Categorical IM intern interested in switching to DR

[2021medresident]

Howdy everyone,

I'm a categorical PGY-1 in a fairly well ranked IM program. I'll spare the details but after a lot of reflection and careful consideration of the field, I decided that I strongly want to switch into diagnostic radiology. I graduated from a lower-tier state MD school. My Step 1 and Step 2 are 238 and 242 respectively. Most of my extracurriculars and research are related to IM and I have 1 publication from undergrad and 2 case reports published in an IM sub-specialty. My program leadership has offered their support and even offered to keep my seat should I chose to do my PGY-2 year and apply then. They've also agreed to provide LORs. Most of my questions are related to making myself as competitive as possible for the upcoming match.

1. I know this is probably a bad reason, but I'm quite burned out after this year and for the sake of my mental health, I'm leaning towards leaving my program rather than continue as a PGY-2 just for the sake of having a job while reapplying. Would it be worth while to take a research year in order to beef up my application before applying this upcoming September? What would be the best approach- should I cold contact radiologists engaging in research? Are paid research positions very common and should I be aiming for such a position? I'm not to familiar about radiology research and what types of projects I should be looking for to be the most productive. Unfortunately when I reached out to the people I know in the rads department at my institution, they didn't provide much help.

2. Will I be looked at significantly less favorably as US MD senior despite successfully completing my intern year? My PD said that my particular reason for switching is very valid and should I have been switching into the program I'm currently in, I would not be viewed as having any red flags. That being said, I'd like to know how much of a disadvantage I'll be in and what my expectations should be entering the match as a re-applicant.

3. Geography has been pretty important to me and played a big factor in my match list last year. If applying, will I essentially need to throw that requirement out the window and expect to match across the country (if I even do match?)

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[Chlorini]

I don’t have much to add, but I think funding will be your biggest issue (and someone please correct me if I’m wrong). When you matched to your categorical IM spot, ACGME approved you for 3 years of funding. You already used your first year. You have 2 years left. As you know, radiology is a 5 year residency. Your radiology program would have to pay out of pocket for your salary for an additional 2 years.

Funding is determined at the time of your first match. This is a very confusing topic and I’m definitely no expert, but I’d reach out to an experienced radiology program director and ask. Some programs have additional sources of funds and it isn’t a huge issue.

Do a Google search on ACGME Medicare funding and see what comes up. I know at my TY program there are a lot of unhappy IM residents that got screwed secondary to funding issues. Most of them were unmatched prelim med residents that wanted radiology or anesthesia but essentially got locked in to IM because of funding (if you match a prelim medicine and not an advanced program, you get 3 years of funding; if you match a prelim and radiology, you get 5 years).

Again, I’m no expert, but I’d look into that first and then apply broadly.

Welcome to radiology!

 

[2021medresident]

I don’t have much to add, but I think funding will be your biggest issue (and someone please correct me if I’m wrong). When you matched to your categorical IM spot, ACGME approved you for 3 years of funding. You already used your first year. You have 2 years left. As you know, radiology is a 5 year residency. Your radiology program would have to pay out of pocket for your salary for an additional 2 years.

Funding is determined at the time of your first match. This is a very confusing topic and I’m definitely no expert, but I’d reach out to an experienced radiology program director and ask. Some programs have additional sources of funds and it isn’t a huge issue.

Do a Google search on ACGME Medicare funding and see what comes up. I know at my TY program there are a lot of unhappy IM residents that got screwed secondary to funding issues. Most of them were unmatched prelim med residents that wanted radiology or anesthesia but essentially got locked in to IM because of funding (if you match a prelim medicine and not an advanced program, you get 3 years of funding; if you match a prelim and radiology, you get 5 years).

Again, I’m no expert, but I’d look into that first and then apply broadly.

Welcome to radiology!

Thanks. The funding issue is something I contacted my PD and the rads PD about. They told me that this will likely be institution based (which doesn't help...). From what I understand if I leave after my first year, I still have a preserved 2 years of 100% IME and DME funding right? Were these prelims originally intending to match rads? Were any of them similar to my situation?

Also @RadiologyPD, would really appreciate the advice to some of my questions if you're around haha

 

[Chlorini]

Yes, you should still have that funding if you leave after one year.

I know of one categorical IM resident who matched radiology after his PGY2 year. From what I understand he was a very competitive applicant. I don’t know much else about him (he was a resident, I was an MS4 doing my radiology elective at my home institution.

