I am a current M3 student at a mid-level medical school in the midwest. I have a PhD in biochemistry; however, my research was largely computational and I have ten years of programming experience including multiple publications for algorithms I have developed and a patent application.
Throughout M3 I enjoyed some of my clerkships to various degrees. FM was definitely my favorite and if I were to do a residency it would be in FM. If I had to be a doctor, I like the idea of an outpatient setting where I manage the same cohort of patients over time and take care of chronic and acute ailments. My step 1 score is above the average for FM, I have good to great M3 grades and good evals, so the match should not be a problem.
The dilemma I am facing is that I miss programming and I have never been happier than I was as a researcher / programmer. Similarly, I have never been more depressed / anxious than in M3. I am seeing a psychiatrist and taking medicine to help but on some level I feel as if it simply is not a match for me. I know M3 is hard and it is not representative of residency or clinical practice; however, if clinical medicine is for me, I feel I should enjoy M3 more than I do currently.
I have long been interested in EHR development / machine learning of medical records and I believe I have the qualifications to to apply and excel at these jobs as I would have some medical experience and CS experience. I had considered FM followed by Clinical Informatics fellowship, but I'm not sure that the time investment is worth it if I am qualified for my ideal job currently.
That said, I understand not doing a residency effectively means I will never be able to practice clinical medicine as matching after a year break would be difficult. Also, due to the MD/PhD the time between step 1 and step 3 becomes relevant in some states for licensure and this will only be exacerbated if I take a detour.
I'm thinking if I were to go the CS / EHR route, I would apply for both residency spots and CS jobs during M4 and if I got into a CS position I enjoyed I would simply not submit a rank list for the match. This way, I have a backup in case I have overestimated my competitiveness.
Source: Original link