Is it possible to switch residencies after successfully matching?

[wood4045]

Hello,

I am very blessed to match during a very competitive Anesthesia cycle. However, as a couple's match applicant, me and my partner fell down our rank list and we failed to match in the same area. Since match day, I have been in such a depressed, heartbroken mood. I didn't expect for us to fall down so low on our rank list based on our stats and interview feedback.

Today, I have been thinking about the idea of possibly re-applying in the 2025-2026 match into IM/FM/Peds/EM/etc so I can potentially move closer to her. Currently, I matched into a Transitional year program + Advanced anesthesiology spot while my partner does OB. Is this idea possible?

In addition, is there any possible way that ResidencySwap could work and how would I go about that?

Thank you for any help and advice. I have been in such a low mood since Friday. Till this day, I can't believe it happened. Thank you again so much.

---

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[smq123]

Hello,

I am very blessed to match during a very competitive Anesthesia cycle. However, as a couple's match applicant, me and my partner fell down our rank list and we failed to match in the same area. Since match day, I have been in such a depressed, heartbroken mood. I didn't expect for us to fall down so low on our rank list based on our stats and interview feedback.

Today, I have been thinking about the idea of possibly re-applying in the 2025-2026 match into IM/FM/Peds/EM/etc so I can potentially move closer to her. Currently, I matched into a Transitional year program + Advanced anesthesiology spot while my partner does OB. Is this idea possible?

In addition, is there any possible way that ResidencySwap could work and how would I go about that?

Thank you for any help and advice. I have been in such a low mood since Friday. Till this day, I can't believe it happened. Thank you again so much.

How far away will you be from each other? And where is your TY in relation to where your partner matched?

 

[wysdoc]

I think you need to see this today 😍
A tale of two deans: The love story of Dr. Paul Klotman and Dr. Mary Klotman - TMC News

 

[NotAProgDirector]

Yes, with caveats.

First, I'm sorry this is happening to you. I assume you exhausted all combinations where you were geographically together. Or did you decide to prioritize program quality over geography and now have regrets? Or did you not actually use the couple's match and just hope for the best?

Regardless, options moving forward:

1. You can waive your anesthesia match if you so choose. You have until Jan 15th to do so, hence I would not rush to do so now. You would need to tell the NRMP that you have changed your mind regarding specialty, and they will waive the match. You will not be allowed to apply to anesthesia again - so that ship will have sailed.
2. Once your match is waived, then you can start looking for a spot in any other field. Your TY may get you up to a full PGY year credit in IM or FM, depending on the content and the interest in the PD. You could apply in the match for a new PGY-1, or look for a PGY-2 spot to start in July (again, depends upon what the PD is willing to consider). There's no central resource for PGY-2 positions, you'd want to connect with the IM PD at your site as they will hear of them. Not sure about EM or peds spots but probably the same applies.

Caveats:
There's no guarantee you'd get a spot near her. It's likely, but unknown. You could end up in a different specialty you like less, and still separated.

You'd probably have to pick one field and go for it. Trying to apply for "anything" close to her may be very difficult. You'll need to try to design your TY to fit whatever career you plan (unless you plan to try to rematch into a PGY-1, then the TY could be anything)

You'll need to interview from your TY. Residency is a job. You may, or may not, be granted time off to interview. They may require that you use your PTO -- and that might limit the amount you can see her this year.

You may be miserable in a new field. Tread carefully.

 

[gutonc]

So, as usual, NAPD nailed it here. I'll comment on a few parts of this. And I also want to say that I'm not downplaying how hard this is and might be on you both.

Caveats:
There's no guarantee you'd get a spot near her. It's likely, but unknown. You could end up in a different specialty you like less, and still separated.

This is the biggest risk you take here. You have to relinquish your advanced spot before you have your rank list submitted. You will need to be absolutely certain that you can match in the location you want to be in, and that's unlikely. Unless you're looking to match somewhere like NYC, Boston, Dallas, Houston, Chicago, SoCal, you may not have any/many good options there and even then in a specialty you don't love.

You'd probably have to pick one field and go for it. Trying to apply for "anything" close to her may be very difficult. You'll need to try to design your TY to fit whatever career you plan (unless you plan to try to rematch into a PGY-1, then the TY could be anything)

Pick one thing. This isn't SOAP or the scramble. And you need to have a good story for your switch, not "my girlfriend lives here".

You'll need to interview from your TY. Residency is a job. You may, or may not, be granted time off to interview. They may require that you use your PTO -- and that might limit the amount you can see her this year.

I keep forgetting that everybody gave up on in person interviews post-Pando. I think that is a massive mistake, but it might actually help you out here. If PDs finally come to their senses and restart in person interviews next year, you're likely going to be limited to half a dozen at the most. But at least they'll be in the same place your partner is.

As I said, I don't discount how traumatic this is for you and your relationship. But you definitely need to sit down together and talk about what this looks like for you (or her) to make a switch at some point.

I will also say that you could throw your hat in the ERAS ring and just see what happens. If you have another specialty you like and you get a bunch of interview offers early on, maybe that's a good sign. If you get nothing or nothing you want, that's another sign.

 

[wood4045]

How far away will you be from each other? And where is your TY in relation to where your partner matched?

We will be about 1000 miles apart unfortunately -- and my TY is the same city as my advanced anesthesia program.

 

[wood4045]

Yes, with caveats.

First, I'm sorry this is happening to you. I assume you exhausted all combinations where you were geographically together. Or did you decide to prioritize program quality over geography and now have regrets? Or did you not actually use the couple's match and just hope for the best?

