How to switch to a different residency within Psychiatry?

[Hot_Sauce]

Psych PGY-1 here, so far not terribly enjoying residency. There are many factors, and I did apply multiple specialties in the Match and ended up ranking Psych #1. However I ended up farther down the list than I hoped. My program is mid-tier academic and is known for being a 'chill' residency in terms of hours, etc. The place I ranked #1, I absolutely loved. Everything I wanted in a psych program - robust medical training intern year, neuromodulation, good combo of patient populations (not just inner city, not just worried-well), and great institution near family that would open many doors professionally. I sent them love letters to get the interview, and afterwards. It all came down to my step 2 CK score, and I did horribly and underperformed by 20+ points. I had an awful test day experience at my prometric test center; I asked for them to switch me stations but they didn't have any other options and I filed a complaint with NBME - which of course did nothing. I think I'm a good candidate otherwise with decent academics, published psych research and other research, awards, leadership. Recently just published again as a trainee.

Does anyone know how common it is to switch to a different residency program within psychiatry, and how I would go about doing that? Sending updates to the PD of my dream institution and asking to switch? Any other tips from people? Thanks

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[Bartelby]

It is possible in some programs if a spot opens up. You can send out an inquiry to that PD to let them know about your interest, don't count on it happening but you may get lucky and find a spot becomes available on the right timeline. You then have to decide if you want to go all in telling your PD, doing the formal application etc.

 

[Hot_Sauce]

they don’t want you there lol they’re not going to let you switch unless you have a very good reason (your mom is dying) you’re not gonna be able to switch because you want to go to a different place for enjoyment

uhh.. I wouldn't call it enjoyment, I would call it strength of training. do you have any experience personally, or are you just guessing.

if they didn't rank me at all, I could agree that they don't want me there. based on my previous interactions with this specific PD, I am pretty confident they ranked me.

 

[Hot_Sauce]

It is possible in some programs if a spot opens up. You can send out an inquiry to that PD to let them know about your interest, don't count on it happening but you may get lucky and find a spot becomes available on the right timeline. You then have to decide if you want to go all in telling your PD, doing the formal application etc.

Makes sense. So it sounds like there's no formal listing site of openings like there is for OB/GYN and CREOG clearing house then? Just "cold calling" PDs?

 

[Dr Tapatio]

uhh.. I wouldn't call it enjoyment, I would call it strength of training. do you have any experience personally, or are you just guessing.

if they didn't rank me at all, I could agree that they don't want me there. based on my previous interactions with this specific PD, I am pretty confident they ranked me.

They didn't rank you high enough because they didn't want you enough. Your persistence in a fantasy will only serve to hurt you and your career. I can't imagine you going to either PD and telling them you want to switch because you believe you are getting subpar training. Even the person on the program you want will be hesitant of you bad mouthing them if they don't meet your "grass is greener" expectation. Your program will likely want to tell you to f-yourself, and if the PD is vindictive enough, they'll just recruit another person to their PGY-2 and leave you SOL. Unless you find a way to swap or have a compelling reason (sick family member), I don't see this happening

 

[Hot_Sauce]

They didn't rank you high enough because they didn't want you enough. Your persistence in a fantasy will only serve to hurt you and your career. I can't imagine you going to either PD and telling them you want to switch because you believe you are getting subpar training. Even the person on the program you want will be hesitant of you bad mouthing them if they don't meet your "grass is greener" expectation. Your program will likely want to tell you to f-yourself, and if the PD is vindictive enough, they'll just recruit another person to their PGY-2 and leave you SOL. Unless you find a way to swap or have a compelling reason (sick family member), I don't see this happening

“persistence in a fantasy”? I am surprised to find this level of condescension and arrogance in this sector of sdn. Judging someone you don’t know based off a couple paragraphs, what’s the word for that- ad hominem or something? anyway we have residents in my program that have switched here because they didn’t like their original program - I wonder if all of them were “persisting in a fantasy”? based on my socioeconomic and community college record, the thought of pursuing the field of medicine could have been construed as “persisting in a fantasy” thank God I didn’t listen to people like you then.

 

[Hot_Sauce]

For anyone with constructive advice, I am interested in switching for more opportunities in neuromodulation (our TMS and ECT faculty recently left and took their machine), and a program with more fellowship trained faculty and staff, not because of a perceived deficit per se in my current residency but seeking more robust training. since the match I’ve had several more publications that others have said have significantly strengthened my CV.

