Because of the competitiveness of derm, I've been thinking of backup plans just in case I go unmatched. I won't be applying to multiple specialties because that seems to be frowned upon. I know that some people will do a prelim year and then 1 or 2 yrs of research. However, by the time of my match, I will have done a research yr already and as much as I love derm, I can't see myself doing more research yrs. The only other field that I enjoyed was surgery. How realistic is it to jump ship, do a prelim surgery, and try to get categorical gsurg or ortho? I know this is kind of a bizarre question but any ideas would be helpful. Thanks!
Backup plan
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Orthopedics is on the level of competiveness of Dermatology. If you use up your Medicaid govn't dollars for traning, it makes you that much less attractive. If your sitting on 4 JBJS articles, then sure this is a feasible back-up plan. I doubt you are so this is not really a feasible option as you'll likely need to do a research year in Ortho to even have a shot.
General Surgey, I think you'll be in better shape; in fact many academic centers have prelim surg spots and I know several people from my medical school that jmped on those when they failed to match in ortho/ent/neurosurg, etc. Whether they give you a categorical position or simply ask you to repeat surgical intern year is program specific. I am not sure about this but PGY2 spots in community surgical programs maybe an option but then you'll be doing categorical surgery at a community program.
Long story short, yes, dual applying looks bad. Can you pull it off? Yes. For Derm, IM is usually an easy backup; many top preliminary medicine spots from prestigious IM programs can become categorical should you decide to finish categorical medicine. I know this firsthand having interviewed and asked these prelim med programs. Gen Surg is not competitive; you can probably get away with applying in that field and Derm since they interview early.
If I were you, I would apply Derm and put some academic prelim medicine programs on my list so I have a plan B. If you really see yourself as a surgeon if you can't be a dermatologist, then I would apply in both fields and see what happens.
General Surgey, I think you'll be in better shape; in fact many academic centers have prelim surg spots and I know several people from my medical school that jmped on those when they failed to match in ortho/ent/neurosurg, etc. Whether they give you a categorical position or simply ask you to repeat surgical intern year is program specific. I am not sure about this but PGY2 spots in community surgical programs maybe an option but then you'll be doing categorical surgery at a community program.
Long story short, yes, dual applying looks bad. Can you pull it off? Yes. For Derm, IM is usually an easy backup; many top preliminary medicine spots from prestigious IM programs can become categorical should you decide to finish categorical medicine. I know this firsthand having interviewed and asked these prelim med programs. Gen Surg is not competitive; you can probably get away with applying in that field and Derm since they interview early.
If I were you, I would apply Derm and put some academic prelim medicine programs on my list so I have a plan B. If you really see yourself as a surgeon if you can't be a dermatologist, then I would apply in both fields and see what happens.
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I agree with medicine123abc. I too thought of doing a prelim surgery year but it seems like they will make you repeat your internship year anyway if you jump into a categorical general surgery program.
I ended up placing some prelim medicine programs on the list and feeling them out on the day of the interview. For the most part, they are more than happy to accommodate you into their categorical program if you should fail to match into dermatology (without making you repeat the internship year). The caveat, of course, is whether you actually enjoy medicine enough to pursue this pathway
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Why did you consider prelim surg? I ask because whenever anyone mentions prelim surg, they're looked at like they're crazy.
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I rather enjoyed my surgery rotation as a 3rd year which is why I was leaning towards prelim surgery. I did not realize it would mean having to repeat internship as a categorical surgery resident which is why I opted for medicine as a backup instead
I think that's the problem with me.. I enjoyed surgery more than medicine so that would be a hard pill to swallow. Say if you do a prelim surgery yr and somehow find a PGY2 spot, does that eliminate the funding issue?
