Intern year of categorical accepted as prelim for advanced?

[mercaptovizadeh]

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If someone does an IM residency, is the intern year of IM recognized as the prelim year for another residency? For example, if someone does IM, and then becomes interested in neuro, psych, derm, rad onc, radiology, etc. do they have to redo the prelim year of those programs, or just the latter 3-4 years?

 

[NotAProgDirector]

If someone does an IM residency, is the intern year of IM recognized as the prelim year for another residency? For example, if someone does IM, and then becomes interested in neuro, psych, derm, rad onc, radiology, etc. do they have to redo the prelim year of those programs, or just the latter 3-4 years?

A PGY-1 categorical IM year will count the same as an IM prelim year.

 

[Nellyakgo]

A PGY-1 categorical IM year will count the same as an IM prelim year.

If this is the case, then why do people do prelim or transitional years? Is the criteria to get into (match into) a prelim or a transitional year different than getting into a categorical program?

Also, I presume one enters the categorical program with the assumption that one will finish it. i.e finish the IM residency. Are there any negatives associated with getting into a categorical IM program and then leaving after the 1st year to get into an advanced specialty?

 

[MrBurns10]

If this is the case, then why do people do prelim or transitional years? Is the criteria to get into (match into) a prelim or a transitional year different than getting into a categorical program?

Also, I presume one enters the categorical program with the assumption that one will finish it. i.e finish the IM residency. Are there any negatives associated with getting into a categorical IM program and then leaving after the 1st year to get into an advanced specialty?

Many.
1. It's much more difficult to match in a competitive specialty as an intern than as a MS4. This includes the fact that it's difficult to get time off for interviewing during your intern year, and that your PD will likely be aware you're doing it.
2. For you not to waste a year, you'd have to find an open PGY-2 position. If you go through the match, you'd still have another year before your advanced position would begin.
3. When you match, the funding a program will receive from Medicare for your training is set based on how long it is. For example, if you match in IM, Medicare will fund you 100% for 3 yrs. People switch specialties all the time so you can get around it, but it does complicate things a little bit.

These are only a few.

 

[smq123]

Are there any negatives associated with getting into a categorical IM program and then leaving after the 1st year to get into an advanced specialty?

This is a HUGELY d-bag move to make. To start out as a categorical intern, knowing that you have no intention of staying past your first year, is a pretty awful thing to do to your program. That will leave an open slot for them that they may have difficulty filling, it makes you look bad, etc. It kind of leaves the program in a bit of a lurch.

As MrBurns points out, as well, you may have difficulty interviewing for another spot, because categorical interns are expected to stay for the whole 3 years, and so getting time off to interview may be hard.

 

[Doctor4Life1769]

This is a HUGELY d-bag move to make. To start out as a categorical intern, knowing that you have no intention of staying past your first year, is a pretty awful thing to do to your program. That will leave an open slot for them that they may have difficulty filling, it makes you look bad, etc. It kind of leaves the program in a bit of a lurch.

As MrBurns points out, as well, you may have difficulty interviewing for another spot, because categorical interns are expected to stay for the whole 3 years, and so getting time off to interview may be hard.

👍

 

[Nellyakgo]

I kind of understand what you all are saying but admit I feel I haven't really got the whole nuances.

The reason I made this post in the first place was because I read through an entire different thread started by someone was getting fired at his 51st week of his first year. In that thread several people said programs look negatively onto and can make life hard for interns who are going to go on to other (advanced/competitive) specialties in their second year.

So then, I thought, if it can get that bad, wouldn't many people do a 1 year of an IM program or maybe a FM program rather than suffer?

I do understand though, that the categorical programs are meant for people to finish that program, rather than use as a 1st year bridge.

I'd appreciate if someone can elaborate more on the points made by MrBurns.

Also, in terms of matching, how does matching into a categorical IM program differ from matching into a TY or matching into a Prelim year?

Thanks.

 

[MrBurns10]

I kind of understand what you all are saying but admit I feel I haven't really got the whole nuances.

