For a doctor to change their specialty is extremely rare, as well as difficult and time-consuming. Only 5% of established physicians practicing for 15 years or more make the effort to change their specialty, which requires a second residency period. This can take as little as a year, or more commonly 3-7 years. The workload is vigorous and requires physicians to be on-call. Even physicians who are relatively new to their career (less than 15 years in) see only 8% decide to switch specialties and complete the required training to do so.
For Maricelina Caro, who has spent her career as an Internist, changing specialties has become a necessity to surpass her current limits in primary care. After spending nearly a decade of her career serving the medical needs of people admitted for care at a psychiatric hospital, Caro’s interest in Psychiatry exceeds that of Internal Medicine.
Returning to a grueling residency won’t be easy, but Caro is confident in her path. For her, the timing is right: her daughters will be in college and her husband is flexible about where he works. Being able to dedicate all of her time to a residency with the ability to not work other jobs means that she will keep from getting burnt out. Her biggest concern is returning to being on-call after spending the last four years sleeping uninterrupted. But it still won’t be easy.
From Telemedicine to In-Person Care
Four years ago, Caro started out in urgent medical care as a telemedical provider. Between work and commuting, she was tired and looking for a change when a colleague suggested telemedicine as a solution. Interested in managing her own schedule and eliminating distractions from her day, Caro found telemedicine to be a way for her to care for patients without outside stressors. Personally, it made her available to care for her parents and keep an eye on her adolescent daughters.
Now, she exclusively practices primary care psychiatry as an internist from the comfort of her home office, where she is thriving. But for her to reach the next step in patient care, Caro requires training to properly diagnose and treat severe mental illnesses such as bipolar I disorder, schizophrenia, conversion disorders, treatment-resistant depression, obsessive-compulsive disorders, and personality disorders. She will need to learn about psychotherapy, assessment of emergency cases and involuntary holds, and advanced treatment options of electroconvulsive therapy, transcranial magnetic stimulation, and ketamine. And she will need to return to in-person care.
Although she originally doubted the efficacy of telemedicine and questioned if she would be able to determine that intangible feeling of how a patient is doing, Caro has found that video meetings still allow for connections with patients. Returning to in-person care during residency will be a major adjustment, but she is looking forward to being able to fully assess and examine what is occurring. She will return to handwritten notes during appointments, and get more exercise as she travels from patient to patient.
The Catalyst for Change
For Caro, her desire to study psychiatry grew over time. Working as a medical doctor at a state psychiatric hospital, she provided essential care to patients with mental health needs and worked closely with psychiatrists. She supported her colleagues by monitoring and managing medication side effects, but she also focused heavily on identifying and stabilizing medical conditions that contributed to mental illness. Her dual efforts ensured the safety and well-being of patients.
Fascinated by the intricate relationship between physical and mental health, Caro became determined to enhance her understanding of psychiatric care and how she could offer comprehensive and holistic care to patients. Thus far, her personal learning journey has been self-directed; her next step is a hands-on residency to fully immerse herself in the field of psychiatry.
With the ultimate goal of bridging the gap between physical and mental healthcare, Maricelina Caro is creating a personalized education of both medicine and psychiatry. She is uniquely equipped to assess how physical health affects mental well-being and vice versa. Doctors who can take into consideration both physical and mental health simultaneously are the doctors of the future.
Changing Lives Through Mental Health Care
Doctors are in a position to receive confirmation that their work changes lives more than almost any other profession. Caro witnessed this firsthand practicing primary care psychiatry, where she recalled patients who had begun taking antidepressants. They would ask, “Wow! Is this how normal people feel?” Those moments were very special to Caro, who saw them feeling even better than just relieved of disease. In fact, these experiences can be considered a pivotal point in her career, and the source of her ambitious plan to transition to psychiatry.
Changing specialties isn’t common, and it isn’t easy, but for physicians like Maricelina Caro, who are absolutely certain that their medical career has shifted focus, it is a necessity. And it is her future patients who will benefit from her return to residency and beyond.
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