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- Mar 23, 2015
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Hey, SDN. I am posting my experience about switching residencies. This is a throw-away account, although I suspect that with the details I am prepared to include, I will be readily identifiable by anybody involved with my personal story.
When I first realized that I wanted to switch out of my program, I had a ton of questions, but felt isolated without anybody to talk to. I came to SDN and did a search, but it wasn't as helpful as I thought it would be. In a desperate attempt, I sent PMs to random people to see if they could help me. Overall, it was a pretty dismal experience, and I promised that once I got out on the other side, I'd make a post here about my experience here so that others down the line could have something to garner information from.
As background, I am a graduate of a US allopathic school. I was an average med student with average board scores. Throughout 3rd year, I had a tough time picking a specialty to apply to because I truly liked most things that I rotated through. After cutting it down to IM and radiology, I chose to apply to radiology.
I began to feel the first tinges of reconsideration during my sub-I in fourth year. Because I front-loaded my schedule with radiology rotations, I didn't get to my (mandatory) IM sub-I until the tail-end of my fourth year. It was an amazing experience and I really loved everything about it. The next chapter was intern year, which was absolutely one of the greatest experiences of my life. I loved every moment of it and I looked forward to going to work everyday. None of the parts that people said were bad about intern year (the long hours; being the low-man on the totem pole) bothered me in the least, because I was having such a good time learning and practicing medicine.
I began to have serious doubts about moving on past IM. Still, I convinced myself that I chose radiology for a reason, and that I only felt this way because I was so far removed from it. I convinced myself that if I loved IM this much, then I would love radiology this much more.
Partway through the course of my intern year, one of the categorical IM interns dropped out for reasons that are unknown to me. I was quite friendly with many of the chief residents at the time, and some of them happened to mention that I was a really great IM intern and that I seemed to really enjoy it; they thought that perhaps I would make a really good IM resident, and that I should talk to the PD about staying on if what they were observing about me was really true.
I gave it some serious consideration, and spent a few evenings talking about it with my wife, who encouraged me to talk to the PD. In the end, I decided against it because I convinced myself that I would like radiology more; additionally, the thought of telling my radiology PD, a person that I met only once, that I was never going to show up because I had a change-of-heart was a bit daunting.
On July 1st of PGY2, I realized that I made a mistake. The feeling got worse with every passing day. I felt like I had something that I loved and that I stupidly let it get away. It felt like breaking up with a perfect girlfriend. The thought of continuing on this path that I didn't want to became unbearable, but I didn't have anybody to talk to. This is about when I made the SDN searches and random PMs.
Eventually, I decided that I would reach out to my old PD, whom I had a cordial, but not totally chummy relationship with. He offered some great support, but ultimately he never wavered from his ultimate message: that my new PD was the only person that could help me, and that he was the only person that I could and should talk to.
So now I was left with the terrifying task of telling my new PD, a person that I barely know, how I truly felt. Mind you that this was still the first or second week of July. I hesitated a lot because I thought he would think that I was ridiculous for being so sure so soon. I hesitated a lot because I barely knew the guy. I hesitated a lot because I was scared to death.
Ultimately, I took the leap and I arranged to meet with my PD. I was too unhappy not to talk about it. The main reason I pulled the trigger was because I was hoping to salvage the year by switching early enough to an IM program to not lose credit for a year of residency (this is silly thinking, which I will explain below). The meeting was as terrifying and awkward as I thought that it would be. Overall, however, my PD was nothing less than supportive. Despite his understanding, he urged me to give it a month or two to see if my feelings changed; perhaps I was just getting the jitters from a change of scenery.
A month or two passed and I didn't change my mind. He gave me the blessing to inquire about residency vacancies (if you talk to programs without obtaining this blessing, then at best they will think you are a sleazy and unreliable resident, and at worst they will tell your current PD what you are doing and he will then think those things about you). This next part is extremely tough, because finding an open position is pretty hard to do. I always assumed that PDs had some means of communicating with each other about things that interest them (terrible applicants, vacancies, etc.). It turns out that a magical central repository of open positions frankly doesn't exist.
The way that open positions are found is two-fold: 1. You meet with your institutional PD of the specialty that you want to switch to, who works his connections and the back channels to find any open positions. 2. You cold-call every program that interests you.
Neither are terribly good options. As for option 1, you are basically at the mercy of how much effort this PD wants to put into you, which is usually very little given that this person doesn't know you and has no vested interest in you. Additionally, you will have the terrible luck of coming to them for help at the start of interview season. The second option is not ideal because you have to take another leap preparing an application and putting yourself out there; furthermore, you have to be prepared for rejections (a lot of rejections). If you get to this step, I wager 98% of people who find a spot do so through method 2.
