failed to match question

[AD28]

Hey all, posting some questions for someone else that is a pretty unique situation and hoping your collective wisdom can answer. I apologize in advance for lack of details since I don't have all the facts.

So Bob wanted to go for a competitive surgical specialty, but his board scores were below average for step 1 and 2. I'm not positive, but he may have failed step 2 on his first try. In any case, he applied anyway and did not match. During SOAP he got an offer from an IM program for a prelim medicine spot but he rejected it, in the hopes that he could snag a prelim surg spot, but he struck out there too.

Since he did not match, he has an arrangement with his school that lets him do more audition rotations this summer and reapply. He decided to go for IM this time around. He asked the IM PD that offered him a spot in the scramble for a LOR from him, but the PD essentially said, "no, try for family medicine." Now the student is in a bind because he still hasn't set up his upcoming rotations and he was really banking on that LOR.

Should he just go for family and set up his rotations in FM? Or should he just stick with IM and hope to get LORs from his audition rotations? What else can he do to improve his chances of matching next year?

Thanks!

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[QofQuimica]

Should he just go for family and set up his rotations in FM? Or should he just stick with IM and hope to get LORs from his audition rotations? What else can he do to improve his chances of matching next year?

Yes, he should go for FM; he's apparently burned that IM bridge but good. And if he's lucky enough to be offered a slot somewhere this time around, he should be smart enough to accept it. Not to kick the man when he's down, but an American med school senior who can't manage to snag a surgery prelim spot is not exactly a super competitive applicant to begin with. And now he's going to be even less competitive since he's sitting out a year. If he wants to ever practice medicine in any capacity, he'd be wise to go into those FM rotations with the attitude like he's found his new life's calling.

 

[smq123]

Yes, he should go for FM; he's apparently burned that IM bridge but good. And if he's lucky enough to be offered a slot somewhere this time around, he should be smart enough to accept it. Not to kick the man when he's down, but an American med school senior who can't manage to snag a surgery prelim spot is not exactly a super competitive applicant to begin with. And now he's going to be even less competitive since he's sitting out a year. If he wants to ever practice medicine in any capacity, he'd be wise to go into those FM rotations with the attitude like he's found his new life's calling.

Print this out and paste it to "Bob's" forehead. Wise words.

 

[atomi]

During SOAP he got an offer from an IM program for a prelim medicine spot but he rejected it, in the hopes that he could snag a prelim surg spot, but he struck out there too.

Since he did not match, he has an arrangement with his school that lets him do more audition rotations this summer and reapply. He decided to go for IM this time around. He asked the IM PD that offered him a spot in the scramble for a LOR from him, but the PD essentially said, "no, try for family medicine." Now the student is in a bind because he still hasn't set up his upcoming rotations and he was really banking on that LOR.

Should he just go for family and set up his rotations in FM? Or should he just stick with IM and hope to get LORs from his audition rotations? What else can he do to improve his chances of matching next year?

Let me get this straight. Bob applied for an IM program in the SOAP, no doubt interviewed for it, actually GOT it, then turned it down without having another offer in hand? Essentially he wasted that program's first round pick in the SOAP? Yeah, I'd be pissed too. But wait, this gets even better. He decides to call the PD who offered him that spot and ask for a LOR? Are you kidding me? Without even knowing the guy and their only interaction being the one where Bob totally flaked out?

And now it sounds like Bob has decided to delay graduation and wants to audition at the same program he snubbed?

Ok, even if Bob failed step 2, I don't think that's why he didn't match. Based one what you've written here, Bob sounds like a self-centered 17 year old boy who fails to understand how his actions impact anybody but himself. Anybody who could be so delusional to think that anything he did was a good idea must have totally blown every interview he had. I simply cannot believe that this person could have demonstrated a mature and confident attitude during interviews. He probably wasn't even ranked anywhere he interviewed. The offer he got in the SOAP was probably a fluke because the 5 minute phone interview didn't allow him enough opportunity to tank himself and was literally the only chance he would have had this year to be employed at graduation.

Ok, so all that really isn't helpful in terms of advice. IM has recently become a very competitive specialty, but it's not saturated. There are community programs that are still non-competitive (categorical... all prelims are competitive -- again it blows my mind that he turned that down). If a program places any of its graduates into cards, GI, pulm, or heme/onc, it's competitive. Ok so here's my advice:

MOST IMPORTANTLY Bob needs to develop some insight. Everything he has done so far demonstrates a remarkable lack of it. He applied to something like Ortho thinking he would have a chance. He now needs to decide what he wants to do. Does he want to do IM now, or is he just doing that because he thinks it is somehow "better" than FM? If he has a legitimate reason for wanting to do IM, then he should go for it and apply broadly to lower end community programs and academic programs in undesirable locations. And use some common sense and set up an away rotation at some place other than the place he snubbed where he can get a LOR from a famous name. He has zero chance at this program and even if he goes there for an away, will not get an interview there. But Ortho-->IM is a pretty big jump. If he still wants to do surgery, then he should try for that by applying to community surgery programs. But he will need a backup, and he will need to decide if he wants to dual apply in another specialty as a backup or apply to surgery prelims as a backup (which he will get through the match). Finally, Bob needs interview coaching. Even if he has a 240 step 1 and step 2, if he comes across as a doofus with no career plans, he won't match into anything.

 

[BlondeDocteur]

Unless the IM LOR person is the med school clerkship director, department chair or home PD I see no reason why he has to abandon medicine as a field. He probably would like to do a procedural specialty. If his home institution refuses to support him in the match though then he is cooked and needs to switch fields.

I would bet Bob goes to a pretty well regarded med school. I've seen this before, where people feel the name of their school will carry them far in the match, and refuse to consider "sub par" programs.

 

[Chickenandwaffles]

Yes, he should go for FM; he's apparently burned that IM bridge but good. And if he's lucky enough to be offered a slot somewhere this time around, he should be smart enough to accept it. Not to kick the man when he's down, but an American med school senior who can't manage to snag a surgery prelim spot is not exactly a super competitive applicant to begin with. And now he's going to be even less competitive since he's sitting out a year. If he wants to ever practice medicine in any capacity, he'd be wise to go into those FM rotations with the attitude like he's found his new life's calling.

