Apply to gen surg as backup?

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GonefromTX

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Hey everyone, so I'm interested in ortho and I'm wondering exactly how you would apply to gen surgery as back ups.

Will I be doing my AI in Ortho or Gen surg? Also, how will I be getting letters of recommendations from general surgeons if all my aways will be in ortho? Will it be okay to just apply to gen surg programs with my away letters in ortho?

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Hey everyone, so I'm interested in ortho and I'm wondering exactly how you would apply to gen surgery as back ups.

Will I be doing my AI in Ortho or Gen surg? Also, how will I be getting letters of recommendations from general surgeons if all my aways will be in ortho? Will it be okay to just apply to gen surg programs with my away letters in ortho?

No. If all your letters are from ortho, they will know you're applying GS as back up. This could limit your interview invites; the program looks at it like "if they don't really want to do this, why should we take them over someone who does want it?". Get GS LORs for GS programs (plus you need a chairman's letter for GS anyhow). A stray ortho letter is ok if it's a good letter and says you're interested in GS rather than ortho. But if you only submit ortho LORs, they will see that as not seriously pursuing GS.

You also should be cautious about applying to ortho and GS programs at the same hospital.

The above advice applies to other surgical subspecialties as well (ENT/GU/plastics).
 
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No. If all your letters are from ortho, they will know you're applying GS as back up. This could limit your interview invites; the program looks at it like "if they don't really want to do this, why should we take them over someone who does want it?". Get GS LORs for GS programs (plus you need a chairman's letter for GS anyhow). A stray ortho letter is ok if it's a good letter and says you're interested in GS rather than ortho. But if you only submit ortho LORs, they will see that as not seriously pursuing GS.

You also should be cautious about applying to ortho and GS programs at the same hospital.

The above advice applies to other surgical subspecialties as well (ENT/GU/plastics).

Yep. You need a completely different set of LORs, apply to different hospitals, etc. it's a pain.

I wouldn't TBH. All in on one or the other.

Jesus I thought applying to two specialties as a backup was a common place thing. So with the high unmatched rate aren't people kind of setting themselves up to get screwed if they apply to a competitive specialty and fail?

Then you either scramble into anything or do a research year, right?
 
Jesus I thought applying to two specialties as a backup was a common place thing. So with the high unmatched rate aren't people kind of setting themselves up to get screwed if they apply to a competitive specialty and fail?

Then you either scramble into anything or do a research year, right?

I can't think of anyone from my class who applied to a backup who was doing Ortho. THAT was what we wanted to do, and if it meant scrambling into an intern year or doing research, then so be it.

As far as reapplying, yeah I applied to some gen surf programs as backups.
 
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Jesus I thought applying to two specialties as a backup was a common place thing. So with the high unmatched rate aren't people kind of setting themselves up to get screwed if they apply to a competitive specialty and fail?

Then you either scramble into anything or do a research year, right?
It's common for people who want to do gen surg subspecialties that offer some categorical programs like cardiothoracic, plastics, or vascular. The straight out subspecialties like ortho, ent, and gu are usually their own beast.
 
I can't think of anyone from my class who applied to a backup who was doing Ortho. THAT was what we wanted to do, and if it meant scrambling into an intern year or doing research, then so be it.

As far as reapplying, yeah I applied to some gen surf programs as backups.

But if you don't get it from what I understand its MUCH harder to get the second time around, right?

How did applying to gen surg programs as a backup go for you? Did they ask you about ortho? Was your yield high?

It's common for people who want to do gen surg subspecialties that offer some categorical programs like cardiothoracic, plastics, or vascular. The straight out subspecialties like ortho, ent, and gu are usually their own beast.

Yeah what do the categorical subspecialties (ortho, ent, gu) do in that situation?
 
But if you don't get it from what I understand its MUCH harder to get the second time around, right?

How did applying to gen surg programs as a backup go for you? Did they ask you about ortho? Was your yield high?



Yeah what do the categorical subspecialties (ortho, ent, gu) do in that situation?

It's harder to match as a reapplicant. Much harder. But I would have rather rolled the dice than spend the rest of my life in a career I did not enjoy and forever ask myself "what if?"

And good thing too; since I got an Ortho residency spot the second time around.

As far as your other ?s I got more than enough gen surg invites that make feel like i would have matched had it come to that.
 
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It's harder to match as a reapplicant. Much harder. But I would have rather rolled the dice than spend the rest of my life in a career I did not enjoy and forever ask myself "what if?"