 

[J ROD]

have you learned about delusional disorder yet?

 

[Dr Tapatio]

“persistence in a fantasy”? I am surprised to find this level of condescension and arrogance in this sector of sdn. Judging someone you don’t know based off a couple paragraphs, what’s the word for that- ad hominem or something? anyway we have residents in my program that have switched here because they didn’t like their original program - I wonder if all of them were “persisting in a fantasy”? based on my socioeconomic and community college record, the thought of pursuing the field of medicine could have been construed as “persisting in a fantasy” thank God I didn’t listen to people like you then.

Thanks for making yourself out to be special, but you're not. My socioeconomic and CC background were probably the same as yours if not more dire. I qualified for the special application waiver for economically needy applicants and was an underrepresented minority that grew up in a medically underserved area. I don't use them as a crutch though

It is a fantasy when you're obsessing on re-doing the match and trying to convince a PD that didn't want you (enough) and keep rationalizing. This is clearly not a case of someone that thought EM was what they wanted, matched, but then a few rotations in residency Surgery made them want to change their pathway in life. Your entire reason to change is because you think you'll like it more. The fact that someone else already saw this as you doing it for enjoyment should clue you in on how your story comes off

If you want to persist on this, go ahead. It's not going to hurt me. It's only going to hurt you

For anyone with constructive advice, I am interested in switching for more opportunities in neuromodulation (our TMS and ECT faculty recently left and took their machine), and a program with more fellowship trained faculty and staff, not because of a perceived deficit per se in my current residency but seeking more robust training. since the match I’ve had several more publications that others have said have significantly strengthened my CV.

You can't even see the contradiction there, can you?

 

[Hot_Sauce]

Thanks for making yourself out to be special, but you're not. My socioeconomic and CC background were probably the same as yours if not more dire. I qualified for the special application waiver for economically needy applicants and was an underrepresented minority that grew up in a medically underserved area. I don't use them as a crutch though

It is a fantasy when you're obsessing on re-doing the match and trying to convince a PD that didn't want you (enough) and keep rationalizing. This is clearly not a case of someone that thought EM was what they wanted, matched, but then a few rotations in residency Surgery made them want to change their pathway in life. Your entire reason to change is because you think you'll like it more. The fact that someone else already saw this as you doing it for enjoyment should clue you in on how your story comes off

If you want to persist on this, go ahead. It's not going to hurt me. It's only going to hurt you


You can't even see the contradiction there, can you?

whatever dude. And, I never mentioned economically needy waiver or being an underrep minority - but you did AND a medically underserved area. but I'm the one using it as a crutch? lol. let's add hypocrisy to the condsecension and arrogance....

no I don’t see contradiction. just because there’s no deficit in my program doesn’t mean other programs don’t have stronger training.

hate on SDN, hate on...

 

[Hot_Sauce]

have you learned about delusional disorder yet?

15+ year lifetime sdn-er with 55,000+ messages? wow rocket scientist, pharmacist, physician, 55,000+ messages AND condescending sarcasm to boot! you must be so very wise with an incredibly awesome real life to be able to post 55,000+ messages. nope never heard of it, please educate me!!

 

[JKinSC]

Does anyone know how common it is to switch to a different residency program within psychiatry, and how I would go about doing that? Sending updates to the PD of my dream institution and asking to switch? Any other tips from people? Thanks

To answer this, people switch every year, generally due to changes in life circumstance or something similarly major. As far as I know, there’s no central clearinghouse, though there are usually a few openings posted on the APA website. Cold-calling PDs may work later in the year as far as seeing if there are any openings expected at the end of the academic year. Even that is not likely to help too much, though, as there are always people looking to switch and there are generally interviews with several applicants for any open slot.

As for the PD of your dream institution, I wouldn’t go any further than a single call towards the end of the academic year. For whatever reason, you didn’t match your number one; I promise you’re not the only one. And continuing to push it is not a good look. As you’ve seen from some of the responses here, it can come across as feeling entitled, whether that’s the actual case or not. Finally, keep in mind that the PD can tell you whatever they want as far as where they ranked you - it’s a black box.

