How does one go about switching from a categorical position?

[whatsthepoint]

You hear all the stories about switching into radiology or anesthesia, but my mentors keep telling me it's impossible. How does this work if you matched into a 3-year residency? I SOAPed into a categorical spot but no one freaking told me this would prohibit my ability to switch later. Can I apply to PGY-2 advanced spots later? Or is funding issues going to make this impossible? Thanks.

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[Apollyon]

You mix several things together here. For one, exactly who are your mentors? They are black letter wrong to say that. Second, funding is a simple question with a complex answer. Short story is, if they want you, they won't say anything about funding. If they don't want you, that's the easy peasy excuse to refuse you.

Since you matched into a 3 year categorical (IM, FM, EM, or Peds), that starts your "clock", as far as funding. This funding is for "DME" - Direct Medical Education. Even if you switch, you only have the years left for DME. If someone starts, say, general surgery, their clock starts at 5 years, so, for them to go from surgical to medical is MUCH easier.

But what happens after DME runs out? Then, it's "IME" - Indirect Medical Education. That comes out to approx 65-80% of what DME would pay the program. That is not limited (to my knowledge). So, no place takes you for free.

 

[Apollyon]

Oh, I missed that. You SOAPed in? Brutally honest, you're going to have trouble finding something else, depending on why you had to SOAP. If it was board scores or personality stuff, you're really stuck. If you aimed too high, and didn't have a backup, that's different, and gives you a bit more leverage.

 

[whatsthepoint]

Oh, I missed that. You SOAPed in? Brutally honest, you're going to have trouble finding something else, depending on why you had to SOAP. If it was board scores or personality stuff, you're really stuck. If you aimed too high, and didn't have a backup, that's different, and gives you a bit more leverage.

It was the latter. Aimed way too high. Didn't dual apply when I definitely should have. I am a competitive applicant USMD and had ortho interviews. So the pathway to switching is to apply through the match again right?

 

[Apollyon]

Depends on what you want. Since you already did the match once, you are now classified as an "independent" applicant. That means some places might not look at your app. Something I believe, but have no proof, is that private places (vs state supported) (like Duke vs UNC-Chapel Hill) are more likely to look at you, despite any funding issues.

But, also, you gotta look everywhere. Again, depending on what you want, the professional society for that specialty might have open positions listed. I wouldn't rely on your "mentors", as they don't seem to know. I'm over 20 years out of the Match PITA, so I some know what is good now, like if "Find a Resident" is even still around and active.

 

[whatsthepoint]

Depends on what you want. Since you already did the match once, you are now classified as an "independent" applicant. That means some places might not look at your app. Something I believe, but have no proof, is that private places (vs state supported) (like Duke vs UNC-Chapel Hill) are more likely to look at you, despite any funding issues.

But, also, you gotta look everywhere. Again, depending on what you want, the professional society for that specialty might have open positions listed. I wouldn't rely on your "mentors", as they don't seem to know. I'm over 20 years out of the Match PITA, so I some know what is good now, like if "Find a Resident" is even still around and active.

Thank you for offering sound advice. The mentors I mentioned are at my medical school who are the same people that pressured me into soaping instead of doing a research year. Very frustrated with them

What I'm looking for is Rads or Anesthesia.

 

[Apollyon]

Thank you for offering sound advice. The mentors I mentioned are at my medical school who are the same people that pressured me into soaping instead of doing a research year. Very frustrated with them

What I'm looking for is Rads or Anesthesia.

Both of those require a prelim year. So, as long as you are not in peds or EM, you should be good from that perspective. As for rads, I don't know if Aunt Minnie is still alive. That used to be an active rads site. As for gas, I don't know from nothing. If you get any electives this year (unlikely), you can try to get one in one or the other (or, if lightning strikes, you get two months of electives), you could do both.

Interestingly, both anesthesia and radiology do their fair share of physics. There's no fooling around with that. The closest I got to physics as a dumb ER doc was telling Ortho about how I saw Klein's line!

 

[GoSpursGo]

Unfortunately, based on post history he's in EM.

Does your current residency institution have an anesthesia program? If so, it may be a good idea to meet with their PD to see if there is a pathway to them if you can score an IM prelim year. Otherwise, you're just stuck needing to apply through ERAS next year.

Radiology is not realistic.

 

[NotAProgDirector]

First, regarding funding, read this: Medicare Payments for Graduate Medical Education: What Every Medical Student, Resident, and Advisor Needs to Know You'll see since you started training in EM, your IRP will be 3 years. After that you get 50% DME and 100% IME. As mentioned above, this is usually not a deal breaker for bigger programs.

I do believe it's too late for this year. But you still can switch to Anesthesia, and I think Rads isn't impossible either. You should pick one and not try to do both. From the way you're talking here, Anesthesia seems the right choice.

You need anesthesia experience. I assume your ED program offers some elective time? You need to do Anesthesia electives. Talk to your PD, find out if anything can be done to get you that between now and June, The more, the better. As mentioned, speak to the Anesthesia PD (if your institution has a program). You'll need to sort out whether the EM PGY-1 counts for a PGY-1 in anesthesia -- although many anesthesia programs are now Categorical and include a PGY-1 experience anyway. The PD might be able to alert you to any openings at other programs.

