Another Intern Hoping to Switch Specialties...=P

[Takumi]

Hello everyone!

I'm currently a PGY-1 FM intern in an unopposed academic setting FM residency program. I'm also in a track offered by the program to be trained as a FMOB throughout three years.

I love my program, my co-residents, the faculty, the hospital, and attendings who are so caring about our education and are excellent teachers. I have to say I'm getting amazing FP training at my current program.

However, I entered medicine wanting to be a Surgeon since I was in middle school. Over the years as I pursued that dream, life and unfortunate personal circumstances happened and I was always discouraged by people telling me that with my status (Top 20 US Undergrad School, Worked as a CPA in a famous public accounting firm, then became a non-traditional applicant and ended-up in a Caribbean medical school, Step 1: 223, Step 2: 238, Step 3 passed above average, still a foreigner needing a visa for residency, and finally matched into a decent FM program), I would have very low chance matching into GS or OBGYN. So I wanted to be safe and didn't even apply to any GS position last year when I entered the match. I applied both OBGYN and FM, ranked my current program first and my OBGYN program 2nd, ended up here because my current program likes me a lot (which I'm very grateful and appreciate the opportunity everyday).

As intern year goes by, and as I had opportunities to get more OR experiences (good things about being an unopposed program) while on my Surgery and OB rotations (yes we have very heavy OB curriculum, to the point that's ridiculous to any other FM program), I just can't lie to myself about how much I love surgeries and OR in general, and I'm seriously considering applying to GS and OBGYN and hopefully can transfer. I had a formal conversation with my advisor and PD already and they are surprisingly supportive. I also have surgeons and OBGYN attendings who are very supportive and would have no problems supporting me with LORs.

Now my question is, I know I'm super late for the game for the 2024 Match at this point.

Should I rush to get my application together at this point and hoping to SOAP into a Categorical GS or OBGYN position in March 2024, or should I wait till next match cycle and be more prepared with my application, possibly making connections to GS and OBGYN PDs during the year, and getting more and stronger LORs (I have 3 months of OB rotations coming up from April.2024 to June.2024)? I just feel that I will be more prepared and both my PD and my GS and OB attendings will have more time worked with me to really write me a good letter if I apply next cycle.

Any thought or advice is really appreciated!

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[smq123]

Hello everyone!

I'm currently a PGY-1 FM intern in an unopposed academic setting FM residency program. I'm also in a track that offered by the program to be trained as a FMOB throughout three years.

I love my program, my co-residents, the faculty, the hospital, and attendings who are so caring about our education and are excellent teachers. I have to say I'm getting excellent FP training at my current program.

However, I entered medicine wanting to be a surgeon since I was in middle school, over the years as I pursue that dream, life and unfortunate personal circumstances happen and I was always discouraged by people telling me that with my current status (Top 20 US Undergrad School, Worked as a CPA in a famous public accounting firm, then became a non-traditional applicant and ended-up in a Caribbean medical school, Step 1: 223, Step 2: 238, still a foreigner needing a visa for residency, and finally matched into a decent FM program), I would have very slim chances matching into GS or OBGYN. So I wanted to be safe and didn't even apply to any GS position last year when I entered the match. I applied both OBGYN and FM, ranked my current program first and my OBGYN program 2nd, ended up here because my current program liked me a lot (which I'm very grateful and apricate the opportunity everyday)

Did you do your general surgery rotation already? How did it go?

 

[Takumi]

Did you do your general surgery rotation already? How did it go?

Yes I did! And it really rekindled my love and passion to surgeries and OR. I think I did well, the GS team at our hospital liked me, still talk positive about me (according to my GS preceptor), and the three surgeons that I worked with are very supportive and will have no problems giving me LORs. I also still scrub in cases whenever I have a chance and when time permits.

 

[ThoracicGuy]

Hello everyone!

I'm currently a PGY-1 FM intern in an unopposed academic setting FM residency program. I'm also in a track offered by the program to be trained as a FMOB throughout three years.

