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How to Approach a Residency Swap

Discussion in 'General Residency Issues' started by JibSail, May 16, 2014.

  1. JibSail


    May 16, 2014
    I am about to begin PGY-1 year in a specialty residency program that is categorical but essentially consists of a prelim year with actual specialty rotations beginning in PGY-2 year.

    I have been in touch with another resident who matched to a program with the same set-up as mine, same specialty, similar reputation. The big difference between the two programs is that one is on one coast, and one is on the opposite coast.

    Both of us would like to switch with each other for geographical reasons. Neither one of us have anything against our respective programs. Neither one of us interviewed at the other's program either.

    We realize that the best time to switch would be the start of PGY-2 year. Both of us have agreed to not have contact with one another for the first 45 days of residency to help avoid Match violations, and then we will begin to mutually discuss how to proceed in autumn.

    My question is: how do we approach this? There seem to be scattered posts a few years old on this topic, but no real "step 1.... step 2..." guideline on the best way to approach this, as well as the major dangers lurking that could jump up and bite you.

    Any help is greatly appreciated!
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  3. Psych2PsychSwitch


    May 15, 2014
    Hey, JibSail! I'm an incoming PGY1 myself, but I know of people who have "swapped" positions in the past--albeit in fields like IM, psychiatry, and pediatrics. My friend, however, is an incoming specialty surgical resident and mentioned meeting a lot of people on her trail who had "swapped" for a number of reasons: one resident to/from Stanford and UCSF (so, clearly, geography wasn't the only thing on his/her mind) and another to/from NYC and Chicago. Swapping may actually be preferable to transferring because both programs will fill their vacancies quickly, without having to advertise the spots to the WWW.

    Anyway, here is the process. It really seems like the wild wild west to me:

    1. Step 1: understand that swapping is inherently dependent on another person, who may fall in love with his/her program or geographical location. YOU may fall in love with your program and the location. People change their minds all the time. We're irrational beings. As much as you'd like to think you can, you CANNOT fully depend on this person, much as this person cannot fully depend on you. Still, keep in touch with him/her and gauge their willingness to swap as the year unfolds.

    2. Step 2: I'm guessing that you have legitimate reasons why you want to end up on the "other coast" vs. staying put: family, friends, a significant other? After 45 days, I'd meet with your program director and be upfront with him/her. Being upfront, honest, and transparent are both extremely professional qualities (they'll serve you well), and your PD should always be kept as up to date as you are. Ensure that your PD understands that it's not the PROGRAM but the LOCATION at the root of your unhappiness. Absolutely NO PD wants an unhappy resident: a "malignant" PD may make life difficult for you, but an enlightened PDs can actually help out quite a bit with the transfer/swap process. Either way, the PD cannot physically stop you from applying for a transfer elsewhere. That's your right and it's protected by ACGME.

    2. Step 2.5. Have your colleague do the same.

    3. Step 3: If BOTH you and your colleague are on-board, then you should tell your respective PDs about each other. What will ensure can and will include any of the following: PD-PD conversation (I'm sure the two PDs know each other); you'll fly out to interview at program X while your colleague will fly out to interview at program Y (your program); there will be more discussion and perhaps more interviewing. If, in the end, everyone agrees to the swap, then it's as simple as finishing out the year... Or, even, swapping mid-year. I've heard of a few stories of the latter.

    Best of luck. I'm in the midst of a transfer/swap myself due to unforeseen family circumstances, so I can certainly empathize with how that you're feeling now.
  4. JibSail


    May 16, 2014
    Superb, thank you Psych2PsychSwitch for that great timeline.

    A few follow-up questions...

    1. What match violations could this possibly incur?

    2. Where do I find the actual rules of what constitutes a match violation?

    3. Is it possible if my PD likes the my switch partner but the other PD doesn't like me, that my program could dump me/take the switch partner and I would be out of a job?
  5. Psych2PsychSwitch


    May 15, 2014
    1. No Match violations, I believe. As long as you show up for Day 1, you're free to do whatever you want, whenever you want (from the NRMP's perspective). You should look into the contract you signed with your program, however. Transfers/swaps happen all the time, especially within the same specialty. Your PD, if he/she has been in the business long enough, is sure to have seen more than a few of them.

    2. Not sure. Not showing up on Day 1 would definitely be a Match violation, unless you have a NRMP waiver.

    3. That's entirely possible, though not probable. I can't see why your PD, or the other program's PD, would do something malicious like that. That said, you really do have to assume some risk with the transfer/swap process... the risk being that you'll end up without a job for PGY2. Maybe your colleague's program will love you, maybe they won't. Odds are that they will, and vice versa. Still, if you're entirely risk averse (which is sounds like you're aren't), then you should stick with your current program.

    Good luck!
  6. Chickenandwaffles

    Chickenandwaffles Banned Banned

    Mar 20, 2014
    There is no real "step 1, 2, etc" because swaps, per se, are not really that common. People changing specialties/programs is not unheard of, I have certainly done it and know numerous others who have also. I do not personally know of a single person who has actually swapped with another.

    The match violation technically involves you discussing or engaging another program regarding a transfer/swap/switch within the 45 days. I personally think it's an idiotic rule that does nothing but really screw up programs as residents who want to switch will simply switch later, and it would make far more sense for residents to switch BEFORE they start a program not after. But I digress. After the 45 day rule there are no issues.

    You would have to try to figure out first if both you and your swap partner are about equal in terms of grades, qualifications, fit, etc. How similar/different are the programs? Why did you guys not IV at each other's programs, particularly given that you both prefer that specific coast? Did you apply or not there, and would have you been granted IVs had you applied if you did not.

    If your PD is nice, and there certainly are nice PDs out there who do want and care for their residents and want their success, you can certainly try to talk to them, and your swap buddy to theirs and see if they would agree to such asituation. if they do, done deal.

    If they don't like the candidate for whatever reason, or one is liked but the other is not liked, well the deal is likely off. Regarding your question regarding malice, since none of us know who your PD is, there is no way to know whether he/she is nice or difficult and whether they would make things difficult for you. If you don't give up your spot per se, I would doubt your PD would just dump you. If you don't voluntarily give up your spot, they would have to fire you to take someone else. So that's unlikely.

    I would try to see whether you like your program first, and if you still don't like it after starting it, then see if you can talk to your PD, depending on the above.
  7. biryani86

    biryani86 2+ Year Member

    Mar 25, 2014
    What if I sign a PGY-2 contract outside of the match, would I be able to swap that for a same-specialty spot in a different state before July?

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