Regardless, options moving forward:

1. You can waive your anesthesia match if you so choose. You have until Jan 15th to do so, hence I would not rush to do so now. You would need to tell the NRMP that you have changed your mind regarding specialty, and they will waive the match. You will not be allowed to apply to anesthesia again - so that ship will have sailed.
2. Once your match is waived, then you can start looking for a spot in any other field. Your TY may get you up to a full PGY year credit in IM or FM, depending on the content and the interest in the PD. You could apply in the match for a new PGY-1, or look for a PGY-2 spot to start in July (again, depends upon what the PD is willing to consider). There's no central resource for PGY-2 positions, you'd want to connect with the IM PD at your site as they will hear of them. Not sure about EM or peds spots but probably the same applies.

Caveats:
There's no guarantee you'd get a spot near her. It's likely, but unknown. You could end up in a different specialty you like less, and still separated.

You'd probably have to pick one field and go for it. Trying to apply for "anything" close to her may be very difficult. You'll need to try to design your TY to fit whatever career you plan (unless you plan to try to rematch into a PGY-1, then the TY could be anything)

You'll need to interview from your TY. Residency is a job. You may, or may not, be granted time off to interview. They may require that you use your PTO -- and that might limit the amount you can see her this year.

You may be miserable in a new field. Tread carefully.

Thank you for the advice. I appreciate it.

Some questions though ----- Do I need to waive my anesthesia advanced spot in order to participate in the 2025-2026 match cycle? Is it possible that I waive my current spot but fail to match in 2025-2026 and be left with nothing?

If I end up going to the re-application process, can I apply for PGY-1 IM/FM spots and PGY-2 IM/FM spots? (assuming they accept my TY)? How would I know if they accept my TY prior to applying to those spots on ERAS?

Luckily for me, my partner is doing her residency in a big city that has about 8 IM/FM programs. Is this a conversation that I should have with my medical school dean soon as well? And how soon with my future anesthesia PD?

Thank you again.

 

[gutonc]

Thank you for the advice. I appreciate it.

Some questions though ----- Do I need to waive my anesthesia advanced spot in order to participate in the 2025-2026 match cycle? Is it possible that I waive my current spot but fail to match in 2025-2026 and be left with nothing?

Yes and yes. That is the risk here.

If I end up going to the re-application process, can I apply for PGY-1 IM/FM spots and PGY-2 IM/FM spots? (assuming they accept my TY)? How would I know if they accept my TY prior to applying to those spots on ERAS?

There are no R2 spots in categorical programs on ERAS. Those are all word of mouth and occasional advertisement. If you're going to go back in the Match, you will be applying to either R1 categorical programs or R2 advanced programs (and not anesthesia).

 

[wood4045]

So, as usual, NAPD nailed it here. I'll comment on a few parts of this. And I also want to say that I'm not downplaying how hard this is and might be on you both.

This is the biggest risk you take here. You have to relinquish your advanced spot before you have your rank list submitted. You will need to be absolutely certain that you can match in the location you want to be in, and that's unlikely. Unless you're looking to match somewhere like NYC, Boston, Dallas, Houston, Chicago, SoCal, you may not have any/many good options there and even then in a specialty you don't love.

Pick one thing. This isn't SOAP or the scramble. And you need to have a good story for your switch, not "my girlfriend lives here".

I keep forgetting that everybody gave up on in person interviews post-Pando. I think that is a massive mistake, but it might actually help you out here. If PDs finally come to their senses and restart in person interviews next year, you're likely going to be limited to half a dozen at the most. But at least they'll be in the same place your partner is.

As I said, I don't discount how traumatic this is for you and your relationship. But you definitely need to sit down together and talk about what this looks like for you (or her) to make a switch at some point.

I will also say that you could throw your hat in the ERAS ring and just see what happens. If you have another specialty you like and you get a bunch of interview offers early on, maybe that's a good sign. If you get nothing or nothing you want, that's another sign.

Thank you for all your input, greatly appreciated it.

I also have a few questions for you.

1. Do I need to waive my anesthesia spot before I start my ERAS application and attend interviews? Or do I only need to waive it prior to submitting a rank list? I'm just wondering so if unfortunately I only have 1 interview in her city, the idea of waiving it is a bigger risk than if I had like 5.

2. We agreed to be engaged by this summer -- should my story be "I realized anesthesia is not for me and I really would like to pursue IM/FM due to x,y,z" and then if they ask me "why here" I can reply that my fiancee lives there?


Anyways thank you again. I think I'm a decently competitive applicant ---- I had 15+ Anesthesia interviews and my partner also lives in a big city with about 8+ IM/FM programs.

 

[gutonc]

Thank you for all your input, greatly appreciated it.

I also have a few questions for you.

1. Do I need to waive my anesthesia spot before I start my ERAS application and attend interviews? Or do I only need to waive it prior to submitting a rank list? I'm just wondering so if unfortunately I only have 1 interview in her city, the idea of waiving it is a bigger risk than if I had like 5.

Answered above. You can go ahead and apply to IM and see how it plays out. Then you have to decide if you want to roll the dice on the Match a 2nd time or stick with your advanced program and gut it out.

2. We agreed to be engaged by this summer -- should my story be "I realized anesthesia is not for me and I really would like to pursue IM/FM due to x,y,z" and then if they ask me "why here" I can reply that my fiancee lives there?

That's up to you, but that seems reasonable.

 

[Dral]

and then if they ask me "why here" I can reply that my fiancee lives there?

Different ways to look at that. If you say 'because my fiance lives here' it may be taken as "Oh, ok they have a high chance of ranking us due to location. That's good". However, programs also like to hear "I want to come here because of your awesome program (not due just to geographical reasons)".