I love my program, my co-residents, the faculty, the hospital, and attendings who are so caring about our education and are excellent teachers. I have to say I'm getting amazing FP training at my current program.

However, I entered medicine wanting to be a Surgeon since I was in middle school. Over the years as I pursued that dream, life and unfortunate personal circumstances happened and I was always discouraged by people telling me that with my status (Top 20 US Undergrad School, Worked as a CPA in a famous public accounting firm, then became a non-traditional applicant and ended-up in a Caribbean medical school, Step 1: 223, Step 2: 238, Step 3 passed above average, still a foreigner needing a visa for residency, and finally matched into a decent FM program), I would have very low chance matching into GS or OBGYN. So I wanted to be safe and didn't even apply to any GS position last year when I entered the match. I applied both OBGYN and FM, ranked my current program first and my OBGYN program 2nd, ended up here because my current program likes me a lot (which I'm very grateful and appreciate the opportunity everyday).

As intern year goes by, and as I had opportunities to get more OR experiences (good things about being an unopposed program) while on my Surgery and OB rotations (yes we have very heavy OB curriculum, to the point that's ridiculous to any other FM program), I just can't lie to myself about how much I love surgeries and OR in general, and I'm seriously considering applying to GS and OBGYN and hopefully can transfer. I had a formal conversation with my advisor and PD already and they are surprisingly supportive. I also have surgeons and OBGYN attendings who are very supportive and would have no problems supporting me with LORs.

Now my question is, I know I'm super late for the game for the 2024 Match at this point.

Should I rush to get my application together at this point and hoping to SOAP into a Categorical GS or OBGYN position in March 2024, or should I wait till next match cycle and be more prepared with my application, possibly making connections to GS and OBGYN PDs during the year, and getting more and stronger LORs (I have 3 months of OB rotations coming up from April.2024 to June.2024)? I just feel that I will be more prepared and both my PD and my GS and OB attendings will have more time worked with me to really write me a good letter if I apply next cycle.

Any thought or advice is really appreciated!

Do you want the realistic answer? If so, the answer is plan to finish your 3 years of training in FM. During your last year, you can apply for a surgery spot if you'd like. You'd need to have time for interviewing, but if your program is willing to accommodate, then it wouldn't be a big issue. At that point, you'd finish your FM training and then start general surgery without having to leave your FM program. If you leave your FM program for a chance at a surgery spot, you risk not being able to finish training. Combine that with needing a visa, and the odds are not in your favor.

By waiting until you are done with FM to start surgery, you guarantee that you can become a board certified physician no matter what happens to the surgery path.

 

[NotAProgDirector]

Complicating matters is that you're on a visa. If you're on a J visa, then you can only change specialties once, and it must be in the first two PGY years. So completing FM and then changing to OB/GS will not be possible. You would absolutely need to apply this year or next.

If you're on an H visa, then there are no rules about specialty change. But that will greatly limit your options of programs, as a good number will not sponsor an H. Already having an H will make it easier to get a new one, but not all programs will care about that. And, an H visa is only good for 3 years and renewable once -- so you may run out of visa time (but there are ways to extend).

If you switch and things do not go well - i.e. you do not progress in the program -- then you will be absolutely stuck. You will not be able to change specialties again, your visa will end, and you will be required to leave the US.

There will be minimal categorical GS or OB programs in SOAP. Last year, there were three GS positions, and four OB positions. You can certainly try for these, but your chances are not great.

It sounds like your program is supportive. What you would need is for them to allow you to apply to the match, and hold your spot for you such that if you don't match, they will let you finish. Not all programs will do this, and they will be more likely to do so for just your PGY-3.

There's also the funding issue. You'll get an IRP of 3 years of full funding since you started in FM. If you match to a GS PGY-1, that would be another 5 years of training. If you've already completed 2 years of FM, it means you'll have 4 years of decreased funding. Some programs will care, others will not.

