Failing to obtain a prelim + effect on rank list

[darthmeow]

Hi all, I'm an MSIV applying for Neuro this cycle.

I searched for an answer to this in prior threads but couldn't figure it out. I know what would happen if I apply to Advanced/categorical neuro programs and preliminary programs, and match into a preliminary but no neurology program. I would be placed into a prelim for PGY-1.

However, how does the Match work if you match into a particular neurology program but no associated preliminary? For example, let's say UCSD (an advanced program) is my #1, and I interviewed at 4 prelims. Let's say Loma Linda is my #2, which is a categorical program. So, my algorithm would go:
1) UCSD
a) prelim1
b) prelim2
c) prelim3
d) prelim4
2) Loma Linda
3)...

If it was determined that I was to match at UCSD, and not match at ANY preliminary program, would the computer go instead to my #2 and match me there? Or would it leave my PGY-1 year hanging and match me at my #1, UCSD anyways?

Thanks in advance!

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[afugazzi]

You would match at UCSD and then have to scramble for a prelim. So definitely important to rank ALL of your prelims under each advanced program, unless you'd rather scramble into a surgery prelim or something.

 

[darthmeow]

Thanks for the reply. So in a sense categorical programs are "safer" to rank higher is the impression I'm getting.

As a follow up question, maybe you or someone else could help me out. I am concerned about obtaining enough preliminary interviews. I have received 7 neurology interview invites, but 0 prelim interviews. I have in fact been rejected by 2 prelim programs already. I applied to about 15 prelim programs (not counting the "linked" med-prelim/neurology ones), almost exclusively in California, where I'm from. Am I making a mistake, and should I apply to more prelims?

 

[typhoonegator]

I'd think about it. I know several people who have matched at top 5 places but didn't get a prelim. Good people. Obviously great applicants. Still didn't get a prelim. One of them had to take a year off. Sucked.

 

[OddNath]

You would match at UCSD and then have to scramble for a prelim. So definitely important to rank ALL of your prelims under each advanced program, unless you'd rather scramble into a surgery prelim or something.

Yes, but remember- a surgery prelim year does NOT count for advanced neurology residency. So, scrambling for prelim is that much more painful for neurology folks- you only have IM and transitional spots available to you, which also happen to be the toughest prelims to get (compared to surgery prelim).

 

[Captain DO]

Wait...so the neuro residency you're applying to doesn't take care of that for you? Applicants have to apply and match into the (required) prelim year separately? that makes no sense to me... they should organize that for the incoming residents...

 

[typhoonegator]

Wait...so the neuro residency you're applying to doesn't take care of that for you? Applicants have to apply and match into the (required) prelim year separately? that makes no sense to me... they should organize that for the incoming residents...

Sure, and they should pay you $100K a year so you'll be happy and focused at work. Some residencies do offer categorical positions with both prelim and advanced match included. Others have a more fluid arrangement. All residencies want you to be fully matched and ready to go, but many of them can't do much to guarantee that happens.

If you're a department of medicine, you want to fill your intern class with the best people out there. What if your hospital has a crappy neurology residency affiliated with it? Would you rather "take one for the team" and accept those neurology prelims, or would you rather take your pick of the myriad derm and rads applicants who have better scores and better LoRs to fill those spots, even though they will be leaving to go to their Harvard advanced positions after the year is over? What if you're that same department of medicine, and you have the residency directors of every advanced residency in your hospital begging you to take their applicants over everyone else? Something has to give.

So yeah, it's a dumb system, but on a macro-economic scale, it is operating exactly as the market forces dictate.

 

[Captain DO]

Sure, and they should pay you $100K a year so you'll be happy and focused at work. Some residencies do offer categorical positions with both prelim and advanced match included. Others have a more fluid arrangement. All residencies want you to be fully matched and ready to go, but many of them can't do much to guarantee that happens.

If you're a department of medicine, you want to fill your intern class with the best people out there. What if your hospital has a crappy neurology residency affiliated with it? Would you rather "take one for the team" and accept those neurology prelims, or would you rather take your pick of the myriad derm and rads applicants who have better scores and better LoRs to fill those spots, even though they will be leaving to go to their Harvard advanced positions after the year is over? What if you're that same department of medicine, and you have the residency directors of every advanced residency in your hospital begging you to take their applicants over everyone else? Something has to give.

So yeah, it's a dumb system, but on a macro-economic scale, it is operating exactly as the market forces dictate.

Gotcha.
Just the way the world works...
I would imagine that would scare some potential neuro applicants away. Having to match at 2 different places seems like twice the amount of work, money, time. Most of all though, the thought of not matching a prelim is rather unsettling...What happens then...you just wait til the next match and try your luck? Must you forfeit your spot at the neuro residency? I hope this is not a common problem for neuro applicants. Goodluck OP...im pullin for ya.

