-2025 ERAS cycle and matched, I would start as a PGY-2 derm resident July 2026). 

After spending 4 years in undergrad, 3 gap years, 5 years of med school (research year) and an intern year, delaying my training by training by another 2 or more years seemed overwhelming. 

But I had a simple tool that allowed me to reframe the decision:

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I have a 24”x36” poster in my apartment called “My Life in Weeks.” Each of the 4,000 boxes represents one week of your life. I was in my thirties when I was making this decision, so the first 3+ rows of boxes were already filled in to represent the thirty-odd years I’d been on the planet. 

So in the immediate present, the decision to “delay” my career by 2 years seems overwhelming and like a ton of time. 

But, in the grand scheme of a (potentially) 8-decade life, 2 years is a drop in the bucket.

The “What if?”

One of the scariest parts of switching a residency is that you are leaving behind a comfortable path whose end promises a stable career in Family Medicine. Quitting my FM residency would mean I am risking not being able to match at all. A Dermatology attending gave me an appropriately stern reality check:

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But I really knew FM was not the right specialty for me. So to help with the “what if?” question, I made a decision tree. 

Uncertainty is one of the hardest things for human beings to tolerate and can be the silly reason standing in your way of making a clear-headed decision. 

So I wrote out all the if/thens in a decision tree:

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No one can make a clear-headed decision when bogged down in the what-ifs, so this was my simple way of removing ambiguity. 

My Two Takeaways for You

1. Contextualize life decisions within the larger context of your life and they don’t seem as daunting.
2. Make uncertain concepts more certain by writing out simple diagrams. Your brain will thank you. 

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Up Next: Part 2 Realizing I was in the wrong specialty

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