Confused about prelim/transitional and advanced anesthesia spots

[AestheticAnesthetic]

Id'd just like to apologize up front in case this has already been asked but I couldn't find a satisfactory answer on my own searching.

I am a US citizen IMG hoping to match into Anesthesia this year, and I have a few questions about the matching process.

1. When applying for advanced positions, do you already have to have a prelim/transitional year completed or do you apply for both at the same time?

2. Do Anesthesia programs have a preference for transitional or prelim in med or prelim in surg for advanced spots?

3. Does applying for advanced and categorical at the same program affect the chances of matching at that program? I'm assuming that means you would have 2 interviews with the same people, one for categorical, and one for advanced. Would they look down on this, or are they independent applications?

4. In order to maximize my chances of matching, would the best way be to apply to all categorical anesthesia spots, advanced anesthesia spots, prelim med, prelim surg, and transitional year programs I qualify for? Meaning potentially 5 interviews at one program?

Sorry for the long post guys. Any advice you can give would be greatly appreciated. Thank you for your time.

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[2010houston]

1- for Advanced spots, you apply & interview at the same time you apply as for prelim year. So for example you were applying this year, you'd be applying for prelim starting jul 2017 and advanced that would start Jul 2018. There are also "R" slots that are physician only that start July 2017, but you would already need to be in or have finished a prelim year to apply for these.

2- I believe most programs have no preference.

3- a majority of applicants apply for both the categorical and advanced slots at a single institution. Definitely not looked down on. You only do one interview. programs will often submit very similar / identical rank lists for their advanced vs categorical slots. It seems like more applicants prefer categorical, but there of course some who prefer to do intern year elsewhere for other reasons- if you're in this situation, the program directors usually ask at the interview if you would prefer advanced to categorical. When you do your rank list, it's totally up to you if you want to rank all categorical first, then all advanced vs 1- program A categorical, 2- prg A advanced, 3- program B categorical etc. people do it both ways.

4- yes , though as above you may want to rank some advanced before some categoricals if you really liked those programs. Prelim med/surg/TY are definitely separate interviews, but the anesthesia cat & adv will only be one.

Hope this helps and did not just confuse things more! Good luck.

 

[sigrhoillusion]

Pretty much the same as above poster.

The big question is do you want to be in the same place for 4 years, or do you want to go to a "chill" one year program which may not be in your #1 advanced spot? What I've seen is that the 4 year programs at big academic centers usually have an intern year that beats the snot out of you and uses you as a surgical/medical intern that they can abuse. Again, that's jsut things I've heard, and I'm sure there are programs with good intern years.

Some benefits of doing all 4 years in the same place:
Learn the system and the hospital.
Meet people that you will be working with in the OR.
I think ACGME only allows 4 weeks of anesthesia elective during intern year, so not sure how much of a jump you get over people who are just arriving for the CA1 year, but again getting used to whatever anesthesia charting system they have might be helpful. Also, figuring out where things are or who to call may be helpful.
Only one move (or no move at all if you're already in that area)

Some benefits of prelim/transition year.
"Usually" more chill. Again you have to do your research. You'll work hard in any intern year, but there's working hard and then there's being the hospital b*tch... Also, helps finding out which ones give the best benefits/vacation time/academic money.
If you're set on living in a major metropolitan area, then you can usually find several one year internships in that city, so again you can save a move.
Maybe you want to live somewhere different for a year and experience something new.

It really depends on what you want from that year. But again, a lot of the one year programs are SUPER competitive, more so than the 3 or 4 year anesthesia programs.

The big key though is ranking your ANESTHESIA programs first and foremost. Do not let one year of possible less work copromise your ultimate goal. That being said, if you like Program X which has a 3 and 4 year program, but don't like there intern program and prefer to go somewhere else, then definitely rank the 3 year program over 4 year.