This is absolutely ridiculous advice. No offense, but you are a foreign grad, so your experiences don't really apply for the most part unless "Bob" is a foreign grad. There are hundreds of IM programs, OP can certainly get letters of rec from med school and his upcoming rotations. The idea that somehow just because one dude with a weak echo in his IM program said no he's never going to be able to do medicine again? Completely absurd.

If OP wants to do medicine, he just needs to do some rotations and do well and get letters, and apply in a reasonable amount of time through the match the next time. "If he wants to ever practice medicine in any capacity, he'd be wise to go into those FM rotations..." really? Are you listening to yourself?! OP could likely get into a number of specialties that are not super competitive surgical specialties. Give me a break.

 

[Chickenandwaffles]

Unless the IM LOR person is the med school clerkship director, department chair or home PD I see no reason why he has to abandon medicine as a field. He probably would like to do a procedural specialty. If his home institution refuses to support him in the match though then he is cooked and needs to switch fields.

I would bet Bob goes to a pretty well regarded med school. I've seen this before, where people feel the name of their school will carry them far in the match, and refuse to consider "sub par" programs.

I agree with you that there is no reason he should abandon medicine. He doesn't need his school to support him in anything either. OP can just go through some rotations, do well, get letters, and put a compelling application together and likely match with no issue.

 

[atomi]

Unless the IM LOR person is the med school clerkship director, department chair or home PD I see no reason why he has to abandon medicine as a field. He probably would like to do a procedural specialty. If his home institution refuses to support him in the match though then he is cooked and needs to switch fields.

I would bet Bob goes to a pretty well regarded med school. I've seen this before, where people feel the name of their school will carry them far in the match, and refuse to consider "sub par" programs.

This was my initial thought as well. If the program that offered him the position in the SOAP was his home program, this makes the whole scenario make a little bit more sense. He will need an LOR from the chair in order to apply for IM. It's certainly not impossible, but it's going to be difficult when he has left a sour impression in the PDs mouth. He would need to excel on the audition rotation and then talk with the PD and humbly try to explain the situation being caught up in the emotions of the SOAP, profusely apologize, and profess his love for IM. If the PD still wants to blacklist him and tells him the chair won't write a letter or won't write a good one, then getting into IM would be more tricky. He would have to try to SOAP into a prelim again, and then jump from a prelim to a categorical spot. Without a chair letter, he would be pretty much limited to going through a backdoor like this or else getting a spot through a connection.

But given that Bob didn't seem to have his heart set on IM since the beginning of school, he may just want to simply consider another specialty where he is not persona non grata.

 

[Chickenandwaffles]

Hey all, posting some questions for someone else that is a pretty unique situation and hoping your collective wisdom can answer. I apologize in advance for lack of details since I don't have all the facts.

So Bob wanted to go for a competitive surgical specialty, but his board scores were below average for step 1 and 2. I'm not positive, but he may have failed step 2 on his first try. In any case, he applied anyway and did not match. During SOAP he got an offer from an IM program for a prelim medicine spot but he rejected it, in the hopes that he could snag a prelim surg spot, but he struck out there too.

Since he did not match, he has an arrangement with his school that lets him do more audition rotations this summer and reapply. He decided to go for IM this time around. He asked the IM PD that offered him a spot in the scramble for a LOR from him, but the PD essentially said, "no, try for family medicine." Now the student is in a bind because he still hasn't set up his upcoming rotations and he was really banking on that LOR.

Should he just go for family and set up his rotations in FM? Or should he just stick with IM and hope to get LORs from his audition rotations? What else can he do to improve his chances of matching next year?

Thanks!

I assume you did medicine at your school for a clerkship or some other institution. Can you not get letters from previous rotations? As an AMG, if you are anywhere near not horrible, even average, you can likely get into a decent IM program. Apply broadly and perhaps to FM as well, sure, but thinking that somehow because one dude has a hurt echo and refuses to help doesn't mean anything. Please.

 

[atomi]

I agree with you that there is no reason he should abandon medicine. He doesn't need his school to support him in anything either. OP can just go through some rotations, do well, get letters, and put a compelling application together and likely match with no issue.

No, if he wants to do IM he will need a letter from the chair. If the program he snubbed is his home program, this is a problem. If it's a big program it may be possible for him to sneakily get one without the chair knowing about the SOAP offer or hearing the PDs opinion, but this is risky and unlikely.

 

[Chickenandwaffles]

This was my initial thought as well. If the program that offered him the position in the SOAP was his home program, this makes the whole scenario make a little bit more sense. He will need an LOR from the chair in order to apply for IM. It's certainly not impossible, but it's going to be difficult when he has left a sour impression in the PDs mouth. He would need to excel on the audition rotation and then talk with the PD and humbly try to explain the situation being caught up in the emotions of the SOAP, profusely apologize, and profess his love for IM. If the PD still wants to blacklist him and tells him the chair won't write a letter or won't write a good one, then getting into IM would be more tricky. He would have to try to SOAP into a prelim again, and then jump from a prelim to a categorical spot. Without a chair letter, he would be pretty much limited to going through a backdoor like this or else getting a spot through a connection.

But given that Bob didn't seem to have his heart set on IM since the beginning of school, he may just want to simply consider another specialty where he is not persona non grata.

You really think it works that way? OP needs only 3 letters for ERAS, and likely only 1 IM letter. While *some* programs may request a chair letter, there are hundreds of programs literally that don't require a chair letter. Profusely apologize? That's just plain silly. This idea that somehow med students/residents have to humiliate themselves over big egos in medicine is just insane.

I had a similar difficult PD of IM dept, and I matched into an incredibly competitive prelim program when I applied to prelims without a letter, with no issues. It takes a lot to really destroy your career in medicine, and that typically involves screwing your license in bad ways, but pissing off attendings with an attitude and bad tempers is an almost daily occurrence in medicine. Luckily if you are smart, you are likely to be able to succeed if you have a good plan.

 

[atomi]

This is absolutely ridiculous advice. No offense, but you are a foreign grad, so your experiences don't really apply for the most part unless "Bob" is a foreign grad. There are hundreds of IM programs, OP can certainly get letters of rec from med school and his upcoming rotations. The idea that somehow just because one dude with a weak echo in his IM program said no he's never going to be able to do medicine again? Completely absurd.

I agree that he needs to do FM now is bad advice (and rather insulting to the profession of FM too). Bob is likely not going to match into ultra competitive specialties now without many years of trying and doing post-doc research, but there are still probably a dozen specialties other than FM he could choose from. The idea that failing to match leaves one only able to do FM is absurd.