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This is a good article to know:
http://umsc.org.uic.edu/documents/medicaregme2013.pdf
"If a specialty requires a broad-based clinical year of training, and you match
simultaneously into both the broad-based year and the specialty program, then your
IRP is determined by the specialty program that begins during your second year of
training. If, instead, you initially match only into a clinical base year or preliminary
year program, your IRP is determined by your clinical base year program—even if
you later match into a different specialty"
Basically, if u match prelim surgery, u are funded for 5 years total. If u match into derm later on you will have enough funding for your entire residency. If u match later on into something else that requires longer training (e.g. neurosurg), the department will have to foot the bill for the extra years.
http://umsc.org.uic.edu/documents/medicaregme2013.pdf
"If a specialty requires a broad-based clinical year of training, and you match
simultaneously into both the broad-based year and the specialty program, then your
IRP is determined by the specialty program that begins during your second year of
training. If, instead, you initially match only into a clinical base year or preliminary
year program, your IRP is determined by your clinical base year program—even if
you later match into a different specialty"
Basically, if u match prelim surgery, u are funded for 5 years total. If u match into derm later on you will have enough funding for your entire residency. If u match later on into something else that requires longer training (e.g. neurosurg), the department will have to foot the bill for the extra years.
I had a backup in another competitive specialty because it was something I was interested in.
When I was looking (and I suspect this is still the case), the derm re-match rate (for those who didn't match into derm their first time) was something abysmal like 8%. That's not a good cost/benefit ratio in my opinion for delaying residency (and repayment of debt, etc) to do research fellowships, etc. I also rotated at a midwestern derm program when I was a student who had a research fellow in her 4th year of "1 year" unpaid research fellowship. Seeing how they were treating her, and that she was willing to go along with it each time in the hopes of getting a derm spot probably soured me a bit.
If you decide to back up, I would lie about it. Interviewers in derm love to ask what your backup plan is, but the honest to God truth is that it's none of their business. If you're defaulting to your backup plan it means they didn't take you and their opinion doesn't matter. If they take you the whole point becomes moot. It's just a mind**** they like to pull. Make sure other students interested in derm or your backup field at your home school don't find out. It was tough for me, but I avoided most of my class for the 3 months leading up to the match because that's all anyone wanted to talk about and I was courting 2 departments. It seems like a dishonest way to do business perhaps, but my view was that if I went unmatched none of these programs were going to shed a tear for me or give me a second thought. You nor I created this cluster of a system, but you are still responsible for making sure you get out the other side intact.
Hope that helps.
When I was looking (and I suspect this is still the case), the derm re-match rate (for those who didn't match into derm their first time) was something abysmal like 8%. That's not a good cost/benefit ratio in my opinion for delaying residency (and repayment of debt, etc) to do research fellowships, etc. I also rotated at a midwestern derm program when I was a student who had a research fellow in her 4th year of "1 year" unpaid research fellowship. Seeing how they were treating her, and that she was willing to go along with it each time in the hopes of getting a derm spot probably soured me a bit.
If you decide to back up, I would lie about it. Interviewers in derm love to ask what your backup plan is, but the honest to God truth is that it's none of their business. If you're defaulting to your backup plan it means they didn't take you and their opinion doesn't matter. If they take you the whole point becomes moot. It's just a mind**** they like to pull. Make sure other students interested in derm or your backup field at your home school don't find out. It was tough for me, but I avoided most of my class for the 3 months leading up to the match because that's all anyone wanted to talk about and I was courting 2 departments. It seems like a dishonest way to do business perhaps, but my view was that if I went unmatched none of these programs were going to shed a tear for me or give me a second thought. You nor I created this cluster of a system, but you are still responsible for making sure you get out the other side intact.
Hope that helps.
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Internal medicine is much more painful than a 15-17 hour day on general surgery in my opinion. I would opt for surgery too
Not that I don't believe you, but where are you getting this statistic that those who fail to match into derm as 4th year medical students have an 8% match rate when they apply again either in internship year or in their derm research fellowship year? Most post-MD derm clinical research fellowships do pay a salary - usually at the PGY-2 level, so it's quite unusual for there to be a clinical research position after getting your MD, having an internship and USMLE Step 3 completed to get a license, and not getting paid, much less 4 years of research fellowship work, assuming he/she actually published and was productive.
I do agree there are fellowship directors and derm residency programs who do take huge advantage of fellows' vulnerability in this process. A lot of this, unfortunately, is reading in between the lines, reading people well, asking the right people who won't come out to tell you, unless you ask.