So if you have 3 top programs and have them definitely in a specific order of where you want to go, but still want to do a relaxing intern year I would rank them as:

Program X - 3yr
Program X - 4yr
Program Y - 3yr
Program Y - 4yr
Program Z - 3yr
Program Z - 4yr

Now let's say you have 3 top programs and you're fine with any of them, but would love to do a nice intern year then you might rank them:
Program X - 3yr
Program Y - 3yr
Program Z - 3yr
Program X - 4yr
Program Y - 4yr
Program Z - 4yr

The key thing to remember is that the way the match works is that it will always go through your main field first. So it would match you based off how you rank the anesthesia programs. Your one year program list will only be ranked after the anesthesia list has been gone through. So if you match into a 4yr program your one year list won't even be used. But if you match into a 3yr program then they will go through the one year programs. The toughest thing might be ranking everything if you don't want to move twice. IF that's the case then you'd be best ranking the 4 year programs, unless you think your competitive enough to rank 3 yr programs and then rank the one year programs based on location.

Either way, good luck.

 

[Dr.Acula99]

As someone doing a one year preliminary right now, I can tell you it's likely much more relaxed than the big academic center, and there's something very comforting about the fact that nobody at my advanced program will see any of my intern year mishaps.

 

[AestheticAnesthetic]

1- for Advanced spots, you apply & interview at the same time you apply as for prelim year. So for example you were applying this year, you'd be applying for prelim starting jul 2017 and advanced that would start Jul 2018. There are also "R" slots that are physician only that start July 2017, but you would already need to be in or have finished a prelim year to apply for these.

2- I believe most programs have no preference.

3- a majority of applicants apply for both the categorical and advanced slots at a single institution. Definitely not looked down on. You only do one interview. programs will often submit very similar / identical rank lists for their advanced vs categorical slots. It seems like more applicants prefer categorical, but there of course some who prefer to do intern year elsewhere for other reasons- if you're in this situation, the program directors usually ask at the interview if you would prefer advanced to categorical. When you do your rank list, it's totally up to you if you want to rank all categorical first, then all advanced vs 1- program A categorical, 2- prg A advanced, 3- program B categorical etc. people do it both ways.

4- yes , though as above you may want to rank some advanced before some categoricals if you really liked those programs. Prelim med/surg/TY are definitely separate interviews, but the anesthesia cat & adv will only be one.

Hope this helps and did not just confuse things more! Good luck.

Thanks a lot, that actually did clear up a lot of my confusion.

So going off of what you said, let's say a program was willing to offer me a categorical spot hypothetically, and during the interview I say I prefer an advanced spot then I would not only lose my categorical spot but I might not even get a prelim thereby forfeiting a year? Would saying categorical be considered the safer option? I'm not worried about moving around, and while obviously no one likes doing extra work, I don't mind it either as long as it means securing a spot.

 

[AestheticAnesthetic]

Pretty much the same as above poster.

The big question is do you want to be in the same place for 4 years, or do you want to go to a "chill" one year program which may not be in your #1 advanced spot? What I've seen is that the 4 year programs at big academic centers usually have an intern year that beats the snot out of you and uses you as a surgical/medical intern that they can abuse. Again, that's jsut things I've heard, and I'm sure there are programs with good intern years.

Some benefits of doing all 4 years in the same place:
Learn the system and the hospital.
Meet people that you will be working with in the OR.
I think ACGME only allows 4 weeks of anesthesia elective during intern year, so not sure how much of a jump you get over people who are just arriving for the CA1 year, but again getting used to whatever anesthesia charting system they have might be helpful. Also, figuring out where things are or who to call may be helpful.
Only one move (or no move at all if you're already in that area)

Some benefits of prelim/transition year.
"Usually" more chill. Again you have to do your research. You'll work hard in any intern year, but there's working hard and then there's being the hospital b*tch... Also, helps finding out which ones give the best benefits/vacation time/academic money.
If you're set on living in a major metropolitan area, then you can usually find several one year internships in that city, so again you can save a move.
Maybe you want to live somewhere different for a year and experience something new.

It really depends on what you want from that year. But again, a lot of the one year programs are SUPER competitive, more so than the 3 or 4 year anesthesia programs.

The big key though is ranking your ANESTHESIA programs first and foremost. Do not let one year of possible less work copromise your ultimate goal. That being said, if you like Program X which has a 3 and 4 year program, but don't like there intern program and prefer to go somewhere else, then definitely rank the 3 year program over 4 year.

