Concerned with match location - transfer down the line?

[FindingHome]

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Hi everyone, long-time lurker here. I’ve read a lot of individual threads on this topic, but I’d really appreciate some direct guidance on how to move forward.

I’m very grateful to have matched into a competitive specialty. At the same time, the program I matched into is much farther from my family than I had hoped for (over 12 hours away by car). My father was recently diagnosed with Alzheimer’s, and although I believe he has a good support system at home, I deeply value the time I still have with him and want to be closer before his condition progresses.

Because of that, I ranked programs primarily based on proximity to home. Unfortunately, I ended up matching at the bottom of my list, which is also the farthest from my family. It’s also a smaller program with long hours and limited research opportunities.

I do like the specialty I matched into, but my personal priorities have shifted significantly. I’ve spent many long nights thinking about what I truly want, and I keep coming back to the idea that I would rather pursue internal medicine or general surgery closer to home. I also really value the research side of medicine and would ideally train at a larger academic center while being near family. While I know time in residency and schedule is limiting, I do think proximity to home would allow me to spend at least some time with him.

I realize some of this may reflect post-Match grief, and I’m trying to work through that honestly. But I haven’t been able to shake the feeling that I may have chosen a specialty/location combination that no longer fits what matters most to me.


With that in mind:
How realistic is it to transfer from a competitive specialty into IM or general surgery closer to home?
Would larger academic programs with strong research environments even consider someone in my position?
How much do applicant metrics still matter in a situation like this?



For context, I think I was a fairly competitive applicant: mid-level home program, Step 2 >265, extensive research, and upper quartile in my class. I hope this doesn’t come across as disingenuous — I’ve just heard mixed things about how much prior competitiveness matters when it comes to transferring or reapplying.


I apologize for the wall of text. I'm sort-of heartbroken in multiple areas of my life, and would love any advice.

 

[DrMetal]

Hi everyone, long-time lurker here. I’ve read a lot of individual threads on this topic, but I’d really appreciate some direct guidance on how to move forward.

I’m very grateful to have matched into a competitive specialty. At the same time, the program I matched into is much farther from my family than I had hoped for (over 12 hours away by car).

What specialty?

We tend to be nomadic in this business, especially while training. You don't truly get to pick where you live until you become an Attending.

Believe it or not, a 12-hour drive (distance wise) isn't that bad. I known plenty that were a 12-hour flight from home.

You could potentially hop on a plane and be home in an hour or two. You could easily spend some weekends at home that way (provided you're not working). If your Dad can still travel, he can also come to see you.

Even if you were doing residency at a hospital 5 minutes from your family, you still wouldn't see them much. It's not the physical distance that separates us, it's the job. So be it.

 

[FindingHome]

What specialty?

We tend to be nomadic in this business, especially while training. You don't truly get to pick where you live until you become an Attending.

Believe it or not, a 12-hour drive (distance wise) isn't that bad. I known plenty that were a 12-hour flight from home.

You could potentially hop on a plane and be home in an hour or two. You could easily spend some weekends at home that way (provided you're not working). If your Dad can still travel, he can also come to see you.

Even if you were doing residency at a hospital 5 minutes from your family, you still wouldn't see them much. It's not the physical distance that separates us, it's the job. So be it.

I appreciate the guidance. I guess my perception of available time in residency is limited.

Will be an Ortho in the Midwest. The flights are pretty expensive to the small town I’m in, but I can stay frugal and fly.

Even just dinners once a week or so would have been ideal. Travel is difficult for him, but maybe utilizing PTO? Would you say it’s not worth the hassle of transferring? Thanks again

 

[DrMetal]

I appreciate the guidance. I guess my perception of available time in residency is limited.

Will be an Ortho in the Midwest. The flights are pretty expensive to the small town I’m in, but I can stay frugal and fly.

Even just dinners once a week or so would have been ideal. Travel is difficult for him, but maybe utilizing PTO? Would you say it’s not worth the hassle of transferring? Thanks again

It's hard to transfer, you have a bird in the hand, don't let it go. Ortho spots are coveted. Your Dad himself would advise you not to make a stupid mistake on his account.

Keep it, figure everything else out.

PTO? Your Dad is still working? Then yes of course, he can travel, use the PTO!

 

[ThoracicGuy]

I appreciate the guidance. I guess my perception of available time in residency is limited.

Will be an Ortho in the Midwest. The flights are pretty expensive to the small town I’m in, but I can stay frugal and fly.

Even just dinners once a week or so would have been ideal. Travel is difficult for him, but maybe utilizing PTO? Would you say it’s not worth the hassle of transferring? Thanks again

I wouldn't transfer from what I've read so far. Even if you were in the same town it's not like you'd be able to have much time to spend with them. If you transferred out, you may live with regrets of not finishing your chosen specialty.

 

[NotAProgDirector]

Ortho and IM are very, very different. Giving up a career you'd really enjoy (if ortho is that) for time now with your father may be a choice you regret in the future. Or not. It's very personal.

