Hi, i am nearing the end of my second year of prelim surgery. My program schedule is that the prelims do the same schedule as the categoricals, so I am technically finishing PGY2 like the categoricals. My residency has offered to let me do 1 more prelim year if I don't get a categorical spot, meaning if I do it I'll have finished PGY3 same as the categorical PGY3. If for whatever reason I am still unable to get a categorical spot, is there anyway for me to work as a physician or surgeon in any capacity with PGY3 general surgery training?
You need to move into a categorical slot in another program if your program cannot accommodate you. Your chances of doing this depend on your program director's willingness to make some calls and fully support your move to another program.
If you want to practice surgery, you have to be BE (finish a surgical residency with minimum five clinical years). Yes, you might be able to get into a critical care fellowship but most of those fellowships will require that you have a PGY-4 year at a program before they accept you. The other thing that might happen is you will run out of eligibility for postgraduate medical training funding if you keep doing preliminary years (seven is max).
Go to the APDS website (do a Google search) and start applying for categorical positions at the PGY-3 and PGY-4 level right now with the assistance of your current program director. Be sure that you weed out the malignant programs as some of them will routinely have openings. You should also make sure that your ABSITE grades and evals are top notch since you are going to have to sell yourself at a later time than most people.
Your program director (and chairman) should become your best advocates at this point making sure that prospective programs know that they just couldn't accommodate you (not that you are a poor resident). They should also want you to be able to practice surgery since you have been in their program for the past two years.
Finally, if you are not able to get something categorical in surgery in the next year, it's time to move into another specialty that you can obtain BE/BC in. Again, you are facing end of eligibility for postgraduate funding because of the number of preliminary years that you have completed.
There is no automatic or easy "conversion" to categorical from preliminary surgical slots. This a risk that anyone in a prelim slot will be taking when they accept a prelim slot. After one year of prelim, you have to make sure that you either have a categorical slot in your program or you re-enter the match (or outside the match) apply for a categorical slot elsewhere. Your competitiveness for a categorical slot is going to rely heavily on your evaluations and in-service exam scores so make sure that these are top level.
While a fair majority of people who are decidedly interested in surgery who are in prelim slots can often get into categorical positions, these categorical slots become very rare after PGY-2 level. (I actually know of few programs that allow a prelim three years.) Most people who have been able to thrive for two years in surgery,will tend to finish the residency. After three years, it's almost unheard of to leave a residency position unless you just aren't interested.
To the OP: get busy right now and find something categorical at the PGY-3 level that starts in July. Sometimes you can get lucky but don't spend a third year in a prelim slot unless your PD knows for sure that they are going to pick you up for categorical next year or you just can't find anything categorical out there.