How much of a dead end are prelim surgery spots

[voxveritatisetlucis]

I know that people say that prelim surgery is a dead end and, statistically, that is probably correct given the percentage of spots that are filled by IMGs in the soap, but does it hold true for USMDs? In other words, if you fail to match categorical the first time around, how likely is it that you can match the second? Anteceotally, about 6/7 grads who matched prelim surgery from my school in the past 5 years matched categorical the following year but I’m not sure if they initially applied to something more competitive.

In other words, for weak gen surg applicants should they do
-Categorical + prelim as a backup (reapply)
-Categorical + other specialty as backup

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[guytakingboards]

I can't directly answer your question, not having particular insight on your situation, but I will say the ultimate outcome of a prelim surgical intern without categorical position is highly dependent on the strength of the candidate's application AND the prelim program itself.

Some programs just use prelims as cannon fodder with no real effort to successfully place them. I did a prelim surgical spot at a top 10 academic surgery program and they placed all of the unmatched prelims my year into pretty darn good situations (though not all in their desired specialties).

Both of the prelim PGY-2's my intern year are now board certified surgeons. One finished PGY-2 year and went to another program to fill an open PGY-3 slot. The other finished PGY-2 and moved over to a very good community-based program, repeating PGY-2 year as a categorical. One of the PGY-1 prelims (who initially didn't match surg subspec) impressed the program enough that the program basically carved out a categorical spot for them (by juggling the research resident roster). Several of the other prelims who didn't match a second time into surgical sub-spec took spots in other desirable specialties like rads and gas.

All that is to say, if you're going to consider a prelim spot then you really need to do your homework on whether the program has a track record of successfully placing their prelims. A strong endorsement from a well-respected PD in surgery will do a lot to boost your career prospects, whether or not that's ultimately in general surgery.

 

[voxveritatisetlucis]

I can't directly answer your question, not having particular insight on your situation, but I will say the ultimate outcome of a prelim surgical intern without categorical position is highly dependent on the strength of the candidate's application AND the prelim program itself.

Some programs just use prelims as cannon fodder with no real effort to successfully place them. I did a prelim surgical spot at a top 10 academic surgery program and they placed all of the unmatched prelims my year into pretty darn good situations (though not all in their desired specialties).

Both of the prelim PGY-2's my intern year are now board certified surgeons. One finished PGY-2 year and went to another program to fill an open PGY-3 slot. The other finished PGY-2 and moved over to a very good community-based program, repeating PGY-2 year as a categorical. One of the PGY-1 prelims (who initially didn't match surg subspec) impressed the program enough that the program basically carved out a categorical spot for them (by juggling the research resident roster). Several of the other prelims who didn't match a second time into surgical sub-spec took spots in other desirable specialties like rads and gas.

All that is to say, if you're going to consider a prelim spot then you really need to do your homework on whether the program has a track record of successfully placing their prelims. A strong endorsement from a well-respected PD in surgery will do a lot to boost your career prospects, whether or not that's ultimately in general surgery.

How do you find out if they place well? Will the PDs tell you straight up during interviews? Or do you just look at their previous prelim interns? I feel like most programs probably archive the “current resident” pages so it may be difficult

 

[Med Ed]

Repost when you have your surgery clerkship grade.

 

[DOVinciRobot]

How do you find out if they place well? Will the PDs tell you straight up during interviews? Or do you just look at their previous prelim interns? I feel like most programs probably archive the “current resident” pages so it may be difficult

You need to talk to the prelims directly. Prelims typically don’t have any loyalty to their program and will typically tell you the truth. This is highly program dependent, majority of our prelims end up where they want to be (even one ENT). Other programs will use prelims purely for scut and not give any effort to helping you further your career.

Some (looking at you Mayo), turn prelim year into the Hunger Games and give a categorical spot to their “best” prelim… there are 12 so you can imagine how well that fosters camaraderie

 

[wysdoc]

I may be misunderstanding here but wouldn't you be applying for general surgery residencies?
And those who end up with a prelim spot are those who fail to match Gen Surg and get a prelim spot in the SOAP round after they didn't match?

If you do end up in a prelim spot, be their best, most helpful and productive intern ever for a chance to move up in the same program, or to get recommendations for your second NRMP application in a year.

 

[Med Ed]

I may be misunderstanding here but wouldn't you be applying for general surgery residencies?
And those who end up with a prelim spot are those who fail to match Gen Surg and get a prelim spot in the SOAP round after they didn't match?

OP has a habit of gaming out worst case scenarios.

 

[voxveritatisetlucis]

I may be misunderstanding here but wouldn't you be applying for general surgery residencies?
And those who end up with a prelim spot are those who fail to match Gen Surg and get a prelim spot in the SOAP round after they didn't match?

If you do end up in a prelim spot, be their best, most helpful and productive intern ever for a chance to move up in the same program, or to get recommendations for your second NRMP application in a year.

