PGY-1, RE-Entering Match, Advice

[THEBACKANDFORTH]

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[ThoracicGuy]

Hi everyone. So shortly after match day I started regretting my rank list and speciality due to moving across the country. Matched into psych, wishing I had tried to stay closer to home. My regret caught me by full surprise. While I think I will really like my program itself, I've reflected a lot this past month, and I just don't think this is the direction I want to take my life now that I'm getting older. I've decided I am going to show up in July, work really hard at my new program for two months, and if I still am having doubts, talk to my PD and try to re-apply in the match for FM this upcoming cycle. Goal is to get back to home region. While I chose psych over FM for lifestyle reasons, I genuinely like doing clinic and learning medicine and being in the hospital on rotations. For stats, I'm a USMD, no major red flags until now, Step exams in 220s, mostly honors, good letters, good MSPE comments. Good at interviews. Will only have one FM letter, but also have IM.

Seeking advice from those who have done this or know somebody who has. How competitive were you the second cycle? How many interviews should I try to get in and do PD's usually accommodate a switch by re-arranging vacation time? Could/would my PD potentially block this (she seemed super nice though on interview)? How many FM programs should I apply to? I want to target a geographic area of around 15-20 programs near my school? Is there anything I'm missing, or is there a better option to accomplish my goal?

Finally, I wrote a personal statement and if anybody is willing to read it I would be extremely grateful.

I know intern year will be stressful, so I'm going to get everything ready to go now while I have time but wait to decide.

Thanks everyone.

You are likely to be busy during training. At least for me, staying near home wouldn't have made all that much difference between where I was and where I went to. Give the new place a good, honest try. It's only 4 years. Afterwards you can move wherever you want to move. You have a spot now, but if you reenter the match, there's a chance you might not end up with a spot later. Good luck.

 

[THEBACKANDFORTH]

You are likely to be busy during training. At least for me, staying near home wouldn't have made all that much difference between where I was and where I went to. Give the new place a good, honest try. It's only 4 years. Afterwards you can move wherever you want to move. You have a spot now, but if you reenter the match, there's a chance you might not end up with a spot later. Good luck.

I hear you. But life is too short to compromise when you don't have to. I'm looking to maximize the chance I end up where I want and minimize the risk. I think the risk of me ultimately not practicing medicine is quite low even if i pursue this.

 

[GoSpursGo]

I hear you. But life is too short to compromise when you don't have to. I'm looking to maximize the chance I end up where I want and minimize the risk. I think the risk of me ultimately not practicing medicine is quite low even if i pursue this.

I hear you, but I also think you should go in with an open mind. You have to be there for 45 days no matter what. Why not give it a fair shot? You may find that moving to a new location is not as bad as you think it will be.

Furthermore, it is not as easy as you think it is to reapply through ERAS while also being an intern. You are not going to go on 10 interviews--you maybe can go on 3-5, and it's going to be a major pain in the butt moving your schedule around to accommodate that. While the odds are in your favor that you can probably match as a US grad with no red flags, that's still a low number of interviews--so I would encourage you that no matter what you do, DO NOT burn any bridges at your psych program. You want to leave the possibility of finishing your psych training open.

 

[THEBACKANDFORTH]

I hear you, but I also think you should go in with an open mind. You have to be there for 45 days no matter what. Why not give it a fair shot? You may find that moving to a new location is not as bad as you think it will be.

Furthermore, it is not as easy as you think it is to reapply through ERAS while also being an intern. You are not going to go on 10 interviews--you maybe can go on 3-5, and it's going to be a major pain in the butt moving your schedule around to accommodate that. While the odds are in your favor that you can probably match as a US grad with no red flags, that's still a low number of interviews--so I would encourage you that no matter what you do, DO NOT burn any bridges at your psych program. You want to leave the possibility of finishing your psych training open.

Yes, I am going to work really hard for two months and decide a couple weeks before ERAS opens. If i feel doubt, will talk to PD. If not, then I will continue the year.

I'm working on an app, but trying to plan for the logistics of this. How many programs do I need to apply to, How many interviews should I target, etc

 

[GoSpursGo]

Yes, I am going to work really hard for two months and decide a couple weeks before ERAS opens. If i feel doubt, will talk to PD. If not, then I will continue the year.

