-

I'm no expert on transferring, but I will tell you what I understand to be true. The one resident that I have talked with who did do it basically just did it from word of mouth (he transferred from 1st year medicine into 2nd year neuro by talking to the PD of neuro about it and there happened to be a spot). My understanding of your situation is that it should be relatively easy for several reasons. According to Iserson's, a good percentage of people change specialties in their career. The earlier you decide, of course, the easier it is. One of the limiting factors is that medicare limits the number of years that it will reimburse hospitals for every person (medicare pays for your salary and then some, it's an incentive for hospitals to pick AMG's over IMG's as they get reimbursed more for them, and it's an incentive to pick someone new over someone who has "used up" all of their medicare training years). I have attached a website that explains this process. I have also attached 2 individual program websites that explain transfer policies. I did do an internet search, even a medline search, but there appears to be a real shortage of published internet materials on transferring. It appears that transferring must be sought through unofficial channels such as contacting program directors, but it may be different for you since you would essentially have to repeat pgy-1 so you might have to apply through eras. You could always "anonymously" call your own or another programs internal medicine residency program director to find out the skinny. Hopefully someone who knows more about the subject will post.

Finally, I would just like to point out nothing in your post indicated that you were truly dissatisfied with surgery. You actually seem to be complaining about not getting enough OR time and not be treated with respect, which is common with surgical interns, but it definitely gets better the further and further away you get from your surgical intern year. Realize that as the years progress, your training will become easier in terms of scut work, hours, and respect. You seem to have a lot of criticism for your program, but remember that your training period is finite, and eventually you will have the rest of your life to do whatever it is that you want to do, whether that's to cut in surgery, or to actually heal people in medicine :) . Be sure to talk it over with a lot of people before you make a final decision, don't make a decision just because you are sleep deprived and being yelled at by a senior or an attending. That can happen in medicine too.

See transfer sections:
http://www.hsc.wvu.edu/som/gme/bylaws.htm
http://www.uams.edu/gme/1.210.htm

Explanation of medicare and residency:
http://www.aamc.org/members/orr/medicarepmt.pdf

See complaint procedures (to address 80 hr work week):
http://www.acgme.org/

"Open" residencies (probably not pertinent to you):
http://www.aamc.org/students/medstudents/findaresident/start.htm
Good luck, and keep us updated on your decision on whether or not to transfer!

HI F.C. Sorry that your intern year has been so tough...it sounds like you are spending alot of time doing scut! Well, I cant claim to know anything about transferring, but according to the post above mine usually these things happen by word-of-mouth and I happen to agree. My program has a spot for a second year next year (we took extra prelim this year). It is an IM program and is a combination of teritiary care center and community hospital north of Boston. I know that you said you are interested in moving out West...well we are defintely East! But feel free to email me at Marianne73@aol.com if you are interested in hearing a bit about it. Lots of luck with your search! :-)

First off, I'm one of the biggest cheerleaders for people coming to IM and possibly doing an IM subspecialty :clap:

I have two friends in my program (Parkland, considered a top 10 IM program) who have switched from General Surgery to IM here (one came from Parkland's own General Surgery program, and one came from Arkansas) who I think would be very valuable resources in terms of your thought process. Parkland IM is generally considered one of the more malignant and rigorous IM programs, hence its reputation, so it tends to attract a lot of folks who seriously considered or actually did some Surgery training but decided to become real doctors :laugh:

I myself am doing GI at Parkland starting in July '04, and originally picked IM over Surgery to do GI or Cardiology, so I share many of your same interests/inclinations in terms of enjoying procedures using my hands but also enjoying the cognitive aspects of being an internist and an IM subspecialist. What swayed me was the idea that training in IM first, in my humble opinion, makes me a "real doctor". I feel as though training in IM develops a geninue clinical acumen and a way of thinking and assessing and prioritizing a patient's clinical issues that is unique and all encompassing. While the Surgeon seems completely focused on the procedure or task at hand, the Internist is better able and equipped to understand and manage the patient as a whole. GI still allows me to hone that procedural skill and focus my expertise while allowing me to retain those best aspects of being an internist first.

Having said that, an IM intern year, as I'm sure you know, is no pleasure ride either. There are arrogant IM and subspecialty attendings that can go toe to toe with your GS staff, but I will say as a whole that IM staff treat their housestaff with much greater regard and respect than many Surgery staff I've seen -- a generalization, no doubt, but there is truth to it. Social issues will break you down, and often times you will feel left out in the sea of consultants working with you to take care of a patient. Sometimes, the idea of managing all of a patient's relevant medical issues is overwhelming, but there is an art to it and a unique clinical skill gained from it -- the "real doctor" I talked about before. However, you learn a lot from interacting with each of these, and there is something to be learned from balancing all these consultants suggestions into what is best for the patient. But, it's only one year, and as with Surgery, the training becomes more fun as you advance into your R2 and R3 year and make the real decisions.

