Considering specialty switch - now vs after residency

[kdade]

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Hello,
Current IM PGY-1 here, considering a switch into surgery. I applied and interviewed predominantly surgery last year, with some IM as backup, ultimately matching IM. My program so far has been a good learning experience, and I really enjoy the people I'm around, and love the area....but surgery remains my passion and I'm really missing the OR and procedural aspects. I've been very seriously considering switching, but I also know this comes with significant risk, and I actually know some people who that did not work out for last year (into different specialties). My dilemma now is, do I take the risk on a slim chance of rematching this year, or finish out IM, and if I still don't love it then, reapply as an already board certified physician?
I know the stats for reapplying aren't great, and my thoughts are that its even riskier this year with the merged match. If I were to fail to match surgery, I would want to keep my seat here, and I know there's pressure on PD's to fill those, so there's a good chance I'd lose my seat.
On the flip side, I know programs don't necessarily want to graduate people who will switch specialties, so they may not be thrilled about that. I've considered starting to email / call surgery PD's, especially those that I interviewed and auditioned with last year, just to see how open they are to consider a re-applicant. I'd also hate for them to call up my PD and have my PD hear this through the grapevine rather than from me.
If anyone's been through this process, or has some insight, I'd appreciate some input. Thanks!

 

[GoSpursGo]

So one point here that is relevant for anyone applying this year who is considering a backup specialty--only apply to the backup specialty if you TRULY would be happy in your backup field. If you're just applying because you want to match *somewhere* and would still try switching specialties later, I think that's a bad idea. There are probably plenty of different things you could be doing with your time that would be more attractive to a potential GS PD than an IM intern year, and you probably hurt your GS app last year by spending energy putting together your backup application that could have been spent improving your chances for your preferred specialty. Again, I'm not saying this to put you down because a lot of people do what you did, but just something for future applicants to keep in mind.

In my mind, the issue here is if you weren't able to match last year as a new graduate, what do you think has changed in the last year that will make you successful as a reapplicant? Assuming you applied to a decent number of programs of appropriate competitiveness, I think you got your answer last year on whether you are competitive for general surgery, and in the absence of a major improvement in your application I'm not sure I would expect a different outcome. I would strongly recommend finishing out IM, and then if you still feel strongly about trying GS apply then with the safety net of already being a board-certified physician. Nobody wants to be a resident for 8 years, but I think it's really hard to justify giving up a spot that you have in hand for a long-shot.

Finally, you're right that you don't want your current PD to hear through the grapevine that you're poking around for possible surgical positions. Stop doing that.

 

[Raryn]

Hello,
Current IM PGY-1 here, considering a switch into surgery. I applied and interviewed predominantly surgery last year, with some IM as backup, ultimately matching IM. My program so far has been a good learning experience, and I really enjoy the people I'm around, and love the area....but surgery remains my passion and I'm really missing the OR and procedural aspects. I've been very seriously considering switching, but I also know this comes with significant risk, and I actually know some people who that did not work out for last year (into different specialties). My dilemma now is, do I take the risk on a slim chance of rematching this year, or finish out IM, and if I still don't love it then, reapply as an already board certified physician?
I know the stats for reapplying aren't great, and my thoughts are that its even riskier this year with the merged match. If I were to fail to match surgery, I would want to keep my seat here, and I know there's pressure on PD's to fill those, so there's a good chance I'd lose my seat.
On the flip side, I know programs don't necessarily want to graduate people who will switch specialties, so they may not be thrilled about that. I've considered starting to email / call surgery PD's, especially those that I interviewed and auditioned with last year, just to see how open they are to consider a re-applicant. I'd also hate for them to call up my PD and have my PD hear this through the grapevine rather than from me.
If anyone's been through this process, or has some insight, I'd appreciate some input. Thanks!

Your application was not sufficient to match surgery the first time and your odds have only gotten worse, not to mention you will struggle to get the time off to interview at this point.

A bird in the hand is absolutely worth two in the bush and internal medicine is quite literally the broadest field within medicine when it comes to career options. Why not consider a fellowship? There are procedural fellowships within IM, and even if you don't end up doing surgery, you can end up doing mostly procedural work.

 

[IMreshopeful]

Your application was not sufficient to match surgery the first time and your odds have only gotten worse, not to mention you will struggle to get the time off to interview at this point.

A bird in the hand is absolutely worth two in the bush and internal medicine is quite literally the broadest field within medicine when it comes to career options. Why not consider a fellowship? There are procedural fellowships within IM, and even if you don't end up doing surgery, you can end up doing mostly procedural work.

