dilemna

[newsguy]

Hello all,

I am a fourth year Osteopathic medical student. I have applied to a specialty for this year's match, however, am beginning to realize I may have made a mistake. I don't really feel like I LOVE the specialty I chose, I chose it only because I needed something and thought it was an okay field. Due to my second guessing, I also applied to traditional osteopathic internships, with the idea that I could complete a PGY-1 year and look for a residency after that.

I did not have a chance to rotate in PM&R earlier. However, I recently had a PM&R rotation and really enjoyed it and know that's what I want to do. My question is, is it worth it to take the chance of doing the internship and not finding a position? If I don't find a PM&R position, I will be probably be stuck doing something like IM, which I would definitely prefer not to do (I would rather do the residency I applied for). Is it difficult to find PM&R positions while still doing a PGY-1 year (I am sure there are far fewer spots than as a fourth year applicant)? I know I can also try to scramble, but that is of course a long shot. I am a decently competitive candidate, with avg to above avg COMLEX scores (no USMLE) and avg grades. Thanks!

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[Ludicolo]

Tough decisions. You have a couple of options.

You could proceed w/ the traditional DO internship (which would serve as your prelim year for PM&R) and try to scramble into an open PGY-2 spot somewhere. What’s unclear is if you have any rehab LORs. Some of the weaker programs may not care about this, but most of the stronger programs will. With the scramble it is hard to predict how desperate programs will be. IMHO, the scramble should be a last resort kind of thing. You might get lucky, or you might end up at a program/location that doesn’t fit your personality/career goals and aspirations. You’ll end up bitter and disgruntled, which doesn’t do anyone any favors.

If the scramble is unsuccessful, you could proceed w/ the DO internship, and reapply to the following year’s match. You’ll get something, probably better than through the scramble. If possible you should do an early elective in PM&R, allowing you to enhance your future application. You could apply to both categorical and advanced programs with this route. You’d also be considered an independent applicant, so if a desirable PM&R spot opened up you could jump on it without violating the Match – but again no guarantees. If you match into a categorical program, basically you will have done an extra year of residency, but with no gaps in your education/training. If you match into an advanced program, you will have to find something reasonable to do to fill in that gap – research, moonlighting, whatever. You may run into residency funding issues as well via this route (not sure how it works with the DO internship and allopathic residency). Something to consider – it may be difficult to schedule/attend interviews during your internship. And internship is stressful enough without adding another residency search to it. But you do what you have to do.

You could withdraw from the match, and possibly extend your fourth year (don’t know if your school gives you this option), or take a year off and do some research or something PM&R related. Get some more rehab experience and LORs in place, buff up your application, and then start the process over again. Your chances at landing at a better quality program, one that better suits your needs, I think is much greater via this route. The tradeoff is that you’ll have to keep practicing delayed gratification.

Hope this helps. Good luck.

 

[DistantMets]

I would call any program that you are willing to travel to on short notice, explain your situation and see if they would be willing to interview you. Interviews are winding down most places and deadlines may have passed, however, lots of people cancel interviews this time of year so there will probably be some slots if they're willing to look at your app last minute. I would have a PM&R oriented personal statement and the rest of your application materials ready to send that day. Hopefully, you have a PM&R LOR as most programs will require at least one. This may at least give you a program or two to rank and see what happens.

If that fails, I would do your DO internship, work hard, keep your nose clean. Use elective time early on to do another rotation, maybe get another LOR. Send a letter to as many programs as you think you can explaining your situation and asking them to consider you as a candidate for any PGY-2 spots that open-up or new spots that they get approved.

Spots open up from time to time each year. My program got approved for another spot my PGY-2 year and we filled it after the match. An internship classmate called to see if I was happy with my current program because his had someone leave. Just gotta put your name out there.

Otherwise, go through the match again, get into a PGY-2 spot and see if you can get a research position at the program where you matched for the year, that way you're getting some nice CV padding without repeating internship. Hope this helps!

 

[newsguy]

thanks for the info. i think i would like to start at least with an internship and then apply for next year and hope something opens up before then. my question is about the funding issue if i start internship and then take a year off or repeat intern year....does this become a problem (i.e., are residencies less likely to take such a resident)? The reason I ask is that I have heard of people doing this and have also heard of people who do a second residency. Exactly how does this work?

 

[Ludicolo]

If you do the DO internship, then go on to do your PGY2 year (either the following year or the year after that), funding is not an issue.

But with other scenarios (repeating internship, switching specialties, 2nd residency, etc.), direct GME funding from Medicare drops by 1/2 after you have completed the number of years slotted for your original specialty. So, if you originally matched into categorical IM, you have a total of 3 years funding. If you decided to switch into PM&R after your intern year, your PGY-4 year would be funded at 50%.

Now, hospitals also have indirect GME funding coming from a variety of sources, which may be able to compensate for the drop of direct funding. Most programs can handle this. But some can’t. Bottom line: if you are talented and desirable enough, programs will find the $$ to keep you.