As alluded to above, the thought of switching out early enough to salvage your year is usually preposterous. This is because programs generally don't have any vacancies early in the summer, because they would have taken care of that before July 1st started. If you are lucky enough to find a spot, the chances that your current PD will be cool with you just leaving is pretty close to nil.
With that said, I did find a program with a vacancy very early into my search. The bad part is that it was a small community program literally on the other side of the country. The PD of that program, while quite nice, was extremely pushy and gave me timetables that pretty much pushed me to make decisions very rapidly. If I wasn't married, I might be at that program now, but taking a position like that so quickly was out of the question for my wife, so I relinquished the opportunities to wait and see if others opened up.
Others will open up. The golden time is November-January. This is when I got correspondence back from ~12 of the 160+ programs that I cold-called in the summer/fall. November-January is about the time that current residents also have a change of heart and leave, or personal issues sprout up, or residents are removed for academic reasons. All of them required interviews, which can be difficult to arrange while you are still a resident.
My conclusion is that I ended up being accepted to a quality university program. One that I feel strongly that I would've matched into had I applied directly to IM from medical school. I am extremely happy with the way that things have turned out.
This post is running (really) long, so I will sum up my recommendations as below:
1. Talk to your PD. He is the only person that can help you. You will be scared that he will turn out to be some horrible monster, but he won't be. If he is, then he's not the kind of person that you want to work for and have advocate for you, anyway. If you meet with your PD and he truly is not helpful to you, then every institution has a "GME director" that overlooks all residencies at that institution; you are allowed to contact him anonymously for help specifically if this occurs.
2. Finding a new position will be hard. There is no central repository of open positions. Residency-swap is a small database, is only for "swappers", and charges a fee. Be prepared to write up a new application and PS. Be prepared to send a lot of emails. Be prepared to make a lot of phone calls. Be prepared for a lot of rejections. Don't be surprised if the fruits of your hard labor don't blossom until November/December/January.
3. Realize that at the end of the day, your PD will have to endorse you to whatever program is interested in you. That means that even if you hate what you're doing, you will have to do your best to fake it, because they will want to know that you are competent and reliable.
4. Have courage and believe in yourself. Pursue your happiness.
Good luck. I hope that this was helpful to whoever reads it.
When I first realized that I wanted to switch out of my program, I had a ton of questions, but felt isolated without anybody to talk to. I came to SDN and did a search, but it wasn't as helpful as I thought it would be. In a desperate attempt, I sent PMs to random people to see if they could help me. Overall, it was a pretty dismal experience, and I promised that once I got out on the other side, I'd make a post here about my experience here so that others down the line could have something to garner information from.
As background, I am a graduate of a US allopathic school. I was an average med student with average board scores. Throughout 3rd year, I had a tough time picking a specialty to apply to because I truly liked most things that I rotated through. After cutting it down to IM and radiology, I chose to apply to radiology.
I began to feel the first tinges of reconsideration during my sub-I in fourth year. Because I front-loaded my schedule with radiology rotations, I didn't get to my (mandatory) IM sub-I until the tail-end of my fourth year. It was an amazing experience and I really loved everything about it. The next chapter was intern year, which was absolutely one of the greatest experiences of my life. I loved every moment of it and I looked forward to going to work everyday. None of the parts that people said were bad about intern year (the long hours; being the low-man on the totem pole) bothered me in the least, because I was having such a good time learning and practicing medicine.
I began to have serious doubts about moving on past IM. Still, I convinced myself that I chose radiology for a reason, and that I only felt this way because I was so far removed from it. I convinced myself that if I loved IM this much, then I would love radiology this much more.
Partway through the course of my intern year, one of the categorical IM interns dropped out for reasons that are unknown to me. I was quite friendly with many of the chief residents at the time, and some of them happened to mention that I was a really great IM intern and that I seemed to really enjoy it; they thought that perhaps I would make a really good IM resident, and that I should talk to the PD about staying on if what they were observing about me was really true.
I gave it some serious consideration, and spent a few evenings talking about it with my wife, who encouraged me to talk to the PD. In the end, I decided against it because I convinced myself that I would like radiology more; additionally, the thought of telling my radiology PD, a person that I met only once, that I was never going to show up because I had a change-of-heart was a bit daunting.