 

[Hot_Sauce]

Hey to future readers of this thread, I think its totally normal to have any variety of reactions to your training program and to seek advice or insight into what's best for you or your future. People switch all the time, including multiple in my program that came from other programs. I was just seeking advice on how to go about this switch and if it makes sense for me. I'm sorry for contributing to the hateful nature of SDN by engaging with some of the posters here who appear to me to be more interested in holier-than-thou, "listen to me here young man," "let me mansplain you why I'm right and you're wrong" posts instead of constructive advice. We all need to have a part in constructive, productive, positive dialogue and I regret not living upto that standard. Peace!

 

[Hot_Sauce]

To answer this, people switch every year, generally due to changes in life circumstance or something similarly major. As far as I know, there’s no central clearinghouse, though there are usually a few openings posted on the APA website. Cold-calling PDs may work later in the year as far as seeing if there are any openings expected at the end of the academic year. Even that is not likely to help too much, though, as there are always people looking to switch and there are generally interviews with several applicants for any open slot.

As for the PD of your dream institution, I wouldn’t go any further than a single call towards the end of the academic year. For whatever reason, you didn’t match your number one; I promise you’re not the only one. And continuing to push it is not a good look. As you’ve seen from some of the responses here, it can come across as feeling entitled, whether that’s the actual case or not. Finally, keep in mind that the PD can tell you whatever they want as far as where they ranked you - it’s a black box.

Thank you very much for the reply. I took the bolded section to heart.

 

[wolfvgang22]

Bartleby already gave you the best advice I think you are going to get.

I'm curious why you think your #1 desired program ranked you, or why you think they ranked you highly. It's common for programs to tell or imply to applicants they will rank them, though perhaps not ethical. I think you are getting a strong reaction from people about your post because it does sound like you think very highly of yourself despite not doing well on the easiest part of the USMLE. I think you'll get further in trying to transfer by showing more humility than you did here.
Good luck.

Edit: JKinSC posted right as I did. I agree with him/her.

 

[Dr Tapatio]

Hey to future readers of this thread, I think its totally normal to have any variety of reactions to your training program and to seek advice or insight into what's best for you or your future. People switch all the time, including multiple in my program that came from other programs. I was just seeking advice on how to go about this switch and if it makes sense for me. I'm sorry for contributing to the hateful nature of SDN by engaging with some of the posters here who appear to me to be more interested in holier-than-thou, "listen to me here young man," "let me mansplain you why I'm right and you're wrong" posts instead of constructive advice. We all need to have a part in constructive, productive, positive dialogue and I regret not living upto that standard. Peace!

Hahaha wow. Nobody knew you had a vagina. Also, how did you know all your replies were by men? Did you assume my gender?!?!?!

Welcome to having been treated equally as we would a man

This thread is an instant classic

 

[rhondabear]

What’s the call schedule like at your program, jw the definition of “chill”

 

[Old&InTheWay]

I agree that asking your current PD would be awkward without some practical reason for wanting to move (sick family member, spouse having to relocate, etc.). If I were in your shoes, I would probably aim to use 4th year electives to fill in any gaps in my training.

 

[docksan]

This thread delivers.

Hold the agitation PRNs. I feel like this is going to get much better.

 

[wolfvgang22]

I actually wondered if this was a really skillful troll post. It certainly drew a strong reaction. It even rubbed me the wrong way, and I'm not entirely sure why. It somehow came across as condescending to me. I can certainly understand why someone might want to be able to do more procedures, or be worried that a better education might be offered elsewhere. It felt like there was a lot of ego involved here.

Maybe for me it's because I graduated from a mid-tier residency with brutal call over a decade ago without a single blemish on my application, and yet felt grateful for the opportunity. I was never bored, I found there was in fact more opportunity at the mid-tier program because everyone wasn't trying to do what I was doing already, all one needed was initiative and energy. I learned later how good I had it when I went to a "top tier" fellowship program where there was a lot of fighting over research turf and mentorship. So, the grass is always greener, no?

 

[deleted1012620]

I don't think it's a troll post. He posted in the anesthesia forum about switching to anesthesia, and I responded since I switched from anesthesia into psych.

He's clearly unhappy about something, and I think he needs to pinpoint what it is.

Do you dislike your current rotation, inpatient psychiatry, the whole specialty of psychiatry, your coworkers, your location, or something in your personal life?

The logistics of switching to anesthesia or another program in psychiatry are very difficult, and I think you need to really figure out what's bothering you before you make a big leap.