I'm working on an app, but trying to plan for the logistics of this. How many programs do I need to apply to, How many interviews should I target, etc

I strongly, strongly recommend that you continue the year regardless. Quitting without a new position in hand is very risky, and also leaves your program in a bind as they are down an intern. It's not fair, but the letter from your PD may be much less enthusiastic if you quit and leave them in a bind. The PD letter is going to be really important.

 

[THEBACKANDFORTH]

I strongly, strongly recommend that you continue the year regardless. Quitting without a new position in hand is very risky, and also leaves your program in a bind as they are down an intern. It's not fair, but the letter from your PD may be much less enthusiastic if you quit and leave them in a bind. The PD letter is going to be really important.

Not going to quit. I will talk to PD about re-applying during intern year as was quite clear in original post

 

[GoSpursGo]

Not going to quit. I will talk to PD about re-applying during intern year as was quite clear in original post

My friend, maybe you thought it was clear but it was not clear to me despite the fact that I assure you I read your original post Then you came back and said you would "continue the year" if you decide you're happy, which implies you WOULDN'T continue the year if you aren't.

As I previously said, it's less a matter of how many interviews you can target and more a matter of how many you can get time off to attend. The answer is likely to max out somewhere around ~5. The number of programs you apply to completely depends on the number of programs which are geographically close enough to your desired location. If location is truly the most important thing to you, then I would likely apply to all of the FM programs within the appropriate radius.

 

[xffan624]

My friend, maybe you thought it was clear but it was not clear to me despite the fact that I assure you I read your original post Then you came back and said you would "continue the year" if you decide you're happy, which implies you WOULDN'T continue the year if you aren't.

As I previously said, it's less a matter of how many interviews you can target and more a matter of how many you can get time off to attend. The answer is likely to max out somewhere around ~5. The number of programs you apply to completely depends on the number of programs which are geographically close enough to your desired location. If location is truly the most important thing to you, then I would likely apply to all of the FM programs within the appropriate radius.

Are most programs doing in person again or are still some places doing virtual? Would virtual allow for a few more interviews maybe?

 

[GoSpursGo]

Are most programs doing in person again or are still some places doing virtual? Would virtual allow for a few more interviews maybe?

I don't think anyone knows the answer for this year. My suspicion is that many programs will transition back to in person but I can't say that with any degree of certainty.

 

[THEBACKANDFORTH]

I think interviews are likely to remain virtual based on a number of PD's, deans, advisors I've spoke with. Trying to get a sense of interview yield, competitiveness, connect with more people who have done this. Those who have reached out on reddit said it was fairly easy switch and their PD supported all of them. I think that will matter a lot here, PD support. I also wonder if I am able to try for PGY-2 spot with psych intern year?

I'm hoping for around 8ish interviews. I got really high on my rank list but my priorities changed over 4th year and realize I made a mistake going for the competitive specialty that would take me away from the life I have going here. My program is a good program in a good location, it's not a hate it place. I genuinely enjoy family medicine. Life priorities have changed. Don't see myself staying there for 4 years but will give it a try

 

[gutonc]

I think interviews are likely to remain virtual based on a number of PD's, deans, advisors I've spoke with. Trying to get a sense of interview yield, competitiveness, connect with more people who have done this. Those who have reached out on reddit said it was fairly easy switch and their PD supported all of them. I think that will matter a lot here, PD support. I also wonder if I am able to try for PGY-2 spot with psych intern year?

I'm hoping for around 8ish interviews. I got really high on my rank list but my priorities changed over 4th year and realize I made a mistake going for the competitive specialty that would take me away from the life I have going here. My program is a good program in a good location, it's not a hate it place. I genuinely enjoy family medicine. Life priorities have changed. Don't see myself staying there for 4 years but will give it a try

Lots of good advice in this thread but to the bolded, the answer is no. You may be given a couple of months worth of "credit for time served" but it will be completely at the discretion of the PD if you match to an FM program and it largely won't do you any good.

