Independent PRS fellowship Application competitiveness

[Halka]

Background:
I am a 3rd year gen surg resident who failed to match into PRS out of medical school who is trying to determine if an additional year or research is necessary to match into an independent PRS program

Hello,

I seem to not be able to find this information very easily online, but how does one determine how competitive they are for independent PRS fellowship?

The information for integrated is out there, but the information for independent track is sparse.

Would anyone who matched in their top few ranked programs be willing to divulge their information or comment on what they think was important for their success?

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[ram006]

Background:
I am a 3rd year gen surg resident who failed to match into PRS out of medical school who is trying to determine if an additional year or research is necessary to match into an independent PRS program

Hello,

I seem to not be able to find this information very easily online, but how does one determine how competitive they are for independent PRS fellowship?

The information for integrated is out there, but the information for independent track is sparse.

Would anyone who matched in their top few ranked programs be willing to divulge their information or comment on what they think was important for their success?

Hey,

I recently matched into PRS last year and I think I can shed some light.

My first questions is this - are you looking to match into a "top tier program" or just any program?

I came from a middle tier University of State program with 3 consecutive in service exams > 90 and a year of research at a major cancer center with a letter from one of the most well known department chairs in the country.

I got interviews at Ohio State, Vandy, and UVA which I consider to be strong programs. Overall, I had a total of 12 invites but got shut out from the big names like NYU, Hopkins, Penn, Harvard, etc.

The reality of the independent match is that it remains deceptively competitive (despite the match rate) bc everyone likes the same programs and the overall number of programs is shrinking. My personal opinion is that the majority of the strong middle tier places are/have transitioned to integrated spots creating a gap between the desirable and less desirable programs.

For example, if your top 5 interviews were Harvard, NYU, Hopkins, Penn and Pitt that's great and all, but you're at a pretty decent risk of falling below that considering those 5 interviews account for 9 total positions. If you're one of the top 9 applicants in the entire match then you're golden. If you elect to do no research you will likely not be in that group. I was pretty surprised at how many people had done 1 or more years in the lab and secured big letters.

There are always exceptions to the rule though and not matching at an ivory tower does not mean you can't get great training.

So, this is a long winded way of saying you get out what you put in.

If you decide not to do research just know there are plenty of people who did decide to - in addition to coming from strong programs, killing their in-service exams and getting letters from heavy hitters. All those things matter. Honestly, this may sound a little lame but I'm not entirely sure why I got snubbed from the big names. The only thing I can think of is my step 1 score. So that may even come in to play.

I put maximal effort into my application. My rank list was what it was and I was very pleased with my result. Had I not done everything I could, I'd probably a) not have interviewed at the quality of places I did and b) felt like I short changed myself.

 

[drranjit]

Thank you, @ram006 .
MS4 here, loved PRS but not competitive enough for integrated PRS, so will be applying Gen Surg. Shooting for a mid-tier, academic Gen Surg program now, and dreaming of perhaps applying for PRS fellowship in 7 years (but I'm probably not smart enough for that anyway!)
I keep hearing that the # of PRS fellowships decrease every year, while integrated programs are expanding. As someone who just went through the independent PRS match, do you have any insight as to what the PRS fellowship (for Gen Surg applicants) will be like in 5-7 years? Have you heard any attending talking about that? I'm wondering if by then, all the fellowship spots would have disappeared and it will be 100% integrated. Also wondering if I should even dream about it at this point! Finally, is it do-able to match PRS fellowship (if there're still spots by then) coming from a lower/mid-tier academic program? How about community ones?

Thanks so much for your help, and sorry about all the questions. It is so hard and rare to find someone who knows about the independent PRS match!

 

[ram006]

Thank you, @ram006 .
MS4 here, loved PRS but not competitive enough for integrated PRS, so will be applying Gen Surg. Shooting for a mid-tier, academic Gen Surg program now, and dreaming of perhaps applying for PRS fellowship in 7 years (but I'm probably not smart enough for that anyway!)
I keep hearing that the # of PRS fellowships decrease every year, while integrated programs are expanding. As someone who just went through the independent PRS match, do you have any insight as to what the PRS fellowship (for Gen Surg applicants) will be like in 5-7 years? Have you heard any attending talking about that? I'm wondering if by then, all the fellowship spots would have disappeared and it will be 100% integrated. Also wondering if I should even dream about it at this point! Finally, is it do-able to match PRS fellowship (if there're still spots by then) coming from a lower/mid-tier academic program? How about community ones?

Thanks so much for your help, and sorry about all the questions. It is so hard and rare to find someone who knows about the independent PRS match!

Flattery will get you everywhere, ha.

I don't think the PRS independent RESIDENCIES (as painful as it is to imagine doing 8 years of residency, that's what it is...) will ever completely disappear.