 

[Sitagliptin]

I have 4 interviews out of 15 scheduled where the program is advanced and I had to apply to their "med prelim" separately. All of them scheduled me an interview with the med program on the same day. Of those four, two use phrases like "reserved PGY-1 spots" or "guaranteed pgy-1 spots" (where the number of guaranteed spots = number of neuro residents they have per year). One of those two programs is one of my top choices. None of these are "top ranked programs" in medicine or neuro as far as I know.

My question is: if a program says that it has PGY-1 medicine spots that are reserved for neurology, does it mean that a person who matches in neuro at that program gets the prelim no matter what unless they opted to go to some other prelim that they placed higher on their supplemental list, or can the medicine program refuse an applicant a "reserved" prelim even if the neuro program matches them?

I know this is a question I should ask the programs directly, but I'm concerned that if I do, I'll look bad/lacking in confidence and hurt my chances before I interview. Sorry if this question seems panicky, but this thread spooked me a bit.

 

[M4NOBMW]

my understanding is that if the neuro and medicine program has pre-set all the spots for the neuro program then its an automatic link, the caveat being that some programs have only guaranteed say 2 out of 6 of the medicine spots for neurology and so you are essentially interviewing against the other neuro candidates for just 2 guaranteed spots. The vast majority of programs that are doing this will say on their curriculum overview whether your first year is at their hospital or not.

On the same note, anyone know if the interview these programs set up with the prelim also count toward being ONLY a prelim (do the first year, then go somewhere else) or is that usually a different selection process.

 

[StartingLine3]

I got an interview today from a prelim program I was very excited about. I literally got on interview broker within 2 minutes of getting interview and there were no spots. I saw that all of their interview dates that were available for me were like 12-15 spots on wait list. Should I expect to actually interview there? It seems kind of unfair to get interview to a place and then find out that there really are no interview spots. I signed up for spot in December with 12 people ahead of me. I will just hope I get opportunity.

 

[tirral]

My question is: if a program says that it has PGY-1 medicine spots that are reserved for neurology, does it mean that a person who matches in neuro at that program gets the prelim no matter what unless they opted to go to some other prelim that they placed higher on their supplemental list, or can the medicine program refuse an applicant a "reserved" prelim even if the neuro program matches them?

I know this is a question I should ask the programs directly, but I'm concerned that if I do, I'll look bad/lacking in confidence and hurt my chances before I interview. Sorry if this question seems panicky, but this thread spooked me a bit.

First, I don't think asking this would make you look bad.

To your question - it depends. My program offers a guaranteed prelim year for those who match Neuro here. The Neurology department has an agreement with the Medicine department, and IM will set aside the exact # of spots that we need for Neuro residents to do their prelims.

At least, that's how it worked five years in a row. Last year, something went awry with the rank list, and half our incoming interns didn't get the "guaranteed" prelim spot. They ended up further down on their prelim/TY rank list. As far as I know, none of them scrambled, and most of them ended up staying at their home institution for prelim. My program director was not happy with IM about that. Apparently the problem is fixed and this year things should be back to guaranteed.

The punchline is, despite anyone's best intentions, random match errors can happen, either due to miscommunication between Medicine/Neuro PDs, or some other chance element. You should have as long a prelim list as you need to ensure that you will match somewhere that you don't hate for intern year.

At my med school, the prelim year was not competitive so it was easy to just rank home institution last and I had a guaranteed fallback plan. I realize many are not so lucky.

 

[Sitagliptin]

Most guaranteed prelim neuro programs have their own category in the match separate from the school's "general" IM prelim. Did your school not have this, or was it another problem?

 

[tirral]

The Medicine program would set aside x/2 spots in the "Neuro Prelim" category and x/2 spots in the "IM - Transitional Year" category, where x = number of incoming Neuro residents.

I am not privy to the specifics, but if I had to guess, I would say the TY spots probably fell through somehow.

 

[typhoonegator]

I have 4 interviews out of 15 scheduled where the program is advanced and I had to apply to their "med prelim" separately. All of them scheduled me an interview with the med program on the same day. Of those four, two use phrases like "reserved PGY-1 spots" or "guaranteed pgy-1 spots" (where the number of guaranteed spots = number of neuro residents they have per year). One of those two programs is one of my top choices. None of these are "top ranked programs" in medicine or neuro as far as I know.

My question is: if a program says that it has PGY-1 medicine spots that are reserved for neurology, does it mean that a person who matches in neuro at that program gets the prelim no matter what unless they opted to go to some other prelim that they placed higher on their supplemental list, or can the medicine program refuse an applicant a "reserved" prelim even if the neuro program matches them?