 

[Chickenandwaffles]

No, if he wants to do IM he will need a letter from the chair. If the program he snubbed is his home program, this is a problem. If it's a big program it may be possible for him to sneakily get one without the chair knowing about the SOAP offer or hearing the PDs opinion, but this is risky and unlikely.

Are you a med student? It seems like you are. No, even if he wants to do IM, there are hundreds of programs he can apply to without a chair letter.

Just like the ridiculous idea that you *have* to let your PD know if you are switching specialties and *need* a letter from the PD to do so. I didn't do either of that, and successfully switched, just like tons of other people have. Tons of people match without *chair* letters.

I find it hard to believe how people are such sheep and believe these silly ideas that are propagated.

 

[atomi]

While *some* programs may request a chair letter, there are hundreds of programs literally that don't require a chair letter.

In my experience, almost every program required a chair letter. Applying without one is conspicuous and would probably get your application round-filed.

 

[atomi]

Are you a med student? It seems like you are. No, even if he wants to do IM, there are hundreds of programs he can apply to without a chair letter.

Just like the ridiculous idea that you *have* to let your PD know if you are switching specialties and *need* a letter from the PD to do so. I didn't do either of that, and successfully switched, just like tons of other people have. Tons of people match without *chair* letters.

I find it hard to believe how people are such sheep and believe these silly ideas that are propagated.

No. I would argue that your experience is the exception rather than the rule. Applying to IM without a chair letter is stupid. Even prelims require them.

 

[Chickenandwaffles]

I agree that he needs to do FM now is bad advice (and rather insulting to the profession of FM too). Bob is likely not going to match into ultra competitive specialties now without many years of trying and doing post-doc research, but there are still probably a dozen specialties other than FM he could choose from. The idea that failing to match leaves one only able to do FM is absurd.

It is absurd correct. Ultra competitive specialties are tough to match into for *everyone* not just *Bob*. But failing to match into I don't know ortho, urology, plastics, etc. doesn't automatically mean *FM*. This idea is ridiculous, and I agree that it is an insult for FM. That's also what my school's dean would tell people who failed to match - apply to FM. It's sooo ridiculous, and if I was a FM physician, I would be insulted. For one, it is possible to reapply to ultra competitive specialties if there is a good plan. If the likelihood of matching is next to none though, another specialty of choice can be obtained if the student in question creates a well thought out plan and follows through.

 

[Chickenandwaffles]

In my experience, almost every program required a chair letter. Applying without one is conspicuous and would probably get your application round-filed.

Unfortunately you are incorrect. IM is still very much a specialty that the vast majority of AMGs, even with some red flags, can easily match into.

 

[Chickenandwaffles]

No. I would argue that your experience is the exception rather than the rule. Applying to IM without a chair letter is stupid. Even prelims require them.

Incorrect. I tell you what-why not go look at programs and see which ones actually do require a letter? I can't tell you how many people I know who never had one of these mythical "chair" letters and matched with no issues.

 

[smq123]

This is absolutely ridiculous advice. No offense, but you are a foreign grad, so your experiences don't really apply for the most part unless "Bob" is a foreign grad. There are hundreds of IM programs, OP can certainly get letters of rec from med school and his upcoming rotations. The idea that somehow just because one dude with a weak echo in his IM program said no he's never going to be able to do medicine again? Completely absurd.

If OP wants to do medicine, he just needs to do some rotations and do well and get letters, and apply in a reasonable amount of time through the match the next time. "If he wants to ever practice medicine in any capacity, he'd be wise to go into those FM rotations..." really? Are you listening to yourself?! OP could likely get into a number of specialties that are not super competitive surgical specialties. Give me a break.

Where on earth did you get the impression that QofQuimica is a foreign graduate???

 

[GoSpursGo]

No. I would argue that your experience is the exception rather than the rule. Applying to IM without a chair letter is stupid. Even prelims require them.

This was always my impression as well, based on my friends who applied to IM. Across the board, they all had chair letters.

 

[atomi]

Incorrect. I tell you what-why not go look at programs and see which ones actually do require a letter? I can't tell you how many people I know who never had one of these mythical "chair" letters and matched with no issues.

Most programs have a hard requirement for a chairman's letter on their website. There are certainly a few that don't specify this on the website. However, applying without one would look odd when most other people have one. Especially because you would almost certainly be applying to another program that does explicitly require one, so you would have that chairman's letter uploaded into ERAS. This raises the question of why you are not sending it. Are you only applying to programs that don't have an explicit requirement for it or do you have one uploaded but are choosing not to send it? Either one is a red flag.

Regardless, the advice you are giving to "Bob" is that he can still get in IM without a chairman's letter. While this may be technically possible, he should not pursue this option unless he is absolutely certain that (1) he wants to do IM and (2) that he cannot get a halfway decent LOR from his chair.

 

[Chickenandwaffles]

Most programs have a hard requirement for a chairman's letter on their website. There are certainly a few that don't specify this on the website. However, applying without one would look odd when most other people have one. Especially because you would almost certainly be applying to another program that does explicitly require one, so you would have that chairman's letter uploaded into ERAS. This raises the question of why you are not sending it. Are you only applying to programs that don't have an explicit requirement for it or do you have one uploaded but are choosing not to send it? Either one is a red flag.

Regardless, the advice you are giving to "Bob" is that he can still get in IM without a chairman's letter. While this may be technically possible, he should not pursue this option unless he is absolutely certain that (1) he wants to do IM and (2) that he cannot get a halfway decent LOR from his chair.

Well we are going to have to agree to disagree here. Even a prestigious program like Harvard says chair's letter or clerkship director letter. Univ of Chicago, another prestigious program, also does not require a chair's letter. I'm certainly not going to go through all the hundreds of IM programs that there are, but many programs do not require letters. And Bob can get into IM without such a letter. Whether he wants to go into IM or not is not the issue here, and not what he asked or my issue. I am simply advicing him on the realistic thing of whether he can get into IM or not.

You perhaps may not be aware of this, but programs cannot see what you have or don't have uploaded into your ERAS when it comes to letters, so your statement above "Especially because you would almost certainly be applying to another program that does explicitly require one, so you would have that chairman's letter uploaded into ERAS. This raises the question of why you are not sending it. " doesn't apply for one. Second, it doesn't make a ton of sense, because obviously if you "had" one you would uploaded it. The whole nature of this argument is if the OP does NOT have one. If he has one, it's a moot point.