So I'd say to craft an answer that integrates both per program.

 

[CopaceticOne]

It has been 4 days since the Match results came out. @wood4045, you need to just stop and take a bit of time before going down the path you’re asking about. I’m not saying don’t do it… Just don’t let your current raw emotions drive very real long term decisions. Let things settle for a little bit - you have the time.

Here are my questions for you and your partner to reflect upon:
1) Why were you both ok with putting the current situation into your rank list when submitted? What conversations did you both have about where that option was on the list?
2) Is there any potential that you two aren’t together in 6mo, 1yr, 4yrs? This is a big decision for both of your futures and animosity can be toxic if you are giving up your dream speciality for their wishes.
3) Have you contemplated the potential logistics of doing the long distance thing? I mean REALLY sit down and look at how to try and make it work? How do you know if you don’t think about it?
4) There is a non-zero chance that you could go through the match process for a different speciality and still not be at a location as close as you want. Would you be willing to only list programs in the same city / immediate area and go unmatched, and untrained, if you didn’t get one of them?
5) Have you had the conversation(s) with your partner about what you are feeling and where those feelings are coming from?

There are more reflective questions I could pose, but hopefully you get the gist.

I know couples that were Derm & Urology in different states for training, Anesthesia & Military in different countries, IM & Peds different cities, IM & IM in the same program… at the end of training they all were (and still are) still together because of the effort they put into maintaining their relationships during training. And likewise, they each made sure to have a support structure outside of their partner to help them with the challenges during training & life.

Nothing is easy… Just take a few deep breaths before completely scraping your current path.

 

[NotAProgDirector]

Agree with all of the above.

For sure, the first thing to do is take a deep breath and do nothing rash. Talk to your partner, come up with a game plan. You're not even engaged yet, just imagine how horrible you'll feel if you resign your spot and then break up.

You didn't answer any of my initial questions, which would help drive this conversation. Did you actually use the couple's match? Did you list all combinations where you were geo co-located? Did you discuss being separated since you ranked those options?

Back to your specific questions:

Yes, you can probably apply for spots while still matched. It's a complex topic since some programs might be quite upset if they find out afterwards that you were actually committed somewhere else. Also, your TY PD might be uncomfortable writing you a letter since they would be "complicit" in any perceived duplicity. If it was me, I'd insist that in my letter it would state that you're matched to an Anesthesia program but will be resigning. In any case you'll need to waive your match before you can participate in a new match, and you'll risk not matching at all.

Applying for a pGY-2 is similar, but is not in ERAS. You'll just reach out t programs. They may be unwilling to talk to you if you are still match committed, as it may be seen as a violation on their part.

 

[wood4045]

Agree with all of the above.

For sure, the first thing to do is take a deep breath and do nothing rash. Talk to your partner, come up with a game plan. You're not even engaged yet, just imagine how horrible you'll feel if you resign your spot and then break up.

You didn't answer any of my initial questions, which would help drive this conversation. Did you actually use the couple's match? Did you list all combinations where you were geo co-located? Did you discuss being separated since you ranked those options?

Back to your specific questions:

Yes, you can probably apply for spots while still matched. It's a complex topic since some programs might be quite upset if they find out afterwards that you were actually committed somewhere else. Also, your TY PD might be uncomfortable writing you a letter since they would be "complicit" in any perceived duplicity. If it was me, I'd insist that in my letter it would state that you're matched to an Anesthesia program but will be resigning. In any case you'll need to waive your match before you can participate in a new match, and you'll risk not matching at all.

Applying for a pGY-2 is similar, but is not in ERAS. You'll just reach out t programs. They may be unwilling to talk to you if you are still match committed, as it may be seen as a violation on their part.

We did use the couple's match on NMRP -- we filled up our list as much as we could with places where we were close to each other (no more than 2 hour drive) --- we just unfortunately fell WAY below our rank couples rank list. We never really talked about what would happen because we had a bunch (45+ combinations) where we were together and our applications were pretty decent so we were sure we would at least match 3-4 hours away worst case scenario and best case, match same city or <2 hours apart (at least 45 combos of the latter).

Opening that letter on match day.....and comparing lists......wow.....my heart has never broken enough before. We figured we would fill up our entire 300 combination list because we would rather go long-distance than go unmatched ---- both in hindsight.....I regret SO MUCH not ending our rank list at 45 and ranking TY's/Prelim spots after 50ish where our "match nearby" list ended.




I apologize for bombarding you with more questions (my dean won't return to his office until next week and I don't have any anesthesia advisors who are up-to-date on the match process) ----------- just to confirm, it is possible to apply for the 2025-2026 upcoming match (IM/FM) without "waiving" my advanced spot but if I get enough IM or FM interviews near my partner's location, I will have to "waive" my advanced anesthesia spot before I can officially rank those programs I interviewed at on the NMRP?

BUT, in the event that I only have like 1 IM interview, I can decide not to undergo the match process so no need to "waive" my advanced anesthesia spot?

For my IM/FM letters, is it best to be up-front with my TY PD/Anesthesia PD about what is going on in my life as soon as possible? One of my letter writers this past cycle was also an IM doctor so could I also use that (assuming they update it if necessary)?


I won't make any life-changing decisions right now of course. It's never good to make an emotional decision. I just wanted some information about my potential next steps if this was even possible. Thank you again.

 

[wood4045]

It has been 4 days since the Match results came out. @wood4045, you need to just stop and take a bit of time before going down the path you’re asking about. I’m not saying don’t do it… Just don’t let your current raw emotions drive very real long term decisions. Let things settle for a little bit - you have the time.