So if you have 3 top programs and have them definitely in a specific order of where you want to go, but still want to do a relaxing intern year I would rank them as:

Program X - 3yr
Program X - 4yr
Program Y - 3yr
Program Y - 4yr
Program Z - 3yr
Program Z - 4yr

Now let's say you have 3 top programs and you're fine with any of them, but would love to do a nice intern year then you might rank them:
Program X - 3yr
Program Y - 3yr
Program Z - 3yr
Program X - 4yr
Program Y - 4yr
Program Z - 4yr

The key thing to remember is that the way the match works is that it will always go through your main field first. So it would match you based off how you rank the anesthesia programs. Your one year program list will only be ranked after the anesthesia list has been gone through. So if you match into a 4yr program your one year list won't even be used. But if you match into a 3yr program then they will go through the one year programs. The toughest thing might be ranking everything if you don't want to move twice. IF that's the case then you'd be best ranking the 4 year programs, unless you think your competitive enough to rank 3 yr programs and then rank the one year programs based on location.

Either way, good luck.

Thank you, I wasn't even thinking that far ahead, you cleared up a lot of potential questions too. Moving around isn't a problem for me, and while I don't want extra work, I don't mind if it means a secure spot. As IMG's we dont get as much freedom of choice so whatever gives me the best chances of matching is what I would go for. My only thing is I would like to eventually do a fellowship in Pain Management, so would my chances of getting into an academic program be higher going the categorical route or the prelim/advanced route?

 

[AestheticAnesthetic]

As someone doing a one year preliminary right now, I can tell you it's likely much more relaxed than the big academic center, and there's something very comforting about the fact that nobody at my advanced program will see any of my intern year mishaps.

Nice, I didn't even think about that. Make all your mistakes somewhere else and show up looking like a pro. I e-mailed a program in Florida the other day for information, and they actually replied saying they prefer candidates for their advanced spots that have gone through a prelim/transitional year at one of their affiliated hospitals over candidates from elsewhere. Is this the norm, or is this a unique scenario?

 

[sigrhoillusion]

Do NOT listen to anything a program says. They can say anything they want. They want you to rank them high, cause they don't want to risk going unmatched just as much as you don't want to not match.

If a program says they are ranking you #1 then nod your head, thank them, say you will do the same and then DO WHATEVER YOU WANT! If you really want to go there then rank them #1, if you don't, then don't rank them (or rank them low if you're worried about not matching at all.)

Make the list based on what YOU want, not what the programs say. If a program has a categorical and an advanced program, just tell them you will rank both of them. If they have any desire to have you they will rank you in both programs, so the one you match would be based on how you rank them.

I'm not 100% sure since I'm not a PD, but I highly doubt programs that have both programs vary their rank lists much between the two. I'm assuming if they have 50 candidates, then both lists probably look exactly the same from #1 to #50. I could be wrong, but can't imagine them having any preference between wanting someone there whether it was 3 or 4 years.

 

[sigrhoillusion]

The main thing that a lot of applicants fail to realize is that in order to match anywhere with 100% probability, you just need to be ranked within the top X spots in ANY program that you rank. Granted it might be your 15th choice, but if that 15th choice has you ranked 9th of 10 spots then YOU WILL MATCH. So as long as you are willing to match at a place you should rank it, and you might as well rank EVERY program you could see yourself mathcing in and rank them according to where YOU want to go first. So even if the top program in the country is your #1 spot but you don't think you'll match there you should STILL rank it #1. As long as they gave you an interview, and you didn't eat your foot during it, there is no harm in ranking it #1 even if they only have 10 spots and they end up ranking you 25th. Granted there are 14 people ahead of you if the top 10 match elsewhere, perhaps the otehr 14 also ranked other places higher. You might as well rank that dream shot #1, cause AT WORST if you don't match there or your #2, or #3 or 4 or.... 14th... then you will STILL match your 15th choice assuming that they have you in their top list.

Shoot for the moon!

