changing specialities after the first year

[Tariq]

Hi.
I got a position in a Family Practice program this year.I want to change my speciality next year .How do i go about this.If i go through the match again then i will need letters of recommendations from the Program Director of Family Practice and i dont think he will be too happy about this.I would like some input from you guys on what to do.Thanks

---

Members don't see this ad.

 

[Sheerstress]

First of all, I would say that you would want to try to make a decision about what specialty you really want to be in.

If you wait til next year, your FP program director will probably not be happy to find out that you were planning to leave the program from the beginning. I'd discuss the issue with some people at your school who are in a position to competently advise you about your options. You should then discuss it with your future residency director.

Another key issue is that the federal government reimburses residency programs through Medicare, and will only allow full funding for so many years. This can make switching specialties very difficult. You will absolutely want to read the brochure: "Medicare Payments for Graduate Medical Education: What Every Medical Student, Resident, and Advisor Needs to Know." You can get a copy of it here (send an e-mail):

<a href="http://www.aamc.org/publications/medicaledu.htm#medicare" target="_blank">http://www.aamc.org/publications/medicaledu.htm#medicare</a>

I hope everything works out for you.

Sheerstress

 

[NuMD97]

Didn't we do this in another area of this site? It depends on what you want to change to. Again, if you want a specialty that requires the PGY-1 year to be in primary care that would make the switch much easier. It is possible. But Sheerstress is correct about capitation funding - if you change to a specialty that requires more years of training, the remaining years would have to be funded by the hospital itself. This alone is not a deterrent, it just depends on the program and their willingness to pay the difference. Oftentimes this is not even entered into the discussion with a possible candidate since, if the person is desired, it's just taken care of. What specialty did you have in mind? The letter from the FP Program Director might be possible, as folks do switch all the time. But don't discuss this with anyone this early in the year - it just wouldn't look good. And whatever you do, don't "coast" this year. You'll need supporting letters from other faculty that have worked with you and can attest to your ability to perform. I think more information about what you want, is needed here before one can say how to go about next year's application process. Good luck.

Nu

 

[Winged Scapula]

Regardless of whether or not you go through the match, any potential future PD is going to want an LOR from your current PD. Thus, you need to be honest with them and leave things on good terms.

As Sheerstress so rightly notes, please also investigate issues surrounding HCFA funding. If you switch into a residency with a longer training period, especially one that requires you to repeat your first year, you may not receive full funding for the duration of your residency training - and some hospitals will not hire those without.

best of luck to you.

 

[Tariq]

Well actually i want to go into surgery.My second choice is Internal medicine.I am an IMG but a american citizen as well.I took Family Practice because i was late in applying this year and i got this position in the post match.I most probably will be changing to surgery.As you must be knowing the match process starts in august so when shall i tell my PD that i wont be continuing in the program next year.

 

[NuMD97]

With all due respect, Kim, I know for certain that when you switch from one specialty to another the LOR from the PD may not be so essential, but letters of support from other faculty members and other resources count for much more. I'll leave you to answer the rest of his questions since it pertains to surgery and that is completely out of my domain.

 

[Winged Scapula]

•••quote:•••Originally posted by NuMD97:
•With all due respect, Kim, I know for certain that when you switch from one specialty to another the LOR from the PD may not be so essential, but letters of support from other faculty members and other resources count for much more. I'll leave you to answer the rest of his questions since it pertains to surgery and that is completely out of my domain. •••••No problem. I'm sure this varies from program to program as to whether a letter from the PD is required (I know it is here) but you are absolutely right that most will also want to see LORs from faculty members as well.

If you've just matched, it might be a little early to let on that you will be leaving - and who knows, you might even like FP once you've tried it! :wink:

 

[Tariq]

I am sure i wont like FP

 

[focker]

•••quote:•••Originally posted by Tariq:
•I am sure i wont like FP•••••Why did you even rank any FP programs on your list if you know you're not going to like it? Why didn't you just wait until next year to apply?

 

[Tariq]

I took the position becoz i am a IMG and i didnt have many options at the time and i thought getting into the system was a good choice.

