Current PGY-1 re-entering upcoming match--advice?

[Guppytrillion]

So I am a PGY-1 in a surgical specialty and, after much reflection, I have come to the conclusion that I went in to the wrong field. I was always torn between surgery and medicine (a weird contrast, I know) but ultimately went with surgery. At my program we do several months with our medicine department and they were by far my best months all year. I hate the OR a lot more than I thought I would and I know now that I would be much happier through IM. I have 3 months of IM floor experience and 2 months surgical ICU experience.

I spoke to the medicine department but they are capped and cannot make room for me.

I know this has had to have happened to some people/people others know--what is the best way to go about this? My current plan involves waiting until I have another 1 year contract signed, then talking to my current PD about re-entering the match (I have reason to expect support after I give my reasoning), going through my PGY-2 year, and applying/interviewing at IM programs with every expectation to have to fully repeat everything I have done. As a MS4 I was decently competitive for mid-tier IM programs, but am I damaged un-funded goods now that I have already matched once?

Other thoughts--What is the best way to go about getting rec letters? Should I try to use some I got as a medical student? I did not get a chance to work with many IM faculty for very long at my program but may be able to find something if it is considered important. Is it standard practice to assume my PGY-3 spot is gone after I initiate this and that I am screwed if I dont match?

Thank you for any help anyone can give!

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[Zarika]

I'm don't have any advice but I don't think your funding is gone. "Surgical Speciality" so 5 or 6 years was the initial plan and after next year you'll have done 2. Medicine is 3 years. 5-2 will still leave you the three full years of funding. (At least that's my understanding of how this whole thing works.)

 

[cheruka]

This makes me mad- why can't ppl switch when they want to? No one works like this in the free market outside of medicine. This whole govt funding is designed not to help the residents at all. If you have a job you can not leave because you can not find another job, that is essentially slavery.

 

[CLETUS.the.FETUS]

This makes me mad- why can't ppl switch when they want to? No one works like this in the free market outside of medicine. This whole govt funding is designed not to help the residents at all. If you have a job you can not leave because you can not find another job, that is essentially slavery.

No that is essentially the real world. You sign a contract, you do the job, if you don't like it or didn't think it through in the first place that's on you not the government.

 

[maygrl110]

First, you need to talk to your PD if you are certain so you don't get stuck doing something you hate. You will need a letter from them to transfer to any program.
I don't think it's too late to switch if you are flexible. You are definitely not out of funding since you have total of five years-so that's an incentive. Also, if you had good scores and additional 1 yr of experience, you can play that to your advantage. You can look for off cycle positions on SDN, residency swap, open residency, or the AMA website. You would have to be flexible. People want to switch or drop for various reasons every year.
You may want to ask one of the PDs if you need to apply for a NRMP waiver to reenter the match since you are not done with your contract. You could probably do either, but will need to convince new programs why you will stay in the new specialty. If you are absolutely sure, you should do it. There's no reason why you need to do something you hate the rest of your life when we have all invested so much energy getting into this field in the first place. Good luck!
I would ask one of the PDs

 

[maygrl110]

This makes me mad- why can't ppl switch when they want to? No one works like this in the free market outside of medicine. This whole govt funding is designed not to help the residents at all. If you have a job you can not leave because you can not find another job, that is essentially slavery.

You can switch when you want to. If a program wants you enough, they will find the funding to match you. The government just wants to get ppl trained asap so they can have more doctors in the workforce. Understandable but annoying, I agree.

 

[BlondeDocteur]

1) Your plan is a wise one. Continue in training-- it will make you a more desirable Match applicant than someone who resigned and is currently unaffiliated. It will also (potentially) allow you to rack up more months' worth of ICU and ER rotations, which can transfer to IM. You might be able to start as a PGY-2 in IM after 2 years of surgery.

2) Your funding clock was set at either 5 or 6 years when you started your categorical residency, depending on your surgical subspecialty. You will be more than covered when you switch to IM, even if you have to repeat internship. Regardless, if you are a compelling candidate programs will be interested in you (speaking from experience here). It doesn't necessarily mean that you have 0 funding support for the years you complete after funding runs out.

 

[NotAProgDirector]

As others have already stated, funding will not be an issue.

As long as you're leaving your program because you don't like it and not because you're having performance problems, you will not have much trouble finding another spot.

You could look for an open PGY-1 for next year. The number of spots will be low, so you won't have much choice.

Entering the match next year is the best way to get the best choice of programs.

If you want to stay at your home program for IM, you could talk to them now about a PGY-1 spot for next year. If they are willing to take you, you could avoid all the trouble of interviewing.

 

[betamale]

you can switch into FM instead like I did. you can put your surgical skills in OB, wound care, sports medicine, derm procedures, urgent care... your prior rotations will most likely cover most of the first year FM rotations and some programs may well let you in as PGY2 outside the match (there are open PGY2 FM spots out there).

can also so hospitalist work. consider it.

 

[Guppytrillion]

Thank you for all the advice! My residency training is only 4 years long total, so I would indeed run out of funding in my 3rd year of IM--does this mean I should target my applications to large centers that can absorb that kind of cost? I did try for a PGY-1 at my home institution but they were at their cap and couldn't take anyone else on. Ill keep this updated in the future as things progress for future reference since the SOAP and all-in policy changed the landscape of finding out of match positions.