 

[ThoracicGuy]

Complicating matters is that you're on a visa. If you're on a J visa, then you can only change specialties once, and it must be in the first two PGY years. So completing FM and then changing to OB/GS will not be possible. You would absolutely need to apply this year or next.

If you're on an H visa, then there are no rules about specialty change. But that will greatly limit your options of programs, as a good number will not sponsor an H. Already having an H will make it easier to get a new one, but not all programs will care about that. And, an H visa is only good for 3 years and renewable once -- so you may run out of visa time (but there are ways to extend).

If you switch and things do not go well - i.e. you do not progress in the program -- then you will be absolutely stuck. You will not be able to change specialties again, your visa will end, and you will be required to leave the US.

There will be minimal categorical GS or OB programs in SOAP. Last year, there were three GS positions, and four OB positions. You can certainly try for these, but your chances are not great.

It sounds like your program is supportive. What you would need is for them to allow you to apply to the match, and hold your spot for you such that if you don't match, they will let you finish. Not all programs will do this, and they will be more likely to do so for just your PGY-3.

There's also the funding issue. You'll get an IRP of 3 years of full funding since you started in FM. If you match to a GS PGY-1, that would be another 5 years of training. If you've already completed 2 years of FM, it means you'll have 4 years of decreased funding. Some programs will care, others will not.

Would they be able to apply for a new visa after the old one expires for a second training program? I didn't realize you had to switch during the first two years. That certainly complicates things.

 

[Takumi]

Complicating matters is that you're on a visa. If you're on a J visa, then you can only change specialties once, and it must be in the first two PGY years. So completing FM and then changing to OB/GS will not be possible. You would absolutely need to apply this year or next.

If you're on an H visa, then there are no rules about specialty change. But that will greatly limit your options of programs, as a good number will not sponsor an H. Already having an H will make it easier to get a new one, but not all programs will care about that. And, an H visa is only good for 3 years and renewable once -- so you may run out of visa time (but there are ways to extend).

If you switch and things do not go well - i.e. you do not progress in the program -- then you will be absolutely stuck. You will not be able to change specialties again, your visa will end, and you will be required to leave the US.

There will be minimal categorical GS or OB programs in SOAP. Last year, there were three GS positions, and four OB positions. You can certainly try for these, but your chances are not great.

It sounds like your program is supportive. What you would need is for them to allow you to apply to the match, and hold your spot for you such that if you don't match, they will let you finish. Not all programs will do this, and they will be more likely to do so for just your PGY-3.

There's also the funding issue. You'll get an IRP of 3 years of full funding since you started in FM. If you match to a GS PGY-1, that would be another 5 years of training. If you've already completed 2 years of FM, it means you'll have 4 years of decreased funding. Some programs will care, others will not.

Thank you so much for the reply! The funding issue is exactly what my PD worried most and warned me as well, and she said it will totally depends on the receiving program's decision.

As for finishing the current program, both my advisor (who is also the APD) and PD said if I didn't match, I will have to stuck with them to finish FM lol (2 of previous residents did the same thing and didn't match, so they finished FM with our program). They have no problem allowing me to apply, and will hold my spot if I didn't match (unless I did horribly in intern year and that will have nothing to do with whether I want to enter the match then, lol).

As for the visa, I'm currently on H, and my understanding is that if I ever match into another specialty, I will just have to apply for a new J-1 visa for that residency, as I don't think you can just transfer a H visa if the receiving program doesn't sponsor H visa, but J-1 is always sponsored by ECFMG and you can always apply as long as the receiving program is okay with J-1? I don't see an issue there and I never heard of the "you need to change specialty during the first 2 years rule", because from my understanding, as long as you change specialty/program, you will need to reapply for a new J-1 visa, same rule applies for fellowship (unless I'm wrong please correct me).

