Late in 4th year and would like to switch to Rad from EM

[ChiDr]

Short and sweet. DO student who applied EM in Sept. Didn't have Rad (IR, DR, Rad onc) until mid/late M4. Really enjoyed DR day to day. Wish I experienced it as an M3 in more detail as I would have applied. Now I am having serious regrets committing to EM and losing the ability to try and match DR.

I am stuck and wondering what I can do and how to even approach this a few weeks away from match.

Do I contact Rad PDs to ask for advice?
Do I not take a guaranteed EM spot at a solid place to SOAP prelim and play my cards again?
Do I rank EM programs with Rad programs higher in hopes of pulling some sort of post-match magic?

A bit lost and confused right now.

I cannot extend med school as my school doesn't offer anything like this for m4s.

Not matching is basically shooting myself in the foot.

What are some solid strategies from the wisdom of this group? Thank you in advance.

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[Rubix8]

I don’t think there is a right answer here. I think matching EM is your safest bet. Radiology has gotten progressively more competitive each year since COVID hit and even USMDs can have trouble matching now because there just aren’t as many spots as some other specialties. Job prospects are very good for radiologists for the foreseeable future, so less residents will want to jump ship from their programs.

Check if EM intern year counts for rads and if not, you can try to transfer to an IM or TY prelim year. Surgery prelim if desperate. Then you can try to match again for physician only rads positions, but keep in mind there are very few so risk is high. There’s also a chance that your love for EM is reignited in intern year and you won’t need to go through all this at all.

Good luck!

 

[bobjonesbob]

Short and sweet. DO student who applied EM in Sept. Didn't have Rad (IR, DR, Rad onc) until mid/late M4. Really enjoyed DR day to day. Wish I experienced it as an M3 in more detail as I would have applied. Now I am having serious regrets committing to EM and losing the ability to try and match DR.

I am stuck and wondering what I can do and how to even approach this a few weeks away from match.

Do I contact Rad PDs to ask for advice?
Do I not take a guaranteed EM spot at a solid place to SOAP prelim and play my cards again?
Do I rank EM programs with Rad programs higher in hopes of pulling some sort of post-match magic?

A bit lost and confused right now.

I cannot extend med school as my school doesn't offer anything like this for m4s.

Not matching is basically shooting myself in the foot.

What are some solid strategies from the wisdom of this group? Thank you in advance.

What does your app look like? Unless it's very strong (>260 step 2, pubs, 1st quartile, etc.) matching rads from the get go would be a challenge as a DO. If you're 100% on rads, pulling out of the match and doing a year of research would probably get you spot next cycle, but you're best option is probably to go through with the match and start EM. Every year there are some R1 spots in the match (that is match in March and start rads in July of the same year) as well as a few programs that have attrition with spots opening up. Your intern year in EM would count and you could slide right in. Worst case scenario if you don't get a spot during PGY1 just complete EM, and if you still really want to do rads apply again during PGY3. Two extra years isn't really that long in end. Virtual interviews make applying during residency much less onerous that it used to be. Outside of ICU months you could probably do a lot of interviews without needing to take time off.

 

[lernaeann]

I am a USDO who successfully matched as a reapplicant during the 2022 cycle. It's honestly pretty hard for us DO's now (the NRMP data from 2020 showed 90+% match rate vs the 60s it is now)... Being a reapplicant DO is not easy. From what I heard, the best option is to delay graduation and try again but most DO's schools won't allow this. My honest advise to you is that if you are deadset on rads, you can try to transfer next year and apply through the match again. The physician only spots and spots open outside the match are extremely rare and usually get taken by an internal applicant or just a stronger USMD to be frank. Just know that if you do this, you will need your PD's support and they can easily choose not to renew your pgy-2 contract. This means it's probably better to just finish EM (it's not that long a residency) and try again. At least you will have a secure career in that scenario.

 

[Ho0v-man]

What are your stats? Last year you posted about applying OBGYN/GS with no step and an average COMLEX. If you don’t have a passed step 1 and a well above bc average Step 2, it may not matter what you want. Not trying to be rude, just trying to be honest.

