Researchers often invoke the metaphor of a pipeline when studying participation in careers in science, technology, engineering, and mathematics (STEM), focusing on the important issue of students who "leak" from the pipeline, but largely ignoring students who persist in STEM. Using interview, survey, and institutional data over 6 years, we examined the experiences of 921 students who persisted in biomedical fields through college graduation and planned to pursue biomedical careers. Despite remaining in the biomedical pipeline, almost half of these students changed their career plans, which was almost twice the number of students who abandoned biomedical career paths altogether. Women changed plans more often and were more likely than men to change to a career requiring fewer years of post-graduate education. Results highlight the importance of studying within-pipeline patterns rather than focusing only on why students leave STEM fields.