Fallen from Grace: Switching to CA-1 Anesthesia or stick it out?

[firewire]

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[Medstudentquest]

So, I applied to Gen Surg last match. Had a change of heart after ERAS was submitted and decided not to do surg, applied to another specialty, too, as a backup. Then I did an anesthesia month and loved it. But everything was too late. Long story short, I did not match but got a sweet categorical FM spot. I believe the reason of not matching was the way I ranked my list. I am not an AOA, but a decent US grad with typical/average credentials (no failed Steps etc.) as far as number goes.

I am thinking of switching to anesthesia as a PGY2 (CA-1) next year, but my program does not have an anesthesia program. So, I cannot do an anesthesia month as an intern. But I do have 2 anesthesia letters as a student. Unfortunately, they might be too generic because it was the Chair (a famous anesthesiologist, though) and an associate director who wrote it. I did not work with them personally. I do have a glowing surgery letter from my school's GS PD. Additionally, I have an anesthesia research and book chapter publication.

1. If I apply for a 2013 CA-1 position, can I use my "awesome" surgery letter in addition to the two standard anesthesia letters? I feel the surgery letter would better represent me. The problem is it would say I would make a great SURGERY resident.

2. How do I bring this up to my current PD? Intern year has not started yet, but I am already thinking about switching. When should I bring this up? Is that after making cold calls to anesthesia programs and when I start getting invites?
This looks bad, but I cannot imagine being a "primary doc" for the rest of my life. I love the OR. I love procedures. I just do not want to be standing for 10+hrs operating.

3. Should I even try switching to anesthesia or should I stick it out and do another residency in anesthesia? FM is pretty easy and unstressful. I can definitely do well in an FM residency. But is it worth sticking out for 3 years just to eventually apply for another residency (i.e., anesthesia)?

4. I know it has been said and done. But with the new "all-in" policy, how does it affect outside-the-match spots? Anybody knows programs that typically offer outside-the-match positions? When should I start looking and making phone calls to these programs?

I am in such dilemma. Any thoughts?

Since no one has said anything, I'll give my opinion here. I'm not in anesthesia or surgery, but I think it's pretty common for people to make the surgery to anesthesia switch. With that said, I am not sure why you did not match in GS. And what specifically about FM do you like? GS is completely different from FM.

I don't htink it makes sense for you to do 2 residencies. If you cannot see yourself being a primary care doc, don't do FM. We don't yet know how the all in/out policy works since it's not in effect in practice yet. However given that the match is over and that the new match does not start until August or whatever anything that is open now is out of the match, and anesthesia spots do open up rather frequently.

With that said, anesthesia is frequently an advanced position, so you could use the first year of your FM residency and apply as a PGY2/CA-1. That way you'll have a job for this year, it will not be wasted since it'll apply for the internship year, and you can likely have a more supportive environment with your PD vs. telling him/her now that you want out.

So in summary I would: complete your current year, and perhaps talk to your PD once you are already in the program, and look for outside the match spots or potentially apply if you can't find for outside the match.

 

[naus]

Is there anything else in your app that might explain why you didn't match GS especially since you have a glowing surgery PD letter too? If it's just purely because your ranklist reached, then you shouldn't have much trouble getting into one anesthesia position, as long as you apply widely this time.

 

[firewire]

Thank you for your replies. I only went to 13 interviews, cancelled a bunch, and only ranked 2. Again, I decided that I really did not want to do surgery, especially some programs I interviewed with were 6-year or 7-year programs. I even cancelled the interview at my home program. When I didn't match, my school pressured me to do FM instead. Since I got FM letters sooner than anesthesia, I got FM offers. FM programs I interviewed with were even puzzled why I didn't match.... Anyway, I had to accept an offer since I figured a job was better than nothing. So, I am sort of stuck with FM for now.....

 

[gasblaster]

Just a heads up, but make sure you do at least a month of ER and ICU during your PGY-1 year. I believe (could be mistaken) those are both requirements in order to start anesthesia residency (CA-1 year).

 

[Medstudentquest]

Thank you for your replies. I only went to 13 interviews, cancelled a bunch, and only ranked 2. Again, I decided that I really did not want to do surgery, especially some programs I interviewed with were 6-year or 7-year programs. I even cancelled the interview at my home program. When I didn't match, my school pressured me to do FM instead. Since I got FM letters sooner than anesthesia, I got FM offers. FM programs I interviewed with were even puzzled why I didn't match.... Anyway, I had to accept an offer since I figured a job was better than nothing. So, I am sort of stuck with FM for now.....

So you only ranked 2 surgery programs because you did not want to do surgery? Then it makes sense why you did not match! Did you get FM during the match or during SOAP? I think what someone else suggested makes sense-do ICU for sure during your intern year, since it is a req. and then try to switch after you've completed the first year. Obviously you'd have to apply shortly after starting, but I would not quit before even starting, particularly since you need an intern year anyways.

 

[TX515]

If you don't want to do family medicine, try to get out.
If you want to do anesthesiology, try to get in.

Ok?