 

[Juice]

Tariq,
bail on the spot now, and fill a prelim surg spot for the next year. It will save you a year. There were over 100 open categorical pgy-2 slots this year, some at some very prestigious places, and i know of 2 ivy league programs that filled open spots with FMG's ( us citizen-so no visa problem). Having a transitional slot this upcoming year will accomplish a few things. The program you are going to be in knows you are looking to leave in one year, and will support you in this process. Do not worry about bailing on the FP slot, it happens frequently. It avoids a very painful year in FP if it is not what you want to do. Look at all the open prelim slots on scutwork, and start calling. The NRMP match is NOT a legal binding contract, nor will ANY contract you sign with a program hold up in court. It may jeapordise your ues of the NRMP in the future, but with the dismal appliacnt pool in gen surg believe me this is not a problem.

 

[Tariq]

Hi Juice.
You message does make sense but i dont think i can take taht risk.I wont have anything to fall back on if i bail out now.

 

[bold and beautiful]

[It may jeapordise your uses of the NRMP in the future]

Sorry for going out of the topic but how exactly does it jeapordise uses of the NRMP in the future.

I am concerned because I did not go to the categorical IM program I matched with as I had to go away from my family and accepted a transitional year program in a nearby hospital

 

[bold and beautiful]

[It may jeapordise your uses of the NRMP in the future]
Dear Juice
Sorry for going out of the topic but how exactly does it jeapordise uses of the NRMP in the future.

I am concerned because I did not go to the categorical IM program I matched with as I had to go away from my family and accepted a transitional year program in a nearby hospital

 

[Winged Scapula]

•••quote:•••Originally posted by bold and beautiful:
•[It may jeapordise your uses of the NRMP in the future]

Sorry for going out of the topic but how exactly does it jeapordise uses of the NRMP in the future.

I am concerned because I did not go to the categorical IM program I matched with as I had to go away from my family and accepted a transitional year program in a nearby hospital•••••The NRMP agreement stipulates that if you refuse a position you match to in the NRMP you are not allowed to take another position for at least a year. I believe the small print may even state that they do not have to accept your application for future matches if you show a pattern of not accepting matched positions.

 

[Winged Scapula]

•••quote:•••Originally posted by Tariq:
•I am sure i wont like FP•••••I don't understand either why you would take an FP spot. There were literally hundreds of open Prelim Surgery positions this year - why not try and get one of those?

I understand that you feel you cannot give up your FP spot, but it isn't too late to look around for a Surgery position; undoubtedly there are some open. Should you be offered a position in one of those, then you can give up the Fp slot.

 

[Careofme]

Kimberli,

When you say that there were "hundreds of open Prelim Surgery positions this year" are you talking about General Surgery spots or specialized surgery spots?

I have seen this posted elsewhere like this and I am confused as to which people are talking about - general surgery, neurosurgery, CT surgery, etc.

Can you clear this up for me?

Thanks!

Careofme

 

[Winged Scapula]

•••quote:•••Originally posted by Careofme:
•Kimberli,

When you say that there were "hundreds of open Prelim Surgery positions this year" are you talking about General Surgery spots or specialized surgery spots?

I have seen this posted elsewhere like this and I am confused as to which people are talking about - general surgery, neurosurgery, CT surgery, etc.

Can you clear this up for me?

Thanks!

Careofme•••••Those "hundreds" (400+ if I remember correctly) are for Preliminary Surgery, which implies General Surgery. All Neurosurgery residents do a Prelim Gen Surg year as do many surgical subspecialties (ie, ENT, Urology) and CT Surgery residents do a complete Gen Surg residency before starting their CT fellowship. In addition to the above "hundreds" of spots in Prelim General Surgery open there are undoubtedly a *few* open in surgical subspecialties like those you've mentioned and others.

Keep in mind that these are not "Categorical" positions - ie, not for the full track but only a year or two. However, we have mentioned this to the OP because it seems that if he was interested in getting into a Categorical Surgery residency (regardless of whether Gen Surg or some subspecialty) his chances at doing so would be enhanced by doing a Prelim Surgical year (and getting to know surgical faculty) over an FP year. The FP year would be helpful in general just by improving your clinical skills but does little to nothing to assist you in obtaining a surgical training spot over a Prelim Surg spot.

These spots are often left unfilled because those that have an option of doing a Prelim Med vs Prelim Surg year (ie, Anesth, Rads, etc.) will almost always choose Medicine and there are more spots open than there are Surgical subspecialty residents who need them.

Hope this helps.