 

[Splenda88]

I don't think it's a troll post. He posted in the anesthesia forum about switching to anesthesia, and I responded since I switched from anesthesia into psych.

He's clearly unhappy about something, and I think he needs to pinpoint what it is.

Do you dislike your current rotation, inpatient psychiatry, the whole specialty of psychiatry, your coworkers, your location, or something in your personal life?

The logistics of switching to anesthesia or another program in psychiatry are very difficult, and I think you need to really figure out what's bothering you before you make a big leap.

That explains it all... because it's unusual for someone to want to go to another program (not specialty) the 1st month of residency. OP is just not happy with psychiatry.

 

[samac]

I think the reason you’re getting such a strong reaction is how hard everyone in this forum has worked. The match is what it is, some of us were lucky enough to get their top, some fell to the bottom of their list. Most of us feel lucky to at least be in psychiatry.
If you don’t know of an opening at the other program I likely wouldn’t try.
You’ll never know if they actually ranked you, if you were at the bottom, and you might have been the next name on the list. But the fact of the matter is they matched people they ranked higher than you or you’d be there. The best thing to do is think of all the positives of your program and move on.

 

[jbomba]

All this said, I know it can be done. Guy I know switched out of a pretty decent program after intern year to go to a better program in a city he liked more. I think he probably got lucky, but it happens.

 

[FlowRate]

In the interest of providing some useful advice--if you have a chill residency that probably means you have a lot of elective time (especially in your 4th year.) You can do "away rotations" with other residency programs. So if you want to get trained in TMS and ECT, plan on spending a couple of months in 4th year at another institution. You don't need multiple years of exposure to become competent to administer either of those modalities.

 

[docksan]

My earnest advice to anyone, including medical students who might be reading this, is to ask yourself a few things. Is it:

1) ...the location that I hate?
2) ...the program?
3) ...the profession?

Two of those you cannot realistically fix without burning a few bridges. The third one, well, that happens all the time and you should consider yourself lucky if that's what it is because you can always attempt to look for open PGY-2 spots in another program. After intern year program directors expect you to have your **** together.

 

[Stagg737]

they don’t want you there lol they’re not going to let you switch unless you have a very good reason (your mom is dying) you’re not gonna be able to switch because you want to go to a different place for enjoyment

They didn't rank you high enough because they didn't want you enough. Your persistence in a fantasy will only serve to hurt you and your career. I can't imagine you going to either PD and telling them you want to switch because you believe you are getting subpar training. Even the person on the program you want will be hesitant of you bad mouthing them if they don't meet your "grass is greener" expectation. Your program will likely want to tell you to f-yourself, and if the PD is vindictive enough, they'll just recruit another person to their PGY-2 and leave you SOL. Unless you find a way to swap or have a compelling reason (sick family member), I don't see this happening

I agree that asking your current PD would be awkward without some practical reason for wanting to move (sick family member, spouse having to relocate, etc.). If I were in your shoes, I would probably aim to use 4th year electives to fill in any gaps in my training.

Just a data point, but one of my co-interns from my psych program transferred to NYC because he couldn't adjust to living in the city I'm in (fairly large metro area). NYC is extremely far from anyone he knew other than his SO who was in D.C. Was 100% honest with our PD (who is amazing, imo) and our PD helped him transfer to a program there. So no, it is not unheard of to transfer programs for less-than-dire reasons, but it does highly depend on your home PD and how much they're willing to help you transfer.

 

[Dr Tapatio]

Just a data point, but one of my co-interns from my psych program transferred to NYC because he couldn't adjust to living in the city I'm in (fairly large metro area). NYC is extremely far from anyone he knew other than his SO who was in D.C. Was 100% honest with our PD (who is amazing, imo) and our PD helped him transfer to a program there. So no, it is not unheard of to transfer programs for less-than-dire reasons, but it does highly depend on your home PD and how much they're willing to help you transfer.

Fair enough, but the feeling I was getting is OP was that she's not unhappy with her program but rather unhappy that she isn't at her ideal program #1 rank and wants to go there in specific. It has been one month. she hasn't even given the program a chance. She refuses to process the match

 

[hallowmann]

...Finally, keep in mind that the PD can tell you whatever they want as far as where they ranked you - it’s a black box.