 

[AestheticAnesthetic]

The main thing that a lot of applicants fail to realize is that in order to match anywhere with 100% probability, you just need to be ranked within the top X spots in ANY program that you rank. Granted it might be your 15th choice, but if that 15th choice has you ranked 9th of 10 spots then YOU WILL MATCH. So as long as you are willing to match at a place you should rank it, and you might as well rank EVERY program you could see yourself mathcing in and rank them according to where YOU want to go first. So even if the top program in the country is your #1 spot but you don't think you'll match there you should STILL rank it #1. As long as they gave you an interview, and you didn't eat your foot during it, there is no harm in ranking it #1 even if they only have 10 spots and they end up ranking you 25th. Granted there are 14 people ahead of you if the top 10 match elsewhere, perhaps the otehr 14 also ranked other places higher. You might as well rank that dream shot #1, cause AT WORST if you don't match there or your #2, or #3 or 4 or.... 14th... then you will STILL match your 15th choice assuming that they have you in their top list.

Shoot for the moon!

I'm one of those applicants, because I didn't know that either. Your advice helps a lot and I think I have an idea of how to proceed now.

Thank you!

 

[sigrhoillusion]

Again, what I said about having 100% probability of matching assumes that at least one of the schools that you interview at has you in their top matching spots. Obviously, if you rank 15 programs and none of them have you ranked in their top X spots, but do have you ranked somewhere on their list, then you have to hope that the people above you match elsewhere. That being said, if you rank 15 programs, there is a REALLY high probability you will rank at one of them even if you aren't there top choices, just based on the probability that the otehr people will match other places. The rough part is when unfortunately every spot above you fills, but again if you're ranking that many programs, the chances are pretty low.

The biggest things you have to ask is are you willing to not match? Do you HAVE to match at only a handful of places or can you "settle" for a program that might not be one of your top choices. And what will you do if you don't match? I think one reason some people don't match is that they limit their selections and only rank a handful of programs, whether it be because of location or prestige. But if you do that, again you have to ask yourself what are you going to do in that lost year? Do you do research, find a one year internship in hopes of finding an open spot the following year? Because you have to remember that with anesthesia you're technically matching TWO years in advance. So although you might find an internship, in order to move on to the CA1 year at a program it has to be vacant from the year prior which you didn't match in (and what are the possibilities of that, especially if it's a competitive program?)

 

[BLADEMDA]

Here is my two cents:

Anesthesia is Not ENT or ORTHO; this means rank and interview at all the programs required to match. Do not be one of the few scrambling to find a spot unless your Step 1 is over 245.
Leave the scrambling to the wanna-be Ortho/Ent people with 250 Step scores who didn't match.

 

[AestheticAnesthetic]

Again, what I said about having 100% probability of matching assumes that at least one of the schools that you interview at has you in their top matching spots. Obviously, if you rank 15 programs and none of them have you ranked in their top X spots, but do have you ranked somewhere on their list, then you have to hope that the people above you match elsewhere. That being said, if you rank 15 programs, there is a REALLY high probability you will rank at one of them even if you aren't there top choices, just based on the probability that the otehr people will match other places. The rough part is when unfortunately every spot above you fills, but again if you're ranking that many programs, the chances are pretty low.

The biggest things you have to ask is are you willing to not match? Do you HAVE to match at only a handful of places or can you "settle" for a program that might not be one of your top choices. And what will you do if you don't match? I think one reason some people don't match is that they limit their selections and only rank a handful of programs, whether it be because of location or prestige. But if you do that, again you have to ask yourself what are you going to do in that lost year? Do you do research, find a one year internship in hopes of finding an open spot the following year? Because you have to remember that with anesthesia you're technically matching TWO years in advance. So although you might find an internship, in order to move on to the CA1 year at a program it has to be vacant from the year prior which you didn't match in (and what are the possibilities of that, especially if it's a competitive program?)

How many programs can you rank? If I apply to 100 programs and I get 20 interviews can I rank all 20? I just want any academic program because I eventually want to do a fellowship in Pain but location or prestige doesn't matter to me. Being from abroad all of America is basically new to me so it's not like I have a reference to judge off of.

