MD I need advice. I don't know what to do.

[Bassurgery]

Match day today... I matched to IM.. my 10th rank. I had 9 categorical gen surg interviews.

I am devastated. What are my options? I know that the NRMP considers your contract "complete" after 45 days. Can I look for spots that open up for categorical PGY1 surgery after July 1st? Or can I use the program that searches for open residency spots and potentially change spots any time during my IM intern year?

I know that I can reapply for the match (and I will), but can I apply for PGY2 after 1 year of IM? If I reapply for the match and don't match, does this mean that I will lose my current residency spot?

I was meant for surgery. This COVID/virtual stuff was just so difficult for me. I applied IM as a backup ONLY because of this year's abnormalities.

Any advice is appreciated.

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[SurfingDoctor]

Match day today... I matched to IM.. my 10th rank. I had 9 categorical gen surg interviews.

I am devastated. What are my options? I know that the NRMP considers your contract "complete" after 45 days. Can I look for spots that open up for categorical PGY1 surgery after July 1st? Or can I use the program that searches for open residency spots and potentially change spots any time during my IM intern year?

I know that I can reapply for the match (and I will), but can I apply for PGY2 after 1 year of IM? If I reapply for the match and don't match, does this mean that I will lose my current residency spot?

I was meant for surgery. This COVID/virtual stuff was just so difficult for me. I applied IM as a backup ONLY because of this year's abnormalities.

Any advice is appreciated.

Why not go into critical care? You get to do the procedures... and you get to practice physiology too...

 

[Bassurgery]

Why not go into critical care? You get to do the procedures... and you get to practice physiology too...

Because I want to do surgery. My personality fits a surgeon. I would prefer to be able to work with my hands more and enjoy the excitement and satisfaction associated with surgery. I have truly never wanted anything else and I really don't want this to be the end of the line for me.

 

[Dral]

I think @NotAProgDirector can probably answer some of your technical qestions.

If you’re going for gen surg, I don’t think you’ll be able to go into PGY2 of gen surg after an intern year in medicine unfortunately. If you find a PGY1 surg open up though that would probably work, but I think that option would only happen in a few rare instances (like a new program opening up or an existing program expanding to include a new spot). Even then, the spots would likely be through the normal match.

In terms of your spot, if you go through the match again, from what I’ve seen at least on SDN, it seems that your PD would likely want to start searching for a replacement and might not wait for you if you happen to not match again.

 

[Bassurgery]

I think @NotAProgDirector can probably answer some of your technical qestions.

If you’re going for gen surg, I don’t think you’ll be able to go into PGY2 of gen surg after an intern year in medicine unfortunately. Likewise if a gen surg spot opens up and you’re in your IM year you won’t be able to take it unless the program somehow lets you start from ground zero...there will likely be a bunch of people doing prelim surg years going for it who can just start at the PGY2 level in surgery outright. If you find a PGY1 surg open up though that would probably work, but I think that option would only happen in a few rare instances (like a new program opening up or an existing program expanding to include a new spot). Even then, the spots would likely be through the normal match.

In terms of your spot, if you leave it to go through the match again, from what I’ve seen at least on SDN, it seems that your PD would likely want to start searching for a replacement and might not wait for you if you happen to not match again.

Thank you for your input. I am just wondering if I can see if someone with a PGY1 gen surg spot will switch to a PGY1 IM spot (like someone who found out surgery wasn't for them). Is this even a possibility?

 

[AnatomyGrey12]

If you were so set on surgery why even apply and rank IM programs.... why not put prelim surgery spots at the end of your list....

 

[Dral]

Thank you for your input. I am just wondering if I can see if someone with a PGY1 gen surg spot will switch to a PGY1 IM spot (like someone who found out surgery wasn't for them). Is this even a possibility?

There are threads about this periodically on here. I think it is technically possible and I think it’s been done. There is a forum in the residency group of forums about open spots and people post ‘trade’ posts. I’m just not sure how likely it is to happen. If someone was leaving a program, I would think the PD would like to at least interview a few people to get the person they wanted instead of just taking a trade of a single person. But if the PD spoke with you and thought you were a fit (and vice versa for the other person) I think it can technically happen? I really don’t know for sure, and hopefully someone can chime in on that one.

