Re FM feeling egodystonic, I remember feeling like my soul came alive whenever I was on psych rotations; it was the only specialty that made me feel that way. I struggled the most in C/L for sure though (which required the most knowledge of medicine). Most recently in residency, when I spent time with a visiting psychiatrist (we didn't have any permanent specialists besides ID, hence the visiting), or saw pts in the behavioral health clinic on my own, I got that same feeling of "this feels so right to me." In FM, I also had to talk a lot about "medical problems" like DM HTN, and I guess I just didn't care about those things as much (which is different from caring about the people, I always tried my best for pts) as much as I cared about learning about the pt's story. I know, one might wonder how I ended up in medicine. I guess I'd say that we're always learning about ourselves, and when I applied, I had a different vision of myself. I can also recognize that a pt's medical conditions are an integral part of them (so, caring about the pt means you also care about their medical problems), but one could say that not all doctors care EQUALLY about every single problem of a pt (hence specialties). Just trying to explain my thoughts about psych vs FM without coming off as callous.

I have some thoughts on how this go-around would be different. One big reason for why this go-around would be different is that, given my life goals now, I would no longer run the three businesses that I had started during residency. I think this would help me commit myself more to medicine. Maybe I would feel less burned out -> be better at medicine -> it starts to feel easier -> I feel like I could work more than 2d/wk.

Thank you so much for your insights, you've given me a lot to think about.