The people at my current problem likely received bad advice or no advice at all. Most of them didn’t match an advanced position the first time (applied to too few programs) and SOAPed a prelim medicine spot and thought they could try again the following year. They didn’t know their funding was “set” at this point. I’m at a community TY— my guess is that these people had other issues or came from low-ranked medical schools. This year, no prelim secured an advanced spot (it was really sad to watch, honestly). They will all be doing IM next year. However there was a FM resident who SOAPed FM (3 years funding) and was successful in matching OBGYN (4 years funding) this cycle, so there must be ways around it.

I’d personally reach out to as many PDs as you can, join resident swap, and put yourself out there! If you’re a competitive US MD/DO you should be able to get something. Worst case scenario you could finish IM then reapply (I think the funding is reset at that point).

 

[2021medresident]

Yes, you should still have that funding if you leave after one year.

I know of one categorical IM resident who matched radiology after his PGY2 year. From what I understand he was a very competitive applicant. I don’t know much else about him (he was a resident, I was an MS4 doing my radiology elective at my home institution.

The people at my current problem likely received bad advice or no advice at all. Most of them didn’t match an advanced position the first time (applied to too few programs) and SOAPed a prelim medicine spot and thought they could try again the following year. They didn’t know their funding was “set” at this point. I’m at a community TY— my guess is that these people had other issues or came from low-ranked medical schools. This year, no prelim secured an advanced spot (it was really sad to watch, honestly). They will all be doing IM next year. However there was a FM resident who SOAPed FM (3 years funding) and was successful in matching OBGYN (4 years funding) this cycle, so there must be ways around it.

I’d personally reach out to as many PDs as you can, join resident swap, and put yourself out there! If you’re a competitive US MD/DO you should be able to get something. Worst case scenario you could finish IM then reapply (I think the funding is reset at that point).

On the topic of potentially going unmached, what would you say as far as my chances on being successful this upcoming cycle? While my school wasn't ranked highly, I think it did a decent job and got me into a fairly competitive IM program. I also think I have a very logical and personal reason for switching which I believe I can flesh out in my personal statement.

 

[Chlorini]

LOL love the edited bunny Easter post haha. Good one SDN!

@2021medresident I’m sure your med school is just fine! I just think something might have been wrong within their applications. People don’t usually broadcast that stuff.

I think you could be successful if you reached out to as many PDs as possible and are willing to move to an undesirable location at a lower ranked radiology program. Your biggest competition will be surgery residents trying to switch out.

 

[2021medresident]

LOL love the edited bunny Easter post haha. Good one SDN!

@2021medresident I’m sure your Easter basket is just fine! I just think something might have been wrong within their Easter egg collections. People don’t usually broadcast that stuff.

I think you could be successful if you reached out to as many PDs as possible and are willing to move to an undesirable location at a lower ranked radiology program. Your biggest competition will be surgery bunnies trying to switch out.

Would my chances be as risky even if I was also applying for advanced positions starting July 2023? Wouldnt I be mostly competing with US seniors?

 

[2021medresident]

LOL love the edited bunny Easter post haha. Good one SDN!

@2021medresident I’m sure your Easter basket is just fine! I just think something might have been wrong within their Easter egg collections. People don’t usually broadcast that stuff.

I think you could be successful if you reached out to as many PDs as possible and are willing to move to an undesirable location at a lower ranked radiology program. Your biggest competition will be surgery bunnies trying to switch out.

Would my chances be as risky even if I was also applying for advanced positions starting July 2023? Wouldnt I be mostly competing with US seniors?

 

[Chlorini]

Would my chances be as risky even if I was also applying for advanced positions starting July 2023? Wouldnt I be mostly competing with US seniors?

Yes, you would be. But there are programs that have direct PGY2 spots without waiting a year.

 

[2021medresident]

Yes, you would be. But there are programs that have direct PGY2 spots without waiting a year.

Is the risk attributable to uncompetitiveness? Are my board scores too low? Is the fact that I want to transition specialties viewed negatively?

 

[Chlorini]

Is the risk attributable to uncompetitiveness? Are my board scores too low? Is the fact that I want to transition specialties viewed negatively?

No, not at all. A lot of people switch! I just know the ones I saw on the interview trail were all ortho, neurosurg, gen surg switchers. I saw one EM but she was already an attending. I don’t know what your board scores are; again it’ll be work on your part but if you want it bad enough you can get it.

