internal medicine to ophthalmology

[portland]

I am considering trying to switch into ophthalmology from internal medicine. I will be finishing my residency next summer at a community internal medicine program. I have received strong evaluations from my attendings, but it is not something I see myself doing for the rest of my career. (I'm planning on doing hospitalist work for now after graduation)

I applied to ophthalmology while in medical school and was unsuccessful in matching despite 7 interviews. I reapplied as an intern and was also unsuccessful (2 interviews that match cycle). I graduated in the middle of the class from an American medical school and had unpublished ophthalmology research.

I would appreciate some advice regarding whether admissions committees consider previous internal medicine training a positive or negative factor. My own experience from applying again as an intern would suggest it is a negative factor, but I'm not sure if being a board certified internist would make a difference. Perhaps Andrew Doan or someone else with knowledge of the residency process could give some insight. Thanks for any replies.

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[JR]

This is a tough situation. I can't say I have a solution, but I have met several people on the interview trail last year who were in the process of trying to switch from surgery, medicine, etc. to ophtho. So, your situation is not uncommon. I don't see how being a US board certified internist can hurt your chances, but previous 2 un-matches certainly may. If I were in your position, I'd opt for a research year at some well-rounded middle-of-the-tier program and I'd make sure I impressed the big wigs at that program. This will definately improve your chances quite a bit.

Just my .02

P.S. I am in the middle of my internship at a small community IM program and I can completely relate to how people don't want to do IM nowdays. Oh well, back to my alcoholic quad metaphetamine abuser who came in last night with DTs...

 

[Jabronimus]

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[Jabronimus]

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[ophthope]

Alright so the reason I'm asking this is because I'm wondering what to do in my situation. I was interested in ophtho during med school, but didn't enter the match for various reasons - took a bunch of time off during med school for personal reasons, third year grades weren't great, so I didn't think I was competitive and didn't even apply.

Now I'm in an internal medicine residency. And like the original poster said ... I can't see myself doing this forever. I want to complete my internal medicine residency for lots of reasons (especially to mitigate the gap in med school time I have), so I'm tying to figure out what I should do from here to prepare my application. Anyone's advice is appreciated - it looks like a pre-match fellowship might be my best bet.

What kind of grades and Step 1/2 do you have? If you're board certified you should be able to moonlight as a hospitalist and support yourself during a pre-residency fellowship. That may be your best bet if your scores are sub-par, since developing a relationship with a program that has a pre-residency fellowship or some similar research position may significantly increase your chances of that program taking you in.

As someone who has already done a residency you may run into another issue: funding problems. Since you've finished an IMED residency, an Ophthalmology program will only receive half of the money from Medicare to support you as a resident that it would receive for a new resident. (See bullet point #7 in this document.) So a hospital without significant additional funds may not be able to support you. Just food for thought.

 

[eyesteve]

Ophthope: Thanks for sharing that document. I wasn't aware of those rules and resident funding details. While you are right that the future ophtho program would get paid 50% by Medicare because Jabronimus had already completed an internal med residency, as far as I can tell this would only be the case for the third year of ophtho residency and not for the intern year or for ophtho years one and two. (Based on IM being three years and each resident is allotted a total of five years, not including potential transitional year, leaving year three of ophtho at 50% Medicare payment for that resident.) See bullet point #8 and the example that follows the explanation in the document you mentioned for details. I could very well be wrong but that is my understanding. Whether or not a potential res program would have an issue with receiving 50% less for one resident for just one year of the three remains to be seen, but I imagine that a program would be willing to overlook this when considering Jabronimus as a potential resident, or he/she could know this going into it and expect to receive a lower salary in year three. All in all, it sounds like more work to iron out the details, but for someone considering starting residency over again I'm sure he/she clearly recognizes the additional work this decision will require. Again, great advice and thanks for posting that document. Best of luck Dr Jabronimus!

 

[Jabronimus]

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[ophthope]

Ophthope: Thanks for sharing that document. I wasn't aware of those rules and resident funding details. While you are right that the future ophtho program would get paid 50% by Medicare because Jabronimus had already completed an internal med residency, as far as I can tell this would only be the case for the third year of ophtho residency and not for the intern year or for ophtho years one and two. (Based on IM being three years and each resident is allotted a total of five years, not including potential transitional year, leaving year three of ophtho at 50% Medicare payment for that resident.) See bullet point #8 and the example that follows the explanation in the document you mentioned for details. I could very well be wrong but that is my understanding. Whether or not a potential res program would have an issue with receiving 50% less for one resident for just one year of the three remains to be seen, but I imagine that a program would be willing to overlook this when considering Jabronimus as a potential resident, or he/she could know this going into it and expect to receive a lower salary in year three. All in all, it sounds like more work to iron out the details, but for someone considering starting residency over again I'm sure he/she clearly recognizes the additional work this decision will require. Again, great advice and thanks for posting that document. Best of luck Dr Jabronimus!

Unfortunately it's not like that - the "IRP" is based on the residency in which you start training - so Jabronimus' IRP is 3 years which he has already done, he can't have 5 years of full pay even if he switches. Every resident isn't given 5 years, 5 years is just the maximum they will pay for. The number of years every person gets is based on the specialty in which they start training and it is the minimum number of years required to become board eligible in that specialty (so if you found a medicine residency that lasted 4 years they would only pay for 3, since that's the minimum it takes to be board eligible in IMED).

But like you said, I don't think most programs will think too hard about this! Unless they are having financial problems or something and just can't spare anything. But hopefully that's not most.

 

[eyesteve]

Ahh yes, you are exactly right. Thanks for the clarification!