Extending a Pre-lim Year into a Categorical Residency

[ialwayslose]

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Hi all,

First of all, thank you for your help.

I am considering applying to categorical internal medicine vs. Dermatology in 2 years, and I am asking the following question to give me the ability to plan ahead, if necessary.

In the event that I choose to apply to dermatology, but would like a backup plan, could I use a preliminary year for that purpose? In other words, If I don't match into Derm, but match into a prelim year at a reasonably competitive program, what are the chances that I could extend that prelim year into a categorical residency at that institution (or another institution) the following year.

This would be extremely helpful to me.

Thank you again

 

[Raryn]

Hi all,

First of all, thank you for your help.

I am considering applying to categorical internal medicine vs. Dermatology in 2 years, and I am asking the following question to give me the ability to plan ahead, if necessary.

In the event that I choose to apply to dermatology, but would like a backup plan, could I use a preliminary year for that purpose? In other words, If I don't match into Derm, but match into a prelim year at a reasonably competitive program, what are the chances that I could extend that prelim year into a categorical residency at that institution (or another institution) the following year.

This would be extremely helpful to me.

Thank you again

There's always a chance, but the answer to your question will be very variable. In general, medicine programs have a much lower attrition rate than surgical ones, so gambling that there will be an extra spot at your same institution would probably be a bet you would lose. That said, the attrition rate is there, and odds are there will be some programs somewhere that are looking to pick up a PGY2 to replace an intern that resigned/was fired/died/etc. If you had an application impressive enough to actually consider derm, you'd probably be able to get yourself into one of those PGY2 spots after a decent prelim... but there would be no guarantees. The only programs available to you might be much lower down the totem pole than you would prefer, or you might get lucky and swing into a reasonably competitive one. Or you might get unlucky and have to repeat PGY1 year.

 

[ialwayslose]

There's always a chance, but the answer to your question will be very variable. In general, medicine programs have a much lower attrition rate than surgical ones, so gambling that there will be an extra spot at your same institution would probably be a bet you would lose. That said, the attrition rate is there, and odds are there will be some programs somewhere that are looking to pick up a PGY2 to replace an intern that resigned/was fired/died/etc. If you had an application impressive enough to actually consider derm, you'd probably be able to get yourself into one of those PGY2 spots after a decent prelim... but there would be no guarantees. The only programs available to you might be much lower down the totem pole than you would prefer, or you might get lucky and swing into a reasonably competitive one. Or you might get unlucky and have to repeat PGY1 year.

Thank you for your input, I really appreciate you taking the time to write that out.

That is understandable and more or less what I expected to hear.

So essentially I would have to count on attrition, there isn't really a chance of flexible residency positions that may be available if I am a reasonable performer? At my current institution (a good one) I am under the impression that there is some flexibility in opening up a new position, but that these positions may not be advertised and may require someone at the pre-lim residency contacting them. Is this at all possible? Obviously this seems like a tenuous backup plan.

 

[Raryn]

Thank you for your input, I really appreciate you taking the time to write that out.

That is understandable and more or less what I expected to hear.

So essentially I would have to count on attrition, there isn't really a chance of flexible residency positions that may be available if I am a reasonable performer? At my current institution (a good one) I am under the impression that there is some flexibility in opening up a new position, but that these positions may not be advertised and may require someone at the pre-lim residency contacting them. Is this at all possible? Obviously this seems like a tenuous backup plan.

It is possible to "make" an extra spot, but it usually requires some extra work on the part of the PD because there's probably a reason they don't always have that extra spot. Either they'll need to scrounge up extra money (i.e. ask the institution to temporarily fund the extra spot), ask the ACGME for a temporary lift in their allotted number of residents, or both. It *can* happen, but still no guarantees.

 

[sluggs]

Apply to both derm and IM and make your ROL according to preference!