I want to get out of a Prematch Contract - Any thoughts ??

[PPGMD]

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I signed a prematch contract back on for Psychiatry. I am having serious 2nd thoughts about the field. I have decent board scores 9X 9X P all first attempts. I am thinking I should have gone for Anesthesia. Here is my problem, if I get out of the contract I don't know what I can get for this year - I'd most likely have to scramble for a spot. Please advise..thank you

 

[howelljolly]

The program where you prematched has probably taken your spot out of the NRMP already and submitted their quota (with one fewer spot). Tomorrow is the last weekday before the quota deadline, so even if the program was willing to void the contract, and re-submit their quota... they may not have time. Basically a case of : they would if they could, but they can't so they wont. So you are too late.

You should not have posted the program name here on the SDN.

 

[peppy]

Even though they can't put the prematch spot back in the match, they can still offer it to someone else, can't they? Candidates still have time to withdraw from the NRMP if they get offered a prematch, so I don't see why they can't use the prematch for someone else.
If I were the program director, I would rather be notified ASAP that the person wanted out of the prematch so I could look for someone else who really wants to be there.
Of course the scramble is very risky and you really have to weigh the risk of not getting a new spot vs. the risk that programs might hold against you that you had used up a year of funding with a year of psych when you try to switch over to anesthesia next year.

 

[ResidentMD]

The program where you prematched has probably taken your spot out of the NRMP already and submitted their quota (with one fewer spot). Tomorrow is the last weekday before the quota deadline, so even if the program was willing to void the contract, and re-submit their quota... they may not have time. Basically a case of : they would if they could, but they can't so they wont. So you are too late.

You should not have posted the program name here on the SDN.

Agreed, especially with the last sentence.

 

[Rogue Synapse]

I would edit your post and remove the name of the program and the date you signed the contract right away if I were you.

 

[NotAProgDirector]

The quota deadline is Jan 31, so they still have time to put the spot back in the match. If they are going to offer it to someone else, they can do so anytime up until ROL deadlines (as candidates can withdraw from the match right up to the end). So, there really is still plenty of time for them to address this. But, if you're going to do it, you need to do it tomorrow to give them the fair option of putting the spot back in the match.

Legally, you can usually cancel a prematch contract in writing. Theoretically the program might be legally entitled to sue you for damages, but this is basically unheard of since most applicants have no money anyway, and it's usually simple enough to find someone new (especially this early).

What to do this upcoming year is a difficult issue for you. You can try to find an anesthesia spot in the scramble, but that could be ugly. As an IMG you might find it difficult -- especially if you don't have LOR's for anesthesia, etc. Anesthesia is more competitive than psych. You could try to scramble into a prelim IM or surgery spot -- some anesthesia programs are PGY-2/Advanced starts and you'd need a prelim year anyway -- however trying to interview at programs while being a prelim can be very difficult. You could try to build your resume with research, or ? further clinical work (if you can find it).

In the end, there is no guarantee that you'd get an anesthesia spot. But if you really don't like psych, you will be miserable.

 

[ResidentMD]

Two things about this post made my day.

#1 - The OP declaring the exact date he/she joined the program (name of which has been specified), while hiding his/her USMLE scores by 9X-9X-P.

#2 -

Theoretically the program might be legally entitled to sue you for damages, but this is basically unheard of since most applicants have no money anyway, and it's usually simple enough to find someone new (especially this early).

 

[synapse lapse]

Well I imagine as soon as the PD at the above program (I'll be nice and not repost the name/date) catches wind of this thread, if he hasn't already, I imagine you will get a call OP. I would edit out your post ASAP before someone contacts them for you! I don't understand how people end up in these situations. Honestly, deciding on a residency and ultimately a career is one of the most important decisions we will ever make, and I don't see how people aren't exceptionally considerate when debating their alternatives and signing contracts. I mean jesus, I put more though into my monthly schedule it seems than some people apply to their lives.

 

[RGupta620]

So from what I understood: after the quota deadline, a program no longer can offer prematch positions. Is this correct? The final quota number reflects the number of positions available exclusively through the match. yes?

