Going back before moving forward?

pendelluft said:

Hi All.
My situation may be a bit unusual. I have completed residency in internal medicine and fellowship in pulmonary and critical care, but unfortunately dislike the field intensely. In fact, during med school my favorite rotations were surgical, not medical, but I thought I didn't have the "surgical personality" and decided to go into internal medicine.

I can't undo what is done, but was hoping it was not too late for a change. My credentials are good - AOA, 99% on USMLE, prestigious IM residency. I don't know if any of this helps me now. Does anyone have an advice on what I need to do in order to apply and get into a good ENT program? Also, could my 8 years in internal medicine be used as a substitute for the 1 prelim year in general surgery?

Thank you!

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I think you're track record is a plus for you going into ENT. However, even if your 8 years of IM could be adequate to cover the Gen Surg prelim year from an academic standpoint, you wouldn't want to skip that year. The surgical foundations you gain in that year, if only from a technical aspect, will greatly aid you in your ENT years. I wouldn't pass that year up even if you could. You'll be a better surgeon for it--the last thing you want to be is the resident with the worst hands in your class and missing that year will very likely make you that.

Sounds like your biggest hurdle might be funding. You're out of funding and some programs might not want to take on that expense for 5 years. Other question might be if your usmle scores are still valid. They have a shelf life and re-taking those would suck. Worth exploring these issues a bit on the eras website. Good luck

What about interventional pulmonary? We had a guy at my institution during residency who was pretty damn close to a surgeon. He helped us out on some nasty tracheal and subglottic tumors on quite a few occasions.

That is a big decision to make the change. You would need to demonstrate your conviction during the application process. Getting to know some ENT faculty and getting a copule good letters of recommendation would be the next step, IMO.

Another potential issue is fitting in as a resident again. At my institution, there was someone who changed from being a internal medicine practitioner to general surgery. He had difficulty going back to the low rung on the ladder as an intern. He was frequently having conflicts with the other residents and ended up leaving the program. You will obviously know more about many things compared to other residents, but that has the potential to be annoying if you can't put things in the proper perspective.

One thing you might consider is seeing if you could set up a clinical rotation with an ENT program. Our ENT program has foreign medical residents do rotations every once in a while, so it seems like that would be something that would be feasible at most programs. That would give you a chance to demonstrate your interest and show that you would fit in as a resident again.

The PGY1 year is now built in to the ENT residency (it is not a GS prelim year). The current RRC guidelines have specific requirements for the rotations that have to be done in that year. I'm sure you have done a couple of the rotations (ER, ICU), but probably not GS, ENT, neurosurg, plastics, which make up the majority of the year. If you get a spot in the match, I wouldn't expect any of your previous residency to count.

The funding could be another issue. I have heard people talking about that.

Good luck!