Changing programs

[RocketSurgeon41]

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Long post incoming:

Background: spouse and I both medical students. Different schools in the same state, though not our home state, we met in our hometown long before starting medicine. She's 2 years ahead of me, and just matched into IM back in our hometown. Our original plan was to tough it out for one year apart (my M3 year and her PGY-1 year), then for me to do as many away rotations as possible back home during M4, and try my best to match back there with her for residency.

A few problems:
1.) the time apart is taking a way bigger toll on us than we thought (and we aren't new at all to long distance, we've done it two separate times for a year or more already)
2.) As an M3, I've already locked into a specialty that I'd like to pursue, but there's only one program in the entirety of my home state (it's a top institution, not sure if I'm competitive enough to get in there)
3.) I don't get as many away rotations as I thought during M4

Essentially, we hate being apart, and instead of me putting all my hopes and prayers in a single institution and not getting in or pursuing a specialty I don't really like in order for us to be closer together, we figured we'd explore the possibility of her switching residencies to my institution, which has both of our desired residencies and is substantially less competitive than in our home state. Here's the problem: my wife interviewed here and ranked this program very highly, but not #1, we are fairly confident they ranked her too, yet she matched to her #1, which was back in our home state (why she didn't just rank my institution #1 to begin ith is a different story for a different day). So now the question :

Is it possible for her to switch into my institution's residency program in the same specialty (either as a PGY2 or a repeat PGY1) if she's already interviewed here and ranked them and possibly been ranked? I guess my question is, would having been ranked previously but matching somewhere else be an asset for her in terms of switching? Or would the program be pissed off about her not ranking them #1 and this be a burned-bridge type scenario?

Sorry for the long post, thanks for the help!

 

[TraumaLlamaMD]

The bigger problem is going to be that your institution would need to have an open spot for her as a PGY2. She can’t just reapply through the Match for an intern spot - she will already have completed her intern year in that specialty. As to your actual question, there’s not really any way for us to predict how that program director will view her application.

 

[deleted950463]

She can have significant resentment from being pulled away from her #1

 

[rokshana]

Long post incoming:

Background: spouse and I both medical students. Different schools in the same state, though not our home state, we met in our hometown long before starting medicine. She's 2 years ahead of me, and just matched into IM back in our hometown. Our original plan was to tough it out for one year apart (my M3 year and her PGY-1 year), then for me to do as many away rotations as possible back home during M4, and try my best to match back there with her for residency.

A few problems:
1.) the time apart is taking a way bigger toll on us than we thought (and we aren't new at all to long distance, we've done it two separate times for a year or more already)
2.) As an M3, I've already locked into a specialty that I'd like to pursue, but there's only one program in the entirety of my home state (it's a top institution, not sure if I'm competitive enough to get in there)
3.) I don't get as many away rotations as I thought during M4

Essentially, we hate being apart, and instead of me putting all my hopes and prayers in a single institution and not getting in or pursuing a specialty I don't really like in order for us to be closer together, we figured we'd explore the possibility of her switching residencies to my institution, which has both of our desired residencies and is substantially less competitive than in our home state. Here's the problem: my wife interviewed here and ranked this program very highly, but not #1, we are fairly confident they ranked her too, yet she matched to her #1, which was back in our home state (why she didn't just rank my institution #1 to begin ith is a different story for a different day). So now the question :

Is it possible for her to switch into my institution's residency program in the same specialty (either as a PGY2 or a repeat PGY1) if she's already interviewed here and ranked them and possibly been ranked? I guess my question is, would having been ranked previously but matching somewhere else be an asset for her in terms of switching? Or would the program be pissed off about her not ranking them #1 and this be a burned-bridge type scenario?

Sorry for the long post, thanks for the help!

So you are just starting M3 and have already locked into a specialty...how is that? If you did this as an M2 when she was in the match did you not know that there was only one program in your home state?
Yeah, there may be a bit of a burned bridge and also if she she were to have to come to your program as a pgy2 when you are a M4, then won’t you be apart again for her pgy 3 year unless you are planning on staying there for residency? Are you expecting her to then again change residency programs?

