Categorial to Prelim and back to Categorical?

[VCorp]

As the title states, I recently left my residency program for performance based issues. I was in a 6-year residency program (5-year residency + 1 year for research) and still wish to continue to be a surgeon. I finished 2-years of residency (2-years of residency and 1 year of research).

My question is with me having 6-years of funding, what are the repercussions of doing a preliminary general surgery year, and trying to match back into a PGY3 position? I was hoping that I could use the preliminary LORs to advocate for me being a strong resident and hope to match back into the original field.

We've tried to apply for open PGY3 positions but have had no luck. My question is, if I did a prelim year, would this go towards the 6-years of funding which I initially received? I hope my question makes sense.

@NotAProgDirector
@Apollyon

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[Apollyon]

Prelim years don't count towards the clock, but, your clock has already started. As such, I shall defer to my most learned colleague, @NotAProgDirector .

 

[VCorp]

Prelim years don't count towards the clock, but, your clock has already started. As such, I shall defer to my most learned colleague, @NotAProgDirector .

That's what I figured as well. Seems like my best shot is to get into a PGY2 position somewhere or match into FM or IM, correct?

 

[Smurfette]

I was under the impression that research years are funded separately. Which would mean if you matched as a categorical in a surgical program, you have 5 years of funding, not 6.

Being let go after a research year implies academic issues. Did you fail the ABSITE multiple times? If so, it may be tough to find a categorical spot as you would be seen as at risk of failing the boards, which is bad for the program.
You can see if you can get a prelim position. If so, you would have to crush the ABSITE to have a chance at getting a categorical spot. And it is possible you would be compared to other PGY3s and not PGY1s given you have a few years of training already (not sure of ABS rules on this)...so the bar would be higher to get a high score. And if you are looking for a position, you'll want to be open to whatever spots you can find that are willing to consider you, be that PGY 3, 2 or starting over altogether.

 

[VCorp]

I was under the impression that research years are funded separately. Which would mean if you matched as a categorical in a surgical program, you have 5 years of funding, not 6.

Being let go after a research year implies academic issues. Did you fail the ABSITE multiple times? If so, it may be tough to find a categorical spot as you would be seen as at risk of failing the boards, which is bad for the program.
You can see if you can get a prelim position. If so, you would have to crush the ABSITE to have a chance at getting a categorical spot. And it is possible you would be compared to other PGY3s and not PGY1s given you have a few years of training already (not sure of ABS rules on this)...so the bar would be higher to get a high score. And if you are looking for a position, you'll want to be open to whatever spots you can find that are willing to consider you, be that PGY 3, 2 or starting over altogether.

Thank you for the message. Did the research year prior to starting the surgical residency. Resigned after PGY2 after not being able to pass Step 3; rather than being terminated and of course passed it after I resigned.

Yes, 100% open to having to restart residency if need be.

Edit: should clarify this was not a general surgery residency but rather another surgical specialty

 

[Smurfette]

Thank you for the message. Did the research year prior to starting the surgical residency. Resigned after PGY2 after not being able to pass Step 3; rather than being terminated and of course passed it after I resigned.

Yes, 100% open to having to restart residency if need be.

Edit: should clarify this was not a general surgery residency but rather another surgical specialty

I apologize, I did not look at your post history prior to replying. Your situation is more complicated.
Some relevant posts are below for others looking to offer help, but everyone should note that these are from 2017:

Congrats guys to those of you who matched. I unfortunately didn't even match. One of the programs interviewed me and didn't even rank me, considering they have two unfilled spots in SOAP.

Should I just throw in the towel of wanting to do surgery as a career? I applied for GS this past cycle and has 7 interviews as an US-IMG. On match day, nothing landed. SOAP process didn't help either. My plan was to go from GS and do Ortho at a program that has both residency programs available.

One of the programs I didn't match at started a Transitional Year residency. The PD of the TY program is friends with the CEO of the hospital, who happens to be one of our family friends. In addition, one of the attendings in the TY program is also a family friend of ours. I figured that with two advantages over this compared to other candidates, I'd surely be in. The interview with the PD went great and he reassured me that I will be a great candidate for the program and he looks forward to seeing me this summer. Unfortunately, I wasn't selected. They interviewed 15 candidates, and picked 6. Said I was "close to the top". Second rejection in two months after not matching.

Recently, I found the website OrthoGate and found a plethora of research fellowships available, but unfortunately many of these listings have "hired" or filled these spots. I recently interviewed for one of the places which had an open spot. I was told I'd be a great fit and I will be in the top 3 spots. I found out last week I didn't get the position, and it's just killing me inside. I'm losing hope on what to do. Third rejection in three months after not matching.

