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deleted957248

I’m a pgy1 finishing a preliminary year and starting a radiology categorical residency in July. Unlike most people who were ecstatic on match day, I was devastated to see I had fallen to my 9th choice to a smaller community hospital last year in a small town. I received over 15 interviews in my preferred field and 10 in IM. I decided to dual apply not due to a concern about competitiveness but due a genuine interest in both fields. I wasn’t the most competitive candidate for the field I matched to, but to be completely honest, all the self reported data would suggest that I am overqualified for the program I ended up in. As time went on I developed regrets about what I had done and the implications of what this program could have on my future career. Furthermore I am sickened about ranking this community program over some strong academic programs in the secondary specialty I interviewed. The program is not terrible and has nice people apparently, but I am just very unsure about how much limitations this will pose in fellowship and job opportunities. How realistic is this stigma and can is there any chance of seeking out a career I want, unless I switch programs/ specialties?
 
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Dr.LeoSpaceman

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Without additional details, it's tough to provide any specific advice (e.g. your likelihood at ending up in a preferred practice setting given training at your designated program).

But in general, two things:
1) It would be best to stop trying to frame things based on what your peers did and whether your potential is being "wasted". Before you do anything, you need to reflect seriously about your short and long term goals. Sure matching into a more prestigious, but less competitive, specialty might "feel" better, but if it's preparing you for a path in which you aren't interested, it's all sizzle with no steak.

2) When you show up to your new spot next year, I'd advise you to work hard to shed this chip on your shoulder (or at least make sure it isn't visible). If your faculty and co-residents sense that you feel like you're too good for the place, it may make for a rough few years. And perhaps more importantly, if this is how you feel, it's going to be a setup for getting burned out pretty quick.
 
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Chlorini

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Based off your previously posts, I'm assuming you matched radiology with anesthesia as a back-up. There is nothing wrong with a radiology community program! I met many people on the interview trail that ranked (and matched) community programs number one over highly-ranked academic programs. If you did match radiology, you should know that fellowships aren't hard to get. Unless you want to do academics, a community program shouldn't hurt your chances of getting the job (or fellowship) that you want. Although I'm not a rads resident yet, I was under the impression that IR is really the only truly "competitive" fellowship.

If you are really concerned about your future program, ask the PD for their fellowship match lists and "google" some of their alumni to see where and who they work for. If it is truly awful, it might be worth it to switch. I say give it a shot for a year and see how it goes.

I don't know too much about anesthesia, but it seems like both fields attract the same personality types. I think it's a common theme to like both. Although you think you might have matched to a more prestigious program in anesthesia, you really can't know that for sure. Finding an anesthesia spot might be harder the second time around and then you'd be back in the same position.

Good luck!
 
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So question for you... if you had matched at what you consider a “strong” academic radiology program, would you be pining for the same strong anesthesia program?
 
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Many people post something like this now. Then, 2 years later, they follow up with a post saying how happy they are, and how they "wish they knew then what they know now". You are likely to be absolutely fine, get great training, and have a great career.
 
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deleted957248

Without additional details, it's tough to provide any specific advice (e.g. your likelihood at ending up in a preferred practice setting given training at your designated program).

But in general, two things:
1) It would be best to stop trying to frame things based on what your peers did and whether your potential is being "wasted". Before you do anything, you need to reflect seriously about your short and long term goals. Sure matching into a more prestigious, but less competitive, specialty might "feel" better, but if it's preparing you for a path in which you aren't interested, it's all sizzle with no steak.

2) When you show up to your new spot next year, I'd advise you to work hard to shed this chip on your shoulder (or at least make sure it isn't visible). If your faculty and co-residents sense that you feel like you're too good for the place, it may make for a rough few years. And perhaps more importantly, if this is how you feel, it's going to be a setup for getting burned out pretty quickly.

I don't think I'm above it at all. I know it's going to be challenging and prep me as well as any other program. Not having the perks and benefits stings a bit. And I just felt like the residents on interview day weren't too thrilled about their own program and a few other red flags, which wasn't even a big consideration to me at the time since I ranked it 9th. They do have a good fellowship match, as do most rads programs.

