Left residency 5 years ago during PGY2 due to family issues, looking to return...do I try to find a PGY2 position or do I start over as PGY1?

[mustang1234]

I left my psych residency 5 years ago due to family issues a few months into my PGY2 year. I want to finish residency, but I'm not really sure where to start. Should I be looking for PGY2 positions, or will I be expected to start over as a PGY1? Is it just going to depend on individual PD's? There were no problems with competence, I was doing fine and one day I went up to my PD and told him I had to leave.

Do psychiatry residencies even offer PGY2 positions through ERAS and the match? Should I apply to PGY1 positions through ERAS, will psych programs even interview someone who has finished a PGY1, for a PGY1 spot? I guess I'll need new LORs and maybe more recent clinical experience...how do I get them? I know it's a bit late for this application cycle, I'm really just trying to get some sense of how I should proceed. Any advice is appreciated.

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[GoSpursGo]

What have you been doing in the last 5 years? That is going to be hugely important to determine if this is even feasible.

To answer your specific questions--PGY2 positions would need to be found outside of the match, but it is sort of irrelevant because you'll definitely have to start back at PGY1 level. You definitely need more recent clinical experience and letters; there isn't really a defined way to do that, but your old psych program if the PD is still there or your old med school MIGHT be able to point you in a helpful direction?

If you try to apply this late, you won't get any interviews, but you could sign up for the NRMP just to try and SOAP. I think that is a long shot as well unless you have recent clinical experience and letter writers lined up, but it's an option.

 

[mustang1234]

What have you been doing in the last 5 years? That is going to be hugely important to determine if this is even feasible.

To answer your specific questions--PGY2 positions would need to be found outside of the match, but it is sort of irrelevant because you'll definitely have to start back at PGY1 level. You definitely need more recent clinical experience and letters; there isn't really a defined way to do that, but your old psych program if the PD is still there or your old med school MIGHT be able to point you in a helpful direction?

If you try to apply this late, you won't get any interviews, but you could sign up for the NRMP just to try and SOAP. I think that is a long shot as well unless you have recent clinical experience and letter writers lined up, but it's an option.

Thank you for your response. I was working in the career I had prior to medicine, ie not medicine related. Is it really not even feasible to return at all? I feel like it should be, I remember seeing FMGs on the interview trail who had been trying to find a spot for years and seemed to have a shot. I'm an American grad and I was an above average candidate as a medical student, if it makes any difference.

In order to SOAP, do I just need to sign up for the NRMP before the deadline? Ie I don't need to apply or interview anywhere, or anything like that?

 

[GoSpursGo]

Thank you for your response. I was working in the career I had prior to medicine, ie not medicine related. Is it really not even feasible to return at all? I feel like it should be, I remember seeing FMGs on the interview trail who had been trying to find a spot for years and seemed to have a shot. I'm an American grad and I was an above average candidate as a medical student, if it makes any difference.

In order to SOAP, do I just need to sign up for the NRMP before the deadline? Ie I don't need to apply or interview anywhere, or anything like that?

The FMGs all presumably had some observerships and medicine-related work in the prior 5 years. You may once have been solid, but your skills have undoubtedly atrophied in the last 5 years. MAYBE it's possible if you can secure some clinical experience to prove yourself, but 5 years is a long time. And I would open yourself up to other specialties including IM and FM, as psych is now fairly competitive.

I think you technically have to apply to one program in order to SOAP.

Finally... you don't have to share details here, but be aware that the fact that you previously resigned and left medicine is a huge, huge red flag. Any prospective program is going to be really worried that you might do that again. You may have had a very good reason for doing what you did, but you're in a really bad spot.

 

[rokshana]

Thank you for your response. I was working in the career I had prior to medicine, ie not medicine related. Is it really not even feasible to return at all? I feel like it should be, I remember seeing FMGs on the interview trail who had been trying to find a spot for years and seemed to have a shot. I'm an American grad and I was an above average candidate as a medical student, if it makes any difference.

In order to SOAP, do I just need to sign up for the NRMP before the deadline? Ie I don't need to apply or interview anywhere, or anything like that?

Yes, but those FMGs have been doing something medically related in their country or are doing research in this country… and even then they are at a disadvantage for having a YOG > 5 yrs. An FMG with recent medical experience will be more competitive than a USMD with no medical experience for over 5 years.
It’s not impossible, but how realistic…meh…
As mentioned, a good first step would be to talk to your old PD … if you left on good terms, s/he may be willing to help.