 

[Takumi]

Do you want the realistic answer? If so, the answer is plan to finish your 3 years of training in FM. During your last year, you can apply for a surgery spot if you'd like. You'd need to have time for interviewing, but if your program is willing to accommodate, then it wouldn't be a big issue. At that point, you'd finish your FM training and then start general surgery without having to leave your FM program. If you leave your FM program for a chance at a surgery spot, you risk not being able to finish training. Combine that with needing a visa, and the odds are not in your favor.

By waiting until you are done with FM to start surgery, you guarantee that you can become a board certified physician no matter what happens to the surgery path.

Thank you, that's the alternative that I'm considering as well. I have no problem doing another residency after I finish my FM one.

I do have a current OBGYN attending that I worked with who graduated from IM program, did IM attending for 4 years and then matched into OBGYN after that, finished OBGYN residency and then 2 years ago finally became an OBGYN attending, so now he is double board-certified. I know his case is very rare and I don't even know whether that's possible to do another residency program after finishing one, because I heard that funding will be an issue too, but then I wonder how did he do 2 residencies? Maybe I should just ask him directly, lol.

 

[ThoracicGuy]

Thank you, that's the alternative that I'm considering as well. I have no problem doing another residency after I finish my FM one.

I do have a current OBGYN attending that I worked with who graduated from IM program, did IM attending for 4 years and then matched into OBGYN after that, finished OBGYN residency and then 2 years ago finally became an OBGYN attending, so now he is double board-certified. I know his case is very rare and I don't even know whether that's possible to do another residency program after finishing one, because I heard that funding will be an issue too, but then I wonder how did he do 2 residencies? Maybe I should just ask him directly, lol.

Funding is only an issue if the program wants it to be an issue. The program still gets the indirect funding for you so its still getting something for your spot even if not getting the full amount.

 

[Takumi]

Funding is only an issue if the program wants it to be an issue. The program still gets the indirect funding for you so its still getting something for your spot even if not getting the full amount.

Okay, thank you for the clarification!

So pretty much I should just finish this year try to get more experience and better letters and enter the match next year? And if I won't be able to get in, just finish FM and then apply?

 

[ThoracicGuy]

Okay, thank you for the clarification!

So pretty much I should just finish this year try to get more experience and better letters and enter the match next year? And if I won't be able to get in, just finish FM and then apply?

If your program is willing to hold your spot, that sounds like a decent plan. I would only go for categorical spots, no prelim spots.

 

[rokshana]

Hello everyone!

I'm currently a PGY-1 FM intern in an unopposed academic setting FM residency program. I'm also in a track offered by the program to be trained as a FMOB throughout three years.

I love my program, my co-residents, the faculty, the hospital, and attendings who are so caring about our education and are excellent teachers. I have to say I'm getting amazing FP training at my current program.

However, I entered medicine wanting to be a Surgeon since I was in middle school. Over the years as I pursued that dream, life and unfortunate personal circumstances happened and I was always discouraged by people telling me that with my status (Top 20 US Undergrad School, Worked as a CPA in a famous public accounting firm, then became a non-traditional applicant and ended-up in a Caribbean medical school, Step 1: 223, Step 2: 238, Step 3 passed above average, still a foreigner needing a visa for residency, and finally matched into a decent FM program), I would have very low chance matching into GS or OBGYN. So I wanted to be safe and didn't even apply to any GS position last year when I entered the match. I applied both OBGYN and FM, ranked my current program first and my OBGYN program 2nd, ended up here because my current program likes me a lot (which I'm very grateful and appreciate the opportunity everyday).

As intern year goes by, and as I had opportunities to get more OR experiences (good things about being an unopposed program) while on my Surgery and OB rotations (yes we have very heavy OB curriculum, to the point that's ridiculous to any other FM program), I just can't lie to myself about how much I love surgeries and OR in general, and I'm seriously considering applying to GS and OBGYN and hopefully can transfer. I had a formal conversation with my advisor and PD already and they are surprisingly supportive. I also have surgeons and OBGYN attendings who are very supportive and would have no problems supporting me with LORs.

