Breaking match contract, applying outside the match

[sgk108]

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Question: I'm currently a PGY-1 who SOAPed into a position for this July. Unfortunately, it is a decision I regret. If I decide to bail before the residency starts, I understand that I will be deemed a match violator and be banned from the match for a while. However, will programs who normally participate in the match but are currently offering positions outside the match for advanced spots (i.e. a PGY2 spot that only opened up after the match) be able to take me without getting in trouble/committing a violation?
Thanks for your input/sharing any experience you've had with this.

 

[NotAProgDirector]

From the NRMP site:

Applicants with a confirmed violation of NRMP policy are subject to the following sanctions:

• One year bar from accepting or starting a position in any program sponsored by a Match-participating institution
• One to three year or permanent bar from participation in future NRMP Matches
• One to three year or permanent identification in the R3 system as a Match violator

The first bullet point would prevent you from taking any spot, even those outside the match, unless the program doesn't participate in the match at all. Note that if you violate the match the NRMP can choose which of these sanctions, if any, to enforce.

 

[sgk108]

From the NRMP site:


The first bullet point would prevent you from taking any spot, even those outside the match, unless the program doesn't participate in the match at all. Note that if you violate the match the NRMP can choose which of these sanctions, if any, to enforce.

Thanks so much for responding. Under what circumstances, if any, would the NRMP not enforce the first bullet point (not being able to accept any spot outside the match with a match participating program)? It seems like it might be in a program's best interest to not take someone who intends to leave after a year anyway, and there would still be time to find a replacement. Would it make a difference if the program director was on board with the decision? And by what means would the NRMP prevent one from taking another spot -- by threatening the new program with a sanction, or by literally not allowing them to start (and if so, how?)?

Advice really appreciated. Thanks again.

 

[Raryn]

Thanks so much for responding. Under what circumstances, if any, would the NRMP not enforce the first bullet point (not being able to accept any spot outside the match with a match participating program)? It seems like it might be in a program's best interest to not take someone who intends to leave after a year anyway, and there would still be time to find a replacement. Would it make a difference if the program director was on board with the decision? And by what means would the NRMP prevent one from taking another spot -- by threatening the new program with a sanction, or by literally not allowing them to start (and if so, how?)?

Advice really appreciated. Thanks again.

NRMP will routinely allow a waiver for change in specialty, but usually that's for an advanced spot that you match >1 year ahead of time, and you have to request the waiver somethingl like 6 months ahead of time. Waiving a SOAP spot, even if both you and the program were willing, is pretty much impossible. You're required to show up to your program the first day, and stay for at least 45 days.

If you violate the match, the NRMP contract with institutions can stop you from taking *any* job at a match participating institution. Even if you just wanted to do research with a department for a year waiting for your match ban to wear off, even that's against the rules.

 

[Crayola227]

you should be kissing some deity's **** that you have a spot and show up

 

[NotAProgDirector]

Thanks so much for responding. Under what circumstances, if any, would the NRMP not enforce the first bullet point (not being able to accept any spot outside the match with a match participating program)? It seems like it might be in a program's best interest to not take someone who intends to leave after a year anyway, and there would still be time to find a replacement. Would it make a difference if the program director was on board with the decision? And by what means would the NRMP prevent one from taking another spot -- by threatening the new program with a sanction, or by literally not allowing them to start (and if so, how?)?

Advice really appreciated. Thanks again.

Taking someone who plans to drop out after a year still gives me a whole year to find a replacement. If you drop out now, I have 2 months to find a replacement and my options might be less than exciting.

"Program Director on board with the decision" is complicated. If a resident tells me that they don't want to start, it puts me in a tough spot -- either say it's "OK" to support the resident's decision, or say no and end up with a bitter resident. Hence, the NRMP decides whether it's OK or not.

Your new program could be sanctioned in the next match.

If you violate the match, the NRMP contract with institutions can stop you from taking *any* job at a match participating institution. Even if you just wanted to do research with a department for a year waiting for your match ban to wear off, even that's against the rules.

Although perhaps "true", the NRMP is only concerned with clinical training positions. I highly doubt they would care about research positions.

 

[Raryn]

Although perhaps "true", the NRMP is only concerned with clinical training positions. I highly doubt they would care about research positions.

Happened to a friend of a friend of mine, where he was told by the institution he was interested in that b/c of his match violator status, he could not be employed in any capacity by their department.

He was so incensed he sponsored a resolution at his state medical society to have the AMA look into the issue. And it's more than just a "friend of a friend" issue, as I was at that meeting when the AMA debated the issue (and I believe it was shot down as being an internal NRMP issue, but that's been a while).