 

[housestaffhustle]

It seems like you've already made up your mind about changing programs. What was it that made you change your mind about psychiatry? Was it just the location of the program or was there more? Psychiatry will definitely give you the better lifestyle both in the short term in residency and in the long run. Doing family medicine as an attending looks really challenging.

Going through your intern year may change your mind about the joys of clinic and hospital medicine. Maybe I'm just jaded now or maybe it's just where I trained, but I've found that some degree of burnout sets in pretty quickly and you'll soon be looking for ways to escape the grind. Though psychiatry isn't my specialty, it does seem to present a quicker path to lighter work weeks. If you really do think you could be happy doing family medicine though, go for it! Just wouldn't want you to make such a life altering decision based primarily on location.

Another thought - Have you talked to your medical school dean about this? They may have some helpful insights. For example, they may be able to put you in touch with your home program's family medicine PD and psychiatry PD who may know of open spots across the country. Or they may know of someone else in a similar situation looking to change programs. I know there are rules, but if there's a way to solve this before the start of intern year, it seems like it would be in everyone's best interest and programs may be willing to bend the rules for that. Having an unhappy intern/resident in your program doesn't turn out well for anyone.

 

[THEBACKANDFORTH]

It seems like you've already made up your mind about changing programs. What was it that made you change your mind about psychiatry? Was it just the location of the program or was there more? Psychiatry will definitely give you the better lifestyle both in the short term in residency and in the long run. Doing family medicine as an attending looks really challenging.

Going through your intern year may change your mind about the joys of clinic and hospital medicine. Maybe I'm just jaded now or maybe it's just where I trained, but I've found that some degree of burnout sets in pretty quickly and you'll soon be looking for ways to escape the grind. Though psychiatry isn't my specialty, it does seem to present a quicker path to lighter work weeks. If you really do think you could be happy doing family medicine though, go for it! Just wouldn't want you to make such a life altering decision based primarily on location.

Another thought - Have you talked to your medical school dean about this? They may have some helpful insights. For example, they may be able to put you in touch with your home program's family medicine PD and psychiatry PD who may know of open spots across the country. Or they may know of someone else in a similar situation looking to change programs. I know there are rules, but if there's a way to solve this before the start of intern year, it seems like it would be in everyone's best interest and programs may be willing to bend the rules for that. Having an unhappy intern/resident in your program doesn't turn out well for anyone.

Hi thanks for the thoughtful response. I appreciate it. I am really trying to keep my mindset open, but there is just a 'gut' feeling that is growing by the day and telling me not to leave 'medicine' behind. I disliked the first two years of medical school, which made me feel like I disliked medicine, and then I lost a ton of clinical time my third year with Covid keeping us virtual. Decided to pursue psych. Now during fourth year took a ton of varied rotations and have absolutely thrived, being able to completely work up and managed patients in say an ED setting has been so rewarding. Add in having to move very far from family + specialty I choose for lifestyle but not necessarily passion, and I am feeling regret. Will give my residency a shot, work hard, keep my mouth shut for 2 months, then speak to PD if my 'gut' is still telling me to go. The program I matched to does seem like an incredibly inviting environment, which is good.

Yes, I met with my school's student affairs dean who said they help and support people changing specialties every year and it will work out if I decide to go for it, but that it would be stressful to coordinate the interviews. I have a meeting with the FM advisor upcoming and they communicated that the psych year would be welcomed by family med programs. Connected with a few people who have done exactly what I'm doing successfully on reddit, but really just trying to get the best information lined up before starting in 2 months thanks

I quite genuinely believe life is too short to not take risks or be somewhere you want for 4 years or a career, although medicine can counter that belief sometimes

 

[housestaffhustle]

Hi thanks for the thoughtful response. I appreciate it. I am really trying to keep my mindset open, but there is just a 'gut' feeling that is growing by the day and telling me not to leave 'medicine' behind. I disliked the first two years of medical school, which made me feel like I disliked medicine, and then I lost a ton of clinical time my third year with Covid keeping us virtual. Decided to pursue psych. Now during fourth year took a ton of varied rotations and have absolutely thrived, being able to completely work up and managed patients in say an ED setting has been so rewarding. Add in having to move very far from family + specialty I choose for lifestyle but not necessarily passion, and I am feeling regret. Will give my residency a shot, work hard, keep my mouth shut for 2 months, then speak to PD if my 'gut' is still telling me to go. The program I matched to does seem like an incredibly inviting environment, which is good.