Now my question is, I know I'm super late for the game for the 2024 Match at this point.

Should I rush to get my application together at this point and hoping to SOAP into a Categorical GS or OBGYN position in March 2024, or should I wait till next match cycle and be more prepared with my application, possibly making connections to GS and OBGYN PDs during the year, and getting more and stronger LORs (I have 3 months of OB rotations coming up from April.2024 to June.2024)? I just feel that I will be more prepared and both my PD and my GS and OB attendings will have more time worked with me to really write me a good letter if I apply next cycle.

Any thought or advice is really appreciated!

Why is the GS or OB program there not giving you a spot? They can be all supportive as get out… but really supportive would be getting you a spot there…

 

[Apollyon]

Why is the GS or OB program there not giving you a spot? They can be all supportive as get out… but really supportive would be getting you a spot there…

The OP says "unopposed". I'm guessing there aren't programs for GSx and OB there.

 

[NotAProgDirector]

As for the visa, I'm currently on H, and my understanding is that if I ever match into another specialty, I will just have to apply for a new J-1 visa for that residency, as I don't think you can just transfer a H visa if the receiving program doesn't sponsor H visa, but J-1 is always sponsored by ECFMG and you can always apply as long as the receiving program is okay with J-1? I don't see an issue there and I never heard of the "you need to change specialty during the first 2 years rule", because from my understanding, as long as you change specialty/program, you will need to reapply for a new J-1 visa, same rule applies for fellowship (unless I'm wrong please correct me).

You are correct. Since you're on an H, you can always switch to a J. and then the specialty switch rule should not matter (I think?) since it would be the first time switching on the J. But as long as you do it at the end of your PGY-2, it won't be a problem anyway. Switching from an H to a J is a bit of a "big deal", since there are distinct advantages to an H that you'd be giving up. But that's your choice.

Fellowships are considered continued training in the same field, so not an issue. And no you don't get a new J visa, it's the same one that gets extended. H visas are employer based, so you need a new one for each program. But J visas are employee based, so you only have one.

Would they be able to apply for a new visa after the old one expires for a second training program? I didn't realize you had to switch during the first two years. That certainly complicates things.

Theoretically yes, practically no. When the first visa would expire, the HRR would kick in. The resident would need to vacate the US for 2 years to their home country. The chances of being successful after that, applying again, are not terribly good.

 

[ThoracicGuy]

You are correct. Since you're on an H, you can always switch to a J. and then the specialty switch rule should not matter (I think?) since it would be the first time switching on the J. But as long as you do it at the end of your PGY-2, it won't be a problem anyway. Switching from an H to a J is a bit of a "big deal", since there are distinct advantages to an H that you'd be giving up. But that's your choice.

Fellowships are considered continued training in the same field, so not an issue. And no you don't get a new J visa, it's the same one that gets extended. H visas are employer based, so you need a new one for each program. But J visas are employee based, so you only have one.

Theoretically yes, practically no. When the first visa would expire, the HRR would kick in. The resident would need to vacate the US for 2 years to their home country. The chances of being successful after that, applying again, are not terribly good.

I'm not sure I'd want to give up the H visa for a J visa if I were in the situation, but that'll be a decision he'll need to make. Best case scenario is he could get an H visa at a new place too.

 

[Takumi]

You are correct. Since you're on an H, you can always switch to a J. and then the specialty switch rule should not matter (I think?) since it would be the first time switching on the J. But as long as you do it at the end of your PGY-2, it won't be a problem anyway. Switching from an H to a J is a bit of a "big deal", since there are distinct advantages to an H that you'd be giving up. But that's your choice.

Fellowships are considered continued training in the same field, so not an issue. And no you don't get a new J visa, it's the same one that gets extended. H visas are employer based, so you need a new one for each program. But J visas are employee based, so you only have one.