 

[howelljolly]

So from what I understood: after the quota deadline, a program no longer can offer prematch positions. Is this correct? The final quota number reflects the number of positions available exclusively through the match. yes?

Yes the quota represents the number of positions that are available through the Match. However, as Peppy and aPD pointed out, if a program has an open out-of-match position available - they can offer that position to an NRMP applicant at any time prior to the Applicant ROL deadline. Or they can offer it to anyone they want until July1.

 

[Gentle]

Well I imagine as soon as the PD at the above program (I'll be nice and not repost the name/date) catches wind of this thread, if he hasn't already, I imagine you will get a call OP. I would edit out your post ASAP before someone contacts them for you! I don't understand how people end up in these situations. Honestly, deciding on a residency and ultimately a career is one of the most important decisions we will ever make, and

I don't see how people aren't exceptionally considerate when debating their alternatives and signing contracts.
How do you know he/she wasn't exceptionally considerate. How do you know whether he spent sleepless nights thinking over this before finally accepting the position.

I mean jesus, I put more though into my monthly schedule it seems than some people apply to their lives
Yes, it might only seem so b/c you really don't know how much effort/time and sacrifice that the OP put into making this decision.

TO the OP,
Have u looked into certain things like
-Is it just the hospital that ur in wh/ is making u want to change ur decision?
-How did u come to the decision of applying for Phsyc in the first place? What has changed about it?
BUT if at the end, u really believe that Psych is now not for you? Then as mentioned above, get out of it by all means b/c u'll be miserable after spending of these yrs in school.

Good luck in your decision.

-Gentle-

 

[howelljolly]

Question for aprogdirector

after the deadline for PDs to take spots out of the match is there a site applicants can access to see if spots were taken out of the match?

You can look at FREIDA and find out how many spots the program has. Then when you rank the program with the NRMP it will tell you how many spots it has in the match. The difference between the two is the number of spots taken out of the match.

 

[ResidentMD]

You can look at FREIDA and find out how many spots the program has. Then when you rank the program with the NRMP it will tell you how many spots it has in the match. The difference between the two is the number of spots taken out of the match.

I know this is a common perception, but I think this is wrong. FREIDA only lists an average number of seats. Some program directors may decide to put one more or one less spot for the match this year - and they may not be offering any out of the match spots.

However, I am not sure about this, and I would especially look for any administrators/program directors/chief residents/anyone with a definite knowledge of this issue to clarify this.

 

[Law2Doc]

... I am having serious 2nd thoughts about the field. I have decent board scores ... I am thinking I should have gone for Anesthesia. ...

My biggest concern with this post (and maybe I'm reading too much into it) is that it sounds like you are having your biggest concerns because you had competitive scores and think you could have gotten anesthesia, not that you actually ever wanted anesthesia. Neither of the fields you have described are ideal for everyone, so it usually takes doing an elective in both and lots of sitting down with physicians in the field to get a strong sense of which is right for you. You don't say, maybe I'll do psych... but wait, I got good scores on the boards so maybe I'll do gas instead...
Doing away rotations for the more competitive things tends to be the norm so that you get the kind of exposure you need to make this kind of career decision. Hopefully I'm reading your post differently than you meant. But if not, then it doesn't matter what board scores you have, you have to shoot for programs you think, after significant research about the field, that you might like. The people who go into gas want to go into gas, they don't go into it because they can "get" it. If they do, they will be miserable, guaranteed.

As far as the prematch/match/scramble aspect, I agree with the above that you are probably running out of time to extricate yourself from a contract amicably for a prematch, and there is no legal reason the PD must let you out, and you are legally obligated to abide by the contract or owe damages (which probably aren't worth the time of the PD to enforce, since you are likely broke, but if he's a vindictive sort he's got that right to destroy your credit for the rest of your life).

