how difficult is it to switch programs?

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blight

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Soo....not to be a downer...but match day brought a very unexpected surprise for me. I was aiming to stay close to my family, but matched into a program that's pretty far from the general area I was hoping to end up in. Anyway, I'm going to go to my new program with an open mind and stay positive.

But just to give me some peace of mind - in the worst case scenario, if it ends up not working for myself and my family - how difficult is it to switch residency programs after a year? Or to switch into a program that has an unexpected opening?

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As long as you are a good resident it's not difficult to switch if you have legitimate reasons to do so. A place will need to have an open pgy2 spot where you want to go for next year (happens all the time), the program with the open spot will need to be interested in having you come, and your program will need to bless your leaving most likely (though not contractually necessary)
 
Soo....not to be a downer...but match day brought a very unexpected surprise for me. I was aiming to stay close to my family, but matched into a program that's pretty far from the general area I was hoping to end up in. Anyway, I'm going to go to my new program with an open mind and stay positive.

But just to give me some peace of mind - in the worst case scenario, if it ends up not working for myself and my family - how difficult is it to switch residency programs after a year? Or to switch into a program that has an unexpected opening?

1. Sometime in the fall, you should start sniffing around for open PGY2 spots.

(a) Some programs have scheduled new PGY2 spots (ie., they take new PGY2's every year), whereas (b) other programs only take new PGY2's if someone has left their program. Typically the spots described in (a) are posted on the program's web site-- e.g., the University of Washington takes new PGY2's every year for their psychiatry program (that's just how they are set up). The spots described in (b) are harder to find. Basically it involves you asking your friends at other institutions to see if they have heard of any interns quitting, transferring, or getting fired.

2. In September or October-- the sooner the better-- you should notify your current program director that you intend to transfer out.

Yes, you need to tell your program director before you have secured a spot elsewhere. Yes, this is fraught with uncertainty. Yes, it could backfire: if you are unsuccessful in transferring out, then you could be stuck at a program with a program director who knows you tried to transfer out but were unsuccessful. But you still need to do this. At a minimum, it is the nice thing to do, because your program director is going to have to scramble to find a replacement. The more time you give her to advertise, interview, etc., the better. In addition, all programs will need your current program director to at least provide a letter of good standing (I verify that blight is a current resident at our program and that she says who she says she is), and some programs may even require your current program director to provide a letter of recommendation (I really like blight because she has maintained exemplary performance as an intern, and I will be really sad to see her go).

3. Once you have your program director's agreement to write the letter, then you will apply.

Applications are either formally to the programs in (a), or informally to the programs in (b). Then you start interviewing in October through January. This may be difficult to do if you are on heavy rotations. Nothing you can do about that. You should try to schedule outpatient rotations if possible. If this is not possible, then you should hope that you can get a fellow resident to cover for you (ie., as a jeopardy resident or something).

4. Receiving acceptance notices from transfer programs will not occur on a set schedule.

Some programs may tell you in November that they have accepted you as a transfer resident; other programs may tell you in January; still other programs may inform you on Match Day. There is additional uncertainty at this stage, because many programs require interns to sign their PGY2 renewal contracts sometime in the winter/spring. (For example, my program sent us our renewal contracts in January and expected signatures within a week.) There is a high likelihood that you will need to decline your PGY2 renewal at your current program before you hear about your acceptance at another program.

-AT.
 
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Soo....not to be a downer...but match day brought a very unexpected surprise for me. I was aiming to stay close to my family, but matched into a program that's pretty far from the general area I was hoping to end up in. Anyway, I'm going to go to my new program with an open mind and stay positive.

But just to give me some peace of mind - in the worst case scenario, if it ends up not working for myself and my family - how difficult is it to switch residency programs after a year? Or to switch into a program that has an unexpected opening?

Rather than changing after one year, why don't you swap before signing the contract. After a year, things will be different and you might jeopardize your chances for fellowship at the program you will be leaving. This is what I think.
 
Rather than changing after one year, why don't you swap before signing the contract. After a year, things will be different and you might jeopardize your chances for fellowship at the program you will be leaving. This is what I think.

How would one go about doing that? Using resident swap?
 
Rather than changing after one year, why don't you swap before signing the contract. After a year, things will be different and you might jeopardize your chances for fellowship at the program you will be leaving. This is what I think.

How would one go about doing that? Using resident swap?

This is terrible advice, mainly because you can't swap a match. The match is binding. If you didn't want to go to this program, you shouldn't have ranked it. You then would have had a chance of going to something that was lower on your rank list. If there was nothing lower on your list that you would rather have, then you got the best spot possible. Had you not ranked this program nor the ones below it, you would have matched into nothing and been in the scramble. The chance of getting something better in the scramble is not great.

Chances are you'll be very happy at your matched program. Best advice is to go in with a good attitude and see what happens.
 
Second best advice is to go to your program with a well-hidden bad attitude and see what happens. You'll still be better off than playing games. If you want fellowship, internship is when you make the connections to your home department.
 
This is terrible advice, mainly because you can't swap a match. The match is binding. If you didn't want to go to this program, you shouldn't have ranked it. You then would have had a chance of going to something that was lower on your rank list. If there was nothing lower on your list that you would rather have, then you got the best spot possible. Had you not ranked this program nor the ones below it, you would have matched into nothing and been in the scramble. The chance of getting something better in the scramble is not great.

Chances are you'll be very happy at your matched program. Best advice is to go in with a good attitude and see what happens.

Sorry, I thought it was flexible. But yes it is very risky thing to do. You are right..if someone is not happy with a program at first place, then should not rank it at all..
 
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