I think mostly when they would happen, it’s across the same specialty and both people are technically up to speed on their training requirements. For example a pgy1 neuro resident couldn’t just trade with a pgy1 pathology resident since the path resident hadn’t done the pgy1 year required for neuro thus far and vice versa. Since pgy1 IM and pgy1 surg are different rotations and requirements, I’m not sure they would fulfill the other program requirements in general to advance to PGY2 after completion of the year.

If you’re dead set on surgery, I think your best bet is to enter the match for surgery again. Apply to and interview at (the harder part since you’ll be an intern responsible for patient care making it harder to interview) as many programs as possible (including surg prelim years). However, as I alluded to, I think you’d likely be giving up your IM spot and not be able to keep it. It’s a roll of the dice. At the very least hopefully you could get a prelim surgery year and work your butt off and be the best intern ever and stay on at that program. Ideally you’d match into cat. gen surg though.

As anatomygrey12 noted, it would have been better if you had applied to, interviewed at, and ranked surg intern years below your cat surg programs on your primary list, but what’s done is done at this point (I just say that so other people reading this know it).

Sorry for the tough spot you’re in. Hopefully others have some advice to help you out.

 

[Bassurgery]

If you were so set on surgery why even apply and rank IM programs.... why not put prelim surgery spots at the end of your list....

I listened to my advisor who said "prelim is a path to nowhere."

 

[SurfingDoctor]

I gotta admit... having seen a couple of trainees switch gears mid-training... its always an issue. Not an insurmountable one... but an issue none the less that always raises questions. But I guess people have to follow what they think is best.

 

[FutureDoctor5000]

I listened to my advisor who said "prelim is a path to nowhere."

This is not true most prelims who are US grads and don’t have visa issues have a decent shot at matching into categorical surgery as either pgy-1 or pgy-2 I know of several such people from my school just in the last year.

 

[NotAProgDirector]

You've already gotten most of the advice I would have written.

Swapping spots is often talked about here on SDN -- in fact I think there's a whole forum dedicated to it. It basically never happens, as it assumes that PD's consider residents like widgets that are interchangeable. Possible but unlikely -- not to mention that the number of people who match GS but change their mind early to switch to IM is very low.

Looking at your post history, you suggest that you're at SGU. Are you a US grad, or US IMG? Advice will be somewhat different.

I don't know whether GS programs will accept an IM PGY-1 for their PGY-1. I expect not, but maybe. Would depend upon ABS rules, and whatever standards a program has.

Trying to rematch is going to be a challenge but can be done. Hope that interviews remain virtual, it will be very difficult to go on enough in-person interviews while being a PGY-1. Match day is mid March, your IM program might refill your PGY-2 position before the match, hence if you don't match you end up with nothing.

US IMG or US MD?

 

[LunaOri]

I listened to my advisor who said "prelim is a path to nowhere."

Not true. Being in a prelim spot positions you to step in to a categorical spot if one opens up, which does happen sometimes.
Is it possible for you to do a research year in surgery and reapply for the match? I don’t know what the repercussions would be of turning down your IM spot.

 

[AnatomyGrey12]

If you are an IMG who didn’t match with 9 surgery interviews the hard to hear truth is that your best way forward IMO is to do the IM residency and recognize you took your shot at surgery and it didn’t work out. I’m not really seeing a viable path to surgery from this juncture unfortunately

 

[and 99 others]

This is not true most prelims who are US grads and don’t have visa issues have a decent shot at matching into categorical surgery as either pgy-1 or pgy-2 I know of several such people from my school just in the last year.

Out of curiosity, how does having a visa make one have less of a shot?

 

[Goro]

If you are an IMG who didn’t match with 9 surgery interviews the hard to hear truth is that your best way forward IMO is to do the IM residency and recognize you took your shot at surgery and it didn’t work out. I’m not really seeing a viable path to surgery from this juncture unfortunately

My young colleague is spot-on in this advice.

The harsh truth OP, is that although you were meant for surgery, surgery was not meant for you.

Are there not IM fellowships that would lead to subspecialties with surgical possibilities? My father-in-law's urologist picked that specialty because he wanted to deal with patients, and do procedures

 

[Goro]

Out of curiosity, how does having a visa make one have less of a shot?

