Need to transfer programs. Advice please.

[BiscoDisco]

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I'm an intern and need to know how feasible it is to transfer programs. Everything is going great, evals have been fine, getting along with everyone. Issue is, my spouse's mother is sick and she desperately wants to be near her. We could handle long distance for a year or so if it were just us two, but we also have a small child which makes long-distance not an option.

I'm at a respectable University program now a couple time zones away from home. I would ideally need to find a program back in southern california. I've tried poking around different threads to get an idea on the feasibility. It sounds like pgy2 is the best chance, with pgy3 being harder to get. What is the time line/process for doing this? Is there any chance to transfer pgy4 year? Any other bits of advice for transferring? Is it simply a matter of looking at various programs resident rosters and if there are less residents in pgy2/3/4 class than in intern class, they must have holes that can be filled?

Thanks for everyones advice.

 

[Sushirolls]

Prepare yourself for Plan B. Wife and kid move to see things thru with the MIL. They return once things settle down with MIL.

 

[BiscoDisco]

Prepare yourself for Plan B. Wife and kid move to see things thru with the MIL. They return once things settle down with MIL.

Is it really that difficult, even if I had to wait until pgy4?

 

[dl2dp2]

Is it really that difficult, even if I had to wait until pgy4?

I've heard that this is the case in Southern California. Esp. if you would restrict to university programs.

 

[BiscoDisco]

I've heard that this is the case in Southern California. Esp. if you would restrict to university programs.

I'd be willing to do NorCal as well if needed. Had no idea it was so hard. I did notice both UCSD and UCLA had fewer residents in pgy 3 class which made me think it would possibly be doable

 

[dl2dp2]

I would start by reaching out to the program directors for the programs you are interested in, and devleop a relationship. Spots pop but in general get filled quickly, and there is no formal mechanism that people use to fill them.

 

[BiscoDisco]

I would start by reaching out to the program directors for the programs you are interested in, and devleop a relationship. Spots pop but in general get filled quickly, and there is no formal mechanism that people use to fill them.

Thanks for the tip.
So I should essentially talk to possible pds first. Then if something opens up approach my own pd?

 

[twospadz]

I think University of San diego accepts a few pgy 2 applicants every year. I would think these spots would be pretty competitive.

Also check this website. I think there is a open pgy 2 spot in Northern California here for 2020.

Psychiatry Residency Training Program Vacancies

The Clearinghouse is APA's free service to residents, students and residency programs.

www.psychiatry.org

 

[dl2dp2]

Thanks for the tip.
So I should essentially talk to possible pds first. Then if something opens up approach my own pd?

There's no point in talking to your own pd now because if there's no open spot you can't move regardless.

 

[clausewitz2]

There's no point in talking to your own pd now because if there's no open spot you can't move regardless.

But also if there is any chance of it actually happening tell your PD pronto, you do not want them finding out from someone else (say, the PD of a program you are contacting). People talk.

 

[BiscoDisco]

But also if there is any chance of it actually happening tell your PD pronto, you do not want them finding out from someone else (say, the PD of a program you are contacting). People talk.

I'm trying to figure out the best way to balance this. Don't want to spill the beans of my plans too soon if things don't work out on the other end. But of course, I don't want them to hear it from someone else either.

This is getting depressing. The idea of 3.5 years of my wife feeling sad she can't be with her mother who is ill or the thought of not being with my daughter during her early years is lose lose.

 

[downwithDTB]

I'm trying to figure out the best way to balance this. Don't want to spill the beans of my plans too soon if things don't work out on the other end. But of course, I don't want them to hear it from someone else either.

This is getting depressing. The idea of 3.5 years of my wife feeling sad she can't be with her mother who is ill or the thought of not being with my daughter during her early years is lose lose.

Long distance parenting should be a non- starter.

Have you comprehensively thought about the level of care MIL needs? How long she will maintain her level of function? How long will she be around after your residency? Ect. Can she move closer to you? The kids always have to come before anyone else and your job is how this kid's gonna get through school and your presence is invaluable.

Final thoughts: if your PD is a decent person, they should be sympathetic to your plight and help you find a new spot. No offense, but we're all pretty replacable, especially if you're at the kind of program with a human enough PD to help you transfer programs due to significant family changes. Also, no one wants a resident who won't be happy, so why not trade you out for someone who will be?

 

[Sushirolls]

The issue won't be letting this resident go, but finding a program in the location where the MIL is.

Furthermore, if MIL is in SoCal, and the only program is in NoCal, that's still a commute for the wife/child to be with MIL, and likely the same logistical issue as current location.

 

[BiscoDisco]

The issue won't be letting this resident go, but finding a program in the location where the MIL is.