It's probably too late to get interviews for gas, and you'd have to generally interview and line up a prelim as well. You could take your shot at the scramble, but bear in mind that you will need to scramble into both a prelim (not a problem) and an advanced program which will be absurdly competitive and there's a huge chance you will end up after the scramble with no gas and just some one year surgery prelim in a non-geographically desirable area, rather than a categorical prematched psych position; and you will have signed a contract for this one too. I probably would suggest that if you really really really don't want to do psych, that you may want to simply get out of your prematch and skip doing the match/scramble this year and instead spend a year hanging with anesthesiologists and doing research in the field. That would probably give you better odds next year of lining up the gas route without taking whatever prelim/advanced combo might be left over in the scramble if you even get one.

The scramble is bad news. Most people who don't land something in the first few hours go away with something other than what they wanted. So if it's simply a sense of "could I do better" rather than really really can't stand psych or really really want gas, then leave things alone.

 

[RGupta620]

My biggest concern with this post (and maybe I'm reading too much into it) is that it sounds like you are having your biggest concerns because you had competitive scores and think you could have gotten anesthesia, not that you actually ever wanted anesthesia. Neither of the fields you have described are ideal for everyone, so it usually takes doing an elective in both and lots of sitting down with physicians in the field to get a strong sense of which is right for you. You don't say, maybe I'll do psych... but wait, I got good scores on the boards so maybe I'll do gas instead...
Doing away rotations for the more competitive things tends to be the norm so that you get the kind of exposure you need to make this kind of career decision. Hopefully I'm reading your post differently than you meant. But if not, then it doesn't matter what board scores you have, you have to shoot for programs you think, after significant research about the field, that you might like. The people who go into gas want to go into gas, they don't go into it because they can "get" it. If they do, they will be miserable, guaranteed.

Absolutely agree.👍

 

[PPGMD]

I have to say this guys, I appreciate the help and advice. I tell you what, as a USIMG - its always a combination of could I have done better or what if that or this.


For me it was the fact that I spent all my clinical years at the place i signed. Its not the greatest place to work in but its a means to an end. I like certain aspects of Psych ie outpatient and consults. I think seeing what takes place on inpatient turned me off completely because some patients can't be helped at all. Some parts of it made me feel what I was doing was in humane - ie patient acts out of control - we drug them.

In the end, I worked things out with the PD at my program and I'll say this - he was understanding and offered an extending hand to help me in whatever direction I choose. Most PD's don't offer options such as him - he gave me an option to void, or do a year and see where I want to go from there. I am really fortunate to have someone like this to work with...my alternative would be family practice in a rural area or IM after next year. Things are definitely more competitive than in years past - even for psych.
I'll be grateful that I am seeing this thing to an end within the next 4 years and hope that what ever happens - I am happy - so cliche but moral of the story is do what makes you and only you happy. Money shouldn't be the only motivating factor because you'll never be great at your career if you have to force yourself each day to work.

P.S. I like outpatient ambulatory medicine - I know you work fairly hard but I love it - if anyone has input on that share as to which area I can go in - feel free

thanks again for those who shared their valuable insight

 

[PPGMD]

Absolutely agree.👍

RGupta, you are correct in reading my post. Part of it was that I felt my hard work on the boards were going to waste on a Psych career. The 2nd part of it is, I never really got a chance to see things for a 2nd time. I knew there were a few things that stood out to me - Psych, FP, IM. I loved outpatient the most and couldn't stand the hospital environment. With that said, FP offered the most out patient of all the areas mentioned and Psych's 3rd and 4th years are devoted to it primarily. The next thing that bothered me was, I would be losing my medicine knowledge over time because we don't use much of it in Psych. So it seems as though, i'll have things fine tuned after this year I suppose. As of now, my insight is poor - I have to admit that. This why I enjoy having people who have lived it share their experience on here.

 

[PPGMD]

Absolutely agree.👍

Duplicate post

 

[Law2Doc]

... Part of it was that I felt my hard work on the boards were going to waste on a Psych career. The 2nd part of it is, I never really got a chance to see things for a 2nd time. I knew there were a few things that stood out to me - Psych, FP, IM. I loved outpatient the most and couldn't stand the hospital environment....