 

[Dave1980]

@2021medresident Leaving your IM program is a very big red flag. You also presumably don't have any track record of being interested in Rads which makes it seem that you are fleeing IM rather than running to Rads.

That being said I think you can match if you apply broadly (and smartly). You will need to apply to the absolute least desirable programs and hope for the best.

 

[2021medresident]

@2021medresident Leaving your IM program is a very big red flag. You also presumably don't have any track record of being interested in Rads which makes it seem that you are fleeing IM rather than running to Rads.

That being said I think you can match if you hop broadly (and smartly). You will need to hop to the absolute least desirable programs and hope for the best.

I'm not sure where you got that presumption, but all I can say is I disagree. The interest stems from my experience doing a few electives in radiology as an M4. But by then, I was registered for the match and by the end of my electives, I seriously regretted not considering radiology sooner. Again I'd rather not get into the details, but all I can say is that there was definitely interest in the field and my preceptors said that I would've made a great radiologist should I have applied. Nevertheless, I felt stuck with IM and compelled to move forward since I even ended up in my #1 ranked program. I experienced a lot of guilt amongst other things since I ended up where I thought I wanted to be and felt horrible for wanting something else. I tried to give IM a sincere chance (as there was must've been a reason I chose it in the first place). However over the course of the first half of the year, I gradually realized my mistake. I told my story to my PD as well as a few radiologists within my my hospital's department and they seemed pretty sympathetic overall.

If what you say is true, I'll take my chances even if its a lesser known community program. I'm just interested in knowing is where I should set my expectations but I certainly don't think my intentions are insincere.

No, not at all. A lot of people switch! I just know the ones I saw on the Easter egg hunt trail were all ortho, neurosurg, gen surg switchers. I saw one EM but she was already an rabbit. I don’t know what your board scores are; again it’ll be work on your part but if you want it bad enough you can get it.

My step 1 is 238 and my step 2CK is 242

 

[Chlorini]

I'm not sure where you got that presumption, but all I can say is I disagree. The interest stems from my experience doing a few electives in radiology as an M4. But by then, I was registered for the match and by the end of my electives, I seriously regretted not considering radiology sooner. Again I'd rather not get into the details, but all I can say is that there was definitely interest in the field and my preceptors said that I would've made a great radiologist should I have applied. Nevertheless, I felt stuck with IM and compelled to move forward since I even ended up in my #1 ranked program. I experienced a lot of guilt amongst other things since I ended up where I thought I wanted to be and felt horrible for wanting something else. I tried to give IM a sincere chance (as there was must've been a reason I chose it in the first place). However over the course of the first half of the year, I gradually realized my mistake. I told my story to my PD as well as a few radiologists within my my hospital's department and they seemed pretty sympathetic overall.

If what you say is true, I'll take my chances even if its a lesser known community program. I'm just interested in knowing is where I should set my expectations but I certainly don't think my intentions are insincere.


My step 1 is 238 and my step 2CK is 242

Your board scores are fine. You'll get a spot somewhere. Good luck!

 

[Dave1980]

I'm not sure where you got that presumption, but all I can say is I disagree. The interest stems from my experience doing a few electives in radiology as an M4. But by then, I was registered for the match and by the end of my electives, I seriously regretted not considering radiology sooner. Again I'd rather not get into the details, but all I can say is that there was definitely interest in the field

If you do have a track record of interest in Radiology that will be good for your application. I don't think doing an elective counts though. You probably did an elective in a bunch of other fields in MS4 .

Even getting some cases into auntminnie case of the day or ACR case in point at this stage would look good and really doesn't take too much time or effort.

 

[2021medresident]

Your board scores are fine. You'll get a spot somewhere. Good luck!

Would I be limited to community programs? Do I have a shot at academic ones?

 

[Chlorini]

Would I be limited to community programs? Do I have a shot at academic ones?

I honestly have no idea. You should be open to community programs but I don’t think academic programs are out of the question at all. Try to send out 2-3 emails a day and reach out to as many different PDs as possible.

 

[Dave1980]

Would I be limited to community programs? Do I have a shot at academic ones?

You will be relegated to the less desirable programs because it seems like you have average USMLE for rads but you have a big red flag.

I wouldn't get too hung up on community vs academic. It really doesn't matter all that much.