Home program is not your first choice. How do you avoid awkwardness?

[noobdoc]

I did not match in my preferred specialty last year. I wound up in a transitional year at a hospital that also has a residency program in my preferred specialty.
At first I was very seriously considering trying to pre-match into the residency program here where I am doing my internship. Now that I have actually had a chance to get to know how that department is at this hospital, though, I'm not sure that it would be the best fit for me. I really think I would prefer to go through the match again because I think I learned from my mistakes and would be more likely to match this time.
I would be happy to put this program I am at on my rank list because I would rather be there than not match at all again, but I am realizing that it is not my #1 choice so I don't think I would be satisfied if I pre-matched there without trying the match again.

My problem: Word has spread in the department here that I am interested in their specialty. Does anyone have any advice for me on how I should deal with interacting with the PD and so forth under these circumstances? I do not want to offend anyone. Has anyone else been in the situation of being at a program that is not your #1 choice but where you would really rather not burn bridges because you *would* be happy to rank it?

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[NotAProgDirector]

There is no easy answer. Simply apply as usual. Either they will offer you a prematch or not. If they do, then you'll have to decide to take it or not -- hopefully by then you'll know how many interviews you'll have (which should be some measure of how likely you are to match). If you turn it down, they may feel that you don't want to go there and hence rank you lower or not at all. There's no way around this. Be polite and professional at all times.

 

[noobdoc]

Thank you for the input. You helped me decide it was time to do some work on my ERAS application tonight.
This hospital is on the smaller side and I see people from the department quite often, so there is a pretty good chance that I will wind up talking with the PD before a formal interview day takes place.
One of my concerns is that I don't want to come across as arrogant or ungrateful if they offer a pre-match and I don't want to accept it. I don't mean to be that way at all. I am actually very terrified about not matching again. I just feel like I need to try again because I think there are several other places I didn't even apply to last time that I think would fit me better (some simply for geographical reasons, not program quality). Do you have any advice about how to word it if I do end up in the situation of having to decline the pre-match?

 

[dragonfly99]

I think APD is right. I don't think anyone is going to hate you, no matter what you decide, as long as you don't act arrogant. However, you may expect that if you turn down a prematch, you would get ranked lower, or maybe not at all. If this is a very competitive specialty like rads or derm or ortho, I think it's likely that if they offer you a spot and you don't take it, you're not going to ranked high enough to match there. Part of this is going to depend on how big a risk you are willing to take.

I got offered a cards spot outside the match, which is basically tantamount to a prematch offer, but I chose not to take it because it wasn't really a program I wanted to train in. This was definitely risky because I basically knew that if I did that I'd probably not be ranked to match at that program...and/or they'd already have given all their spots away and not be using the match at all. I still acted really nice to them, and stated I would be happy to train there, because I planned to rank them, but I pretty much just said I'd have to get back to them on their offer. I later sent them a polite f/u letter that I would be happy to train there, would be ranking them highly, etc. (a bit of a white lie b/c I did rank them, but not that highly...). I basically wanted them to consider still ranking me, but knew I was taking a big risk. I basically gambled, assessed the risk/benefit and felt like I could match somewhere with better training and that I liked better. If any of the programs on the top 2/3 of my list or so had offered me a spot, I would have taken it and not looked back, even if it wasn't my top choice of where to train.

For you, you're in a different situation. For me, it was fellowship...that's not required. What you're looking at is needing to get in SOMEWHERE...in a specialty you didn't previously match into. You need to realistically assess your chances of getting in somewhere else. If they aren't >>50% and this program where you are doesn't suck, I think it's at least worthwhile to strongly consider staying there if you can get a spot. If you really don't want to stay there, you might want to give them some solid reasons why you don't want to take a prematch...you could say that for family/geographic reasons you're still considering different options. Still, they aren't dumb and any time you turn down a prematch offer, they're going to know they weren't your first choice of where to train. Approach with caution. Personally, if this is some specialty like derm or rads, I'd take the spot, unless the place totally sucks...esp. since you already didn't match once.