And if you think programs, given the tremendous number of apps they get, do this whole mental examination of your intents or what not, you are highly mistaken.

If I were Bob and wanted to say, forget the competitive surgical specialty, I want to do IM, I would certainly apply, with a letter if he can get it, or without one if he cannot get it. Either way, if he puts a good app forward, he will likely have a high chance at success when it comes to IM. You don't have to agree with me on this btw.

 

[AD28]

Thank you all for your replies!

I believe that the IM program was in fact his home institution. If it is true that he needs a chair's letter this could complicate things. He is planning on doing 3 more rotations before applying, so I'm thinking the first one should be an away sub-i in IM, where he can attempt to get a LOR from that chair, the second could be FM, and the third can be another IM or FM and then he can just apply broadly to both specialties. What do you guys think of this strategy?

 

[amine2086]

Thank you all for your replies!

I believe that the IM program was in fact his home institution. If it is true that he needs a chair's letter this could complicate things. He is planning on doing 3 more rotations before applying, so I'm thinking the first one should be an away sub-i in IM, where he can attempt to get a LOR from that chair, the second could be FM, and the third can be another IM or FM and then he can just apply broadly to both specialties. What do you guys think of this strategy?

I think applying to both IM and FM is probably his best option although he is very unlikely to match IM given he had difficulty securing a surgery prelim spot. I was under the impression that many surgery prelim spots go unfilled which tells me "Bob" has some serious red flag(s). Most/all IM program require a letter from the chair or his/her designee. So if "Bob" has burned that bridge it's going to be even more difficult for him to secure an IM spot.

 

[rokshana]

chicken, we can all agree that bob is not getting harvard or UChicago so if these places don't require a chair's LoR, it really isn't relevant to bob's application

and i have to agree with the others that applied to IM…most of the 60 some programs i applied to back in the day required 3 LoRs, one specifically being from the Chair of the IM dept (many would allow a designated rep for the chief to write a letter, but that is usually someone who is selected to represent the chair, not just a random IM person)…if bob burned the IM bridge at his home program, its gonna be hard to get a letter out of that program…he will, as someone stated, need to do an away sub I somewhere and pray he can get a letter from the Chief at that program (the requirement isn't a chief's letter from the home program, its any chair)…but that would be easier said than done…bob would effectively need to do the sub i WITH the chief to get to him to know him well enough to give an away student a LoR.

the other issue is bob couldn't get a surgery prelim in the SOAP??? there are other things going on and it sounds like bob lucked into that prelim IM spot and was too dense to figure it out…

bob need to start scouring for an off cycle opening in something and anything he can…they may not be as picky about the LoRs when they need to fill a spot fast.

 

[BlondeDocteur]

Bob probably only wanted a very competitive surg prelim at a top program and those spots go very quickly. The big bloated pool of surg prelims are open but they're snapped up by desperate FMGs. By the time the fifth or so round of the SOAP came around and he lowered his standards they were probably gone.

Actually in his case delaying gradation and putting together a decent application for a new specialty was smarter than being stuck in a dead end workhorse prelim.

 

[Chickenandwaffles]

chicken, we can all agree that bob is not getting harvard or UChicago so if these places don't require a chair's LoR, it really isn't relevant to bob's application

and i have to agree with the others that applied to IM…most of the 60 some programs i applied to back in the day required 3 LoRs, one specifically being from the Chair of the IM dept (many would allow a designated rep for the chief to write a letter, but that is usually someone who is selected to represent the chair, not just a random IM person)…if bob burned the IM bridge at his home program, its gonna be hard to get a letter out of that program…he will, as someone stated, need to do an away sub I somewhere and pray he can get a letter from the Chief at that program (the requirement isn't a chief's letter from the home program, its any chair)…but that would be easier said than done…bob would effectively need to do the sub i WITH the chief to get to him to know him well enough to give an away student a LoR.

the other issue is bob couldn't get a surgery prelim in the SOAP??? there are other things going on and it sounds like bob lucked into that prelim IM spot and was too dense to figure it out…

bob need to start scouring for an off cycle opening in something and anything he can…they may not be as picky about the LoRs when they need to fill a spot fast.

I'm not suggesting that Bob will get into Harvard or UChicago, I'm simply suggesting that many many many programs can be applied to without a chair letter. Bob can likely apply to 20-30 programs with no letter from a chair, perhaps get 1/2 of interviews and still match. Just because someone doesn't get a spot in the SOAP is not telling of anything. In the SOAP, there are a few spots for tons of apps. I personally don't like to judge people whose qualifications I don't know, that seems silly to me.

I remember someone who was applying to Derm who did not match in the regular match process, and then they were desperately trying to get into anything. They applied for an FM spot in their area and yet did not get the spot. When they called, they were informed that for the one available FP spot, there were 10,000 applications. Since none of us know how many people applied for the SOAP spots, I don't think any of us can really talk about the situation. I have seen plenty of smart, bright, good people fail to match through the years, put themselves together later and successfully get through at a different time. So I'm personally not willing to get the pitchfork and damn "Bob" for anything. I know if I were in a similar situation, I would want people to provide me help and advise without condemning me or tell me what a fool or what this or that i was. I think that's the goal of this forum, not to judge others, whom we don't know.

 

[Chickenandwaffles]

Bob probably only wanted a very competitive surg prelim at a top program and those spots go very quickly. The big bloated pool of surg prelims are open but they're snapped up by desperate FMGs. By the time the fifth or so round of the SOAP came around and he lowered his standards they were probably gone.

Actually in his case delaying gradation and putting together a decent application for a new specialty was smarter than being stuck in a dead end workhorse prelim.

Thank you, this precisely.

 

[Top Gun]

I didn't have a chair letter when I was applying for IM, just a letter from a regular IM attending, and I matched.

 

[Chickenandwaffles]

I didn't have a chair letter when I was applying for IM, just a letter from a regular IM attending, and I matched.

Precisely, what he said.

 

[QofQuimica]

This is absolutely ridiculous advice. No offense, but you are a foreign grad, so your experiences don't really apply for the most part unless "Bob" is a foreign grad.

