Advice on returning to residency after break

[MCB2014]

Hello...

To make a long story short: I left residency after intern year (neurology) to do a postdoc (neurobiology). I am now looking into returning in a different specialty (psychiatry), for the 2014 match. This would mean a total of two years in between finishing PGY-1 and starting again. For anyone with experience in similar situations, (1) will I need to repeat my PGY-1 year, since it did not include psychiatry training, (2) what barriers can I expect to getting interviews and matching given my meandering back and forth between medicine and basic science, and (3) how concerned should I be that my Dean's letter, STEP1/2 scores, letters of recommendation, electives, and academic performance were all geared towards Neurology during medical school, and are now outdated?

I know it is sort of an atypical situation, but any advice from my future colleagues will be much appreciated!

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[Yoyomama88]

pretty sure you can start psych as a pgy-2. Your intern year will count. Maybe you might need a few LORs from psych docs? My guess is the rest shouldn't matter.

 

[notdeadyet]

Typically, for someone in your circumstances, they tend to come in as PGY-2's and use elective months to make up any deficits that you may have compared to your counterparts.

 

[MCB2014]

My guess is that the there are not that many PGY-2 positions open each year, unless someone leaves a program after PGY-1, as I did. Maybe I will have more options available to me if I apply as a PGY-1?

 

[TexasPhysician]

Hello...

To make a long story short: I left residency after intern year (neurology) to do a postdoc (neurobiology). I am now looking into returning in a different specialty (psychiatry), for the 2014 match. This would mean a total of two years in between finishing PGY-1 and starting again. For anyone with experience in similar situations, (1) will I need to repeat my PGY-1 year, since it did not include psychiatry training, (2) what barriers can I expect to getting interviews and matching given my meandering back and forth between medicine and basic science, and (3) how concerned should I be that my Dean's letter, STEP1/2 scores, letters of recommendation, electives, and academic performance were all geared towards Neurology during medical school, and are now outdated?

I know it is sort of an atypical situation, but any advice from my future colleagues will be much appreciated!

I do not know how competitive you are, but UTMB Galveston sometimes adds an additional PGY-2. I'd contact them first. UT-Houston has had fluctuations in their classes sizes and are considering larger classes. Baylor has had turnover in recent years of people leaving. Those are in-order the TX programs id contact with TT El Paso being #4.

Some programs in the NE have dedicated PGY-2 spots.

 

[MDchouette]

We had a resident do a full neuro residency before starting as a PGY2. I agree with those who have said you should be able to start as a PGY2. It's worth it to avoid being an intern again!

There are a number of programs that offer PGY2 spots every year -- Hopkins comes to mind and I have heard likes getting people who are switching from other fields -- but do a search on here and you'll find a longer list. U Maryland might be on there too, but I could be wrong.

 

[MCB2014]

That is very helpful, thank you! I'll take a look at what might be available. Competitiveness is hard for me to gauge at this point. Academically, I've done well, though not perfect, I do have a PhD, and may get at least one nice publication out of my postdoc. Family is on the West Coast, and I'd prefer to be closer to them as they are getting older, so this may make things more challenging.

 

[MCB2014]

Would it be best to contact the Program Director's directly?

 

[whopper]

The average resident getting into psychiatry doesn't have a post-doc, and several programs will likely have the academic equivalent of salivation upon seeing cheesecake at the idea of getting someone so well educated in neurology into a psychiatry program.

I agree that avoiding being an intern is a good thing....but, and mind you I'm playing devil's advocate, so take my tone with a grain of salt....

If you nix PGY-1, you could be limiting yourself in terms of your learning opportunities. If you apply as a PGY-2, you'll likely more than decimate the number of programs willing to take you since very few programs have PGY-2 spots open. If you get into a program as a PGY-2, if you're clinically rusty and you likely will be (nothing against you-I would be and so would a lot of people I know that are good physicians), expect to experience a lot of frustration while being on a accelerated learning curve and be in situations where the nurses are baffled as to why you don't know how to do something simple like put orders into the hospital's EMR system when you're a PGY-2 and you should've already learned this stuff as a PGY-1, and then hearing them and attendings treat you like the village idiot until you are on track with your colleagues. You'll likely get there, it'll take maybe 1-3 months.

 

[MCB2014]

The average resident getting into psychiatry doesn't have a post-doc, and several programs will likely have the academic equivalent of salivation upon seeing cheesecake at the idea of getting someone so well educated in neurology into a psychiatry program.

