IM to General Surgery?

[grouchard128]

Hello everybody. I am currently a PGY-2 in Internal Medicine (US graduate) but have been becoming less and less interested in IM over the past year. Meanwhile, I have been gaining interest in surgery... enough so that I am thinking about applying this winter 2012 to start a General Surgery residency in 2013 (after completing my Internal Medicine training)...

I actually failed my Step 1 the first time and then my Step 1/2/3 scores were 89, 83, and 77 respectively... so not great.

What are my chances of getting into an academic surgery residency?? Any advice on how I can start making this transition? I was thinking about starting to do some shadowing of the surgeons in my current hospital to get some letters of recommendations.

Thanks for all your help. I have tried searching, but this seems to be a very unique situation

---

Members don't see this ad.

 

[Buzz Me]

What will you say when interviewers ask why you initially chose Internal Medicine over Gen Surg?

 

[grouchard128]

What will you say when interviewers ask why you initially chose Internal Medicine over Gen Surg?

That I don't like IM anymore.

My main question is if my scores are enough to get me a decent Surgery position... and possibly any other advice to make myself a more attractive candidate. Best way to get rec letters for Surgery from an IM residency? Start shadowing surgeons at my program?

 

[hikikomori]

Your stats are not that great. And you failed Step 1, too. It was a good thing you at least matched at a residency program. With such scores, GS programs would see you as a liability, meaning you are more likely to fail the in-service exam and get kicked out of the program eventually. GS is getting more and more competitive and lifestyle is not exactly better than IM... worse, in fact.
So think long and hard about that. If you like procedures, just finish IM and get into a fellowship like cards or GI... but these are also competitive. Hard to pull off with your stats maybe, but easier than gen surg. At least, if you bail on your IM fellowship, you're already a fully trained internist and can make an attending's salary.

 

[grouchard128]

Your stats are not that great. And you failed Step 1, too. It was a good thing you at least matched at a residency program. With such scores, GS programs would see you as a liability, meaning you are more likely to fail the in-service exam and get kicked out of the program eventually. GS is getting more and more competitive and lifestyle is not exactly better than IM... worse, in fact.
So think long and hard about that. If you like procedures, just finish IM and get into a fellowship like cards or GI... but these are also competitive. Hard to pull off with your stats maybe, but easier than gen surg. At least, if you bail on your IM fellowship, you're already a fully trained internist and can make an attending's salary.

Yeah, I plan on finishing IM first, just so I have something to fall back on in the worst case.

The in-service exam isn't really important as it's only in-house, correct? I believe if anything, they would worry about me passing the GS boards, so I could understand that...

Any advice on what else I could do to improve my chances and show devotion/interest?

 

[DrNick Riviera]

Clearly, you are misinformed. The in service exam is given to ALL GS residents across the country. It is administered by the American Board or Surgery. Thus, it is supposed to be e best indicator of how you will perform on the GS board written exam.

With your stats, you would have difficulty matching to a GS residency straight out of med school. Although your stats alone may get you interviews, the fact that you have done something else is a huge red flag and basically will black list you. People who have done a prelim year in general surgery have difficulty matching into a categorical position.

Plus, you have to consider the fact that CMS only reimburses hospitals for training up to a certain number of years. Thus, since you have done 3 years already, you may only have a couple years left. Ie, the program would have to foot your entire bill for the rest of those years. Not exactly sure if this holds true for doing multiple residencies (I know it comes into play for people doing many years as a prelim), so others more in the know can confirm this.

Basically, you have an uphill battle. The same advice applies to any questionable candidate on here. Apply very broadly (>150) programs. Focus on community programs and other programs that have a history of taking marginal or non-traditional applicants such as yourself.

 

[Winged Scapula]

As noted above, the ABSITE (the American Board of Surgery In-Training Examination) is taken by all GS residents, every year. And as opposed to the IM ITE, the scores *are* important (i.e., residents have been placed on probation or even fired for not achieving certain scores); many programs have requirements for achievement on the examination.

For clarification purposes, when you matched into Internal Medicine "the clock" for your funding was set at 3 years. That cannot be extended. Therefore, if you use all 3 years in completing IM residency, any program will only receive approximately 50% of the total funding (there are two sources - this has been discussed extensively elsewhere). This may or may not make a difference to a program. Thus, a program will get some funding for you, but there are programs that will not/cannot accept residents without full funding (which you will not have).

I have always felt that you will never know unless you try. That is, while your switching from IM to GS may be looked at askance, there may be program directors that would see that as a strength (we had a Uro resident who had been an internist in his prior life; the attendings loved him). I would encourage you to broaden your horizons beyond "academic general surgery" and consider a wide breadth of programs, as some of the smaller programs might be willing to take a chance on you. That being said, finishing IM is a good plan.