The reason I made this post in the first place was because I read through an entire different thread started by someone was getting fired at his 51st week of his first year. In that thread several people said programs look negatively onto and can make life hard for interns who are going to go on to other (advanced/competitive) specialties in their second year.

So then, I thought, if it can get that bad, wouldn't many people do a 1 year of an IM program or maybe a FM program rather than suffer?

I do understand though, that the categorical programs are meant for people to finish that program, rather than use as a 1st year bridge.

I'd appreciate if someone can elaborate more on the points made by MrBurns.

Also, in terms of matching, how does matching into a categorical IM program differ from matching into a TY or matching into a Prelim year?

Thanks.

You're not getting it. 99.9% of prelims finish out their intern years in good standing and move onto their advanced specialty. The OP's case is very rare.

And I'm not sure what more elaboration you need of the points I made. What do you still have questions about?

Matching into a categorical IM position is completely different from a prelim year. Same ERAS, same NRMP, but totally different process. You'd need letters that talk about what a great IM doctor you'd make (ideally), you'd have to convince IM PDs that you really want to do IM, etc. Plus, you couldn't match into your advanced specialty as well.

Please don't entertain this idea...it would be one of the worst decisions in ERAS history to purposely match categorical with the intention of switching out after PGY-1. If you want to match to an advanced specialty, apply to a prelim.

 

[Mattchiavelli]

I think what's being missed is that in the threat where the intern was fired in their 51st week, someone had mentioned that some prelims going into a different advanced specialty get looked down on because the prelims have an attitude of "well I'm going into derm/gas/etc so I don't really care about this IM junk" and really half ass their prelim years.

It does get kind of confusing because some of the advanced specialties that include general IM internships are termed categorical. When I was interviewing for neurology some made us meet and do an interview with the IM dept (although every one of those I did they said from the get go that if I matched to neurology there I had my categorical spot and it was mainly a formality and chance to ask questions).

Criteria for a stand-alone prelim spot is not different but you're competing for those against all specialties that require them, and for example in my case I know I wasn't as much of a shining star as someone that was going to end up matching into derm. There are other reasons to do a separate one as well, for example if you're an MS4 and your spouse is an MS3 and you do your TY in the area where you did med school then both you and your spouse go somewhere together for residency.

 

[MrBurns10]

I think what's being missed is that in the threat where the intern was fired in their 51st week, someone had mentioned that some prelims going into a different advanced specialty get looked down on because the prelims have an attitude of "well I'm going into derm/gas/etc so I don't really care about this IM junk" and really half ass their prelim years.

If that's the concern, then it's easily preventable: you just need to not have that attitude.

I just finished my prelim year and we were treated with a lot of respect from categorical residents and faculty alike. I was repeatedly told that this was the best prelim class in a long time, and much of that was because we "didn't have an attitude of superiority" and we still worked hard. Prelims will be respected if they earn it.

 

[Nellyakgo]

OK, thanks. This all helps.

Another question: How hard/easy is it to match into a prelim or TY as opposed to matching into a full program?

And the prelim & TY programs - do they take into account whether you actually have an advanced 2nd year lined up?

 

[MrBurns10]

OK, thanks. This all helps.

Another question: How hard/easy is it to match into a prelim or TY as opposed to matching into a full program?

And the prelim & TY programs - do they take into account whether you actually have an advanced 2nd year lined up?

I'm still confused why you're asking which one is easier to match into as it's not a choice you make. You should be comparing the ultimate specialties (e.g. radiology vs IM) rather than IM with the prelim year, which is just a stepping stone. And since you apply to both the prelim and the advanced specialties at the same time, you won't already have an advanced program "lined up" when you're applying to the prelim program. But they will know what specialty you're applying to.

Something tells me you still don't quite understand the process of applying to categorical and advanced programs. If you have any more questions, feel free to PM me if you don't want to ask them here.

 

[Mattchiavelli]

OK, thanks. This all helps.

Another question: How hard/easy is it to match into a prelim or TY as opposed to matching into a full program?

And the prelim & TY programs - do they take into account whether you actually have an advanced 2nd year lined up?

The 1 year prelim/tansitional programs are done entirely independently- you interview for them and they have the understanding that they are getting 1 year of work out of you and after that they really don't care because you've done your duty.

