prelim vs categorical

[secretwave101]

I'm sure this question comes through the forum all the time, but for us losers who still don't know:

What is the diff. b/t a prelim surg spot and a categorical one?

Do you get much OR exp. in a prelim spot? If you do prelim, can you then match to a gen surg, or is prelim specifically for people wanting specialist spots?

The prelim spots didn't seem to get filled almost anywhere during this last match, according to the stats I saw. The gen surg spots often filled up. It would seem that the prelim spots are pretty accessible to applicants who want them. Is that true?

---

Members don't see this ad.

 

[triathlete411]

Preliminary means you are only guaranteed one or two years of residency. Categorical is for the entire 5-7 years of residency. A lot of prelim spots go unfilled because many would rather do something less intensive for their required intern year before starting residencies in things like radiology, anes, derm, etc. The amount of surgery a prelim does depends on the program and on you personally.
You can move into a categorical spot if you are a prelim. I know a guy who was a prelim, became a categorical, and is now doing a CT fellowship.

 

[secretwave101]

So, why do they exist at all? Is it for people to see if they really want to do surgery, and if not, to re-apply to a medical residency like fam or IM?

I'm not sure I see the point of prelim surg spots, but there sure seem to be quite a few of them.

 

[womansurg]

Many residencies either recommend or require an intern year of general surgery prior to entering their training program. Examples would be orthopedic surgery, urology, ENT, anesthesia, radiology... So, many prelims are folks who have already matched in another specialty which they will begin after one year with us. These are the most desirable applicants to program directors. Usually these folks are very smart, very hard working, and do a good job for you in the year that they are there.

Another scenario is a person who has failed to match in their area of interest - g surg, ortho, ER, optho - and chooses a year of gen surg to try and rack up some good LORs and experience to hopefully become more competetive. These folks are more of a gamble. There's often a reason why they failed to match, and sometimes there are problems with work ethic, personality, so forth. Of course, many are hard working and well intentioned.

The attrition rate in general surgery is about 30%, so about one third of people starting out as categoricals end up leaving and doing something else. Some prelims are counting on this expected turnover to open up a spot for them as a categorical resident.

Another scenario is a person who is unsure of what s/he wants, think s/he might be interested in gen surg and would like to 'try it on'.

 

[secretwave101]

Womansurg,

You (I think) replied to a post of mine in the FP section. I was looking for as much surg. exp as possible while still w/in an FP residency.

I'm hoping to work internationally as much as possible, and my impression is that having a good deal of surgery/procedural experience will be extremely useful in very isolated places.

But FP really doesn't seem to give residents much true surgical experience. On the other hand, I'm not sure I want to live the life of a surgeon here in the US. I'll need to work primarily in the US to be able to afford any overseas work. But I'll need the flexibility to leave frequently. So I'm not too enamored with my perception of the life of a surgeon (which I could have wrong): 80hrs/week, inability to work part time bec. of malpractice costs, group practice politics = no freedom for many years, etc.

But, when my global politics don't play into the equation, I find that surgery is simply more interesting than obsessing about increasing cardiac output. I'm only an MSII, so I'll need to see how yrs 3 and 4 go. But it seems like doing a prelim surg year would be good for me. I'd get good surg. experience that would be useful to me as an FP (when overseas) if I decided to do FP. Or, it would show me that I loved it and I could stay with surg.

Does a prelim rotation count as one of the years of a surg residency if you are accepted into a gen surg spot the next year?

 

[womansurg]

Does a prelim rotation count as one of the years of a surg residency if you are accepted into a gen surg spot the next year?

That depends on what position you match into. If you are applying to fill a vacant PGY-2 spot, left open because someone bailed out or was canned, then it would count as your intern year. Those are rare opportunities, however. Most folks just re-enter the match as a PGY-1, in which case you'd likely be doing it over again.

I'm not too enamored with my perception of the life of a surgeon

It's true, being a surgeon is a life choice, not a job. It tends to swallow up a big chunk of who you are and what you do. There are folks who practice part time in a limited way, doing primarily breast surgery or outpatient procedures, like hernia repair, but that's unusual. I think that, to be a GOOD surgeon, you have to devote your life to it. Sort of like being a professional tennis player or golfer - it's just not possible to reach the level of expertise that you need unless you are living/breathing/pooping your pursuit. Certainly this is true during your training. You can count on 5+ years of being completely absorbed in your work, or you likely wouldn't survive. Most people who leave surgery during residency do so because of lifestyle issues.

The sacrifices that are demanded of surgeons really are so great that I don't think that the rewards are able to offset them, unless you are just pathologically, fanatically in love with doing surgery. At the end of a 36 hour shift, if the idea of taking a trauma GSW to the OR for exploration doesn't rally you to new levels of excitement, then you will be one the one-third of surgery residents who decide that it's all just not worth it. Being in the OR is the carrot on our stick. You either have that bizarre obsessive interest in it, or you don't. If you don't, I wouldn't put myself through the pain.

Truly, pick a career you can practice and be happy with here in the states. Any experience you have or need in an international forum will likely be forthcoming at that time - don't build your career on projections about what you might or might not run across later - it's impossible to predict.

-ws