Sorry for the late reply, was traveling over the weekend.

 

[AestheticAnesthetic]

Here is my two cents:

Anesthesia is Not ENT or ORTHO; this means rank and interview at all the programs required to match. Do not be one of the few scrambling to find a spot unless your Step 1 is over 245.
Leave the scrambling to the wanna-be Ortho/Ent people with 250 Step scores who didn't match.

Well to be honest my step 1 is barely over 250, but I havent gotten my step 2 results yet, so who knows how that'll go. I'm definitely planning on applying everywhere, but if I'm asked my preference during the interview would it be considered the safer choice to say categorical or advanced? I've heard prelim/transitional spots are pretty competitive since people think it'll be a more relaxing year.

 

[pjl]

Well to be honest my step 1 is barely over 250, but I havent gotten my step 2 results yet, so who knows how that'll go. I'm definitely planning on applying everywhere, but if I'm asked my preference during the interview would it be considered the safer choice to say categorical or advanced? I've heard prelim/transitional spots are pretty competitive since people think it'll be a more relaxing year.

Just say that you dont really have a preference, and that you will be ranking them 1 and 2 (or whatever). Unless you have a preference, then say you will be ranking them 2 and 1.


Sent from my iPad using SDN mobile app

 

[Mad Jack]

Well to be honest my step 1 is barely over 250, but I havent gotten my step 2 results yet, so who knows how that'll go. I'm definitely planning on applying everywhere, but if I'm asked my preference during the interview would it be considered the safer choice to say categorical or advanced? I've heard prelim/transitional spots are pretty competitive since people think it'll be a more relaxing year.

Transitional spots tend to be pretty cushy, but prelim IM and surgery are often as difficult as their respective categorical intern years (though in surgery you'll probably end up with less OR time and more scut work). Getting a prelim spot in surg or IM isn't all that difficult (prelim surg has many spots that go completely unfilled each year), even as an IMG.

 

[sigrhoillusion]

Don't quote me on this, but I'm pretty sure you can rank as many programs as you want. I forget if there is a cost to the whole application process.

 

[AestheticAnesthetic]

Awesome, thanks a lot for all your guys' advice. Just about took care of all my concerns. If I think of something else to bother you guys with, I know where to look.

 

[NNoor]

so if you apply for advance anesthesia Ca1 and transitional IM; you get interview for transitional IM but none for Ca1, what do you do?

 

[AestheticAnesthetic]

so if you apply for advance anesthesia Ca1 and transitional IM; you get interview for transitional IM but none for Ca1, what do you do?

from my understanding if you dont get any pgy2 interviews then you can rank the pgy1 program on your main rank order list and then apply for any open pgy2 spots during the scramble in march. If you still don't get any advanced spots in the scramble, then you would start your pgy1 (in this case transitional year) program and apply again through eras the next year for all the advanced and reserved spots. then go through the whole interview process again and hope some program takes you. The only good thing is that if you apply the next year then since you're already doing a transitional year you dont have to apply for any other transitional or prelim spots, only advanced or Reserved spots. You could also apply for categorical spots but then you would have to restart from pgy 1 so you'd be wasting a year.

 

[RT2MD]

Lots of good advice on this thread. My $0.02:

I applied to both categorical and advanced positions. When I applied (current PGY-3) you could pay one amount of money to get 20 applications in a specialty, which I did. My secondary rank list consisted of IM and surgery programs. I had a lot of family/personal reasons that a TY year wouldn't work out (mostly due to geography). One price got me 10 IM applications and 10 surgery applications. I got a good response on my interviews, and ended up canceling several to end up at a total of 9 anesthesia programs. My final rank list ended up being:
1) top program categorical
2) top program advanced
3) second program categorical
4) third program categorical
5) fourth program categorical
6) fifth program categorical
7) sixth program categorical
8) second program advanced
and so on...

My secondary rank list was a mixture of IM and surgery, ranking ordered differed on geography tied to advanced spot. I ended up getting my second choice (top program, advanced spot) and I ended up doing a prelim surgery program... in an old school program... in the intervention arm of the duty hour study... good times.

