Need some serious advice on possible residency switch. Please HELP!

[lizaem90]

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Hi SDN! I need some serious help here, i'm down to the wire. I've been incredibly stressed for months over this.

I am currently an IM PGY-1 in a program that was my top choice in my hometown. I have family, friends here and great support. I love the hospital however I've realized I don't really enjoy IM or want to be a hospitalist. I love EM and am passionate about EMS. I was afraid to apply EM due to being afraid of not matching, which I now regret.

My institution has an EM program here. Side note: I've worked EMS for my hospital prior to medical school, volunteered in EMS in town, did an EMS/EM elective here and know many of the EM residents from being in the IM program. I approached the EM PD back in October of last year as well as my IM PD stating my interest in applying EM. The IM PD immediately stated that it was ok to apply, however I would no longer have an IM spot. I ultimately decided not to apply IM with the risk of being out of a residency program, and I told my IM program so.

Fast forward to now. The EM program just contacted me stating they requested a resident compliment back when I first expressed interest (adding another resident to the next class) in hopes to offer me a transfer position and got it approved by the ACGME! However they unfortunately are not allowed to offer it to me outside of the Match. Meaning I would have to now apply to just their program and enter into the Match this year for the added spot to the incoming class.

I need some advice. I want to go for it but I am absolutely terrified or the risk! Of being out of a residency and now pissing off my PD and my program because I am now changing my mind again when I told them back in November i'd be staying. The thought of being out of a residency is just...awful. Unsure I could find a PGY-2 spot. I also didn't perform as well as I could have for these first 6 months because I just felt depressed, not interested, and my IM program definitely noticed. I'm afraid I wouldn't be able to get decent letters, etc. if I didn't Match.

Any advice? I meet with the EM program director this coming week.

Thanks guys. Much love.

 

[Crayola227]

Why wouldn't you just meet with the EM PD and say most of this? Ask if he would rank to you match.

I know someone who transferred from IM to psych in basically exactly this way. They had to go through ERAS and all that, but it was literally a formality and everyone knew it. It was basically just the way the transfer was being handled.

I do agree that I wouldn't breathe a single word of this to your PD until the EM PD gives you an assurance that your spot is for sure.

 

[lizaem90]

Why wouldn't you just meet with the EM PD and say most of this? Ask if he would rank to you match.

I know someone who transferred from IM to psych in basically exactly this way. They had to go through ERAS and all that, but it was literally a formality and everyone knew it. It was basically just the way the transfer was being handled.

I do agree that I wouldn't breathe a single word of this to your PD until the EM PD gives you an assurance that your spot is for sure.

Well, can he tell me it’s for sure? I know there’s rules to the match, etc. It seems like if he ranks me within the 1-9 residency spots then it’s a done deal. They were saying a few months back I’d still go to interview day and meet with other ED faculty who’d also have a say. I’m also super worried about my IM PD sabotaging it somehow once I tell her I’m applying since I’m going back on my word.

I guess I’m just super nervous about the worst!


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[DocWinter]

These things happen and it does seem as if you really want this ER spot and have a good shot of achieving it. The only way to know for sure obviously is to talk to the ER program director. As stated above, address your concerns with him or her and make a step after that.
It is scary but it’s not as if you were throwing it all up for a chance at some random spot somewhere else. You have a connection which means a lot. Your IM PD May even be more supportive than you think right now

 

[Crayola227]

These things happen and it does seem as if you really want this ER spot and have a good shot of achieving it. The only way to know for sure obviously is to talk to the ER program director. As stated above, address your concerns with him or her and make a step after that.
It is scary but it’s not as if you were throwing it all up for a chance at some random spot somewhere else. You have a connection which means a lot. Your IM PD May even be more supportive than you think right now

I wouldn't go this far. It is very possible that if the IM PD gets a whiff of this they will immediately go looking for someone to fill the position. Especially this late in the year.

But imho it's worth talking to the EM PD, and honestly it's probably true they don't have unilateral say in hiring (usually it's more a question that others have some veto power (so no matter how much the PD loves you, don't really piss off the aPD interview day), or it is exactly the sort of thing they have to say because of the technicalities of the match.

I think it's worth at least meeting with them, and I just wanted to second for OP that the Match and handwaving about interviewing is indeed one way that I've seen an intern transfer out of a program to another specialty, with everything settled in advance. In that case both PDs were on board and everyone knew it was a settled deal. I remember talking to that intern personally about the details of this, I was surprised that it was all arranged yet they still had to go through the match, attend an interview, meet all the faculty and whatnot at the other program.

