Need some advice please

[rmarchigiani]

I am coming to all of you for your honest input and advice and would like to thank you ahead of time for your help.

I am currently a PGY1 categorical general surgery resident. Since I can last remember, I always wanted to go into surgery. However, going through medical school, other things tend to spark your interest. PMR was one of those things, however it was a rather new field and heard very few things about it until towards the end of my 3rd year. I did a neuro rotation with a doc that did some PMR and loved it, however, because of, what I thought at the time, was my first love, I opted to go into general surgery and give it a try. I decided that although I really liked PMR and what it had to offer, if I did not try surgery, I may regret it. Therefore, I continued with my 3 LORs from surgery and applied to all general surgery programs.

Well here I am, regretting going into surgery. Its not the hours, the in house call Q2-Q3, or working my ***** off day in and day out. In fact, I enjoy working hard, but I like it more when I enjoy what I am doing. Its strictly the field…the surgeries….the patient set backs. I initially thought I would do ortho, but I am a FMG from AUA. My board scores are 225/229/Pass….all first attempts. I didn’t try ortho, but I convinced myself I would enjoy gen surg enough to finish residency and do a fellowship. Well that is just not happening. I really just can’t stand gen surg and the procedures. Even if this was ortho, I still would rather be on the floor with patients than in the OR. Surgery is just not for me. I just don’t enjoy it. I don’t share the passion the other residents have when they get to go to the OR. I would rather be on the floor taking care of patients than being called away to the OR. I truly enjoy watching patients progress, observing them improving, and assisting them in their rehabilitation, especially post-operative. I’d rather deal with the patients postoperative, helping them to get better, than being in the OR operating. I should of listened when they told me if you can see yourself doing anything else, then surgery is not for you.

So here is my dilemma and where I need some advice. I obviously have to go back through the match and I need to get a LOR from a physiatrist. My plan is to finish my intern year where I am and then apply during my second year. This way I can work on doing some volunteer work with a physiatrist in the area to get a LOR, as well as apply nice and early next year.

My questions are….
1. Do you think being in my position I have a reasonable chance to match? Will they look negatively at the fact that I am a general surgery resident and want to switch?
2. Since PMR is an advanced position, what do you recommend I do with the year in between finishing my second year and starting my first year as a PMR resident?
3. What else can I do to increase my chances? I plan to apply EVERYWHERE! I am not limited geographically at all.

The fact is I really cant wait to transfer into PMR. I truly love the field, and I wish I went into it in the first place.

Well that’s where I stand. I would be happy to supplement any additional info you may need to help understand my position. I am just genuinely interested in hearing what some of you might have to say, or if you previously knew/know someone in my position.

Thanks again.

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[rysa4]

I am coming to all of you for your honest input and advice and would like to thank you ahead of time for your help.

I am currently a PGY1 categorical general surgery resident. Since I can last remember, I always wanted to go into surgery. However, going through medical school, other things tend to spark your interest. PMR was one of those things, however it was a rather new field and heard very few things about it until towards the end of my 3rd year. I did a neuro rotation with a doc that did some PMR and loved it, however, because of, what I thought at the time, was my first love, I opted to go into general surgery and give it a try. I decided that although I really liked PMR and what it had to offer, if I did not try surgery, I may regret it. Therefore, I continued with my 3 LORs from surgery and applied to all general surgery programs.

Well here I am, regretting going into surgery. Its not the hours, the in house call Q2-Q3, or working my ***** off day in and day out. In fact, I enjoy working hard, but I like it more when I enjoy what I am doing. Its strictly the field…the surgeries….the patient set backs. I initially thought I would do ortho, but I am a FMG from AUA. My board scores are 225/229/Pass….all first attempts. I didn’t try ortho, but I convinced myself I would enjoy gen surg enough to finish residency and do a fellowship. Well that is just not happening. I really just can’t stand gen surg and the procedures. Even if this was ortho, I still would rather be on the floor with patients than in the OR. Surgery is just not for me. I just don’t enjoy it. I don’t share the passion the other residents have when they get to go to the OR. I would rather be on the floor taking care of patients than being called away to the OR. I truly enjoy watching patients progress, observing them improving, and assisting them in their rehabilitation, especially post-operative. I’d rather deal with the patients postoperative, helping them to get better, than being in the OR operating. I should of listened when they told me if you can see yourself doing anything else, then surgery is not for you.

