This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

jason.lafluer

Full Member
7+ Year Member
Joined
Feb 26, 2016
Messages
78
Reaction score
5
post

Members don't see this ad.
 
Last edited:
I am not an expert of this by no means. But, I would think you need to see what specialties the PD will write a good LOR for you. Will he write one for another surgical program? Etc.

You then need to look for open spots in PGY 2 in whatever area you decide to continue. How to best find those spots I am not sure.
 
I am not an expert of this by no means. But, I would think you need to see what specialties the PD will write a good LOR for you. Will he write one for another surgical program? Etc.

You then need to look for open spots in PGY 2 in whatever area you decide to continue. How to best find those spots I am not sure.

Thanks for your reply. My initial impression in talking to him (my PD) is that he was not very supportive that I continue on in Surgery. Similarly, it is not likely that he would give me a strong recommendation to another Surgery program although I'm not certain of this at this point.
 
Thanks for your reply. My initial impression in talking to him (my PD) is that he was not very supportive that I continue on in Surgery. Similarly, it is not likely that he would give me a strong recommendation to another Surgery program although I'm not certain of this at this point.
Yeah, I would think that as well. I would ask he could write you a good LOR to something similar like Anes or Rads.
 
  • Like
Reactions: 1 user
be thankful your PD is being supportive. look into anesthesia and rads, both require the pgy-1 base year and you may be able to find an open spot for july.
 
  • Like
Reactions: 1 user
be thankful your PD is being supportive. look into anesthesia and rads, both require the pgy-1 base year and you may be able to find an open spot for july.
Thanks for your reply. Good advice. Maybe I could still scramble?..
 
Unfortunately, the timing couldn't be worse. The NRMP deadline for registration was Wednesday. What you would have wanted to do is participate in SOAP to try and find a spot -- you could SOAP into a PGY-2 for Radiology or Anesthesia (for 2017), or if you're really crazy you could SOAP into a prelim GS PGY-1 and then hope that better performance gets you a PGY-2. But from what I can see, you had to register for all of this by Wednesday. You could call NRMP on Monday to see if there is any way you could register just for SOAP -- and if so, then you need to rush to get an ERAS application ready. If not, then you're stuck -- you could see what's left after SOAP completes but there will be very little left at that point.

Otherwise you would need to look for open PGY-2 positions in Rads/Anesthesia for 2016. I don't know if these are listed anywhere, usually it comes down to calling around. If your home institution has these programs, that's a place to start.
 
  • Like
Reactions: 1 user
If your faculty suggests you should look into pathology, then perhaps you should not look into anesthesia either. I think a field like pathology or radiology may be worthwhile to look into. I don't know how one has issues with regards to post-op checks or discharges (I did 3 months of surgery my intern year), but it sounds contrary to what you believe (or they have you believe) in that it may have been a patient safety related issue. Anesthesia has moments of intensity and quite a bit of stress, and you are actively involved in constant patient care. Perhaps if you wish to consider a specialty that involves direct patient care, then you may want to look into PM&R. If you like clinic, FM is a viable option, but if you don't then I would not pursue FM.

Be happy you actually have a supportive PD. Keep lines of communication open while you are there, ask for advice and get his thoughts on what he thinks may be worthwhile for you. I would look at what other specialties are within your hospital and relay this to your PD.

It definitely sucks, but at least you have been given 4 or so months.
 
  • Like
Reactions: 1 users
Unfortunately, the timing couldn't be worse. The NRMP deadline for registration was Wednesday. What you would have wanted to do is participate in SOAP to try and find a spot -- you could SOAP into a PGY-2 for Radiology or Anesthesia (for 2017), or if you're really crazy you could SOAP into a prelim GS PGY-1 and then hope that better performance gets you a PGY-2. But from what I can see, you had to register for all of this by Wednesday. You could call NRMP on Monday to see if there is any way you could register just for SOAP -- and if so, then you need to rush to get an ERAS application ready. If not, then you're stuck -- you could see what's left after SOAP completes but there will be very little left at that point.

Otherwise you would need to look for open PGY-2 positions in Rads/Anesthesia for 2016. I don't know if these are listed anywhere, usually it comes down to calling around. If your home institution has these programs, that's a place to start.