I have no idea where you got the impression that I'm a foreign grad, but I'm not. Not only did I attend a name brand American med school, I went there on full scholarship. This has to be the first time in the entire decade I've been on SDN that anyone has ever confused me for an IMG.

There are hundreds of IM programs, OP can certainly get letters of rec from med school and his upcoming rotations. The idea that somehow just because one dude with a weak echo in his IM program said no he's never going to be able to do medicine again? Completely absurd.

If OP wants to do medicine, he just needs to do some rotations and do well and get letters, and apply in a reasonable amount of time through the match the next time. "If he wants to ever practice medicine in any capacity, he'd be wise to go into those FM rotations..." really? Are you listening to yourself?! OP could likely get into a number of specialties that are not super competitive surgical specialties. Give me a break.

There's no need to be rude just because you don't agree with me. The OP asked for opinions, and I gave mine, which is that "Bob" blew it. First, he went through the match as a med school senior and failed to match anywhere. Maybe it's because he wasn't realistic about his chances in his preferred specialty, or maybe it's because he didn't plan well for a backup, or maybe it's because he blew his interviews, or failed Step 2, or whatever. Who knows. He then was offered an IM prelim slot that he turned down, and now that PD is through with him to the point that the PD told Bob to apply to another specialty altogether. I mean, seriously, ouch. If that isn't a blow to the old ego, I don't know what is.

And let's be honest: Bob *doesn't* want to be an internist. If he had, he wouldn't have applied for "a competitive surgical subspecialty." He would have applied for IM. The IM PD knows that Bob doesn't really want to be an internist. The OP knows this. You and I know this. Bob knows this. All of us also know that Bob doesn't really want to be a FP either. But, right now the FM PD doesn't know this. And if Bob is smart, the FM PD won't ever know this, because Bob will bust his a** on his FM rotations, impress the FM powers that be, and get good letters. Then Bob will get a FM residency slot somewhere and go on to become a BC FP some day.

IM is still very much a specialty that the vast majority of AMGs, even with some red flags, can easily match into.

Along those same lines, I'd argue that it's not any more insulting to say that Bob should apply in FM than it is to say that Bob should apply in IM. Because again, Bob could have been doing IM right now if he had really wanted to be doing IM. He was offered an IM spot, and he turned it down. Why did he turn it down? Because he doesn't want to do IM. Why then do you think it's insulting to FPs for the IM PD to say that Bob should have to apply to FM, but it's not insulting to internists for you to say that Bob should apply to IM because it's "a specialty that the vast majority of AMGs, even with some red flags, can easily match into," even though we all know that Bob preferred to risk going unmatched altogether over taking the IM prelim?

I believe that the IM program was in fact his home institution. If it is true that he needs a chair's letter this could complicate things. He is planning on doing 3 more rotations before applying, so I'm thinking the first one should be an away sub-i in IM, where he can attempt to get a LOR from that chair, the second could be FM, and the third can be another IM or FM and then he can just apply broadly to both specialties. What do you guys think of this strategy?

Makes sense to me. Tell him game face on.

 

[Chickenandwaffles]

I have no idea where you got the impression that I'm a foreign grad, but I'm not. Not only did I attend a name brand American med school, I went there on full scholarship. This has to be the first time in the entire decade I've been on SDN that anyone has ever confused me for an IMG.


There's no need to be rude just because you don't agree with me. The OP asked for opinions, and I gave mine, which is that "Bob" blew it. First, he went through the match as a med school senior and failed to match anywhere. Maybe it's because he wasn't realistic about his chances in his preferred specialty, or maybe it's because he didn't plan well for a backup, or maybe it's because he blew his interviews, or failed Step 2, or whatever. Who knows. He then was offered an IM prelim slot that he turned down, and now that PD is through with him to the point that the PD told Bob to apply to another specialty altogether. I mean, seriously, ouch. If that isn't a blow to the old ego, I don't know what is.

-So basically you decided to judge someone when he's down? I see. Well I don't do that, I find that rather tacky. Sorry for actually having compassion. I guess not all of us are perfect like you. I guess some people have dreams and don't want the first time around into what they want, I guess not everyone can match into highly competitive specialties first time around. I did not realize that was so awful.
-A *prelim* IM spot is worthless, as there is no guarantee whatsoever of a second year spot. Again, you are putting someone down when he is already down. Rather tacky, once again, in my opinion.


And let's be honest: Bob *doesn't* want to be an internist. If he had, he wouldn't have applied for "a competitive surgical subspecialty." He would have applied for IM. The IM PD knows that Bob doesn't really want to be an internist. The OP knows this. You and I know this. Bob knows this. All of us also know that Bob doesn't really want to be a FP either. But, right now the FM PD doesn't know this. And if Bob is smart, the FM PD won't ever know this, because Bob will bust his a** on his FM rotations, impress the FM powers that be, and get good letters. Then Bob will get a FM residency slot somewhere and go on to become a BC FP some day.

-It doesn't matter what Bob wants to be. No one other than him can determine what he's willing to settle for. Who are you to decide? And again, suggesting that he could never get into an IM program because some lousy, egotistical PD told him to apply to a different specialty would forever mean he can't get into such said specialty is beyond absurd. It's mind-blowingly ridiculous.

Along those same lines, I'd argue that it's not any more insulting to say that Bob should apply in FM than it is to say that Bob should apply in IM. Because again, Bob could have been doing IM right now if he had really wanted to be doing IM. He was offered an IM spot, and he turned it down. Why did he turn it down? Because he doesn't want to do IM. Why then do you think it's insulting to FPs for the IM PD to say that Bob should have to apply to FM, but it's not insulting to internists for you to say that Bob should apply to IM because it's "a specialty that the vast majority of AMGs, even with some red flags, can easily match into," even though we all know that Bob preferred to risk going unmatched altogether over taking the IM prelim?

-It is insulting of course, because Bob actually considered applying for IM, so perhaps Bob realizes that in what he needs to settle for, IM may be something he can tolerate/settle for. You suggesting he do FM as his only last choice ever to have a medical career is because you are suggesting that FM is the least competitive specialty that he could get into, because he somehow did something terrible. I guess him making choices is somehow not allowed and terrible in medicine. Incredibly insulting to FM physicians.
I will reiterate in case it was somehow missed-taking a prelim IM spot is basically wasting a complete year of his life. It will provide him nearly 0 chance of moving on to PGY2, as programs have a close count of the # of spots that are available, and categorical PGY1s go onto PGY2, not prelims. Prelims are meant for other specialties.

