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MIRBP2400

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I am going to be an incoming PGY-1 resident going into my prelim year next week. I made a huge mistake on my rank order list, choosing to rank a community prelim medicine program higher because it was rumored to be "chill," a good schedule, short commute over a more competitive academic prelim which on paper looked 100x better for me in every respect (distance, pay, name etc). I ended up ranking the smaller program higher because I thought it would be a more manageable experience. Although not my first choice, I ended up matching there. It's pretty painful to go into specifics, but everyone who's heard my story agrees that I made a mistake. I received my schedule last week and I certainly agree with that. It's brutal and I was foolish for thinking it wouldn't be as much. There is no true justification for what I have done. A small silver lining is that I was not the most competitive candidate and may not have matched at the bigger program. I also did not interview at the bigger program, and the offer was just included as a bonus when I interviewed for the advanced program there. I've been having crippling waves of regret and disgust at myself for passing up on a clearly better opportunity and making this stupid move. I've even had the crazy thought to reach out to the PC at the larger program to see if I would have matched there, at the risk of getting no response and being blacklisted for seeming neurotic. However, it has been bothering me tremendously. Another reality that has begun to sink in, is that this year will be a permanent mark on my CV, and frankly, having it there in combination with my advanced program doesn't set me up for an academic career, which I had hoped to pursue. I'm certainly grateful to have matched, but this feeling of gnawing regret has just been crippling. Does anyone know any potential recourse to this situation? Has anyone switched prelim years midway through? Possibly considering gen surg as it could at least help me more with my career goals. Any advice is much appreciated.
 

rokshana

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I am going to be an incoming PGY-1 resident going into my prelim year next week. I made a huge mistake on my rank order list, choosing to rank a community prelim medicine program higher because it was rumored to be "chill," a good schedule, short commute over a more competitive academic prelim which on paper looked 100x better for me in every respect (distance, pay, name etc). I ended up ranking the smaller program higher because I thought it would be a more manageable experience. Although not my first choice, I ended up matching there. It's pretty painful to go into specifics, but everyone who's heard my story agrees that I made a mistake. I received my schedule last week and I certainly agree with that. It's brutal and I was foolish for thinking it wouldn't be as much. There is no true justification for what I have done. A small silver lining is that I was not the most competitive candidate and may not have matched at the bigger program. I also did not interview at the bigger program, and the offer was just included as a bonus when I interviewed for the advanced program there. I've been having crippling waves of regret and disgust at myself for passing up on a clearly better opportunity and making this stupid move. I've even had the crazy thought to reach out to the PC at the larger program to see if I would have matched there, at the risk of getting no response and being blacklisted for seeming neurotic. However, it has been bothering me tremendously. Another reality that has begun to sink in, is that this year will be a permanent mark on my CV, and frankly, having it there in combination with my advanced program doesn't set me up for an academic career, which I had hoped to pursue. I'm certainly grateful to have matched, but this feeling of gnawing regret has just been crippling. Does anyone know any potential recourse to this situation? Has anyone switched prelim years midway through? Possibly considering gen surg as it could at least help me more with my career goals. Any advice is much appreciated.

its a year...keep your head down, be a good intern and be happy when you move onto to your advanced program...and don't let your disappointment about your choice to affect your ability to get through your prelim year...would suck for you to not make it though your prelim year and then not be able to do your advanced program....that would be the real permanent mark on your CV.

This is a a good post for future applicants...choosing a "chill" program so you have less work isn't always the best option.
 
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MIRBP2400

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its a year...keep your head down, be a good intern and be happy when you move onto to your advanced program...and don't let your disappointment about your choice to affect your ability to get through your prelim year...would suck for you to not make it though your prelim year and then not be able to do your advanced program....that would be the real permanent mark on your CV.

This is a a good post for future applicants...choosing a "chill" program so you have less work isn't always the best option.

That advice is better directed to top tier candidates choosing to go to competitive TY year programs, rather than to my case. I ranked several TYs lower because I'd rather have location, over the "chiller" program. I wanted someplace that will train me to be a good doctor, build my confidence in treating patients, and prepare me for my advanced specialty. In retrospect, the smaller program isn't as fine-tuned to those needs, but I could be wrong. My foolish mistake was to listen to the advice of current residents on the interview trail, who advertised certain programs over others. The real warning here should be to pick the most prestigious program and maximize the tangible benefits so you can move forward with no regrets.
 