So here is my dilemma and where I need some advice. I obviously have to go back through the match and I need to get a LOR from a physiatrist. My plan is to finish my intern year where I am and then apply during my second year. This way I can work on doing some volunteer work with a physiatrist in the area to get a LOR, as well as apply nice and early next year.

My questions are….
1. Do you think being in my position I have a reasonable chance to match? Will they look negatively at the fact that I am a general surgery resident and want to switch?
2. Since PMR is an advanced position, what do you recommend I do with the year in between finishing my second year and starting my first year as a PMR resident?
3. What else can I do to increase my chances? I plan to apply EVERYWHERE! I am not limited geographically at all.

The fact is I really cant wait to transfer into PMR. I truly love the field, and I wish I went into it in the first place.

Well that’s where I stand. I would be happy to supplement any additional info you may need to help understand my position. I am just genuinely interested in hearing what some of you might have to say, or if you previously knew/know someone in my position.

Thanks again.

When I applied ( a few years ago ;-)) you needed letters of rec but not necessarily from a physiatrist. Perhaps your year of general surgery would meet a requirement for a PGY1 year? I know its not standard fare but it might fly. get your letters from the docs you do work with and apply now, or try and scoop up a pgy2 spot somewhere so you can slide in is one option. I have seen this done.

otherwise you can go back and do more time as you have outlined. YMMV

 

[Paddington]

There's a lot of former surgeons in PM&R.

So here is my dilemma and where I need some advice. I obviously have to go back through the match and I need to get a LOR from a physiatrist. My plan is to finish my intern year where I am and then apply during my second year. This way I can work on doing some volunteer work with a physiatrist in the area to get a LOR, as well as apply nice and early next year.

This is what I'm not sure about. I'd think long and hard about this. Are you saying you want to stay in your program as a PGY-2 and do some PM&R shadowing in your free time? IMO, if you're not going to be a surgeon, then why keep doing it? It's a bad idea on a number of fronts. You only get a certain number of years of residency funding. Also, if right now you tell your program director that you plan on leaving at the end of the year, then it's zero problem for him to replace you. He can have literally 1000 candidates lined up to take that spot. A PGY-3 spot, however, is not so easy to fill. I understand there's the small matter of $45,000 a year, but surgery residency pays like **** for the hours you work. Maybe consider doing some observerships in PM&R, while working another job or doing some research next year?

Either way, the most important thing for you will be to get a *good* reference from your program director. Work hard. Get good evaluations. Don't complain about call schedules. Stay out of office politics, etc.

Another thing I should warn you about though is that there's this popular perception that PM&R is a poor man's Ortho. In reality, PM&R has little in common with Orthopedic surgery.

 

[Ludicolo]

GME funding won’t be an issue. Having originally matched as a general surgeon, the OP gets 5 years of GME funding. Completing a pgy2 year in surgery, followed by 3 years of PM&R, means he/she doesn’t lose anything. If the OP leaves after internship, then he/she can apply to both advanced and categorical PM&R programs, again w/ no funding problems. But who wants to do another intern year?

OP - Your motives are pure. Your scores are fine. Your past surgical history won’t come back to haunt you. Your FMG status may be an issue, depending on program bias. Applying broadly is important. But because you are an independent applicant, you could accept positions outside the match as well – even open PGY2 spots for next year.

You’ll definitely need to talk about this w/ your PD sooner rather than later, and get a LOR vouching for your clinical skills, professionalism, etc. Agree w/ the above comment that leaving after internship would put your PD in a better position to fill a PGY2 slot vs. a PGY3.

A rehab LOR is a must for you. And shadowing may not be sufficient. Ideally, the letter should come in the setting of a clinical rotation. You probably don’t get electives as a surgical intern, but if you discuss the issue w/ your PD maybe something could be arranged. Now, if you pass step 3 and get licensed, perhaps you could moonlight for a rehab doc, or maybe as an overnight hospitalist for an inpatient rehab facility and gain clinical experience that way. But I don’t honestly know if anyone would hire you in this regard. Research may be another option.

Final thoughts: This might work. Good luck.

 

[axm397]

1. Do you think being in my position I have a reasonable chance to match? Will they look negatively at the fact that I am a general surgery resident and want to switch?