Yes, I met with my school's student affairs dean who said they help and support people changing specialties every year and it will work out if I decide to go for it, but that it would be stressful to coordinate the interviews. I have a meeting with the FM advisor upcoming and they communicated that the psych year would be welcomed by family med programs. Connected with a few people who have done exactly what I'm doing successfully on reddit, but really just trying to get the best information lined up before starting in 2 months thanks

I quite genuinely believe life is too short to not take risks or be somewhere you want for 4 years or a career, although medicine can counter that belief sometimes

That's great. You should go for it then. Sounds like you've really thought this through. I have thought a lot about how COVID has affected training for medical students and residents. Sounds like it took a large enough chunk out of your training for you to make some reconsiderations. Best of luck

 

[THEBACKANDFORTH]

That's great. You should go for it then. Sounds like you've really thought this through. I have thought a lot about how COVID has affected training for medical students and residents. Sounds like it took a large enough chunk out of your training for you to make some reconsiderations. Best of luck

It definitely affected my class greatly. We lost > 1/2 our clinical time in every rotation and had some core rotations completely cancelled. I have multiple close friends finding their true passion 4th year and feeling regret. This is probably true with every med school class but definitely more pronounced in Covid classes.

For my friends who started residency in quarantine, I know that many of them had been feel more isolated and lonely than expected.

Thanks !! Maybe I'll update after match day in 11 months!

 

[rokshana]

just remember that you are taking the risk of not matching into a local program and after you tell your PD that you are not continuing, they will look to replace you fairly quickly.

as a US grad you have a better chance to rematch, but you are your most competitive as a US senior.

and unless interviews are still virtual, you will probably not be able to attend many interviews, so will be important that you are fairly competitive.

how many FM programs are there in the area you want to be? that m/l will be your limiting factor...would you be a competitive candidate for those programs?

 

[THEBACKANDFORTH]

just remember that you are taking the risk of not matching into a local program and after you tell your PD that you are not continuing, they will look to replace you fairly quickly.

as a US grad you have a better chance to rematch, but you are your most competitive as a US senior.

and unless interviews are still virtual, you will probably not be able to attend many interviews, so will be important that you are fairly competitive.

how many FM programs are there in the area you want to be? that m/l will be your limiting factor...would you be a competitive candidate for those programs?

Thanks, this is exactly what I’m trying to figure out. There’s about 10 preferred programs that just scoop up grads from my school, then about 10 rural regionally (2-6 hr drive) that are less competitive and fill up with DO/IMG/and the occasional grad from my school who I assume has family ties or some red flags. Weighing chance of end up in one of these vs having to apply broader and ending up elsewhere or even SOAPING

 

[rokshana]

Thanks, this is exactly what I’m trying to figure out. There’s about 10 preferred programs that just scoop up grads from my school, then about 10 rural regionally (2-6 hr drive) that are less competitive and fill up with DO/IMG/and the occasional grad from my school who I assume has family ties or some red flags. Weighing chance of end up in one of these vs having to apply broader and ending up elsewhere or even SOAPING

So is this about wanting a different specialty or not wanting to leave family?
Why would you want to take the chance of soaping? That is the kiss of death…there have been less and less spots available in soap and you are competing with the derm, optho, etc people that didn’t match.

Is it that you haven’t lived far a way or need family support for kids ? Are you older that 4 years away is that long a time? In the setting of a career that last 30 years or so, 4 years is a drop in the bucket.

PDs will be more receptive to the idea that you are in the wrong specialty… ultimately they want people that want to be on their specialty…but may not be as sympathetic for someone who decides that they just want to be closer to home( unless of course there has been a change in circumstances… sick parent for example)… because you had the ability to rank places closer to home.