What I learned: If you really want to go to a program, apply to both categorical and advanced spots (if that is an option). Doing a general surgery intern year is, actually, quite helpful. I learned how surgeons think and how they like to manage their patients. I also feel like my surgical colleagues express more respect after learning that I did a gen surg prelim year. I feel like missing out on cardiology was the biggest downside (other than the hours worked) of doing surgery, but I feel like I have been able to catch up. My class is pretty close to half advanced and half categorical. Not doing intern year here made my ICU month more difficult, as I wasn't familiar with the order entry system/etc. There were also several social cliques formed prior to my arrival, but that wasn't a huge deal. Honestly, it was nice to do my intern year in a different place - as I now have exposure to different systems. It also worked out much better for my family. Blessing in disguise that I didn't match categorical... although if I had, I'm sure I would have been happy with that too!

Best of luck to all the applicants this year!
-RT2MD

 

[DOFOSHO]

The main thing that a lot of applicants fail to realize is that in order to match anywhere with 100% probability, you just need to be ranked within the top X spots in ANY program that you rank. Granted it might be your 15th choice, but if that 15th choice has you ranked 9th of 10 spots then YOU WILL MATCH. So as long as you are willing to match at a place you should rank it, and you might as well rank EVERY program you could see yourself mathcing in and rank them according to where YOU want to go first. So even if the top program in the country is your #1 spot but you don't think you'll match there you should STILL rank it #1. As long as they gave you an interview, and you didn't eat your foot during it, there is no harm in ranking it #1 even if they only have 10 spots and they end up ranking you 25th. Granted there are 14 people ahead of you if the top 10 match elsewhere, perhaps the otehr 14 also ranked other places higher. You might as well rank that dream shot #1, cause AT WORST if you don't match there or your #2, or #3 or 4 or.... 14th... then you will STILL match your 15th choice assuming that they have you in their top list.

Shoot for the moon!

I am in the following scenario: I have 5 advanced programs on my Primary ROL, 1 through 5, each with several prelim programs on the Secondary ROL. Is it a good idea to list the same 5 advanced programs, 6 though 10, WITHOUT Secondary ROL? This is in case I don't match any prelim programs and my Primary ROL (1 through 5) is exhausted, it will match me into an advanced spot and I can SOAP into a prelim.

*I am not going into anesthesia but this questions fits on this thread.

 

[d9sccr]

I am in the following scenario: I have 5 advanced programs on my Primary ROL, 1 through 5, each with several prelim programs on the Secondary ROL. Is it a good idea to list the same 5 advanced programs, 6 though 10, WITHOUT Secondary ROL? This is in case I don't match any prelim programs and my Primary ROL (1 through 5) is exhausted, it will match me into an advanced spot and I can SOAP into a prelim.

*I am not going into anesthesia but this questions fits on this thread.

Unless something has changed in the past few years (PGY-3 now), the matches are independent of each other. You can match an advanced and not match a transitional/prelim year without a repeat of your list w/o a ROL for the prelims

 

[AestheticAnesthetic]

I am in the following scenario: I have 5 advanced programs on my Primary ROL, 1 through 5, each with several prelim programs on the Secondary ROL. Is it a good idea to list the same 5 advanced programs, 6 though 10, WITHOUT Secondary ROL? This is in case I don't match any prelim programs and my Primary ROL (1 through 5) is exhausted, it will match me into an advanced spot and I can SOAP into a prelim.

*I am not going into anesthesia but this questions fits on this thread.

as d9sccr stated above, the primary and supplemental ROL are independent. If you match into one of the advance spots then that spot will be held for you until the end of SOAP assuming you didn't match into a prelim spot during the main match and SOAP. If you matched into a prelim spot in either the main or SOAP then you're good to go on the advanced spot too, but if you don't match anywhere in your main list then even if you matched to a prelim program on the supplemental list, you lose that spot. So you can't do the prelim year if you don't have an advanced year lined up too, unless you put one of your prelim programs on your main list, but then it's not on your supplemental list...so up to you how you want to deal with that.

