Preliminary spots

[deleted89854]

I have a friend who was wondering what kind of surgery programs have preliminary spots available in the scramble. They are deciding between taking a categorical spot at a program they don't really want to be at and attempting to transfer after the first year or taking a prelim spot (which they did not apply for). Do the more prestigious programs have open prelim spots every year (UCSF, Stanford, etc)? Any help would be appreciated.

---

Members don't see this ad.

 

[Ezangjen]

Quickly scanning through the scramble list, UWashington, UCLA, Baylor, Vandy, NYU, Michigan, Minnesota, Brigham, Beth Israel all had available Prelim spots. Of course, I would assume you'd work like a dog and be treated like one as well at these top tier places.

 

[Winged Scapula]

Boy, in this day and age of competition for spots, your friend had better be awfully miserable to give up a possible categorical position for a prelim one.

There is no guarantee that they'll be any happier in a Prelim spot at another program (unless they have intimate, inside knowledge of that program), IF they got a spot and there is even less of a guarantee that they would be offered a categorical spot, much less a PGY2 categorical spot, in that program or any other (these are few and far between and highly competitive).

Of course, if they don't match, then the point is moot as there will unlikely be many unfilled categorical spots.

 

[deleted89854]

Is it really difficult to reapply the following year, or do you think they would be better off taking another year for research (She's at 1 already). Also, how does it work to transfer out of a categorical spot? Does that happen very often? Thanks again for all your help.

 

[Winged Scapula]

Is it really difficult to reapply the following year, or do you think they would be better off taking another year for research (She's at 1 already). Also, how does it work to transfer out of a categorical spot? Does that happen very often? Thanks again for all your help.

The process to get a Categorical position from a Preliminary is as follows:

1)enroll in ERAS and the NRMP just like you did for your intern year, except now you are an Independent Candidate

2)look for PGY2 categorical positions but find there aren't many listed, so apply for PGY1 categorical positions at programs you are interested in (just like you did last year)

3) tell everyone you know that you are looking for a PGY2 categorical surgery position; scour web sites like APDS looking for listings. Ask your PD and faculty to let you know of any he/she hears about.

4) if you like the program you are at for a Prelim position, let them know you are interested in staying; work hard all year as its essentially a year long audition

5) accept that you may not find a PGY2 categorical position and may have to repeat your intern year

6) while there is attrition in surgery, it is generally difficult to "transfer" into a PGY2 position. This entails that a position *somewhere* opens up (someone quits, dies, is fired, etc.), that you hear about it, you apply and they offer you the position. There are lots of others out there with Prelim spots also looking for PGY2 positions, so there will be competition.

7) most spots open up in either PGY1, 2 or 3. In academic programs with lab years, they may have room to take someone in PGY3 with the move in and out of the labs. Programs without research years have less flexibility with the number of residents they can have.

8) the most successful applicants come from within - ie, prelims at the program with the open spot. They are a known entity and a problem you know about is better than the one you don't.

9) keep in mind that starting this year (I believe) the ACS will not certify anyone training in more than 3 programs; so you need to settle down asap and not spend years at different programs trying to get a categorical position.

So it can be difficult if one finds themself needing a categorical PGY2 position and doesn't want to repeat their intern year because very few positions up open and there is lots of competition. Doesn't mean it doesn't happen because it does every year. She/he needs to be honest with her PD when she matches (if she chooses to take a Prelim spot), work hard, be on good terms and status (which will be required to get into another program) and be prepared to use vacation time to interview.

But if he/she cannot stand any of the categorical programs they have interviewed at and fear matching at one of them, then I suppose taking a prelim position is a way out. Its just no guarantee of 1) getting a categorical position and 2) getting a categorical position at a program he/she would be happier with than the ones they initially interviewed with.

Bird in the hand... (which is a town in PA, BTW).

 

[neuroticchica]

Great advice! I will say that all of the top programs will have prelim spaces. Two years ago, I know Brigham, JHU, UCSF, Vandy, Emory, and UCLA to name a few had them. As someone who knows someone very well who did a prelim surgery year at a top tier program, let me say Kimberli knows of what she speaks! I definitely would urge your friend to think long and hard about taking a prelim position rather than a categorical position. The prelim place is NOT obligated to promote your career. You are there to perform a service and all they owe you is 40K, a 401 plan, insurance, and minimal vacation. I personally feel that as a prelim you start with a target on your back. If you make a mistake, it will be magnified and your accomplishments will be minimized. A categorical will on the other hand have their mistakes overlooked and be praised regularly. Categoricals will get some mentoring that you may not. It is very difficult to get time off to interview and places may not allow you the option of using your vacation time for this purpose. (For example, you may be given vacation in August and have no choice.) In addition, if you reapply for surgery, some programs will be hesitant to take you wondering why no one wanted you last year. They will be hesitant to take you thinking no one would repeat a second intern year in surgery. (The program told my friend upfront that she would not be offered a place in their program as a repeat intern because they would consider her "damaged goods" and would prefer a person coming straight out of med school.) At many top programs, the residents will stick it out, so there will be very few places accepting transfers into the PGY2. You may have some options at PGY3, but still few.

The process to get a Categorical position from a Preliminary is as follows:

1)enroll in ERAS and the NRMP just like you did for your intern year, except now you are an Independent Candidate

2)look for PGY2 categorical positions but find there aren't many listed, so apply for PGY1 categorical positions at programs you are interested in (just like you did last year)

3) tell everyone you know that you are looking for a PGY2 categorical surgery position; scour web sites like APDS looking for listings. Ask your PD and faculty to let you know of any he/she hears about.

4) if you like the program you are at for a Prelim position, let them know you are interested in staying; work hard all year as its essentially a year long audition

5) accept that you may not find a PGY2 categorical position and may have to repeat your intern year

6) while there is attrition in surgery, it is generally difficult to "transfer" into a PGY2 position. This entails that a position *somewhere* opens up (someone quits, dies, is fired, etc.), that you hear about it, you apply and they offer you the position. There are lots of others out there with Prelim spots also looking for PGY2 positions, so there will be competition.

7) most spots open up in either PGY1, 2 or 3. In academic programs with lab years, they may have room to take someone in PGY3 with the move in and out of the labs. Programs without research years have less flexibility with the number of residents they can have.

8) the most successful applicants come from within - ie, prelims at the program with the open spot. They are a known entity and a problem you know about is better than the one you don't.

9) keep in mind that starting this year (I believe) the ACS will not certify anyone training in more than 3 programs; so you need to settle down asap and not spend years at different programs trying to get a categorical position.

So it can be difficult if one finds themself needing a categorical PGY2 position and doesn't want to repeat their intern year because very few positions up open and there is lots of competition. Doesn't mean it doesn't happen because it does every year. She/he needs to be honest with her PD when she matches (if she chooses to take a Prelim spot), work hard, be on good terms and status (which will be required to get into another program) and be prepared to use vacation time to interview.

But if he/she cannot stand any of the categorical programs they have interviewed at and fear matching at one of them, then I suppose taking a prelim position is a way out. Its just no guarantee of 1) getting a categorical position and 2) getting a categorical position at a program he/she would be happier with than the ones they initially interviewed with.

Bird in the hand... (which is a town in PA, BTW).