The psychological aspect of being shut down is just taking a mental toll on me. I'm thinking I should just call it quits, accept my losses, and apply for low hanging fruit such as FM &/or Psych. Dad has a fairly large FM practice, and my parents were encouraging me to go into the field. It has its pros of me taking over his practice and large patient base. However, I just couldn't see myself being happy regardless of the financial incentive it would provide.

I'm turning 32 this summer. I feel my life is currently in limbo because of not matching. I just want to get my life started and I can't seem to get my ducks lined up properly. 🙁

So you presumably graduated from an international program in 2017 and initially failed to match. It seems as though at some point you found a spot after some research, but after your PGY-2 year, you had failed to pass step 3 and were let go. You have since passed step 3.
Did you pass all steps within 7 years? If not, you will have licensing issues in the US.

Not being able to pass step 3 is a big flag, as is being an IMG, being far out from graduation, and being let go from a prior program. That's a lot of red flags. If it was a surgical specialty in the US, odds are extremely low you will get back in or end up in any surgical program and you need to pivot to primary care as a better option. Primary care is going to be tough as well due to your flags causing you to be screened out before getting interviews. GS is going to be out of reach but you *might* be able to land a prelim GS spot and if you impress that program, *maybe* they would consider giving you a GS spot. But this scenario is a HUGE stretch with all your flags and you need to prepare to switch to a new career path. (Side note: you could look into things that allow you to have a license without being board certified, like wound care. This has its own set of issues but you can search SDN for threads on this). All in all, your best bet would probably be with the program that let you go/resign due to not passing step 3, assuming there weren't other issues with your performance that had them concerned. However, every program is going to be very concerned about your ability to pass the boards if you struggled to pass step 3.

 

[NotAProgDirector]

Looking at your post history, and piecing together your story, you're a Carib grad in 2016. You appear to have low but passing scores on S1 and S2, and then struggled quite a bit with S3 which it looks like you started attempting back in 2017. You may have applied in 2016 for residency, but then definitely applied to GS in 2017, got 7 interviews but didn't match. Then looks like you applied for research positions, and appear to have turned that into a residency spot. You completed 2 years, and then were likely let go for not passing S3. Unclear how long ago this was, now you've passed S3 and trying to move forward. You mention that this was a surgical sub, your prior posts suggest an interest in Ortho. If you actually ended up with an Ortho spot I am honestly quite impressed - had you asked (and you have lots of posts, perhaps you did), I would have told you it would be almost impossible to do so. I assume this was an actual categorical spot -- not a prelim PGY-1 and prelim PGY-2 which I have seen in the past.

First, let's correct some errors above. You get 5 years of full funding. Research years are not funded by CMS, so they don't count. Prelim and TY years absolutely do count. For those that match into a field that needs a prelim year, the IRP gets set at the total (so those matching into Radiology get 5 years, 1 year for prelim and 4 for radiology).

Your situation is very, very unique so will be impossible to base decisions on prior graduate experiences. As an IMG with poor scores, likely multiple S3 fails, and a distant graduation date (2016), I would usually tell you that your chances for surgery were very poor, close to impossible. But if you had 2 years of performance in a surgical program and your performance was good, and the only reason they let you go was S3, then that's something that's impossible to predict. It's certainly possible someone might consider you if that was the case.

So:

• As mentioned above, if you have more than 7 years between S1 and S3, that can cause licensing problems. Each state is different, many have a 7 year limit. Some have a 10 year limit, and some have no limit at all. And you can sometimes work around this by getting a license in a state with no limit first, and then using that license as a basis to get a license in another state that has a limit.
• You have 3 years of full funding left. After that you get partial funding, which may not be an issue at all for larger sites that might be over their cap anyway. Read this: Medicare Payments for Graduate Medical Education: What Every Medical Student, Resident, and Advisor Needs to Know
• I think you'll find it a real challenge to get a PGY-3 spot. Programs don't have openings like that often, and other parts of your application are problematic. If you were in an Ortho or similar program, then you might not even get enough GS credit for a PGY-3 spot (I am not an expert in this).
• I think you'll find it difficult to get a PGY-1 spot also. Most programs don't want to take over-qualified people into internship. It can be really difficult for the other interns, and even for residents who are trying to supervise you. Not impossible, but don't be surprised if interest is low.
• Lateralling into another field is possible, but has it's own challenges. You'd basically start over in IM or FP. All of your training would count for a PGY-1 in most other fields (perhaps except neuro that has strict rules).

I'm not telling you anything you don't already know, but losing your spot was a catastrophe. You had beaten the odds. You're now behind the 8 ball again. Best of luck.