 

[Temeraire]

What I've seen is that the 4 year programs at big academic centers usually have an intern year that beats the snot out of you and uses you as a surgical/medical intern that they can abuse

Some benefits of prelim/transition year.
"Usually" more chill. Again you have to do your research. You'll work hard in any intern year, but there's working hard and then there's being the hospital b*tch

For anyone struggling with the decision to rank advanced+pgy1 over a big academic categorical spot in their ROL, I'd say do it (as long as your secondary lists aren't full of malignant prelims). I had my doubts too, but right now I am ridiculously glad that I am NOT doing my intern year at my advanced program's hospital. I'm at a TY program where, although I work hard during my medicine wards months (our hospital is always at max capacity, and our admitting teams always cap), I still get plenty of electives to decompress and focus on just being a learner. I have infinite choice in choosing electives, picking the usuals like pulmonology and cardiology, but also good stuff like transfusion medicine, ENT, and echo reading. I too have a mandatory month of being a general surgery scut slave, but it was useful to learn how the surgical service runs and how surgeons think (but I don't need a whole year of that thank god). Finally, the camaraderie of working with everyone at a smaller community-style hospital is really nice.

OTOH whenever I chat and catch up with my categorical colleagues, they seem SO tired and beat down by their intern year. They get month after month of grueling medicine wards feeling like a scut monkey-in-the-middle between ivory tower specialty services who basically dictate their patients' care for them. The exhaustion and frustration of being a cog is palpable.

That's my 2 cents anyways.

 

[Dr.Acula99]

For anyone struggling with the decision to rank advanced+pgy1 over a big academic categorical spot in their ROL, I'd say do it (as long as your secondary lists aren't full of malignant prelims). I had my doubts too, but right now I am ridiculously glad that I am NOT doing my intern year at my advanced program's hospital. I'm at a TY program where, although I work hard during my medicine wards months (our hospital is always at max capacity, and our admitting teams always cap), I still get plenty of electives to decompress and focus on just being a learner. I have infinite choice in choosing electives, picking the usuals like pulmonology and cardiology, but also good stuff like transfusion medicine, ENT, and echo reading. I too have a mandatory month of being a general surgery scut slave, but it was useful to learn how the surgical service runs and how surgeons think (but I don't need a whole year of that thank god). Finally, the camaraderie of working with everyone at a smaller community-style hospital is really nice.

OTOH whenever I chat and catch up with my categorical colleagues, they seem SO tired and beat down by their intern year. They get month after month of grueling medicine wards feeling like a scut monkey-in-the-middle between ivory tower specialty services who basically dictate their patients' care for them. The exhaustion and frustration of being a cog is palpable.

That's my 2 cents anyways.

Couldn't agree more. It's also good exposure. Who knows where you'll end of working after residency. I know I got very little exposure outside of a tertiary care medical center throughout medical school.

 

[bkg912]

I have a related question I can't seem to find elsewhere... When applying through ERAS, is it better to check both categorical and advanced with regards to programs? My plan was to focus on Categorical (I feel I'm competitive, Step 1 249 although go to a newer allopathic school), but then Anesthesiology residents I've talked to suggested to check both since it's only 1 interview and the rank lists are likely the same. I know it doesn't hurt to apply both, but it's mentally exhausting trying to map out all of the prelim possibilities that accompany an advanced position. Would appreciate any and all advice! Thank you.

 

[2010houston]

I would suggest you check both / /apply to both. Then plan on having categoricals at the top of your rank list if that's how you prefer to do it... BUT if you absolutely fall in love w a program that has both, then you can consider ranking it #1 cat /# 2 advanced, for example. Don't worry about interviewing for prelims if you're really planning to do categorical, but keep this as an option for the bottom of your rank list (after all the cats) or if you're blown away by a specific program. I think it's still quite possible for an applicant like you to soap into a surgery prelim if need be (someone pls correct me if I'm wrong). But as you stated, you're competitive and unlikely to have to do that if you're applying appropriately. Good luck!!

 

[parcus]

Nice, now if only I had an efficient way of figuring out whitch of those 264 prelim surg programs I should apply to.