Preparing to try for a PGY-2 vacancy

[peppy]

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OK, so as I have discussed extensively elsewhere, I didn't match for a PGY-1 spot and the scramble was futile (several spots that were on the scramble list didn't even really exist, and one of the programs that really did have a spot seemed to only want to consider people who were geographically close by enough to come in for an in-person interview that day). I am probably going to wind up getting a traditional rotating internship with the hope of finding a vacant PGY-2 psych position for next year (and if that fails, I'll just reapply for first year positions like everyone else does).

So now I am trying to think about the practical aspects of trying again.
What do I do about letters of recommendation? Some of the places I might wind up at for internship don't seem to offer much in the way of psychiatry exposure, so I am not sure how many electives in psych I can do as an intern. Is it considered acceptable to go back to my original letter writers and ask for an updated letter? (Even though I cringe at having to do that)
How do I get time off for interviews from my internship program?
Is all this kind of stuff handled differently when you are dealing with PGY-2 spots that are offered outside the match? What rotations do I absolutely need to do during my internship to be eligible for PGY-2 positions?

I am hoping anyone out there who has switched into psych from a different field can offer pointers.

 

[OldPsychDoc]

OK, so as I have discussed extensively elsewhere, I didn't match for a PGY-1 spot and the scramble was futile (several spots that were on the scramble list didn't even really exist, and one of the programs that really did have a spot seemed to only want to consider people who were geographically close by enough to come in for an in-person interview that day). I am probably going to wind up getting a traditional rotating internship with the hope of finding a vacant PGY-2 psych position for next year (and if that fails, I'll just reapply for first year positions like everyone else does).

So now I am trying to think about the practical aspects of trying again.
What do I do about letters of recommendation? Some of the places I might wind up at for internship don't seem to offer much in the way of psychiatry exposure, so I am not sure how many electives in psych I can do as an intern. Is it considered acceptable to go back to my original letter writers and ask for an updated letter? (Even though I cringe at having to do that)
How do I get time off for interviews from my internship program?
Is all this kind of stuff handled differently when you are dealing with PGY-2 spots that are offered outside the match? What rotations do I absolutely need to do during my internship to be eligible for PGY-2 positions?

I am hoping anyone out there who has switched into psych from a different field can offer pointers.

First off--kudos for starting to think about this and take action now. May your lemons become refreshing lemonade by this time next year! I hope you'll stick with us here through the process.

I think that doing a rotating internship will have one advantage for you--no one will expect that you're interested in anything except learning medicine and positioning yourself for a psych residency, so the agenda will be clear. As such, be up front about your expectation of needing time to interview, and work now to schedule lighter rotations and vacation during that season.

Remember all that stuff I wrote about contacts with programs between the interview and match day not mattering? Well forget it--it doesn't apply to you anymore. It's time now to be shamelessly assertive, to call a couple of those people that you thought you hit it off with at programs you felt good about and say "I was disappointed that I was unable to match with you this year. What would you suggest I do to strengthen my application in the coming year as I'm working on this internship? And Oh yes, by the way, if one of your interns doesn't show up on July 1, or if you have a sudden vacancy, please feel free to give me a call". (p.s. make sure you have alibis in case one of their interns does go missing! )

Other than that, go on and be a good intern. Try to get Step 3 passed as soon as you can too--that's an advantage. You will want a good letter or two from the internship, but what you want a psych PD to see is that "Peppy is a hard worker and a great doctor. We have no reservations about her practice of medicine". I think you can recycle your original psych letters, but if there's a really good rec that you want to have write an update about how determined you are to enter psychiatry and what a great attitude you've had even in the face of not matching, etc. that will probably be a good thing.

Good luck!

 

[peppy]

Thanks for the advice and encouragement. You make it sound do-able!

As far as the issue of a sudden vacancy coming up in a psych program, what can I do if I hear about a vacancy in psych after I've committed to an internship position? Would it be realistic to expect the internship program to let me out of my contract in that situation?
The only thing that is holding me back on signing on with an internship is that I don't want to face the situation of finding out in a few weeks that a spot has opened up at my dream program but being unable to leave the internship. That would be the worst twist in this story yet!

 

[m1forever]

OK, so as I have discussed extensively elsewhere, I didn't match for a PGY-1 spot and the scramble was futile (several spots that were on the scramble list didn't even really exist, and one of the programs that really did have a spot seemed to only want to consider people who were geographically close by enough to come in for an in-person interview that day). I am probably going to wind up getting a traditional rotating internship with the hope of finding a vacant PGY-2 psych position for next year (and if that fails, I'll just reapply for first year positions like everyone else does).