 

[Tariq]

I wish i knew about this earlier.I was under the impression that surgery would be difficult to get in the post match so i applied in Family Practice.The problem now is that i have moved to a new apartment and have all my things in order for this position so leaving it at this stage is almost impossible for me.Anyway i am still going to change my speciality next year.I think this Family practice year will be helpful for me as i have no clinical experience at all and i am not familiar with the american system of medicine.So ill use this year to get up to date with how things work here.

You are given NO clinical experience in Afghanistan? That will be a hindrance. At any rate, what you were told about the difficulty in obtaining a post-match position in Surgery pertains to CATEGORICAL positions, not Prelim ones. That is unfortunate, because while I agree that doing a year of FP will allow you to learn about the American system of medicine and gain some clinical skills, taking a Prelim Surgery year would have done the same and possibly have saved you a year of training. No one wants to repeat their intern year (which you will undoubtedly have to do when applying for Surgery).

 

[Derek]

What country are you from that they didn't have the internet available for you to access NRMP to view the match statistics before you scrambled?

 

[Tariq]

I am from afghanistan.No internet there.Happy now

 

[bold and beautiful]

•••quote:•••The NRMP agreement stipulates that if you refuse a position you match to in the NRMP you are not allowed to take another position for at least a year. I believe the small print may even state that they do not have to accept your application for future matches if you show a pattern of not accepting matched positions ••••Dear Dr.Kimberly Does that mean I willnot be able to participate in the match next year. Di I make a wrong decision. How do rectify this?
I am just so scared because being an fmg and with average scores I matched to this categorical IM afer trying very hard (for second Time) and left the program because I wanted to be with my 2 year old son and Husband.
I don't know if I di right thing. Any body with any experience/ suggestions to relieve my anxiety <img border="0" title="" alt="[Frown]" src="frown.gif" />

 

[bold and beautiful]

quote:
--------------------------------------------------------------------------------
The NRMP agreement stipulates that if you refuse a position you match to in the NRMP you are not allowed to take another position for at least a year. I believe the small print may even state that they do not have to accept your application for future matches if you show a pattern of not accepting matched positions
--------------------------------------------------------------------------------

Dear Dr.Kimberly or any one Please reply

Does that mean I willnot be able to participate in the match next year. Did I make a wrong decision. How do rectify this?
I am just so scared because being an fmg and with average scores I matched to this categorical IM afer trying very hard (for second Time) and left the program because I wanted to be with my 2 year old son and Husband.
I don't know if I did right thing. Any body with any experience/ suggestions to relieve my anxiety

--------------------
A stich in time saves nine

 

[Winged Scapula]

•••quote:•••Originally posted by bold and beautiful:
•quote:
--------------------------------------------------------------------------------
The NRMP agreement stipulates that if you refuse a position you match to in the NRMP you are not allowed to take another position for at least a year. I believe the small print may even state that they do not have to accept your application for future matches if you show a pattern of not accepting matched positions
--------------------------------------------------------------------------------

Dear Dr.Kimberly or any one Please reply

Does that mean I willnot be able to participate in the match next year. Did I make a wrong decision. How do rectify this?
I am just so scared because being an fmg and with average scores I matched to this categorical IM afer trying very hard (for second Time) and left the program because I wanted to be with my 2 year old son and Husband.
I don't know if I did right thing. Any body with any experience/ suggestions to relieve my anxiety

--------------------
A stich in time saves nine•••••No need to post the same question within 10 hours time. Despite all appearances to the contrary, I DO actually spend some time in the OR, in clinics and on the wards. :wink:

I am curious as to why you would "try so hard, for 2 years" to obtain a US residency spot, then left the program.

You will have to contact the NRMP. Generally you are allowed to participate in the match the NEXT year but are prevented from accepting a position during the SAME year as you withdrew/didn't accept the matched position. However, it sounds as if you accepted the position, started but then quit. That is a different situation from someone who refuses to accept the matched position and doesn't even start.

How much these regulations are enforced I do not know.

Check the NRMP web site for more information on the rules regarding someone who refuses a position offered. Best of luck to you.

 

[bold and beautiful]

Dear Dr. Kimberly,

Thanks for the reply. I repeated the post because it was getting more towards the bottom ( I don't know how it works) but People usually do not pay attention to older post and then it might would have gone neglected.