And good thing too; since I got an Ortho residency spot the second time around.

As far as your other ?s I got more than enough gen surg invites that make feel like i would have matched had it come to that.

Awesome, congratulations.

What would you say was the key to matching the second time around for you? Especially considering you were fighting an uphill battle.
 
Awesome, congratulations.

What would you say was the key to matching the second time around for you? Especially considering you were fighting an uphill battle.

No idea. Probably simply being the right kind of person my PD-to-be was looking for at that particular time. It was a program that I did not interview at the first time.

It's all pretty random sometimes.
 
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I applied to both at the same time, and fortunately matched Ortho. Yes it was a pain, but I would have done anything to avoid a scramble. I was "content" with gensurg as a backup, which is something I recommend--if you have a backup, make sure you're at least okay with it. If you truly would rather face the scramble than do something non-Ortho, then "go all in" as was suggested above. But know the risks...
 
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I applied to both at the same time, and fortunately matched Ortho. Yes it was a pain, but I would have done anything to avoid a scramble. I was "content" with gensurg as a backup, which is something I recommend--if you have a backup, make sure you're at least okay with it. If you truly would rather face the scramble than do something non-Ortho, then "go all in" as was suggested above. But know the risks...

That's exactly my thought process. How did you do it? Did you do an ortho home AI, 2 ortho aways and 2 gen surg aways?
 
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That's exactly my thought process. How did you do it? Did you do an ortho home AI, 2 ortho aways and 2 gen surg aways?

You don't have to do GS aways, plus the timing of them is going to be a problem if you are also trying to do ortho aways. That's a lot of away rotations. Plus they tend to hurt more than help, IMO (at least for GS).
 
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No idea. Probably simply being the right kind of person my PD-to-be was looking for at that particular time. It was a program that I did not interview at the first time.

It's all pretty random sometimes.

Sweet...

I applied to both at the same time, and fortunately matched Ortho. Yes it was a pain, but I would have done anything to avoid a scramble. I was "content" with gensurg as a backup, which is something I recommend--if you have a backup, make sure you're at least okay with it. If you truly would rather face the scramble than do something non-Ortho, then "go all in" as was suggested above. But know the risks...

So how much garbage is the scramble?

And the risks of going unmatched = probably having to go gen surg anyway with 1 year wasted?

You don't have to do GS aways, plus the timing of them is going to be a problem if you are also trying to do ortho aways. That's a lot of away rotations. Plus they tend to hurt more than help, IMO (at least for GS).

Why?
 
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Hey everyone, so I'm interested in ortho and I'm wondering exactly how you would apply to gen surgery as back ups.

Will I be doing my AI in Ortho or Gen surg? Also, how will I be getting letters of recommendations from general surgeons if all my aways will be in ortho? Will it be okay to just apply to gen surg programs with my away letters in ortho?

You just triggered @SouthernSurgeon !
 
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So how much garbage is the scramble?

And the risks of going unmatched = probably having to go gen surg anyway with 1 year wasted?

The scramble sucks, but it's not the end of world (or your career)

Having said that, it's applicant dependent. Would you be just as happy in general surgery (or any other backup?) Then by all means. I would echo the above sentiments that you pretty much need to make two applications and be cognizant of the programs your applying to in order to avoid overlap.

But applying for a backup just because you don't want to endure the inconvenience of SOAPing seems to me shortsighted . This is your career/ the rest of your life vs one year. And you don't want to look back a decade later with regret.
 
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Because when you rotate:
1. You are unfamiliar with the hospital, the culture, and the EMR, and will likely look clueless in comparison to the home M4s. They also usually know some of the residents and attendings and know of various preferences and quirks. The home M4s get first dibs on picking rotations, so they usually take the spots early in the year (to get LORs, etc.) and set the bar. It's harder to stand out positively when you're starting with such a disadvantage. By the time you learn these basic things, you've already lost a week or two to impress.
2. If you're not competitive for a given program, it's very, very hard to be an outstanding enough away rotator to move yourself high on the rank list, although usually you will get a courtesy interview.
3. If you are competitive for a given program, doing or saying one stupid thing could suddenly make you less desirable. In other words, you aren't going to move yourself up the rank list, but you can get yourself moved down it.
4. It's not considered as important in GS to do an away rotation or two, as most students have a local GS residency program to get LORs from.

This gets discussed on the surgery forums from time to time, and consensus always seems to be that aways hurt more candidates than it helps. I am referring to GS and not ortho; if ortho recommends away rotations, do what is expected.
 