 

[redalert]

If I were you I would stick with EM. Rads is great but I'm not sure if it is worth taking such a big risk as pulling out of the match and trying again next year. Think on the bright side, you'll be an attending earlier than your rads colleagues, still have lots of interactions with rads if you'd like, have opportunities to do bedside procedures, etc. If you really don't like EM and want to switch, you might still be able to find a residency spot later on because every year someone drops out of rads, or go through the match again as long as your intern year counts. If this were early 4th year you should definitely go for it, but at this point the opportunity costs are just too high.

 

[Tiger100]

If you don't like EM, then don't do it.
If you like rads (or any other field) , then go for it even if it is at the expense of 1-2 years.

You live once. You are still too young. Do whatever you like in your life. You have more than enough time to spend a few years exploring what you want.

Just imagine that one day you will be my age. I am very happy with my career decision but not so much with some other parts of my life. Looking backwards, I wish I had taken more risks when I was in my 20s and 30s.

 

[vanfanal]

.Just imagine that one day you will be my age. I am very happy with my career decision but not so much with some other parts of my life. Looking backwards, I wish I had taken more risks when I was in my 20s and 30s.

Like what?
I’m in my early 30s and early career. I’ve found the advice of seniors to be very helpful to this point and always appreciate insights.

 

[Tiger100]

Like what?
I’m in my early 30s and early career. I’ve found the advice of seniors to be very helpful to this point and always appreciate insights.

If you want to do something, do it NOW. Don't delay it for the future.

It is much better to do something wrong and regret it than not doing it at all. Most physicians are very conservative.

People are overrated. Don't care what others say or think about you. Do what you think is right for you. Be a good person but don't let other people dictate your life. Most physicians are prisoners of "being a Doctor".

When it comes to money and finances, enjoy the money that you make. Save some and invest some. When it comes to investments don't be afraid of taking risk when you have the chance.

 

[ChiDr]

Thank you all for all this great input. Appreciate the feedback. All risk/reward. It is unfortunate that it is so hard for reapplicants or making changes after match.

I have average test scores, DO scores are 571, 610. Passed step 1, didn't take step 2 due to family medical tragedy, great for EM, average for rad, based on stats. I would fall in the middle of the pack based on matched data. Not sure about being a reapplicant.

As far as my app, nontraditional, did MS/PhD in engineering, medical device design, lots of published things, patents, etc. I had excellent LORs. I don't have an issue interviewing being very social. I received solid reviews from programs

Being a bit on the older side compared to mid 20's, I am concerned about EM burnout. I see miserable EM doctors in their 40s, 50s and 60s and not sure it would be reasonable down the line. Yes, I know they have been doing it for a long time or have other issues. I get that and I am realistic as I do have plenty of professional experience.

Family is important as I have several kids and wanted something that provided more family time and flexibility. I loved anatomy, wanted surgery during second and third year but changed due to lifestyle. EM gave me anatomy, variety, procedures, reasonable shift #. Rad gives me less burnout at an older age, anatomy, variety, flexibility, more telerad. I have a few connections with rad that I am trying to get in my corner.

Match list due in two days, as of now, ranked my first 5 EM programs and top 3 also have rad programs that I would love to be at. Going to get intern year clinical experience, talk to rad PDs, talk to my EM PD (Not sure when). Will try to transfer internal first. If I end up at a program without a rad program, I will be more concerned. Especially with the stats out there but I never let fear drive me away. If I wanted something, I pushed down the doors.

If I fail, so be it, I will try again and find a home somewhere. If programs look at someone that tried to get something they want but were not successful and decide to write them off, it isn't a place I would like anyway.

When would you have a conversation with your new EM PD? Ha. Anyone on here have any pointers on how to approach this conversation or examples of what they did?

 

[Ho0v-man]

With an above average step 2 you’d be a great rads applicant with everything else on your CV. Sadly, without a step 2 score you’re not in the running at the majority of programs.