Here are my questions for you and your partner to reflect upon:
1) Why were you both ok with putting the current situation into your rank list when submitted? What conversations did you both have about where that option was on the list?
2) Is there any potential that you two aren’t together in 6mo, 1yr, 4yrs? This is a big decision for both of your futures and animosity can be toxic if you are giving up your dream speciality for their wishes.
3) Have you contemplated the potential logistics of doing the long distance thing? I mean REALLY sit down and look at how to try and make it work? How do you know if you don’t think about it?
4) There is a non-zero chance that you could go through the match process for a different speciality and still not be at a location as close as you want. Would you be willing to only list programs in the same city / immediate area and go unmatched, and untrained, if you didn’t get one of them?
5) Have you had the conversation(s) with your partner about what you are feeling and where those feelings are coming from?

There are more reflective questions I could pose, but hopefully you get the gist.

I know couples that were Derm & Urology in different states for training, Anesthesia & Military in different countries, IM & Peds different cities, IM & IM in the same program… at the end of training they all were (and still are) still together because of the effort they put into maintaining their relationships during training. And likewise, they each made sure to have a support structure outside of their partner to help them with the challenges during training & life.

Nothing is easy… Just take a few deep breaths before completely scraping your current path.

I kinda of answered this in my recent response to another poster but I will add still;

Ultimately, we were ok with adding our current situation to our rank list because it was really down our list and we never would have imagined matching at that combo. We messed up. I know. Absolutely horrible decision that we will live with for the rest of our lives.

Fortunately, we have both discussed our current situation already and we both have no doubts about continuing this relationship - we have discussed marriage and kids plenty of times and had already decided to be engaged by this summer. We will do long-distance if needed and both of our parents are very supportive and will help with flight $$$ if needed. But being together + switching to IM/FM (how I see it at this very moment) is more important to me than doing anesthesia residency for 4 years long-distance with her.

If it is possible, I'm willing to rank at least 3-4 IM or FM programs near my partner and run the risk of not matching.

But I totally understand that I need to relax for the time being. I just like having a potential plan in place. Who knows, maybe Im stuck in the bargaining phase of the stages of grief. Regardless, thank you for all your advice, it is very much appreciated x 1000.

 

[NotAProgDirector]

We did use the couple's match on NMRP -- we filled up our list as much as we could with places where we were close to each other (no more than 2 hour drive) --- we just unfortunately fell WAY below our rank couples rank list. We never really talked about what would happen because we had a bunch (45+ combinations) where we were together and our applications were pretty decent so we were sure we would at least match 3-4 hours away worst case scenario and best case, match same city or <2 hours apart (at least 45 combos of the latter).

Thanks for the details. Not trying to re-open wounds, but understanding how you got here is helpful in planning next steps. Assuming you didn't end up with a frame shift mutation when entering your rank lists, it sounds like you just got unlucky with which programs were interested in you both.

Opening that letter on match day.....and comparing lists......wow.....my heart has never broken enough before. We figured we would fill up our entire 300 combination list because we would rather go long-distance than go unmatched ---- both in hindsight.....I regret SO MUCH not ending our rank list at 45 and ranking TY's/Prelim spots after 50ish where our "match nearby" list ended.

Perhaps this thread will help someone else not make the same mistake, if prioritizing being together is the #1 issue.

I apologize for bombarding you with more questions (my dean won't return to his office until next week and I don't have any anesthesia advisors who are up-to-date on the match process) ----------- just to confirm, it is possible to apply for the 2025-2026 upcoming match (IM/FM) without "waiving" my advanced spot but if I get enough IM or FM interviews near my partner's location, I will have to "waive" my advanced anesthesia spot before I can officially rank those programs I interviewed at on the NMRP?

Yes, you can do this. You'll apply in September and should have interviews by end-october. If you choose to waive your match, you should do so in Early November. Although you technically have until mid January the process is not always fast, and you need it finished long before ranking. Plus, it's better to go to interviews and state that the waiver process has been started.

The one problem with this plan is PGY-2 spots. You can't accept one of those until you have your waiver complete. SHould you interview at a program and they have a PGY-2 spot open in July and they want to offer it to you -- they cannot. And they might offer it to someone else in the meantime.

BUT, in the event that I only have like 1 IM interview, I can decide not to undergo the match process so no need to "waive" my advanced anesthesia spot?

Correct, and you would proceed in Anesthesia.

For my IM/FM letters, is it best to be up-front with my TY PD/Anesthesia PD about what is going on in my life as soon as possible? One of my letter writers this past cycle was also an IM doctor so could I also use that (assuming they update it if necessary)?

You should absolutely be up front with your TY PD - again they might be able to build your TY to meet IM (or maybe FM) curricular needs for a PGY-1. And you'll need to scope out how they support (or not) interviews.

I won't make any life-changing decisions right now of course. It's never good to make an emotional decision. I just wanted some information about my potential next steps if this was even possible. Thank you again.

Sounds good.

 

[NotAProgDirector]

There is the other side of this coin. What field is your partner in? Could they manage to change locations at the end of PGY-1 to be close to your Anesthesia spot?

 

[gutonc]

There is the other side of this coin. What field is your partner in? Could they manage to change locations at the end of PGY-1 to be close to your Anesthesia spot?

OB. And I asked the same question.

 

[wood4045]

Thanks for the details. Not trying to re-open wounds, but understanding how you got here is helpful in planning next steps. Assuming you didn't end up with a frame shift mutation when entering your rank lists, it sounds like you just got unlucky with which programs were interested in you both.