Residency programs do not want to deal with Visa issues

 

[and 99 others]

Residency programs do not want to deal with Visa issues

ah yeah I'm aware of that but I meant is there something specifically about matching from prelim to categorical surgery as a US MD international student. Or was the implication just that its hard to match into surgery for an international student, period?

 

[Goro]

ah yeah I'm aware of that but I meant is there something specifically about matching from prelim to categorical surgery as a US MD international student. Or was the implication just that its hard to match into surgery for an international student, period?

The bolded

 

[Lem0nz]

Do your IM residency and find something else you'll enjoy. GI, cards, pulm/cc. All very procedure heavy. People here mentioning residency swaps are mentioning a unicorn - its probably us doing you a disservice. Its not going to happen even if it 'technically exists'. If such a spot for surgery opens up, it will go to someone in a surgery prelim spot, not you.

It is hard. It is sad. But is the truth.

 

[GoSpursGo]

As hard as it is to hear, I agree with the advice you have been given—you shot your shot on surgery, and it turns out you weren’t competitive enough for it. You surely must have known this was a possibility since you dual-applied. No one is guaranteed to get their preferred specialty.

I know this is disappointing, but life will go on. Do your IM residency. Be a good doctor. Maybe find a subspecialty you enjoy. But as a US IMG, doing anything other than putting your head down and playing the hand you’ve been dealt would be a grave mistake.

 

[Dral]

I was going to mention that your advisor maybe didn’t give you the best advice, but if you’re an IMG, they probably actually did give you decent advice.

I truly hope you end up in surgery somehow, but ya gotta be prepared to accept that it might not happen. It’s the brutal truth that if you were an AMG, you’d have a better chance of getting it second time around, but as an IMG it’s just not as likely to happen.

Keep going for it. You obviously have the passion. Best of luck. Even if you don’t get surgery, you have an IM spot that a lot of people would love to have. As long as you play your cards right you should end up being a boarded physician. That’s a great accomplishment any way you play it.

 

[Helper3]

Another idea is to go to your IM, bust your butt and impress them, network with their surgery department to see if you can switch over to pgy1 surgery there the following year. I would be very transparent with your PD though but only after you give IM a serious shot until end of Aug so it doesn't seem like you went in with that intention.
Who knows you might hear enough about IM & surgery in the meantime, to realize maybe you are in a better spot.

 

[Redpancreas]

Match day today... I matched to IM.. my 10th rank. I had 9 categorical gen surg interviews.

I am devastated. What are my options? I know that the NRMP considers your contract "complete" after 45 days. Can I look for spots that open up for categorical PGY1 surgery after July 1st? Or can I use the program that searches for open residency spots and potentially change spots any time during my IM intern year?

I know that I can reapply for the match (and I will), but can I apply for PGY2 after 1 year of IM? If I reapply for the match and don't match, does this mean that I will lose my current residency spot?

I was meant for surgery. This COVID/virtual stuff was just so difficult for me. I applied IM as a backup ONLY because of this year's abnormalities.

Any advice is appreciated.

This may be a difficult decision emotionally for you, but it's fairly straight forward.

If, for you, it's truly surgery or bust... you need to forfeit your PGY-1 IM categorical spot and scramble into a surgical prelimary spot. A preliminary year is how a majority of less competitive applicants get surgery. I am going to give you a dose of reality which is that if you elect to participate in the 2021-22 match, you will not match a categorical GS program but just another preliminary surgical position starting July 2022 that you were eligible for this year. Therefore, if you only want surgery, it makes the most sense to get out of that IM spot and try secure a preliminary surgery position for 2021. Your Carribean advisor, in short, played you so now on their list you show up as matched at categorical IM.

If you choose to do the above, you're taking big risks.

1.) You may not secure a 2021 prelim surg spot and have to sit out 2021 while applying ERAS 2021-2022. This will look bad.
2.) You're giving up a sure path to becoming a certified physician (categorical internal medicine 3 year contract) for a conditional 1 year contract with no guarantee of renewal. Some people have done it and found some way into surgery. The vast majority of C-IMGs have tried screwed themselves.
3.) If you secure a 2021 prelim surg spot, after the prelim, you'll either be offered a PGY-1 or 2 GS spot, be asked to do another prelim year, or told there's no more room which leaves you at the mercy of your 2021-2022 match results where you can find either do prelim surgery again and play the same game at a different institution or see if you match IM/FM which will be a lot harder the second time around because of your YOG and Carribean status. If you don't get IM/FM in the 2021-22 match, you're likely gonna be stuck with nothing but prelims and probably not find US residency training.

