intern seeking advice on switching as pgy-2

[clover7]

---

Members do not see this ad.

I did not match in my chosen specialty and was forced to scramble. I got lucky (most would say) and landed a categorical spot in another specialty.

-I have heard that canceling a contract of the scramble does not have the same punishments because it is not through NRMP. Has anyone done this and if so, what were the repercussions?

-If I decided to break the contract and sit out a year, would my chances be worse or better sitting out but strengthening my app geared toward my original specialty vs. completing an internship?

-How easy is it to switch to another specialty that is slightly more competitive as a pgy-2, given that I work hard during intern year? what if I have no recent letters geared toward my original specialty?

-I honestly feel bad about taking this position away from someone who wants to pursue this specialty, because I know I want to switch to my original specialty if I can land a spot. I would love to hear from a program director who could explain to me what is best. It seems to me like informing the PD that I don't want the position now wouldn't be so terrible bc they have lots of time to fill that spot with someone who will be there for the entire duration of training. Am I wrong about this?

-if I re-enter the match for a pgy-1 spot in my desired specialty, how in the world do you coordinate interviews with being an intern? this seems impossible...

please advise!

 

[justaregularmed]

I did not match in my chosen specialty and was forced to scramble. I got lucky (most would say) and landed a categorical spot in another specialty.

-I have heard that canceling a contract of the scramble does not have the same punishments because it is not through NRMP. Has anyone done this and if so, what were the repercussions?

-If I decided to break the contract and sit out a year, would my chances be worse or better sitting out but strengthening my app geared toward my original specialty vs. completing an internship?

-How easy is it to switch to another specialty that is slightly more competitive as a pgy-2, given that I work hard during intern year? what if I have no recent letters geared toward my original specialty?

-I honestly feel bad about taking this position away from someone who wants to pursue this specialty, because I know I want to switch to my original specialty if I can land a spot. I would love to hear from a program director who could explain to me what is best. It seems to me like informing the PD that I don't want the position now wouldn't be so terrible bc they have lots of time to fill that spot with someone who will be there for the entire duration of training. Am I wrong about this?

-if I re-enter the match for a pgy-1 spot in my desired specialty, how in the world do you coordinate interviews with being an intern? this seems impossible...

please advise!

You could be a smidge less vague.

I think the first question is to figure out WHY you didn't match first of all and then move from there.

 

[Entgegen]

I did not match in my chosen specialty and was forced to scramble. I got lucky (most would say) and landed a categorical spot in another specialty.

-I have heard that canceling a contract of the scramble does not have the same punishments because it is not through NRMP. Has anyone done this and if so, what were the repercussions?

-If I decided to break the contract and sit out a year, would my chances be worse or better sitting out but strengthening my app geared toward my original specialty vs. completing an internship?

-How easy is it to switch to another specialty that is slightly more competitive as a pgy-2, given that I work hard during intern year? what if I have no recent letters geared toward my original specialty?

-I honestly feel bad about taking this position away from someone who wants to pursue this specialty, because I know I want to switch to my original specialty if I can land a spot. I would love to hear from a program director who could explain to me what is best. It seems to me like informing the PD that I don't want the position now wouldn't be so terrible bc they have lots of time to fill that spot with someone who will be there for the entire duration of training. Am I wrong about this?

-if I re-enter the match for a pgy-1 spot in my desired specialty, how in the world do you coordinate interviews with being an intern? this seems impossible...

please advise!

Kinda' curious as to an answer to the bolded question as well.

 

[Law2Doc]

Kinda' curious as to an answer to the bolded question as well.

If you timed it right, you might be able to schedule your vacation time during the time you would want to interview. It's also probably possible to interview someplace local during the day while you are on night float, but that means you are going to get by on negligible sleep. But in most cases, it's not going to be feasible to interview without your PD knowing you are interviewing. Thus the undesignated folks in prelim programs can often work with their program to get to a few interviews (in exchange for vacation days), but folks in categorical programs interviewing on the sly are going to have a very hard (if not impossible) time.

 

[NotAProgDirector]

I did not match in my chosen specialty and was forced to scramble. I got lucky (most would say) and landed a categorical spot in another specialty.

-I have heard that canceling a contract of the scramble does not have the same punishments because it is not through NRMP. Has anyone done this and if so, what were the repercussions?

This is true. Since the scramble is separate from the match, it is not a match violation to "break" the contract. That being said, don't forget that it's illegal to break the contract -- you signed it, and you can be held to it. It probably has some sort of "resign" clause in it to terminate it. You'd need to give notice to your employer, and complete how ever much of it is required by the contract (usually 90 or 120 days).