I agree that avoiding being an intern is a good thing....but, and mind you I'm playing devil's advocate, so take my tone with a grain of salt....

If you nix PGY-1, you could be limiting yourself in terms of your learning opportunities. If you apply as a PGY-2, you'll likely more than decimate the number of programs willing to take you since very few programs have PGY-2 spots open. If you get into a program as a PGY-2, if you're clinically rusty and you likely will be (nothing against you-I would be and so would a lot of people I know that are good physicians), expect to experience a lot of frustration while being on a accelerated learning curve and be in situations where the nurses are baffled as to why you don't know how to do something simple like put orders into the hospital's EMR system when you're a PGY-2 and you should've already learned this stuff as a PGY-1, and then hearing them and attendings treat you like the village idiot until you are on track with your colleagues. You'll likely get there, it'll take maybe 1-3 months.

Thanks for your input whopper, it's helpful to know how this is viewed from an attending stand-point. If my experience returning to the wards as a student after finishing graduate school is predictive, I expect to feel like the village idiot (again) for a little while regardless of whether I start as a PGY-1 or a PGY-2. That's ok, it will pass, and since I know that I'm not an idiot (I'm not taking offense), I can ignore how others will treat me. The point about limiting my learning opportunities and the positions available to me is more concerning to me, so I will have to think that over. I liked neurology, and don't hate internal medicine, so I could cope with repeating PGY-1 and doing those inpatient blocks again. I'm not in a rush, I'll be a lot older than my colleagues anyway, one year won't make a huge difference.

 

[TexasPhysician]

Something else to consider is that you can't start again as a PGY-1 and get full funding. The competitive programs in my region would likely automatically reject your PGY-1 application do to only 3 years left of funding. Competitive programs with a PGY-2 position would appreciate the phd and full funding.

 

[whopper]

I don't know if the dynamics have changed. Is it possible to apply and say you're open to a PGY I or II, or do you have to stick with just one?

Another factor, some programs would rather have a fresh new PGY-I because, frankly, they usually do more calls. Where I did residency, a PGY-II came on-board and the head of the department allowed her to come in outside of the MATCH if she agreed to do a PGY-1 call schedule. As below the belt as that might've seemed, I knew what was going on and that department head needed the human-work-hours filled based on the dynamics of the existing residents and attendings. That dept head could've simply told that PGY-II no.

Point is you might have some luck just calling programs up, briefly telling your situation and asking about joining possibly outside the MATCH, though remember, if you do so, the MATCH offers protections. You could be possibly getting a good deal you might not have with using the MATCH or getting a very bad one using that method.

 

[OldPsychDoc]

Some of the dynamics have changed, Whopper. Out of Match appointments need to begin before February 1 due to the "All In" policy--otherwise, if a program is putting any positions into the Match, they must all go via the Match.

 

[MCB2014]

I was not aware of the full-funding issue, and the rest I guess will depend on the programs, what their needs are, and what they are willing to do. Guess I'll just start contacting them and see how it goes! Thanks for all the advice, very helpful.

 

[psychattending]

As others have said, you can start as a PGY2 but also as a PGY1. AS OPD indicated you cannot take an Out-of-Match position if you are doing a normal July 1 start. I would recommend that in your personal statement you indicate that you could do either as this will increase your and the program's flexibility. I would also recommend that you explain well why you chose to drop out of neuro residency mid-stream and leave the practice of medicine and why you have now decided on psych. You will need to convince people that psych and residency training is really for you and that you are just not going to drop out like you did in neuro and return to straight research. From a LOR standpoint, you will need to get a letter from your previous program director. You would strengthen your application by getting psych letters (i.e. I would not just resend old letters that say you want to be a neurologist) and possibly getting additional experience in psych.

 

[MCB2014]

Does it make sense/is it necessary to take step III? It will actually be 3 years since leaving PGY-1 if I apply in fall of 2014 and get a position starting the summer of 2015.

 

[TexasPhysician]

Does it make sense/is it necessary to take step III? It will actually be 3 years since leaving PGY-1 if I apply in fall of 2014 and get a position starting the summer of 2015.

You may want to check state requirements. Some states require you to complete all 3 steps within a certain number of years, or you may have to start them all over again.

 

[psychattending]

In addition to TexasPhysician's statement, which is correct. Some states (and programs) also require passage of Step 3 by a certain PGY level. Not taking it as an intern will raise some concern among PDs; so taking and passing it now would be a good idea.