It's just unfortunate to know I could have scored 10-15 pts lower on each board exam done no research, ECs, and STILL gotten into this same program. Should have enjoyed that time and relaxed tbh... Or better to have taken a research year and aim for a higher tier program because this embarrassment and potential for poor job outlook is terrible.
 
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It's just unfortunate to know I could have scored 10-15 pts lower on each board exam done no research, ECs, and STILL gotten into this same program. Should have enjoyed that time and relaxed tbh... Or better to have taken a research year and aim for a higher tier program because this embarrassment and potential for poor job outlook is terrible.

You can’t know for sure that you would have matched here with lower scores. The elephant in the room here is that, for whatever reason, you did match at #9 on your list - you’ll never know what happened with #1-8, but it could be that something in the way you came across in your interview, or some other red flag, caused those programs to rank you a bit lower. Without all that hard work you put in, it’s possible you might have dropped lower still on your rank list. I do wish you the best, just hoping to offer a little perspective from someone who did match a bit lower than I was expecting and is doing just fine now. Good luck in the next few years!
 
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deleted957248

So question for you... if you had matched at what you consider a “strong” academic radiology program, would you be pining for the same strong anesthesia program?

No, I wouldn't be pining for it at that point. I'd have done: academic rads>academic gas> community rads> community gas. I probably shouldn't have interviewed at all those beautiful academic places. I am much more a research-oriented person and desire an academic career, just wish I had enough time to prove it to the PDs. Such a shame.
 
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deleted957248

You can’t know for sure that you would have matched here with lower scores. The elephant in the room here is that, for whatever reason, you did match at #9 on your list - you’ll never know what happened with #1-8, but it could be that something in the way you came across in your interview, or some other red flag, caused those programs to rank you a bit lower. Without all that hard work you put in, it’s possible you might have dropped lower still on your rank list. I do wish you the best, just hoping to offer a little perspective from someone who did match a bit lower than I was expecting and is doing just fine now. Good luck in the next few years!

Thanks a lot for the advice. I really appreciate it

To clarify I definitely wasn't a strong candidate on paper, hence falling 9/25 wasn't unexpected. Additionally, I was part of a large competitive group of fellow classmates going for rads in a very limited geographic location this year. My advisors told me that I would have been very desirable just a few years ago when radiology was in ints downswing. I got fairly decent interview feedback on the trail praising professionalism, enthusiasm, stating I'd "fit in well" etc., so not sure if I was that bad at the interviews. If it was, I would be relieved as it would be something I can work to fix, and not something inherently wrong with me.
 
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No, I wouldn't be pining for it at that point. I'd have done: academic rads>academic gas> community rads> community gas. I probably shouldn't have interviewed at all those beautiful academic places. I am much more a research-oriented person and desire an academic career, just wish I had enough time to prove it to the PDs. Such a shame.
You can still go into academia by doing a fellowship in an academic centers after residency. Also, jobs at academic centers are nowhere near as competitive as you think, since they generally make less money than someone working in a non-academic setting. I wouldn't rule anything out just because of where you did your residency. You might even come to appreciate non-academic settings as most physicians do and prefer.

Speaking for myself, I would rather be in a bottom tier program in a specialty that I love, than in a top tier program in a specialty I am ambivalent for. To quote one of my favorite TV shows, "it is better to be at the bottom of a ladder you want to climb then half way up one you don't".
 
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deleted957248

Thanks a lot for the advice. I really appreciate it

To clarify, I wasn't the strongest candidate for the field on paper, hence falling a bit wasn't unexpected. Additionally, I was part of a large competitive group of fellow classmates going for rads in a very limited geographic location that year. My PD advisor told me that I would have been competitive just a few years ago when radiology was in its downswing. I got fairly decent interview feedback on the trail praising professionalism, enthusiasm, stating I'd "fit in well" etc., so not sure if I was THAT bad at the interviews. Although falling low, with high interview count suggests that may be a possibility. If it was, I would be relieved as it would be something I can work to fix, and not something inherently wrong with me.

True, I do not know for sure. I am basing this off of information I heard from the current residents and my incoming co-residents.
 

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It's just unfortunate to know I could have scored 10-15 pts lower on each board exam done no research, ECs, and STILL gotten into this same program.

