ed resident switch to psych

[done2009]

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Hi! I am an intern and am strongly contemplating switching to psych. I have good reasons but I wasn't sure how to proceed. I am limited by one program in my city, since my husband is also an intern. So if I am upfront with my program director and dont match in that program what happens? Also, I will be lacking neuro experience so do I find pgy2 spots or pgy1? Apply within eras or outside?

Thanks.

 

[Scorcher31]

I have no experience in this so I'm honestly not sure what the right thing is to do in this case. First make sure you really want to do psych. If this is the case, I would line up a psych residency before you tell you tell your director you are going to leave in case you can't find another one. That seems to be how it works in the working world outside of medicine (for the most part). I would never tell my boss I'm leaving/applying elsewhere until I already knew I had a job somewhere else.

I guess if you have a long relationship with them or they have the right kind of personality they may be supportive of you and even try to help you with it, but I highly doubt this is the majority.

We had three residents come into our program from other programs. To my knowledge none of them went through ERAS. They contacted our program director, were guarenteed a contract, told their own program director and gave acceptable notice, then signed the contract.

 

[atsai3]

Hi! I am an intern and am strongly contemplating switching to psych. I have good reasons but I wasn't sure how to proceed. I am limited by one program in my city, since my husband is also an intern. So if I am upfront with my program director and dont match in that program what happens? Also, I will be lacking neuro experience so do I find pgy2 spots or pgy1? Apply within eras or outside?

Thanks.

You will be looking for PGY2 spots. To make up for any ACGME requirements you missed as an intern, typically the program to which you transfer will work with you to integrate those rotations into your PGY2, or even your PGY3, year.

You should be up front with your current program director. Right around now is the time to inform your program director. (Incidentally, right around now is the time you should be asking around at other programs to see if they have available openings.) This is because s/he will also need to find a replacement PGY2, and the more lead time you give her, the easier it will be for her to find a suitable replacement who can match the quality of the other residents in your cohort. Additionally, the program to which you are applying to transfer will likely request a letter of recommendation, or at the very least some sort of minimal letter of good standing ("I am the program director and I confirm that this resident is in good standing in our program"), from your program director.

Many programs accept PGY2 transfers unofficially; these typically come about because the program has lost residents (eg., residents may be fired, or they may transfer to other programs). Some programs accept a smaller number of PGY1s than they require in terms of PGY2 service needs, and make up for the shortfall by accepting PGY2 transfers through ERAS (eg., UCSF, or at least used to until this year; Stanford; UW).

Applying to transfer requires that you assume some risk, with the primary risk being that your attempt to transfer is ultimately unsuccessful. There is no way to get around this. Applying to transfer through ERAS increases the risk. Typically, PGY1s have to sign the PGY2 contract sometime during the winter of their intern year. Your program director may have an internal deadline that expires before the match results are released. So you may end up being in the position of having to decline a PGY2 contract at your current institution before you actually get accepted as a PGY2 at the transfer institution.

-AT.

 

[psychattending]

Hi! I am an intern and am strongly contemplating switching to psych. I have good reasons but I wasn't sure how to proceed. I am limited by one program in my city, since my husband is also an intern. So if I am upfront with my program director and dont match in that program what happens? Also, I will be lacking neuro experience so do I find pgy2 spots or pgy1? Apply within eras or outside?

Thanks.

I agree with atsai3. This is not something to keep from your current PD. You should be talking to him/her about your thoughts of transferring. The vast majority of us see part of our job as helping the residents navigate the pitfalls of training. It is not uncommon that interns realize during their first year that they did not choose the correct specialty. One of our jobs is to help the resident think through what he/she wants to do and then help the person transfer to the correct program. PDs are required to communicate with each other prior to the time of acceptance so that the accepting program can determine if they are able to met all the educational needs of the resident. Programs will usually require a formal letter of recommendation from 1 or 2 MDs in your current program.

The main determinant of whether you will be a PGY1 or 2 in psych next year is the following guidelines:

"Physicians may enter psychiatry programs at either the first-year or second-year postgraduate level. Physicians entering at the second-year postgraduate level must document successful completion of a clinical year of education in an ACGME-accredited specialty requiring comprehensive and continuous patient care, such as a program in internal medicine, family medicine, pediatrics, or transitional year program. For physicians entering at the PG-2 level after completion of such a program, the PG-1 year may be credited toward the 48-month requirement."

ER medicine is not one of the listed fields. However, the psych boards have made an exception for ER in the past if the training has had 4 months comprehensive and continuous patient care in one of those specialties. If you have had 4 months, then you will likely be a PGY2. If you are a PGY2 you will be going outside of the Match. Whether or not people use ERAS for that is variable. Our program tends to not use ERAS. Prior to officially applying it is probably much more helpful to contact the PD of the program in which you are interested directly to find out if there is a slot open for you. If the program is at your current institution, the psych PD will probably be happy to meet with you and will help you work through the issues.