Couples matched into backup specialty - HELP!

CouplesMatch2017

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Hello SDN,

Been a long time lurker but created a new account for this post. I'd appreciate any and all advice.

Situation: My fiancee and I entered the couples match this year (both of us competitive but US-IMGs). She wanted OBGYN but she matched into her backup IM. I wanted IM and matched into IM. We are both at the same location/same program. The thought of not doing OBGYN is devastating to her and we are looking into our options. I believe it's better to try and switch specialties early on than for her to resent me for going through IM and wasting 3 years of her life. We are also thinking that couples matching might have hurt us because she might have matched into OBGYN had she not couples matched.

From what we have gathered, she could either:
A) complete 45 days of residency and drop out, try to get a letter of good standing, reapply to obgyn
B) complete 1 yr of IM, inform PD early on to get letter of good standing and reapply to obgyn
C) Complete 3 yrs of IM and reapply to obgyn

The location where we matched has 1 obgyn residency that is 1 hour drive away but is very competitive. So I think it would be nearly impossible for me to stay at the same residency. I would then go into residency swap to try and get a spot near her.

Is there even a possibility of her matching obgyn and me swapping into the same city?

We have been driving each other crazy over this and would really appreciate your help.

Sincerely,
CouplesMatch2017


Stats:
Fiancee: US IMG, Step 1: 240, Step 2: 240, CS: pass first time, has published research, lots of EC
- received total of 22 obgyn invites, went on 16 obgyn interviews, ranked 13 because I did not receive invites near 3 of them

Me: US IMG, Step 1: 245, Step 2: 250, CS: pass first time, published research, some EC
 
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CouplesMatch2017

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Just an idea

4) Complete 1 yr so she doesn't fall behind, find an open position for FM. Complete the remaining 2 years of FM, then do an OB and/or women's health fellowship.

Thanks for the response. We looked into FM -> OB/women's health fellowship and unless we practice in a rural area then it is not the same. My fiancee really enjoys the GYN surg part of OBGYN so really OBGYN is for her. She did 4 Sub-i's in OBGYN and she knows that its for her. Again, thank you for your response.
 
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ProfMD

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I would suggest option B (complete 1 year IM - apply to next year's Ob/Gyn match). Be aware that she will have a funding issue. Medicare has allotted her 3 years of GME funding. She will use 1. This leaves her 2 years of funding for a 4 year ob/gyn residency.

I wouldn't count on both of you transferring. Might have to plan on 2 years apart while you finish IM.

Who know, maybe she will like IM better than she thought she would.
 
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ThoracicGuy

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Hello SDN,

Been a long time lurker but created a new account for this post. I'd appreciate any and all advice.

Situation: My fiancee and I entered the couples match this year (both of us competitive but US-IMGs). She wanted OBGYN but she matched into her backup IM. I wanted IM and matched into IM. We are both at the same location/same program. The thought of not doing OBGYN is devastating to her and we are looking into our options. I believe it's better to try and switch specialties early on than for her to resent me for going through IM and wasting 3 years of her life. We are also thinking that couples matching might have hurt us because she might have matched into OBGYN had she not couples matched.

From what we have gathered, she could either:
A) complete 45 days of residency and drop out, try to get a letter of good standing, reapply to obgyn
B) complete 1 yr of IM, inform PD early on to get letter of good standing and reapply to obgyn
C) Complete 3 yrs of IM and reapply to obgyn

The location where we matched has 1 obgyn residency that is 1 hour drive away but is very competitive. So I think it would be nearly impossible for me to stay at the same residency. I would then go into residency swap to try and get a spot near her.

Is there even a possibility of her matching obgyn and me swapping into the same city?

We have been driving each other crazy over this and would really appreciate your help.

Sincerely,
CouplesMatch2017


Stats:
Fiancee: US IMG, Step 1: 240, Step 2: 240, CS: pass first time, has published research, lots of EC
- received total of 22 obgyn invites, went on 16 obgyn interviews, ranked 13 because I did not receive invites near 3 of them

Me: US IMG, Step 1: 245, Step 2: 250, CS: pass first time, published research, some EC

The chances of A being successful is negligible. She will not get a letter of good standing in this situation. The chances of B being successful are a bit better, but depends on your program. She'll only have a few months experience to get those letters and they won't say much. If she goes for OBGYN, she risks losing her spot in IM and thus losing her chance for becoming board eligible in something. Option C has more security in she would be able to practice in something should OB fall through.

