How hard to find a PGY 3 general surgery year? Want to find out before ranking

[Somedaydoc]

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Hey guys, I am trying to figure out how to rank places before I potentially lock myself into a career mistake. I am an OK applicant: American medical grad, great Step 2 (240s), but failed Step 1 the first time and had to repeat 3rd year. I had some trouble in medical school trying to figure out what studying style suited me best and tried my best to recover from that. The problem is that although I love surgery, it doesn't exactly love me back. I applied to categorical programs but only got one interview, where the PD had been nice when I emailed him (not sure if I would have gotten the interview otherwise). The same place also offered me their preliminary spot. Once I saw my chances in surgery were very slim and I didn't want to not have a chance at categorical positions, I applied in medicine as well. I got a lot of categorical medicine interviews. Now, I'm going to rank the categorical Surgery program as my first spot on the ROL. I am not sure where to rank their preliminary spot. The PD made it sound as though I would be able do my PGY-2 year there as well (they have PGY 1 and 2 preliminary positions). He said that it was fairly easy to find PGY-3 positions after that. Having seen people go through the scramble and try to find positions post-scramble, I am not so sure that it would be easy. Also, now the NRMP has an "all-in" policy in which all positions a program has are either in the match or not (nothing in-between)-and I don't know how this would affect the hunt for a PGY3 spot. What do you all think? Would I need to start over and do all 5 years somewhere new? (in which case GME funding becomes an issue since I would have used up 2 years of funding).

Also, can you do a burn fellowship after just 3 years of general surgery and become a burns surgeon? Or another fellowship? Or do you need to complete all 5 years of general surgery?

I'm not so sure that I would be able to match as a categorical applicant at the same program after doing 2 prelim years. I'm pretty confused as to what I should do and would appreciate any advice, especially from residents and attendings, would Winged Scapula have any words of wisdom? Thank you all!

 

[Winged Scapula]

For the facts:

you can do a burn fellowship, some ICU, etc. after PGY-3. However, you will not be BE/BC and will find yourself in the same predicament that anyone does when they don't finish residency.

I'm not sure why someone would hire a non-BE/BC, incompletely trained (most of your operating and patient management are in the PGY4/5 years) physician to be their burn surgeon when they could get someone who had finish training. After all, there aren't a lot of positions for burn surgeons.

the attrition for general surgery is about 20%; the vast majority of positions are PGY-1, although occasional PGY-2/3/4 positions do come up. Go here to see what it currently looks like.

No one knows whether or not you will get a Prelim PGY-2 position or whether that will translate into a Categorical one. Does the program have a history of taking their Prelims on as Categoricals? THAT will be your best indication.

The bottom line is: do you want to be a surgeon and if you do, how hard and long are you willing to work to become one? If you can accept doing 2 Prelim years and the possibility of never getting a Categorical one, then you know what to do.

 

[filter07]

From what I can see, many who are prelim due to a blemish on their app but are otherwise solid with good intern evals and ABSITE end up getting a categorical spot. As a US grad who did well on step 2 you have a decent shot. I would say the people who have the hardest time are foreign grads as there seems to be an inherent bias. That being said I would just rank the categorical surgery spot and then rank medicine but that is just my opinion.

 

[LucidSplash]

I think the fact that you had to repeat all of 3rd year is a pretty big red flag. While failing a Step is bad, a good score on a subsequent attempt can ameliorate some of the fallout (though certainly not all). I've known a couple people who had to repeat a single clerkship, but I can't fathom a situation which would require someone to repeat all of 3rd year. I suspect that this aspect of your resume is going to outweigh your good Step 2 score; one would expect a halfway decent score if you did 3rd year twice. Did you really repeat the entire year after having completed it or just part of it?

Agree with the rest below. I think your absolute best shot is to perform brilliantly as a prelim (and I suspect you would have to do both PGY1&2 as a prelim) and have that program then take you as a categorical. Without the benefit of seeing your work and interacting with you daily for 2 years, applying to positions at other programs, other PDs are going to have the same concerns they have now, even if you get stellar reviews and letters from the program where you did your prelim year(s). They will likely wonder why, if you are so great, the program you started at did not give you a categorical position.

Agree with everything below, especially WS's final statement. It's not impossible to do this, but you have to consider the high likelihood that you could work for 2 years and still end up in IM at the end, needing to do the full three years of that residency. If you perform poorly as a prelim, there's also the chance that you could end up without a spot anywhere, as you'll need your PD's endorsement. If you're willing to take those chances and really accept that you may not get the outcome you want, then you're ready to be a prelim surgery intern and work your tail off.

 

[Winged Scapula]

I hate to "out" you OP, but it looks like you were applying to IM last year. Your posts from December 2011 talk about ranking IM Prelim and Categorical programs and how you weren't very successful in getting interviews.

So my question is: what happened? Are you in residency now and if so, doing a medicine Prelim? Aside from the obvious red flags are there other things in your application (such as already have graduated, doing medicine, only having IM letters, etc.) that would make Surgery programs shy away from you. If you aren't in residency, what are you doing to strengthen your application?

All in all, it probably doesn't matter because if you can get a Prelim Surgery program you may have a shot. I worry however that you may still have trouble with time organization (do you have children - wasn't clear from one of your threads). A Prelim surgery position is a YEAR LONG audition; there is no room for slacking and you need to be prepared for that and the possibility, as I noted above, that you may never get a Categorical position.

 

[Somedaydoc]

Thank you all so much for the advice, it really means a lot. I PM'd a few folks with more explanation since ranking is going on right now and I'm a little worried about PD's reading this. Although after Feb.20th, I'm an open book🙂 Thanks again, I have a lot of thinking to do.

 

[Buzz Me]

I'm also a little confused about your situation...why exactly were you forced to repeat all of your M3 year? You said you failed Step 1...what was your score the second time round? And what, exactly, have you been doing in the time since graduating from med school?

Feel free to PM me if you don't wan't to post potentially incriminating/sensitive material.