In any case, to answer your question, if you decide to bail on ortho and go into IM instead, it will be no problem at all. You'll be a very competitive IM candidate. We love getting people from the ROAD specialties who see the light. You would need to start again as a PGY-1, you won't get much/any credit for an ortho PGY-1.

Although being there is better, facetime is pretty amazing also.

 

[RangerBob]

What specialty?

We tend to be nomadic in this business, especially while training. You don't truly get to pick where you live until you become an Attending.

Believe it or not, a 12-hour drive (distance wise) isn't that bad. I known plenty that were a 12-hour flight from home.

You could potentially hop on a plane and be home in an hour or two. You could easily spend some weekends at home that way (provided you're not working). If your Dad can still travel, he can also come to see you.

Even if you were doing residency at a hospital 5 minutes from your family, you still wouldn't see them much. It's not the physical distance that separates us, it's the job. So be it.

Unless OP has an SO, if they did training in the same city as their family, they could see them at least weekly if not daily (depending on specialty and the specific program) for meals.

I saw my wife at least daily, and other than days where her work schedule differed from mine, we had plenty of time together. It helped we lived in the same home, but if she lived across the town I’d have easily been able to see her for an hour or two most days of my training.

As others says, it’s really up to the OP to decide what their priorities are. Yes. IM and ortho are extremely different. But it’s also true that our priorities change vastly during our lives. Ortho residents do work very long hours and have little time off, so if FaceTime doesn’t work well for the OP (personally I don’t get much out of FaceTime—I need to see people in person) then they’re looking at seeing their family every few months at best—for for years.

The OP’s dad may not want OP to give up an ortho position for him, but it’s also not up to OP’s dad (or us) to decide what OP finds most fulfilling—it’s up to the OP.

As a parent now, I’m very much on the “family is everything” bandwagon, and I’m happy if I can just tolerate/enjoy my job “enough” because the source of my happiness is not my job anymore, but the people I’m doing it for.

With that said, this is a huge change OP is talking about, and they’re talking about it during a time of grief (the disappointment of where they matched), and I would advise them to take some time to let emotions calm down a bit before they make any big changes.

 

[FindingHome]

It's hard to transfer, you have a bird in the hand, don't let it go. Ortho spots are coveted. Your Dad himself would advise you not to make a stupid mistake on his account.

Keep it, figure everything else out.

PTO? Your Dad is still working? Then yes of course, he can travel, use the PTO!

Thank you for the insight. I meant to say time-off for my residency (3 weeks according to the onboarding), but I understand what you mean.

I wouldn't transfer from what I've read so far. Even if you were in the same town it's not like you'd be able to have much time to spend with them. If you transferred out, you may live with regrets of not finishing your chosen specialty.

Thank you for the reply. I do agree with this. I'm usually a person that thinks what-if. Its a bit childish in hindsight haha

Ortho and IM are very, very different. Giving up a career you'd really enjoy (if ortho is that) for time now with your father may be a choice you regret in the future. Or not. It's very personal.

In any case, to answer your question, if you decide to bail on ortho and go into IM instead, it will be no problem at all. You'll be a very competitive IM candidate. We love getting people from the ROAD specialties who see the light. You would need to start again as a PGY-1, you won't get much/any credit for an ortho PGY-1.

Although being there is better, facetime is pretty amazing also.

Thanks for the response to the question. If I do continue down the route, I had a strong feeling the year wouldn't count.

I understand you are "NotAProgDirector", but if you were... is there a common consensus on how already matched reapplicants are viewed?

I guess I'll cross the bridge when the time comes. In the mean time, occasional flights and Facetime will have to suffice.

Unless OP has an SO, if they did training in the same city as their family, they could see them at least weekly if not daily (depending on specialty and the specific program) for meals.

I saw my wife at least daily, and other than days where her work schedule differed from mine, we had plenty of time together. It helped we lived in the same home, but if she lived across the town I’d have easily been able to see her for an hour or two most days of my training.

As others says, it’s really up to the OP to decide what their priorities are. Yes. IM and ortho are extremely different. But it’s also true that our priorities change vastly during our lives. Ortho residents do work very long hours and have little time off, so if FaceTime doesn’t work well for the OP (personally I don’t get much out of FaceTime—I need to see people in person) then they’re looking at seeing their family every few months at best—for for years.

The OP’s dad may not want OP to give up an ortho position for him, but it’s also not up to OP’s dad (or us) to decide what OP finds most fulfilling—it’s up to the OP.

As a parent now, I’m very much on the “family is everything” bandwagon, and I’m happy if I can just tolerate/enjoy my job “enough” because the source of my happiness is not my job anymore, but the people I’m doing it for.

With that said, this is a huge change OP is talking about, and they’re talking about it during a time of grief (the disappointment of where they matched), and I would advise them to take some time to let emotions calm down a bit before they make any big changes.

Thank you for the reply. You summarized my concern extremely well and I gratefully appreciate the guidance.

There is no doubt that some of this stems from a somewhat unexpectedly unsuccessful cycle, and I'm hoping the grief for the match (among other areas of concern) resolves over time.


I'm truly blessed to have everyone reply and deeply appreciate everyone's time in answering these questions.