Perhaps this thread will help someone else not make the same mistake, if prioritizing being together is the #1 issue.

Yes, you can do this. You'll apply in September and should have interviews by end-october. If you choose to waive your match, you should do so in Early November. Although you technically have until mid January the process is not always fast, and you need it finished long before ranking. Plus, it's better to go to interviews and state that the waiver process has been started.

The one problem with this plan is PGY-2 spots. You can't accept one of those until you have your waiver complete. SHould you interview at a program and they have a PGY-2 spot open in July and they want to offer it to you -- they cannot. And they might offer it to someone else in the meantime.

Correct, and you would proceed in Anesthesia.


You should absolutely be up front with your TY PD - again they might be able to build your TY to meet IM (or maybe FM) curricular needs for a PGY-1. And you'll need to scope out how they support (or not) interviews.

Sounds good.

For the PGY-2 IM/FM Spots, from my understanding, they seem to be just strictly just word of mouth or internet postings correct; nothing via ERAS? So this December, if I randomly find a PGY-2 listing starting on July 2026 on the internet and apply, I cannot get the spot assuming they like me? Any reason why they cannot wait just 1~months for the waiver to be complete? Just curious. I'm honestly OK with repeating PGY-1 if needed if I land in my partner's area.


Do you know how soon I should talk to my TY PD and Anesthesia PD about my case? I've read on Reddit from other transplants that it may be a better idea to wait 2~ months so you can build a relationship with my PD first before breaking the big news. My problem is that I don't know how much facetime I will get with my anesthesia PD since I will be doing my TY first ---- lucky for me, they are both in the same area.

Or should I break the news to both of them by asking to meet with them for a private meeting as soon as I move there after orientation?

Thank you.

 

[wood4045]

OB. And I asked the same question.

There is only one other OB spot near my city and it's extremely competitive - don't know how feasible with will be. Unlike me, she is absolutely obsessed with her specialty.

However, if she wanted to at least try to transfer out, would her best bet be looking for an opening on ResidencySwap? Is that website legit?

 

[NotAProgDirector]

For the PGY-2 IM/FM Spots, from my understanding, they seem to be just strictly just word of mouth or internet postings correct; nothing via ERAS? So this December, if I randomly find a PGY-2 listing starting on July 2026 on the internet and apply, I cannot get the spot assuming they like me? Any reason why they cannot wait just 1~months for the waiver to be complete? Just curious. I'm honestly OK with repeating PGY-1 if needed if I land in my partner's area.

Mostly correct. PGY-2 IM/FM spots are not in the match, and you would need to just find a spot. Spots are often not listed publicly. Although a program could wait 1 month, they might be worried you're looking at other spots and decide to offer to someone else to avoid not getting anyone.

Do you know how soon I should talk to my TY PD and Anesthesia PD about my case? I've read on Reddit from other transplants that it may be a better idea to wait 2~ months so you can build a relationship with my PD first before breaking the big news. My problem is that I don't know how much facetime I will get with my anesthesia PD since I will be doing my TY first ---- lucky for me, they are both in the same area.

Or should I break the news to both of them by asking to meet with them for a private meeting as soon as I move there after orientation?

Thank you.

There's no right answer. Your TY PD probably won't care. You're there for a year and out either way. The only impact will be some interview time which is relatively minor. Plus, if you want to consider IM PGY-2's you'll need your TY to have mostly IM stuff in it. So for all those reasons, I'd let them know now.

The anesthesia PD can probably wait. But you'll want to be sure they know for recruitment season so they can look for a PGY-2 to match into an R position.

There is only one other OB spot near my city and it's extremely competitive - don't know how feasible with will be. Unlike me, she is absolutely obsessed with her specialty.

However, if she wanted to at least try to transfer out, would her best bet be looking for an opening on ResidencySwap? Is that website legit?

Mixed bag. Transferring in OB is going to be very difficult. You're correct the move is probably on your end.

 

[anonperson]

There is only one other OB spot near my city and it's extremely competitive - don't know how feasible with will be. Unlike me, she is absolutely obsessed with her specialty.

However, if she wanted to at least try to transfer out, would her best bet be looking for an opening on ResidencySwap? Is that website legit?

No offense but the chances of your partner practicing a full career as an OBGYN is probably on the lower side. Just the reality of the situation.

Would be hard pressed to throw away an anesthesia career where you are making $600k plus.

I know, I know, but my relationship. Just stand back and think rationally.

 

[AnglerfishMan]

Agree with all of the above.

For sure, the first thing to do is take a deep breath and do nothing rash. Talk to your partner, come up with a game plan. You're not even engaged yet, just imagine how horrible you'll feel if you resign your spot and then break up.

You didn't answer any of my initial questions, which would help drive this conversation. Did you actually use the couple's match? Did you list all combinations where you were geo co-located? Did you discuss being separated since you ranked those options?

Back to your specific questions:

Yes, you can probably apply for spots while still matched. It's a complex topic since some programs might be quite upset if they find out afterwards that you were actually committed somewhere else. Also, your TY PD might be uncomfortable writing you a letter since they would be "complicit" in any perceived duplicity. If it was me, I'd insist that in my letter it would state that you're matched to an Anesthesia program but will be resigning. In any case you'll need to waive your match before you can participate in a new match, and you'll risk not matching at all.

Applying for a pGY-2 is similar, but is not in ERAS. You'll just reach out t programs. They may be unwilling to talk to you if you are still match committed, as it may be seen as a violation on their part.

I am in a similar situation, except a spot near my SO just opened up, can I apply to the spot while matched elsewhere?