Thanks for the reply and your advice. From your username, I take it you are probably a program director. I can see myself doing Rads or Anesthesia. Maybe I will call NRMP on Monday. Any thoughts on research or employment for a year that would help me in applying for the next cycle?
 
If your faculty suggests you should look into pathology, then perhaps you should not look into anesthesia either. I think a field like pathology or radiology may be worthwhile to look into. I don't know how one has issues with regards to post-op checks or discharges (I did 3 months of surgery my intern year), but it sounds contrary to what you believe (or they have you believe) in that it may have been a patient safety related issue. Anesthesia has moments of intensity and quite a bit of stress, and you are actively involved in constant patient care. Perhaps if you wish to consider a specialty that involves direct patient care, then you may want to look into PM&R. If you like clinic, FM is a viable option, but if you don't then I would not pursue FM.

Be happy you actually have a supportive PD. Keep lines of communication open while you are there, ask for advice and get his thoughts on what he thinks may be worthwhile for you. I would look at what other specialties are within your hospital and relay this to your PD.

It definitely sucks, but at least you have been given 4 or so months.

Thanks for your reply and advice. Honestly, they didn't give me any specific examples related to the issues. I made a bad impression on a few attending and others gradually jumped on board; in my opinion. I do agree, my clinical skills aren't yet where they should be. I know I can regain ground in those areas; it's just a matter of getting a little more experience. Not interested in PM&R/FM at all. Pathology....i don't know. I have thought about seeking a pgy-1 or pgy-2 prelim to get more patient management experience; clearly it could lead to a difficult outcome. Thanks again. Keep throwing your thoughts at me if you wish.
 
Thanks for your reply and advice. Honestly, they didn't give me any specific examples related to the issues. I made a bad impression on a few attending and others gradually jumped on board; in my opinion. I do agree, my clinical skills aren't yet where they should be. I know I can regain ground in those areas; it's just a matter of getting a little more experience. Not interested in PM&R/FM at all. Pathology....i don't know. I have thought about seeking a pgy-1 or pgy-2 prelim to get more patient management experience; clearly it could lead to a difficult outcome. Thanks again. Keep throwing your thoughts at me if you wish.

I guess it depends on what happened leading to bad impression. However, I'm fully aware that attendings are gossip queens too.
 
Early on, there were rounds where I wasn't prepared - didn't have all the lab values, didn't know that an NG clamp trial was done the night before, didn't have a sound understanding of a patients disposition. In general, many thought that I didn't seem interested. I was definitely overwhelmed at first. My medical school class were the first cohorts to be put through a clinical curriculum change - long boring story, but I missed out on learning some traditional clinical patient management skills. Doesn't mean I couldn't have put in more time/effort to gain these. I'll stop with excuses.

Are you the quiet type, too?
Serious question. Generally, the clueless blow-hards seem to get more of a free pass on stuff as long as they're socially adept and well liked. The quiet ones seem to get the reputation of "lacks interest, nervous/anxious" when not performing "at par." Sounds pretty trivial to hammer you on it early intern year and hold it against you throughout the intern year. Then again, I wasn't there.
 
Are you the quiet type, too?
Serious question. Generally, the clueless blow-hards seem to get more of a free pass on stuff as long as they're socially adept and well liked. The quiet ones seem to get the reputation of "lacks interest, nervous/anxious" when not performing "at par." Sounds pretty trivial to hammer you on it early intern year and hold it against you throughout the intern year. Then again, I wasn't there.

That's very insightful of you to interject that. I was perceived as more reserved and introverted. These qualities would be more pronounced in unfamiliar situations which are plentiful in surgery internship. I do regret that I didn't ask more questions; I did have them; the other side of the coin is that you ask the wrong question to the wrong person and they think you lack knowledge... I was overall liked as a person and was told that I was respectful and had a good attitude.
 
That's very insightful of you to interject that. I was perceived as more reserved and introverted. These qualities would be more pronounced in unfamiliar situations which are plentiful in surgery internship. I do regret that I didn't ask more questions; I did have them; the other side of the coin is that you ask the wrong question to the wrong person and they think you lack knowledge... I was overall liked as a person and was told that I was respectful and had a good attitude.