 

[Lawpy]

If you were so set on surgery why even apply and rank IM programs.... why not put prelim surgery spots at the end of your list....

Yep exactly.

 

[Redpancreas]

Another idea is to go to your IM, bust your butt and impress them, network with their surgery department to see if you can switch over to pgy1 surgery there the following year. I would be very transparent with your PD though but only after you give IM a serious shot until end of Aug so it doesn't seem like you went in with that intention.
Who knows you might hear enough about IM & surgery in the meantime, to realize maybe you are in a better spot.

I felt bad downvoting because you meant well but no level of butt-busting in IM will put OP in a favorable position to match surgery (prelim or cat) because OP will inevitably piss off the IM PD by leaving. The place for OP to bust their butt is at a prelim surgery program which OP should be looking for now if he wants to roll the dice to try to eventually become a surgeon at some point.

 

[Bassurgery]

I felt bad downvoting because you meant well but no level of butt-busting in IM will put OP in a favorable position to match surgery (prelim or cat) because OP will inevitably piss off the IM PD by leaving. The place for OP to bust their butt is at a prelim surgery program which OP should be looking for now if he wants to roll the dice to try to eventually become a surgeon at some point.

How is it possible to forfeit this IM spot without a match violation?

 

[Redpancreas]

How is it possible to forfeit this IM spot without a match violation?

You know TBH, I read from somewhere here recently that match was binding after 45 days and went with that plus the fact that a whole lot of people are posting asking for switches now so I figured what I describe is possible. If not, I think it's best for you to just take the IM position now, do it and get whatever experience you can from it. If you like it stay, but if not switch out for a surgical prelim for July 2022.

EDIT: Looked up the 45 day thing. It isn't what I thought it was which was that applicants have up to 45 days until July 1st to jump ship...it actually means once you're match you have to work 45 days until I guess you're eligible to switch. Regardless OP you may be able to jump ship from IM to surgery prelim (will look really stupid) but I could see some surgical prelim taking you.

 

[Bassurgery]

You know TBH, I read from somewhere here recently that match was binding after 45 days and went with that plus the fact that a whole lot of people are posting asking for switches now so I figured what I describe is possible. If not, I think it's best for you to just take the IM position now, do it and get whatever experience you can from it. If you like it stay, but if not switch out for a surgical prelim for July 2022.

EDIT: Looked up the 45 day thing. It isn't what I thought it was which was that applicants have up to 45 days until July 1st to jump ship...it actually means once you're match you have to work 45 days until I guess you're eligible to switch. Regardless OP you may be able to jump ship from IM to surgery prelim (will look really stupid) but I could see some surgical prelim taking you.

Just have hope that maybe a new cat pgy1 gen surg resident finds surgery isn't for them and wants IM 🙏

 

[Chads2]

Bust your butt in IM.

Match Gastroenterology - the ability to endoscopically stop bleeds or stent open CBD’s or drain pancreatic pseudocysts meets your criteria of healing with your hands.

Or match cardiology - treating acute MI’s with stenting or replacing valves via TAVR, TEE-guided pericardiocenteses, meets your criteria of healing with your hands.

Match pulmonology / critical care and then interventional...tumor debulking, airway stenting, perc traching...all meet your criteria of healing with your hands.

Also, even if you include 3 years of IM, 3 years of fellowship and +1 for advanced (eg structural cardiology or advanced pulm), you’d be at or just barely beyond waiting 1 year plus 5 years of gen surg.

OP, I’m neither here to kick you while you’re down nor offer you misguided hope and rah-rah cheering. But perhaps if you were familiar with any of the above specialties, you can re-orient where you are placing your finishing line.

 

[Taco Time]

Dude do the 3 years of IM, and then you could think about reapplying to surgery. It looks better that you’ve completed a residency. And if you leave IM after one year, it may take a couple of years of prelim surgery to get a spot as a categorical GS resident. It would be a wash in years spent.

