As a PGY 8, I made one of the biggest choices of my life. I was a transplant surgery fellow at Washington University in St. Louis and chose not to complete the second year of the program. I didn’t have a great plan, but I knew that I didn’t want to be a transplant surgeon for the rest of my life—my heart wasn’t all in. While it was the right decision for me personally, I felt ashamed and alone. My felt that my choice was unconventional and a bit taboo in the world of surgery. I began avoiding eye contact, skipping M&M, and dreaded talking about the subject.
Since becoming an endocrine surgeon at the University of Wisconsin, multiple residents and fellows have contacted me– some known, but many unknown. The one thing these individuals have in common is that they want to change something about their current life: their specialty, subspecialty, training program, research lab, you name it. They tell me, “I’m unhappy.” “I’m not sure this is right for me.” “I can’t tell if I hate the program or the specialty.”
They come seeking advice, but all I can provide is support. I share my own experience and let them know they are not alone. I reassure them that everything will work out. “You can always be an overqualified Starbucks barista. Starbucks has a really great health plan!”
What I’ve noticed about these residents and fellows is that they are all worried about disappointing their attendings, mentors, programs, friends, family—a whole laundry list of people. They’re concerned about what people will think and how it will affect their career. But perhaps most of all, each person is afraid to disappoint their self. As surgeons, we are all overachievers with high and sometimes unrealistic expectations, and we are often unable to put ourselves first, which makes decisions like changing your specialty terrifying.
In the last few weeks, Yeo et al. published an important paper in Annals of Surgery that identifies those residents who are at greatest risk of not completing surgical training.1 The article started a discussion about how we can best support residents and create interventions to decrease attrition. However, much of the discussion assumes that the support should be aimed at keeping these individuals in surgery.
I wholeheartedly agree that we could do a better job at being there for these residents. But, the support we provide should be unconditional and unbiased toward a particular outcome. In addition, we need to change our culture so that “changes of heart” are considered acts of courage rather than acts of failure. Perhaps a more supportive environment that encourages open discussion of wanting to switch will lead to change itself.
My best friend from intern year told me one day out of the blue that she was leaving surgical residency and had already secured a spot in radiology at the Cleveland Clinic. Shocked and in disbelief I thought, “What? No!!! Don’t leave me!” It took me months to realize how isolated she was in making this life-changing decision. She couldn’t talk about it with me, because I would have tried to convince her to stay. Twelve years later, she is a thriving breast imaging specialist, and I have never seen her happier.
As we develop ways to support residents and decrease attrition, our #LeaveNoResidentBehind campaign should remember that being left “behind” for some might actually be putting them ahead.