Combined/categorical/prelim thoughts

[Naruhodo]

I still have some time and honestly this feels like a moving target so things may shift before I apply, but I definitely feel conflicted/confused and if possible wanted to start to get some input from others. Basically, I'm interested in a subspecialty that recently changed rules/announced that they will consider applicants to their residency after intern year. Technically this is now the fastest route, and I've had 2 program directors from excellent programs tell me they would definitely take the right candidate after PGY-1. However, another program director who I trust shared with me that frankly he wants residents already able to hit the ground running, and he thinks just intern year is not enough. So here's the 3 paths I am contemplating and what I see as pros/cons of each:

1. Combined programs: probably the route I'm most inclined to go with, given that it means I'd be able to establish myself in one place and not have to go through a second set of applications/interviews. Generally 4 years, though some of the programs ask for a commitment of 5 years (tends to be at the most elite institutions, so even though it means an extra year I think I'd be very happy matching those places).

2. Categorical program and then subspecialty residency: If I finished the entire categorical this would take 5 years minimum. I definitely know of someone who added on a chief year, and extra time during his subspecialty so ended up taking 6 and 1/2yrs and was bitter about all this time in training/lost opportunity cost. If I were open with the program director from the get-go, would it still be frowned upon to consider leaving after PGY-1 or PGY-2? I feel like I shouldn't apply to smaller programs because I don't want to leave them in a tough spot if I left early. Is doing this at all a douchebag move anywhere?

3. Prelim program followed by subspecialty residency: Although this may seem like the obvious choice, there's really not many prelim programs near me geographically and it feels somewhat foolish to move our lives just for a year and then move again. Theoretically if all went smoothly I could be done in 3 years, but the gamble seems risky. I wouldn't apply to any prelims at places that had combined programs (as I think that would be sending mixed messages) and that leaves me with just a few prelims at places that I am less excited about. Even more worrisome, what if those 2 PDs were painting too rosy a picture of my odds applying after just PGY-1 and I didn't match at all into my subspecialty and wasn't in a categorical program that I could finish either?

Sorry for the long/ somewhat complicated post, but as I said I am curious for others thoughts.

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[gutonc]

Sorry for the long/ somewhat complicated post, but as I said I am curious for others thoughts.

It's not so much long and complicated as it is maddeningly vague.

Specialty?
Stats?

Everything else is crap without the above.

 

[Naruhodo]

Fair enough. Tough because it is a tiny specialty, especially for combined (20 spots offered last year) so I feel like it would be hard to remain anonymous/ probably less familiarity for posters on here regardless. As for stats, I'm one of the lucky ones going to a school where both pre-clinical and clinical are P/F (including clerkships) and we take all our steps incredibly late (as in, within 6 months of when our residency apps are due). I hope to be as strong a candidate as possible, but at this point that is just me being hopeful.

I'll probably just create a new thread/ revive this one when I am in the final few months before I have to submit the residency applications. But it is wild to me that essentially the same training could take anywhere between 3-5 (possibly even 6) years depending on how I go about things after med school. Doesn't that strike other people as odd?

 

[rokshana]

Fair enough. Tough because it is a tiny specialty, especially for combined (20 spots offered last year) so I feel like it would be hard to remain anonymous/ probably less familiarity for posters on here regardless. As for stats, I'm one of the lucky ones going to a school where both pre-clinical and clinical are P/F (including clerkships) and we take all our steps incredibly late (as in, within 6 months of when our residency apps are due). I hope to be as strong a candidate as possible, but at this point that is just me being hopeful.

I'll probably just create a new thread/ revive this one when I am in the final few months before I have to submit the residency applications. But it is wild to me that essentially the same training could take anywhere between 3-5 (possibly even 6) years depending on how I go about things after med school. Doesn't that strike other people as odd?

Not if we don’t know the specialty...sounds like integrated plastics or child psych...since you are not actually one of the 20 residents I doubt anyone is gonna figure out who you are...

 

[clausewitz2]

Not if we don’t know the specialty...sounds like integrated plastics or child psych...since you are not actually one of the 20 residents I doubt anyone is gonna figure out who you are...

Not child psych. Even the triple board route. There are probably at least twice that number of spots in total.