-If I decided to break the contract and sit out a year, would my chances be worse or better sitting out but strengthening my app geared toward my original specialty vs. completing an internship?

Depends. Depends on how much you can really strengthen your application. Just getting one year out from your graduation makes your application weaker, so you'd need to overcome that. Also, there is no guarantee that you'd get another spot in any field should you do this. What exactly are you going to say when programs ask you what happened in last year's match? Lie and say you just didnt get a spot? Tell the truth and say you got a spot in the scramble and then decided to renege on your contract? The first is fraud. The second would likely get you rejected. Would you hire someone who quit immediately from their last job?

-How easy is it to switch to another specialty that is slightly more competitive as a pgy-2, given that I work hard during intern year? what if I have no recent letters geared toward my original specialty?

Not terribly easy. You'd need to make yourself more competitive for that field. More elective time, research, etc. That will be hard to do during an internship. However, it is possible that some PD's will see the clinical experience as valuable (although you'll be applying in September, so the time to get LOR's from your internship is very short and often say 'Just started training, seems to be doing OK')

-I honestly feel bad about taking this position away from someone who wants to pursue this specialty, because I know I want to switch to my original specialty if I can land a spot. I would love to hear from a program director who could explain to me what is best. It seems to me like informing the PD that I don't want the position now wouldn't be so terrible bc they have lots of time to fill that spot with someone who will be there for the entire duration of training. Am I wrong about this?

Sure, except that many of the good people have already committed to other programs, so PD's will be left trying to fill your spot with whomever is left. There aren't plenty of good candidates sitting around unassigned.

On the other hand, if you show up on Day 1 and tell your PD: "Hey, actually I don't want to do this field at all, how about you write me an LOR so I can get a spot elsewhere, and I'll need lots of time off to interview", that's not going to make people happy either.

-if I re-enter the match for a pgy-1 spot in my desired specialty, how in the world do you coordinate interviews with being an intern? this seems impossible...

please advise!

It is quite difficult, as mentioned above.

 

[peppy]

Panda Bear MD (former poster here) switched from categorical FM into EM. He wrote a blog post about how he managed to wrangle some interviewing time:
http://www.pandabearmd.com/2006/03/22/the-residency-match-part-4/

It is definitely a lot harder to interview as an intern if your program isn't supportive though. I think the best strategy is to just tell them as early as you can and hope that they will be reasonable about allowing you to take rotations where you can spare time off during interview season.

 

[clover7]

aProgDirector: thanks for the advice, although it's pretty discouraging. What is the likelihood though, that the PD is going to write me a solid letter to switch to another specialty, when I've basically screwed them by wanting to switch out? I am worried that they will hold it against me. Otherwise, I would go ahead and tell them NOW, before they make my schedule so that I can get my vacation time during interview season...

I would love to know from someone who has done this. Should I inform the program prior to starting, ASAP? or wait until I've made a good impression and worked a little while before dropping the bomb?

peppy: the link didn't work =( thanks for the pointer though, I'll look over his posts...

 

[squareknot]

Hey clover,
Seeing how you would only really have 3-4 months, do you think that would be enough time to "show" for any improvement to your app? What specifically about your application prevented you from matching this year? I think you would nee more than 1 year to make any worthwhile dent to your application, especially if you're thinking about research, but will have to juggle that with "weaker applicant with more time since graduation".

 

[TGAmed]

There are a couple PGY-3's at my home institution who have switched. One from IM to OB, One Surg to Psych, couple of surg to surg subspecialties. They all seemed to think that switching within your institution is the easiest way to go. The IM program even allowed the intern to do a couple OB months to help him decide (they were hoping he'd run back to IM 🙂 ). I would think that the best thing to do would be to approach your PD and be honest about how you got where you are. He know's he acquired you in the scramble and that these things happen. Maybe also speak to the PD of your desired field and see what he/she thinks.

Tough spot. Good luck.

 

[Smurfette]

There are a couple PGY-3's at my home institution who have switched. One from IM to OB, One Surg to Psych, couple of surg to surg subspecialties. They all seemed to think that switching within your institution is the easiest way to go. The IM program even allowed the intern to do a couple OB months to help him decide (they were hoping he'd run back to IM 🙂 ). I would think that the best thing to do would be to approach your PD and be honest about how you got where you are. He know's he acquired you in the scramble and that these things happen. Maybe also speak to the PD of your desired field and see what he/she thinks.

