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[confusedstudent2021]

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[deleted480308]

These attendings will make phone calls for him but not match him?

 

[deleted480308]

What do you mean?

I mean to ask how good can their recommendations be if the don’t like him enough to give him a space in their program?

Is he ready to consider other less competitive specialties?

 

[DocWinter]

Man that sucks.
Honestly, either he has completely horrible luck or there is something else that keeps the PDs from making this happen. I have no doubt he wants to be a surgeon, but how he is unable to get in 3 years in a row despite good LOR, etc is not boding well.

 

[rokshana]

So why is he not on here looking for help? It’s not that hard to make an account...

Is he an USMD, DO, IMG?

And it’s an appropriate question...if his PD Os willing to write supportive letters, then why is she not willing to find him something, either at her own program or another program? It’s a small world and PDs know each other...there is something else at play here...he is probably not telling you everything and you really are only hearing one side of the story.

I don’t understand how he is doing a fellowship without having completed a GS residency. Is this like plastics, where you do 3years GS and then 3 yrs plastics and come out able to do plastics? Will he be able to do burn surgery as a stand alone after finishing this fellowship?

And why prelim GS out of Med school? If he is a US MD he should not have had issues with getting a cat GS spot.

It seems a bit immature to say, if I can’t be a surgeon, then I’m not going g to be a doctor...more like a 3yr old having a tantrum, then a grown man doing a realistic assessment of what is possible as a career...is financially independent enough that he can throw away years of education and training to do something else?

Has he thought about re entering the match and try for a cat GS pgy 1 spot?

 

[DokterMom]

I'm curious -- How much of your knowledge of your boyfriend's situation comes solely from what he's told you? And how much have you discovered and/or verified through independent sources? He seems to have had a pretty long streak of bad luck... Like @rokshana, I'm curious how it is that if he's truly "done so well!" that none of his PDs were willing to do more to help him find a spot... It sounds more like as case of "not bad enough to fire outright, but not good enough to keep."

 

[wantnoscrub]

FM is definitely possible. If he goes rural, he can do primary C-sections. He can do screening colonoscopies too. That is the most likely outcome at this point. Surgery is very stubborn when it comes to prelims. They don't like them. They don't trust them. If he can get an anesthesia spot, he should take it and run. Never look back. There is a reason his PD won't match him to the home program. They're just not being up front. It's a messed up system.

 

[HighwayVagabond]

I replied to this in another thread, but thought it would be worthwhile adding here in case anyone else involved with the thread above knows something different regarding this:

I don't like being the bearer of bad news, but here it goes...

In order to be board eligible in general surgery you can not complete your training at more than three institutions. Statement straight from ABS:

• The ABS instituted in 2007 a new limit on the number of programs by which an applicant for general surgery certification may complete residency training.
• Effective with residents graduating in the 2007-2008 academic year or thereafter, the 5 years of progressive general surgery residency training (PGY 1-5) must be accomplished at no more than 3 residency programs for an individual's application for certification to be accepted.

If I'm reading this right, he's already been through three programs. I find it highly unlikely any general surgery program will take someone that is no longer board eligible. Maybe others can comment about that aspect who have more experience with it.

 

[rokshana]

We were together and he just told me to post it. He will likely be making his own account. He is a USMD. She will send him available positions and tell him to apply, but says there is not availability in their program. You may be right and I may not know 100% of the story. When you say something else is at play, what do you mean?
As far as he has told me, he says she will offer positive remarks if programs need to speak to her, but there just isn't an opening in their program. She has offered to potentially help him towards an anesthesia spot at their institution (or nearby), but that is LAST resort as surgery is his dream.

He will have to finish his general surgery training in order to practice as a burn surgeon. Burn fellows are available to GS residents who have completed at least 2 years of training.

The goal was obviously a categorical spot out of medschool, but he did not land it. He did not end up taking step 3 until after so that may have had something to do with it. He also did an MD/MPH program, he won a scholarship where he was abroad for 1 year of medical school implementing a public health program. I believe that also ended up interfering with match when he returned.

Does reentering match for a cat PGY1 or going into a new specialty really even a genuine possibility at this point?

I know you mean well, but things are just not adding up...
His PD is willing to say good things in a LoR , but isn’t actively looking for a place for him to be able to continue... frankly, she should be able to do so...medicine is a small world and academia even moreso...when I was a resident, there was a prelim intern that decided he wanted to stay in IM instead of moving onto his matched anesthesia residency...our program did not have space for him, but our PD made sure he had a spot at another program...PD to PD at a program that had the space...

and really? His current program could have said, look go back into the match and we will rank you number 1 if you are ok with starting over as a pgy 1 if it’s truly about space/money...but they didn’t, so...