So Bob is actually doing the best thing he can do for himself, which is waiting out a year and applying through the match again.
This outright mean, sadistic way that people on this forum have of attacking others and explaining how they must of have done something soooo awful that they should beg, and apologize, and be thankful if they can get into anything bla bla bla is just absolutely crazy and one of the many things that is wrong in medicine. This belief that abusive behavior is fine and the "let's kick them while they are down" mentality is just outright unacceptable in my opinion.


Makes sense to me. Tell him game face on.

 

[atomi]

I will reiterate in case it was somehow missed-taking a prelim IM spot is basically wasting a complete year of his life. It will provide him nearly 0 chance of moving on to PGY2, as programs have a close count of the # of spots that are available, and categorical PGY1s go onto PGY2, not prelims. Prelims are meant for other specialties.

So Bob is actually doing the best thing he can do for himself, which is waiting out a year and applying through the match again.
This outright mean, sadistic way that people on this forum have of attacking others and explaining how they must of have done something soooo awful that they should beg, and apologize, and be thankful if they can get into anything bla bla bla is just absolutely crazy and one of the many things that is wrong in medicine. This belief that abusive behavior is fine and the "let's kick them while they are down" mentality is just outright unacceptable in my opinion.

People who complete a PGY-1 prelim med position can typically jump directly into an open PGY-2 categorical spot. You are thinking of PGY-1 surgical prelims where this is usually not the case. IM prelim spots are almost all occupied by people going on to advanced residencies. There is very little competition amongst prelims for PGY-2 IM openings. Whereas in surgery, they are typically occupied for FMGs and people with no other options and without an advanced program, and there is fierce competition for any PGY-2 openings.

If Bob had completed his PGY-1 prelim med, he could have done that, or he could have jumped into an open Anesthesia, PM&R, radiology, hell maybe even optho if that was his original choice. Unless Bob was set on reapplying to his original specialty or surgery, he was a fool not to take that prelim spot. If wanted to do primary care, he could have found an open primary care track PGY-2 IM spot. Now he's got a year of downtime to do what, apply in FM? Come on.

My personal opinion is that Bob should still go for surgery if that's what he wants. I agree with you Mr. Waffles, about the way this forum views everyone's chances at residency as black and white. Subpar applicants fail to match in competitive specialties and find a backdoor to get in them all the time. Maybe Bob applied for integrated plastics? He could do a surgical prelim, excel, get a good letter, do a research year and match. OR he could match into a general surgery program, excel, and land a plastics fellowship. There are post-doc programs out there for people who fail to match but who are committed to the field and don't want to give up. Yet, we often see the advice on here, "Didn't match the first time? You're boned. You have to do primary care even if you don't want to, but make sure to keep it a secret." That's bogus. After spending 8 years in college and med school, you should be willing to spend an extra few to jump through a few more hoops to get what you want. The problem is that people want a 'sure thing' especially after going through something as traumatic as not matching. The gut reaction is "I want a guaranteed PGY-2 position as soon as possible and will have daily panic attacks until I have one" not "I will spend up to 5 years trying to get into orthodermaneuroopthacologic surgery because that's what I want to do."

If people don't want to do primary care, they shouldn't be in primary care. That's bad for the doctor, the residencies, the profession, and the patients. This case is clear-cut. Bob declined a prelim IM spot (which are VERY competitive, often cushy, and open a lot of doors) in the HOPE of getting a prelim surg spot (which are non-competitive, highly malignant, and is often a dead end road). That's how bad Bob wants to be a surgeon. He should either do a crap ton of away rotations and research this year followed by a research fellowship in the sub-specialty he wants, or else he should apply to general surgery with prelim surgery spots as a backup (which he WILL GET through the match. Getting prelim surg spots in the match is easy. Getting them in the SOAP is notoriously difficult). End of story.

 

[atomi]

double posted.

 

[Chickenandwaffles]

People who complete a PGY-1 prelim med position can typically jump directly into an open PGY-2 categorical spot. You are thinking of PGY-1 surgical prelims where this is usually not the case. IM prelim spots are almost all occupied by people going on to advanced residencies. There is very little competition amongst prelims for PGY-2 IM openings. Whereas in surgery, they are typically occupied for FMGs and people with no other options and without an advanced program, and there is fierce competition for any PGY-2 openings.

If Bob had completed his PGY-1 prelim med, he could have done that, or he could have jumped into an open Anesthesia, PM&R, radiology, hell maybe even optho if that was his original choice. Unless Bob was set on reapplying to his original specialty or surgery (which he clearly isn't), he was a fool not to take that prelim spot. If wanted to do primary care, he could have found an open primary care track PGY-2 IM spot. Now he's got a year of downtime to do what, apply in FM? Come on.

My personal opinion is that Bob should still go for surgery if that's what he wants. I agree with you Mr. Waffles, about the way this forum views everyone's chances at residency as black and white. Subpar applicants fail to match in competitive specialties and find a backdoor to get in them all the time. Maybe Bob applied for integrated plastics? He could do a surgical prelim, excel, get a good letter, do a research year and match. OR he could match into a general surgery program, excel, and land a plastics fellowship. There are post-doc programs out there for people who fail to match but who are committed to the field and don't want to give up. Yet, we often see the advice on here, "Didn't match the first time? You're boned. You have to do primary care even if you don't want to, but make sure to keep it a secret." That's bogus. After spending 8 years in college and med school, you should be willing to spend an extra few to jump through a few more hoops to get what you want. The problem is that people want a 'sure thing' especially after going through something as traumatic as not matching. The gut reaction is "I want a guaranteed PGY-2 position as soon as possible and will have daily panic attacks until I have one" not "I will spend up to 5 years trying to get into orthodermaneuroopthacologic surgery because that's what I want to do."

If people don't want to do primary care, they shouldn't be in primary care. That's bad for the doctor, the residencies, the profession, and the patients. This case is clear-cut. Bob declined a prelim IM spot (which are VERY competitive, often cushy, and open a lot of doors) in the HOPE of getting a prelim surg spot (which are non-competitive, highly malignant, and is often a dead end road). That's how bad Bob wants to be a surgeon. He should either do a crap ton of away rotations and research this year followed by a research fellowship in the sub-specialty he wants, or else he should apply to general surgery with prelim surgery spots as a backup (which he WILL GET through the match. Getting prelim surg spots in the match is easy. Getting them in the SOAP is notoriously difficult). End of story.