 

[gutonc]

I am in a similar situation, except a spot near my SO just opened up, can I apply to the spot while matched elsewhere?

Assuming you just matched last week? No.

 

[Lost in Translation]

No offense but the chances of your partner practicing a full career as an OBGYN is probably on the lower side. Just the reality of the situation.

Would be hard pressed to throw away an anesthesia career where you are making $600k plus.

I know, I know, but my relationship. Just stand back and think rationally.

Take this advice OP. You realistically have the higher earning potential and a more stable future field. Your partner should be putting in the same amount of effort to try and find an OB program (or even FM that has a robust OB experience) closer to your location as you are trying to go from 500k+ a year starting to 300k max (unless you gun for Cards or GI or Heme/Onc and play city roulette all over again) just to be closer to her.

One option is to reach out to your future Anesthesia department now and explain the situation and see if they can facilitate a parlay between you and the OB department to see if that program is willing to hold a PGY1 spot next year for your partner. But you had better be a stellar applicant and one that your future department would bend over backwards to keep, and she’d better be at least as good on paper as the weakest resident at that OB program.

If neither of you are willing to break with their ideal field then do LDR or call it quits. It’s not fair for one of you to give up their dreams for the other when you’ve both independently been through so much to get to where you are now.

 

[mcl]

There is only one other OB spot near my city and it's extremely competitive - don't know how feasible with will be. Unlike me, she is absolutely obsessed with her specialty.

However, if she wanted to at least try to transfer out, would her best bet be looking for an opening on ResidencySwap? Is that website legit?

ACOG has a clearinghouse for open residency positions that stays updated. She should look there regularly while you are contemplating your specialty switch. Definitely DON'T go through Residency Swap or any of the other paid services. CREOG Clearinghouse: Find Residency and Fellowship Positions

 

[wood4045]

Mostly correct. PGY-2 IM/FM spots are not in the match, and you would need to just find a spot. Spots are often not listed publicly. Although a program could wait 1 month, they might be worried you're looking at other spots and decide to offer to someone else to avoid not getting anyone.

There's no right answer. Your TY PD probably won't care. You're there for a year and out either way. The only impact will be some interview time which is relatively minor. Plus, if you want to consider IM PGY-2's you'll need your TY to have mostly IM stuff in it. So for all those reasons, I'd let them know now.

The anesthesia PD can probably wait. But you'll want to be sure they know for recruitment season so they can look for a PGY-2 to match into an R position.

Mixed bag. Transferring in OB is going to be very difficult. You're correct the move is probably on your end.

Do you know how common it is for TY PD's to be OK with letting their residents take time to interview? This is also one of my biggest worries. They said they will start working on our schedule and be sent out sometime in May so I'm unsure if I should tell my TY PD so maybe I can squeeze in a few IM or clinic rotations before ERAS opens up in September.

But if I tell my TY PD about my plan, I feel like I would also have to email my Advanced Anesthesia PD so it doesn't look like I'm doing things behind their back. I want to be as transparent as possible with everyone. But I feel like having this type of conversation with my Anesthesia PD should be in-person rather than letting them know via email.......but I won't move to my new residency program until late June.

For me, it sounds like these are my options; let me know if this sounds correct.

best case scenario = I find an open anesthesia PGY2 spot that is near my partner sometime this year and my anesthesia PD spot is ok with it ---- probably gonna be super rare though.

second best scenario = I tell my TY/Anesthesia PD's about my situation and they are understanding. They let me take some personal days off for IM/FM interviews and I submit my waiver around December after getting like 5 interviews. I match and start IM/FM in my partner's city.

Worst case scenario = My anesthesia PD is upset; they don't let me re-apply. I'm on their bad side for 3 years.

WORST WORST case scenario = I somehow re-apply to the match; I submit my waiver. However, I only get 2 interviews and I fail to match AND lose my anesthesia spot.

 

[anonperson]

Do you know how common it is for TY PD's to be OK with letting their residents take time to interview? This is also one of my biggest worries. They said they will start working on our schedule and be sent out sometime in May so I'm unsure if I should tell my TY PD so maybe I can squeeze in a few IM or clinic rotations before ERAS opens up in September.

But if I tell my TY PD about my plan, I feel like I would also have to email my Advanced Anesthesia PD so it doesn't look like I'm doing things behind their back. I want to be as transparent as possible with everyone. But I feel like having this type of conversation with my Anesthesia PD should be in-person rather than letting them know via email.......but I won't move to my new residency program until late June.

For me, it sounds like these are my options; let me know if this sounds correct.

best case scenario = I find an open anesthesia PGY2 spot that is near my partner sometime this year and my anesthesia PD spot is ok with it ---- probably gonna be super rare though.

second best scenario = I tell my TY/Anesthesia PD's about my situation and they are understanding. They let me take some personal days off for IM/FM interviews and I submit my waiver around December after getting like 5 interviews. I match and start IM/FM in my partner's city.

Worst case scenario = My anesthesia PD is upset; they don't let me re-apply. I'm on their bad side for 3 years.

WORST WORST case scenario = I somehow re-apply to the match; I submit my waiver. However, I only get 2 interviews and I fail to match AND lose my anesthesia spot.

The best case scenario is you keep your current anesthesia spot and don't rock the boat.

It's telling that in this relationship, you are going to potentially throw away the more lucrative and stable career.

I know several OBGYNs who have either scaled back completely (complete with pay cut) or who barely practice because of burnout or becoming gunshy because of lawsuits.

 

[smq123]

There is only one other OB spot near my city and it's extremely competitive - don't know how feasible with will be. Unlike me, she is absolutely obsessed with her specialty.