No - I don't think that is an issue at all. Many people "find" PM&R late and many non-match spots are filled that way. I think your priority now is to get as much exposure to PMR as possible as you have not done any rotations in PM&R and that definitely will be looked at poorly.


2. Since PMR is an advanced position, what do you recommend I do with the year in between finishing my second year and starting my first year as a PMR resident?

does your FMG status mean you need a visa?

options:
- switch to transitional internship - lehigh and st lukes both have some nice prelim/transitional programs

- continue PGY2 in surgery (harder to get time off to do rotations and schedule interviews)

- find a PM&R related researcher with a grant who can give you a modest stipend to live on while helping with their research which should ideally end in a publication

- use as much time in July, Aug, Sept, and Oct to do rotations/shadowing and get LORs.

- find a position outside of the match after scramble/match day

- email/contact as many program coordinators and directors as you can in the spring (now is too soon) to tell them you are available to take an open PGY2 spot. I would do this in march - june 2010 as this is the time they will be finding out about residents who changed their minds, had family issues, etc. also, check back on sdn often as open spots get posted here throughout the year.


3. What else can I do to increase my chances? I plan to apply EVERYWHERE! I am not limited geographically at all.

My suggestion would be to find a physiatrist to shadow - the Academy's member database has 6 physiatrists in bethlehem and 10 in Allentown. If you can get to harrisburg/hershey, I know some of the physiatrists there. You can even cross the border into NJ. Find as many variety of physiatrists - inpatient, outpatient, MSK, TBI, SCI, etc. etc.

If you have any research or elective time during your intern year get some rotations lined up. if u can't, use your vacation time to at least get some face time. switch calls with your peers and try to get as many weekdays off as possible to get this time.

look for alums from your school in PM&R and contact them for ideas and contacts.

Find mentors - this can be face to face type mentors as well as electronic communication only mentors. find research (case report, whatever you can) and submit to the AAP and AAPM&R.

hope this helps

 

[topwise]

One important piece of advice I have is this: if your program director is not a complete jerk, you should talk to them ASAP. It's early enough in the year that this will give them ample time to replace you if you decide to leave as a PGY2, and they might also be able to finagle some elective time in PM&R for you. Plus you are going to want to get a LOR from your current program, so being honest with them and considerate is important.

If you act now, you might be able to get into a PGY2 PM&R year in July, rather than doing another year and a half of surgery.

 

[PMR 4 MSK]

Sometimes you can get a pgy-2 outside the match. Watch for open positions here and other sites.

Depending on your attending and PD, your decision to trade surgery for PM&R may be looked down upon. The reality is that in many places, especially the "old school" types, PM&R suffers from lack of respect. While we tend to have high job satisfaction, we constantly are expected to justify ourselves.

Start by shadowing a PM&R for a few days and see if that truely is what you want to do. Understand that our field is very broad, and no one physiatrist does all aspects. Even many residencies don't touch on all aspects - mine had no burn and little interventional pain.

Your scores are good, you likely interview well to get into surgery. In your off year, if you are stuck with one, do research or do some full time moonlighting if you have your license - such as urgent care clinics or rural ER's, cover call at hospitals, etc. There are a lot of possibilities.

 

[rmarchigiani]

Hello everyone, sorry for my absence. It's been one of those weeks.

Thank you for all your replies, there is some very helpful advice that I need to dissect and figure out what is best for me, my program, and time constraints.

To answer some questions, I am a US citizen, so a Visa is not an issue for me. I was born and raised in Chicago. As far as my plan for next year, that is really where I have a dilemma. Ideally, I would not want to do another year of Surgery, however, I was considering it for a few reasons.

One, Its a guaranteed spot and a guaranteed salary. Two, I don't have the time off, the resources, or the required LORS to re-apply for PMR now.

The problems Im having are.... one, at times I don't care how guaranteed the spot/salary are I just want out of surgery. Two, I don't want to put my PD in a bad position as some of you mentioned. Three, time off for interviewing while in surgery is going to tough, as some of you mentioned.

As of right now, the best plan I have come up with is...continue as a PGY 2 in surgery, try to get as much time in as possible with a physiatrist (during vacations, during off service rotations), then reapply during my PGY 2 year for PMR, and possible a prelim/ty year in medicine to fill the gap, or maybe find a research position somewhere. Finally, I could try to find a pgy2 year some how so I don't have a gap.