So I was wondering whether it is better to apply categorical gen surg and then soap into prelim surg as a backup or apply categorical gen surg with a backup specialty like EM or neuro. I suppose the latter would be better if prelim surgery was usually a dead end because if so then it’s basically a waste of a year

 

[voxveritatisetlucis]

majority of our prelims end up where they want to be

Is this more because your program is supportive of prelims or more because it only takes prelims with strong records who maybe tried for a sub specialty and didn’t match?

 

[LucidSplash]

OP has a habit of gaming out worst case scenarios.

And also of rendering opinions and offering advice with scant experience to do either.

 

[LucidSplash]

Is this more because your program is supportive of prelims or more because it only takes prelims with strong records who maybe tried for a sub specialty and didn’t match?

It’s because some programs are supportive and others use prelims as cheap labor. The best way to know the difference is to talk to prelims at those programs really, or talk to people who were prelims and later moved onto a categorical position in something. Yes, better applicants who failed to match in a surgical sub will after have better stats and thus land “better” prelim spots in the SOAP. They will then often have a better chance of going onto matching into a residency spot the next go around.

As far as whether it is “better” to do a prelim year vs apply to a backup specialty in the initial match, totally depends on your goals and your stats.

 

[DOVinciRobot]

Is this more because your program is supportive of prelims or more because it only takes prelims with strong records who maybe tried for a sub specialty and didn’t match?

Program is supportive.

 

[operaman]

Depends on your specific situation, but generally speaking would favor GS with prelim backup for one simple reason: the logistics of applying to two different fields is much harder than it seems. Your prelim app will use all the same letters and PS from your GS app. You’ll presumably also have research and activities favoring GS.

Trying to mount a strong application to an unrelated field is not easy. It’s also not cheap. For EM you’ll need to get your SLOE so now you’re burning precious early M4 slots for a backup field. And every program that reviews your app will be able to tell that they are a backup field, or at least suspect.

Your first app cycle is always your strongest. Don’t dilute it unless there’s a highly compelling reason to do so.

 

[Redpancreas]

I know that people say that prelim surgery is a dead end and, statistically, that is probably correct given the percentage of spots that are filled by IMGs in the soap, but does it hold true for USMDs? In other words, if you fail to match categorical the first time around, how likely is it that you can match the second? Anteceotally, about 6/7 grads who matched prelim surgery from my school in the past 5 years matched categorical the following year but I’m not sure if they initially applied to something more competitive.

In other words, for weak gen surg applicants should they do
-Categorical + prelim as a backup (reapply)
-Categorical + other specialty as backup

Do you see yourself only being a surgeon?

 

[guytakingboards]

How do you find out if they place well? Will the PDs tell you straight up during interviews? Or do you just look at their previous prelim interns? I feel like most programs probably archive the “current resident” pages so it may be difficult

If you are interviewing specifically for a prelim surgery spot, you absolutely should ask the PD and they should be willing to talk about the outcomes of their prior prelims. Just like a categorical applicant would want to know about categorical resident outcomes.

If they don't know and/or have that data readily available, that's a big red flag.

I would also say if you're to the point where you're evaluating prelim programs, you should be hella selective on which prelim programs you look at. You should ask yourself which ones will help boost your career prospects and even consider just outright asking the prelim programs what they can do to help you match general surgery later on. That is absolutely something they should have an answer for.

 

[VincentAdultman]

So I was wondering whether it is better to apply categorical gen surg and then soap into prelim surg as a backup or apply categorical gen surg with a backup specialty like EM or neuro. I suppose the latter would be better if prelim surgery was usually a dead end because if so then it’s basically a waste of a year

In general I think it’s a bad idea to wage a war on two fronts. You’ll venture most competitive as a fourth year so dedicate your time and resources to the field you want to do for the rest of your life; worry about backups if you don’t match.

And I know n=2 but me and the other nondesignated prelim marched into ortho.

 

[GoSpursGo]

So I was wondering whether it is better to apply categorical gen surg and then soap into prelim surg as a backup or apply categorical gen surg with a backup specialty like EM or neuro. I suppose the latter would be better if prelim surgery was usually a dead end because if so then it’s basically a waste of a year

These sorts of hypotheticals can't be done in a vacuum. In general, for some of the reasons highlighted by @VincentAdultman , I recommend against dual applications. It is hard enough to put together a personal statement, find LORs, audition, and interview well for ONE specialty. Replicating the process for a specialty that you don't actually want will only suck up time that could have been spent to maximize your chances for the specialty that you actually want. If you wind up not matching, you can always reapply either out of a prelim year or after delaying graduation for a year and dual-apply on your second time through. Yes, it sucks to lose a year of your life by needing to reapply, but when you're weighing either becoming a surgeon vs going into EM or neuro, you want to truly put your best foot forward. Plus, if your backup is EM, you can probably SOAP into that anyways.