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Sweet...



So how much garbage is the scramble?

And the risks of going unmatched = probably having to go gen surg anyway with 1 year wasted?



Why?


The scramble, at least when I applied, gave you no choice, you had to go where they put you. I wasn't willing to do that.
But yes, you will likely end up in a gensurg prelim year. I was not willing to do that either. I wanted to be one and done.
 
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The scramble, at least when I applied, gave you no choice, you had to go where they put you. I wasn't willing to do that.
But yes, you will likely end up in a gensurg prelim year. I was not willing to do that either. I wanted to be one and done.

Ok, so your mentality was you were more ok with doing Gen Surg than you were doing a gen surg prelim year then reapplying or continuing with gen surg?

Because when you rotate:
1. You are unfamiliar with the hospital, the culture, and the EMR, and will likely look clueless in comparison to the home M4s. They also usually know some of the residents and attendings and know of various preferences and quirks. The home M4s get first dibs on picking rotations, so they usually take the spots early in the year (to get LORs, etc.) and set the bar. It's harder to stand out positively when you're starting with such a disadvantage. By the time you learn these basic things, you've already lost a week or two to impress.
2. If you're not competitive for a given program, it's very, very hard to be an outstanding enough away rotator to move yourself high on the rank list, although usually you will get a courtesy interview.
3. If you are competitive for a given program, doing or saying one stupid thing could suddenly make you less desirable. In other words, you aren't going to move yourself up the rank list, but you can get yourself moved down it.
4. It's not considered as important in GS to do an away rotation or two, as most students have a local GS residency program to get LORs from.

This gets discussed on the surgery forums from time to time, and consensus always seems to be that aways hurt more candidates than it helps. I am referring to GS and not ortho; if ortho recommends away rotations, do what is expected.

So how does this not apply to all away rotations then?
 
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How do I delete this?
 
Because when you rotate:
1. You are unfamiliar with the hospital, the culture, and the EMR, and will likely look clueless in comparison to the home M4s. They also usually know some of the residents and attendings and know of various preferences and quirks. The home M4s get first dibs on picking rotations, so they usually take the spots early in the year (to get LORs, etc.) and set the bar. It's harder to stand out positively when you're starting with such a disadvantage. By the time you learn these basic things, you've already lost a week or two to impress.
2. If you're not competitive for a given program, it's very, very hard to be an outstanding enough away rotator to move yourself high on the rank list, although usually you will get a courtesy interview.
3. If you are competitive for a given program, doing or saying one stupid thing could suddenly make you less desirable. In other words, you aren't going to move yourself up the rank list, but you can get yourself moved down it.
4. It's not considered as important in GS to do an away rotation or two, as most students have a local GS residency program to get LORs from.

This gets discussed on the surgery forums from time to time, and consensus always seems to be that aways hurt more candidates than it helps. I am referring to GS and not ortho; if ortho recommends away rotations, do what is expected.

I'm not gonna doubt that it can hurt you in general surgery, as I'm pretty unfamiliar with that process.

But your first three reasons would apply to doing Ortho aways as well...and it's pretty well established that doing aways at Ortho programs your interested in is very important to match.
 
I'm not gonna doubt that it can hurt you in general surgery, as I'm pretty unfamiliar with that process.

But your first three reasons would apply to doing Ortho aways as well...and it's pretty well established that doing aways at Ortho programs your interested in is very important to match.

Sure. Different specialty. It's not viewed as important to the match in GS, which is why it tends to hurt more than it helps. While virtually every medical school in the country requires a surgery rotation of their students (which is usually 6-8 weeks), few, if any, require an ortho rotation. Some people interested in ortho have zero clinical exposure to it as an M3, yet apply to it as an M4. Most of the elective ortho rotations were also only 2 weeks where I went to school, as well as where I did residency (whereas GS had 4 week rotation electives as standard at both). So showing that you have adequate exposure to ortho to *know* you want to do it is important; hence doing away rotations.
 
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Ok, so your mentality was you were more ok with doing Gen Surg than you were doing a gen surg prelim year then reapplying or continuing with gen surg?



So how does this not apply to all away rotations then?


With competitive specialties, aways are part of the culture for whatever reason.
 