Furthermore, if MIL is in SoCal, and the only program is in NoCal, that's still a commute for the wife/child to be with MIL, and likely the same logistical issue as current location.

We could find a way to make a cheapish 50 min flight work from norcal to socal. I think my wife would be able to compromise by being there a few days every week or so. My MIL has a quickly diminishing neurocognitive impairment such that in a couple years she probably won't even know who her daughter is...thus why she wants to spend these next few years with her.

The programs like Kaweah Delta, while in California are far enough away that it would take longer to get from there to home than it would from a flight where I'm currently at (big urban area). So I'd need something in Socal or the Bay Area essentially.

@downwithDTB my PD seems like a genuinely good-hearted person. Everyone really likes her. I think she'd be willing to work with me. It's just a matter of a spot opening up elsewhere. Are you under the belief that emailing PDs at every program which would be acceptable is the best move at this point?

 

[dl2dp2]

The issue won't be letting this resident go, but finding a program in the location where the MIL is.

Furthermore, if MIL is in SoCal, and the only program is in NoCal, that's still a commute for the wife/child to be with MIL, and likely the same logistical issue as current location.

Bingo. Esp. if your wife makes no money frankly you don't have any option. Ideally your MIL should move closer to you, rather than the other way around, which is very backward in the long run. MIL has no remunerative engagement at her present location, and care-giving can be done anywhere.

It's also important to address other important issues in caring for family members with dementia prior to initiating job moves of this type. I see this in clinical practice all the time... Where is it CLINICALLY more optimal for the MIL in the next few years? Often urban centers have more accessible care. What about legal guardianship? What about nursing support? Psychiatric care? In many instances, if the patient is in rapid cognitive decline, it's much more important that this person has significant support in addition to a primary care giver. What this means that YOUR presence would be important, especially as a physician/psychiatrist, in contributing valuable input in various clinical decisions. Long distance is not ideal in these scenarios IMO--obviously we don't have a full picture here based on limited information, but if I was the physician and you are the family member, it would be ill advised to for someone like this to live indepednently without significant family support.

 

[deleted736562]

We could find a way to make a cheapish 50 min flight work from norcal to socal. I think my wife would be able to compromise by being there a few days every week or so. My MIL has a quickly diminishing neurocognitive impairment such that in a couple years she probably won't even know who her daughter is...thus why she wants to spend these next few years with her.

The programs like Kaweah Delta, while in California are far enough away that it would take longer to get from there to home than it would from a flight where I'm currently at (big urban area). So I'd need something in Socal or the Bay Area essentially.

@downwithDTB my PD seems like a genuinely good-hearted person. Everyone really likes her. I think she'd be willing to work with me. It's just a matter of a spot opening up elsewhere. Are you under the belief that emailing PDs at every program which would be acceptable is the best move at this point?

It sounds to me like it's more reasonable to bring this up with your PD first. Let her know where you are standing and your potential plans. She would also appreciate you talking to her early in the process about this You will need her full support regardless and if you let programs know you have the approval of your PD they will be more likely to engage you.

 

[Mass Effect]

Is it really that difficult, even if I had to wait until pgy4?

If you're willing to wait until PGY 4 year, I would suggest you just finish your residency. Your wife can go now to spend some time there and then come back and maybe closer to her mom in a year or so? The kid thing is complicated. How old are your kids? If I were you, I would be looking at programs that are anywhere within driving/affordable flight distance so that your wife can be close to mom every weekend and can still live with you. That might mean places in AZ, NV, etc. Those states may have more openings than CA.

Bingo. Esp. if your wife makes no money frankly you don't have any option. Ideally your MIL should move closer to you, rather than the other way around, which is very backward in the long run. MIL has no remunerative engagement at her present location, and care-giving can be done anywhere

Disagree. Moving a person with dementia, especially if it's to a place she's never been, will only disorient her further. The familiarity of her home and home town is important.

 

[SourceOfDenial]

Sounds like a really tough situation. No armchair quarterbacking here—you and your partner will know what will be best for your family, if it’s being close to MiL, then you try to go. Training takes a backseat and lets be honest—it really doesn’t matter all that much.

I’d talk with your PD and explain what’s going on. They will be your biggest advocate to transfer, emailing other PDs, reaching out personally, and writing your letter. If it’s a PD worth their weight they will do what’s best for you.

We had a coresident who needed a transfer and left after PGY1. We all understood and remained friendly—as professionals we should recognize that things happen.

 

[Bartelby]

I thought I would need to transfer in PGY3 for personal reasons. I talked to my PD early and found her totally supportive (obviously sad to see me go but understanding). That let us talk through timelines to make final decisions, etc in a way that would work for my program as well, and ensured support from my program's end. In the end a lucky break in my personal life meant that I did not need to move and I stayed with my program. I think telling my PD was the right call. Unless your PD is malignant I really recommend talking with him/her before telling other programs.