Like I said previously, though, I think there will continue to be a paucity of solid middle tier programs in desirable locations (I would have included Duke, UNC, UCSD in that group). The high- power prestigious programs (NYU, Harvard, Penn, Pitt, Hopkins) etc. seem to keep the spots around for diversity of residents or whatever. Then there are the holdouts like Vandy (which, though not necessarily an ivory tower, may have been the most sought after position in the match).

In my experience, those spots are out of reach for most people in the match so essentially they don't really count for Joe Blow from "middle tier state" with no research or home program.

So then you're "left" with all the other programs. Places like Wayne State, Henry Ford or Iowa which, undoubtedly, provide good training but are in pretty tough places to live if your'e coming from a metro area, married with a family and/or have no ties. I didn't even apply to those programs for that reason.

Add to that scheduling conflicts (Penn and Pitt interviewed on the same day last year) and the number can dwindle even more.

So to summarize, I think they will always be there (excluding, of course, issues with Medicare funding a resident for 8 years when the same product is producible in 6... but that's a separate soap box for me...) but don't let the match rate fool you. Getting a good spot (as opposed to any spot) is pretty hard.

I was not willing to move to some places and I got shut out at the power houses, so I was pretty anxious.

I ended up very pleased, but it was not a fun experience. I had a CV that I thought would put me in group A but I clearly was not (maybe group B+). There are still some ballers out there going for plastics.

 

[drranjit]

@ram006 , thank you so much for taking the time to answer, especially to a med student. I really appreciate your help.
Huge congratulations on matching PRS, this is so exciting!

For now, I will hope to get into a decent, academic gen surg program and see where the future takes me. Sounds like everything matters during residency (research, in service exams, letters), so I can only hope I will be able to perform to that level when I get there. I am far from being a super star in terms of test taking, but I am willing to work hard.
Honestly, as of now, I would love to get into ANY PRS program, so I would gladly go to Iowa if that means I can do PRS. But you're right, who knows in 5-7 years!

Would you have any final recommendation for a MS4, about to enter the match, with a LOT of free time until graduation?

Thanks again for your help!

 

[ram006]

Would you have any final recommendation for a MS4, about to enter the match, with a LOT of free time until graduation?

Enjoy being a 20 something year old with free time. It's a long haul.

 

[VCorp]

Hey,

I recently matched into PRS last year and I think I can shed some light.

Thank you for the informative write up, as I learned something new in your post, and after doing some research - I wasn't aware that you can do 3 years of GS residency and then apply for a plastics residency. Doing a google search, I was brought to this site:

http://acaplasticsurgeons.org/residency-resources/Pathways-to-Plastic-Surgery.cgi

which states

The Independent Model


This model includes programs with two or three years of plastic surgery training. The Independent Model has two options. The first option has two variations. Each of the pathways described satisfy the requirements of the ABPS for entry into the certification process.

1. Option 1, variation A requires at least three years of clinical general surgery residency training to complete the PREREQUISITE requirements of the ABPS. Candidates must complete a minimum requirement of 36 months of training including specific rotations, which are noted in the ABPS Booklet of Information. This requirement of ABPS stipulates that a minimum of three years of clinical training in general surgery, with progressive responsibility, in the same program must be completed before the resident enters a plastic surgery residency.

Sorry if this is a dumb question, but did you do research while you were a resident, or did you take a year off to do the research between PGY1-2 or 2-3? I'm just trying to get an idea of what options are available to me as a GS resident.

 

[ram006]

Thank you for the informative write up, as I learned something new in your post, and after doing some research - I wasn't aware that you can do 3 years of GS residency and then apply for a plastics residency. Doing a google search, I was brought to this site:

http://acaplasticsurgeons.org/residency-resources/Pathways-to-Plastic-Surgery.cgi

which states

Sorry if this is a dumb question, but did you do research while you were a resident, or did you take a year off to do the research between PGY1-2 or 2-3? I'm just trying to get an idea of what options are available to me as a GS resident.

That info is old. Switching after three years of GS and starting as a PRS PGY4 is no longer possible.

You can, however, still transfer into an integrated residency with certain limitations, you just can't progress from GS PGY3 to PRS PGY4 (i.e. you can switch after GS intern year and start as a PRS PGY2 or after GS PGY2 for a PRS PGY3). Personally, I think it's kind of stupid that option no longer exists but it is what it is I guess. There's a previous thread on here somewhere where I posted the most recent ACGME rules for transfer.

I interviewed at an integrated program as a GS PGY3 for an integrated PGY3 (i.e. a lateral move) and, in retrospect, it was a waste of time and money. They clearly had their people picked before the interview day. That's not to say you shouldn't try, but those open positions are highly sought after and if you're not somebody's guy (or gal) they're a hard, if not impossible, pull.

I did research between my PGY2 and 3 years.

As far as your options go, you can try and switch with the above limitations. If you're at a place with an integrated PRS program that would help, but again, pretty unlikely. It would obviously be ideal to save a couple years but realistically the most attainable path is completing a GS residency and continue your training in PRS.

 

[VCorp]

That info is old. Switching after three years of GS and starting as a PRS PGY4 is no longer possible.

.