The former scenario provides you with the outcome of being a board certified internist with options-e.g. procedural IM fellowship, reapplying for GS. That is a guarantee and the floor.

Leave now and reapply? No guarantees. Especially as a US IMG

 

[SurgDoc95]

Just have hope that maybe a new cat pgy1 gen surg resident finds surgery isn't for them and wants IM

You do realize this is almost certainly not going to happen right? Those of us who busted our butts (not suggesting you didn’t) and were able to match categorical GS are not going to give it a month and a half and go “meh I’ll do something else”. You’ve been given good advice, be the best IM doc you can be and go into a sub specialty heavy on procedures, but you don’t want to hear it. Time to have a reality check and be honest with yourself. Best of luck

 

[The Last Ankibender]

As a IMG, your chances of matching in anything were less that 50%. You matched celebrate that. Become a physician, if you give up you IM spot, chances of getting a categorical GS as a IMG that quit residency are slim to none


beggars can’t be choosers

 

[drducky.]

As a IMG, your chances of matching in anything were less that 50%. You matched celebrate that. Become a physician, if you give up you IM spot, chances of getting a categorical GS as a IMG that quit residency are slim to none


beggars can’t be choosers

Sounds like op really busted his ass for 4 years and put together a strong app.

He’s not your traditional img that barely scraped by. The classic “settle for fm/im cuz youre img” doesn’t apply here.

 

[bigindian4891]

Sounds like op really busted his ass for 4 years and put together a strong app.

He’s not your traditional img that barely scraped by. The classic “settle for fm/im cuz youre img” doesn’t apply here.

OP busted his ass for 4 years and put together a strong app. Like many of the applicants and residents in GS. OP gave it his best shot and didn't get accepted. They still have an opportunity to be a doctor, and have many procedures in the wide field of IM. But OP does not want to listen.

OP is not entitled to anything.

 

[Banco]

Man I really feel for you, and I really understand that it hurts.

The most realistic path for you would be however to do the 3 years of IM and go into a procedural fellowship - these can be really rewarding and can definitely fill your need for working with your hands - think GI, Interventional Cardiology. And you will have a better work life balance to boot.

This is your best option. Playing around with forfeiting spots is playing with fire with a chance of success that is likely very low. I won't say impossible, but it's low. And you will be taking a really big risk and giving up a guaranteed categorical spot. Think about if it doesn't work out and you then end up with nothing...

 

[ACSurgeon]

Just have hope that maybe a new cat pgy1 gen surg resident finds surgery isn't for them and wants IM 🙏

You know residents don’t own their residency spots right? So if you find a resident who wants to switch, it’s not up to you and that person. It’s up to the programs to allow a swap. When I was a resident our program denied someone transferring in despite having an open position. There’s lots of reasons why....

OP if you forfeit your spot be ready to never be a board certified physician as a real possibility. Do two years of IM and apply as a 3rd year resident again to surgery programs. It’s 3 “wasted” years of your life, but it’s much better than leaving a sure thing for a very very unlikely thing.

 

[mrbreakfast]

Off-topic question: do GS residencies account for expected attrition of residents? If, statistically speaking, the average GS residency loses a resident every year or two, do they just make it work, or do they accept a larger class expecting someone to drop out?


On-topic: gunna agree with everyone else that you should just do the IM residency and re-apply for GS afterwards. I know a few people who did that (IM residency -> another residency). You'll end up very knowledgeable, and could work for a year or two as an attending in between to pay off those loans.

I think the only other realistic opportunity would be an intra-institution transfer (i.e. some GS resident in your program wants to do IM) but that'd be a long shot and would probably necessitate you starting residency over - my anecdotal understanding is a good percentage of transfers out of surgery happen PGY2 year.

 

[SurfingDoctor]

Off-topic question: do GS residencies account for expected attrition of residents? If, statistically speaking, the average GS residency loses a resident every year or two, do they just make it work, or do they accept a larger class expecting someone to drop out?


On-topic: gunna agree with everyone else that you should just do the IM residency and re-apply for GS afterwards. I know a few people who did that (IM residency -> another residency). You'll end up very knowledgeable, and could work for a year or two as an attending in between to pay off those loans.