It's very clear from this post that anesthesia shouldn't be your goal. You didn't list it as something you experienced and enjoyed. And most gas is practiced in "the hospital environment". If you haven't done an elective in it you enjoyed, and want to do something outpatient, you shouldn't go with anesthesia, sorry. This isn't about getting the "most prestigious" career your numbers suggest you might get, it's about finding what you might enjoy for the next 40 years in your life. This for some is psych, for others is FP, for still others is anesthesia. And it's not score dependent so much as career fulfillment dependent. You pick out the field that will make you happy, the rest are just perqs. Uneducated people who are lucky to get that job stocking shelves in Wallmart are the ones with no choices and life and get jobs that best pay the bills. Someone going into a profession has to be focused on career satisfaction because you are and have committed far more time and resources.

 

[howelljolly]

RGupta, you are correct in reading my post. Part of it was that I felt my hard work on the boards were going to waste on a Psych career. The 2nd part of it is, I never really got a chance to see things for a 2nd time. I knew there were a few things that stood out to me - Psych, FP, IM. I loved outpatient the most and couldn't stand the hospital environment. With that said, FP offered the most out patient of all the areas mentioned and Psych's 3rd and 4th years are devoted to it primarily. The next thing that bothered me was, I would be losing my medicine knowledge over time because we don't use much of it in Psych. So it seems as though, i'll have things fine tuned after this year I suppose. As of now, my insight is poor - I have to admit that. This why I enjoy having people who have lived it share their experience on here.

Youre lucky to have such an understanding PD. If you like outpatient medicine, and hate inpatient medicine... give psych some more time to grow on you.... Anesth. is about as inpatient as you can get... whether its in the OR or in the SICU. You dont seem to express any interest in Gas at all.

Boards are a means to an end in one sense.... your hard work got you the scores you wanted. You met the goal, and thats it. You didnt say your hard work was to get a Gas residency..so.... anyway..... and you aren't "wasting" your hard work on a Psych career (thats almost insulting). But don't think for a minute that high USMLE scores guarantee/entitle you to a competitive specialty.... so don't think that you cashed in before you should have. Thats simply not true.

I dont know why you got into psych in the first place.... but I kinda understand where you are coming from. It does bother me that there is so little general medicine in psych, and that oftentimes patients are just medicated and put in a room. But I did notice that people who were in psychiatry who really enjoyed it had a different perspective on medicine than I did. They were much more concerned with quality of life rather and easing suffering rather than worrying about finding cures and fixing things. So for them, they had just the right about of biochemistry, physio, pharm, etc. to do that. So maybe with time your perspective will change.

Anyway.... board scores dont mean much, and dont make up for grades and pedigree ... so dont have buyers remorse.

 

[ResidentMD]

Youre lucky to have such an understanding PD. If you like outpatient medicine, and hate inpatient medicine... give psych some more time to grow on you.... Anesth. is about as inpatient as you can get... whether its in the OR or in the SICU. You dont seem to express any interest in Gas at all.

Boards are a means to an end in one sense.... your hard work got you the scores you wanted. You met the goal, and thats it. You didnt say your hard work was to get a Gas residency..so.... anyway..... and you aren't "wasting" your hard work on a Psych career (thats almost insulting). But don't think for a minute that high USMLE scores guarantee/entitle you to a competitive specialty.... so don't think that you cashed in before you should have. Thats simply not true.

I dont know why you got into psych in the first place.... but I kinda understand where you are coming from. It does bother me that there is so little general medicine in psych, and that oftentimes patients are just medicated and put in a room. But I did notice that people who were in psychiatry who really enjoyed it had a different perspective on medicine than I did. They were much more concerned with quality of life rather and easing suffering rather than worrying about finding cures and fixing things. So for them, they had just the right about of biochemistry, physio, pharm, etc. to do that. So maybe with time your perspective will change.

Anyway.... board scores dont mean much, and dont make up for grades and pedigree ... so dont have buyers remorse.

I agree. You worked hard, so you could choose what YOU wanted to do. Just because I got 270s on both my USMLEs and honored all my rotations doesnt make me feel I am selling myself short by going into Family Practice, if I really want to. Maybe I can go to the best Family Practice residency there is.