Theoretically yes, practically no. When the first visa would expire, the HRR would kick in. The resident would need to vacate the US for 2 years to their home country. The chances of being successful after that, applying again, are not terribly good.

I'm assuming you guys all don't have to deal with immigration issues so I just want to clarify few things:

The biggest advantage of H visa is that as long as you submit your green card application within the 6 years of valid period of H visa, you can renew it every 3 years until you get the actual green card, but you can only start the application once you are an attending and the hiring hospital will sponsor you for that, you can't start the application while being a resident, even on the H visa. The major disadvantage of J1 visa is that you will need to do a J waiver after residency then transfer to H visa as an attending and then start the green card process.

To be honest I don't care too much about the advantage of my current visa. If I'm being miserable and not liking what I'm doing everyday, what's the point? AKA I have no problem doing waiver job after residency or whatever it takes if I'm in the field that I truly enjoying.

So back to the topic, I think pretty much at this point I should just finish my intern year and try to get more GS and OB experience and stronger LORs, and prepare for the match cycle next year?

 

[NotAProgDirector]

You're correct about the visa issues. Except that remember that a J waiver position may limit your options about where you can work. You'll certainly get a job, but waiver positions can be limited. Each state only has 50 each year. Hence getting one in Cali can be a real challenge. (It's more complicated than that, as you can always get a waiver spot at a VA, but not everyone wants to work at a VA). Also a waiver job must be full time / 1.0 FTE.

But yes, your best plan (at this point) is to complete your PGY-1 year and continue into your PGY-2 year. During your PGY-2, you apply in the match again. If you match, you finish your PGY-2 and start a new PGY-1 somewhere else, either on an H or J. If you don't, you continue into your PGY-3 and finish the FM program. Applying again during your PGY-3 would be problematic, as you'll need a job to continue your visa and you'll need to have that settled long before match day.

 

[Takumi]

You're correct about the visa issues. Except that remember that a J waiver position may limit your options about where you can work. You'll certainly get a job, but waiver positions can be limited. Each state only has 50 each year. Hence getting one in Cali can be a real challenge. (It's more complicated than that, as you can always get a waiver spot at a VA, but not everyone wants to work at a VA). Also a waiver job must be full time / 1.0 FTE.

But yes, your best plan (at this point) is to complete your PGY-1 year and continue into your PGY-2 year. During your PGY-2, you apply in the match again. If you match, you finish your PGY-2 and start a new PGY-1 somewhere else, either on an H or J. If you don't, you continue into your PGY-3 and finish the FM program. Applying again during your PGY-3 would be problematic, as you'll need a job to continue your visa and you'll need to have that settled long before match day.

Okay, thank you so much for helping me and for all the details! Yes I will definitely keep the timeline and drawbacks of J1 in mind while I'm applying. I will try as much as I can, and I guess at the end of the day it's all destiny? lol

 

[pazzer2]

Have you thought about doing an Obstetrics fellowship after FM? Many of them offer a lot of surgical training (C-section, tubal ligation, perineal lacs, etc)?

 

[Giovanotto]

You're correct about the visa issues. Except that remember that a J waiver position may limit your options about where you can work. You'll certainly get a job, but waiver positions can be limited. Each state only has 50 each year. Hence getting one in Cali can be a real challenge. (It's more complicated than that, as you can always get a waiver spot at a VA, but not everyone wants to work at a VA). Also a waiver job must be full time / 1.0 FTE.

But yes, your best plan (at this point) is to complete your PGY-1 year and continue into your PGY-2 year. During your PGY-2, you apply in the match again. If you match, you finish your PGY-2 and start a new PGY-1 somewhere else, either on an H or J. If you don't, you continue into your PGY-3 and finish the FM program. Applying again during your PGY-3 would be problematic, as you'll need a job to continue your visa and you'll need to have that settled long before match day.

You're a gem. The amount that you do to help international students/residents on here is remarkable.