If you decide to switch specialties during the covid season as a pgy1 (i.e. 2020-2021...?

MickyMyki

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    1. Are you put in separate pile from US seniors? i.e. last resort. or does a good performance as an intern mean anything? No red flags on my app, average clinical grades, good board scores
    2. during the covid app season, would a pgy1 potentially fare better, esp at the home institution, for the other specialty, assuming you are considered a really, really good intern? because of all the havoc of prometric, i was wondering if having all my step 1/2, CS completed would work in my favor
    3. what is the worst thing that can happen if you're a solid intern and try to switch specialties? is the worst case scenario really that I would never be a doctor again? or would the worst case be something milder, esp if the PD of my initial specialty is known to be friendly?

    overall, just want to assess my benefit:risk ratio





    thanks!
     

    differentiating

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      The worst-case scenario is that you don’t match in the new specialty and you lose your spot in the old one because your PD, as nice as they are, has to fill your spot in case you leave.

      What specialties are you switching between? Had you tried to apply to the new specialty before, or would this be a new shift? I’d think your odds would be much better in the latter case. Either way, you’re going to need a good letter from your current PD and good letters from people in the specialty you’re pursuing, I imagine.
       

      hallowmann

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        1. Are you put in separate pile from US seniors? i.e. last resort. or does a good performance as an intern mean anything? No red flags on my app, average clinical grades, good board scores...

        Yes. If you apply as an intern there's a few downsides associated with this, namely that you will be designated as a graduate and not a senior, which is in and of itself a red flag. Good performance as an intern may mean something at the same institution, but generally speaking applying as an intern puts you in a weaker position than if you applied as a senior.

        The other issue is a matter of funding and credit for training. When you start one type of training program, you are "locked in" to a specific length of funding, e.g. if you start an IM program, your training length is 3 yrs, but if you switch to a Rads program (4 yrs), even if they count your intern year for credit, then your last year would be non-funded (a bit more complex then this, realistically its partially funded, but less than if you matched in it outright). Some programs just avoid the hassle by avoiding graduates altogether. Also there is a very real probability that programs will make you start over and not recognize your whole year of training.

        In general, applying as an intern puts you in a worse position and limits your options more, especially if there were no red flags that could have been fixed by the intern year (e.g. poor LORs, newly passed licensing exams, etc.).

        ...2. during the covid app season, would a pgy1 potentially fare better, esp at the home institution, for the other specialty, assuming you are considered a really, really good intern? because of all the havoc of prometric, i was wondering if having all my step 1/2, CS completed would work in my favor...

        Generally speaking, no. Being at your home institution and making connections can certainly help, especially if you are a good intern, but there are downsides to applying as an intern as described above.

        I really wouldn't put much value into having your minimum licensing boards done. Most programs would want to see Step 3 from an intern applicant, and you won't have that. Plus, the vast majority of students pass their Steps. I doubt programs would really seek out current interns for this reason alone. Its certainly nice if you have your steps completed and others don't, but I wouldn't expect that it'll give you more of an advantage than being a current student would.

        ...3. what is the worst thing that can happen if you're a solid intern and try to switch specialties? is the worst case scenario really that I would never be a doctor again? or would the worst case be something milder, esp if the PD of my initial specialty is known to be friendly?

        overall, just want to assess my benefit:risk ratio

        thanks!

        As above, the worst case scenario is that you fail to match in the other specialty and lose your spot in the current one. If you are a US graduate, then you could get a permanent license in >30 states with successful completion of an intern year, so you wouldn't necessarily be out of medicine, but your career options would be limited. If you're an IMG, then unfortunately you will need at least 2 yrs and in most cases 3 to get licensed.

        Losing your residency doesn't necessarily mean you could never get another one, but it does put you at risk for that. Whether its worth it will depend on a lot of factors, like the program you're applying from and the program you're applying to. Obviously the safest option is applying to a program within the same institution, because you have the ability to make connections with the other program, impress them on electives/off-service rotations, etc.

        Overall, it's risky, but if the alternative is being stuck in a specialty you hate, then it might be worth it. Another alternative is to finish your current program and then reapply, so you'll have a good backup plan if it fails. If you're an IMG and trying for a more competitive specialty, I would finish your first program first. If not, I might consider it, especially if you can transfer within the same institution.
         

        ThoracicGuy

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          Wondering this as well, but wouldn't your spot still be ok since theoretically contract signing would be after you would figure out if you found a position to switch to or not? I'm thinking similarly but have red flags (board fails) which I was hoping I could theoretically compensate for with good performance/Step 3. Mine would be a 3 year to 4 year program switch. Also if you finish your current program and reapply, you would have even more funding issues since you used up all of your funding...?

          Contacts may be given out in January or February and you may not have the luxury of waiting. Your PD will likely want to know which way you want to go before the match happens so they can fill your spot. You can always apply and see what your interview offers are before committing. But then, you may have a PD willing to let you go through the match.
           
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