Programs offering both categorical and advanced spots

[pietachok]

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When we select programs in ERAS, some offer both categorical and advanced neuro programs. Is there any reason not to select both?

I'd like to stay where I am for my prelim year if possible, since I own my home. So if I apply to both, am I correct in believing I can rank such programs:

1. ProgramX-advanced (+prelim at another school)
2. ProgramX-categorical

without risking my final match putting me in the advanced program without getting a prelim even though I could have gone to the same program as a categorical (I assume programs don't separately rank us for adv/cat spots)?

Thanks in advance for any help.

 

[Elipsis]

http://www.nrmp.org/match-process/about-rol/
"Applicants in the Main Residency Match who rank advanced (PGY-2 level) programs on their primary ROLs also can submit a supplemental ROL that is linked to one or more advanced programs on the primary ROL. By attaching supplemental ROLs to primary ROLs, applicants attempt to obtain a "full match" by simultaneously securing PGY-1 and PGY-2 positions.
It is possible for an applicant in the Main Residency Match to match to an advanced position on the primary ROL but not to a preliminary position on the corresponding supplemental ROL. In that case, the applicant still is committed to the advanced position and must seek a qualifying first-year position during the Supplemental Offer and Acceptance Program or after the Main Residency Match has concluded."

So... unfortunately not. If you matched an advanced position on your own match and failed to match a prelim on your supplemental rol you would have to do soap. Figuring out how to safely apply for these prelims has been one of the most confusing things for me in doing these applications. My internal medicine program director recommended ranking at least 5 prelims on the supplemental list. At this point my plan is to apply for both the "linked" and standard preliminary medicine spots on ERAS for the programs I'm applying to and hope I'll be considered for both when the medicine programs rank. Anyone have any feedback on this?

My thought is that if I rank programs highly that offer linked medicine prelims for half or more of their medicine positions I will be relatively safe as my odds of matching at my home institution for prelim are high and I'll have a handful of other prelims on my list as well, some from institutions where the neuro spots are linked and others that are unlinked. I expect to have be very cautious about ranking the purely advanced neuro programs. I've seen some horror stories on this board about people matching their neuro spots but not prelims.

On a side note I took a look at the NRMP match data last year and the number of total medicine preliminary positions available has not actually changed, contrary to what I had been told. I assume that's because more and more of these prelim positions are being linked to residency positions. 80% of them were matched by U.S. seniors. Also relevant for us, the SOAP spots didn't fill (not even close), so that should mean that were we to mess this up too bad we could still find ourselves some awesome prelims where we end up spending 10/12 months in the CCU or something.

 

[pietachok]

Thanks. I'm so irritated that neuro isn't uniformly advanced or categorical.
So if I apply to categorical program A, and advanced X & Y, and prelims a,b,c and rank them:

1. X(a > b)
2. Y(c only)
3. A categorical

and match first with X, I will be given X regardless of lacking a prelim, & even if I could have had prelim c. There is no way to rank in a way that says "if I can't have X with prelim a or b, I'd rather go to Y with any prelim, and if I don't match a prelim I prefer A."?? I still cannot tell from the nrmp blurb if they're talking about when you are too poorly ranked to get a, b, or c.

Prelims are hard to get in SOAP, right? And the other people who need them are disproportionately strong applicants (ophtho etc.), so I feel like we're on average at a disadvantage for getting desirable preliminary spots.

You're only applying to 5 prelims? I was told to pick 15 to 20! (and I'm coming from a decent school w good step 1 scores, etc.)

 

[drzing]

Thanks. I'm so irritated that neuro isn't uniformly advanced or categorical.
So if I apply to categorical program A, and advanced X & Y, and prelims a,b,c and rank them:

1. X(a > b)
2. Y(c only)
3. A categorical

and match first with X, I will be given X regardless of lacking a prelim, & even if I could have had prelim c. There is no way to rank in a way that says "if I can't have X with prelim a or b, I'd rather go to Y with any prelim, and if I don't match a prelim I prefer A."?? I still cannot tell from the nrmp blurb if they're talking about when you are too poorly ranked to get a, b, or c.

Prelims are hard to get in SOAP, right? And the other people who need them are disproportionately strong applicants (ophtho etc.), so I feel like we're on average at a disadvantage for getting desirable preliminary spots.