 

[sgk108]

Happened to a friend of a friend of mine, where he was told by the institution he was interested in that b/c of his match violator status, he could not be employed in any capacity by their department.

He was so incensed he sponsored a resolution at his state medical society to have the AMA look into the issue. And it's more than just a "friend of a friend" issue, as I was at that meeting when the AMA debated the issue (and I believe it was shot down as being an internal NRMP issue, but that's been a while).

How did it ultimately work out for him? Did he find a spot in his specialty of choice, and if so, was it via or outside the match?

 

[Raryn]

How did it ultimately work out for him? Did he find a spot in his specialty of choice, and if so, was it via or outside the match?

*shrug*. He was partway through his 3 year match ban last I heard. That was 4-5 years ago, but not someone I particularly knew.

 

[sgk108]

That's rough. Anyway, thanks for the insight. I'll obviously have to start the year and take it from there.

 

[j4pac]

What makes you think that you will match a second time if you were lucky to SOAP the first time? Sounds like poor decision making to me.

 

[sgk108]

What makes you think that you will match a second time if you were lucky to SOAP the first time? Sounds like poor decision making to me.

Without sounding ungrateful for the opportunity I'm being given (and accepted), I do think I was a relatively competitive applicant for the specialty I SOAPed into, and I'd have an okay chance of finding something else in a different specialty outside the match (or through the match again next year) were I able to get out of the contract before the year starts. Clearly, though, that's not a realistic option at this point. Perhaps it'll turn out to be a good thing.

 

[ThoracicGuy]

Without sounding ungrateful for the opportunity I'm being given (and accepted), I do think I was a relatively competitive applicant for the specialty I SOAPed into, and I'd have an okay chance of finding something else in a different specialty outside the match (or through the match again next year) were I able to get out of the contract before the year starts. Clearly, though, that's not a realistic option at this point. Perhaps it'll turn out to be a good thing.

You SOAPed into a position. I'm not sure you're all that competitive... Go into your program that you have with the intentions of liking it and doing well. You may just find you really enjoy it.

 

[tantacles]

You SOAPed into a position. I'm not sure you're all that competitive... Go into your program that you have with the intentions of liking it and doing well. You may just find you really enjoy it.

It sounds like OP applied for a different specialty and soaped into this one after failing to match, meaning she very well might have been very competitive for this specialty.


Large dogs

 

[candbgirl]

But she wants to go into yet another specialty and she just may not be competitive at all. And then there is whole breaking her match contract and applying outside the match issue...


Sent from my iPad using SDN mobile app

 

[sgk108]

So, here's what happened (in case my story is of any use to future readers). Initially applied to competitive integrated surgical subspecialty, didn't match, and took a pgy1 prelim spot. As a prelim, applied to gen surg, didn't match, and, in the heat of the moment, decided to SOAP into a COMPLETELY different field, and regretted it shortly thereafter. Really want to keep trying for gen surg and do another prelim year (which obviously aren't so difficult to obtain); the regret plagues me every day. However, as I've learned, there's apparently no feasible way to get out of my contract at this point and it seems I'd be barred from starting even another prelim year (please correct me if I'm mistaken). One alternative, which is completely ridiculous, would be to do a year of this specialty and, if I decide I still want to give surgery another shot, then leave for another surgical prelim year (while I still have some funding left), though the odds of this ultimately panning out are low and I could of course be left with nothing. Maybe, hopefully, I'll end up liking this new residency a lot and I'll stop thinking about surgery; if not, however, it seems like it might be worth the gamble. Anyone know of someone who did something like this? For now, though, there's clearly nothing left for me to do but go into my new program with an open mind and work hard to be one of the best residents there.

 

[NotAProgDirector]

Another choice is to apply next year to Gen Surg and/or the initial specialty you were interested in. If you match, you finish the year in your current field (or resign, your choice). If you don't, then you continue. I wouldn't apply for prelims again -- that's a dead end.

Last choice is to finish your new field, and then apply again to surgery. I have seen this done -- one of my IM grads applied for and matched into Derm, and another matched into Gen Surg and ultimately became a transplant surgeon.