Leaving your spot is extremely high risk as well. This may mean living apart for a period of time if she truly wants OBGYN.
 
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ThoracicGuy

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Thanks for the response. We looked into FM -> OB/women's health fellowship and unless we practice in a rural area then it is not the same. My fiancee really enjoys the GYN surg part of OBGYN so really OBGYN is for her. She did 4 Sub-i's in OBGYN and she knows that its for her. Again, thank you for your response.

Why does she feel that she didn't match in OB the first time around?
 
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CouplesMatch2017

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Why does she feel that she didn't match in OB the first time around?

I think its partially the couples match and partially ranking some less desirable obgyn programs lower than this IM program. Hindsight is a B, and we should have ranked all obgyn programs above the first IM program on her list. We might have been overconfident in the top half of our list too because she received some "love letters" from some programs while I did not. Sadly, I'm beating myself up for this because I do believe she would have matched obgyn if she did not couples match.
 

ProfMD

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Why does she feel that she didn't match in OB the first time around?

This is a key question to answer. She better have thought about this and have answers for interviewers.

"I did not rank your mediocre program high enough last time" is not an answer they will want to hear.
 
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CouplesMatch2017

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This is a key question to answer. She better have thought about this and have answers for interviewers.

"I did not rank your mediocre program high enough last time" is not an answer they will want to hear.

I agree that they will not want to hear that, but the couples match is dependent on both parties. The majority of obgyn programs she interviewed at only have 3-4 spots available. If she was ranked #5 by the program then its likely she wont match. This year all the categorical obgyn spots were filled. And then adding another degree of difficulty with couples matching - my program must rank me very high as well. There are many variables that could have been solved by not couples matching but then its likely we wouldn't be in the same location.
 

ProfMD

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I agree that they will not want to hear that, but the couples match is dependent on both parties. The majority of obgyn programs she interviewed at only have 3-4 spots available. If she was ranked #5 by the program then its likely she wont match. This year all the categorical obgyn spots were filled. And then adding another degree of difficulty with couples matching - my program must rank me very high as well. There are many variables that could have been solved by not couples matching but then its likely we wouldn't be in the same location.

I understand that. However, she has an uphill battle as a re-applicant and is going to want to have well thought out answers. People who recognize their own short comings and do something to address them have an advantage over those who have no answer or blame others/the situation.
 
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ThoracicGuy

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Thank you for all your responses. I truly appreciate them.

So as far as Medicare GME funding goes, if she finishes 1 full year of IM and then reapplies through the match for obgyn, she will only have 2 years of funding for a 4 year residency. Are there any ways to remedy this situation?

For most places it wouldn't be a huge deal. There's nothing you can do about it.
 
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Raryn

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Hello SDN,

Been a long time lurker but created a new account for this post. I'd appreciate any and all advice.

Situation: My fiancee and I entered the couples match this year (both of us competitive but US-IMGs). She wanted OBGYN but she matched into her backup IM. I wanted IM and matched into IM. We are both at the same location/same program. The thought of not doing OBGYN is devastating to her and we are looking into our options. I believe it's better to try and switch specialties early on than for her to resent me for going through IM and wasting 3 years of her life. We are also thinking that couples matching might have hurt us because she might have matched into OBGYN had she not couples matched.

From what we have gathered, she could either:
A) complete 45 days of residency and drop out, try to get a letter of good standing, reapply to obgyn
B) complete 1 yr of IM, inform PD early on to get letter of good standing and reapply to obgyn
C) Complete 3 yrs of IM and reapply to obgyn

The location where we matched has 1 obgyn residency that is 1 hour drive away but is very competitive. So I think it would be nearly impossible for me to stay at the same residency. I would then go into residency swap to try and get a spot near her.

Is there even a possibility of her matching obgyn and me swapping into the same city?

We have been driving each other crazy over this and would really appreciate your help.

Sincerely,
CouplesMatch2017


Stats:
Fiancee: US IMG, Step 1: 240, Step 2: 240, CS: pass first time, has published research, lots of EC
- received total of 22 obgyn invites, went on 16 obgyn interviews, ranked 13 because I did not receive invites near 3 of them

Me: US IMG, Step 1: 245, Step 2: 250, CS: pass first time, published research, some EC

At this point, you really have to step back and re-evaluate the situation. The time to decide that she'd rather have any Ob program than be close to you and be in an IM program was BEFORE the match.