 

[rokshana]

Hi SDN! I need some serious help here, i'm down to the wire. I've been incredibly stressed for months over this.

I am currently an IM PGY-1 in a program that was my top choice in my hometown. I have family, friends here and great support. I love the hospital however I've realized I don't really enjoy IM or want to be a hospitalist. I love EM and am passionate about EMS. I was afraid to apply EM due to being afraid of not matching, which I now regret.

My institution has an EM program here. Side note: I've worked EMS for my hospital prior to medical school, volunteered in EMS in town, did an EMS/EM elective here and know many of the EM residents from being in the IM program. I approached the EM PD back in October of last year as well as my IM PD stating my interest in applying EM. The IM PD immediately stated that it was ok to apply, however I would no longer have an IM spot. I ultimately decided not to apply IM with the risk of being out of a residency program, and I told my IM program so.

Fast forward to now. The EM program just contacted me stating they requested a resident compliment back when I first expressed interest (adding another resident to the next class) in hopes to offer me a transfer position and got it approved by the ACGME! However they unfortunately are not allowed to offer it to me outside of the Match. Meaning I would have to now apply to just their program and enter into the Match this year for the added spot to the incoming class.

I need some advice. I want to go for it but I am absolutely terrified or the risk! Of being out of a residency and now pissing off my PD and my program because I am now changing my mind again when I told them back in November i'd be staying. The thought of being out of a residency is just...awful. Unsure I could find a PGY-2 spot. I also didn't perform as well as I could have for these first 6 months because I just felt depressed, not interested, and my IM program definitely noticed. I'm afraid I wouldn't be able to get decent letters, etc. if I didn't Match.

Any advice? I meet with the EM program director this coming week.

Thanks guys. Much love.

you have to ask yourself, is doing EM worth the risk of sitting out a year and replaying, this time to EM, for 2020. Yes, the EM position could work out and yay! everyone would be happy.

your IM PD was very honest with you...most PDs are going to want people who are happy and if someone isn't, they are generally willing to help get the resident to a place that they could be happy...and your PD gave you that chance...and you decided that you didn't want to take that risk...but now you want to have your cake and eat it too...a guarantee that you get to keep you spot if if it doesn't work out for you...while you program and PD have to deal wit the fall out of having a open spot.

Talk to the ED PD, but realize you cannot ask where they are going to match you...that is a match violation. If the PD gives you assurance that this is all formality, then you need to tell your IM PD ASAP...ASAP!! that you are going to leave your IM residency so they can put your spot into the match...they have to tell the NRMP how many spots they are giving by Jan 31. Tell them now and overall you may not inconvenience them too much.

And i gotta feeling your IM PD already knows something about this...can't imagine the EM PD wouldn't have talked to him/her.

The other option, of course, to complete the IM residency and then apply for EM after that...it would be a long haul, but then you get to do what you want as a career. The other is if you could see if could do a combined residency there with IM/EM.

 

[GoSpursGo]

Agree that you can't ask if they will "rank you to match..." however, I'm curious whether it would be OK for the OP to ask "are you interviewing other applicants for this position?" As others say, they can volunteer that you would be "ranked to match" but you can't ask. In the absence of being told that you are assured of the spot, I agree with the general consensus that I wouldn't abandon your current spot. Just too risky. If you DO get that clear signal though, I'd probably go for it. This is your career.

Yeah, this would be a kind of crappy thing to do to your current program. But you've been as up front as you reasonably could be throughout this process, and you've gotta look out for yourself during your training.

 

[Psai]

If they're petitioning for a new spot just for you it seems like they do want you, but there are no guarantees in life. We can't tell you that everything will be rainbows and sunshine and there is a chance that not only do you not get the EM spot, you may be left out of the IM program as well. I think the risks outweigh the benefits but I'm not the one in your shoes.

 

[Ironheme]

You seem to be having regrets. You picked the IM, tried to stick it out and you're still uncertain/unhappy about your choice. Yes, it's a risk. But do you want to be asking yourself in 5 years, what if I had gone for the EM spot?

 

[lizaem90]

You seem to be having regrets. You picked the IM, tried to stick it out and you're still uncertain/unhappy about your choice. Yes, it's a risk. But do you want to be asking yourself in 5 years, what if I had gone for the EM spot?

True. I meet with the EM PD this Thursday. I really want the spot, I’m just so scared of what I have to loose.


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