I think the only other realistic opportunity would be an intra-institution transfer (i.e. some GS resident in your program wants to do IM) but that'd be a long shot and would probably necessitate you starting residency over - my anecdotal understanding is a good percentage of transfers out of surgery happen PGY2 year.

No residency banks on having residents drop out. That’s exactly one of the reasons for the Match in the first place, to weed out those who aren’t interested.

 

[FindersFee5]

Off-topic question: do GS residencies account for expected attrition of residents? If, statistically speaking, the average GS residency loses a resident every year or two, do they just make it work, or do they accept a larger class expecting someone to drop out?


On-topic: gunna agree with everyone else that you should just do the IM residency and re-apply for GS afterwards. I know a few people who did that (IM residency -> another residency). You'll end up very knowledgeable, and could work for a year or two as an attending in between to pay off those loans.

I think the only other realistic opportunity would be an intra-institution transfer (i.e. some GS resident in your program wants to do IM) but that'd be a long shot and would probably necessitate you starting residency over - my anecdotal understanding is a good percentage of transfers out of surgery happen PGY2 year.

That's actually a really interesting question. They're probably the only program who would need to do this. I think next highest is neurosurgery at ~5%, and those residencies are small enough that you couldn't hire an extra 1/20 of the program.

 

[FindersFee5]

Also just realized that I have no idea how much intra-residency variation there is. Are some like 2% dropout and some are like 40%, or are they all kinda around 15 - 25?

 

[longhaul3]

Off-topic question: do GS residencies account for expected attrition of residents? If, statistically speaking, the average GS residency loses a resident every year or two, do they just make it work, or do they accept a larger class expecting someone to drop out?

No. The permitted class size for surgical residencies is determined by the ACGME based on the program's case volume and statutory case requirements for residents. Programs can only offer as many spots in the match as they are accredited for by ACGME. Plus, taking more and banking on attrition could theoretically put residents on track not to have enough cases to graduate if not enough people quit/get fired.

 

[xffan624]

Also just realized that I have no idea how much intra-residency variation there is. Are some like 2% dropout and some are like 40%, or are they all kinda around 15 - 25?

According to this, psych is the highest at 6% with general surgery being the second highest at 2.7%.

 

[The Last Ankibender]

Sounds like op really busted his ass for 4 years and put together a strong app.

He’s not your traditional img that barely scraped by. The classic “settle for fm/im cuz youre img” doesn’t apply here.

Not to be the bad guy but barely scraping by IMGs dont match. Good IMG candidates are the ones struggling just to get to internal medicine. OP should be happy, she can easily do three year IM then apply to GS if that really her dream. But do you really think OP should leave IM for nothing.

Just to add you don’t even know OP stats. Sure getting 9 interview for GS as an IMG, OP stats should be good but we are speculating

 

[mrbreakfast]

According to this, psych is the highest at 6% with general surgery being the second highest at 2.7%.

The reason I asked is anecdotally (and according to a quick google search, e.g. here and here) the overall attrition rate for surgery (across ~5 years) is ~20%; I have a friend whose cohort is losing two residents this year alone. From the perspective of my field (neurology) losing even a single resident would have a pretty significant affect across all the classes for the average/smaller program.

If I'm reading the data you cited correctly, though, an annual attrition rate of 6% for psychiatry blows that out of the water...

 

[ACSurgeon]

Off-topic question: do GS residencies account for expected attrition of residents? If, statistically speaking, the average GS residency loses a resident every year or two, do they just make it work, or do they accept a larger class expecting someone to drop out?


On-topic: gunna agree with everyone else that you should just do the IM residency and re-apply for GS afterwards. I know a few people who did that (IM residency -> another residency). You'll end up very knowledgeable, and could work for a year or two as an attending in between to pay off those loans.

I think the only other realistic opportunity would be an intra-institution transfer (i.e. some GS resident in your program wants to do IM) but that'd be a long shot and would probably necessitate you starting residency over - my anecdotal understanding is a good percentage of transfers out of surgery happen PGY2 year.

