First off, please realize that prelim or first year medicine and surgery spots are a dime a dozen. Get in one.
The reasons for this is:
1. You will not waste the year, since you need a transitional year or prelim year anyways.
2. You can do research within the year and perhaps do an elective month in PM&R (i.e. make connections and get your name out there)
3. You will have a program director that can be witness to the fact that you are still a clinically strong candidate for any residency program. This point might be the strongest. Program director to program director is the strongest connection you can make when trying to get into any residency program.
Second, if you truly looked into prelim/transitional spots in chicago and nyc, then did you also look into categorical spots as well?
The reason for this is:
1. You sign a contact yearly in categorical positions, for what I am told. Therefore, you can still complete your intern year and look for PM&R spots and not sign the contract for the following year after you secure a spot. However, some internal medicine programs might be open to this anyways. Because they realize that they are filling one of their open positions and possibly getting a categorical resident (if you don't find a PMR spot).
2. I know that you are destined for PM&R, but would you like a residency spot versus no residency at all? People start off in one speciality and switch all the time.
Third, perhaps you should not limit yourself to just chicago and nyc.
The reason for this is:
Obvious, there are good programs out there besides the ones in chicago and nyc. This also raises the possibility of getting a spot.
Hope this helps.