The fact that she is willing to help him get an anesthesia spot makes me think there is something she feels makes him not surgery material...

Step 3 has nothing to do with it...US seniors don’t have step 3 done before graduating...did he not apply to enough programs? Not get or go to enough interviews or not rank enough places?

He needs to seriously reassess whether surgery is a reality for him...he needs to talk to a mentor he trusts or sit down with his PD for a honest discussion or whether surgery is truly feasible...

He can consider something like ob/gyn which has a strong surgical component or a surgical subspecialty( though they tend to more competitive than GS), anesthesia, then do pain management which has some surgical component to it, radiology with interventional fellowship...not surgical, but procedure heavy, or even IM and the do a procedure heavy fellowship like cards or gi.

As always, he could just start over and try to get a pgy 1 cat GS in next years
Match...or try to SOAP into something this year, though generally there are not that many cat GS or OB spots in the SOAP, but given his background, could be a desirable candidate.

 

[radsisrad]

There are a number of ways for departments to shift funding around to add residents in different years. It happens less infrequently than most realize. I don't really understand how this resident never convinced a program to find a way to keep him on. Something strange...

 

[mikeGR]

I replied to this in another thread, but thought it would be worthwhile adding here in case anyone else involved with the thread above knows something different regarding this:

I don't like being the bearer of bad news, but here it goes...

In order to be board eligible in general surgery you can not complete your training at more than three institutions. Statement straight from ABS:

• The ABS instituted in 2007 a new limit on the number of programs by which an applicant for general surgery certification may complete residency training.
• Effective with residents graduating in the 2007-2008 academic year or thereafter, the 5 years of progressive general surgery residency training (PGY 1-5) must be accomplished at no more than 3 residency programs for an individual's application for certification to be accepted.

If I'm reading this right, he's already been through three programs. I find it highly unlikely any general surgery program will take someone that is no longer board eligible. Maybe others can comment about that aspect who have more experience with it.

My way of interpreting this is that he has to do 5 consecutive years (PGY1-5) in up to 3 institutions - I don't imagine they care how many prelim PGYs one did before that. That said, I was under the impression that Medicare would pay for up to 7 years MAX for each resident (don't have the source on that).

Otherwise, I'm sorry OP but I would tend to agree with the others, there is probably a reason this keeps happening, and switching specialties sounds wise. We had several prelim PGY1 and PGY2s where I did residency, most of them great guys/gals but not great enough to get a categorical spot (although some of them did- combination of personality, skills, connections, and luck). One of the guys switched to IM (after 2 prelim years in 2 different institutions) bc he had a family to take care of, and he graduated before me, ended up practicing IM, and is about 100x happier now than he ever was before.

We surgeons consider switching specialties a personal defeat but the truth is, for many many surgeons, a different specialty would work out much better.

Best of luck!

 

[MedEdAssoc]

There are two policy issues to be aware of here:
1) American Board of Surgery - (Training Requirements | American Board of Surgery)

• A minimum of 5 years of progressive residency education satisfactorily completed in a general surgery program accredited by the ACGME or RCPSC.
• The 60 months of training at no more than 3 residency programs. If credit is granted for prior foreign training, it will count as one program.
• At least 48 weeks of full-time clinical activity in each residency year, regardless of the amount of operative experience obtained.
• A categorical PGY-3 year completed in an accredited general surgery residency program. Note that completing three years at PGY-1 and -2 levels does not permit promotion to PGY-4; a categorical PGY-3 year must be completed and verified by the ABS' resident roster. The only exception is in cases where 3 years' credit has been granted for prior foreign graduate training.
• At least 54 months of clinical surgical experience with increasing levels of responsibility over the 5 years, with no fewer than 42 months devoted to the content areas of general surgery.
• No more than 6 months assigned to non-clinical or non-surgical disciplines during all junior years (PGY 1-3).
• No more than 12 months allocated to any one surgical specialty other than general surgery during all junior years (PGY 1-3).
• The final two residency years (PGY 4-5) in the same program.

2) The Federal government through CMS will pay only 5 years for a general surgery resident. The first year sets the eligibility length. A good explanation of this eligibility and how it works can be found in the Physician Career Guidebook Volume 1: The Road to Residency. It can be found at Amazon.com/author/shericlarke. The burn fellowship would not count against this funding, if it is not accredited. He could transfer to a shorter program and still have almost full funding. He would not have funding for OB/GYN (4 years), but I have seen multiple surgery residents transfer to emergency medicine (3 years) and do very well. The funding is not specific to the resident. It is paid to the hospital for the number of funded positions that the hospital reports up to a maximum (cap). Hospitals do not have a pot of money that they get for each resident. If they have all their capped positions filled, they will get 50% for the resident.