 

[paki20]

don't be stupid, if you got a categorical spot in residency consider yourself fortunate..our MD degrees are pretty useless without a residency, don't risk it

if you're as competitive as you say you are (clearly most programs you applied to did not think so) but if you truly are then you can always switch specialties later down in the line..don't risk getting a match violation it will shut several doors for you

 

[Lostin_space]

So, here's what happened (in case my story is of any use to future readers). Initially applied to competitive integrated surgical subspecialty, didn't match, and took a pgy1 prelim spot. As a prelim, applied to gen surg, didn't match, and, in the heat of the moment, decided to SOAP into a COMPLETELY different field, and regretted it shortly thereafter. Really want to keep trying for gen surg and do another prelim year (which obviously aren't so difficult to obtain); the regret plagues me every day. However, as I've learned, there's apparently no feasible way to get out of my contract at this point and it seems I'd be barred from starting even another prelim year (please correct me if I'm mistaken). One alternative, which is completely ridiculous, would be to do a year of this specialty and, if I decide I still want to give surgery another shot, then leave for another surgical prelim year (while I still have some funding left), though the odds of this ultimately panning out are low and I could of course be left with nothing. Maybe, hopefully, I'll end up liking this new residency a lot and I'll stop thinking about surgery; if not, however, it seems like it might be worth the gamble. Anyone know of someone who did something like this? For now, though, there's clearly nothing left for me to do but go into my new program with an open mind and work hard to be one of the best residents there.

Ok, as someone who has actually transferred residencies, let me tell you that 1- it's hard to actually transfer without creating all sorts of havoc and stress, and 2-if you don't have a significant # of IVs in specialty #2 where you want to transfer to, don't risk it as it's going to be difficult to transfer. It seems that you've tried a number of times to match into Surg and it has not worked out. After trying a few times, it becomes more difficult to match as you know. Continuing to do prelim years is a waste for you, since if you have not given the option to continue in the program after prelim #1 it's unlikely that they will make you that offer after doing another prelim year. Care to share what your currently matched to program is in terms of specialty? If you truly despise it, maybe try to continue to switch. But given that 2 matches have not gone in the hoped for way, I would caution you against trying to continue to match in that field as it's unlikely. How long is your currently matched to residency? My advice would be to continue where you are unless you hate it. It would be unfortunate to have no residency position, and several matches already that have gone in a non desired outcome.

 

[j4pac]

Is Gen Surg actually competitive though? If you said Derm or ENT, I would be more confident. But a mediocre Gen Surg applicant (which you apparently are) doesn't make a great primary care applicant...especially after acquiring a red flag in ditching a prior program.

 

[Lostin_space]

Is Gen Surg actually competitive though? If you said Derm or ENT, I would be more confident. But a mediocre Gen Surg applicant (which you apparently are) doesn't make a great primary care applicant...especially after acquiring a red flag in ditching a prior program.

Gen surg is sufficiently competitive, certainly in that there are more applicants than there are positions. I think you are being a little harsh don't you think? The point of this forum is to provide advice, not to be harsh to others. I'm certain you have good advice to provide, but I would suggest maybe a more gentle approach. Putting someone down who already has had issues with matching into their preferred specialty by calling them a "mediocre applicant" doesn't really do much good. My 0.02.

 

[j4pac]

Gen surg is sufficiently competitive, certainly in that there are more applicants than there are positions. I think you are being a little harsh don't you think? The point of this forum is to provide advice, not to be harsh to others. I'm certain you have good advice to provide, but I would suggest maybe a more gentle approach. Putting someone down who already has had issues with matching into their preferred specialty by calling them a "mediocre applicant" doesn't really do much good. My 0.02.

I don't care about your $0.02. Don't try to mod me.

Failing to match to a specialty is the definition of mediocre applicant for that specialty. The OP needs to hear it because it could help him prevent a mistake he will regret. Giving sound advice is the point of this forum...not giving people back rubs and giving them false security.

 

[Lostin_space]

I don't care about your $0.02. Don't try to mod me.

Failing to match to a specialty is the definition of mediocre applicant for that specialty. The OP needs to hear it because it could help him prevent a mistake he will regret. Giving sound advice is the point of this forum...not giving people back rubs and giving them false security.

It's not about "giving people back rubs" - tearing someone down is what makes a nasty, hostile destructive environment. Big difference between giving sound advice while not tearing someone down and giving false security. AProgDirector is a master of that. He lays it down very objectively while at the same time not destroying the applicant.
You have an awsome quote on your profile - "By the grace of God" - don't forget that when giving others advice. Remember your own match experience when advicing others.

 

[j4pac]

It's not about "giving people back rubs" - tearing someone down is what makes a nasty, hostile destructive environment. Big difference between giving sound advice while not tearing someone down and giving false security. AProgDirector is a master of that. He lays it down very objectively while at the same time not destroying the applicant.
You have an awsome quote on your profile - "By the grace of God" - don't forget that when giving others advice. Remember your own match experience when advicing others.

Get off your soap box. Youre not being helpful