 

[g3tb0mbed]

Thank you all for all this great input. Appreciate the feedback. All risk/reward. It is unfortunate that it is so hard for reapplicants or making changes after match.

I have average test scores, DO scores are 571, 610. Passed step 1, didn't take step 2 due to family medical tragedy, great for EM, average for rad, based on stats. I would fall in the middle of the pack based on matched data. Not sure about being a reapplicant.

As far as my app, nontraditional, did MS/PhD in engineering, medical device design, lots of published things, patents, etc. I had excellent LORs. I don't have an issue interviewing being very social. I received solid reviews from programs

Being a bit on the older side compared to mid 20's, I am concerned about EM burnout. I see miserable EM doctors in their 40s, 50s and 60s and not sure it would be reasonable down the line. Yes, I know they have been doing it for a long time or have other issues. I get that and I am realistic as I do have plenty of professional experience.

Family is important as I have several kids and wanted something that provided more family time and flexibility. I loved anatomy, wanted surgery during second and third year but changed due to lifestyle. EM gave me anatomy, variety, procedures, reasonable shift #. Rad gives me less burnout at an older age, anatomy, variety, flexibility, more telerad. I have a few connections with rad that I am trying to get in my corner.

Match list due in two days, as of now, ranked my first 5 EM programs and top 3 also have rad programs that I would love to be at. Going to get intern year clinical experience, talk to rad PDs, talk to my EM PD (Not sure when). Will try to transfer internal first. If I end up at a program without a rad program, I will be more concerned. Especially with the stats out there but I never let fear drive me away. If I wanted something, I pushed down the doors.

If I fail, so be it, I will try again and find a home somewhere. If programs look at someone that tried to get something they want but were not successful and decide to write them off, it isn't a place I would like anyway.

When would you have a conversation with your new EM PD? Ha. Anyone on here have any pointers on how to approach this conversation or examples of what they did?

I just want to be realistic, with a P on Step 1 and no Step 2 score AND being a DO, you are not a middle of the pack rads applicant, you are bottom of the pack. If you had gotten a 260+ step 2 you would have a chance but as it is, you do not have a chance at any rads program. Wishing you the best of luck

 

[ChiDr]

I appreciate the candor. I guess I was just looking at matched data from DOs in 2022 but again you don't know how that data relates to their STEP scores which would be a more helpful data point. Also, the P is an unknown as this will be the first year with that data. I feel all the other things in my app are pretty strong but I know scores are a big part of the equation. Nevertheless, at least 40-50 matched with similar DO scores so perhaps if I focus on programs that take a good percentage of DOs I'll have a better shot.

Going to look into taking STEP 2 intern year with level 3. If anything, perhaps finish EM and reevaluate or see how it goes at transferring internally.

 

[Kuratz]

Like others have pointed out your application is suboptimal given the simple "Pass" on Step 1, no Step 2, being a DO (sorry its the reality). You have the PhD which is unique and presumably demonstrates some other academic aptitude.

If I were you:
1. Match into EM as planned. This serves two purposes: you satisfy the internship requirement for Rads (yes EM counts), and it gives you a realistic look at EM practice before you decide to pursue Rads. It's too late to realistically pursue anything else without taking a year off. Best to match somewhere with a DR program for multiple reasons.
2. Take and excel on Step 2. I would use the remaining part of MS4 to study hard for Step 2 and do well. Yes, this takes time and effort (and money) when you should be enjoying the post-match period but it's realistically the only time you'll have to really put in the appropriate time to get a good score. You need this data point for a good application. Even if you don't ultimately re-apply its better to have it than not.
3. Give EM a realistic chance but make a decision early. Your best chance at matching to either a "Physician" position or an advanced position is to apply on time. A late application really hinders your chances. Work very hard on your initial rotations, do your best, try to envision life as an EM physician and then go all-in either way. Once you decide then don't waste time arranging an application.
4. Once decided on switching to Rads, be transparent with your PD. Extremely important to be honest with your PD and co-residents but even more important to be a team player, take your rotations seriously even if you leave EM, and get everyone on your side. Do not do anything to piss your home program off. You should also build connections with the radiology dept (hopefully they have a DR program) to get their support.
5. Don't sweat it if you match into an advanced position but not a Physician position. Do your research on Physician programs to maximize your chances but those spots are relatively hard to come by. If you are serious about a career switch then an additional year where you have a gap between internship and R1 is not that big of a deal. You can find paying research positions etc (we have residents who did this) to bridge that gap financially. This is peanuts compared to a 30 year career.