As far as difficulty matching into them, it depends on how competitive you are as an applicant. Your ranking by the program will depend on your step1, letters, class rank, etc. People applying to more competitive advanced programs (derm, diagnostic rads, etc) have a leg up only because they will have to have better numbers to get into their advanced positions as opposed to people trying for less competitive advanced programs (neurology, PM&R). There are still people in the top of their class with 260's on their step1s applying to PM&R and neurology, it's just not necessary like it is for the derm/rads people.

When I was interviewing I got the impression from the neurology programs that the advanced programs were trying to become categorical because they felt applicants were ranking categorical programs better b/c applicants would rather have all 4 years guaranteed than the possibility of having an advanced position and scrambling into a PGY-1 spot. It also can be a PITA to interview at a bunch of 1 year programs because the stand alone years are usually a whole day to themselves of interview and travel, and the time and money add up. I met a few people that were only applying to categorical programs because they didn't want to do the extra interviewing. The ones that were categorical but had an IM interview as a formality would schedule near the interview for the advanced program as a courtesy, but the stand alone PGY-1 years could be months apart.

 

[Nellyakgo]

Something tells me you still don't quite understand the process of applying to categorical and advanced programs.

Sorry if my questions sound "off". As I wrote in one of my earlier posts I'm sure I don't completely get this process. I'm trying 🙂. I'm an FMG and don't have US clinical experience, hence...
Thanks for helping me understand.

The reason I ask about which is easier to match into is because I have MAJOR major major disadvantages in terms of getting into a residency - but due to my background am genuinely interested in (and in love with) one of the most competitive specialties. But I have to be realistic too. So I'm asking the questions so that I may formulate the best strategy for myself.

I hate the word strategy by the way 🙄 I'd rather things just fall into place...

Soo, with all that said, if there's anything else you could add, I'd appreciate it. Transitional year vs. Prelim year for example. Differences btwn them and (sorry for asking again - OK hit me - btwn TY and Prelim, what are the different criteria programs have, and which one is easier to get into.

And a different question. Let's say you do match into a TY or Prelim year but don't match into the advanced specialty. What are the options for people in that position, short of just attending that 1 year of TY/Prelim with the intent of applying for the match again the next year for the advanced specialty, and hoping for the best, and knowing that they will have the 1 year gap in between should they match the following year.

 

[MrBurns10]

Sorry if my questions sound "off". As I wrote in one of my earlier posts I'm sure I don't completely get this process. I'm trying 🙂. I'm an FMG and don't have US clinical experience, hence...
Thanks for helping me understand.

The reason I ask about which is easier to match into is because I have MAJOR major major disadvantages in terms of getting into a residency - but due to my background am genuinely interested in (and in love with) one of the most competitive specialties. But I have to be realistic too. So I'm asking the questions so that I may formulate the best strategy for myself.

I hate the word strategy by the way 🙄 I'd rather things just fall into place...

Soo, with all that said, if there's anything else you could add, I'd appreciate it. Transitional year vs. Prelim year for example. Differences btwn them and (sorry for asking again - OK hit me - btwn TY and Prelim, what are the different criteria programs have, and which one is easier to get into.

And a different question. Let's say you do match into a TY or Prelim year but don't match into the advanced specialty. What are the options for people in that position, short of just attending that 1 year of TY/Prelim with the intent of applying for the match again the next year for the advanced specialty, and hoping for the best, and knowing that they will have the 1 year gap in between should they match the following year.

No problem. It can be complicated to understand all the nuances.

TY = an internship where you rotate through various services (IM, peds, surgery, etc)
-in general, tend to be cushier than prelim years
-as such, they tend to be pretty competitive
-usually hosted by community or private hospitals

Prelim = a year of internal medicine or surgery
-tend to be less competitive than TY
-can be offered at big name academic and community hospitals alike

You have a couple options if you don't match advanced and are unsuccessful in the scramble. One is to rank prelim programs at the end of your list, and if you match at one of them, you could either reenter the match the next year (and have one additional year) or try to find open PGY-2 slots. This can be very difficult, but sometimes people leave or programs expand. Another option is to take a year off and do research, which is what I tend to recommend. If you know your application isn't where it needs to be to be competitive, I would suggest taking a year off NOW (i.e. before 4th year) and doing research in it, and if possible, I would recommend doing it in the States. That can really boost your application.