As someone with plenty of experience going through the match, prelims, switching, etc I can tell you that the scenario you paint is a pretty rosy one which is not likely. First of all, PGY2 positions in medicine don't open up all the time, they typically don't, and it is entirely hit or miss as to whether one will be available. It is much harder than you think to get a PGY-2 in medicine. PGY-2 positions are also out of match, and out of match positions are much harder to obtain period. Getting into specialties such as rads, gas, ophtho, etc as you mention - do you think people just apply and get them? If you think that, then you are incredibly wrong. While all of those specialties are facing challenges right now, they are very much competitive, and there are plenty of candidates who have actually wanted to match in them from the get go and didn't. Do you think that someone with no specific interest/rotations/letters/research can just go in and swoop in? Highly unlikely.

I'm really not going to continue going on and on with this discussion. So Bob did not match into something he wanted. Big deal. Now he's trying to figure out what to do and move on. Good for him. Let's cut the man some slack and provide helpful advice. Beating him up and trying to somehow read his mind about his intents and what not is not cool imo. It's rather distasteful. I will leave it at that.

 

[rokshana]

not sure why you think a prelim pgy 1 would find it so difficult to continue on in IM…if they performed well during the year and talk to the PD about their interest in staying on, the program will work on getting them a spot…and if somehow it can't be managed then the PD will generally help them find a spot elsewhere…seen it enough to know that is not that unusual.

but the biggest point seems to be that bob probably really isn't interested in IM...

 

[MordFustang]

Just wanted to add something about the chair's letter... I'm a US-IMG and I went through this year's match cycle and matched successfully in a different specialty (not IM). I did however apply to over 100 IM categorical programs in the NE as a backup. The breakdown was about 10 university programs and 90 community/university-affiliated community programs. From my experience, all the university programs required a chair's letter but none of the 90+ community programs/uni-affiliated programs wanted one. I'm not sure if this requirement will change in the coming match cycle but as it stands now, you can definitely apply to IM very broadly without having a chair's letter.

Just my .02 cents

 

[robberbaronista]

Thank you all for your replies!

I believe that the IM program was in fact his home institution. If it is true that he needs a chair's letter this could complicate things. He is planning on doing 3 more rotations before applying, so I'm thinking the first one should be an away sub-i in IM, where he can attempt to get a LOR from that chair, the second could be FM, and the third can be another IM or FM and then he can just apply broadly to both specialties. What do you guys think of this strategy?

Ugh. What a joke. Until you.... heh hem..... Bob, is grown up enough to pony up and admit that you are posting for yourself you should abandon medicine all together. The inability to take responsibility for yourself and your past, even on an anonymous online forum, suggests a critical lack of insight and integrity. You are exactly the kind of person who the system fortunately filters out. Figure out how to admit your mistakes, figure out how to make yourself better, and quit fooling yourself into thinking anyone owes you anything. Own your shortcomings, address them, grow from them. To pretend they dont exist is to exist as an 8 year old parading in a white (albeit still short) coat. Quit pretending to be something you are not and improve upon what you already are.

 

[gutonc]

I think there are several things we can all agree on here.

1. "Bob" is not going to get a LOR/Chair's Letter from his home school IM program.
2. "Bob" has a lot of problems and #1 above ranks pretty low on the list (lack of psychological insight and the inability to reason are #1 and 2).
3. People love to argue about dumb s*** on the internet.

 

[Raryn]

As someone with plenty of experience going through the match, prelims, switching, etc I can tell you that the scenario you paint is a pretty rosy one which is not likely. First of all, PGY2 positions in medicine don't open up all the time, they typically don't, and it is entirely hit or miss as to whether one will be available.

There are six thousand categorical medicine spots each year. If you don't think that some number of medicine interns quit or get kicked out over the course of the first year, you're fairly confused. The number of PGY2 spots that open up every year probably numbers in the low hundreds. I know a number of residents who got PGY2 medicine spots after prelims, for one reason or another.

It is much harder than you think to get a PGY-2 in medicine. PGY-2 positions are also out of match, and out of match positions are much harder to obtain period.t.

It depends on when they become available. PGY2 spots that open up before February ("R spots") can *only* be filled in the match. PGY2 spots that open up later are filled outside the match.

 

[Chickenandwaffles]

Ugh. What a joke. Until you.... heh hem..... Bob, is grown up enough to pony up and admit that you are posting for yourself you should abandon medicine all together. The inability to take responsibility for yourself and your past, even on an anonymous online forum, suggests a critical lack of insight and integrity. You are exactly the kind of person who the system fortunately filters out. Figure out how to admit your mistakes, figure out how to make yourself better, and quit fooling yourself into thinking anyone owes you anything. Own your shortcomings, address them, grow from them. To pretend they dont exist is to exist as an 8 year old parading in a white (albeit still short) coat. Quit pretending to be something you are not and improve upon what you already are.

Pretty harsh words from a med student eh? Especially given that you seem to have a pretty messy situation yourself. This is exactly what I mean. Unless you have some special power we all don't, you have no idea who this person is, and as a med student coming down on someone else with no insight into who they are, it's practically insane. Who do you think you are to make such harsh comments on someone you don't know?

What does the OP have to apologize for? Where is he saying he is owed anything? "abadon medicine all together"

It all sounds delusional. You are talking to the OP like he did something horrendous and terrible. Dude didn't match and didn't want to take a prelim.

You are the one who really needs to come down to reality and get it together imo.

 

[atomi]

Ugh. What a joke. Until you.... heh hem..... Bob, is grown up enough to pony up and admit that you are posting for yourself you should abandon medicine all together. The inability to take responsibility for yourself and your past, even on an anonymous online forum, suggests a critical lack of insight and integrity. You are exactly the kind of person who the system fortunately filters out. Figure out how to admit your mistakes, figure out how to make yourself better, and quit fooling yourself into thinking anyone owes you anything. Own your shortcomings, address them, grow from them. To pretend they dont exist is to exist as an 8 year old parading in a white (albeit still short) coat. Quit pretending to be something you are not and improve upon what you already are.

Yeah man, take that USMLE again and show em who's boss. Oh wait...