For the OP, I would sit with a Derm faculty mentor and be upfront asking about your chances of matching into Derm. Don't pussyfoot around it - trust me. If you're going to apply for a backup specialty, you better make sure all your ducks are in order in terms of separate LORs for both specialties (i.e. your letter writer not f'ing up and mislabeling his letters), separate personal statements, etc. It might be obvious though looking at your application since you can't send 2 separate ERAS applications, if you're applying for 2 disparate specialties that have no connection: PM&R and Derm, when they see your research and your transcript has Derm electives. Keep both completely separate and don't tell anyone.
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You guys are both crazy. Do a transitional year.
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Lol! I could sit in the OR all day. Think about it, you get some good music, you are involved suturing/retracting, you get to see some amazing anatomy, rounds are To The Point, you are solving a problem, scrubs are easy to wear get dirty get another pair, do line placements, I/D, procedures, learning a tangible skill.
Medicine..... you are pre-rounding, rounding again, having a bagel and coffee, nurse & social work meeting/rounds, admit & discharge moving meat all day, consult medicine to handle hypertension, consult medicine for diabetes, you have to have your ironed shirt tie pants combination each day, all day discussing differentials, rounding again/baby sitting patient complaints about the hospital food and all the other social madness.
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So then you have no idea what being a surgical intern entails, I see. No wonder you're still entertaining that thought.
You'll probably be lucky if you get to sniff the OR from the hallway. Operating/being in the OR is probably last on the list of prelim surgical interns' list of tasks.
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I am talking about the positive sides. Surgical interns need to know everything and handle a lot of the same things medicine interns do. It is not a walk in the park. They need to know their patients inside and out. If you get the opportunity to operate, then you enjoy those nice positives. Lot's of BS consults for surgery as well. However, some people cannot stomach being on medicine. I am one of those. A lot of people do surgical intern years for those reasons.
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The smart ones do TYs. I had two months of medicine floors. Two months of ED, and basically the rest were electives.
Even if you hate internal medicine/inpatient medicine, the other 10 months make stomaching two annoying ones easy as pie.
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Wow they gave that many electives?! Ok, that is a really good gig then. Some friends I had did Transitional years and it was horrible where they were. Their hours were the same as the surgery residents (I don't know how that was possible).
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That sounds terrible.
We truly had 5 months of electives that were super cush. Two months of medicine, some ED and urgent care (good hours), and night float that was hardly actual night float.
A cush TY is the best gig you can get (unless you truly are looking for a challenging academic intern year).
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I did a legit prelim year at a top 25 and had 5 floor months, 1 ICU, and 6 months of rotations with all weekends off (5 of them were electives).
2 weeks of night float where I would get like 5 calls a night. I just watched adult swim/Cartoon Network all night. I wish I would have had more NF.
The only bad thing I can say about it is that there were a few DBs/bitch face co-residents....but heck, get that almost anywhere.
2 weeks of night float where I would get like 5 calls a night. I just watched adult swim/Cartoon Network all night. I wish I would have had more NF.
The only bad thing I can say about it is that there were a few DBs/bitch face co-residents....but heck, get that almost anywhere.
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There are IM prelim years at community hospitals that give you 4-5 months of electives also.
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Sounds like the TY I'm headed to. We do have quite a bit of night float according to current residents, but if its chill I don't mind. I actually enjoyed my night float weeks in M3 and a few M4 electives, 90% of the time they ended up being Netflix binges.
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We did have a month-long night float on a very very light service. I watched the entire Breaking Bad series in the first two weeks or so on Netflix.
Out of curiosity, where are you headed? You can feel free to PM me. If you would rather not divulge that, that's understandable as well.
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Going to Scripps in sunny SD. Funny about Breaking Bad - I did the last 2 seasons (well, the two parts of the last season) during my night float of L&D.
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It depends from program to program and I don't think it would hurt to ask.
I don't believe this is an option in a TY. My prelim medicine program seemed to hint on the interview day that if I were to fail to match into an advanced position and if I were interested in continuing as a categorical resident, there would be room to accommodate me.
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I'm going DO route but had the same question. This affects me mainly because I can't even apply to derm until I'm an intern. So if I don't get in, it would be super nice to be able to slide into an IM ACGME 2nd year spot. Is that even possible? It seems like I would have to reapply to a categorical IM year. That's the huge risk of applying derm. Possible wasting a year
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