Now it makes sense why they thought you'd be a good fit for pathology. Don't do anesthesia, and I mean it. That's my 2 cents.
 
  • Like
Reactions: 1 user
Now it makes sense why they thought you'd be a good fit for pathology. Don't do anesthesia, and I mean it. That's my 2 cents.

I appreciate your feedback. Why not Anesthesia? Seems the hours might be a little better.. What field are you in?
 
I appreciate your feedback. Why not Anesthesia? Seems the hours might be a little better.. What field are you in?
I can't tell if you are joking about anesthesia hours being better than pathology. On the off chance you are misinformed - there are very rarely pathology emergencies at 2 in the morning.
 
  • Like
Reactions: 1 user
I appreciate your feedback. Why not Anesthesia? Seems the hours might be a little better.. What field are you in?

I switched from anesthesia to FM because I wanted more patient interaction and more variety, which anesthesia generally does not provide (unless you do critical care/interventional pain).

The hours overall may be better, but you are at the beckon of the surgeon. You take 24hr calls, you generally will have to care for the sickest of patients and a lot of cases are urgent in addition to the usual elective cases. You'll also have to work in emergency cases and at times you may have routine surgeries that become emergencies. You have to be able to work in that environment, stress level, situation but from what I have read I don't think it'd be a great fit for you.
 
I can't tell if you are joking about anesthesia hours being better than pathology. On the off chance you are misinformed - there are very rarely pathology emergencies at 2 in the morning.

LoL, thank for your reply. No, what I meant was Anesthesia total weekly work hours compared to Surgery. Is there not much of a difference that you know of? How about in terms of residency as well? Thanks.
 
I switched from anesthesia to FM because I wanted more patient interaction and more variety, which anesthesia generally does not provide (unless you do critical care/interventional pain).

The hours overall may be better, but you are at the beckon of the surgeon. You take 24hr calls, you generally will have to care for the sickest of patients and a lot of cases are urgent in addition to the usual elective cases. You'll also have to work in emergency cases and at times you may have routine surgeries that become emergencies. You have to be able to work in that environment, stress level, situation but from what I have read I don't think it'd be a great fit for you.

Interesting. It makes sense. Although the core of my contract non-renewal problem wasn't the inability to manage stress. At least I think. How are you liking FM?
 
Interesting. It makes sense. Although the core of my contract non-renewal problem wasn't the inability to manage stress. At least I think. How are you liking FM?

It's about managing detoriating patient status and the related stress when managing a patient being operated upon. They can die quickly.

I am loving FM.
 
  • Like
Reactions: 1 user
Unfortunately, the timing couldn't be worse. The NRMP deadline for registration was Wednesday. What you would have wanted to do is participate in SOAP to try and find a spot -- you could SOAP into a PGY-2 for Radiology or Anesthesia (for 2017), or if you're really crazy you could SOAP into a prelim GS PGY-1 and then hope that better performance gets you a PGY-2. But from what I can see, you had to register for all of this by Wednesday. You could call NRMP on Monday to see if there is any way you could register just for SOAP -- and if so, then you need to rush to get an ERAS application ready. If not, then you're stuck -- you could see what's left after SOAP completes but there will be very little left at that point.

Otherwise you would need to look for open PGY-2 positions in Rads/Anesthesia for 2016. I don't know if these are listed anywhere, usually it comes down to calling around. If your home institution has these programs, that's a place to start.


Thank you for your concern and replying to my post. Say for example, I did pathology PGY-1 year after doing a Surgery PGY-1 year and absolutely hated pathology and left. How would this affect my ability to obtain funding for future residency training in another field?
 
Thank you for your concern and replying to my post. Say for example, I did pathology PGY-1 year after doing a Surgery PGY-1 year and absolutely hated pathology and left. How would this affect my ability to obtain funding for future residency training in another field?
It would in theory make it harder. The place would have to fund you. And it would not look "good" to have left 2 different programs and 2 different specialties.
 
  • Like
Reactions: 1 user
It would in theory make it harder. The place would have to fund you. And it would not look "good" to have left 2 different programs and 2 different specialties.

Thanks for your reply. This supports it would be a better choice to wait next year out if it gives me a better chance of changing to a specialty that I'm more confident I would like. Again, the most disappointing part of this problem is that I still love Surgery but I guess it didn't show. Thanks again.
 