 

[BiscoDisco]

Bingo. Esp. if your wife makes no money frankly you don't have any option. Ideally your MIL should move closer to you, rather than the other way around, which is very backward in the long run. MIL has no remunerative engagement at her present location, and care-giving can be done anywhere.

It's also important to address other important issues in caring for family members with dementia prior to initiating job moves of this type. I see this in clinical practice all the time... Where is it CLINICALLY more optimal for the MIL in the next few years? Often urban centers have more accessible care. What about legal guardianship? What about nursing support? Psychiatric care? In many instances, if the patient is in rapid cognitive decline, it's much more important that this person has significant support in addition to a primary care giver. What this means that YOUR presence would be important, especially as a physician/psychiatrist, in contributing valuable input in various clinical decisions. Long distance is not ideal in these scenarios IMO--obviously we don't have a full picture here based on limited information, but if I was the physician and you are the family member, it would be ill advised to for someone like this to live indepednently without significant family support.

Agreed with all of that. My wife works (actually makes about 25% more than I do) so keeping her salary would be key. Luckily she works remote so she is flexible. The reason my wife wants to move closer to her mother is because her siblings are all there too. With work and a small child my wife could not be a primary care giver. She would be splitting those duties with her two siblings. Her sister is the primary care giver, I think she just really wants to be around her mom before she really starts losing her faculties. So from this perspective, moving MIL to us is not really the best option.

 

[futuredo32]

I think it will be easier than you think. Many residents leave pgy3 for child psych which leaves open spots. I got into a different program pgy 3

 

[MacDonaldTriad]

Fast tracking opens PGY-4 slots not PGY-3. Most programs don't replace missing PGY-4s because it is risky to graduate people you only train for 12 months, and most PGY-4 years are mostly electives anyway.

 

[Merely]

Fast tracking opens PGY-4 slots not PGY-3. Most programs don't replace missing PGY-4s because it is risky to graduate people you only train for 12 months, and most PGY-4 years are mostly electives anyway.

risky in what way

 

[OldPsychDoc]

risky in what way

As the graduating PD, you are the one attesting to their qualifications. So if you really don't know the resident you can be on the hook for that.
You need to trust that the PD transferring the resident to you isn't just unloading one of their problem children on you.

 

[withoutface123]

One other wrinkle to think about: the Medical Board of California is transitioning to a provisional training license system where you must train for at least 36 months before you can apply for your medical license proper, and 24 of those months must be consecutively at the same institution (and I think they must be in California though I am not sure). This goes into effect beginning January 1, 2020, meaning this year's current interns are the first class to be affected by it, and we are encouraging our PGY-2's to apply for their license before December 31st to avoid having to get the training license. So your best bet would be transfering into a California program at the end of your PGY-1 year, and you would get credit for 12 months of training plus the subsequent additional 24 months at your new program. Transfering after PGY-2 or PGY-3 may create a bit more of a complicated situation, though to be honest, when the medical board explained all this to us, even they didn't seem to sure about certain scenarios.

I feel for you friend, sounds like a really tough and frustrating situation to be in. All the best wishes in your decision making and your family's health.

 

[LABrondo]

One other wrinkle to think about: the Medical Board of California is transitioning to a provisional training license system where you must train for at least 36 months before you can apply for your medical license proper, and 24 of those months must be consecutively at the same institution (and I think they must be in California though I am not sure). This goes into effect beginning January 1, 2020, meaning this year's current interns are the first class to be affected by it, and we are encouraging our PGY-2's to apply for their license before December 31st to avoid having to get the training license. So your best bet would be transfering into a California program at the end of your PGY-1 year, and you would get credit for 12 months of training plus the subsequent additional 24 months at your new program. Transfering after PGY-2 or PGY-3 may create a bit more of a complicated situation, though to be honest, when the medical board explained all this to us, even they didn't seem to sure about certain scenarios.

I feel for you friend, sounds like a really tough and frustrating situation to be in. All the best wishes in your decision making and your family's health.

Doubt that you would have to do 2 years residency in California to get a California license lol

 

[MacDonaldTriad]

You would have to do 2 years of residency at the same program to license in California. These wouldn't have to be in California. The ABPN also has rules about splitting training over 3 different programs. ABPN is national of course where as every state makes up their own rules.

 

[JonteMD]

The above has cause so much pain for me. It's true. 2 of the 3 years (max) must be within the same program. This program does not have to be in CA. If you a PGY-1 moving to CA for preliminary position, work to stay within the same program for the next 2 years. If not, you will not be able to be fully licensed in CA and will not be able to complete training in CA. This is regardless of having PTL.