Surgery training used to be a pyramid system where they would fire a certain number of residents every year. That’s no longer the case and programs get in trouble for loosing “too many” residents. So, no. They don’t recruit more than they need/plan to graduate.

the GS attrition is 20%. Mostly the first few years. Many programs have residents going in and out of research years that can be flexed for manpower. Many programs have NPs and PAs and fellows so having someone leave or get fired isn’t the end of the world from a workflow perspective. Also, since most attrition happens in he first few years, there are first and second year prelim residents to fill positions as needed. Again, just because a program has a vacancy does not mean they’ll fill it if they’re not happy with their choices.

 

[ThoracicGuy]

As a IMG, your chances of matching in anything were less that 50%. You matched celebrate that. Become a physician, if you give up you IM spot, chances of getting a categorical GS as a IMG that quit residency are slim to none


beggars can’t be choosers

And there's a risk that quitting IM for surgery never pans out and then the OP can't get any further position... Then they'd be stuck with Caribbean school debt. That is not a good place to be.

 

[OraclePL]

Look at it in terms of probabilities. If you give up your categorical IM position, there's a very small chance you live out your dream of being a surgeon and a far larger chance you are left saddled with debt and no real career prospects.

It's really not a difficult equation. If you give up your spot, then best of luck to you, but don't say you weren't warned.

 

[Chads2]

Dear OP,

You have certainly caused quite a stir (without intent to do so) and I am genuinely hoping that you end up getting what you want, with the caveat that many of us who start the path of medicine never get what we want. I am not here to lecture you or judge you, but rather to have open discourse

Your post is entitled “I need advice. I don’t know what to do.” You have received plenty of advice...the problem with asking for advice is that it is inherently based on the experiences and opinions of those giving the advice. That means you run the risk of hearing things you don’t want to hear. Most of us are doctors....we tell people (patients) what they don’t want to hear all the time and we shake our heads when they don’t do as we say.

You don’t believe IM is for you and if it isn’t, then it’s not good for you, or your program, or your patients. I am lucky enough to love IM and love doing it every day and love teaching it to others and even love just being right. I cannot make you love IM...maybe a year of doing it can.

Good luck, OP. I hope you get what you love, or learn to love what you have. Either way, we’d like to know how things go for you.

 

[Lem0nz]

To answer others questions on surgery when they lose a resident in community programs that don’t have fellows, research years, or midlevels:

You suck it up and get more weekend call and night float if you’re the ones that stayed. PGY1-3s get replaced, on average about 6-9 months later after you lose one, from prelims. PGY4-5s, if you lose them they’re generally lost and you have less chiefs for one to two years and it really sucks. From personal experience. We lost a four twice in a row and my class was down a person two years running.

I guess our operative logs looked nice at least. :/

 

[sloop]

According to this, psych is the highest at 6% with general surgery being the second highest at 2.7%.

Although this is not specifically germane to the current discussion regarding surgery, I would like to point out that that figure for psychiatry is probably not accurate.

Reading through that article, it's pretty ambiguous as to how they're getting the figures for non-EM specialties. They define their study population as residents in an ACGME-accredited EM program. They describe their methods, but it's unclear whether those methods only relate to their study population or whether those are the methods they used to arrive at the data for all specialties. For our purposes here, I'll assume they used the same methods to assess attrition in psychiatry.

The article states the following:

There are two main ways to view resident attrition: There is attrition from the training program the resident initially enrolled in, and there is attrition from the specialty altogether. For several reasons, we chose the most inclusive definition by counting all attrition statuses, including attrition from one EM program to go to another EM program as well as attrition from the specialty altogether.​

This leads me to believe that they assessed the attrition in psychiatry by including any resident who switches programs prior to the completion of their full 4 years of categorical residency in the attrition group. They don't explicitly describe the details of how this was determined for psych residents but my strong suspicion is that residents who fast-tracked into child psychiatry got lumped into the attrition group. That is, these residents were part of a 4-year general psychiatry program but left their program in PGY-4 to start a 2-year child psychiatry fellowship where the first year is counts as their last year of general psychiatry training.

This would inflate the attrition numbers for psychiatry. I don't think that fast-tracking into child is reasonably seen as attrition for many meaningful purposes.

Anecdotally, a 6% attrition rate seems extremely high to me for psychiatry, which is why I strongly suspect that something's off about how they're measuring it.