On the flip side, if you truly are not competitive for a specialty, you should be honest with yourself about that and figure out what is actually attainable and would make you happy.

 

[voxveritatisetlucis]

These sorts of hypotheticals can't be done in a vacuum. In general, for some of the reasons highlighted by @VincentAdultman , I recommend against dual applications. It is hard enough to put together a personal statement, find LORs, audition, and interview well for ONE specialty. Replicating the process for a specialty that you don't actually want will only suck up time that could have been spent to maximize your chances for the specialty that you actually want. If you wind up not matching, you can always reapply either out of a prelim year or after delaying graduation for a year and dual-apply on your second time through. Yes, it sucks to lose a year of your life by needing to reapply, but when you're weighing either becoming a surgeon vs going into EM or neuro, you want to truly put your best foot forward. Plus, if your backup is EM, you can probably SOAP into that anyways.

On the flip side, if you truly are not competitive for a specialty, you should be honest with yourself about that and figure out what is actually attainable and would make you happy.

If one does preliminary surgery, is there enough time to get an SLOE/EM/neuro letters so the second time one can apply as a backup? Or does that all have to be done fourth year

 

[GoSpursGo]

If one does preliminary surgery, is there enough time to get an SLOE/EM/neuro letters so the second time one can apply as a backup? Or does that all have to be done fourth year

Hard to say

 

[guytakingboards]

If one does preliminary surgery, is there enough time to get an SLOE/EM/neuro letters so the second time one can apply as a backup? Or does that all have to be done fourth year

This goes back to what people have said but it really depends on how much energy/effort you want to divert to a backup strategy: now or later.

In the hypothetical scenario where you end up in a prelim surgery spot, you’re not gonna have a lot of available vacation time to do interviews in surgery as well as whatever backup you think you’d be okay with. You may barely have enough time to do surgery interviews.

If you’re so gung ho surgery, in that situation I would maximize whatever surgery interviews you get and just roll the dice on the SOAP if you don’t match a second time.

If you’re in the SOAP, no one is going to care all your letters are for surgery.

 

[Smurfette]

If one does preliminary surgery, is there enough time to get an SLOE/EM/neuro letters so the second time one can apply as a backup? Or does that all have to be done fourth year

Odds are as a prelim surgery resident, you will not have an ER rotation (and odds of doing it early enough in the year to get a LOR for your app is even less) and you will 100% not have a neurology rotation. MAYBE you'll do a month or two of neurosurgery depending on how they use their prelims.

 

[mrbreakfast]

You have a low chance at getting a spot, let alone a decent spot, if you dual apply neuro as an obvious surgery applicant. If you haven't done a neurology sub-I, the only alternatives are sub-Is in medicine (or neurosurgery); if you've done a general surgery sub-I and aren't good enough to match GS, you probably also aren't matching neuro.

Neuro programs WILL take surgery prelims who performed well, but you're starting back at intern year.

 

[voxveritatisetlucis]

My OBGYN grade was entered incorrectly. I honored it so now I have a pass in FM, honors in OB so maybe there is some hope afterall

 

[voxveritatisetlucis]

However, general surgery is definitely becoming more competitive. My schools program which formerly always matched multiple DOs and IMGs (nothing against that of course, they are actually usually best surgeons in their classes) now only matches from MD schools. This year, we have interns from duke, Iowa, and rochester

 

[LucidSplash]

However, general surgery is definitely becoming more competitive. My schools program which formerly always matched multiple DOs and IMGs (nothing against that of course, they are actually usually best surgeons in their classes) now only matches from MD schools. This year, we have interns from duke, Iowa, and rochester

It’s been about the same level of competitiveness for the last several years judging by the charting outcomes data.

 

[guytakingboards]

However, general surgery is definitely becoming more competitive. My schools program which formerly always matched multiple DOs and IMGs (nothing against that of course, they are actually usually best surgeons in their classes) now only matches from MD schools. This year, we have interns from duke, Iowa, and rochester

Where do you come up with some of this stuff? "they are actually usually best surgeons in their classes"

 

[Lost in Translation]

Former SOAP Gen Surg prelim here.

Matched into a growing-more-competitive-by-the-year categorical spot after prelim year.

Will most likely match into a competitive subspeciality within said field soon.

I’m not the first nor will I be the last.

 

[voxveritatisetlucis]

Former SOAP Gen Surg prelim here.

Matched into a growing-more-competitive-by-the-year categorical spot after prelim year.

Will most likely match into a competitive subspeciality within said field soon.

I’m not the first nor will I be the last.

Congrats! Did you apply gen surg first time around or a competitive sub specialty

 

[Lost in Translation]

Competitive field.

 

[voxveritatisetlucis]

How bad would it look to get HP clinically and H on the shelf exam? Honors is rarely given for surgery at my school