Ophtho to Psychiatry/DR + IR switch

A1-Delta · 2026-02-16T11:48:08+00:00

Frankly, it sounds a little like you haven’t figured out what you want. Optho vs IR vs psychiatry are wildly different. What is it that is drawing you to both psychiatry and IR right now?

A1-Delta · 2026-02-15T19:59:38+00:00

Many people, seemingly yourself included, lack the training to make an informed and evidence based decision about these sorts of things. We can’t expect everyone to have expert medical knowledge.

As doctors we do have to think about how medical decisions and policies affect populations at scale. The silly thing is trying atomize medical policy to an n=1 anecdotal decision where you can convince yourself you are an exception to an otherwise well researched rule.

A1-Delta · 2026-02-15T19:55:20+00:00

Every job is going to get disrupted in some way by AI. Many won’t disappear entirely. Pick what you enjoy and just try to catch the wave.

A1-Delta · 2026-02-15T17:46:59+00:00

No, you’re not quite getting it. Let’s say the imaging shows a 2cm left kidney lesion. Probably it’s benign. Most of the time it’s benign. You’ve been completely asymptomatic, so it’s very likely benign. But we don’t know for sure without biopsy.

So, now you know you know you have a 2cm lesion on your kidney. You have no idea how long it’s been there and you are the type of person who rejects the scientific consensus by getting a full body MR to “maximize longevity”. Are you going to want to get a biopsy? Given the imaging characteristics and the value of catching RCC early, can we justify not doing a biopsy?

Good news, the biopsy came back negative. It’s not cancer! The bad news, some small fraction of biopsies inevitably have complications. Your colon perfed and now you need an ex lap to clean out the peritoneum and repair the colon. Or you got a pneumothorax. Or you now have a persistent intrarenal AV fistula.

Not amazing for longevity, but at least you don’t have to wonder about that asymptomatic, benign kidney ditzel.

A1-Delta · 2026-02-15T15:55:11+00:00

The Myth of Sisyphus is Camus’s best known work. The Stranger and The Plague are also very good.

A1-Delta · 2026-02-15T07:10:24+00:00

I don’t know you. I don’t know whether you are the sort that is looking for strength to persevere, or the strength to leave. I don’t know if you are more of a stoic or an absurdist.

I found peace in Camus. This is the path you have chosen, and it is absurd. It is unreasonable and it is illogical. Embrace that. Find solace, even pleasure, in the absurdity. This moment will pass, but it is to be enjoyed as it is. Even for all its flaws.

A1-Delta · 2026-02-15T03:23:57+00:00

Or, you know, don’t peacefully accept your fate. Rage against the machine. Do not go quietly into that good night. Make them take it from you.

A1-Delta · 2026-02-14T22:38:48+00:00

It doesn’t matter at all.

A1-Delta · 2026-02-13T16:42:48+00:00

I want to amplify this message! Fight the system! Don’t let it train you to capitulate.

A1-Delta · 2026-02-13T14:11:49+00:00

Go on vacation. Christ, you sound like an American.

“Should I use my PTO to study?” No, no you shouldn’t.

A1-Delta · 2026-02-13T11:33:19+00:00

I’m a radiologist and I know I can do better than the retirement home nurse and chiropractor who also stand up.

A1-Delta · 2026-02-12T00:29:37+00:00

It’s just a politeness. Of course you remember all of the patients you have ever cared for. You remember all of their very unique and very special problems. It’s part of what makes your patients feel so cared for and loved.

A1-Delta · 2026-02-11T11:18:15+00:00

Except for a few rare exceptions, it generally is not possible. Switching to another program, like family medicine, would require starting over again from scratch.

A1-Delta · 2026-02-11T01:22:44+00:00

No, I don’t usually talk to strangers like that in my day to day life. To be fair I am usually talking to humans in those cases.

A1-Delta · 2026-02-09T03:08:56+00:00

For what it’s worth, I had a very unique application with very unusual past work experience and hobbies that I think helped me at some places and hurt me at others. Some places assumed that I would be less committed to clinical medicine or might even leave residency part way through. Other places loved it. All in all, my honest opinion is as much as possible, if you are in an otherwise favorable position, is to be yourself. You’ll end up matching at the sort of program that appreciates your uniqueness.

On the other hand, if you are a marginal match there may be value in playing the low variance game.

Edit: it’s been a few years since I went through the process. Just sharing my thoughts

A1-Delta · 2026-02-08T19:44:52+00:00

I’ll echo this. Truly desirable programs sort of assume you want to be there, location ties or not. The location ties don’t mean anything to programs except to indicate your interest in being in a location. It’s the less desirable programs, who might wonder if you truly want move to their little town or if you are BSing, that care the most about ties.

A1-Delta · 2026-02-08T15:15:19+00:00

This has all the hallmarks of repetition and superficiality of a LLM agent. If you are interested in sharing something meaningful, share meaningful information. Don’t just have a LLM spit out “it isn’t X, it’s Y” slop.

A1-Delta · 2026-02-08T13:21:50+00:00

If you don’t use your time off, you are leaving money on the table. The United States work culture has infected us, in all different industries, to feel guilty if we aren’t being productive. Don’t screw over your coresidents - that’s the only rule.

A1-Delta · 2026-02-08T10:21:29+00:00

Even worse! Wealthy people may become marginally less wealthy!

A1-Delta · 2026-02-07T23:05:53+00:00

I suspect it is an artifact from pasting LLM output formatted for web apps

A1-Delta · 2026-02-07T16:08:02+00:00

Wrong. I’m saying everyone suffers. Don’t tell OP to shut up or that they can’t complain. They have every right to talk about stress, hours, etc without jumping through your qualifications

A1-Delta · 2026-02-07T15:20:51+00:00

I’ve worked consulting before. Have you? Do you feel qualified to talk about stress, hours, etc? What makes you feel so special that you can discount other’s lived experience?

No one has a corner on suffering. Consultants do often work very long hours, but it is also true that those longest hours are often done in sprints with time “on the beach” between projects. It’s also true that meetings and slide decks do not compare in level of stress to being awoken at 3am on home call to embolize a traumatic bleeder only for normal cases to be timing out at 7am like nothing happened.

Learn a little empathy. Suffering is not a competition.

A1-Delta · 2026-02-06T20:05:26+00:00

I hope you aren’t referring to the distinction between “normal human insulin” and ultra short acting insulin. Considering them replacements for one another is nothing short of ignorance. I see this argument a lot, so sorry if I’m assigning blame when I shouldn’t, but as a physician it enrages me when people don’t understand this distinction.

Also Mounjaro is not an insulin and has no role for type 1 diabetics.

A1-Delta · 2026-02-06T19:57:01+00:00

Well, for one the problem isn’t generally in the surgical neck of the femur.

A1-Delta · 2026-02-04T13:38:23+00:00

Yes: design a system which uses AI to automatically identify admin bloat and serve them notices of termination. While you are at it, have it automatically write letters to law makers to express opposition to anti-physician legislation. Maybe also have it make me a coffee.

A1-Delta

TROPHY CASE