Thanks for the info! Shortly after I made that post I saw online how this was stopped in 2009, as well. Smh.

Yeah, the program which I have a good chance of getting into for GS doesn't have a PRS program, unfortunately.

I did the search for PRS programs and found a list available, which also has a GS residency. The real only IMG "friendly" place on there that id have a shot of getting into their GS program is Albany MC.

Seems like the best viable option will be completing the 5-6 yrs of GS, and then doing a PRS fellowship. I have University of Maryland on my list for GS residency. They have a mandated 2 year research requirement for their residency. Seems appealing, but that means I'm looking st 10-11 years for everything to be completed.

 

[ram006]

Thanks for the info! Shortly after I made that post I saw online how this was stopped in 2009, as well. Smh.

Yeah, the program which I have a good chance of getting into for GS doesn't have a PRS program, unfortunately.

I did the search for PRS programs and found a list available, which also has a GS residency. The real only IMG "friendly" place on there that id have a shot of getting into their GS program is Albany MC.

Seems like the best viable option will be completing the 5-6 yrs of GS, and then doing a PRS fellowship. I have University of Maryland on my list for GS residency. They have a mandated 2 year research requirement for their residency. Seems appealing, but that means I'm looking st 10-11 years for everything to be completed.

Ya it's a long haul. I'll end up doing 9 (counting research) possibly 10 if I can't get a job without a super fellowship.

I've already put the feelers out there and, as expected, I've run into the "they just don't make residents the same these days" kind of attitude with some people implying they wouldn't take someone without advanced training (micro, hand, whatever). I expect a fellowship on top of PRS will become the norm-- even if it's not truly necessary to be a safe, efficient surgeon. Hopefully, that's not the case though I'm getting tired of training already...

If you find anything else you could see yourself doing during GS, I would seriously consider it.

In retrospect, had my program not been so backloaded with operative experience, I may have pursued CRS. I also really liked pedi, but wasn't interested in doing more research to have a 40% chance of matching or whatever.

What it really boiled down to for me was I couldn't see myself having a 30 year career in GS (and being happy) whereas a 26-27 year career in plastics seemed much more doable. But alas, that is the difficult thing about residency and specialty choice. We make decisions based on our experience as a resident without knowing for certain what it's like to be an attending.

 

[VCorp]

What it really boiled down to for me was I couldn't see myself having a 30 year career in GS (and being happy) whereas a 26-27 year career in plastics seemed much more doable. But alas, that is the difficult thing about residency and specialty choice. We make decisions based on our experience as a resident without knowing for certain what it's like to be an attending.

One of the reasons why my parents don't want me to do surgery. I'm a bit older than most of the people traditionally entering residency (31). So if everything goes planned, we're at a best case scenario of 8 years, but since I'm an IMG, I'll add 2 extra years. One for prelim year and another just for the sake of having to take time off to do research, if I can't juggle it during training. This puts me at 41 by time I'm done.

A hospital here in my city just made a rule that surgeons can't practice in their hospital after the age of 65, giving me a shelf life of only 24 years...ehh, pretty small shelf life for devoting a decade of my life to medicine. Don't get me wrong, they're super supportive and they have far better foresight than I do.

Dad wants me to take over his private practice, but it's in a specialty that I struggled with during med school and as a result not too fond of it. It certainly would be the ultimate silver platter to be done and have a practice ready for me, and I'd be done by 36, TOPS. Wouldn't have to worry about any age restrictions and could easily practice well into my late 60s if I wanted to.

Just curious, but would you be interested in working with a SDN member on your PRS research? I just got my first case report published, and I have two more in the pipline which are submitted and waiting to hear back. One of them I had to revise. I would absolutely love to collaborate with you if you're interested.

 

[ram006]

One of the reasons why my parents don't want me to do surgery. I'm a bit older than most of the people traditionally entering residency (31). So if everything goes planned, we're at a best case scenario of 8 years, but since I'm an IMG, I'll add 2 extra years. One for prelim year and another just for the sake of having to take time off to do research, if I can't juggle it during training. This puts me at 41 by time I'm done.

A hospital here in my city just made a rule that surgeons can't practice in their hospital after the age of 65, giving me a shelf life of only 24 years...ehh, pretty small shelf life for devoting a decade of my life to medicine. Don't get me wrong, they're super supportive and they have far better foresight than I do.

Dad wants me to take over his private practice, but it's in a specialty that I struggled with during med school and as a result not too fond of it. It certainly would be the ultimate silver platter to be done and have a practice ready for me, and I'd be done by 36, TOPS. Wouldn't have to worry about any age restrictions and could easily practice well into my late 60s if I wanted to.

Just curious, but would you be interested in working with a SDN member on your PRS research? I just got my first case report published, and I have two more in the pipline which are submitted and waiting to hear back. One of them I had to revise. I would absolutely love to collaborate with you if you're interested.

Appreciate the offer but my research was a means to an end. I'm gonna enjoy my chief year and spend as much time not working as possible..