Even if you complete an entire EM residency you are only out a whopping 2 years. That's not a huge deal and while challenging to go back and do a second residency, it's not unheard of. Ultimately for most people there are several fields/careers where they would be happy. This is the framework I would use if I were in your position. Best of luck. It'll work out if you put in the effort.

 

[ChiDr]

Like others have pointed out your application is suboptimal given the simple "Pass" on Step 1, no Step 2, being a DO (sorry its the reality). You have the PhD which is unique and presumably demonstrates some other academic aptitude.

If I were you:
1. Match into EM as planned. This serves two purposes: you satisfy the internship requirement for Rads (yes EM counts), and it gives you a realistic look at EM practice before you decide to pursue Rads. It's too late to realistically pursue anything else without taking a year off. Best to match somewhere with a DR program for multiple reasons.
2. Take and excel on Step 2. I would use the remaining part of MS4 to study hard for Step 2 and do well. Yes, this takes time and effort (and money) when you should be enjoying the post-match period but it's realistically the only time you'll have to really put in the appropriate time to get a good score. You need this data point for a good application. Even if you don't ultimately re-apply its better to have it than not.
3. Give EM a realistic chance but make a decision early. Your best chance at matching to either a "Physician" position or an advanced position is to apply on time. A late application really hinders your chances. Work very hard on your initial rotations, do your best, try to envision life as an EM physician and then go all-in either way. Once you decide then don't waste time arranging an application.
4. Once decided on switching to Rads, be transparent with your PD. Extremely important to be honest with your PD and co-residents but even more important to be a team player, take your rotations seriously even if you leave EM, and get everyone on your side. Do not do anything to piss your home program off. You should also build connections with the radiology dept (hopefully they have a DR program) to get their support.
5. Don't sweat it if you match into an advanced position but not a Physician position. Do your research on Physician programs to maximize your chances but those spots are relatively hard to come by. If you are serious about a career switch then an additional year where you have a gap between internship and R1 is not that big of a deal. You can find paying research positions etc (we have residents who did this) to bridge that gap financially. This is peanuts compared to a 30 year career.

Even if you complete an entire EM residency you are only out a whopping 2 years. That's not a huge deal and while challenging to go back and do a second residency, it's not unheard of. Ultimately for most people there are several fields/careers where they would be happy. This is the framework I would use if I were in your position. Best of luck. It'll work out if you put in the effort.

This was great. Thank you for taking the time to write this. Hiking up the mountain isn't bad, just makes it feel sweeter on top.

 

[Dantes]

Like others have pointed out your application is suboptimal given the simple "Pass" on Step 1, no Step 2, being a DO (sorry its the reality). You have the PhD which is unique and presumably demonstrates some other academic aptitude.