However, if she wanted to at least try to transfer out, would her best bet be looking for an opening on ResidencySwap? Is that website legit?

Are you also having second thoughts about anesthesia? Not just the location, but the specialty? What was your initial motivation to apply for anesthesia?

Did you get into anesthesia as a pathway to Pain? Or Critical Care? Or was it just "I like the OR but don't want to be a surgeon"?

I don't understand the motivation for applying to FM, other than it's a fairly easy specialty to get into. It's the diametric opposite of anesthesia. As FM myself, I've met lots of people who have transferred into FM (OB, ortho, surgery) but never from anesthesia. If you like the general atmosphere of anesthesia, then doing FM-primary care clinic, day in and day out as a career, might make you nauseated. That's ok - I'm well aware that primary care isn't for everyone. My husband has said that if he had to do primary care forever, he just wouldn't be a physician, and that's ok too.

But it IS something to think about. What are you going to say at an FM or at a peds interview? "Your specialty is easy to get into and my partner's apartment is 3 miles away"?

 

[smq123]

We will be about 1000 miles apart unfortunately -- and my TY is the same city as my advanced anesthesia program.

I met a nice guy at the tail end of my MS3 year. He was in the tail end of the PhD phase of his MD/PhD, at a neighboring medical school a few miles away from mine.

4 months later, he leaves to do a year long post-doc far away - 2 time zones/over 2000 miles away, to be specific. We keep in touch.

A year later, I don't match OB, and I scramble into an FM spot about 10 miles away from my medical school. He decides to finish out his post-doc and then spends several months in Southeast Asia.

I start intern year. He returns to medical school to do clinical rotations. We're in the same city as each other for maybe 30% of the time; he's off doing rotations and comes and goes.

During my PGY-2 year, he is off doing away rotations on the other side of the country. He comes back for interviews and 4th year rotations sporadically.

At the end of my PGY-2 year, he matches - intern year 800 miles away, categorical 1000 miles away.

During my PGY-3 year, I am able to find a job in the same city as his categorical. We move in together after I finish residency.

During his PGY-3 year, he spends 3 months doing a required rotation 200 miles away. He also spends 3 months abroad, doing research in Europe.

All this was years ago. Almost 17 years (!!!) after our first date, our two kids are sleeping in the next room. We just got back from Disney. We are able to put together a roomful of IKEA furniture together and still be on speaking terms at the end of it (my personal metric for how strong a couple's relationship is).

The beginning was hard and I don't necessarily recommend it, but it was doable. Close proximity is nice, but it isn't the only way for a successful relationship to flourish - particularly in this era of FaceTime and Zoom and texting. Plenty of people live in close proximity to their partner and their relationships still break down.

All of this is a long winded way of saying - don't throw away your specialty choice just because of distance. LDRs are tough, but doable.

 

[wysdoc]

Are you also having second thoughts about anesthesia? Not just the location, but the specialty? What was your initial motivation to apply for anesthesia?

Did you get into anesthesia as a pathway to Pain? Or Critical Care? Or was it just "I like the OR but don't want to be a surgeon"?

I don't understand the motivation for applying to FM, other than it's a fairly easy specialty to get into. It's the diametric opposite of anesthesia. As FM myself, I've met lots of people who have transferred into FM (OB, ortho, surgery) but never anesthesia. If you like the general atmosphere of anesthesia, then doing FM-primary care clinic, day in and day out as a career, might make you nauseated. That's ok - I'm well aware that primary care isn't for everyone. My husband has said that if he had to do primary care forever, he just wouldn't be a physician, and that's ok too.

But it IS something to think about. What are you going to say at an FM or at a peds interview? "Your specialty is easy to get into and my partner's apartment is 3 miles away"?

I'm going to agree with really asking yourself these kinds of questions.
Do you know what an OB residency is like? You will seldom see each other.
What if she is annoyed with you for not spending all your time with her when she has time off? Will you be annoyed back? Because you have plans for your free time too.
Wouldn't it be better to coordinate a weekend a month to visit each other when you are both off? Hell, 1000 miles away is 1 plane flight.
Don't settle, for a specialty you have no interest in or lose your match over wanting to be in the same city as your girlfriend.

 

[ThoracicGuy]

I'm not sure if this has been asked yet or not, but how far down on your personal list of matches, the ones outside the couples match, did you fall? This could tell you how competitive you might be for a spot. Giving up a sure thing for the chance that you might get matched in a handful of interviews could be tough. In the end you would have to determine if you are more willing to lose a spot and not match or stay where you are and do long distance.

 

[wood4045]

Are you also having second thoughts about anesthesia? Not just the location, but the specialty? What was your initial motivation to apply for anesthesia?

Did you get into anesthesia as a pathway to Pain? Or Critical Care? Or was it just "I like the OR but don't want to be a surgeon"?

I don't understand the motivation for applying to FM, other than it's a fairly easy specialty to get into. It's the diametric opposite of anesthesia. As FM myself, I've met lots of people who have transferred into FM (OB, ortho, surgery) but never from anesthesia. If you like the general atmosphere of anesthesia, then doing FM-primary care clinic, day in and day out as a career, might make you nauseated. That's ok - I'm well aware that primary care isn't for everyone. My husband has said that if he had to do primary care forever, he just wouldn't be a physician, and that's ok too.

But it IS something to think about. What are you going to say at an FM or at a peds interview? "Your specialty is easy to get into and my partner's apartment is 3 miles away"?

Just went into anesthesia because good lifestyle, enjoyed the chill atmosphere during rotations and I feel like I had the grades for it tbh. Nothing crazy.