I agree with this. I would consider a procedural fellowship like GI or cards if the procedure bug is biting hard.

I don’t think the chances are good otherwise

 

[collegestud2013]

Hello,
Current IM PGY-1 here, considering a switch into surgery. I applied and interviewed predominantly surgery last year, with some IM as backup, ultimately matching IM. My program so far has been a good learning experience, and I really enjoy the people I'm around, and love the area....but surgery remains my passion and I'm really missing the OR and procedural aspects. I've been very seriously considering switching, but I also know this comes with significant risk, and I actually know some people who that did not work out for last year (into different specialties). My dilemma now is, do I take the risk on a slim chance of rematching this year, or finish out IM, and if I still don't love it then, reapply as an already board certified physician?
I know the stats for reapplying aren't great, and my thoughts are that its even riskier this year with the merged match. If I were to fail to match surgery, I would want to keep my seat here, and I know there's pressure on PD's to fill those, so there's a good chance I'd lose my seat.
On the flip side, I know programs don't necessarily want to graduate people who will switch specialties, so they may not be thrilled about that. I've considered starting to email / call surgery PD's, especially those that I interviewed and auditioned with last year, just to see how open they are to consider a re-applicant. I'd also hate for them to call up my PD and have my PD hear this through the grapevine rather than from me.
If anyone's been through this process, or has some insight, I'd appreciate some input. Thanks!

If you applied GS last year with IM as a back-up, you probably already knew there was at least a reasonably good chance you wouldn't match into GS. If you really wanted GS in this situation, the best back-up plan should've been to apply to GS prelims as well (which are very easy to get into). GS does have a low match rate but also one of the highest attrition rates of any specialty and many of those drop out by end of PGY-1 year, so there's a good chance that many PGY-2 spots would open up either at your home institution or at another program. However, it's much harder to switch to GS as a categorical IM resident since your IRP for Medicare funding is set at 3 years and GS is a 5-year residency. As suggested above you could do a GI or cards fellowship after IM residency (though these are by no means easy to match into, especially if you're not a USMD or are at a lower tier community IM program with no associated in-house fellowship).

 

[kdade]

Thanks everyone for the feedback so far. Any thoughts on finishing IM and then switching to surgery? I've only heard of one person doing this, but my thought is that if I go that route, I would at least have a career to fall back on rather than risking not matching altogether.

 

[CanIMakeIt]

From what i understand about funding is that Medicare/govt only pays for one speciality and if surgery programs were to match you after IM, then they need to pony up your salary. So make sure application is good enough. Why did you not just do surgery prelim year instead and you could have tried to find open PGY-2 spots later?

 

[gutonc]

From what i understand about funding is that Medicare/govt only pays for one speciality and if surgery programs were to match you after IM, then they need to pony up your salary. So make sure application is good enough. Why did you not just do surgery prelim year instead and you could have tried to find open PGY-2 spots later?

You do not understand funding correctly.

 

[CanIMakeIt]

You do not understand funding correctly.

👍
you are correct. That was not completely true answer and only partially true - my bad

GME Funding and Specialty Choice, Part II - this is old articles and gives some overview

Since then I did a little more research and found this reply

Doing a second residency??

Just curious. I will be finishing FP next year due to default circumstance. I still really want to do general surgery. Does anyone out there know about applying for a second residency? Do you just call up programs?:confused: Any ideas about how you get paid since medicare has already paid for...

forums.studentdoctor.net

This explains funding a little better - explained by @f_w midway through the thread

I will see if I can dig up some more on this

 

[NotAProgDirector]

https://aamc-black.global.ssl.fastly.net/production/media/filer_public/64/77/6477adae-c4c6-4e0e-8c6f-adcdabf2bdec/dgme_-_medicare_gme_payments_what_you_need_to_know_-_20190430.pdf

Or, if you like videos, look at the links over on the right of this page: Medicare Direct Graduate Medical Education (DGME) Payments - Graduate Medical Education (GME) - Government Affairs - AAMC

 

[NYCNative]

Stay in your program, and reapply as a board certified doc later if you must. My advice -might- be different if you had matched at your #1 IM program, and had only applied IM. As a borderline applicant, be grateful for the moment that all your hard work was not for naught, and just reapply later if you really feel called to surgery.

 

[CidHighwind]

What? Don’t go into GS, most GS don’t want to be GS. Just go on to do GI, make bank, and thank us later.