On July 1st of PGY2, I realized that I made a mistake. The feeling got worse with every passing day. I felt like I had something that I loved and that I stupidly let it get away. It felt like breaking up with a perfect girlfriend. The thought of continuing on this path that I didn't want to became unbearable, but I didn't have anybody to talk to. This is about when I made the SDN searches and random PMs.
Eventually, I decided that I would reach out to my old PD, whom I had a cordial, but not totally chummy relationship with. He offered some great support, but ultimately he never wavered from his ultimate message: that my new PD was the only person that could help me, and that he was the only person that I could and should talk to.
So now I was left with the terrifying task of telling my new PD, a person that I barely know, how I truly felt. Mind you that this was still the first or second week of July. I hesitated a lot because I thought he would think that I was ridiculous for being so sure so soon. I hesitated a lot because I barely knew the guy. I hesitated a lot because I was scared to death.
Ultimately, I took the leap and I arranged to meet with my PD. I was too unhappy not to talk about it. The main reason I pulled the trigger was because I was hoping to salvage the year by switching early enough to an IM program to not lose credit for a year of residency (this is silly thinking, which I will explain below). The meeting was as terrifying and awkward as I thought that it would be. Overall, however, my PD was nothing less than supportive. Despite his understanding, he urged me to give it a month or two to see if my feelings changed; perhaps I was just getting the jitters from a change of scenery.
A month or two passed and I didn't change my mind. He gave me the blessing to inquire about residency vacancies (if you talk to programs without obtaining this blessing, then at best they will think you are a sleazy and unreliable resident, and at worst they will tell your current PD what you are doing and he will then think those things about you). This next part is extremely tough, because finding an open position is pretty hard to do. I always assumed that PDs had some means of communicating with each other about things that interest them (terrible applicants, vacancies, etc.). It turns out that a magical central repository of open positions frankly doesn't exist.
The way that open positions are found is two-fold: 1. You meet with your institutional PD of the specialty that you want to switch to, who works his connections and the back channels to find any open positions. 2. You cold-call every program that interests you.
Neither are terribly good options. As for option 1, you are basically at the mercy of how much effort this PD wants to put into you, which is usually very little given that this person doesn't know you and has no vested interest in you. Additionally, you will have the terrible luck of coming to them for help at the start of interview season. The second option is not ideal because you have to take another leap preparing an application and putting yourself out there; furthermore, you have to be prepared for rejections (a lot of rejections). If you get to this step, I wager 98% of people who find a spot do so through method 2.
As alluded to above, the thought of switching out early enough to salvage your year is usually preposterous. This is because programs generally don't have any vacancies early in the summer, because they would have taken care of that before July 1st started. If you are lucky enough to find a spot, the chances that your current PD will be cool with you just leaving is pretty close to nil.
With that said, I did find a program with a vacancy very early into my search. The bad part is that it was a small community program literally on the other side of the country. The PD of that program, while quite nice, was extremely pushy and gave me timetables that pretty much pushed me to make decisions very rapidly. If I wasn't married, I might be at that program now, but taking a position like that so quickly was out of the question for my wife, so I relinquished the opportunities to wait and see if others opened up.
Others will open up. The golden time is November-January. This is when I got correspondence back from ~12 of the 160+ programs that I cold-called in the summer/fall. November-January is about the time that current residents also have a change of heart and leave, or personal issues sprout up, or residents are removed for academic reasons. All of them required interviews, which can be difficult to arrange while you are still a resident.
My conclusion is that I ended up being accepted to a quality university program. One that I feel strongly that I would've matched into had I applied directly to IM from medical school. I am extremely happy with the way that things have turned out.
This post is running (really) long, so I will sum up my recommendations as below:
1. Talk to your PD. He is the only person that can help you. You will be scared that he will turn out to be some horrible monster, but he won't be. If he is, then he's not the kind of person that you want to work for and have advocate for you, anyway. If you meet with your PD and he truly is not helpful to you, then every institution has a "GME director" that overlooks all residencies at that institution; you are allowed to contact him anonymously for help specifically if this occurs.
2. Finding a new position will be hard. There is no central repository of open positions. Residency-swap is a small database, is only for "swappers", and charges a fee. Be prepared to write up a new application and PS. Be prepared to send a lot of emails. Be prepared to make a lot of phone calls. Be prepared for a lot of rejections. Don't be surprised if the fruits of your hard labor don't blossom until November/December/January.
3. Realize that at the end of the day, your PD will have to endorse you to whatever program is interested in you. That means that even if you hate what you're doing, you will have to do your best to fake it, because they will want to know that you are competent and reliable.
4. Have courage and believe in yourself. Pursue your happiness.
Good luck. I hope that this was helpful to whoever reads it.
