JASMA

First: name the kind of “unsure” you are

“Unsure” can mean several different things, and each needs a different solution. Before you consider a big move
(like switching specialties), figure out which bucket you’re in.

1) “I don’t like my current rotation” unsure

You might be judging a whole specialty based on one brutal month, one difficult service, or one personality clash.
The question here isn’t “Do I hate this specialty?” but “Do I hate this version of it?”

• Is it the patient population, or the workflow?
• Is it the specialty, or the setting (academic vs community, ICU-heavy vs clinic-heavy)?
• Is it the work, or the team culture?

2) “My values changed” unsure

Maybe you thought you wanted high acuity forever, but now you want continuity. Or you assumed you could power
through night call indefinitely, but your body voted “no” with migraines and heartburn. Values shifting with real
exposure is normal, not a moral failure.

3) “I like parts of this, but not enough” unsure

This is the most common: you’re not miserable, but you’re not convinced. This often means your current lane has
sub-lanesfellowship paths, outpatient vs inpatient tracks, procedural niches, or hybrid rolesthat you haven’t
explored yet.

4) “I’m burned out” unsure

Burnout can impersonate “wrong specialty.” Exhaustion turns everything into a bad idea. If you’re running on fumes,
do a quick reality check: are you unsure on your post-call day (still unsure), or only on day 6 of 6 (everything is
wrong, including the concept of time)?

If burnout is driving the doubt, your first intervention may be support, schedule adjustments, or wellness resources
through your programbefore making a career decision that’s hard to reverse.

A decision framework that works in real residency life

Big decisions feel “emotional,” but you can still structure them. Try this three-part approach: reflect, test,
and commit. It’s like evidence-based medicine, but the patient is your future self.

Step 1: run a quick “values and energy” audit

Forget prestige. Forget what your med school friends are doing. Focus on what reliably gives you energy (or drains
it). Write down answersyes, with a penbecause your brain is a known liar after 28 hours awake.

• Energy: Which tasks make time pass faster? Which ones make you check the clock like it owes you money?
• People: What patient interactions feel meaningful: longitudinal relationships, brief but intense encounters, procedures, consultative problem-solving?
• Work style: Do you prefer variety or repetition? Quick decisions or deep dives?
• Environment: OR, clinic, ICU, ED, wards, lab, imaging suitewhere do you feel most “in the zone”?
• Boundaries: What lifestyle constraints are non-negotiable (health, family, geography, call tolerance)?

Step 2: define your “must-haves” and “deal-breakers”

Create two short lists:

• Must-haves (3–5): e.g., procedures, continuity, team-based care, predictable schedule, strong job market.
• Deal-breakers (3–5): e.g., frequent overnight call, minimal patient contact, high-volume documentation, constant high-stakes decisions.

If you can’t name deal-breakers, you’re trying to avoid disappointment by avoiding specificity. Unfortunately,
“keeping options open” is not a specialty.

Step 3: build a simple specialty scorecard

Pick 3–6 specialties (including your current one). Score each 1–5 on categories that matter to you:

• Daily work (do I like the actual hours?)
• Patient relationships
• Procedural vs cognitive balance
• Training length and flexibility
• Call burden and schedule realities
• Career options and job market
• Culture fit (do I like the people I’d work with?)

The scorecard won’t “decide” for you, but it will reveal patterns. If every specialty you’re drawn to shares the
same features (procedures + short encounters + shift work), that’s not a coincidenceit’s data.

Do the cheapest experiments first

When you’re uncertain, don’t immediately blow up your entire training path. Start with low-cost tests that produce
high-quality information.

Experiment A: targeted shadowing (even as a resident)

Ask for 1–2 half-days shadowing in the specialty you’re consideringideally in the setting you might actually work
in (community outpatient, academic subspecialty clinic, procedural suite, etc.). Focus on the boring middle of
the day, not the adrenaline highlights.

Experiment B: two “informational interviews” with attendings

Pick one early-career attending and one mid-career attending. Ask:

• “What’s different between training and real practice?”
• “What do people misunderstand about this specialty?”
• “What kind of resident thrives hereand who struggles?”
• “If you could redo residency, what would you choose and why?”