As you can tell, im rather confused. I never thought I would have to be going thru this again. Now I have to worry about money, time, matching, my current program, etc.

Either way, thank you again for all the information. Im really going to try and sift through everything you guys said to see what sounds best for my current situation.

Thanks again.

 

[joseppi]

If you can- I think to make the most of your situation and time you should bust your *ss now to get your application together and appply NOW! I can't hurt, only can help in getting out of your current situation. The path of least of resistance is to do another surgery year, but really were is that going to help! You still need to re-apply in another year, meanwhile working ungodly hours doing something you really don't LOVE.
Do what you can to get it together, yes you are a bit late and people are already interviewing. (inteview go until early jan at some palces) But, just pull togehter an application; LOR's, and stellar personal statement to explain your situation.

Hello everyone, sorry for my absence. It’s been one of those weeks.

Thank you for all your replies, there is some very helpful advice that I need to dissect and figure out what is best for me, my program, and time constraints.

To answer some questions, I am a US citizen, so a Visa is not an issue for me. I was born and raised in Chicago. As far as my plan for next year, that is really where I have a dilemma. Ideally, I would not want to do another year of Surgery, however, I was considering it for a few reasons.

One, Its a guaranteed spot and a guaranteed salary. Two, I don't have the time off, the resources, or the required LORS to re-apply for PMR now.

The problems Im having are.... one, at times I don’t care how guaranteed the spot/salary are I just want out of surgery. Two, I don’t want to put my PD in a bad position as some of you mentioned. Three, time off for interviewing while in surgery is going to tough, as some of you mentioned.

As of right now, the best plan I have come up with is...continue as a PGY 2 in surgery, try to get as much time in as possible with a physiatrist (during vacations, during off service rotations), then reapply during my PGY 2 year for PMR, and possible a prelim/ty year in medicine to fill the gap, or maybe find a research position somewhere. Finally, I could try to find a pgy2 year some how so I don’t have a gap.

As you can tell, im rather confused. I never thought I would have to be going thru this again. Now I have to worry about money, time, matching, my current program, etc.

Either way, thank you again for all the information. Im really going to try and sift through everything you guys said to see what sounds best for my current situation.

Thanks again.

 

[rysa4]

If you can- I think to make the most of your situation and time you should bust your *ss now to get your application together and appply NOW! I can't hurt, only can help in getting out of your current situation. The path of least of resistance is to do another surgery year, but really were is that going to help! You still need to re-apply in another year, meanwhile working ungodly hours doing something you really don't LOVE.
Do what you can to get it together, yes you are a bit late and people are already interviewing. (inteview go until early jan at some palces) But, just pull togehter an application; LOR's, and stellar personal statement to explain your situation.

This advice was very good:

- email/contact as many program coordinators and directors as you can in the spring (now is too soon) to tell them you are available to take an open PGY2 spot. I would do this in march - june 2010 as this is the time they will be finding out about residents who changed their minds, had family issues, etc. also, check back on sdn often as open spots get posted here throughout the year.

I have seen this done many times, including by my former roommate from medical school, who,like you,disliked general surgery and managed to jump into an open ENT spot at a great program. The situation may be more common than you think! GOOD LUCK!

 

[rmarchigiani]

If you can- I think to make the most of your situation and time you should bust your *ss now to get your application together and appply NOW! I can't hurt, only can help in getting out of your current situation. The path of least of resistance is to do another surgery year, but really were is that going to help! You still need to re-apply in another year, meanwhile working ungodly hours doing something you really don't LOVE.
Do what you can to get it together, yes you are a bit late and people are already interviewing. (inteview go until early jan at some palces) But, just pull togehter an application; LOR's, and stellar personal statement to explain your situation.

Thank you very much for ther above advice. I am considering trying to reapply now, in fact I just got in touch with two physiatrist and am trying to set up some time with them where I can shadow. I just want to make sure I have all my ducks in a row before I apply. Because once I apply I have to tell my PD, and once I do that, I no longer have a spot here, so If I dont match in PMR, then I am stuck, unless I apply for prelim and get that somewhere. Also, I need to see my financial status. I dont know if I have the money right now to apply and fly around for interviews. However, it is good advice, and I am going to see what I can do. So thank you.

email/contact as many program coordinators and directors as you can in the spring (now is too soon) to tell them you are available to take an open PGY2 spot. I would do this in march - june 2010 as this is the time they will be finding out about residents who changed their minds, had family issues, etc. also, check back on sdn often as open spots get posted here throughout the year.