 

[howelljolly]

I agree. You worked hard, so you could choose what YOU wanted to do. Just because I got 270s on both my USMLEs and honored all my rotations doesnt make me feel I am selling myself short by going into Family Practice, if I really want to. Maybe I can go to the best Family Practice residency there is.

Exactly, every specialty has their competitive top-tier residencies. Most people know about MGH and JHU for Internal Med..... But at the same time, (Im making these up...) you need a 260+ and pubs to get into Pediatrics at CHOP, or Psych at Bellevue or Duke.... The competition is just as fierce in the top residencies in every field.

At this stage, you should have realized this.

 

[PPGMD]

you all are very correct. Scores opens doors. In my case, I was from the state I signed at and my family lives 20mins from the place. I know as one progresses through residency, you lose touch with them till your done. I guess I am rather fortunate after reflecting on things. We tend to get caught in these loops where you think - What if...I have a good opportunity, I can go in many directions from this starting point FP, IM, Neuro. I will have a good chance to evaluate and learn more about things from the inside this coming year and make an informed decision which I can live with for 30 years. Once again, thanks everyone. Gentle, thanks for reading between the lines as seeing that a single rotation can cause one to doubt their choice. I have had friends who have also helped me realize that residency isn't perfect, there are parts that are less appealing- you have to keep your end point in front of you at all times so you get through it.

 

[tarlovcyst]

I signed a prematch contract back on for Psychiatry. I am having serious 2nd thoughts about the field. I have decent board scores 9X 9X P all first attempts. I am thinking I should have gone for Anesthesia. Here is my problem, if I get out of the contract I don't know what I can get for this year - I'd most likely have to scramble for a spot. Please advise..thank you

Honestly, it is probably too late to renege, especially the contract being a legal binding document.

I know it will cost you a year to re-apply, but this is why applicants should think these decisions through thoroughly....

 

[mathur]

I have to say this guys, I appreciate the help and advice. I tell you what, as a USIMG - its always a combination of could I have done better or what if that or this.


For me it was the fact that I spent all my clinical years at the place i signed. Its not the greatest place to work in but its a means to an end. I like certain aspects of Psych ie outpatient and consults. I think seeing what takes place on inpatient turned me off completely because some patients can't be helped at all. Some parts of it made me feel what I was doing was in humane - ie patient acts out of control - we drug them.

In the end, I worked things out with the PD at my program and I'll say this - he was understanding and offered an extending hand to help me in whatever direction I choose. Most PD's don't offer options such as him - he gave me an option to void, or do a year and see where I want to go from there. I am really fortunate to have someone like this to work with...my alternative would be family practice in a rural area or IM after next year. Things are definitely more competitive than in years past - even for psych.
I'll be grateful that I am seeing this thing to an end within the next 4 years and hope that what ever happens - I am happy - so cliche but moral of the story is do what makes you and only you happy. Money shouldn't be the only motivating factor because you'll never be great at your career if you have to force yourself each day to work.

P.S. I like outpatient ambulatory medicine - I know you work fairly hard but I love it - if anyone has input on that share as to which area I can go in - feel free

thanks again for those who shared their valuable insight

first of all I would like to congratulate you to get such a PD,but as a MD in neurology I would like to advice you if you don't like inpatient psychiatry don't do psychiatry because , first year it is all about inpatient psychiatry,so don't fall in that trap 😀,you never know ,after joining in residency you wont get more than 2 months of clinical exposure before you apply for a spot for next year , you already have sound clinical experience,good score ,no visa problem so you can easily get in to a good residency program even in IM,neurology,but if you join psychiatry and next year if you want to go through match process program will ask letter from your previous PD,and it is obvious that he will not be very happy to give that kind of letter of recommendation,and above all those program will ask why do you want to leave that program,if you say I did not like psychiatry that wont be good for your interview as it will indicate your weak characteristic,one of my friend had similar situation like you ,but he stayed back and he joined radiology next year as a fresh candidate,good luck,