Tough spot. Good luck.

Surgery to Psych??!! Wow, haven't seen that one before. As a PGY3? Talk about a BIG culture change.

 

[blue2000]

aProgDirector: thanks for the advice, although it's pretty discouraging. What is the likelihood though, that the PD is going to write me a solid letter to switch to another specialty, when I've basically screwed them by wanting to switch out? I am worried that they will hold it against me. Otherwise, I would go ahead and tell them NOW, before they make my schedule so that I can get my vacation time during interview season...

I would love to know from someone who has done this. Should I inform the program prior to starting, ASAP? or wait until I've made a good impression and worked a little while before dropping the bomb?

peppy: the link didn't work =( thanks for the pointer though, I'll look over his posts...

I hate to sound harsh, but why shouldn't they hold it against you? You took a categorical spot that now you don't want. I know we're all supposed to be about individual happiness, but you are screwing them slightly.

Now that being said, I'm not telling you to stay in a job you won't be happy to save other people's feelings. I'm just saying that you can't expect flowers and balloons when you walk into the PDs office, ask for a specific schedule and make their life harder. Professionals understand that people make decisions about their jobs for personal reasons, but no one is going to be thrilled.

 

[mokavious]

b

 

[Bostonredsox]

Surgery to Psych??!! Wow, haven't seen that one before. As a PGY3? Talk about a BIG culture change.

On my residency interview trail I encountered a first year EM resident who had completed 4 years of Gen surg before he realized how much he hated his life and despite being one year away from an attending surgeon he elected to start over in the ED. Don't underestimate how much hating your job can influence your life decisions.

 

[gutonc]

Surgery to Psych??!! Wow, haven't seen that one before. As a PGY3? Talk about a BIG culture change.

I have a friend who switched after PGY3 year Gen Surg to Peds. She realized peds was the best option for her because the only time she didn't want to stab herself in the face with a bovie (sp?) was when she was on Peds Surg.

 

[Smurfette]

On my residency interview trail I encountered a first year EM resident who had completed 4 years of Gen surg before he realized how much he hated his life and despite being one year away from an attending surgeon he elected to start over in the ED. Don't underestimate how much hating your job can influence your life decisions.

I've seen the PGY3 surgery resident switch to anesthesia/ER/Path (wanted to do autopsies/surg path)/surg subspecialty.
I've seen junior surgery residents contemplate switching to peds (though all I knew stuck it out hoping they'd eventually match into peds surg). And I've seen prelim surgery residents go into a variety of things.

Psych, however, is so different that it does baffle me that it took three YEARS to figure out surg wasn't for them. ER, anesthesia, etc. at least are procedural, so I can see it taking a while in a surgery residency (especially if a top-heavy program) to realize the 'bigger' procedures/responsibilities/outcomes/lifestyle aren't as enjoyable for them. But, for psych, there isn't a lot of clinical overlap with surgery, so it is a much bigger change and functions at a very different pace. And let's be honest, *most* surgery types are not "let's talk about your feelings" type of people! But at least they switched before they ended up miserable as a surgeon somewhere.

 

[TGAmed]

Surgery to Psych??!! Wow, haven't seen that one before. As a PGY3? Talk about a BIG culture change.

Sorry, been a while since I checked this thread. They are PGY3s now, but all switched after PGY-1 year. 🙂 Surg to psych would be a big game changer. The psych attending thinks this change occurs sometimes because both are invasive?...sounded like a psych explanation to me 🙂

 

[Pir8DeacDoc]

I've seen the PGY3 surgery resident switch to anesthesia/ER/Path (wanted to do autopsies/surg path)/surg subspecialty.
I've seen junior surgery residents contemplate switching to peds (though all I knew stuck it out hoping they'd eventually match into peds surg). And I've seen prelim surgery residents go into a variety of things.

Psych, however, is so different that it does baffle me that it took three YEARS to figure out surg wasn't for them. ER, anesthesia, etc. at least are procedural, so I can see it taking a while in a surgery residency (especially if a top-heavy program) to realize the 'bigger' procedures/responsibilities/outcomes/lifestyle aren't as enjoyable for them. But, for psych, there isn't a lot of clinical overlap with surgery, so it is a much bigger change and functions at a very different pace. And let's be honest, *most* surgery types are not "let's talk about your feelings" type of people! But at least they switched before they ended up miserable as a surgeon somewhere.

We had two surgery to psychs here. One was undesignated prelim and the other categorical surgery. Does seem like a big change.