I also really like this advice. If I start contacting programs in March, do I need to go through the match now? Or can I just start contating them and explain my situation? If I plan on doing that, when should I let my PD know?

If I tell him now and dont get anything, then he is going to know I dont want to be here and Ill be stuck for another entire year...and chances are they will make my life a living hell... even more than now! I am trying to be fair, but at the same time, I am trying to protect my own a**. I want to tell him, but I want to wait till I know I dont have to come back and I have some kind of plan in case it doesnt work out. Or if it does, then i have somewhere else to go. The point is....I dont want to have to be stuck here even after telling him I dont want to be here. At the same time, I dont want to tell him, then have to leave, with nothing else to do. I feel like that is even worse then doing another year of surgery.

Thanks again

 

[joseppi]

If you apply now, don't immediately let your program know. Wait to see if any interview come in. It may be in your best intesrest, this way if nothing really comes together and you don't mind staying on another year it will still be there. By doing this I don't necessarily think you are being misleading, but instead looking out for your best interest which after you tell them, they may not be too concerned with..... my 2C for what its worth

Also, if you are able to find an open spot now by calling around, it is my understanding that you don't need to go through the match. I would push hard to get your app together, make sure the LOR's are strong and don't waste too much time because people are interviewing...

 

[topwise]

You don't need to go through the match if you're doing PGY2 in PM&R next year. I actually don't think it's too early to be contacting programs now. Based on personal experience, I can tell you that empty spots can get filled well before March.

I understand your dilemma of not wanting to tell your PD because they'll make you miserable, but I also think if you go in that direction, you need to be careful. If your PD finds out you're hunting for another residency behind his back (which only one call from another program would alert him to) then you are going to be in bad shape.

Furthermore, if you only start looking for PGY2 spots in March, what are you going to do if someone takes you in May? Will you then tell your PD that you're leaving, effectively screwing over all the residents you're leaving behind who are now one short? I've been in two programs where this happened and it really sucks for everyone.

You definitely have to look out for yourself, but I also believe honesty is the best policy.

 

[TRAMD]

1. Do you think being in my position I have a reasonable chance to match? Will they look negatively at the fact that I am a general surgery resident and want to switch?

* FMG may be an issue but your board scores should help. You should have a more than reasonable chance to match. It is quite common for residents to switch out of surgery/anesthesia/etc and go into PM&R so that should not hurt you much. Many PM&R docs would hate to be surgeons so we understand.

2. Since PMR is an advanced position, what do you recommend I do with the year in between finishing my second year and starting my first year as a PMR resident?

*You will need money to live on and experience in PM&R. Move to a state where you can get your license after just an internship and passing Step 3, get your license, moonlight for money. You can make more money moonlighting and working 15 hours per week than you can as a full-time resident so you will have time to attempt to set up shadowing positions with PM&R docs in the area for experience in PM&R . . . I thought about this more and you would need the experience while you are in your second year of surgery (I am assuming you are halfway through your 1st year now). You might be best off leaving after intern year and doing 2 years of the above.

3. What else can I do to increase my chances? I plan to apply EVERYWHERE! I am not limited geographically at all.

*Setting up a shadowing opportunity at a program that you like may help you at that program. Applying to less competitive programs will obviously help your chances of matching.

 

[rmarchigiani]

Thanks again everyone for your advice. Im trying to figure out the best plan of action. I really do not want to stick around for my PGY 2 year....its miserable. So I am going to do my best to get out of my current situation and get into something more enjoyable than what I have now.

So thanks again, and Ill do my best to keep you all updated.

 

[rmarchigiani]

One other question.....when I start to contact programs about a PGY2 position, do you guys recommend contacting them by phone or email?

Thanks

 

[medocus]

One other question.....when I start to contact programs about a PGY2 position, do you guys recommend contacting them by phone or email?

Thanks

Just curious. It has been a year and a bit.Did you manage to change? I hope you got what you wanted.