 

[THEBACKANDFORTH]

So is this about wanting a different specialty or not wanting to leave family?
Why would you want to take the chance of soaping? That is the kiss of death…there have been less and less spots available in soap and you are competing with the derm, optho, etc people that didn’t match.

Is it that you haven’t lived far a way or need family support for kids ? Are you older that 4 years away is that long a time? In the setting of a career that last 30 years or so, 4 years is a drop in the bucket.

PDs will be more receptive to the idea that you are in the wrong specialty… ultimately they want people that want to be on their specialty…but may not be as sympathetic for someone who decides that they just want to be closer to home( unless of course there has been a change in circumstances… sick parent for example)… because you had the ability to rank places closer to home.

I want to both change specialty and be near family. If it were only one I wouldn’t do this. Trying to figure out if I need to apply beyond my region of 20 programs or if what I’ve described is safe. I want to go home, but would take FM away if need be. I am older that 4 years away is a long time yes. Soap sucks, want to high yield this. Believe my program will likely support me with 1 year notificd of change of specialty

 

[rokshana]

I want to both change specialty and be near family. If it were only one I wouldn’t do this. Trying to figure out if I need to apply beyond my region of 20 programs or if what I’ve described is safe. I want to go home, but would take FM away if need be. I am older that 4 years away is a long time yes. Soap sucks, want to high yield this. Believe my program will likely support me with 1 year notificd of change of specialty

You should apply to all 20 programs…then if you get 10 invites or more then can be more selective…but you need to give yourself the most options.

 

[THEBACKANDFORTH]

You should apply to all 20 programs…then if you get 10 invites or more then can be more selective…but you need to give yourself the most options.

I am wondering if I should apply to more than 20 programs in adjacent states, etc. If I did so I could probably find around 50 potential programs

 

[THEBACKANDFORTH]

Update for future people who may read this: Program very supportive, should be able to squeeze in at least 10 interviews likely more (virtual interviews appear here to stay), SDN was much more negative than real life--psychiatrists are nice--, I'm unsure if I'll get location I want but I'm going to apply broadly and pretty sure I'll match at least. I am going to email all my programs ahead of match to try to avoid being screened out. Residency is going well, but I'm willing to give up cush life to note lose medicine. Still not sure how many programs I should apply to, money is somewhat tight

 

[EthylMethylMan]

Update for future people who may read this: Program very supportive, should be able to squeeze in at least 10 interviews likely more (virtual interviews appear here to stay), SDN was much more negative than real life--psychiatrists are nice--, I'm unsure if I'll get location I want but I'm going to apply broadly and pretty sure I'll match at least. I am going to email all my programs ahead of match to try to avoid being screened out. Residency is going well, but I'm willing to give up cush life to note lose medicine. Still not sure how many programs I should apply to, money is somewhat tight

The advice you got here wasn't "negative," it was realistic. You should apply to as many programs as you have the time and money for. Figure out how much money in your budget isn't going towards the absolute essentials and put all of that towards your application.

 

[rokshana]

Update for future people who may read this: Program very supportive, should be able to squeeze in at least 10 interviews likely more (virtual interviews appear here to stay), SDN was much more negative than real life--psychiatrists are nice--, I'm unsure if I'll get location I want but I'm going to apply broadly and pretty sure I'll match at least. I am going to email all my programs ahead of match to try to avoid being screened out. Residency is going well, but I'm willing to give up cush life to note lose medicine. Still not sure how many programs I should apply to, money is somewhat tight

Not sure where this community has been negative…you were told to speak with your pd early…and it’s august… that’s great that your program will accommodate for you to be able to take the time off for 10 IVs… but you have to get 10 of them… your return m/l will not be 10/10…especially as a reapplicant…would you rather we tell you it’s going to be a piece of cake and it’s not?
Good luck … but better to be realistic and prepare for the worst case scenario and be pleasantly surprised, than to be scrambling around with no plans on how to be successful… and with no program for next year.

 

[NotAProgDirector]

I think you'll likely be fine. US grad, changing to a less competitive specialty, applying to what sounds like a low competitive geography, who has support from their current program. And no funding issues, since switching from psych to FM.

You won't get much credit for your psych PGY-1, so an FM PGY-2 isn't a viable option.

