Is this a good or bad idea?

[ArrogantSurgeon]

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Hi all...first post on SDN.

I've realized that a lot of the top academic general surgery programs out there (Hopkins, UCLA, Washington etc) don't always fill their preliminary surgery spots. And checking around, I've found that some of these spots are for 2 years. Now my question is, would it be a good idea to match into a 2-year preliminary general surgery residency at a top program rather than a 5-year categorical residency at a mediocre program if I want to be an academic surgeon?

My hope is to finish the 2-year preliminary residency at a top program and then hopefully move into the 3rd year of a categorical program at the same or another well-regarded program. I know it's a risk, but at least it would give me a chance to do some of my residency at a top academic program (and maybe even finish it all at there or at another program of equal caliber) rather than be binded to 5 years at a program that is not academically strong.

Your thoughts would be appreciated.

 

[southerndoc]

It would probably be foolish to do such a thing.

You will only be able to transition from preliminary to categorical if the institution has open positions (either someone quit, was let go, or the institution just created a position for you). You'd have to be very good for them just to create a position for you.

If you want to be a general surgeon, then you should really apply to a categorical program.

KEEP IN MIND THAT I AM A MEDICAL STUDENT THOUGH. Some of the residents might tell you differently, but I have an opinion that most will agree. (Maybe I'm being arrogant? 🙄 )

Cheers!

 

[womansurg]

If you are unable to match into a highly competitive program to start with, then probably it is because your clinical performance, grades, so forth have not been of sufficient caliber. As a prelim you will be heavily scrutinized, and often treated a bit like a bastard stepchild, especially if you are there without holding a permanent position upon graduation. You will also find yourself compared with the categorical interns who - since they did secur a spot in the first place - are probably exceptionally bright and capable. It's a difficult situation to be in. Everyone will be gunning to impress people, and more often than not, it is the prelims who come out looking like the weak links in the chain.

I suppose you need to examine why it is that you weren't able to perform at an expected level for such programs, and decide how likely you think it is that those factors are alterable over the nex year.

You definitely would have no trouble getting into academic surgery coming from a mid tier program if your performance was solid, and I suspect the risk of you experiencing failure and frustration would be much less.

Good luck with your decision.

 

[ArrogantSurgeon]

thanks for the reply Geek Medic.

I'd be interested in knowing how often 3rd year general surgery positions open up at academic programs?

For example, a fair number of categorical general surgery residents at academic programs take 1-2 years after PGY2 to do research before coming back to PGY3. Now lets say a program takes 5 categorical residents per year, and two of them take a year or more off after PGY2 to do research. Would this not open up 2 positions in PGY3 since those residents would be in their research years? Would it be possible for a preliminary residents from that or another program to move in their PGY3 spots?

 

[ArrogantSurgeon]

Womansurg, I hear what your saying. My hope is to match into a strong categorical academic program out of med school. Yet, I'm just wondering if it's worth taking the risk of matching into 2-year prelim spot at a "dream" program over a categorical spot at a "safety" academic program. I guess I'm contemplating if the risk is too great to take up a 2-year prelim spot at one of these dream programs with the possibility of moving into a PGY3 position at the same institution or a program that is equally as strong, rather than being stuck for 5-years at a program that is not so strong.

 

[SurgResident]

ArrogantSurgeon,

It definitely is a risky move, but I think it's a reasonable risk if you are absolutely committed to an academic program/career. My program brings in more than a handful of prelims each year. Each year, at least one prelim stands out. Because of the usual turnover rate in GS residency and also because of requests for extra lab-time by some residents, we take prelims into the categorical program every once in a while (sometimes several in a year). I must tell you that these prelims are on par with the categorical interns and by the time they finish residency, you would never guess that some chiefs came in as prelim interns. If you go this route, you need to be confident in your skills/knowledge/dedication.

 

[ArrogantSurgeon]

Thanks for the advice Skylizard.

If you are in the 2-year prelim surgery program, and you can't find a categorical spot for PGY3, will the PD allow you to go into research at the institution after PGY2 and get paid like the categorical residents who go into research after PGY2? Or will they basically boot you out the door after your 2 years are up.

 

[droliver]

I would disagree with the feedback given so far. There are a signifigant amount of spots that open in the PGY-2 & 3 years just thru attrition & the like. Doing a prelim year at a large & reputable program has been a very effective way to parlay yourself into categorical programs for many years. If you go somewhere & do a good job people notice even if you're a prelim & they are more then willing to go out of their way to help you find a job @ their program or elsewhere thru networking.

 

[ArrogantSurgeon]

Now I'm even more unsure after droliver's repsonse. Droliver says that there are a significant number of spots that open up at the PGY2 and PGY3 level, but others say that very few open up.

Is there anyway I can find out who is more correct? Is there any published data on the attrition rate of categorical general surgical residents or the percentage of prelim residents who move into categorical spots??

 

[duramaterdoc]

Hi,

I think that ranking ANY preliminary spot over a categorical spot is very risky and NOT WORTH IT.

To do academic surgery, you don't necessarily have to come from a top level program. YOU DO have to survive and do well. If you want to do academics I think you should TRY to match into an academic (rather than community program) but ultimately you should match categorical....EACH year you attempt to match when you're not a 4th year student SIGNIFICANTLY LOWERS your chances of ever matching.

Yes, spots do open...but they are NEVER guaranteed....Also, they are most likely to be filled by people WITHIN the institution...you may never even know about them let alone have the program give you a greater chance than a resident already familiar with the system, etc.


I agree that the attrition rate of general surgery may decline in the next couple of years with the new work week.

Also, if you match into a categorical you can always transfer if a spot opens....

Loki is right, ANYONE who is a prelim. in general surg. is thought of as an "extra"--no real talent but provides a good strong back. You would look better if you matched into some OTHER residency and switched...prelims are generally though of as "people who couldn't match at all"--meaning they will always suspect there is "something wrong with you" whether or not that is a valid thing to do.

If you match at a mid-tier program, so what, do an AWESOME job there, shine and get a KICK-BUTT fellowship!

Good luck.