 

[atomi]

It depends on when they become available. PGY2 spots that open up before February ("R spots") can *only* be filled in the match. PGY2 spots that open up later are filled outside the match.

Technically ALL Pgy-2 spots have to go through the match unless the spot becomes open after January 30 and starts in July of the current year OR the position starts off cycle prior to January 30. However, programs by and large seem to be ignoring this rule and interviewing for PGY-2 spots outside of the match. Whether they put them in the match as R positions and don't rank anybody to be technically compliant with the rule (but having already selected somebody outside of the match) or just ignore the rule altogether, I don't know, but people were afraid the new rule was going to make it impossible to apply for open positions, and that's clearly not happening. It's a completely ridiculous rule, the main intent of which seems to be preventing programs from filling PGY1 categorical and PGY2 advanced spots outside of the match PRIOR to the match. While unfilled spots and new openings technically fall under the rule, they aren't what the rule was designed to prevent, and nobody seems to be taking the enforcement of violations for these spots seriously, which is a GOOD thing.

That said, yes, there are many, many PGY-2 positions that open up in IM throughout the year (usually a handful open and actively interviewing at any given time), for which an AMG would have first dibs. Chickenwaffles doesn't know what he's talking about for this one point.

 

[GoSpursGo]

I don't think it's worth arguing over minor nuances such as whether every single IM program requires a chair letter, whether someone is "childish" for possibly posing as a "friend" to post on SDN, etc.

Regardless of whether or not you buy that you can get into an IM program without a chair's letter (I wouldn't know if it's not a requirement at community programs as my friends who applied generally only went for large academic programs, where it seems and I still maintain it is largely expected), I still would recommend applying to both IM and FM. A re-applicant with a failed first attempt on Step 2 who doesn't have a home PD willing to go to bat for him really isn't assured of anything, and I would cast as wide of a net as possible. Much better to feel silly and prove us wrong by winding up with 20 community IM interviews than to fail to match a second time and wish that you had applied to FM as well.

 

[rokshana]

I don't think it's worth arguing over minor nuances such as whether every single IM program requires a chair letter, whether someone is "childish" for possibly posing as a "friend" to post on SDN, etc.

Regardless of whether or not you buy that you can get into an IM program without a chair's letter (I wouldn't know if it's not a requirement at community programs as my friends who applied generally only went for large academic programs, where it seems and I still maintain it is largely expected), I still would recommend applying to both IM and FM. A re-applicant with a failed first attempt on Step 2 who doesn't have a home PD willing to go to bat for him really isn't assured of anything, and I would cast as wide of a net as possible. Much better to feel silly and prove us wrong by winding up with 20 community IM interviews than to fail to match a second time and wish that you had applied to FM as well.

didn't think about the community programs not requiring a chair's letter…there should be enough that he could at least get by that issue…

 

[Chickenandwaffles]

didn't think about the community programs not requiring a chair's letter…there should be enough that he could at least get by that issue…

Precisely

 

[NotAProgDirector]

Technically ALL Pgy-2 spots have to go through the match unless the spot becomes open after January 30 and starts in July of the current year OR the position starts off cycle prior to January 30. However, programs by and large seem to be ignoring this rule and interviewing for PGY-2 spots outside of the match. Whether they put them in the match as R positions and don't rank anybody to be technically compliant with the rule (but having already selected somebody outside of the match) or just ignore the rule altogether, I don't know, but people were afraid the new rule was going to make it impossible to apply for open positions, and that's clearly not happening. It's a completely ridiculous rule, the main intent of which seems to be preventing programs from filling PGY1 categorical and PGY2 advanced spots outside of the match PRIOR to the match. While unfilled spots and new openings technically fall under the rule, they aren't what the rule was designed to prevent, and nobody seems to be taking the enforcement of violations for these spots seriously, which is a GOOD thing.

That said, yes, there are many, many PGY-2 positions that open up in IM throughout the year (usually a handful open and actively interviewing at any given time), for which an AMG would have first dibs. Chickenwaffles doesn't know what he's talking about for this one point.

to clarify, only PGY-2 spots that would normally be in the match (i.e. programs that have Advanced spots) need to be filled as R positions. IM PGY-2 positions are not filled via the match.

 

[atomi]

to clarify, only PGY-2 spots that would normally be in the match (i.e. programs that have Advanced spots) need to be filled as R positions. IM PGY-2 positions are not filled via the match.

Yes, thank you for clarifying, and that brings up a good point.

 

[AD28]

Ugh. What a joke. Until you.... heh hem..... Bob, is grown up enough to pony up and admit that you are posting for yourself you should abandon medicine all together. The inability to take responsibility for yourself and your past, even on an anonymous online forum, suggests a critical lack of insight and integrity. You are exactly the kind of person who the system fortunately filters out. Figure out how to admit your mistakes, figure out how to make yourself better, and quit fooling yourself into thinking anyone owes you anything. Own your shortcomings, address them, grow from them. To pretend they dont exist is to exist as an 8 year old parading in a white (albeit still short) coat. Quit pretending to be something you are not and improve upon what you already are.

Spewing such vitriol at someone you don't know shows some great maturity (sarcasm). Not that I have to prove anything to you, but I matched at one of the most competitive EM programs in the country this year. Life is pretty damn awesome

"Bob" is a family friend whose dream of being a surgeon isn't working out so well. I had never heard of this delaying graduation to do more rotations situation he was in, so I turned to this forum for some advice. Honestly, I've only talked to him through family members but as far as I can tell, he received some bad counseling and I guess he underestimated how difficult it would be to land a spot in SOAP. I agree that Bob could have handled this situation differently, but it is what it is, and I wouldn't wish his predicament on ANYONE. Even you, robberbaronista.

Truly, thank you to everyone else for their advice. While he may have burned the bridge at his home institution, he will try to get a letter from a chief elsewhere. Even if he can't, it seems like he can still apply to community programs without it and he will likely apply to FM too, just in case.

 

[mvenus929]

"Bob" is a family friend whose dream of being a surgeon isn't working out so well. I had never heard of this delaying graduation to do more rotations situation he was in, so I turned to this forum for some advice.

FWIW... we had someone at our school delay graduation because he was going for a competitive surgical subspecialty. He reapplied with our class jointly into the surgical field and into a less competitive primary-care field. He ended up matching into the surgical field this year.