IMG Switching Specialties

[statia]

Hey Everyone-

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[Mikkus]

Why do you feel you only received 4 surgery interviews, and why do you think you would be more successful this time around? The worst thing you want to do is ostrisize the program who took you, and leave yourself stranded.

Only getting 5 surgery interviews after applying broadly would be a big red flag something is not right.

If you leave your program after 45 days you are pretty much screwing them, and unless you have extenuating circumstances I would think it would be much harder to get a second change. Whatever you do make sure to keep your current pd happy, because any future program is going to want your current pds take on the situation.
If you do decide to leave after your intern year and reapply through eras, remember your current spot will be filled, so if you don't match a second time you will be soaping.
Personally, I would be thankful For your spot and run with it.

 

[Winged Scapula]

Moving to ERAS forum

 

[673441]

Hey Everyone-

Looking for a bit of direction here. I'm an American IMG (spare me the snarky comments please) who matched this year into internal medicine. I'm very thankful to have matched as some of my class didn't, but I was hoping to match into surgery.

I applied broadly and everywhere, had 4 categorical surgery interviews and 5 internal medicine interviews. The internal medicine was a backup specialty and I probably could have secured more if my application wasn't so obviously geared toward surgery (LOR's, electives, ECA's etc).

I ranked the four surgery spots first, followed by the five IM. On match day I came to find out that I matched my first IM choice, but can't help feeling like it's not really where the passion is.

YES, I understand I should only rank places/specialties I want to go into
YES, I understand I'm an IMG and should be happy with a residency
YES, I understand the odds of an IMG getting any surgery position
I understand all of it.

I'm posting this looking for advice on switching specialties once the match has been completed.
1) Has anyone ever done it?
2) Has anyone requested a waiver from the NRMP for a specialty change?
3) After the completion of PGY-1, can I enter the match again without any other action? IE: If I match somewhere else can I just not sign my PGY-2 IM contract? Or do I need to sort this out before hand? (Obviously the PD would be involved at this point for the sake of respect etc).
4) I completely understand the funding issues with this as well. Has anyone here ever switched to a specialty they had to partially/fully self fund?
5) Has anyone ever left a residency position after the 45 day commitment period and actually survived?

Any insight would be appreciated.

Stats:
IMG, top 5 school
Graduate Highest honors
241, 233, 1st pass
Masters of Public health
Prior Congressional Candidate
President of School
Fluff research, nothing groundbreaking

I guess you gotta learn to love it. I know, it sucks, but as IMGs we really need to take what we can.


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[mcl]

You wouldn't qualify for a waiver at your matched program simply because you failed to match in a preferred specialty that you ranked higher. That's not really a change of heart.

Please think very carefully about your next move, because a slim chance of success really isn't that good if it means that you end up not completing a residency at all. Your best bet would be to impress your IM PD with your energy and work ethic while getting his/her support for pursing your true interest, then networking with the Surgery service where you matched (i.e., meet with that PD, go to some of their grand rounds/conferences as your duties permit, ask to observe cases, etc.) before ERAS opens again in Sept.

 

[Mountaineer12]

Would it be a good idea for OP to consider completing the IM residency and then applying for surgery? That way they would be IM boarded if they don't match surgery. I know funding would be an issue and I'm not sure how that could be worked out. IM being so short, it just seems like such a risk, especially in PGY2 when you'd be halfway there. I have some friends going through similar feelings right now, OP. It's hard.


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[IMPD]

Would it be a good idea for OP to consider completing the IM residency and then applying for surgery? That way they would be IM boarded if they don't match surgery. I know funding would be an issue and I'm not sure how that could be worked out. IM being so short, it just seems like such a risk, especially in PGY2 when you'd be halfway there. I have some friends going through similar feelings right now, OP. It's hard.


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Yes, funding is an issue. You matched to a 3-year program, so you will only get 100% funding for 3 years. It's true that if you did switch to surg, your system would get 50% funding for any years past 3, but it's an issue.

I've had residents tell me that they want to switch and I generally help them figure out if it's feasible. It is good for me to have happy residents. This is not universal and you may make your PD unhappy if you tell them this.

On the other hand, there is no way to switch with good will without telling them.

Simply leaving after 45 days sounds like a horrendous idea and I would strongly discourage it. This is not professional and will reflect extremely poorly on you no matter what happens next.

@aProgDirector usually has the best advice in these situations, but the long and short of it is that I hope you have an understanding PD. Be an excellent PGY1. When the time is right, make an appointment to discuss your strong wish to be a surgeon. Worst case scenario is that you get a black mark and have to lay low for the rest of training. That would suck. However, it's the only way to get actual help and guidance to change your training program.

 

[NotAProgDirector]

Sounds like you gave GS your best attempt this year. Applying again next year is going to be difficult -- you won't be able to take large amounts of time off to interview, applications are due in Sept (and so you'll barely have started in your IM program, your letters will probably say "Just started, seems fine"). An IM year won't impress any surgeons. Your interview offers are likely to be less next year. If you really want to do surgery, you'd probably need to start with a prelim GS year, work like crazy, and hope to get lucky and get a categorical spot. But you'd risk getting nothing, and then might not get IM either.

Your best plan is to try to get a GS spot at wherever you've matched for IM. Hopefully they have a program there. Shmooze with the surgeons. Try to do some surgical electives. Hope for the best.

Otherwise, the safe play is to complete your IM residency, and then apply for surgery. You'd use your 3rd year in IM to do surgical electives (or end of 2nd year). There's usually more flexible time in the 3rd year for interviews. If you get a spot, then you're all set. If not, you still have a career in IM. You probably can't apply for surgery spots and IM fellowships as the two timelines overlap (although you could apply to both, and drop out of the surgery match if you don't get interviews).

The funding issue is complicated. For a second residency (or any fellowship), you get 50% DME and 100% IME funding. The math depends on the institution, but usually comes out to more than 75% (because IME is >> than DME). Some institutions may care, others may not. In any case, once you start IM you only get 3 years of full funding no matter what you do, so even transferring after your first year has a funding problem.