I know this is a question I should ask the programs directly, but I'm concerned that if I do, I'll look bad/lacking in confidence and hurt my chances before I interview. Sorry if this question seems panicky, but this thread spooked me a bit.

Not at all inappropriate to inquire, clearly it helps you plan your interviews. Remember that if there were always as many "guaranteed" neuro prelim spots as residency spots, then the program would be categorical. More often, there are agreements to set aside a certain number of spots, because there are always people that want to do prelim years somewhere else close to home or whatever. The problems can arise when medicine programs have these sort of deals with several departments, and then a funny year comes along where everyone wants to get prelim years in their advanced locations. Someone will lose in that situation, and it ain't the medicine program. I was "guaranteed" a prelim spot in my advanced program, and didn't get it.

So yeah, they can refuse, or forget to rank you, or be forced to choose others ahead of you, or just screw up the ranking.

 

[Sitagliptin]

Yikes. I was stupid and didn't apply to many prelims outside the so called guaranteed ones and hadn't gotten any interviews from those extra prelims, so I guess I could be in trouble for the advanced programs I interviewed at.

Out of curiously, typhoonegator, did the prelim at your advanced program have a special "neuro prelim" category in the NRMP when you ranked it in your supplemental list? Can you tell me more about the circumstances behind what your advanced program told you re: prelims? It would be extremely helpful for decision making for my rank order list.

 

[typhoonegator]

Yikes. I was stupid and didn't apply to many prelims outside the so called guaranteed ones and hadn't gotten any interviews from those extra prelims, so I guess I could be in trouble for the advanced programs I interviewed at.

Out of curiously, typhoonegator, did the prelim at your advanced program have a special "neuro prelim" category in the NRMP when you ranked it in your supplemental list? Can you tell me more about the circumstances behind what your advanced program told you re: prelims? It would be extremely helpful for decision making for my rank order list.

Too long ago to inform your current situation. San Francisco Match early match days.

 

[Sitagliptin]

Thank you so much for the info!

 

[darthmeow]

Are people getting many prelim interviews yet? I'm at 5, but all 5 of these are because of the neurology program inviting me, and the Medicine department doing an informal interview the same day. Do prelim invites tend to go out later in the season? Not sure if these informal interviews that I do have make it less likely or not to match concurrently with an advanced program at a different institution.

On a related note, how many prelims (per program) is it generally considered to be "safe" to rank (i.e. you will likely match somewhere for PGY-1)?

Thanks for your help everyone.

 

[Sitagliptin]

I'm keenly interested in this as well. I dug around the forums and I saw a 2013-era thread that states there should be 1 prelim for every 3 advanced (which seems damn generous), with some people disputing that. Another said up to 10; but I wasn't sure how many advanced progs each person was applying to.

The thread:

http://forums.studentdoctor.net/threads/interview-invites-for-2013.1037039/#post-14535903

I plan to have my worst case scenario for the advanced programs be just ranking the linked prelim specific to the institution and all the other linked prelims I've interviewed at under each advanced program's supplemental list. Hopefully I get a few freestanding prelims as well.

 

[StartingLine3]

I have had to work pretty hard to get myself in a position where I am happy with the number of preliminary interviews I have received. These felt really hard to get. I was not proactive in soliciting neurology interviews, but put a ton of effort into being proactive for prelim interviews. I have been told by program directors and by people within my home neurology program that failing to get a prelim spot for an advanced neurology is common. This is common because we have to compete against other competitive subspecialties for these positions and most schools do not have a lot of prelim spots. In addition, a lot of programs see neurology as a categorical subspecialty and will not interview applicants for prelim spots if their program is categorical. One consistent strong piece of advice I got was that if you do not have enough prelim interviews to feel comfortable matching at a program do not rank that program over a categorical. You put yourself in a position to have to scramble for prelim spot. There will likely be spots open, but they are highly likely to be in tough, undesirable programs (such as some in New York where you might be drawing labs and hanging saline drips). In addition, I have been told to not count on preliminary interviews you have gotten at one advanced neurology program for another neurology program. For example, if you got a prelim interview at neurology program A you will likely only match at that prelim if you match for neurology at program A. This is especially true if you got the prelim interview through contact with the neurology program. Therefore, if you have not received prelim invites outside of concomitant neurology invites then you may be in a position where you are only realistically one deep in matching to a prelim spot for each program. To me that is a dangerous risk. One thing I have been doing is looking at advanced neurology programs and seeing what percentage did their pgy1 at the same place. This can kind of give a sense of how fruitful the prelim offers they give through the neurology department are.