It's Official... I've Defected.

There aren't many people out there likely to find this even half as big a deal as it feels like to me. But I've changed programs.

I am no longer an emergency medicine resident. Well, not really. I am now a family medicine resident. But since I have every intention of doing a third year of emergency medicine training when I am done my two years of family, I've really just gone from being an emerg doc in five years to being one in three.

Considering that it's a pretty minor switch, in the grand scheme of things, it's awfully symbolic. I've had it with academia. I have no patience for the egos or the politics. I just want to get out of the city and practice medicine. Not medicine with research and administration, just medicine. See, the five year program approaches emergency medicine as a four-headed being-- clinical medicine, administration, research and teaching. In spite of my best efforts, I could never warm up to administration. And I did make an effort... the sole reason I became a union rep was to see if there wasn't more to administration that I wasn't seeing. Now I'm locked into an elected position that bores the crap out of me for the rest of the year. So much for administration.

Research? Well, everyone assumed that since I'd done a very research-oriented master's degree before medical school that I'd take to it like a duck to water. Instead, I'm left with a very PTSD kind of thing. I realized it a few months back when I was assisting in a c-section, and the obstetrician was talking about her latest grant application. I got a viceral reaction... immediate nausea. I hate applying for money, I hate the literature searches, I hate the way you have no control over the pace of your work, I hate the pressure to publish... I hate all of it. Not good when you're expected to go into academic practice.

So I started to think about it. What kind of practice do I see myself having in 10 years? Easy. I want to practice emergency medicine in a smallish town (think Milton, Peterborough, Kingston, Orillia, Barrie, Sudbury). No research. I don't want to run the ER. I might like to continue teaching informally, like by supervising residents, but not by teaching at a university. So then I came to the realization... what the hell am I doing in the academic stream?

The 2+1 program (one year of emergency medicine after two years of family medicine) is far better suited to what I want to do. I can work in all but the biggest academic centres (even the place I'm at now has as many 2+1's working in their ER's as 5-year grads). I won't be under constant pressure to do research. I won't have to take on an administrative role that I don't want. And best of all, if I ever get burnt out (like everyone says I will... it's apparently inevitable) I can do locums or work in a walk-in clinic, which is far more appealing to me than doing research or administration full-time.

So it's done. Once I had made the decision, all that was left was going through the paperwork and telling people. That was the worst part. I was so tied up in knots over telling my program director that I didn't eat for two days. The past month has been a flurry of meetings, wheelings and dealings. I've been back and forth between the department of family medicine, the department of emergency medicine and the postgraduate education office more times than I care to think about. But now, all there is left is to submit the paperwork and have it rubber-stamped, all of which is out of my hands.

I change programs on January 1st, 2006. Hopefully this knot in my stomach will have subsided by then.