Experiment C: talk to residents who transferred or switched

Find one person who switched specialties and one who stayed but re-shaped their path (e.g., fellowship, outpatient
focus, nonclinical niche). You’re collecting “decision narratives,” not gossip.

Experiment D: compare “day-in-the-life,” not stereotypes

Specialty stereotypes are lazy shortcuts: “Derm is lifestyle,” “Surgery is intense,” “IM is broad.” Instead, compare
real schedules, real patient panels, and real administrative load. Every specialty has paperwork. The question is:
which paperwork makes you least cranky?

If you’re considering switching specialties: what to know (and what to do)

Switching is possible. It’s also a process with rules, timelines, and professional relationships you’ll want intact
afterward. Think “planned transition,” not “escape.”

Understand the difference: switching programs vs switching specialties

Some residents transfer to a different program within the same specialty because of fit, family, or geography. Others
switch specialties entirely. These are different conversations and different logistics.

Expect documentation and a formal paper trail

Transfers generally require sharing documentation of your completed training and performance data (evaluations,
milestones, and other program materials) with the receiving program. This is not meant to punish you; it’s meant to
protect patients and maintain training standards. Plan for it early rather than hoping it won’t come up.

Timing matters (a lot)

Switching is often easier after you’ve built a track record of solid performance, good professionalism, and strong
support from your current leadership. That doesn’t mean you must wait forever, but it does mean “rage-quitting” is
not a strategy. If you need to re-enter a formal match process, understand the relevant policies and deadlines that
could apply to your situation.

How to talk to your program leadership without setting off alarms

The goal is clarity, not drama. Use a calm opener:

• “I’m doing a structured career review and would value your guidance.”
• “I’m not making any immediate decisions, but I want to explore fit.”
• “Can we talk about ways to broaden my exposure within this specialty before I conclude anything?”

Most leaders would rather help you think clearly than have you suffer silently and then vanish like a ghost on
graduation day.

Be honest about your “why,” but keep it professional

If you do apply elsewhere, you’ll likely be asked why you’re switching. “I hate my life” is honest but not helpful.
A stronger narrative is: what you learned, what you’re moving toward, and how your current training prepared you for
the new specialty.

A practical example: the “procedural pull”

Imagine an internal medicine resident who loves physiology and acute care but feels restless in continuity clinic.
They might test anesthesia, critical care, or EM. Instead of assuming “I chose wrong,” they can run experiments:
shadow anesthesia in the OR, spend a day with an intensivist, compare shift-work in EM, and then score each path
against must-haves (procedures, time-limited patient encounters) and deal-breakers (longitudinal clinic, heavy inbox).
The result might be switching specialtiesor simply tailoring an IM path toward critical care.

If you stay: how to reshape your path within a specialty

Many residents don’t need a specialty switchthey need a different version of their specialty. Before you jump
ship, look for “internal switches”:

• Setting: academic vs community; inpatient vs outpatient; consult-heavy vs primary service.
• Scope: generalist vs subspecialist; broad vs niche practice.
• Role: clinician-educator, researcher, quality improvement leader, admin, informatics, policy.
• Practice model: employed vs private; shift-based vs longitudinal panel; procedure-focused vs cognitive.

Use mentorship strategically

One mentor is rarely enough. Build a small “board of directors”:

• One person who knows your day-to-day performance (advisor/program leader)
• One person in a specialty you’re curious about
• One person who has your long-term values in mind (a trusted attending, senior resident, or career advisor)

Your goal is not to get everyone to agree. Your goal is to hear patterns in the feedback and spot blind spots.

Common cognitive traps (a.k.a. why your brain is messy on call)

Trap 1: confusing “hard” with “wrong”

The steep part of the learning curve feels terrible. That’s not proof you chose wrongit’s proof you’re still
learning. Ask yourself: am I stressed because I’m incompetent right now, or because I dislike the work even when
I’m good at it?

Trap 2: chasing someone else’s version of success

If you picked a specialty because you love the identity, the prestige, or the vibe, but you dislike the daily work,
that’s a mismatch. You don’t have to hate your work to “earn” the right to change.

Trap 3: making a permanent decision in a temporary crisis

If your doubt spikes during a toxic rotation, after a bad outcome, or during a personal crisis, pause. Get support,
stabilize, then reassess with a clearer head.

