While in Prelim Surgery what do I apply to?

[thinker]

I'm a Med3 nonUS-IMG and I want to make sure I understand my options if I go into a preliminary surgery year.

First I would apply and hopefully get in and then sometime DURING the PGY-1 preliminary year i would start applying for something for next year. This something could be one of the following:
1) PGY-2 categorical
2) PGY-2 prelim
3) PGY-1 categorical
4) PGY-1 prelim
5) Internal Medicine PGY-1 categorical
6) Paid Researcher? (I have a Master's degree with publications from Canada)
7) PMS (Professional Male Stripper)

So first question, when does the application process start? i.e. do I have to worry about those things before or during my application to my initial PGY-1 prelim spot?

Second.. If I want to apply to program X.. I can just tick on my application that I want all of the above options (obviously except the IM), and then they would match me into whichever I get? Or I need to select only one of the above options per program? i.e. I can apply to PGY-2 categorical at program X but they won't let me apply to a PGY-1 categorical as back up..

I don't see myself applying for another preliminary spot.. so for me it's either I make it into a categorical surgical spot or I'm packing for something else..

The problem is, even if I want to do Surgery at my current institution they have a pyramidal system in which they kick interns out every year.. no spot is categorical.. so might as well do the same process in the US...


Thanks a lot!!

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[ar2388]

and why dont you just want to apply to a gen surgery program?

 

[thinker]

as in why not apply categorical right away? because I'm a non-US IMG. I figure it's best going prelim first.. did I get ur question right!?

 

[gutonc]

as in why not apply categorical right away? because I'm a non-US IMG. I figure it's best going prelim first.. did I get ur question right!?

You got his question right, but your answer is wrong. You're best bet is to go all in right now. Go for (low end) categorical Gen Surg programs with Prelim as a backup. You're highly unlikely to improve your chances of matching a categorical program (other than the one you match in as a prelim) the 2nd time around.

 

[thinker]

You got his question right, but your answer is wrong. You're best bet is to go all in right now. Go for (low end) categorical Gen Surg programs with Prelim as a backup. You're highly unlikely to improve your chances of matching a categorical program (other than the one you match in as a prelim) the 2nd time around.

Hey

Yes makes sense. I will definitely apply to categorical general surgery. But i would do prelim if that doesn't work out.. so my questions regarding the next step, in my first post, are still valid.

i.e. when I apply after a prelim to a surgery program.. do i apply separately to PGY1 and PGY2 positions or will i be simultaneously interviewing for both options?


Also if can I apply Categorical and Prelim at the same program? is it one interview for both?


Thanks for your help!

 

[ar2388]

once you've done a prelim surgery, i dont think you can apply to another PGY1 surgery rpogram.. that's my understanding at least. you can do a PGY1 in a different specialty though..
someone correct me if im wrong?

 

[Smurfette]

Wrong. You can apply to both PGY 1 (any, including surgery) and PGY 2 programs (if they will accept your surgery prelim year as equivalent to their own PGY 1 requirements).

Most surgery prelims who are looking for positions look for both PGY1 and PGY2 spots in order to increase their odds of finding a position.

 

[ar2388]

oh wow. thats for correcting me. i had no idea someone could do 2 PGY1 surgery years.

 

[choweee]

You can do as many PGY-1 surgery years as you want, lol! Hospitals don't mind the cheap labor. If you look at the NRMP data, plenty of hospitals have a dozen prelim spots open for anyone who wants it. From community hospitals to academic places like BIDMC.

I'm doing my TY at a small community hospital and there are many IMGs here (both US and non) who are doing a prelim surgery here to increase their chances of matching categorical here. They did apply broadly categorical before, but had to scramble into a prelim.

 

[thinker]

I'm doing my TY at a small community hospital and there are many IMGs here (both US and non) who are doing a prelim surgery here to increase their chances of matching categorical here. They did apply broadly categorical before, but had to scramble into a prelim.

any success stories?

 

[Winged Scapula]

You can do as many PGY-1 surgery years as you want, lol!.

Actually that is no longer correct. As of 2002, the ACGME and the American Board of surgery no longer allow someone to do more than two nondesignated pre-lim years. This is to try and prevent the long history of hiring people for cheap labor with no intent of providing a full surgical training.

 

[Law2Doc]

any success stories?

