Aways Without Home Program - Considerations

TheVagüs

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To any attendings/residents who still read this subforum,

I am an applicant in the upcoming cycle, and I do not have a home program or even home department (neurosurgeons here are under the umbrella of the surgery or peds departments). We do have a subI, but it's run out of the local private hospital and the attending who runs it is not an academic or known in the neurosurgery community at large. I was originally accepted a few weeks ago to an away in my state, but it was cancelled today as the institution made an ultimatum to restrict outside rotators. This is the second major institution in my state to cancel away possibilities even for students without a home program.

Regarding the SNS suggestions on aways, how far is too far away? I can only do one, I need one, and I need to really make it count. Currently a lot of programs have removed their rotations from VSAS, and many of those available are not accepting applications at this time or are 1000+ miles away. I may have to get flexible with where I go, but I don't want to overstep the society recommendations.

To add, is anyone aware of programs in the southwest/south that they know for sure will be taking outside rotators without a home program?

Thanks everyone for your time and help.
 

TheVagüs

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I think you need to get your dean to start making calls to place you at one program that will accept away rotations from schools that do not have home programs.

Thank you for the advice. You are actually the second person to mention that approach to me this week. I have a good relationship with our dean and will reach out to him tomorrow.

I hope things have been going well for you over the past couple months.
 
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libertyyne

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Thank you for the advice. You are actually the second person to mention that approach to me this week. I have a good relationship with our dean and will reach out to him tomorrow.

I hope things have been going well for you over the past couple months.
Its really a ****show for me as well. I am unsure if I will be able to match after all is said and done. But I am along for the ride .
 
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TheVagüs

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Its really a ****show for me as well. I am unsure if I will be able to match after all is said and done. But I am along for the ride .

I feel the same way. We'll work hard and hold on tight this app season. We might just end up with a job we like at the end of it.

I know your stats are solid- I'll be rooting for you.
 

TheVagüs

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I could be mistaken, but I had heard that neurosurgery was not allowing away rotations anywhere this year.

My understanding of the SNS statement on aways and interviews was that those without a home program will be granted an exception for local away rotations. It contains the following:

For students without a home program, they should have 8 weeks (2 rotations) of neurological surgery experience at the closest ACGME accredited program, in order to minimize travel and keep within regional disease demographics.

Our dean is only allowing a single away for students without a home program, so that's what I am trying to arrange. We have a subi here at the private hospital across the street, but there is no home department or residency.
 
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longhaul3

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Sounds like a tough spot. Obviously nobody knows how this year is going to turn out, but my first instinct is that you would have almost no chance of matching with this local non-academic sub-i as your only rotation. How are you going to get your letters? Is there only one neurosurgeon on staff there? If there are no residents, how will you take call, see consults, give your research talk, etc.? That just doesn't sound like a true neurosurgery sub-i to me, and rigorous sub-i's are the backbone (no pun intended) of the match.

I know this is all speculation and it doesn't help to point out the obvious, but my point is that if the letter of the "law" requires you to do this rotation instead of a real university sub-i because it's the closest, and you follow it, you probably won't match. So you may want to do the closest true academic sub-i that will take you, regardless of whether it's 100% in line with the recommendations.

You should get someone much more official than an internet stranger to interpret this with you (are the neurosurgery faculty at your home school well connected, even if it's not a teaching program? has anyone from your school matched in neurosurgery recently?), but as someone who has gone through the neurosurgery match that is my take. If all else fails maybe you could just contact someone at the SNS and try not to reveal your identity.

Edit: My bad, I missed the part that says "closest ACGME program." That's very clear. From what you're describing the local place is not an ACGME program. Here's an unofficial list.
 
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TheVagüs

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Sounds like a tough spot. Obviously nobody knows how this year is going to turn out, but my first instinct is that you would have almost no chance of matching with this local non-academic sub-i as your only rotation. How are you going to get your letters? Is there only one neurosurgeon on staff there? If there are no residents, how will you take call, see consults, give your research talk, etc.? That just doesn't sound like a true neurosurgery sub-i to me, and rigorous sub-i's are the backbone (no pun intended) of the match.

I know this is all speculation and it doesn't help to point out the obvious, but my point is that if the letter of the "law" requires you to do this rotation instead of a real university sub-i because it's the closest, and you follow it, you probably won't match. So you may want to do the closest true academic sub-i that will take you, regardless of whether it's 100% in line with the recommendations.

You should get someone much more official than an internet stranger to interpret this with you (are the neurosurgery faculty at your home school well connected, even if it's not a teaching program? has anyone from your school matched in neurosurgery recently?), but as someone who has gone through the neurosurgery match that is my take. If all else fails maybe you could just contact someone at the SNS and try not to reveal your identity.

