What if I Don't Want to Do a Residency?

Question:

I didn't enjoy my third year of medical school and now I'm not sure if I want to do a residency anymore. What should I do?

Response from Sara Cohen, MD Fellow, Department of Physical Medicine and Rehabilitation, Harvard University, Boston, Massachusetts; Fellow, Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, Massachusetts

Near the end of my third year of medical school, I went out to dinner with a few of my classmates. Naturally, the conversation quickly turned to which residencies we wanted to get. My friend Ben, who had just finished his surgery rotation and still had circles under his eyes, said, "I don't think I want to do residency. I hate patient care."

We were all aghast. "So what are you going to do?" someone asked.

"I don't know," Ben admitted. "But there must be some options out there for an MD who doesn't want to do a residency, right?"

Since my conversation with Ben, I've heard that question posed many times by exhausted medical students. Some students thrive on the excitement of third year, but some hate waking up early, working weekends, being constantly sleep-deprived, and missing out on time with their families. Other students find that they hate procedures or dealing with difficult patients.

The first question to ask yourself is why you don't want to do a residency. Is it because of the long hours and difficult call schedule? If so, you might consider some of the specialties that have less grueling residencies. The infamous ROAD specialties (radiology, ophthalmology, anesthesiology, and dermatology) are known for combining high pay with reasonable hours, although for that same reason, these residencies are generally very competitive. Emergency medicine also has reasonable shift work, even during residency. Other specialties with reasonable hours that tend to be less competitive include psychiatry, pathology, and physical medicine and rehabilitation (PM&R). As a PM&R resident, I worked mainly 8 to 5 with rare weekends and call from home. It was nowhere near as grueling as, say, a surgery residency, and I didn't miss my family or feel sleep-deprived. (Learn more about PM&R in an article I wrote previously for Medscape.)

If your main concern is that you dislike direct patient interaction, consider one of the specialties where patient care is minimal, such as radiology, pathology, or preventive medicine. Whereas radiology and preventive medicine require a clinical transitional year, pathology does not. That means that if you enter a pathology residency, you'll never have to see another patient.

If you like patient care but hate procedures, consider psychiatry. If you love procedures but hate long-term patient care, consider anesthesiology or emergency medicine.

The field of medicine is incredibly broad, with many specialties, and it is likely that a good "fit" can be found for everyone, depending on individual likes and dislikes. Residency is probably the best option for someone who has completed medical school, and just because you complete a residency doesn't mean that 100% of your future job must involve patient care. A lot of clinicians do some research, teaching, or administrative work in addition to their clinical duties, so you can divide your time and create the lifestyle you want.

Try to remember why you went to medical school in the first place, and allow yourself some time to recover from your exhaustion. Medical students can get discouraged when they don't immediately love one of the core clerkships during third year, which is why you should try to set up interesting electives that are potential career choices. Also, you might see things differently when you've had a few good nights of sleep.

If after thinking it through thoroughly, you still decide that residency isn't for you, you can pursue several options. It's a good idea to complete at least 1 year of residency so that you can get a medical license. That way, if you ever decide to return to medicine, you will be in a better position if you already have a license.

A physician who doesn't want to do clinical work has many other options. If you have a mind for business, you may want to consider getting an MBA (Master of Business Administration) and working in the administrative end of medicine. Alternately, you can get an MPH (Master of Public Health) and find work in public health. Careers in medical writing, informatics, engineering, and consulting are also possible.

Dr. Joseph Kim hosts an extensive Website about nonclinical medical jobs, including actual job opportunities as well as general guidance about pursuing a nonclinical career. But keep in mind that each of these fields has its own set of challenges, so you should thoroughly investigate these options before making a dramatic career switch.

As for my friend Ben, after a nice long shower and a nap (and possibly some research), he decided that residency wasn't such a bad option after all. He matched with the rest of us.