 

[ThoracicGuy]

There is no doubt that some of this stems from a somewhat unexpectedly unsuccessful cycle, and I'm hoping the grief for the match (among other areas of concern) resolves over time.


I'm truly blessed to have everyone reply and deeply appreciate everyone's time in answering these questions.

We tend to see that people that initially were sad about where they matched ended up liking it by the end. If you go into with a good attitude and want to make it work, it probably will. It's perfectly fine to vent, just don't make a rash decision without truly giving it a try.

 

[NotAProgDirector]

Thanks for the response to the question. If I do continue down the route, I had a strong feeling the year wouldn't count.

I understand you are "NotAProgDirector", but if you were... is there a common consensus on how already matched reapplicants are viewed?

I guess I'll cross the bridge when the time comes. In the mean time, occasional flights and Facetime will have to suffice.

I was a PD of an IM program in the past. Did that for 15+ years. Changed from aProgDirector to NotAProgDirector when I stepped down.

Every program / PD will be different, but most are perfectly happy to look at people whom already matched to another field. The question that will be asked is whether you're running away from something, or running towards. The big concern is ensuring that you're not failing out of one program and trying to lateral into another -- or if you are, that it's a good fit. I've had transfers from surgical programs where the resident was a "klutz in the OR" but otherwise fine -- and that's not an issue at all. But professionalism issues are forever.

Bottom line is if you can write a good story about how you've changed your mind, and if your LOR's support that story, you'll be fine should you decide to reapply.

 

[dozitgetchahi]

I appreciate the guidance. I guess my perception of available time in residency is limited.

Will be an Ortho in the Midwest. The flights are pretty expensive to the small town I’m in, but I can stay frugal and fly.

Even just dinners once a week or so would have been ideal. Travel is difficult for him, but maybe utilizing PTO? Would you say it’s not worth the hassle of transferring? Thanks again

It’s not worth transferring. You have a spot in ortho, which these days is as good as gold. You’ll get to become one of the overpaid doctors the hospital dotes on because you bring in the facility fees and revenue (only half joking here).

Seriously. Take the golden ticket and become an orthopedist.

 

[FindingHome]

I was a PD of an IM program in the past. Did that for 15+ years. Changed from aProgDirector to NotAProgDirector when I stepped down.

Every program / PD will be different, but most are perfectly happy to look at people whom already matched to another field. The question that will be asked is whether you're running away from something, or running towards. The big concern is ensuring that you're not failing out of one program and trying to lateral into another -- or if you are, that it's a good fit. I've had transfers from surgical programs where the resident was a "klutz in the OR" but otherwise fine -- and that's not an issue at all. But professionalism issues are forever.

Bottom line is if you can write a good story about how you've changed your mind, and if your LOR's support that story, you'll be fine should you decide to reapply.

I really appreciate this guidance. Thank you for the help.

It’s not worth transferring. You have a spot in ortho, which these days is as good as gold. You’ll get to become one of the overpaid doctors the hospital dotes on because you bring in the facility fees and revenue (only half joking here).

Seriously. Take the golden ticket and become an orthopedist.

Thank you for your insight. Out of curiosity, would you have a similar mindset with a very lucrative alternative specialty (I.e. Plastics, ENT, Derm, etc.)? This post garnered significant responses from individuals with similar excellent jobs far away from home, but many are not becoming orthopods.

Again, thank you everyone for your responses.

 

[dozitgetchahi]

I really appreciate this guidance. Thank you for the help.


Thank you for your insight. Out of curiosity, would you have a similar mindset with a very lucrative alternative specialty (I.e. Plastics, ENT, Derm, etc.)? This post garnered significant responses from individuals with similar excellent jobs far away from home, but many are not becoming orthopods.

Again, thank you everyone for your responses.

If it was any other lucrative specialty, I’d be saying the exact same thing.

I’m assuming you chose this specialty because you liked it. If you still enjoy the idea of becoming an orthopedist, do it. IMO, the only reason to not do it is if you realize that you don’t want to practice it.

 

[DrMetal]

the hospital dotes on because you bring in the facility fees and revenue (only half joking here).

What do you mean 'half-joking'? This is exactly true!

OP: lets trade spots. I'll take your Ortho residency. You can have my current job as an Attending hospitalist. You don't even need to do an IM residency, you can do the job right now (all I do is follow mandated nurse-driven protocols, and AI writes my notes . . . easy gig).

 

[mistafab]

I encourage you to keep your program and stick it through.

There are a lot of unknowns ahead. Even with your father's diagnosis, and you certainly have my thoughts and prayers, there is a huge amount of time that can go forward - it can be a long, grueling process.

I caution you that if you were 100% sure about Ortho prior to match... that you need to see this through and take every opportunity possible to see or talk with your dad where you can. You can't give up your life for your parents life. This is a critical decision that may alter your entire working career, possibly the next 40 years of your life - and your future children's lives. Your program may even be able to be flexible if you needed to take FMLA or an extended leave if things were to tailspin with family. Just try to be as levelheaded about this and don't make an emotional decision without getting more advice - I also encourage you to speak with your family about this.