I didn't mind my FM rotation at all; yes it was tedious at times but for the most part, it was alright.

To answer your last question, my plan was to talk about some unique EC's I did in med school regarding rural healthcare/primary care + talk about not enjoying inpatient rotations as much I woulda liked (just to milk it more idk). Yeah, my main factor is being near my partner but in complete honesty, I'm just one of those med students who felt neutral to most rotations and thought of it as just a job (except doing surgery lol)

 

[wood4045]

I'm not sure if this has been asked yet or not, but how far down on your personal list of matches, the ones outside the couples match, did you fall? This could tell you how competitive you might be for a spot. Giving up a sure thing for the chance that you might get matched in a handful of interviews could be tough. In the end you would have to determine if you are more willing to lose a spot and not match or stay where you are and do long distance.

I would say I fell around 11 out of 15+ interviews anesthesia interviews. Interviewed at some t25 programs too. No idea why I fell so low though. I wonder if I over-emphasized couple's matching and made it seem like I wouldn't attend their program if my partner didn't match there either. Multiple interviewers told me I was a really strong candidate. I guess people just fall through the cracks sometimes.

I feel if I were to re-apply to the 10+ IM programs and multiple FM programs (thankfully my s/o is in a pretty big city) I would have a decent shot at the community programs/hca at worst. I'm not expecting anything from the academic places of course, who knows.

 

[wood4045]

I met a nice guy at the tail end of my MS3 year. He was in the tail end of the PhD phase of his MD/PhD, at a neighboring medical school a few miles away from mine.

4 months later, he leaves to do a year long post-doc far away - 2 time zones/over 2000 miles away, to be specific. We keep in touch.

A year later, I don't match OB, and I scramble into an FM spot about 10 miles away from my medical school. He decides to finish out his post-doc and then spends several months in Southeast Asia.

I start intern year. He returns to medical school to do clinical rotations. We're in the same city as each other for maybe 30% of the time; he's off doing rotations and comes and goes.

During my PGY-2 year, he is off doing away rotations on the other side of the country. He comes back for interviews and 4th year rotations sporadically.

At the end of my PGY-2 year, he matches - intern year 800 miles away, categorical 1000 miles away.

During my PGY-3 year, I am able to find a job in the same city as his categorical. We move in together after I finish residency.

During his PGY-3 year, he spends 3 months doing a required rotation 200 miles away. He also spends 3 months abroad, doing research in Europe.

All this was years ago. Almost 17 years (!!!) after our first date, our two kids are sleeping in the next room. We just got back from Disney. We are able to put together a roomful of IKEA furniture together and still be on speaking terms at the end of it (my personal metric for how strong a couple's relationship is).

The beginning was hard and I don't necessarily recommend it, but it was doable. Close proximity is nice, but it isn't the only way for a successful relationship to flourish - particularly in this era of FaceTime and Zoom and texting. Plenty of people live in close proximity to their partner and their relationships still break down.

All of this is a long winded way of saying - don't throw away your specialty choice just because of distance. LDRs are tough, but doable.

I honestly really enjoyed reading this. Thank you so much for this perspective. I'm so happy for you both and your family!!

 

[smq123]

Just went into anesthesia because good lifestyle, enjoyed the chill atmosphere during rotations and I feel like I had the grades for it tbh. Nothing crazy.

I didn't mind my FM rotation at all; yes it was tedious at times but for the most part, it was alright.

To answer your last question, my plan was to talk about some unique EC's I did in med school regarding rural healthcare/primary care + talk about not enjoying inpatient rotations as much I woulda liked (just to milk it more idk). Yeah, my main factor is being near my partner but in complete honesty, I'm just one of those med students who felt neutral to most rotations and thought of it as just a job (except doing surgery lol)

Like other people have said, just make sure that you take some time to really really think about what you want your life to look like in 10 years. Relationships are important, but it's important to make sure that you don't loathe your job.

There have been times over the past few years where me taking an urgent care job would have made things easier for our family. But, man, I have some VERY STRONG feelings about urgent care (all negative, in case you couldn't tell) and I just could. not. do. it. I appreciate the fact that my husband didn't force it, despite the fact that it really would have solved a bunch of issues for our family.

So if you find family medicine tedious, you do have to take the time to make sure that it is something that you can do until you retire. Or IM or peds or ophtho or whatever you decide to do, if you can't make anesthesia work.

 

[airwaycart169]

Curious how often residents successfully swap. I know it’s only a few years but figured it’s possible to find a match.

 

[ThoracicGuy]

Curious how often residents successfully swap. I know it’s only a few years but figured it’s possible to find a match.

True swaps would be pretty rare. What are the chances that you are a person that the other program would want and the other person is someone your program would want at the same time?

 

[Neuronix]

I honestly really enjoyed reading this. Thank you so much for this perspective. I'm so happy for you both and your family!!

That's pretty significant survivorship bias. I had several relationships painfully fall apart because they were LDRs before finding "the one" I built a family with.

In my case, the physician-scientist pathway has been incredibly difficult to coordinate with any other partner's career. I've had to move cities in every stage of my training, and I am now moving across the country as a mid-career physician-scientist.

I'm glad that my wife has been understanding about the multiple moves we've been through. Several relationships beforehand were not willing to do that. But, as painful as it is when one relationship ends, the reality is that you will almost certainly find someone else if it does.

In summary, some career compromise may make sense, but don't go off the deep end. Your partner clearly is not going to make a major change, so the worst case is that your relationship ends anyway and you made an unfavorable career move unilaterally that you have to live with the rest of your life.