When you sat down and made the rank list that did not include some of the Ob programs and put yet other Ob programs below some IM programs, you and your significant other made a conscious decision that you'd rather be together in IM than far apart with her in Ob/Gyn. Nothing has changed now compared to February 20th when you made that decision.

I understand that matching where you did on the rank list came as a bit of a shock, but you have to understand (especially as US IMGs) that your first chance was your best chance. The odds that BOTH of you would be able to find a second program after leaving your first? They're slim. So absolute best case scenario you guys are long distance for 3+ years or only one of you ends up being a board eligible attending. Worst case scenario? Neither of you is able to complete residency training.

Remember back to your reasoning (you'd rather be together than long-distance for 3 years, you'd rather a decent IM program to a crappy Ob program, whatever you were thinking when you made the rank list) and trust your past self a little more. Start your residencies with an open mind, you might be surprised at how your next year ends up.
 
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ProfMD

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How does this work, anyway (running out of GME funding)? The hospital pays the remainder of your salary in exchange for cheap labor?

You need to find a place willing to cover the otherwise uncovered years. They could take someone who has their full amount waiting to be spent. So, you need to convince them to take you instead.
 

gutonc

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How does this work, anyway (running out of GME funding)? The hospital pays the remainder of your salary in exchange for cheap labor?
It's been described ad naseum in this forum. The short answer is the hospital pays somewhere around 30% of what it costs to train you after you "run out of funding". CMS still provides funding, assuming the spot is already funded.
 

gutonc

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I think its partially the couples match and partially ranking some less desirable obgyn programs lower than this IM program. Hindsight is a B, and we should have ranked all obgyn programs above the first IM program on her list. We might have been overconfident in the top half of our list too because she received some "love letters" from some programs while I did not. Sadly, I'm beating myself up for this because I do believe she would have matched obgyn if she did not couples match.
It's not the couples match. It was your ranking strategy. Full stop.

As to your original question. You are staying where you are or you're more than likely not going to finish a residency.

As for your fiancee, choice A is a terrible idea, worse even than your ranking strategy. Choice B is a marginally better idea for her, as long as you stay where you are and finish. That way at least one of you can get a job. Choice C is the best option, even though it may not seem like it right now.

You're both allowed to grieve the fact that things didn't work out the way you wanted them to. But you also need to be realistic about the options for both of you going forward. Now is the time for grieving. April is for getting your residency paperwork done. May is for vacation/relaxation. June is for getting your s*** together and planning to be the top 2 interns at your program next year.
 
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sazerac

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I agree that they will not want to hear that, but the couples match is dependent on both parties. The majority of obgyn programs she interviewed at only have 3-4 spots available. If she was ranked #5 by the program then its likely she wont match. This year all the categorical obgyn spots were filled. And then adding another degree of difficulty with couples matching - my program must rank me very high as well. There are many variables that could have been solved by not couples matching but then its likely we wouldn't be in the same location.
Several times now in this thread you have blamed the couples matching system. This shows a lack of insight. Let me ask you two questions:

(1) do you wish you had matched further down your combined match list than you did?

(2) do you wish you had (attempted to) match some different combination first that wasn't on your match list, but could have been?
 
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rokshana

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your fiancee seems to lack insight to her situation...ob/gyn is competitive for an IMG...if she wanted ob/gyn and IM was her back up, then frankly she should have ranked every single ob/gyn spot above IM...or ranked herself unmatched to your matched spot so she could try again...and now thinks that leaving a program high and dry, either 45 day or 1 yr, is going to get her a good letter?

go to the SOAP thread and read...and then realize how UNBELIEVABLY lucky ya'll are...
 
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NRAI2001

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You are US IMGs who both matched in america in the same city. You won the lottery.

Do not drop out. And no matter what, don't both of you drop.

I agree... you essentially did get very very lucky.

So if you went to VEGAS rolled the magical match-dice and "lost"... would you expect to get away without paying?? Basically it is what it is. Consider yourself as basically "breaking even" in the match gamble. You didn't loose and you didn't necessarily win (IMO you did actually very well).
 

NRAI2001

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My wife and I did the couples match and we matched at programs 4 hours apart from each other.. time actually went much quicker than we thought it was going to go. You re just so busy during residency you don't even really notice the time.

Why didnt she apply to FM? That would have been a better back up IMO and an easier transition if you were going to attempt to transfer or reapply?
 
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