Changing Specialties for Advanced PGY-2 spot

[boulevard84]

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I am a non-US IMG (born and raised in China) doing my prelim year in internal medicine and going into PM&R next year in the same hospital (but it's not a categorical program). After 2 1/2 months of internship, I am miserable and lonely and tired. I realized that it's hard for me to deal with people (patients, nurses, other doctors) and I would like to switch to a non-clinical field like pathology. In truth, pathology was my close second but I thought I'd miss caring for patients. But now that I've been exposed to Americans and medicine in America, pathology would suit me better.

The problem is I've talked with the PD of my advanced position and he said that because of the NRMP's "All-In" rule, they cannot find a replacement for me if I switch. She was almost angry that I would be leaving the program (and that I did not realize my social woes before) and they would have an empty spot in their program for three whole years. Is this true? In NRMP's website, the application for the waiver includes a choice for "Change of Specialty" and this will be accepted as long as it's before January 15.

Are programs really unable to get someone else if I leave my spot because it's not through the Match?

Has anyone submitted a Waiver Request Form to the NRMP for a "Change of Specialty"?

It's Sept 11th and I need to get my applications in for 2014's Match. And more importantly, I am so miserable internship and all the hospital work. Changing to pathology won't be a bed of roses but I know it will be more manageable for me.

Please help me.

 

[NaggleNole]

Sent you a message. May be able to help

 

[NotAProgDirector]

Your PM&R PD is completely incorrect.

Here's what happens:

1. You apply for a waiver of your match commitment. As you mentioned, as long as the reason is you will be changing specialties and you apply before Jan 15th, you will automatically get it. It does take a few weeks (even though it seems like it should be instantaneous).

2. Once the match commitment is waived, your PM&R program is free to fill the open spot. Your future PD may be angry because they could have had the "next person" on the list and now they have to find someone new, but that's life. To fill the spot, they advertise for someone to start as a PGY-2 PM&R resident in July 2014. They then register in the match for an "R" position. They will rank applicants on their "A" (Advanced) list for positions to start July 2015, and on their "R" list for the position starting in July 2014. The difficulty is letting people know that a 2014 position is open, but it can be done.

3. Meanwhile, you'll have two choices for a spot. You can register for the match for a position in pathology for July 2014. ERAS opens on monday, so you need to get moving if you want an application submitted in time. You'll need new letters, and update everything. You can't use your application from last year, you need to start again.

The other option is to start looking for a path spot starting now. Perhaps a path program has an open spot, you could quit your current program and start path early. If you do this, you need to give your prelim program adequate notice (at least 3 months).

Another option is to quit your prelim now. Again, you need to give them adequate notice.

4. You also need to think about how you plan to interview for path. If you keep working, how do you plan to take the days off to interview? Your program doesn't have to be flexible.

5. You're assuming that a program will take you. There is some chance you will give up your PMR spot, and then not get a path spot. That's a risk you take. In general, path is not terribbly competitive, so it's likely you will find a spot.

6. If you're on a visa and you quit your job, you will need to leave the country and get a new visa if you get a new spot.

 

[Buzz Me]

Sent you a message. May be able to help

😕

You joined 3 years ago and just wrote this as your first post ever?

 

[boulevard84]

Thanks, aPD! That PD from my program was a big disappointment. He gave me wrong information or, at least, he himself was confused about the new regulations. He was almost threatening me about ruining my own reputation. That was very short-sighted of him. He'd rather have a miserable resident than get someone else who'll be enthusiastic about PM&R and his program.

I have gotten my waiver from PM&R and I am applying for the Match next year. I hope a program would be sympathetic to an applicant switching fields.

Thanks, again aPD.

 

[HeyThereJude]

Your PM&R PD is completely incorrect.

Here's what happens:

1. You apply for a waiver of your match commitment. As you mentioned, as long as the reason is you will be changing specialties and you apply before Jan 15th, you will automatically get it. It does take a few weeks (even though it seems like it should be instantaneous).