Any way I left the IM categorical because
1. It was fa--------r ( west coast)from the place where I live now( east coast)My husband would not have been able to find a soft ware job there and we have 2 year old son.

2. There was this transitional year opening in my area and I took a chance and I was offered taht position. I thought I may take a chance, work there for 1 year and try to find a spot in the next year.
But I was not aware of this NRMP pOLICY.

3. I just wish I did not have to choose betwwen this transitional in local area vs Categorical in an area far from from my family.

I understand this is my own personal problem and do not expect any reply but I posted it just to find someone who had similar experience.I don't want to repent on my decision

Thanks

 

[Winged Scapula]

Dear B&B,

I'm not sure you have to choose btwn them. I would:

a) check with NRMP as to the exact policy (if you call them, do so anonymously, no use harming yourself by having them investigate)

b) make sure you have a contract wit the Transitional year program

c) talk with the PD at your Categorical program and explain your situation. They may very rightly ask WHY you would have even applied to their program when you knew it would be a problem. However, the sooner you let them know the more time they have to find someone to fill your spot.

 

[bold and beautiful]

Thanks Dr. Kimberly.

Actually everything has been set. I made this decision back in March. I informed the PD immediately (1 week) after the match day ie on mach 27 I guess. He was OK with it. Actualy he was very nice. He told me he completely understands my situation and also asked me if he could be of any help. I sent him the email about not being able to join the program only after I signed the contract and other papers from the program where I got the transitional year. So that is not a problem.

I just got worried because I may have to register with NRMP again if I need a second year spot in any specialty which need copmpletion of one year of internal medicine.

Thanks any way for the idea to call NRMP anonymously. I will do that.

 

[Winged Scapula]

Since you won't be registering with NRMP until next year's cycle, it shouldn't be a problem. But I agree - read the fine print on the website and if you don't find your answer give them a call.

Best of luck.

 

[Derek]

•••quote:•••Originally posted by Tariq:
•I am from afghanistan.No internet there.Happy now•••••How could you participate in the match if you couldn't do ERAS or NRMP?

Did you have to sign a contract for residency outside of the match?

 

[NuMD97]

For B&B:

I wouldn't worry too much since you had a legitimate reason for leaving the categorical program. You should take the PD's offer to help you out if he can. Seek his advice for the PGY-2 spot. It's worth a shot. Are you currently in the transitional spot?

As far as taking a Prelim Surgery spot: what if the climate changes for the following year and there are no PGY-2 spots? I had an acquaintance try that route some years ago and it failed miserably. Just a thought. I think Tariq is correct in staying with the FP spot at least for now. One, it's the right thing to do and two, if he's not familiar with the American health care delivery system, it will be a real eye-opening experience for him, since he will rotate in all major areas of primary care. Either way, if he switches or not, it won't be a year wasted in my opinion.

 

[Winged Scapula]

•••quote:•••Originally posted by NuMD97:
•As far as taking a Prelim Surgery spot: what if the climate changes for the following year and there are no PGY-2 spots? I had an acquaintance try that route some years ago and it failed miserably. Just a thought. I think Tariq is correct in staying with the FP spot at least for now. One, it's the right thing to do and two, if he's not familiar with the American health care delivery system, it will be a real eye-opening experience for him, since he will rotate in all major areas of primary care. Either way, if he switches or not, it won't be a year wasted in my opinion.•••••I wasn't assuming he would get a PGY-2 spot but rather enter the match for BOTH PGY-2 spots AND intern years. After all, if he does an FP intern year he will HAVE to repeat his intern year if he applies for Surgery (ie, he cannot enter into a PGY-2 year without having done an intern year in Surgery), but there's a chance that he could get a PGY-2 spot if he did his first year Prelim Surgery. If he doesn't match into a PGY-2 spot, he's not losing anything by starting PGY-1 Surgery - he's in the same position he'd be in by doing FP for a year.

Make sense?

 

[bold and beautiful]

Dear NuMD 97,

Thanks a lot. I was just looking for few such words. You are right about asking the PD for 2nd year.

I just love this forum and all the people here.

 

[Tariq]

Well you are right.Getting into a prelim position in surgery would have been better but at that time i wasnt sure of my chances.I had heard it was difficult to get into surgery.Anyway i am willing to start from year 1 next year.I am prepared for that.