So now I am trying to think about the practical aspects of trying again.
What do I do about letters of recommendation? Some of the places I might wind up at for internship don't seem to offer much in the way of psychiatry exposure, so I am not sure how many electives in psych I can do as an intern. Is it considered acceptable to go back to my original letter writers and ask for an updated letter? (Even though I cringe at having to do that)
How do I get time off for interviews from my internship program?
Is all this kind of stuff handled differently when you are dealing with PGY-2 spots that are offered outside the match? What rotations do I absolutely need to do during my internship to be eligible for PGY-2 positions?

I am hoping anyone out there who has switched into psych from a different field can offer pointers.

what are you going to do next year? A transitional? medicine prelim? medicine categorical? family? I don't see any transitionals left and the prelim med slots are slim pickings at places I wouldn't want to go.

One thing to consider about getting a pgy-2 position from a prelim or ty is that every program filled this year. With people who wanted to do psych. So it's hard enough to get a pgy-2 opening now, but next year it's going to be even harder. Plus you're pgy-2 program is going to make you take intern type psych call most likely(since you wont have had any psych call) and so in some ways it will be like doing an internship twice.....thats not for me.


Me....Im planning on just applying to all the low tier programs in my region for a pgy-1 next year and prematching. We can do that next year, and *a lot* of lower tier psych programs this year prematched. Some programs only were trying to fill like 2 of 5 spots through the match because they prematched 3.

The advantages of doing a prelim medicine year are that some/most programs would let you do more psych electives your pgy-1 year rather than the 4 months of medicine/family since you will have already covered them. But some programs have built in arraingements(financially...like if they are associated with a VA that funds 1/5 of the program and in exchange the VA always gets a psych person to rotate through medicine or neuro) then thats not even a guarantee. But it is pretty likely.

I know the reason I didn't match.....I didn't take interviews at supposedly low-tier programs that I wouldnt have minded going to at all and ranked a ridiculously small number of schools. I thought there would be tons of slots in the scramble, so why worry. Maybe I'll feel differently in a week, but right now I just can't stomach the thought of doing a whole year of medicine at some place I dont want to be taking q4 call and spending 3 months in the ccu/icu. If you can tolerate inpatient medicine and the icu/ccu more than me though, then thats probably a good option.

 

[m1forever]

Thanks for the advice and encouragement. You make it sound do-able!

As far as the issue of a sudden vacancy coming up in a psych program, what can I do if I hear about a vacancy in psych after I've committed to an internship position? Would it be realistic to expect the internship program to let me out of my contract in that situation?
The only thing that is holding me back on signing on with an internship is that I don't want to face the situation of finding out in a few weeks that a spot has opened up at my dream program but being unable to leave the internship. That would be the worst twist in this story yet!

I've been told that the chance of spots opening up is very small....and honestly, even if 1 or 2 slots does open up, it's not like we are the only two viable candidates out there who would want that spot. Plus it's not even a guarantee that the program would want to fill it at the last moment. There is a good shot they would just eat the slot and possibly use it for an advanced opening next year when they have time to sort through bunches of candidates again.

 

[peppy]

So sorry to hear that you too are dealing with this.
I am most likely going to try to get into a traditional rotating internship (the osteopathic world's equivalent of a transitional year).
What are you planning to do with your year off?

I am worried that if I don't have a job in something next year I will run into trouble with my student loan debts. Even if it turns out to be financially feasible, though, I'm worried that then I will have trouble with programs wanting me to justify what I did with my time over the year and deciding it wasn't enough.

 

[m1forever]

So sorry to hear that you too are dealing with this.
I am most likely going to try to get into a traditional rotating internship (the osteopathic world's equivalent of a transitional year).
What are you planning to do with your year off?

I am worried that if I don't have a job in something next year I will run into trouble with my student loan debts. Even if it turns out to be financially feasible, though, I'm worried that then I will have trouble with programs wanting me to justify what I did with my time over the year and deciding it wasn't enough.

ah....you're in a better position than me then since you're a DO grad. I wish I could do the osteopathic ty. I heard some of them arent actually that bad, and involve less ccu/icu/ed months. I met a do on the interview trail who was in the middle of his do ty applying for a pgy-1 and he acted like it was not very stressful and a decent schedule.

the ty's here in the non-do world are all gone. Well there are supposedly 2 left(1 program in north dakota has like 5 spots unfilled but they have no intention of filling them) and the other 2 are ty's that require you to already be matched in certain things(neuro and rads). The preliminary medicine slots in the regular match are pretty much gone for the most part. A few malignant programs in ny are listed as being open, but they arent answering their phone and honestly I cant see myself doing a year of prelim medicine in a malignant program in ny. And I dont think I'd get into them anyways.