Or you could have done less and matched at a place even less desirable. Playing what-ifs is easy, and an understandable reaction. But it's not going to make you feel any better about where you're at. I'd also point out that--more globally--this attitude is one of the things wrong with the state of medical education. Doing those things (research, ECs, doing well on boards) should have intrinsic value beyond how they position you for a residency. You should have (hopefully) done them because there was an element of enrichment that makes you a better physician (and/or investigator). And if you did them just because you felt they were required, then I'd go back to my original post and tell you that it's important to figure out where you want to be and only do the things that contribute to that. When you make things transactional, it will never end. Then at some point you'll realize you've been going through the motions without actually deriving any fulfillment from what you're doing.

I'd also say that you should shift gears to find what opportunities exist at the place you're going...not dwelling on theoretical opportunities you have missed. If you look around at the people whom are successful, you can often pinpoint the ways in which they created their own opportunities at some point. I'm far from the "most accomplished" person out of my residency, but I showed up and developed an academic interest in something that really wasn't a known strength of the program. Because it was something I became passionate about, I found a mentor outside the usual suspects for our department and "made it work". Through some combination of good fortune and perseverance, it developed into a niche that likely got me what I would consider my "perfect" job. And it all started because one of my attendings said "Hey, you should come to this meeting."

Also, jobs at academic centers are nowhere near as competitive as you think, since they generally make less money than someone working in a non-academic setting.

I don't know what it's like in other specialties, but for general surgery and its subspecialties this is absolutely not true.
 
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I don't know what it's like in other specialties, but for general surgery and its subspecialties this is absolutely not true.

OP is in rads. I presume that not many places outside of academic centers do many of the complex surgeries that neurosurgeons or CT surgeons get well compensated for, but I find it difficult to believe your average plastic surgeon or orthopedic surgeon would forgo the potential significant increase in revenue by working privately or at a non-academic center to work at an academic center.

I’m not in surgery however, so I may be missing a piece.
 
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deleted957248

Or you could have done less and matched at a place even less desirable. Playing what-ifs is easy, and an understandable reaction. But it's not going to make you feel any better about where you're at. I'd also point out that--more globally--this attitude is one of the things wrong with the state of medical education. Doing those things (research, ECs, doing well on boards) should have intrinsic value beyond how they position you for a residency. You should have (hopefully) done them because there was an element of enrichment that makes you a better physician (and/or investigator). And if you did them just because you felt they were required, then I'd go back to my original post and tell you that it's important to figure out where you want to be and only do the things that contribute to that. When you make things transactional, it will never end. Then at some point you'll realize you've been going through the motions without actually deriving any fulfillment from what you're doing.

I'd also say that you should shift gears to find what opportunities exist at the place you're going...not dwelling on theoretical opportunities you have missed. If you look around at the people whom are successful, you can often pinpoint the ways in which they created their own opportunities at some point. I'm far from the "most accomplished" person out of my residency, but I showed up and developed an academic interest in something that really wasn't a known strength of the program. Because it was something I became passionate about, I found a mentor outside the usual suspects for our department and "made it work". Through some combination of good fortune and perseverance, it developed into a niche that likely got me what I would consider my "perfect" job. And it all started because one of my attendings said "Hey, you should come to this meeting."



I don't know what it's like in other specialties, but for general surgery and its subspecialties this is absolutely not true.

Yes it is a flaw. Take the research years that have become almost mandatory to match into derm/ some surgical subspecialties.

Anyway, I thoroughly enjoyed my med school activities and the opportunities afforded to me. I'm not the one who decided to make these research, volunteering, and leadership activities included in the selection process. That's something to bring up with PDs. Personally, it was never a concern for me that any of these items would be on the application. In fact, this probably contributed to my downfall, since many of my activities were in line with exploring other interests in medicine, and not staying as focused on building myself in my chosen specialty starting early on. Unfortunately doing activities for the app is a necessary evil that is required in a hypercompetitive world - and not doing so has cost people dearly.

Regarding opportunities, I've already done so, but it is clear that the follow up is spotty and the infrastructure for research is not as robust. Likely will need to wait to see if I will have one of the spontaneous experiences that you described.
 