Thanks for your reply. This supports it would be a better choice to wait next year out if it gives me a better chance of changing to a specialty that I'm more confident I would like. Again, the most disappointing part of this problem is that I still love Surgery but I guess it didn't show. Thanks again.
Well, I think it would be better to find a specialty you like pretty much now. I would not sit out a year. You are in a pretty bad spot here. Need to think about that quickly. Being dismissed will make you a red flag, sitting out a year getting rusty will give you another red flag, get enough red flags and well you get the point.........
 
  • Like
Reactions: 1 users
Well, I think it would be better to find a specialty you like pretty much now. I would not sit out a year. You are in a pretty bad spot here. Need to think about that quickly. Being dismissed will make you a red flag, sitting out a year getting rusty will give you another red flag, get enough red flags and well you get the point.........

Yes, those are good points. Maybe a research year would be an option.
 
My biggest concern would be that having not been renewed in a surgery program and without a glowing endorsement from your PD you probably aren't going to be a lock for anything even moderately competitive. I would think anesthesia and radiology would be very hard sells -- there are plenty of applicants for these every year who don't have this kind of red flag. People don't usually get to "fall up" -- if you wash out of a moderately competitive field you usually have to settle for something less competitive, not say "oh well, I can't be a surgeon so ROAD here I come". Path is probably a realistic suggestion because it isn't very competitive, but does require a lot of attention to detail. Things like FM, psych, maybe PM&R are also relatively less/noncompetitive. I worry though that if a surgeon says you belong in path he isn't really saying you should only be cutting on dead people, rather than meaning you'd actually make a good pathologist/diagnostician.
 
  • Like
Reactions: 1 users
Yes, those are good points. Maybe a research year would be an option.

Bad idea. There are already significant concerns about your abilities as a clinician. Spending time in the lab will not help.

Realistically, research only helps otherwise strong applicants who want to be at research-oriented, competitive programs. which doesn't apply to your case.
 
  • Like
Reactions: 2 users
My biggest concern would be that having not been renewed in a surgery program and without a glowing endorsement from your PD you probably aren't going to be a lock for anything even moderately competitive. I would think anesthesia and radiology would be very hard sells -- there are plenty of applicants for these every year who don't have this kind of red flag. People don't usually get to "fall up" -- if you wash out of a moderately competitive field you usually have to settle for something less competitive, not say "oh well, I can't be a surgeon so ROAD here I come". Path is probably a realistic suggestion because it isn't very competitive, but does require a lot of attention to detail. Things like FM, psych, maybe PM&R are also relatively less/noncompetitive. I worry though that if a surgeon says you belong in path he isn't really saying you should only be cutting on dead people, rather than meaning you'd actually make a good pathologist/diagnostician.
eh, while they are "ROADs" the competitiveness of the 2 has been dropping...and its not unusual for surgery residents to transition to these 2...if his PD really is going to be supportive and they spin this as a change of specialites, its possible...
 
Bad idea. There are already significant concerns about your abilities as a clinician. Spending time in the lab will not help.

Realistically, research only helps otherwise strong applicants who want to be at research-oriented, competitive programs. which doesn't apply to your case.
but better than sitting out a year doing nothing...and not being able to do SOAP this year, the OP doesn't have a lot of other options.
 
eh, while they are "ROADs" the competitiveness of the 2 has been dropping...and its not unusual for surgery residents to transition to these 2...if his PD really is going to be supportive and they spin this as a change of specialites, its possible...

Thanks for your reply. I agree.
 
My biggest concern would be that having not been renewed in a surgery program and without a glowing endorsement from your PD you probably aren't going to be a lock for anything even moderately competitive. I would think anesthesia and radiology would be very hard sells -- there are plenty of applicants for these every year who don't have this kind of red flag. People don't usually get to "fall up" -- if you wash out of a moderately competitive field you usually have to settle for something less competitive, not say "oh well, I can't be a surgeon so ROAD here I come". Path is probably a realistic suggestion because it isn't very competitive, but does require a lot of attention to detail. Things like FM, psych, maybe PM&R are also relatively less/noncompetitive. I worry though that if a surgeon says you belong in path he isn't really saying you should only be cutting on dead people, rather than meaning you'd actually make a good pathologist/diagnostician.