Btw, psych is trending up in competitiveness so it may be a different world now

 

[mustang1234]

I'm definitely open to IM, I was thinking of doing IM/psych as a med student. I did speak with my PD, unfortunately he didn't have much in terms of concrete advice but we did leave on good terms and I have his support in trying to find a spot.

Doing research is something I've heard mentioned, I'm open to doing that. Are there paid research positions out there for MD grads? Or is it more like a part time volunteer thing? How would I find these positions?

 

[GoSpursGo]

Doing research is something I've heard mentioned, I'm open to doing that. Are there paid research positions out there for MD grads? Or is it more like a part time volunteer thing? How would I find these positions?

There are paid research positions. You are overqualified as an MD, but you could apply for them. The real question is whether such a position would provide you with the level of clinical exposure to lead to a letter that will vouch for your current clinical ability. That is the crux of what you have to demonstrate, that after 5 years off you still have the ability to practice medicine competently; just doing research and maybe getting your name on a few papers won't help with that.

 

[Raryn]

*If* you find a program willing to take you as a PGY2 (and you would need to find out outside the match), the program director can *at their discretion* give you credit. They'll often need to submit something to the relevant board, but if it's the same specialty that wouldn't be an issue. If it's a different specialty, there may be a max # of months they can give you credit (can be just a few).

Regardless though, the program director can also simply choose to give you no credit whatsoever. Totally up to them. Psych programs are among the most flexible so they *might* give you a years credit. Or they might not. Honestly, with a five year gap, I'd be grateful to get a position at all, much less an advanced one.

 

[NotAProgDirector]

Since you've already completed a psych PGY-1, it's possible to start as a PGY-2. The question you should ask yourself is "are you ready to be a psych PGY-2"? Are you ready to start supervising PGY-1's? Almost certainly not. Hence, you're probably going to need a PGY-1 position.

However, psych PGY-1 positions usually contain some number of IM rotations -- often 4 months or something similar. You don't need to repeat those -- I doubt they are really helpful in the long run, and you've already done them so should have credit for them. Therefore, what you could try to find is an off cycle PGY-1 position. If there was a program out there that has an open position in Jan or Feb, then they could take you there, have you do 6 months of only psych PGY-1 rotations, and then by July you're likely ready for a PGY-2 spot. off cycle spots are not in the match, so you'd just have to hunt around for them by contacting programs.

Restarting as a PGY-1 is certainly an option.

The 5 year gap is definitely going to be a concern. That you're a USMD and were a good candidate to begin will work in your favor. You will need an LOR from your old program -- you should request that now, you'll need it for any pathway forward.

You might be able to apply for an Occ Med or Preventive Med residency. Both reqire a PGY-1 year, it's possible that your psych year will count. These sppots are in the match, you'd probably need to wait until next year although you could try for this year.

SOAP would be a reasonable option for this year. To apply in SOAP, you need to apply to at least one program in ERAS. It can be any program, in any field -- you'll pay the minimum fees. You'll want that PD LOR, and whatever LOR's you can get. Then, in SOAP, you can apply to 30 programs total. Any combination of fields, but 30 programs. Can't buy any more. No cost beyond your initial app fees. Hard to say how successful you'll be, but the cost is low.

I'm hoping you have taken USMLE S3. If not, you have more problems.

So:

1. You need an LOR from your prior program. You should also try to network as much with them as they are willing -- they may be able to help you find programs with off cycle spots. You should assume and be up front with them that you are not looking to match there. You can hope they will take you back, but you shouldn't count on it. You should tell them up front that you don't expect them to take you back -- else they will worry that's what you're trying to do.

2. Apply in ERAS. Consider PM/OM programs if that interests you. If so, rech out to them as your app is very late and explain your situation. Not sure if the psych year will count or not. You can apply to psych programs but most/all will be done looking at apps. if you have any connections, use them.

3. Prep for SOAP. Come up with a plan. You have plenty of time -- it's in March. You'll have 30 apps, use them wisely.

4. Get clinical experience. Hopefully you have taken S3. If so, you can get a medical license in many states (although your long gap now may limit your options -- some state boards won't license you with the gap). With a license, you may be able to get some clinical experience. Again, use any connections you have. Start this process now -- it's long and slow, and you'll want clinical experience before you're applying next year if possible. Choose the field you want - psych, PM, OM, IM, or something else. Pathology is also low competitive, and they may care less about your gap. But you'll need some experience -- which can be easier since much of path isn't directly patient facing.

Best of luck.