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OP is in rads. I presume that not many places outside of academic centers do many of the complex surgeries that neurosurgeons or CT surgeons get well compensated for, but I find it difficult to believe your average plastic surgeon or orthopedic surgeon would forgo the potential significant increase in revenue by working privately or at a non-academic center to work at an academic center.

I’m not in surgery however, so I may be missing a piece.

If the only goal is to maximize your salary, then yes, an academic position is not the best choice. But there are other considerations, and they aren't (generally) scope of practice. If your goal is to have a research component to your career, or to chase prestige, then an academic position is generally the pathway. This ends up being a self-selected subset of people, but there are still relatively few jobs compared to a larger applicant pool.
 
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deleted957248

Based off your previously posts, I'm assuming you matched radiology with anesthesia as a back-up. There is nothing wrong with a radiology community program! I met many people on the interview trail that ranked (and matched) community programs number one over highly-ranked academic programs. If you did match radiology, you should know that fellowships aren't hard to get. Unless you want to do academics, a community program shouldn't hurt your chances of getting the job (or fellowship) that you want. Although I'm not a rads resident yet, I was under the impression that IR is really the only truly "competitive" fellowship.

If you are really concerned about your future program, ask the PD for their fellowship match lists and "google" some of their alumni to see where and who they work for. If it is truly awful, it might be worth it to switch. I say give it a shot for a year and see how it goes.

I don't know too much about anesthesia, but it seems like both fields attract the same personality types. I think it's a common theme to like both. Although you think you might have matched to a more prestigious program in anesthesia, you really can't know that for sure. Finding an anesthesia spot might be harder the second time around and then you'd be back in the same position.

Good luck!

Fellowships aren't difficult currently. But there are going to be something like 15 new residents added to my match cycle in my state alone due to new programs and expanding slots. Hopefully, there are enough fellowships/ jobs available to accommodate these new grads.
 

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Fellowships aren't difficult currently. But there are going to be something like 15 new residents added to my match cycle in my state alone due to new programs and expanding slots. Hopefully, there are enough fellowships/ jobs available to accommodate these new grads.

Ahh I see. You want to stay in the same state. Networking goes a long way in radiology, though. Apparently Twitter is a huge thing in the rads world (had no idea until recently). Get involved as much as you can. Also, when I’m feeling bummed or stressed out, I go on radworking.com and search jobs in the location I want to live. As of now, there’s plenty of jobs to go around. Those job posts cheer me up real quick. Radiology is a great field! Give it a chance!
 
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Fellowships aren't difficult currently. But there are going to be something like 15 new residents added to my match cycle in my state alone due to new programs and expanding slots. Hopefully, there are enough fellowships/ jobs available to accommodate these new grads.
I presume those individuals aren’t going to be competing with you when you apply though, since they are just starting out this year.
 
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deleted957248

I presume those individuals aren’t going to be competing with you when you apply though, since they are just starting out this year.

I mean that there were several new spots opened up for people who I'll be competing with directly in my fellowship year. New programs opened+ size of programs increased.
 

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I mean that there were several new spots opened up for people who I'll be competing with directly in my fellowship year. New programs opened+ size of programs increased.
Am I misunderstanding your situation? You are doing a prelim year and starting rads as a PGY2, right? And these new positions are more for people starting as PGY1s, right?
 

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At this point, you have very little real information (hard data and personal experience) to go on other than "what-if-isms" and intern neuroses. Recognize your feelings for what they are (bruised ego and anxiety), and vow not to give them too much weight until you can actually see if your fears are grounded in reality. At this point, all you can really do is start your residency and give it a fair shot. Try to like it, and you might be very pleasantly surprised. There are generally many opportunities to be found in a 'smaller pond' if you take the initiative.


Speaking for myself, I would rather be in a bottom tier program in a specialty that I love, than in a top tier program in a specialty I am ambivalent for. To quote one of my favorite TV shows, "it is better to be at the bottom of a ladder you want to climb then half way up one you don't".

Love the quote - Stealing it.
 
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deleted957248

Am I misunderstanding your situation? You are doing a prelim year and starting rads as a PGY2, right? And these new positions are more for people starting as PGY1s, right?