Common sense says that she should stay put ...this year is going to be pretty busy for both of you as a M3 and intern and then you may have more time to spend with each other next year and hopefully she has more free time as a 3rd year to travel to where you are.

Y’all could talk to the program there, but doubt they are going to be really all that sympathetic.

You also may find during your M3 year that you are not quite settled on your specialty of choice.

 

[hallowmann]

Seems like a bad move. She should stay put. She's 2 years ahead, so unless she's in a 5 year residency or something, 1-2 yrs extra of being apart so you can both pursue the career you both want is a pretty small price to pay.

Its a big ask to have someone relocate, move residencies, redo intern year adding another year on to her residency training and losing a year of attending salary, etc. Based on your post you don't seem to grasp how big of a negative impact this may have on her career, let along her mental well-being. Intern year is a suckfest. It truly is. Med school is nothing by comparison. If I were you, I'd try my best to get a spot at that top program, but if not, then let her finish and move to you when she's an attending and can support you (both mentally and financially) during residency.

I'm not gonna lie, it'll suck being apart, but if you guys can't manage this, how exactly are you gonna manage both of you being in residency simultaneously, where there may literally be months that you two barely see each other? Let alone the rest of life's challenges.

So you are just starting M3 and have already locked into a specialty...how is that? If you did this as an M2 when she was in the match did you not know that there was only one program in your home state?
Yeah, there may be a bit of a burned bridge and also if she she were to have to come to your program as a pgy2 when you are a M4, then won’t you be apart again for her pgy 3 year unless you are planning on staying there for residency? Are you expecting her to then again change residency programs?

Common sense says that she should stay put ...this year is going to be pretty busy for both of you as a M3 and intern and then you may have more time to spend with each other next year and hopefully she has more free time as a 3rd year to travel to where you are.

Y’all could talk to the program there, but doubt they are going to be really all that sympathetic.

You also may find during your M3 year that you are not quite settled on your specialty of choice.

Many good points.

 

[BoardingDoc]

explore the possibility of her switching residencies to my institution, which has both of our desired residencies and is substantially less competitive than in our home state.

Just to clarify:
You want her to try to switch residencies into your med school site, presumably with her as a PGY-2 (unless you're asking her to restart her residency as an intern again next year) because you, as an MS3 in July, know with 100% certainty what specialty you like and are also supremely confident that you will be able to match at your current site?

Significant hurdles here:
1: Very high chance that your current site won't have a PGY-2 spot available for your wife
2: She will have already completed 1 year of training next year, so even if she reapplies via the match for an intern spot (which sounds terrible) there are likely to be funding issues.
3: You're just starting MS3. There is a VERY high chance that you will want to go into something else by the end of this year. I started MS3 thinking I wanted to do CT surgery. Turns out I don't actually like surgery and I love EM. Until you rotate through a specialty as a med student and get to actually do things, you really don't know.
4: Let's say she gets a spot at your current site, you stick with this specialty you've apparently settled on, and then you aren't able to match there. I don't know what the familial consequences of this option are, but I suspect they aren't good. You should have a plan for this if you are even considering what you're proposing.

I'm well aware that I'm pointing out problems and not solutions, but my entire point here is that the devil you know may be better than the one you don't.

 

[deleted950463]

To me it seems like OP is trying to dictate her career

 

[Dave1980]

I'm skeptical that OP's significant other wants to change programs.

He/She ranked the current place #1 and now OP is posting for them 3 weeks into intern year.

Maybe they wanted to get away?

 

[deleted950463]

I'm skeptical that OP's significant other wants to change programs.

He/She ranked the current place #1 and now OP is posting for them 3 weeks into intern year.

Maybe they wanted to get away?

Yep, the fastest way to breed resentment is to have a full discussion with spouse, decided to do long distance for a bit, then go back on that.

What’s next, OP, telling her that she must stay home and take care of the kids?

There is a reason why a lot of medical marriages don’t work out, this reason is lack of respect for the other’s career.

Like the above poster said, she ranked the place number one for a reason.

 

[hamstergang]

my wife interviewed here and ranked this program very highly, but not #1, we are fairly confident they ranked her too, yet she matched to her #1, which was back in our home state (why she didn't just rank my institution #1 to begin ith is a different story for a different day).