Thanks for your reply. You have good points.
 
My biggest concern would be that having not been renewed in a surgery program and without a glowing endorsement from your PD you probably aren't going to be a lock for anything even moderately competitive. I would think anesthesia and radiology would be very hard sells -- there are plenty of applicants for these every year who don't have this kind of red flag. People don't usually get to "fall up" -- if you wash out of a moderately competitive field you usually have to settle for something less competitive, not say "oh well, I can't be a surgeon so ROAD here I come". Path is probably a realistic suggestion because it isn't very competitive, but does require a lot of attention to detail. Things like FM, psych, maybe PM&R are also relatively less/noncompetitive. I worry though that if a surgeon says you belong in path he isn't really saying you should only be cutting on dead people, rather than meaning you'd actually make a good pathologist/diagnostician.

Tons of surgery prelims/washouts transition to anesthesia or radiology. The competitiveness of those specialties, especially in the below average programs, is not a serious issue for anybody who managed to match into most surgical residencies.
 
Tons of surgery prelims/washouts transition to anesthesia or radiology. The competitiveness of those specialties, especially in the below average programs, is not a serious issue for anybody who managed to match into most surgical residencies.

Thanks for your reply. That's encouraging.
 
eh, while they are "ROADs" the competitiveness of the 2 has been dropping...and its not unusual for surgery residents to transition to these 2...if his PD really is going to be supportive and they spin this as a change of specialites, its possible...
There's a HUGE difference between "transitioning" from surgery to one of these and trying to get one because you didn't get renewed/got fired. If OP was killing it in surgery, but just felt it wasn't his passion, things would be very different. Competitiveness has dropped a bit in these fields but really not to the point that discards from other fields get them easily.

I also am dubious of how supportive his PD really will be if he won't endorse OP to start over in another surgery program -- a letter from the PD hinting that "X isn't cut out for surgery but i believe would be great in your field" really won't fly. Nor will a recommendation that says his attitude is great but he fails to understand the complexities of patient management and discharge to the point that it isn't even worth trying to remediate further at our program.

Maybe his PD will massage the story enough to help him more than I think, but I sure wouldn't want to bank on that. Most of these times PDs won't outright undermine their own integrity just to help out a guy they don't want in their program. Why would they? I've actually seen situations exactly like this and the letters read very lukewarm, like "X always showed up on time and didn't demonstrate huge lapses in professionalism or patient care. I am sure he will do fine in another, more appropriate setting". But that letter IMHO doesn't get him anesthesiology or radiology. That's more the kind of letter that at best might not keep him out of a noncompetitive spot. OP needs to grab what he can get, not be picky, IMHO.
 
  • Like
Reactions: 1 users
I know that I can be successful in Surgery. This predicament ultimately lies in my lack of skills in patient management. They have improved since I started and I know I can get there. What if I did a prelim surgery year to refine these skills that I'm lacking in with the plans of trying to find a categorical surgery position the next year? Pretty risky and uncertain? Or maybe it would also speak to my determination and commitment for the field...
 
I know that I can be successful in Surgery. This predicament ultimately lies in my lack of skills in patient management. They have improved since I started and I know I can get there. What if I did a prelim surgery year to refine these skills that I'm lacking in with the plans of trying to find a categorical surgery position the next year? Pretty risky and uncertain? Or maybe it would also speak to my determination and commitment for the field...
well, no, your PD has already said that you can't be successful in surgery...and more tot he point, m/l will not support you for another surgical position...and you will need his support even for a prelim spot...any program will want a letter from your current PD, surgery or not.
 
  • Like
Reactions: 1 user
There's a HUGE difference between "transitioning" from surgery to one of these and trying to get one because you didn't get renewed/got fired. If OP was killing it in surgery, but just felt it wasn't his passion, things would be very different. Competitiveness has dropped a bit in these fields but really not to the point that discards from other fields get them easily.

I also am dubious of how supportive his PD really will be if he won't endorse OP to start over in another surgery program -- a letter from the PD hinting that "X isn't cut out for surgery but i believe would be great in your field" really won't fly. Nor will a recommendation that says his attitude is great but he fails to understand the complexities of patient management and discharge to the point that it isn't even worth trying to remediate further at our program.