 

[Cherbourg]

You might be able to apply for an Occ Med or Preventive Med residency. Both reqire a PGY-1 year, it's possible that your psych year will count. These sppots are in the match, you'd probably need to wait until next year although you could try for this year.

2. Apply in ERAS. Consider PM/OM programs if that interests you. If so, rech out to them as your app is very late and explain your situation. Not sure if the psych year will count or not. You can apply to psych programs but most/all will be done looking at apps. if you have any connections, use them.

An important point to keep in mind: not all Occ Med or Prev Med programs are on ERAS, so one may miss some programs by only looking there. An up-to-date list of the programs can be found here: https://www.acpm.org/getmedia/dec92...e932855/pmrresidencydirectoryaug2021.pdf.aspx

Also, these specialties don't actually participate in the match. Occ Med has a standard decision day, but otherwise it's the wild west. The reason why that may be relevant is because there isn't something similar to the match agreement, so spots can open up in the spring if people back out. Prev Med has a pseudo-match that they run on their own; based on a quick look at their website, they don't seem to have a binding match agreement either, but I am not 100% certain of this.

In any case, if someone is interested in Occ Med or Prev Med, right now is probably too late to apply via the standard timeline, but it is still a good idea to reach out to programs in case a spot does open up.

 

[mustang1234]

Since you've already completed a psych PGY-1,...

Really appreciate this post. Fortunately I took Step 3, and I have a license. What sort of clinical experience should I be thinking of here, how would I find such positions, what would they look like? Is it sort of a matter of networking and seeing how people might be willing to accommodate me, or are there specific kinds of positions I should be looking for?

 

[ortnakas]

Really appreciate this post. Fortunately I took Step 3, and I have a license. What sort of clinical experience should I be thinking of here, how would I find such positions, what would they look like? Is it sort of a matter of networking and seeing how people might be willing to accommodate me, or are there specific kinds of positions I should be looking for?

Have you been maintaining your license with CME all this time?

 

[NotAProgDirector]

Really appreciate this post. Fortunately I took Step 3, and I have a license. What sort of clinical experience should I be thinking of here, how would I find such positions, what would they look like? Is it sort of a matter of networking and seeing how people might be willing to accommodate me, or are there specific kinds of positions I should be looking for?

It is totally a matter of networking. You have a medical license, so technically you can "do stuff". But there won't be any positions advertised for "anyone with a PGY-1 completed and a license". You'll need to be creative.

 

[futuredoc331]

Really appreciate this post. Fortunately I took Step 3, and I have a license. What sort of clinical experience should I be thinking of here, how would I find such positions, what would they look like? Is it sort of a matter of networking and seeing how people might be willing to accommodate me, or are there specific kinds of positions I should be looking for?

I have absolutely zero experience with this and I don't know how legitimate it is, but I was browsing the interwebs yesterday and found the attached website. Looks like they're trying to recruit docs who didn't finish residency for wound care jobs. It may be a way to get some clinical experience that can then be used to get some more.

I've not been in your particular situation but I've been in enough funky spots to know that when there's a will there's a way.

 

[Mass Effect]

Ok so I'm not known for mincing words so I'll just tell you my honest opinion. It's not personal and I obviously can't predict the future so I hope you'll show me I'm wrong.

First of all, IM/psych is likely out. There are only a handful of combined programs and they tend to be more competitive and geared toward people who are fresh out of MS4 (i.e. they still aren't good, but the medicine is fresh, unlike someone who's been away for 5 years).

I don't think it's going to happen in psychiatry. Or if it does, it's going to be with a lengthy detour. No program is going to take you as a PGY 2 when you haven't had clinical experience for FIVE years. I mean, in psychiatry, we count on our PGY 2s to run the unit at night by themselves. No in-house supervision. I don't know of a single program that would take on the liability of having a PGY 2 they don't know who's been out of medicine for 5 years, work solo on an inpatient unit overnight. Not only that, but you'll be tasked with supervising interns, most (if not all) of whom likely know more than you do about both medicine and psychiatry considering your absence from the field. It's not a good setup.

So then we're back to you starting as an intern. This is possible, but unlikely. There are too many good candidates who don't match psychiatry for me to consider you having a even a decent shot of matching over one of them with your 5 year absence.

You should apply for PGY 1 positions in psych and see what happens. You should also apply for transitional year or a preliminary internship year. Take whatever you get. If you end up with a prelim, then you can re-apply to psych the following year, but at least you'll get back into medicine. It'll be up to your future psych program whether they give you credit for the prelim year or whether you have to start over again. So you may be looking at repeating your intern year twice more before you get to do any psychiatry.