Especially give the last few posts, maybe today is the day for this story. Why did your wife rank her program #1 and not where you're in school?

 

[Dave1980]

Especially give the last few posts, maybe today is the day for this story. Why did your wife rank her program #1 and not where you're in school?

Also wondering how long it took him/her to download tinder after getting to the new city (jk...kind of).

 

[rokshana]

Like the above poster said, she ranked the place number one for a reason.

And presumably the OP agreed to her ROL.

Looking back at the OPs previous posts, there is no guarantee that he will even get an orthopedics residency ...to the OP you could always attempt to transfer to the medical school where your wife is doing her residency. And if the state you mentioned in one of your old posts is your home state, there are 3 ortho residencies per FREIDA.

 

[GoSpursGo]

my wife interviewed here and ranked this program very highly, but not #1, we are fairly confident they ranked her too, yet she matched to her #1, which was back in our home state (why she didn't just rank my institution #1 to begin ith is a different story for a different day).

Realistically there's no way to know how the program is going to react to not getting ranked highly enough for her to match there, and then doubling back to try and get in anyways. Maybe your wife is a rockstar and they'll fall all over themselves to find a spot for her, but I generally agree with others who say they are unlikely to be sympathetic.

Honestly, I think y'all made your decision when she didn't rank your program number 1. You jointly decided a year ago that The Plan was for her to match back home and for you to follow two years later. If the problem is that being apart is way harder than you thought it would be and you don't think you can sustain this for 2 years, that's one thing, though I would say give it more than a couple of weeks into PGY-1 to come to that decision. If instead the issue is that you to decided after the match that you want a specialty that is not conducive to The Plan, that would frankly be unfair. That's pulling the rug out from under her.

A medical couple can't have it all. At some point someone has to sacrifice for the other's career, and more likely both people will need to make sacrifices at different times for the other. You do your best, come up with a plan that works for both of you, and then stick to the plan to the best of your ability. In this case, unless the root problem is just that you need to get back together ASAP, I strongly urge you to reconsider your position that there is only one true specialty that will make you happy.

 

[Smurfette]

The problem is, your wife has to do what's in her best interest NOW because you still have 2 years to go. IM is 3 years, and after that, she may want to do a chief year or move onto fellowship. Even if she transfers to your current institution, there is ZERO guarantee that is where you'll end up, which means you will still end up in different places and she may have sacrificed to a somewhat lesser program in her eyes for nothing. Having to repeat a year of training is costly from a career and financial standpoint. If she sticks it out, she may be able to do a fellowship match or get a hospitalist position where you are at, starting during your PGY2 year.

A better option may be for YOU to delay graduation and do a year of research before graduating. Both you and her would be graduating at that point from your respective points of training, and you may find an institution with both a residency of your choice and fellowship or hospitalist position of her choice, or plan to go to a big city with lots of options for both of you so you won't be separated.

 

[NotAProgDirector]

She can certainly try to transfer back as a PGY-2. Personally, I wouldn't be upset that she chose to match somewhere else. People make bad decisions all the time, and if she realizes that she'd rather be back at my program, that's fine. Already stated is that it depends if I have an opening, which might or might not happen. Also unstated is whether she WOULD have matched at your current program. For all you know, maybe she was below their last match. You have no idea.

Is this your idea, or hers?

"the time apart is taking a way bigger toll on us than we thought " - it's only been 1 month, seems like there is more to the story.

If you called me and told me your plan, I might not take her back -- sure, you'd be together for 1 year, but what if you match somewhere else? Would she want to transfer again? Or be miserable?. Therefore, here's the deal: If you pursue this, you commit to a gap year. Take a year of research, such that she finishes just as you are starting. That's the cost to you for this plan, and would make me much more comfortable. Note that this still causes problems for her if she wants a fellowship -- she will need a gap year so that she knows where you will be.

Last, I will point out that transferring at the PGY-2 level in IM is very difficult -- leading and running a team (which is what many programs have their PGY-2's do) when you don't know the EMR/System/People is a huge challenge. It also usually requires a gap year for fellowship -- can be hard to generate the research and letters you need (although this depends upon the field)