How to decide: a “90-day clarity plan” for busy residents

If you do nothing else, do this. It’s designed to fit into residency life without requiring a sabbatical or a
personality transplant.

Weeks 1–2: reflection and data capture

• Write your must-haves and deal-breakers.
• Track your energy: after each shift, note what energized/drained you (2 minutes max).
• Pick 3–6 specialties to compare (including your current one).

Weeks 3–6: low-cost experiments

• Shadow 2 half-days in one alternative specialty.
• Do two informational interviews.
• Talk to one resident who switched and one who stayed but reshaped their path.

Weeks 7–10: build your narrative and plan

• Update your scorecard and identify front-runners.
• Draft a 5-sentence “why” story for each option: what you learned, what you want, why it fits.
• Identify next steps: electives, research, mentorship, or formal application planning.

Weeks 11–12: professional conversations

• Meet with your advisor/program leadership with a calm, structured update.
• If switching is likely, ask about logistics, timing, and support resources.
• If staying, ask how to pursue the best-fit track within your specialty.

Conclusion: you’re not “late”you’re learning with real data

Being unsure about your specialty choice doesn’t mean you failed. It means you’re doing what physicians do:
gathering evidence, evaluating fit, and adjusting course based on reality instead of fantasy.

Make the decision the way you’d want a smart colleague to do it: define what matters, run small experiments, talk to
the right people, and choose the path you can practice with competence and sustainability. Your future self doesn’t
need a perfect choicethey need a workable one.

Experiences from residents who’ve been there (and lived to tell the tale)

“I thought I hated my specialty. Turns out I hated my schedule.”

One resident described spending months convinced they’d chosen the wrong field. The work felt endless, the learning
curve felt vertical, and the pager felt like an ankle monitor. Their breakthrough wasn’t a dramatic epiphanyit was a
boring spreadsheet. They tracked their weeks and noticed something: on certain rotations, they still felt tired, but
not hopeless. The difference wasn’t the specialty; it was the combination of staffing, call structure, and lack of
predictable recovery time. After a candid conversation with leadership, they shifted electives, protected some time,
and found mentors who practiced the specialty in a different setting. “Same field, different life,” they said. The
doubt didn’t vanish overnight, but it shrank to a manageable sizesmall enough to think clearly.

“I stayed, but I changed the version of my job.”

Another resident liked patient care but dreaded the specific workflow they were training in. They assumed the only
solution was switching specialties. Instead, they explored internal pathways: different practice models, different
settings, and different roles. They spoke to a community attending who had a schedule and scope that looked nothing
like academic training. They also met someone who blended clinical work with quality improvement and teaching. The
resident realized they didn’t need a new identitythey needed a new structure. The “specialty decision” became a
“practice design” decision, which is often the real issue residents are trying to solve.

“Switching wasn’t quitting. It was finishing a sentence.”

A resident who did switch specialties described it as stepping out of a story they were trying to force. They weren’t
failing, and they weren’t lazy. They simply noticed a persistent mismatch between what energized them and what their
day required. They did the unglamorous work: shadowing, informational interviews, and building a professional
narrative that wasn’t bitter. They learned quickly that switching involves logistics, documentation, and timing, and
that relationships matter. They didn’t disappear; they communicated. They didn’t trash their old program; they thanked
it for the training it provided and explained what they were moving toward. Years later, they still talk about that
period as one of the most stressfuland one of the most clarifyingchapters of their training.

“My doubt was really grief.”

One resident shared something that doesn’t get said enough: sometimes uncertainty isn’t about specialty fit at all.
It’s grief after a hard outcome, a personal loss, or cumulative stress that finally catches up. They felt numb and
concluded, “I must be in the wrong specialty because I don’t feel anything.” With supportpeer conversations,
counseling resources, and timethey regained emotional range. Only then did they reassess career fit. Their lesson was
simple: don’t let a temporary shutdown make a permanent decision.

If these stories share a theme, it’s this: clarity usually arrives through small, honest experimentsnot through one
giant, dramatic leap. You don’t need to have it all figured out today. You need a process that helps you learn the
truth, one realistic step at a time.