 

[Nellyakgo]

Thank you!

- If the prelim programs tend to be in big name academic hospitals, does it follow that they "teach better", that residents get better training?

- If TY is cushier, does it also follow that you learn less and get less training?

- If you do a prelim year at a big name academic hospital, does that add any value/prestige to your resume, or does it really not matter because what matters is where/what specialty you finish?

- The "extra year" matter you wrote about - sorry if I got that completely bumbled:
In the case of getting into a prelim or TY but not getting into a specialty and going into the match again and having to do one additional year - if I understand this correctly - next year you match into a different program, (e.g. categorical IM) so you end up doing an extra year of whatever, so instead of finishing in say 3 years, you end up finishing in 4. Is that right? I had read in some other thread that there are issues regarding funding and that a resident gets funded for x years depending on what specialty he/she goes into to start with. So if he/she transfers to another program but needs to do say 1 year more there than he has funding for, I understood that mostly programs would not want to accept that individual because he/she wouldn't have adequate funding.
So how does this work?

 

[MrBurns10]

Thank you!

- If the prelim programs tend to be in big name academic hospitals, does it follow that they "teach better", that residents get better training?

- If TY is cushier, does it also follow that you learn less and get less training?

I would say yes...the more rigorous your training, the better trained. However, truthfully, the difference won't matter if you're going into something else entirely. Almost all residents in advanced specialties (radiology, ophtho, etc) will tell you to do the cushiest year you can. You'll learn a lot as an intern regardless where you are, and the difference in lifestyle between a rigorous prelim year and a TY is far, far greater than the difference in training that will have any impact on your future career. You'll learn what you need to during your actual residency. I followed this advice and haven't once regretted my decision.

- If you do a prelim year at a big name academic hospital, does that add any value/prestige to your resume, or does it really not matter because what matters is where/what specialty you finish?

Won't make an ounce of difference. Now, your case may be special as an FMG if you don't match advanced and are planning on trying again during your intern year. In that case, it may help your case to be at a well-known program. But if you match advanced the first time around, it won't make any difference at all where you do your internship.

- The "extra year" matter you wrote about - sorry if I got that completely bumbled:
In the case of getting into a prelim or TY but not getting into a specialty and going into the match again and having to do one additional year - if I understand this correctly - next year you match into a different program, (e.g. categorical IM) so you end up doing an extra year of whatever, so instead of finishing in say 3 years, you end up finishing in 4. Is that right? I had read in some other thread that there are issues regarding funding and that a resident gets funded for x years depending on what specialty he/she goes into to start with. So if he/she transfers to another program but needs to do say 1 year more there than he has funding for, I understood that mostly programs would not want to accept that individual because he/she wouldn't have adequate funding.
So how does this work?

My understanding is that if you match to just a prelim year, you're not limited by that rule to just a year of funding by Medicare. As for needing an additional year where you're not fully-funded, usually that's not a huge deal to programs. The issue arises when you need multiple years of funding that you can't have (e.g. you finish IM residency and decide to switch to rads). But I admit I'm not completely sure how this works, so maybe someone else can chime in.

 

[Nellyakgo]

Thank you. Thank you.
So much to think about...

 

[Law2Doc]

...
And the prelim & TY programs - do they take into account whether you actually have an advanced 2nd year lined up?

This question really comes into play in the scramble, because as Burns suggested if you match the prelim won't have the opportunity to know. But yeah, a program would rather have a "designated" prelim over a "non designated" prelim. The main reason--the program won't feel obligated to help you find a subsequent position or allow you time off to interview. Plus theres the psychological effect of wanting someone more if someone else wants him/her.

As a FMG worried about competitiveness, you probably should delete transitional year from your vocabulary. The cushier ones can be the most competitive slots in the match (because every lazy future derma, radiology, optho and gas resident wants them).