 

[mindofagenius]

Is it harder in the case of a non-US IMG?

 

[NotAProgDirector]

Yes, it will be more difficult. You'll need to find a new program that's willing to take you, and being an IMG will limit that. It will also depend upon your visa type - a J visa can change specialties, once, before the PGY-3 year. An H visa makes finding a new program more difficult as less places will be willing to sponsor an H visa.

 

[mindofagenius]

Yes, it will be more difficult. You'll need to find a new program that's willing to take you, and being an IMG will limit that. It will also depend upon your visa type - a J visa can change specialties, once, before the PGY-3 year. An H visa makes finding a new program more difficult as less places will be willing to sponsor an H visa.

Thanks for that. I am on a J1 visa, and my CV has enormously improved since last year with 2 very strong LORs as well (from a very well-established institution).
Should I go for it or will my PD give me an ultimatum? Do I have to do it from ERAS? or is it safer to email programs outside of it?
would appreciate some insight!

 

[rokshana]

Update for future people who may read this: Program very supportive, should be able to squeeze in at least 10 interviews likely more (virtual interviews appear here to stay), SDN was much more negative than real life--psychiatrists are nice--, I'm unsure if I'll get location I want but I'm going to apply broadly and pretty sure I'll match at least. I am going to email all my programs ahead of match to try to avoid being screened out. Residency is going well, but I'm willing to give up cush life to note lose medicine. Still not sure how many programs I should apply to, money is somewhat tight

So…how did the match go for you?

 

[gutonc]

Thanks for that. I am on a J1 visa, and my CV has enormously improved since last year with 2 very strong LORs as well (from a very well-established institution).
Should I go for it or will my PD give me an ultimatum? Do I have to do it from ERAS? or is it safer to email programs outside of it?
would appreciate some insight!

What do you mean by the entire 2nd paragraph?

You’re either going to need to give us more information, or out your alt so we can figure it out on our own.

 

[NotAProgDirector]

Thanks for that. I am on a J1 visa, and my CV has enormously improved since last year with 2 very strong LORs as well (from a very well-established institution).
Should I go for it or will my PD give me an ultimatum? Do I have to do it from ERAS? or is it safer to email programs outside of it?
would appreciate some insight!

Usually the only way to apply for a spot is in ERAS. Only exceptions are PGY-2 spots that are not in NRMP (like an IM PGY-2).

We can't tell you what your PD will do.

Not clear that 2 new LOR's will make your app any more competitive for whatever field you're looking at.

 

[GoSpursGo]

Thanks for that. I am on a J1 visa, and my CV has enormously improved since last year with 2 very strong LORs as well (from a very well-established institution).
Should I go for it or will my PD give me an ultimatum? Do I have to do it from ERAS? or is it safer to email programs outside of it?
would appreciate some insight!

As mentioned by others, we don't have nearly enough information to advise you. I generally would not consider LORs to hugely move the needle, though if you were previously missing USCE maybe this does help you. It would be helpful to know what specialty you're currently in, what specialty you were hoping for, and whether you originally received any interviews for your preferred specialty when you originally applied.

In general, I would be very very hesitant to try and change specialties as a non-US IMG on a visa.

 

[mindofagenius]

As mentioned by others, we don't have nearly enough information to advise you. I generally would not consider LORs to hugely move the needle, though if you were previously missing USCE maybe this does help you. It would be helpful to know what specialty you're currently in, what specialty you were hoping for, and whether you originally received any interviews for your preferred specialty when you originally applied.

In general, I would be very very hesitant to try and change specialties as a non-US IMG on a visa.

thank you for your reply. I applied for EM and IM, got interviews in both and matched into EM (which I prioritized in the Rol), but a change of heart and wished I went into IM.
Should I really be hesitant? What are the risks I might encounter?

 

[ThoracicGuy]

thank you for your reply. I applied for EM and IM, got interviews in both and matched into EM (which I prioritized in the Rol), but a change of heart and wished I went into IM.
Should I really be hesitant? What are the risks I might encounter?

Is there an IM department at your facility? If so, talk with the PD there and see if you have a shot.