One of my friends I mentioned above who did two years of General Surgery at Arkansas before switching to IM here (she's now an R2) recounted a story of being on Burns on call as the only resident on service at night (taking call) and having to manage many sick as **** patients with multiple medical comorbidities without knowing what the hell she was doing. It was then she decided to change to IM in order to learn about how to take care patients, and to learn about what she was doing in terms of management to truly UNDERSTAND the process behind it. She just wasn't comfortable doing things "just because" but wanted to know why. She just came off the Parkland MICU, which she says makes Trauma and Burns seem like a cakewalk, and now feels like she is learning the "why" of things. My other friend, who switched after his Gen Surg intern year echoes some of the same sentiments.

However, I'd like to echo the previous sentiment by an earlier post. Some of your concerns about your Gen Surg training focus facets of intern year and your disappointment with those facets. Make sure in your own mind that this becomes an issue of "Am I training to become the kind of doctor I want to be?", and nothing else. I think that's key.

PM me if you'd like to talk to the folks I mentioned above, as I think they can help you with your thoughts. And PM/email me if you have other questions I can help with.

Good luck.

I generally agree with the above posts. You still have to be aware that internship is a demeaning, tedious, and sometimes infuriating experience...both in medicine and surgery. Medicine folks just tend to be a bit more empathetic and humble...which helps. I have found myself now as a medicine resident, being drawn towards things surgical, but always being reminded of why I had the wisdom in my 4th year to steer away from it...for many of the reasons you listed. Still, being the lamb of ECF dispositions is not cake either and much of your days as a medicine intern will be spent mastering the fine art of getting your 86 yo lady with 50 medical problems out of the hospital into an ECF...then condensing her "stat" discharge summary into something that doesn't resemble Tolstoy's "War and Peace".

Medicine has a lot of opportunities which include surgical leanings (GI, Cards, Pulm/CCM)...but its not the same as going in, navigating the anatomy and "fixing" the problem and the "cure" in medicine...is often more elusive than surgery. Perhaps the other thing to remember is that when you are a surgeon, you are a surgeon...your flexibility...which may become important to you is made rigid by the title and responsibilities....Medicine is a bit more forgiving, mainly because of the breadth of training opportunities and venues to work.

As for switching to IM...go for it, but don't do it because you think it will be easier (it won't be), do it because you really want to know internal medicine and use it...your patients will appreciated you more for that.

Call some of the residency programs on the west coast and ask if they anticipate openings the next year. Some programs look like they filled on paper, but in reality, ended up taking extra prelims leaving them w/ openings for PGY-2s. There are some great community programs all along the west coast, so don't rule them out. I do know all the portland programs filled last year (no extra prelims) but occassionally both OHSU and the Portland community programs have had unexpected openings in the past. Good luck.

Foxy,

Hate to hear that life's so rough. I'd wonder if maybe you should consider looking at other surgery programs. My surgery program has been pretty benign, so far. I've been fortunate to have fairly easy services to start, but things seem pretty reasonable here.

Good luck. This is a tough decison. Just make sure that you do what you want.

Dude, you need to do radiology. IM is cool, but rads is better. Your life will be much better, and you can get patient contact if you want it.

I went to the easiest internship I could find, and am glad I did.

call saint louis university. one of teh pgy-1 interns just quit the other day, give them a call there might be an opening.

Foxy,

Bust out of Surgery NOW!

Saying "But I love to operate" in the face of all the abuse you are taking is similar to a battered wife who won't leave her husband because she loves him.

Get out now and go anywhere! Leave medicine if you must.

Nobody, especially somebody with a doctorate, deserves to be mistreated ever.

I remember recognizing the abuse I experienced during surgery and thinking "Do I ever want to spend the next 5 years of my life with these kinds of people?" I did enjoy working with a few, but they were far too few to justify my making myself miserable for. Plus, there was so much incredible arrogance and not enough empathy for fellow workers (no "I" in team ring a bell?). Good luck with your decision. I have only had one truly horrible experience in IMED as far as being belittled and it was by a horrible R2, not even an attending. Luckily that's not the norm in IMED. Intern year is tough, but I will survive it and have learned so much management already. IMED is worth it as far as teaching the why and understanding of problems. I'm even starting to know which antibiotics to reach for first in the middle of the night! Imagine that! Best of luck!

Mike

I think you need a new program more than anything else! It might be better somewhere else, and you could be a surgeon if you still want to. Talk to some of the second and third years- does life get better at your program?

I remember a surgery resident telling me when I was a med student that you should only go into surgery if being the in OR gives you more of a rush than anything else because you will have to give up everything else to be a surgeon. That counted me out right away. I really HOPE that that is only true for a limited period of time (residency). It was still too much for me.