You'll need to decide what you want to do with next year. You could complete your EM PGY-2 while applying for new programs. This gives you the possibility of completing EM training if you were to not match to anesthesia. But, it also uses one more year of your full funding, and if you truly hate EM may not be a good choice. Otherwise, you resign at the end of the year and just find a job for next year -- could be anesthesia research, but could be anything honestly. Is better if the position is somehow anesthesia related.

All of this assumes you don't need a visa, which would make everything very messy.

 

[whatsthepoint]

Unfortunately, based on post history he's in EM.

Does your current residency institution have an anesthesia program? If so, it may be a good idea to meet with their PD to see if there is a pathway to them if you can score an IM prelim year. Otherwise, you're just stuck needing to apply through ERAS next year.

Radiology is not realistic.

Why would radiology not be realistic? The radiology program at my institution told me that EM intern year will count for Rads.

Also, would you recommend applying to Prelim years through the SOAP this march instead of starting PGY-2?

 

[whatsthepoint]

First, regarding funding, read this: Medicare Payments for Graduate Medical Education: What Every Medical Student, Resident, and Advisor Needs to Know You'll see since you started training in EM, your IRP will be 3 years. After that you get 50% DME and 100% IME. As mentioned above, this is usually not a deal breaker for bigger programs.

I do believe it's too late for this year. But you still can switch to Anesthesia, and I think Rads isn't impossible either. You should pick one and not try to do both. From the way you're talking here, Anesthesia seems the right choice.

You need anesthesia experience. I assume your ED program offers some elective time? You need to do Anesthesia electives. Talk to your PD, find out if anything can be done to get you that between now and June, The more, the better. As mentioned, speak to the Anesthesia PD (if your institution has a program). You'll need to sort out whether the EM PGY-1 counts for a PGY-1 in anesthesia -- although many anesthesia programs are now Categorical and include a PGY-1 experience anyway. The PD might be able to alert you to any openings at other programs.

You'll need to decide what you want to do with next year. You could complete your EM PGY-2 while applying for new programs. This gives you the possibility of completing EM training if you were to not match to anesthesia. But, it also uses one more year of your full funding, and if you truly hate EM may not be a good choice. Otherwise, you resign at the end of the year and just find a job for next year -- could be anesthesia research, but could be anything honestly. Is better if the position is somehow anesthesia related.

All of this assumes you don't need a visa, which would make everything very messy.

I definitely don’t need a visa. I’m a US MD. Thank you for clarifying everything. My school should educate themselves instead of lying to their former students.

If I leave after EM intern year to do a research position, do you think programs will still look at me? Not sure if this would be seen as a red flag.

 

[CopaceticOne]

Why would radiology not be realistic? The radiology program at my institution told me that EM intern year will count for Rads.

The desired transition from EM, or originally Ortho, to Anesthesia typically makes sense to people - still procedural with time sensitive clinical care. The switch into Radiology is more nuanced and will require a past history to back up that you are not just being reactionary in desiring a switch.

A word of caution for someone with first hand knowledge - currently anesthesia is one of the very desirable specialties for people. You will need to strongly self reflect as to why you didn't succeed in your pursuit to be an orthopod. The competition is very strong right now for anesthesia spots and there is no underlying need for programs to take a chance on questionable candidates to ensure they fill their program.

 

[GoSpursGo]

Why would radiology not be realistic? The radiology program at my institution told me that EM intern year will count for Rads.

Also, would you recommend applying to Prelim years through the SOAP this march instead of starting PGY-2?

I still generally perceive radiology as being more competitive than anesthesia, so I think the odds of switching from EM to rads is lower. Just because the PGY1 would count doesn’t mean a position will be available.

To me reapplying to prelims via soap sounds very risky. I would not jump ship on a categorical program for only a prelim

 

[Dral]

Thank you for offering sound advice. The mentors I mentioned are at my medical school who are the same people that pressured me into soaping instead of doing a research year. Very frustrated with them

What I'm looking for is Rads or Anesthesia.

I'm not saying this was the case for sure, but med school admins/faculty like to see high match numbers (even if SOAP'd) on their graduation list instead of having people 'unmatched'.

It's similar to undergrad institutions discouraging some people from applying to med school when the student would have a perfectly fine chance (maybe just not a shoe in). They want to say "100% of our students who applied to med school got in".

Those sound like jaded views, but I'm sure they happen. I'm not saying that happened in your case for sure since we do not know all the details, but I would like to put it out there in the case it could help someone else. We would all like to think so, but unfortunately not all individuals in education have the best interest of the student in mind 100% of the time.

 

[A Deep Breath]

I agree that medical schools do appear to chase that metric.

However, I think their perspective is skewed by witnessing firsthand the occasional disasters that unfold from going unmatched.

When the student could’ve had a job, just not in the speciality a person would’ve picked in a perfect world. Which is reality for many, if not most, medical students. They just usually never try or give up early. Life goes on and people have better things to worry about than what could’ve been.

And I also agree that everyone should take their medical school’s advice into consideration as part of a bigger picture. You have a better idea than anyone else how much suffering you’re willing to risk to get what you want.

 

[whatsthepoint]

OP here. I'm a long-time sdn lurker and this site helped me get into medical school, so I hope this thread helps someone in the future. Med students/pre-meds, don't do what I did. I am thankfully ending up back on my feet, but my 4th year of medical school sucked horribly because I did not dual apply and did not explore enough specialties prior to applying to residency. Take a research year if it helps you get where you want to be. Explore every specialty and have no regrets!