2. Once the match commitment is waived, your PM&R program is free to fill the open spot. Your future PD may be angry because they could have had the "next person" on the list and now they have to find someone new, but that's life. To fill the spot, they advertise for someone to start as a PGY-2 PM&R resident in July 2014. They then register in the match for an "R" position. They will rank applicants on their "A" (Advanced) list for positions to start July 2015, and on their "R" list for the position starting in July 2014. The difficulty is letting people know that a 2014 position is open, but it can be done.

3. Meanwhile, you'll have two choices for a spot. You can register for the match for a position in pathology for July 2014. ERAS opens on monday, so you need to get moving if you want an application submitted in time. You'll need new letters, and update everything. You can't use your application from last year, you need to start again.

The other option is to start looking for a path spot starting now. Perhaps a path program has an open spot, you could quit your current program and start path early. If you do this, you need to give your prelim program adequate notice (at least 3 months).

Another option is to quit your prelim now. Again, you need to give them adequate notice.

4. You also need to think about how you plan to interview for path. If you keep working, how do you plan to take the days off to interview? Your program doesn't have to be flexible.

5. You're assuming that a program will take you. There is some chance you will give up your PMR spot, and then not get a path spot. That's a risk you take. In general, path is not terribbly competitive, so it's likely you will find a spot.

6. If you're on a visa and you quit your job, you will need to leave the country and get a new visa if you get a new spot.

Hope the OP finds his way, sounds like a stressful process. I was just wondering though, I thought through NRMP, applicants are committing to at least 1 year - so how could the OP "quit now" in the middle of his intern year, or switch into an open spot early - doesn't he have to go through the NRMP?

I know several people who switched field, and I always wondered how this could be possible:
- wouldn't the OP's current PD not write him a LOR, which he would need?
- how would a person applying to a different field get the LORs they need if they have spent all their time as an intern in another field?
- can a person considering switching fields hold onto their current spot until they find out if they did truly match into their new specialty, or can the PD kick them out because they can't wait until March's match day to find out if the person is staying or going?

 

[NotAProgDirector]

Hope the OP finds his way, sounds like a stressful process. I was just wondering though, I thought through NRMP, applicants are committing to at least 1 year - so how could the OP "quit now" in the middle of his intern year, or switch into an open spot early - doesn't he have to go through the NRMP?

I know several people who switched field, and I always wondered how this could be possible:
- wouldn't the OP's current PD not write him a LOR, which he would need?
- how would a person applying to a different field get the LORs they need if they have spent all their time as an intern in another field?
- can a person considering switching fields hold onto their current spot until they find out if they did truly match into their new specialty, or can the PD kick them out because they can't wait until March's match day to find out if the person is staying or going?

The OP matched into Prelim IM for the 2013-2014 year (Prelim match) and PM&R for the 2014-2015 year (Advanced match). He's already in his prelim year, and has satisfied his match commitment (needs to complete 90 days). He has applied for, and received, a match waiver for his Advanced match by stating that he is no longer interested in PM&R. He cannot try to get a "better" PM&R program now, but is free to get a spot either in or outside the match in any other field. Since he's interested in Pathology, he either needs to apply via the match for a spot starting July 2014, or he can try to find an open path PGY-1 spot now, quit his current program, and start in Path.

For your other questions:

1. Yes, his PD perhaps could be a jerk and not write a letter. But, despite what you might read here on SDN, most of us are actually pretty nice and would write him a good letter -- assuming he's doing fine.
2. You get LOR's from the field you're in, and try to do an elective in the field you want. Mostly, a new program is going to want to know you were doing good work in your old program.
3. Yes, this can (and does) happen. It's not fair to me to hold your spot until mid March, when then I'll have trouble filling it. If I don't fill the spot, your classmates are the one's that get affected. So, my personal way of addressing this situation is looking for a replacement -- if I find one, before I offer them a spot I give you a last chance to keep yours. By then, you usually have some sense of how likely you are to get a new spot. But there is some risk involved. That's life.