If I were you:
1. Match into EM as planned. This serves two purposes: you satisfy the internship requirement for Rads (yes EM counts), and it gives you a realistic look at EM practice before you decide to pursue Rads. It's too late to realistically pursue anything else without taking a year off. Best to match somewhere with a DR program for multiple reasons.
2. Take and excel on Step 2. I would use the remaining part of MS4 to study hard for Step 2 and do well. Yes, this takes time and effort (and money) when you should be enjoying the post-match period but it's realistically the only time you'll have to really put in the appropriate time to get a good score. You need this data point for a good application. Even if you don't ultimately re-apply its better to have it than not.
3. Give EM a realistic chance but make a decision early. Your best chance at matching to either a "Physician" position or an advanced position is to apply on time. A late application really hinders your chances. Work very hard on your initial rotations, do your best, try to envision life as an EM physician and then go all-in either way. Once you decide then don't waste time arranging an application.
4. Once decided on switching to Rads, be transparent with your PD. Extremely important to be honest with your PD and co-residents but even more important to be a team player, take your rotations seriously even if you leave EM, and get everyone on your side. Do not do anything to piss your home program off. You should also build connections with the radiology dept (hopefully they have a DR program) to get their support.
5. Don't sweat it if you match into an advanced position but not a Physician position. Do your research on Physician programs to maximize your chances but those spots are relatively hard to come by. If you are serious about a career switch then an additional year where you have a gap between internship and R1 is not that big of a deal. You can find paying research positions etc (we have residents who did this) to bridge that gap financially. This is peanuts compared to a 30 year career.

Even if you complete an entire EM residency you are only out a whopping 2 years. That's not a huge deal and while challenging to go back and do a second residency, it's not unheard of. Ultimately for most people there are several fields/careers where they would be happy. This is the framework I would use if I were in your position. Best of luck. It'll work out if you put in the effort.

I've heard varying degrees of difficulty with regards to funding if doing a second residency. OP would only be fully funded with direct and indirect GME payments for his initial three-year residency. Afterwards CMS will only pay somewhere between 50-100%. I'm not sure if this means you should aim for academic programs where funding is less of an issue, but something to keep in mind.

Graduate Medical Education (GME): Payments to Teaching Hospitals

Learn about regulatory changes affecting direct and indirect graduate medical education (GME) payments.

www.aamc.org

 

[PB2464]

Thank you all for all this great input. Appreciate the feedback. All risk/reward. It is unfortunate that it is so hard for reapplicants or making changes after match.

I have average test scores, DO scores are 571, 610. Passed step 1, didn't take step 2 due to family medical tragedy, great for EM, average for rad, based on stats. I would fall in the middle of the pack based on matched data. Not sure about being a reapplicant.

As far as my app, nontraditional, did MS/PhD in engineering, medical device design, lots of published things, patents, etc. I had excellent LORs. I don't have an issue interviewing being very social. I received solid reviews from programs

Being a bit on the older side compared to mid 20's, I am concerned about EM burnout. I see miserable EM doctors in their 40s, 50s and 60s and not sure it would be reasonable down the line. Yes, I know they have been doing it for a long time or have other issues. I get that and I am realistic as I do have plenty of professional experience.

Family is important as I have several kids and wanted something that provided more family time and flexibility. I loved anatomy, wanted surgery during second and third year but changed due to lifestyle. EM gave me anatomy, variety, procedures, reasonable shift #. Rad gives me less burnout at an older age, anatomy, variety, flexibility, more telerad. I have a few connections with rad that I am trying to get in my corner.

Match list due in two days, as of now, ranked my first 5 EM programs and top 3 also have rad programs that I would love to be at. Going to get intern year clinical experience, talk to rad PDs, talk to my EM PD (Not sure when). Will try to transfer internal first. If I end up at a program without a rad program, I will be more concerned. Especially with the stats out there but I never let fear drive me away. If I wanted something, I pushed down the doors.

If I fail, so be it, I will try again and find a home somewhere. If programs look at someone that tried to get something they want but were not successful and decide to write them off, it isn't a place I would like anyway.

When would you have a conversation with your new EM PD? Ha. Anyone on here have any pointers on how to approach this conversation or examples of what they did?

In EM and I often think I would've enjoyed rads more so I would say go for it. EM clinical work is draining. Nights are terrible. Although, at least doing EM, you can drop to part time pretty easily and do locums work at a pretty high rate of pay. It's easy to cut back hours and stick to day shifts only. Even cut out weekends. It's all supply and demand. In that sense, I've made it into a lifestyle speciality.

 

[chudat]

This was great. Thank you for taking the time to write this. Hiking up the mountain isn't bad, just makes it feel sweeter on top.

where did you end up matching