Basically, if they really wanted him, they would have shuffled things around for him. Sometimes programs tell you they can't make it work or don't have funding, so they don't have to tell you the truth. If he is not an exceptional candidate for a program, this funding issue will make it even harder for him to get a position as well. It is time to reconsider his specialty. He may need to do some soul searching to determine if he is really hearing what they are telling him.

 

[rokshana]

Thank you for your thorough explanation. The burn surgery aside... since it is not contributing to "general surgery residency"... he has done 2 PGY1 prelim years and 1 PGY2 prelim year... making it 3 prelim years. From what I understand, you are stating that the federal government will only pay for 5 years of residency. This means that if he was to get a categorical year 3 position for next year... he would only have an income for his 3rd and 4th years. For his final year, PGY5, he would not be given an income. (Which I think would be the least of his worries in the grand scheme of things, right now. He does have really good savings & hopefully can get his finances sorted out in advance before it got to that point..)

That being said, I am still not 100% certain where the information written puts him in terms of being able to finish residency & become board certified. He has done his two prelim PGY1 years at two different institutions & did his prelim PGY2 year at a third institution... making it 3 different institutions, thus far. If he was able to secure categorical year 3 spot at a new institution (and remain there until he graduates) will he have a problem from the board because it ends up being 4 institutions? If yes, Is his only option to try and secure a spot at one of these 3 institutions he has been at? Or.... will he be fine as long as he is able to land a categorical 3rd year somewhere for next year?
Are there any differences with the statements you gave/im asking about based on prelim vs. categorical? I would think the rules may be slightly different, no?
Unfortunately his entire heart and soul is set on surgery. I have seriously never seen someone so passionate about something. And I believe with all my heart he would make an exceptional surgeon, but has had some really bad luck. Nonetheless, I do agree with you that that souls searching is always a positive and good thing to do as well.

They will have to pay him...ACGME doesn’t allow for residents not to be paid...the money would have to come from the hospital and not from cms funds.

They are lots of people out there that would make great surgeons...but don’t get the chance. He will need to decide if he would rather not be in Medicine if he can’t do surgery or look for something that could be satisfying in another field as a plan b.

Has he looked on the www.apds.org website to see what open residency spots are out there?

Open Training Positions - Association of Program Directors in Surgery

apds.org

Heck they even have a place for residents to post that they are available

Residents & Fellows | Association Of Progr

apds.org

 

[TJH]

https://gme.med.ufl.edu/files/2013/02/Medicare-Payments-for-Graduate-Medical-Education-2013.pdf

Best of luck!

 

[sandy0477]

I have heard of similar agonizing stories from IMG's. See the problem is Prelim PGY 1 GS is offered to basically any US grad who is remotely qualified. Prelim PGY 2 GS positions fall in the same category. It was the wrong decision to go into the second PGY2 GS prelim.

Burn fellowships are the same thing. They are offered to anyone who has done 2 years of surgery and does not require a VISA.

He is stuck now. The problem is he can only go into categorical GS starting at PGY1 or directly go into PGY 3 categorical GS (since prelim PGY3 does not exist).

As far as why he chose the path of GS is quite obvious he is passionate about it. But passion does not add up to scores or qualifications for GS. Prelim positions are irrelevant(PGY1 or PGY2), trust me when I say they are given to anyone who is remotely competent. Since he does not require a VISA he got the burn fellowship. Burn fellowships at several institutions are left unfilled many years in a row cause of a lack of applicants. Since he does not require a VISA, completed 2 years of GS (min required to get into burn fellowship) and is a US grad he got the position.

In conclusion, he got the prelim positions and burn fellowships cause he was the most qualified. Not cause he was passionate or he worked hard. He might have worked hard or might have slacked, the point is it does not matter. He got those positions cause he was qualified for them.

What are your solutions:
Now coming to the categorical GS PGY1 position, its a straight shot if he gets it.
Now the ideal solution is he can go into PGY 3 now (Please for god's sake do not do another prelim PGY2). But for this, there are several hurdles apart from the above-mentioned ones. He needs to have done 200 surgeries (actual surgeries, burn fellowship does not count) and be the primary surgeon in 50 of them the last time I checked. So if he has them and they are entered into the national database with attendings sign off he would qualify for PGY3. On a side note, one of my friends is in a similar situation but could not get 200 surgeries and now he has no way forward.

PGY3 openings are very rare and are usually snapped up by very well qualified people who are in GS residency and want to switch programs. Its a tall order but wouldn't hurt to check for openings every day. I would suggest the following sites APDS, residentswap, residencyopenings.com and yes all of em you need to pay a monthly fee.