I know several folks who did prelim surgery and managed to transition to categorical or a surgical subspecialty at the same hospital after a stellar year, sometimes still involving a repeat of the intern year. I've not personally seen many make the jump successfully from prelim surgery to categorical at another program, and for many it's likely a dead end. Basically it's going to involve going above and beyond expectations for the year, blowing away the absite, becoming the intern all the attendings like working with, and maybe being a bit lucky that there is an open spot. To get a prelim surgery spot you really just have to be a warm body with a good work ethic and no big red flags, but for the next step you are going to have to show a lot more, and positive word from all your attendings and PD will matter hugely. Basically it's a year long audition, and you'll have to be on your game 24/7, always ready to roll up your sleeves and dive in, even when it's something your categorical counterparts might not be asked to deal with.

 

[Law2Doc]

Actually that is no longer correct. As of 2002, the ACGME and the American Board of surgery no longer allow someone to do more than two nondesignated pre-lim years. This is to try and prevent the long history of hiring people for cheap labor with no intent of providing a full surgical training.

Well, if the third PGY1 year is "designated", that's still a lot of cheap labor.

 

[gutonc]

Well, if the third PGY1 year is "designated", that's still a lot of cheap labor.

Yeah, but there didn't used to be any limit on it and IMGs (usually with visa issues) would wind up doing 4 or 5 "PGY1" years at crappy programs with the promise of "maybe next year" before they finally gave up.

 

[thinker]

What would be an ideal Surgery Prelim program?

I'm seeing in the NRMP a variety of scenarios.

Some programs are big name, with lots of prelim spots (9+) that are all filled out
Some programs are average, with lots of prelim spots with barely any filled out (2/13 for example)
Some programs have just 2 prelim spots that are either completely or partially filled out

How do we know if a program has non-designated PGY2 spots? or have mandatory research years that allows residents to go in and out of the program and possibly allows a prelim resident to sneak in at the PGY2 or PGY3 level?

Thanks!

 

[Law2Doc]

What would be an ideal Surgery Prelim program?

I'm seeing in the NRMP a variety of scenarios.

Some programs are big name, with lots of prelim spots (9+) that are all filled out
Some programs are average, with lots of prelim spots with barely any filled out (2/13 for example)
Some programs have just 2 prelim spots that are either completely or partially filled out

How do we know if a program has non-designated PGY2 spots? or have mandatory research years that allows residents to go in and out of the program and possibly allows a prelim resident to sneak in at the PGY2 or PGY3 level?

Thanks!

In general, if you are applying for prelim surgery "ideal" isn't your deal breaker issue. A bigger program has more of a chance to lose someone categorical, meaning more spots a star prelim could try and jump into. (they usually figure out coverage for mandatory research years well ahead of time, so these spots tend not to catch them by surprise, but people sometimes get pregnant and choose not to return, or leave for more lifestyle oriented paths, or contract a debilitating illness, or relocate due to family). A smaller place may mean all the attendings know each prelim better and can help if they like you. Benign and malignant reputations are pretty important when dealing with these potentially grueling dead end spots as well.

 

[thinker]

Thanks Law2Doc

Are Surgery prelim spots very difficult to attain in Johns Hopkins or other big name places? Do they offer any advantage for matching at a smaller program later on?

Also if one did a PGY1 prelim then did a research year, can he then theoretically at least go back to PGY2? I will need a visa btw

 

[BlondeDocteur]

Most of the bigger name places with only a handful of spots-- 2-4-- are looking for AMGs only. There are plenty of very good people who didn't match into a surgical subspecialty who are in the SOAP, and thats who they're looking for.

The big-name places that have multiple spots take AMGs and IMGs, and those prelims tend to be more abusive. Less famous places take IMGs, except at very small community programs where they can't afford a wild card.

Look at the websites of the programs of interest-- are there any IMGs on the roster at all?

Know that prelim surgery is a dead end, surgically speaking, for most people who do it. There are about 450 non-designated PGY-1 prelims in the country. Judging from the places where such things are advertised, there are about 10-20 categorical intern slots, and categorical R2 spots, on the open market annually. Other places fill from within whenever someone quits or is fired. So, let's say 50/450 make it into a surgical field without having to repeat their intern year. A certain number-- lets say 40-50-- will be successful in the Match and obtain a new categorical surgery position; they are mainly AMGs. At best, about 25% are successful.

What is invaluable, though, as an IMG is that glorious year of USCE the prelim represents. Once you get your foot in the door and get this position-- even if it's really crappy-- it's an immense boost to your applicatiions in, say, a primary care field. It's harder to match FM/ IM as an IMG than many people think, but doing well in a prelim really increases your chances.

Also, there are separate program #s on ERAS for categorical versus prelim positions at the same place.