The new positions are just the ones I remember from my time interviewing. I interviewed at all of these places. So those new positions would be all be same year as me when fellowships and jobs come around. Not the biggest deal, but perhaps slightly increased competition worsened by lower tier program.
 

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The new positions are just the ones I remember from my time interviewing. I interviewed at all of these places. So those new positions would be all be same year as me when fellowships and jobs come around. Not the biggest deal, but perhaps slightly increased competition worsened by lower tier program.
Ah, gotcha. I misunderstood and thought you were talking about positions that had opened up this year, not last year. I'm sure you will have excellent opportunities either way once you finish residency.
 
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deleted957248

At this point, you have very little real information (hard data and personal experience) to go on other than "what-if-isms" and intern neuroses. Recognize your feelings for what they are (bruised ego and anxiety), and vow not to give them too much weight until you can actually see if your fears are grounded in reality. At this point, all you can really do is start your residency and give it a fair shot. Try to like it, and you might be very pleasantly surprised. There are generally many opportunities to be found in a 'smaller pond' if you take the initiative.




Love the quote - Stealing it.

I know I have no choice in the matter and have no choice but to give it a shot. Personally, I drive past 3 beautiful mid tier academic centers where I interviewed at, to get to this smaller community program. Every time I pass by them it’s a stab in the heart. The the name recognition, the perks, the motivated colleagues. Just disgusted by this whole situation. I feel like I would have definitely stood a better shot at them a few years ago or a year or two later where there wasn’t so much competition in this region. Also kind of feel like I should have gone with a specialty that actually wanted me, not one where I barely scraped into.
 

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Apparently Twitter is a huge thing in the rads world (had no idea until recently).

As a frequent twitter user, I'm suddenly glad I'm not in Rads.
 
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I know I have no choice in the matter and have no choice but to give it a shot. Personally, I drive past 3 beautiful mid tier academic centers where I interviewed at, to get to this smaller community program. Every time I pass by them it’s a stab in the heart. The the name recognition, the perks, the motivated colleagues. Just disgusted by this whole situation. I feel like I would have definitely stood a better shot at them a few years ago or a year or two later where there wasn’t so much competition in this region. Also kind of feel like I should have gone with a specialty that actually wanted me, not one where I barely scraped into.

You seriously have to work on that superiority complex.
 
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You seriously have to work on that superiority complex.
Not at all. I should have done better on my part to get some of these stereotypical advantages. Not my fault they exist. I can see why it seems like it but perhaps it would sound less so, if it reflected my full story over the past year since match day.

The the name recognition, the perks, the motivated colleagues.
I meant to rephrase as a drive to set up a larger research-integrated programs, although this is more of an institutional issue.
 

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Every year in the spring there are always several posts about people who are really upset by their Match results. A majority of the time we hear back later that they love their program and are glad they didn't try to switch.

Hopefully you will fall into that category.
 
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rokshana

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I know I have no choice in the matter and have no choice but to give it a shot. Personally, I drive past 3 beautiful mid tier academic centers where I interviewed at, to get to this smaller community program. Every time I pass by them it’s a stab in the heart. The the name recognition, the perks, the motivated colleagues. Just disgusted by this whole situation. I feel like I would have definitely stood a better shot at them a few years ago or a year or two later where there wasn’t so much competition in this region. Also kind of feel like I should have gone with a specialty that actually wanted me, not one where I barely scraped into.
i get it to some extent...but you did have a choice...you could have ranked those places higher and it was your decision to make your ROL the way you made your ROL...and if you ranked the 3 "beautiful" mid tier academic centers higher than your current match, then they didn't rank you high enough to match pure and simple.

maybe you would have had a better shot a different year, but also you would have been taking your exams at a different time and you may not have score as well either...

granted, now is the time to get this all out so you can go to this program with a clean slate, with no chip on your shoulder...because if you don't, it WILL affect your performance as a resident and reputation at your program...people aren't stupid and when you come in feeling that you are better than the program you are in or that you somehow got shafted in the match, they will see it...and it will affect how people perceive you.

realize that now it will be very important that you be able to make connections and have faculty at your program support you to be able to get the fellowship you want...you will be surprised at the the connections some people at smaller community programs have...medicine is a small world, academic medicine is a smaller world and in specialties such as radiology...its even smaller...bring the " i'm better than this program" attitude and you can harm your chances to advance you career...and that ultimately will be of your doing as well.

aim to be the big fish in a small pond...you will be surprised at what opportunities are there for you.

if after a year in and you think anesthesiology is more suited for you, then you can approach your PD and tell him/her that you want to switch specialties...if you have been a good/great R1, they will help you find another program.
 