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MIRBP2400

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That advice is better directed to top tier candidates choosing to go to competitive TY year programs, rather than to my case. I ranked several TYs lower because I'd rather have the location, over the "chiller" program. I wanted someplace that will train me to be a good doctor, build my confidence in treating patients, and prepare me for my advanced specialty. In retrospect, the smaller program isn't as fine-tuned to those needs, but I could be wrong. My foolish mistake was to listen to the advice of current residents on the interview trail, who advertised certain programs over others. The real warning here should be to pick the most prestigious program and maximize the tangible benefits so you can move forward with no regrets.
its a year...keep your head down, be a good intern and be happy when you move onto to your advanced program...and don't let your disappointment about your choice to affect your ability to get through your prelim year...would suck for you to not make it though your prelim year and then not be able to do your advanced program....that would be the real permanent mark on your CV.

This is a a good post for future applicants...choosing a "chill" program so you have less work isn't always the best option.
And I'll take it from your reply that there is no recourse possible...
 

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Wait so you thought the program you matched would be chill but you got your schedule and realized it’s not chill?
 
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Kracin

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in combination with my advanced program doesn't set me up for an academic career, which I had hoped to pursue

You're crazy if you think a 1 year prelim before your residency will preclude you from reaching academia. Enjoy the 1 year of short commute at your community program and calm down on the self-pitying. Your prelim medicine is about building your knowledge, not establishing yourself as an expert.
 
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NotAProgDirector

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There are plenty of threads that start like this, and then 6-9 months later the OP comes back saying how happy they are, how if they knew then what they know now that this program would have been #1 on their list.

Absolutely no one is going to care where your prelim year was. It's not going to affect your career at all.
 
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MIRBP2400

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Wait so you thought the program you matched would be chill but you got your schedule and realized it’s not chill?

A resident I met at another interview basically said if you don't get into a TY year, you should go to this IM program. That stuck with me when I made my rank list and i dropped my common sense. I thought 'similar to TY' meant possible elective time, diverse rotations, etc. Schedule turns out to be strict IM year. If I wanted that, I could have gotten that at the academic center that was much better in every practical respect.

And don't care about "chill", but the personality of attendings and co-residents mattered to me. I liked it on interview day at the smaller hospital, and didn't really get to experience it at the bigger hospital since there was no interview. As I went in for orientation though, I realized the atmosphere wasn't necessarily what I had expected. And I took a huge pay sacrifice for the smaller hospital, which hurts big time.
 

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A resident I met at another interview basically said if you don't get into a TY year, you should go to this IM program. That stuck with me when I made my rank list and i dropped my common sense. I thought 'similar to TY' meant possible elective time, diverse rotations, etc. Schedule turns out to be strict IM year. If I wanted that, I could have gotten that at the academic center that was much better in every practical respect.

And don't care about "chill", but the personality of attendings and co-residents mattered to me. I liked it on interview day at the smaller hospital, and didn't really get to experience it at the bigger hospital since there was no interview. As I went in for orientation though, I realized the atmosphere wasn't necessarily what I had expected. And I took a huge pay sacrifice for the smaller hospital, which hurts big time.

How huge of a pay cut could it be? Residency salaries don’t vary THAT much...
 
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GoSpursGo

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Another reality that has begun to sink in, is that this year will be a permanent mark on my CV, and frankly, having it there in combination with my advanced program doesn't set me up for an academic career, which I had hoped to pursue.
I'm just going to ignore the rest, which honestly is mostly noise and doesn't matter in the big scheme of things. But your prelim program will have 0% impact on your long-term career trajectory; if your advanced program isn't at an institution known for launching academic careers, having a prelim year from a more prestigious institution wasn't going to change that fact. And frankly, it's not like you know that you would have matched there anyways.

Please don't waste your time trying to find a way to switch out of your prelim program. The great thing about prelim years is that they only last 12 months, so if you arrive and it turns out that you hate it every bit as much as you expect to, it will come to its natural conclusion before too long.
 
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The real warning here should be to pick the most prestigious program and maximize the tangible benefits so you can move forward with no regrets.

For those reading in the future, this is not the real warning. Others have provided you with the requisite outlook on how this isn't going to be a big deal. But I would warn you that this is the wrong lesson to learn here. Your mistake wasn't failing to pick the most prestigious program. It was an apparent failure understand what this program offered in comparison to what you wanted/needed in a program. For someone else the less prestigious program may have been perfect.
 
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akwho

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Too neurotic. Dial it back. Chill out. Cruise through intern year and you will be on to bigger and better things next year.

Do you remember the lasting impact 4th grade had on your life? This is the adult equivalent.
 
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No one is going to even notice where you did your prelim year. Most TYs are looking for a small community hospital with a chill schedule and get done with the year. Maybe the schedule isn't as bad as you think. Or you might learn a **** ton before your next stop.
 