This cannot be overstated. I know multiple people that were sent love letters from PDs or told they were be ranked "to match" or even "number 1" to either not match there, or worse yet to fail to match and find out that not only did the program not rank them highly, they didn't rank them at all because the person didn't match and the program didn't fill. Moral of the story, don't trust what they say about how you were ranked.

 

[Mass Effect]

This is like getting married to someone who will provide you love and stability for decades to come and leaving that person to pursue the ex of your dreams who dumped you just because she's more fun.

 

[docksan]

This is like getting married to someone who will provide you love and stability for decades to come and leaving that person to pursue the ex of your dreams who dumped you just because she's more fun.

Only to find out you made a critical mistake and should have stayed with the first person because long term you're miserable.

 

[JKinSC]

This is like getting married to someone who will provide you love and stability for decades to come and leaving that person to pursue the ex of your dreams who dumped you just because she's more fun.

Only to find out you made a critical mistake and should have stayed with the first person because long term you're miserable.

This has taken an oddly specific turn...

 

[Dave1980]

Does anyone know how common it is to switch to a different residency program within psychiatry, and how I would go about doing that? Sending updates to the PD of my dream institution and asking to switch? Any other tips from people? Thanks

You have no chance at the dream program. They didn't rank you highly in the match and you wanting to bail on your current program one month into residency is going to make them like you less. Stick it out...it's 4 years.

 

[Mass Effect]

This has taken an oddly specific turn...

It's a cliche. That's why we all know how it ends.

 

[Stagg737]

Fair enough, but the feeling I was getting is OP was that she's not unhappy with her program but rather unhappy that she isn't at her ideal program #1 rank and wants to go there in specific. It has been one month. she hasn't even given the program a chance. She refuses to process the match

Wasn't really the point of my post. Some people could say "I want to transfer because I feel like it" and the programs would be okay with. Some people could have dying parents across the country and a malignant program would say "too bad" or even try and sink the person's career. I wasn't really addressing the issues with OP's situation as much as saying that the ability to transfer is highly variable and dependent on both situation and staff at the home program. I stopped taking OP's situation seriously when they said "mansplaining".

This cannot be overstated. I know multiple people that were sent love letters from PDs or told they were be ranked "to match" or even "number 1" to either not match there, or worse yet to fail to match and find out that not only did the program not rank them highly, they didn't rank them at all because the person didn't match and the program didn't fill. Moral of the story, don't trust what they say about how you were ranked.

My Ob/gyn attending in med school actually knew someone this happened to and the person scrambled into one of the programs that didn't rank them. Apparently the PD was changing, but I can't imagine how horribly awkward that would be.

 

[JKinSC]

My Ob/gyn attending in med school actually knew someone this happened to and the person scrambled into one of the programs that didn't rank them. Apparently the PD was changing, but I can't imagine how horribly awkward that would be.

How does a PD let this happen? By not ranking someone at all, you’re making it very clear that you would rather have an empty spot than have that individual. In the years I served on our selection committee, we never once got into the depths of our lists, and we still had very long conversations about anyone that we chose not to rank.

 

[Stagg737]

How does a PD let this happen? By not ranking someone at all, you’re making it very clear that you would rather have an empty spot than have that individual. In the years I served on our selection committee, we never once got into the depths of our lists, and we still had very long conversations about anyone that we chose not to rank.

Note sure. It’s possible the change in PD had something to do with it, but Idk as this was something I was told secondhand.

 

[FlowRate]

How does a PD let this happen? By not ranking someone at all, you’re making it very clear that you would rather have an empty spot than have that individual. In the years I served on our selection committee, we never once got into the depths of our lists, and we still had very long conversations about anyone that we chose not to rank.

My guess is that at least some of these situations are basically just clerical error.

 

[docksan]

How does a PD let this happen? By not ranking someone at all, you’re making it very clear that you would rather have an empty spot than have that individual. In the years I served on our selection committee, we never once got into the depths of our lists, and we still had very long conversations about anyone that we chose not to rank.

It could also be that they were not ranked by the candidate. It doesn't necessarily mean the PD did not rank the individual.

 

[Tampa1234]

I think you should try to change residencies if you are unhappy. It can be done because I knew several who did it.

Residency was one of the most miserable and abusive experiences I have had in my life and it took a LONG time for me to get over it. I graduated in 2004 and wish I had tried to switch. Since graduating, life has been very good for me and I have never found myself in that type of situation again.