Edit: My bad, I missed the part that says "closest ACGME program." That's very clear. From what you're describing the local place is not an ACGME program. Here's an unofficial list.

Thanks for the advice. My plan was exactly that- to do the "subI" here in town at the affiliate private hospital and the one away at the nearest ACGME program that will take me. It's a bit hairy at the moment as nobody seems willing to take me yet, especially not before September as the home students are playing catch up. I've reached out to my dean for some assistance here.

To answer your questions, we do have people match neurosurgery most years, although everyone from here usually does 3 aways. We have 2 faculty neurosurgeons at our main hospital and a few pedi guys at the dedicated children's hospital (part of the private hospital). They are not well connected.

My app is strong (high 250s step 1, AOA, all honors, solid pubs). I think I can make it work and have a successful cycle, but like you said I need that one away rotation for letters/connections and right now it's up in the air.
 

longhaul3

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Thanks for the advice. My plan was exactly that- to do the "subI" here in town at the affiliate private hospital and the one away at the nearest ACGME program that will take me. It's a bit hairy at the moment as nobody seems willing to take me yet, especially not before September as the home students are playing catch up. I've reached out to my dean for some assistance here.

To answer your questions, we do have people match neurosurgery most years, although everyone from here usually does 3 aways. We have 2 faculty neurosurgeons at our main hospital and a few pedi guys at the dedicated children's hospital (part of the private hospital). They are not well connected.

My app is strong (high 250s step 1, AOA, all honors, solid pubs). I think I can make it work and have a successful cycle, but like you said I need that one away rotation for letters/connections and right now it's up in the air.
No problem. That sounds reasonable. I don't think you could be faulted for doing the "home" one in addition to one ACGME away.

I'm not sure what other people around the country are doing, but if I were in your shoes I would be as aggressive as possible about securing an away at the closest ACGME institution that will take you and doing so as soon as possible. It seems unfair to require you to stick to the absolute closest one if you can't secure a spot there and wait in limbo for months. If you're in the southwest, where there aren't many programs around, that could mean the nearest one that will actually take you is 1k miles away in CA, TX, AZ, CO, UT, whatever, and I think you would be justified in going there in good faith if someone asks you about it on an interview.

Congrats on a solid app so far. It would be a shame for you to be denied the opportunity to match because of hemming and hawing and factors outside your control.
 
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TheVagüs

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No problem. That sounds reasonable. I don't think you could be faulted for doing the "home" one in addition to one ACGME away.

I'm not sure what other people around the country are doing, but if I were in your shoes I would be as aggressive as possible about securing an away at the closest ACGME institution that will take you and doing so as soon as possible. It seems unfair to require you to stick to the absolute closest one if you can't secure a spot there and wait in limbo for months. If you're in the southwest, where there aren't many programs around, that could mean the nearest one that will actually take you is 1k miles away in CA, TX, AZ, CO, UT, whatever, and I think you would be justified in going there in good faith if someone asks you about it on an interview.

Congrats on a solid app so far. It would be a shame for you to be denied the opportunity to match because of hemming and hawing and factors outside your control.

I actually am in the southwest. I thought a lot about what you said and decided yesterday to go ahead and email programs the next state over. As luck would have it I also got an email this morning from our student affairs office saying this was ok as long as we have a certain number of local rejections. Fingers crossed that this next batch of emails yields an opportunity.

Thanks again for taking the time.
 

longhaul3

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Nice. Good luck. You mentioned earlier that you were in the southwest—I'm not sure if it's true but I heard that the Barrow was planning on taking sub-i's this year. If you get a spot somewhere, you might think about doing your home "sub-i" before you go so you can learn the ropes a little bit. Usually visiting students are held to a somewhat higher standard because most of them have already done their home rotation, which prepares them for their aways. If you've never seen a mayfield or been pimped on a head CT before and suddenly start on service at another institution, it will be very stressful and you will have to work hard to overcome that shaky first impression even though they'd know in the back of their minds that you won't have had a home rotation.
 

TheVagüs

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Nice. Good luck. You mentioned earlier that you were in the southwest—I'm not sure if it's true but I heard that the Barrow was planning on taking sub-i's this year. If you get a spot somewhere, you might think about doing your home "sub-i" before you go so you can learn the ropes a little bit. Usually visiting students are held to a somewhat higher standard because most of them have already done their home rotation, which prepares them for their aways. If you've never seen a mayfield or been pimped on a head CT before and suddenly start on service at another institution, it will be very stressful and you will have to work hard to overcome that shaky first impression even though they'd know in the back of their minds that you won't have had a home rotation.

Thanks! I guess I thought I was being clever throwing in "south" as well haha. And yea, I will definitely be doing my home rotation first. I get one shot to impress and intend to make it count.
 
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