On strategic warfare

[agranulocytosis]

Guys, I really need your advice.

I am applying for general surgery for this match cycle. I really want it and feel I will make a great candidate. However, I have some reservations. For one, I am a caribbean student. I fully understand all the implications this has. Second, not one student from my school has matched into a categorical program in its history of graduating its students.

As it stands, I am finalizing my personal statment, which is understandably heavily slanted towards the surgical sciences. All of my LORs are from surgeons. Basically, my application has no room for other specialties.

The worst possible thing for anyone to endure, from what I have been told, is to go unmatched. I wouldn't want that either. So my question is this, what sort of back-up plan should an applicant such as myself have in place?

I will of course apply to both categorical and preliminary positions, but for arguments' sake, let's say that I will potentially face the possiblity that I will only get accepted for interview at prelim positions I would not want to accept.

Should I just go ahead and apply for IM as a backup? Is preliminary general surgery the ideal back-up for my ultimate goal of finishing a general surgery residency?

Thanks.

 

[hippiedoc13]

How strong is your application? USMLE scores, grades, research, letters?

Even without knowing those specifics, the general advice is going to be to apply early and broadly. Very broadly. And make sure your rank list is long enough.

 

[ccfccp]

I second the above. Apply to all the programs you can afford to that you would possibly want to go to. With a record like your schools, it will be difficult to be picky. You may only have choices of places other people don't want to go. That being said, the training you're likely to get will have a lot to do with what you put into it.

If you're gung-ho surgery, which it sounds like you are, a surgery prelim will be infinitely better than Internal Medicine. Prelim spots are independently funded and so they won't affect your funding to whatever residency you next apply. If you go into internal medicine for a year and then decide you want to change, you'll have to explain why a program should fit the bill for an extra year of training for which they will not be reimbursed by Medicare.

That being said, you should apply to all the categorical surgical programs you can. Who knows? You could be the first one to match there. There's no guarantee you can get a catagorical spot from a prelim, so it would certainly be safer if you get into a catagorical. Either way it will be hard work, but if you bust your butt, and as long as your application details aren't too bad, it should be doable.

 

[dingleberry007]

what are your step scores and which school? that would be helpful in giving appropriate advice.

 

[agranulocytosis]

Thanks guys. For a full perspective, Step 1 was 239, CK 242. HPs for all of clinicals this far with a couple of honors in FM, OB and cards. Ortho and CT surg are pending.

I just don't want to go unmatched, but it may seem that wasting a year in IM would be far worse. If I do not match, would a year of surgery-related research be better than an intern year in IM?

 

[peppy]

I think it would make more sense to apply to prelim surgery programs as your backup. Applying to prelims rather than scrambling into one will give you the luxury of time to investigate where the program's prelims end up going (some institutions have better track records for helping their prelims get into categorical spots later than others do). Hope things work out for you and you get a categorical spot.

 

[turquoiseblue]

do a surgical prelim because they can go on to get categoricals. it improves your chances, especially if u do well on the absite. i've seen it happen to some IMG's. if u want to match for sure get some backup specialties, but you won't be able to leave them once you start and your career will take on a new path, so you may want to take a year out to do surgical research, get to know some people who can hook you up.

 

[NotAProgDirector]

Doing an IM year is a bad idea unless your backup plan is "if I don't get surgery, then I'll do a full IM residency instead". In that case, applying for IM as a backup makes plenty of sense. Whether anyone would take you seriously with all surgical letters is another thing.

The decision betweem a surgical prelim and a research year is tough. The prelim would give you more clinical experience, and as mentioned above would give you a chance at a categorical spot. Some programs are "well known" for taking a bunch of prelims and then picking the top 1-2 for categorical spots. The downside of a prelim is that many prelim programs are "dead ends" in that the PD's don't really help you get another spot. Also, interviewing while being a prelim intern can be very challenging.

A research year would allow you to expand your application in a new direction. You'd have plenty of time for interviewing. The rest of your app (USMLE's, grades) looks OK. The down side is that it's one more year delay to getting what you want, and there's no guarantee that you'd get it. And, it can make it even harder to apply for IM or another backup field, as it makes it more obvious that you want surgery.

Good luck!

 

[agranulocytosis]

Thanks for your perspective! For what it's worth, I absolutely do not want to be in internal medicine. You're very right that it's a tough decision between prelim surg and a research year. I feel like I'll be struggling to make a decision until the very end. I guess I should just go through the process and see how the interviews turn out.

Which raises another point, when is an ideal time to start looking for research positions? It seems like there could be a glut of applicants after the match, so would it be a good idea to start looking now? I mean it only makes sense to hedge your bets.