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i get it to some extent...but you did have a choice...you could have ranked those places higher and it was your decision to make your ROL the way you made your ROL...and if you ranked the 3 "beautiful" mid tier academic centers higher than your current match, then they didn't rank you high enough to match pure and simple.

maybe you would have had a better shot a different year, but also you would have been taking your exams at a different time and you may not have score as well either...

granted, now is the time to get this all out so you can go to this program with a clean slate, with no chip on your shoulder...because if you don't, it WILL affect your performance as a resident and reputation at your program...people aren't stupid and when you come in feeling that you are better than the program you are in or that you somehow got shafted in the match, they will see it...and it will affect how people perceive you.

realize that now it will be very important that you be able to make connections and have faculty at your program support you to be able to get the fellowship you want...you will be surprised at the the connections some people at smaller community programs have...medicine is a small world, academic medicine is a smaller world and in specialties such as radiology...its even smaller...bring the " i'm better than this program" attitude and you can harm your chances to advance you career...and that ultimately will be of your doing as well.

aim to be the big fish in a small pond...you will be surprised at what opportunities are there for you.

if after a year in and you think anesthesiology is more suited for you, then you can approach your PD and tell him/her that you want to switch specialties...if you have been a good/great R2, they will help you find another program.

Thanks so much for your thoughtful response. To clarify I applied to categorical medicine programs as an addition to my prelim programs, not to anesthesia, despite having strongly debated pursuing it early on. To be honest I should have taken a decisive stand early on when I had applied. My experiences in this prelim year have added to my regret. I feel like I’ll miss the patient interaction and level of formal didactics I have been used to. Almost ended up asking my PD at my prelim year program to switch, but thought better of it.

Anyway, I think this open forum to get multiple perspectives is something I personally find helpful to get over any remaining shred disappointment of not ending up exactly where I wanted. And helpful to go into R1 with that same hope I had prior to learning my match placement
 

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I’m a pgy1 finishing a preliminary year and starting a radiology categorical residency in July. Unlike most people who were ecstatic on match day, I was devastated to see I had fallen to my 9th choice to a smaller community hospital last year in a small town. I received over 15 interviews in my preferred field and 10 in IM. I decided to dual apply not due to a concern about competitiveness but due a genuine interest in both fields. I wasn’t the most competitive candidate for the field I matched to, but to be completely honest, all the self reported data would suggest that I am overqualified for the program I ended up in. As time went on I developed regrets about what I had done and the implications of what this program could have on my future career. Furthermore I am sickened about ranking this community program over some strong academic programs in the secondary specialty I interviewed. The program is not terrible and has nice people apparently, but I am just very unsure about how much limitations this will pose in fellowship and job opportunities. How realistic is this stigma and can is there any chance of seeking out a career I want, unless I switch programs/ specialties?


My advise:

Get over yourself.

Residency is hard. It is hard everywhere. You are coming in knowing very little about how to be a practicing radiologist. It is really easy to make a hard situation untenable due to a bad attitude. You will have a much better 4 years of your life if you enjoy the work you do and the people you do it with.
 
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deleted957248

For sure! Appreciate it! I definitely understand how little I know about daily practice, and am excited to learn more honestly. Looking forward to the new opportunities... just wanted to shed some of the weight and assess my fears of future career limitation, I’ve been carrying for the past year. But starting to realize the possibilities and immense blessings. Thank y’all for all the input, both kind and real!
 
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NotAProgDirector

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Start your radiology residency and see how it goes. Maybe you'll love it -- if so, come back and post again. If not, you can almost certainly get a PGY-2 position in a good IM program. I'd recommend that you meet with your IM PD at your current location before you leave, and tell them you're having second thoughts. Then, if you're unhappy, you can reach out again and they will likely help you secure a PGY-2 spot. Might take one additional year to complete training, but that's minor if it makes you happy.
 
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