Because when you rotate:
1. You are unfamiliar with the hospital, the culture, and the EMR, and will likely look clueless in comparison to the home M4s. They also usually know some of the residents and attendings and know of various preferences and quirks. The home M4s get first dibs on picking rotations, so they usually take the spots early in the year (to get LORs, etc.) and set the bar. It's harder to stand out positively when you're starting with such a disadvantage. By the time you learn these basic things, you've already lost a week or two to impress.
2. If you're not competitive for a given program, it's very, very hard to be an outstanding enough away rotator to move yourself high on the rank list, although usually you will get a courtesy interview.
3. If you are competitive for a given program, doing or saying one stupid thing could suddenly make you less desirable. In other words, you aren't going to move yourself up the rank list, but you can get yourself moved down it.
4. It's not considered as important in GS to do an away rotation or two, as most students have a local GS residency program to get LORs from.

This gets discussed on the surgery forums from time to time, and consensus always seems to be that aways hurt more candidates than it helps. I am referring to GS and not ortho; if ortho recommends away rotations, do what is expected.

I've been doing ortho aways for a couple of months now and agree with all this with the exception of the following:

Aways for ortho are pretty much "required" in that they're a box you have to check. Residents and attendings understand the difficulty of shining in a foreign environment so they cut rotators some slack.

They let you break scrub a little early so you have a buffer to get lost as you find your way to Grand Rounds, for example. Or they send you home from call at a reasonable hour if you have an important meeting with the PD in the morning. They understand that your priority is to look good in front of the attendings so as long as you bust your butt while you're with them and don't leave for BS reasons (such as lunch while everyone is working) they'll cut you slack when you need it.

I still haven't figured out how to wow the socks off my attendings while I'm on aways, so instead I focus on working hard, having a good attitude, being engaged, and most importantly, not saying or doing anything stupid. I've been the yes-man during these months* and I hope this is enough to get me an interview and some sort of advantage over non-rotators, but we'll see as the season goes on.

Also, almost everyone does their home rotation around the same time so you will usually be on aways with other outside rotators after you've finished your home month. Regardless, it's actually super helpful to end up with someone at their home program because they have the insider info on everything. They can log you into the EMR if you don't have access, help you find your way around the hospital, tell you each attendings' quirks (who pimps and on what), etc. It's a "pay it forward" kind of attitude because we will all be in a foreign hospital at one point and will rely on others for these things.

Maybe I've been lucky with my choice of programs, but everyone I have met thus far has been super collaborative and helpful. This includes other students, residents, attendings, and staff. We help each other when we can and have a good time while working hard. This attitude is a huge part of why I love ortho. It's a good group of people to be around.

Having said all that, I think it's way easier to make a bad impression than a good one (points 2 and 3 above). But in ortho you don't have the option of not doing aways so you hope for the best.

---
* The only time I said "No" to something was when a resident really wanted to Stryker a patient with suspected compartment syndrome on his last day of trauma, but there was no real clinical indication for it. He turned to me and jokingly said, "So...how badly do you want to be in this program?" Before he could finish his question, I told him, "Hell, no! Stryker yourself first," and we all shared a good laugh.
 
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Sure. Different specialty. It's not viewed as important to the match in GS, which is why it tends to hurt more than it helps. While virtually every medical school in the country requires a surgery rotation of their students (which is usually 6-8 weeks), few, if any, require an ortho rotation. Some people interested in ortho have zero clinical exposure to it as an M3, yet apply to it as an M4. Most of the elective ortho rotations were also only 2 weeks where I went to school, as well as where I did residency (whereas GS had 4 week rotation electives as standard at both). So showing that you have adequate exposure to ortho to *know* you want to do it is important; hence doing away rotations.

I mean the issue with that is if you truly didn't know jack about ortho and showed up in the fall of your 4th year to an away exhibiting those characteristics, you're pretty SOL to get into a bunch of other residencies at that point right? You wouldn't be able to do other aways and you would have lets a short few months to scrap together a whole new app from scratch...

I feel like if people were that irresponsible programs wouldn't even let them through the front door. Leads me to believe that might be a secondary reason, though I'm not convinced I know the primary one.

Yes that is correct.

Could you expand on that please? I've been exposed to mostly the opposite perspective, people who are willing to live and die for a competitive subspecialty.
 
Could you expand on that please? I've been exposed to mostly the opposite perspective, people who are willing to live and die for a competitive subspecialty.

I'm not sure how to expand. I didn't want to go through the scramble. I wanted certainty. Plus, I was reasonably sure I'd match ortho, but I didn't want to leave anything to chance. I see myself as a successful person, and I knew I would make the best of general surgery if that ended up being my path. But it didn't.
 
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