Prelim-categorical?

So inevitably I have to ask this. What happens if someone does a PGY-1 prelim/transitional, and they do not match to the PGY-2 specialty they wanted so they decide to continue as a categorical and later do a fellowship. If they do not want to stay at their institution, what are the options-re doing PGY-1?

Can someone apply through the match, match as a PGY-1 but get credit and continue as a PGY-2? Any advice would be appreciated. Thanks.

Dermpath said:

So inevitably I have to ask this. What happens if someone does a PGY-1 prelim/transitional, and they do not match to the PGY-2 specialty they wanted so they decide to continue as a categorical and later do a fellowship. If they do not want to stay at their institution, what are the options-re doing PGY-1?

Can someone apply through the match, match as a PGY-1 but get credit and continue as a PGY-2? Any advice would be appreciated. Thanks.

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If your transitional/prelim program is nice (or has a dropout /fail) they CAN pick you up. This happens often with derm prelims in medicine programs. It is something you should talk to your current PD about.

You CAN do a lateral transfer to another program. Staying in the field you just completed is hard enough. Going lateral do a different specialty and counting your intern year as their requirement is harder. If your current prelim program likes you, but has no room for you, they can help you arrange a switch. Otherwise, you gotta know someone in some other program that will take you.

Often, and this is only from my experience with colleagues, if your prelim program doesn't take you, its back to intern year at another categorical program.

SO:
1. Im in prelim year in medicine, can I continue categorical medicine?
Usually yes.

2. Im in prelim year in medicine, can I lateral shift to another medicine program as categorical?
Probably yes, but harder

3. Im in prelim year in medicine, can I start some other specialty categorical next year?
Probably not. Its really hard, but if you or your PD have a connection, they might make it happen. You'd probably be going into a program where people get fired or quit, so be ready for not-the-greatest.

4. Im in prelim year in medicine, can I start a Derm categorical next year?
No. You'd have to start over, unless you get super lucky or have a back door.

OveractiveBrain said:

3. Im in prelim year in medicine, can I start some other specialty categorical next year?
Probably not. Its really hard, but if you or your PD have a connection, they might make it happen. You'd probably be going into a program where people get fired or quit, so be ready for not-the-greatest.

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The primary difficulty in this scenario is that you probably won't have letters specific to the new specialty and probably won't have any opportunity to get them while you're a prelim. Nor will you have much chance to interview...if you're "lucky" you can use some/all of your vacation to do that in December/January but that's kind of a crappy way to spend your vacation.

That said, I knew a couple of people who switched to new advanced programs (that they had considered but went for IM instead) after intern year (in a categorical program, not prelim though, primarily because our institution doesn't have any non-designated prelim spots).

4. Im in prelim year in medicine, can I start a Derm categorical next year?
No. You'd have to start over, unless you get super lucky or have a back door.

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Are there Derm categorical programs? Like PGY1-4 programs? I was under the impression that all Derm programs (or at least the vast majority) were advanced, in which case, you could do the interview during intern year thing and then ask if places had a spot open for the next academic year (I know a couple of people who have scored spots like this) or just match for the following year and take a year off. That said, it's not like your competitiveness for a Derm spot is going to increase after a year of doing IM so it may be a wasted effort.

gutonc said:

The primary difficulty in this scenario is that you probably won't have letters specific to the new specialty and probably won't have any opportunity to get them while you're a prelim. Nor will you have much chance to interview...if you're "lucky" you can use some/all of your vacation to do that in December/January but that's kind of a crappy way to spend your vacation.

That said, I knew a couple of people who switched to new advanced programs (that they had considered but went for IM instead) after intern year (in a categorical program, not prelim though, primarily because our institution doesn't have any non-designated prelim spots).



Are there Derm categorical programs? Like PGY1-4 programs? I was under the impression that all Derm programs (or at least the vast majority) were advanced, in which case, you could do the interview during intern year thing and then ask if places had a spot open for the next academic year (I know a couple of people who have scored spots like this) or just match for the following year and take a year off. That said, it's not like your competitiveness for a Derm spot is going to increase after a year of doing IM so it may be a wasted effort.

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Hi,

Well maybe my question was misinterpreted. I only asked one question, I am not sure who posted the other questions that you were referring to.

My question is the following-I was hoping very much to get into dermatology, but I am not sure if it will happen. I feel really down about this, as I have wanted to do this for a long time and is mostly what I prepared for in medical school. So I am completing my prelim year, but if I apply again and can't get in Derm, what are my options?

So that's why I asked, what if I go into a categorical medicine and just decide to stay in categorical medicine, and pursue a medicine fellowship (I have thought about heme-onc). I have seen some open PGY-2 spots, but not ones I'd consider. If I go through the match for IM, and say I match in a program, would I be able to get credit for my PGY-1? OR do I have to repeat my PGY-1? Thanks.

This is a common problem. From the details above, I assume you applied to derm and prelim last year, and matched only prelim, which is what you're completing now.

As has been mentioned before, it's hard to get a derm spot from your position. You need to make yourself more competitive for derm -- hopefully you did so from March to June of your MS IV, since a prelim year is not really going to make you stand out nor offer much time for research, etc. The one thing you could try to do is to get known as much as possible by your local derm program (assuming that there is one).

Presumably, you have applied for derm programs in this year's ERAS process. One of three things happen -- you get no interviews, and hence you know you have no chance of getting derm; you get a few interviews, and know there is some chance but very less than certain, or you get lots of interviews and it seems likely you'll match to derm.

In the former, you then need to figure out what you want to do. If finishing IM is is, then you would start looking for open PGY-2's to start July 2012. Those usually start appearing in Dec/Jan, which is "convenient" since that's when you'll know you have no derm interviews.

Plan A is seeing if your home program has a spot, assuming you'd want to stay there.

Plan B is trying to find a PGY2 elsewhere. There is no centralized list of spots -- it's all hard work / word of mouth. Your IM PD might be able to help you. As mentioned above, staying at your current program is sometimes the easiest to arrange but totally depends on a spot being available.

Plan C is applying into the match. Note that you'll be late for this in Dec/Jan. There are two reasons for applying into the IM match -- 1) you could match somewhere, or 2) programs could review your application, realize that you could be a PGY-2, have a PGY-2 spot open that they are not advertising, and consider filling it with you. If you match into a PGY-1, you don't "get credit" for your PGY-1 and skip ahead -- you've filled a slot that is 12 months of PGY-1 work, and you'd be repeating your PGY-1. That's why finding an open PGY-2 is much better.

If you get derm interviews, the process gets trickier. Now you need to wait until mid March before you know if you match or not. Obviously, if you match, you're all set (you'd have one year off between the end of your prelim and derm, since you'd be in the match for a July 2013 derm spot -- but you could do anything with that year). But if you don't match, you are now quite late to start looking for open PGY-2 spots. It still is certainly possible, but can be a rush, options might be much more limited, and this could impact upon your ability to get Heme/Onc in the future.

So, you're at a tough crossroads. Derm is what you want to do. Trying one more time is possible, but could make finding a PGY-2 medicine spot more difficult. Looking for both derm and medicine at the same time is possible, but if you get a medicine PGY-2 offer you're often stuck making a tough choice -- taking the IM spot and giving up on derm, or letting the IM spot go and hoping for the best.

In the above referenced scenarios, does it make sense to go to as good of a prelim program (ie academic institution) in case I wanted to stay? I am wondering if the more academic places have less attrition. How often to PGY2 spots "open up" to allow for a prelim to stay?