 

[Naruhodo]

Not child psych. Even the triple board route. There are probably at least twice that number of spots in total.

Actually just 21 spots for last year for the triple board according to the main match result data from 2018. I'm eying the specialty just above the blue line from that in table 13. Again, I don't so much feel like I need advice on the subspecialty itself and I am almost certainly applying to the majority of the combined programs. I am just wondering if in addition to the combined programs it would be a wiser move to apply categorical or prelim for the alternate pathway (given the details laid out above). Thanks for advice/ thoughts.

 

[differentiating]

I think the issue here - and why people were trying to figure out what specialty you meant - is that it would vary based on how competitive the specialty is and other factors. For peds/genetics, I'd think you'd be better served applying categorical than prelim peds, since there are few prelim peds spots in my understanding and the utility of a prelim peds year otherwise is pretty low. I do know one person in my class who applied peds/genetics, and he applied categorical peds as backup, but that was likely before this rule change.

 

[Naruhodo]

I'd think you'd be better served applying categorical than prelim peds, since there are few prelim peds spots in my understanding and the utility of a prelim peds year otherwise is pretty low

Thanks for your response, and I suspect you are right. It is tempting to try to take the 3-yr route instead of the 5-yr route, but it is way more risky and might turn out badly. I think I can predict the community response, but I'll ask anyway: Thoughts on leaving a categorical residency early for specialty training?

 

[differentiating]

Thanks for your response, and I suspect you are right. It is tempting to try to take the 3-yr route instead of the 5-yr route, but it is way more risky and might turn out badly. I think I can predict the community response, but I'll ask anyway: Thoughts on leaving a categorical residency early for specialty training?

Regarding leaving a categorical residency: pretty significantly frowned upon, from what I've heard. The only peds residents I know who left cat peds were able to do so through pathways the residency had set up (e.g., 2 peds residents/year can apply for fast-track GI fellowship after only 2yrs peds). I don't think that your categorical program would give you positive recommendations for leaving them in the lurch like that, and you wouldn't be peds boards eligible unless you got a specialized 2-year schedule like combined tracks have. I also imagine it'd be hard to find the time to interview for fellowship positions without your program's support.

 

[Naruhodo]

You see why the prelims are tempting then, right (even if there's not many of them)? They know that you will need to find a PGY-2 position, and you aren't leaving them in the lurch by not staying. I've heard from several PDs though that they are fine hiring folks who are not peds boarded.

 

[differentiating]

You see why the prelims are tempting then, right (even if there's not many of them)? They know that you will need to find a PGY-2 position, and you aren't leaving them in the lurch by not staying. I've heard from several PDs though that they are fine hiring folks who are not peds boarded.

I personally would rather take the longer path than have to reapply the following year and hope for one of the few fellowship positions available. But that's me, and I tend to be very risk-adverse.

 

[ThoracicGuy]

You see why the prelims are tempting then, right (even if there's not many of them)? They know that you will need to find a PGY-2 position, and you aren't leaving them in the lurch by not staying. I've heard from several PDs though that they are fine hiring folks who are not peds boarded.

Going for a prelim spot without a guaranteed advanced spot afterwards is not that smart. Applying for that spot during your prelim year will be hard. You won't get unlimited time for interviews. You'll also not have much time to get much in the way of experience or references when you are doing the applying.

 

[mvenus929]

Thanks for your response, and I suspect you are right. It is tempting to try to take the 3-yr route instead of the 5-yr route, but it is way more risky and might turn out badly. I think I can predict the community response, but I'll ask anyway: Thoughts on leaving a categorical residency early for specialty training?

As someone who trained in a program where someone did just that—stayed for intern year, then left for an advanced program, it sucked. Granted, we had some other issues (another person left, then we gained one who left mid year, and the chiefs didn’t redo the schedule until last minute...) and if that was the only thing that affected my senior schedule, I probably wouldn’t have cared. But how much it will impact a single program depends a lot on the size of the program.

 

[Naruhodo]

That's the main thing for me - I really don't want to inconvenience a program or fellow residents. Thus why I'm still still thinking about including some prelim programs in the mix. I will also speak more with the PDs I know to make sure I wasn't misinterpreting what they were suggesting. As far as I know there's no option in this case to apply for advanced programs at the same time as prelims or I'd definitely try to do that.