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ThoracicGuy

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Anyone have any idea on switching prelim programs after starting? I matched to an advanced rads program but i am not at all happy with the prelim medicine program I matched to (made a huge mistake on my ROL). I need to switch out either to any open medicine or surgery programs. Apologize for not going into detail but the ROL mistake I made is substantial and to be honest, I don't think I can't seriously work a year at the place I matched to after going to orientation and figuring out my living and travelling situation. I'm also willing switch to any open surgery prelim spots. I developed a bit of a late interest in IR as well and I feel a surgery prelim would at least give me a better exposure to the field. However I didn't apply to any because I heard mixed things about the need for a surgery prelim on the trail. I know the risks involved, rocking the boat etc, and it's all things I'm considering. Right now, I wanted to just get some realistic ideas/ experiences on how to practically approach this kind of switch mid-early residency. How much did I screw myself here?

You really should just stop. Your career will not be made or broken by where you did your prelim year. No one will ever care. Ever. The only thing that people will care about is if you finished the year. You cannot switch to another program. You will risk losing your advanced position.

A surgical prelim year will not give you any specific IR experience.

Just keep your head down and get through your year. Don't go in with this bad attitude or you will have problems and if it gets bad enough, that could cause you to lose your advanced program.
 
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rokshana

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The thing that will hurt your career is if you lose the opportunity to start your advanced program...not doing or finishing a prelim intern year will risk that.
You screwed up with your poor decision and now need to live with the consequences... just pull up your wo/man pants and suck it up.
 
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MIRBP2400

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How can it be a screw up if it supposedly won't hurt my career? Wouldn't that just be not as big a deal?? Its human nature for any job recruiter or fellowship director to see a top tier name on an application and be inclined to trust that applicant more. Even as a patient, who would you trust more: a person with Harvard in his CV or some bumble hospital? Anyway, I don't write the rules, I just try to not get destroyed by them. And to make sure others don't fall into the same trap of "it doesn't matter," because let's be honest - at the end of the day, it all matters, despite what low-tier candidates (objective fact, not opinion) reassures themselves with.
 
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smq123

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How can it be a screw up if it supposedly won't hurt my career? Wouldn't that just be not as big a deal?? Its human nature for any job recruiter or fellowship director to see a top tier name on an application and be inclined to trust that applicant more. Even as a patient, who would you trust more: a person with Harvard in his CV or some bumble hospital? Anyway, I don't write the rules, I just try to not get destroyed by them. And to make sure others don't fall into the same trap of "it doesn't matter," because let's be honest - at the end of the day, it all matters, despite what low-tier candidates (objective fact, not opinion) reassures themselves with.

You're being histrionic.

You can screw up in other ways that don't hurt your career. Like - this won't hurt your career but it might be inconvenient to get to this hospital. Or you might not like the PD or your fellow interns. But it's just one year, so you can suck it up and do it.

And a "top tier" prelim year is hardly going to attract anyone's attention.
 
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MIRBP2400

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You really should just stop. Your career will not be made or broken by where you did your prelim year. No one will ever care. Ever. The only thing that people will care about is if you finished the year. You cannot switch to another program. You will risk losing your advanced position.

A surgical prelim year will not give you any specific IR experience.

Just keep your head down and get through your year. Don't go in with this bad attitude or you will have problems and if it gets bad enough, that could cause you to lose your advanced program.

Anyone that knows me knows that I will put up and shut up on the job. Professionalism is key. That's why I am just expressing my inner anguish on this forum. After match was a scary time. Felt trapped and like I had flushed a bunch of reputation and cash down the toilet out of some ill-conceived notions about each program. Will never happen again if I am ever given a choice like this again. However, I have a soft spot in my heart for this kind of community program and don't want to drag them into a mess if this is a truly insignificant issue. The objective of this post is to see if there is any APPROPRIATE way to approach this unique situation without hurting anyone. Seems like no one knows any. Anyway, for more context, I am fortunate enough to be in a position where I don't have a lot of medical school debt and have enough funds to sustain myself for a year. So even had the crazy thought of offering to work for free at the larger hospital, particularly since I have experience working with their systems. And would continue to work for the smaller hospital until they can find a possible replacement. Probably will be stymied by bureaucracy, insurance, and admin not wanting to deal with it, but just a crazy thought to preserve what is left of my ego, CV, and my sanity.
 
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smq123

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I feel like this discussion continues to spin in circles, without getting anywhere except increasingly ridiculous ideas about how prelim years work.

Closing.
 
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