His other options change the residency, practice as a general provider and wound care specialist. General provider and wound care specialist pay well upwards of 200k. He will also qualify for a PGY 2 EM opening as two years of GS is equal to one year of EM. I see many openings for PGY2 EM regularly.
All these options are better than continuing the path of GS unless he gets into GS3.

Honestly trust me when I say this he got the prelims and the burn fellowships cause he is a US grad and doe not require a VISA. Prelim positions are given to anyone remotely competent.

As far as PD's making calls and writing letters, they have to do it. If a guy works for you like a dog for a year you should write a letter or make a phone call. Again my friend who I mentioned above was in a similar situation and the PD's wrote him a letter and made calls. But it comes back to the most important thing is he qualified for a PGY3?

Most surgery training gets serious in PGY3. That is when residents become very independent and attendings rely on them, hence the bottleneck for PGY3 positions. This does not mean he cannot handle this, but it means there is a bottleneck and most people will not take a chance even if they get calls from other PD's.

I would advise picking wound care physician jobs if he is tired of training or change specialty preferably EM PGY2. FM/IM/neuro would suck after so many years in GS. EM is the only specialty that comes close to the intensity of GS.

Again 200 surgeries, 50 as lead, above mentioned hurdles regarding training barriers, the bottleneck of openings and reliability in a person who is at 3 different institutions in 3 years. Think about it if you find a PGY 3 position very well snap it up, PGY2 EM snap it up or just go into wound care. I honestly feel bad for the guy, PD's play this game where they need to fill the prelim positions to reduce stress on categoricals and run the department. Later end up saying they do not have a position.

Regarding his PD promising him a PGY3 and later dropping it. Its quite obvious imagine you are a PD and you have to create a PGY3 opening for your PGY2 resident, its quite tough. If some program creates PGY3 for him that means they have to find two other residents for PGY 1 and PGY 2. The only scenario suited to your BF is if a PGY2 categorical drops out of GS (at the end of PGY2). But they would already have a PGY 2 prelim most likely at their program.

Don't be discouraged its a tough situation but your best option is PGY2 EM and wound care. Both of them honestly pay more than GS attending if you work equal hours. There is nothing wrong with your BF, he is the victim of the system and the constant focus on scores.

 

[sandy0477]

For example:

The Maine Medical Center - PGY-2 Emergency Medicine Resident Position

The Maine Medical Center Emergency Medicine Residency Program is Accepting Applications to join our PGY-2 class starting in July (Class of 2022) The Maine Medical Center (MMC) residency program is a 3 year program with 10 residents per year. Our program embodies the idea that residents do not...

www.unmatchedmd.com

Geisinger Medical Center - PGY-3 General Surgery Categorical Resident Position

The General Surgery Residency Program at Geisinger Medical Center located in Danville, PA has an opening for a PGY-3 Categorical position to begin on July 1, 2020. Applicants are required to have successfully completed their PGY2 year in good standing and in an ACGME accredited General Surgery...

www.unmatchedmd.com

 

[rokshana]

Thank you so much for your thorough response. You must be in surgery yourself, everything you said was correct! Regarding his logs, he says he has all of his cases necessary logged. More than he needs really... More than 300 and he says he didn't even log all of them. He took his board this year and recently got his results back. He says he got in the 80th or 90th percentile so I think that should really help him.
It is certainly a super tough and stressful situation, he is checking the sites as much as he can. His heart is set on surgery, but not many spots. I think it is going to take a lot for him to change to anything else. I admire the dedication so much. But I am trying to keep him open minded as well.... Hoping a higher power can help him get to where he is meant to be.

what board? his ABSITE? High score should help but I can't imagine he was able to sit for the Surgical boards...you have to be a chief resident (4/5th year)to qualify for those...

did you this this thread?

Position Available - PGY1 - General Surgery - Six New Positions Open Now in Orange Park

Six PGY1 General Surgery Residency Positions Open Now! Orange Park Medical Center Date Posted: September 23, 2019 3 categorical and 3 preliminary PGY1 positions available for immediate start in newly accredited program. Currently accepting applications for all six positions. How To Apply...

forums.studentdoctor.net

 

[Spectreman]

Update?

 

[Spectreman]

UPDATE: he got a categorical surgery spot!!!!! He is in a good surgery program & he’s doing great!!
It all finally worked out in his favor & he finally got the opportunity he always deserved!

x be well!

Amazing. God is good and things really do work out.

 

[Surgeon D.O.]

This read was definitely inspiring.

Makes me believe that if I want to be a surgeon bad enough, it will happen one way or another, just maybe not in the time frame I expect.

I needed this in the midst of STEP/LEVEL 1 studying!