Im going to have to talk to the financial aid office before I graduate and see what I can do loan-wise if I dont take a spot somewhere in the post-match. Right now Im considering the following:

1) getting a job for a year in something non-medical
2) if a family medicine categorical spot is open after the match in an area I could tolerate and the program looks tolerable, just doing a year of family while I reapply for psych, most likely for pgy-1 slots. Of course the problem there is I would be bolting a categorical, so I dont know how that would look(is it unethical to take a categorical slot knowing you have no intention of holding up on it....would psych programs look down on it? would the program refuse to release me?)

As for how programs would view #1, my strategy next year will be pretty simple:

-look at all the programs that typically have problems matching, take a lot of img's, and usually prematch a lot of spots. And apply to them. If I apply to 30 programs like that and go on 10-15 interviews, I'm pretty sure I'll get a prematch offer at what one of those programs. And I'll take it.

It really sucks.......it must suck even worse for you because you're interview strategy doesnt seem to have been flawed(mine was horrendous) and you seem to be a stronger candidate than me.

 

[peppy]

I'm not necessarily any better off. There is some question about if the internship spot that I was hoping to get will in fact be possible because the program is unsure if they have enough spots for anyone else after all. A few categorical IM programs are ready to welcome me with open arms though. I am not sure if I should just go ahead and take one of the IM programs so I can stop freaking out over what I am going to do next year, or if I should keep waiting and hope that the internship still pans out.
What is with my luck? I had adjusted and accepted the idea of doing an internship, and yet here I am once again being faced with the news of another rejection? 🙁

 

[RemnantDoc]

I am also a DO, who completed a traditional internship, but failed to find PGY-2 spots in Psych. I didn't get into match this year since I was looking for a PGY-2. Now I find myself in an awkward position looking for a psych residency while other specialty programs will not take me seriously. One serious problem was this: I graduated from a D.O. internship (not dual-accredited), and some programs would only consider filling their PGY-2 spot with an applicant who finished ACGME-accredited training. I looked at an option for scrambling this year for PGY-I, but the available vacancy was too small in number (like 9, compared to 50s a few years ago). What possibilities might I have for this year or next year? If possible, I want to stick with psychiatry because that's where my passion lies. BTW, I do have CA license with DEA license as well. Probably have to look for a job... which might be rare to find.

 

[peppy]

Well, since you are a DO, if you would rather stay in medicine even if it meant not being in psych, I think your best bet would be to contact osteopathic IM and family practice programs. I was in contact with a lot of IM programs still looking for people this week. Unfortunately I am not sure if there is much hope for getting a psych position this year.
Good luck finding something you like.

To update on my own situation: thankfully the internship spot worked out after all! Hope others out there get great news soon too!

 

[m1forever]

I am also a DO, who completed a traditional internship, but failed to find PGY-2 spots in Psych. I didn't get into match this year since I was looking for a PGY-2. Now I find myself in an awkward position looking for a psych residency while other specialty programs will not take me seriously. One serious problem was this: I graduated from a D.O. internship (not dual-accredited), and some programs would only consider filling their PGY-2 spot with an applicant who finished ACGME-accredited training. I looked at an option for scrambling this year for PGY-I, but the available vacancy was too small in number (like 9, compared to 50s a few years ago). What possibilities might I have for this year or next year? If possible, I want to stick with psychiatry because that's where my passion lies. BTW, I do have CA license with DEA license as well. Probably have to look for a job... which might be rare to find.

just a curious question(and dont take this in a negative way because I didnt match either this year): why didn't you apply for pgy-1 positions through eras this year? Were you that confident you could match into an open pgy-2? from everything I've heard, unless if you have connections or excellent credentials, it's pretty hard to go from a ty or prelim, especially from a non-dual accredited program, into a pgy-2. It can be done, but I would never be so confident in doing it that I would skip out on the pgy-1 categorial match.

Also, there werent 9 spots this year in the scramble. There were more like 2 or 3 in reality.

I think for this year your options are similar to mine:

1) get a job doing something
2) do another transitional or prelim somewhere if you can find one
3) apply broadly for both pgy-2 and pgy-1 positions next year in the match and be prepared to follow through with a pgy-1 through the regular match

good luck.