Maybe his PD will massage the story enough to help him more than I think, but I sure wouldn't want to bank on that. Most of these times PDs won't outright undermine their own integrity just to help out a guy they don't want in their program. Why would they? I've actually seen situations exactly like this and the letters read very lukewarm, like "X always showed up on time and didn't demonstrate huge lapses in professionalism or patient care. I am sure he will do fine in another, more appropriate setting". But that letter IMHO doesn't get him anesthesiology or radiology. That's more the kind of letter that at best might not keep him out of a noncompetitive spot. OP needs to grab what he can get, not be picky, IMHO.

again its about spin...if his PD wants, he can say that the OP is better suited to the other specialty, which can at least give his remediation another spin...WILL he? well that's a different question all together.
 
Tons of surgery prelims/washouts transition to anesthesia or radiology. The competitiveness of those specialties, especially in the below average programs, is not a serious issue for anybody who managed to match into most surgical residencies.
not sure about "tons"
 
  • Like
Reactions: 1 user
again its about spin...if his PD wants, he can say that the OP is better suited to the other specialty, which can at least give his remediation another spin...WILL he? well that's a different question all together.

I think he will. We have a pretty good relationship.
 
again its about spin...if his PD wants, he can say that the OP is better suited to the other specialty, which can at least give his remediation another spin...WILL he? well that's a different question all together.
Agreed. But given the timing, it's going to be clear OP has not been renewed. And my experience is that a PD unsupportive about you being in his field is not the guy who is going to write you a great letter for another. And again if he writes that "this guy isn't right for surgery but I am sure he would do fine in another setting" (which realistically IMHO is the best he's going to get), very few PDs are going to read that as a ringing positive endorsement.
 
  • Like
Reactions: 2 users
Anectodaly, we had a PGY-1 general surgery resident get terminated last year and she has found another general surgery program..
You would be foolish not to reach out to her and find out what she did, to what extent she managed to get PD support, and even see if her program might have a pgy1 or 2 spot.
 
  • Like
Reactions: 2 users
You would be foolish not to reach out to her and find out what she did, to what extent she managed to get PD support, and even see if her program might have a pgy1 or 2 spot.

That is a great idea. Thanks.
 
You would be foolish not to reach out to her and find out what she did, to what extent she managed to get PD support, and even see if her program might have a pgy1 or 2 spot.
hopefully she is doing well there and is a good example for the PD...he may then look favorably on the the OP
 
  • Like
Reactions: 1 user
hopefully she is doing well there and is a good example for the PD...he may then look favorably on the the OP

Yeah, I don't know her that well but will definitely contact her soon. This whole think frustrates me the more I think about it. I wish they would have told me the next step was contract non-renewal; I misjudged the urgency of the situation. Also, regarding your comment on a surgery prelim spot. Are you saying that it would be difficult to get outside of the scramble? I don't think that a prelim spot would absolutely require a PD letter but I could be wrong.
 
Yeah, I don't know her that well but will definitely contact her soon. This whole think frustrates me the more I think about it. I wish they would have told me the next step was contract non-renewal; I misjudged the urgency of the situation. Also, regarding your comment on a surgery prelim spot. Are you saying that it would be difficult to get outside of the scramble? I don't think that a prelim spot would absolutely require a PD letter but I could be wrong.

I would contact her yesterday if you are able.

As for looking for a surgery prelim spot, like others have said, you are in a rough spot. You'll have problems getting a spot that could turn into something. What happens if you fail out of that? You'll have an even harder time landing something afterwards. And coming from another surgery program, the new PD will want to talk to the old PD...
 
  • Like
Reactions: 1 users
Yeah, I don't know her that well but will definitely contact her soon. This whole think frustrates me the more I think about it. I wish they would have told me the next step was contract non-renewal; I misjudged the urgency of the situation. Also, regarding your comment on a surgery prelim spot. Are you saying that it would be difficult to get outside of the scramble? I don't think that a prelim spot would absolutely require a PD letter but I could be wrong.

not could , you would be...EVERY PD will want at least a letter, and m/l will want to talk to your old PD.
 
  • Like
Reactions: 2 users
Top