You're only applying to 5 prelims? I was told to pick 15 to 20! (and I'm coming from a decent school w good step 1 scores, etc.)

so asked my dean about this. say your rank list looks like: 1. advanced A. 2. advanced B. 3. categorical 4. advanced C 5. categorical.
each advanced you apply to you make a seperate rank list of prelim programs...i.e for your first advanced your list would be 1. prelim at A, 2. prelim at random. 3. prelim at random. and then for your next advanced spot you make a whole other list of prelims...this gives you a better chance of getting your prelim at the same place at the place you match for neuro.

hope this helps. let me know if it doesn't and i can try to explain it better

 

[TUGM]

so essentially, you create a supplement rank list with preferred prelims for each advanced program you apply to?

 

[drzing]

so essentially, you create a supplement rank list with preferred prelims for each advanced program you apply to?

yes, you would be correct.

 

[IonClaws]

so asked my dean about this. say your rank list looks like: 1. advanced A. 2. advanced B. 3. categorical 4. advanced C 5. categorical.
each advanced you apply to you make a seperate rank list of prelim programs...i.e for your first advanced your list would be 1. prelim at A, 2. prelim at random. 3. prelim at random. and then for your next advanced spot you make a whole other list of prelims...this gives you a better chance of getting your prelim at the same place at the place you match for neuro.

hope this helps. let me know if it doesn't and i can try to explain it better

I know that OP wanted to do a preliminary year at his/her home institution, but if this isn't a concern for someone else, shouldn't you rank categorical positions above all advanced positions, if they are available at the institutions you want?

 

[SoCar]

if i'm applying to advanced programs that have guaranteed prelim spots at their institution do i need to be applying for the prelim spots on ERAS at the same time as the neuro spots? Or can I add those in later (like after the interview) if I like the program?

 

[drzing]

same time.

 

[Elipsis]

I applied to 12 prelims total, but the majority of those have some sort of linkage. Like I mentioned above, I think my rank list will be heavily influenced by how likely I am to get a prelim at the same program. I remember somebody posting a year or two ago about only applying to categorical programs; I can really sympathize with that.

 

[Shunnar]

Why would you rank advanced programs before categoricals? I think categoricals should be higher because this way if they accept you, you don't have to look for prelims....

Thanks. I'm so irritated that neuro isn't uniformly advanced or categorical.
So if I apply to categorical program A, and advanced X & Y, and prelims a,b,c and rank them:

1. X(a > b)
2. Y(c only)
3. A categorical

and match first with X, I will be given X regardless of lacking a prelim, & even if I could have had prelim c. There is no way to rank in a way that says "if I can't have X with prelim a or b, I'd rather go to Y with any prelim, and if I don't match a prelim I prefer A."?? I still cannot tell from the nrmp blurb if they're talking about when you are too poorly ranked to get a, b, or c.

Prelims are hard to get in SOAP, right? And the other people who need them are disproportionately strong applicants (ophtho etc.), so I feel like we're on average at a disadvantage for getting desirable preliminary spots.

You're only applying to 5 prelims? I was told to pick 15 to 20! (and I'm coming from a decent school w good step 1 scores, etc.)

 

[pietachok]

Why would you rank advanced programs before categoricals? I think categoricals should be higher because this way if they accept you, you don't have to look for prelims....

???
Because some of the top programs are advanced programs. Would you go to Program X over Harvard?
And location. Not having to relocate can be a big deal if you own your home or have a family . . . or don't love the inconvenience of moving. Some jobs are not available outside of major cities such that one's spouse may not be able to get a job nearby, so it may be necessary to rank adv programs above cat to stay in a place where both spouses can be employed.

 

[Shunnar]

???
Because some of the top programs are advanced programs. Would you go to Program X over Harvard?
And location. Not having to relocate can be a big deal if you own your home or have a family . . . or don't love the inconvenience of moving. Some jobs are not available outside of major cities such that one's spouse may not be able to get a job nearby, so it may be necessary to rank adv programs above cat to stay in a place where both spouses can be employed.

my point is: I prefer getting a categorical position at a mid-tier program, than getting an advanced one at a big center and suffer looking for prelim

 

[Thama]

my point is: I prefer getting a categorical position at a mid-tier program, than getting an advanced one at a big center and suffer looking for prelim

Especially since many top-tier programs are also at least partially categorical. Really the only major city that is essentially all advanced now is Boston. Even in the PGY-1 crunch of NYC, Columbia is half categorical and Cornell is all categorical. And if you're couples matching then the advanced thing becomes borderline untenable. IMO, programs that aren't at least partially categorical/guaranteed at this point either need to be a) Partners/Hopkins/etc, or b) willing to lose out on a lot of applicants that have plenty of other options that are just as good if not better.

 

[pietachok]

my point is: I prefer getting a categorical position at a mid-tier program, than getting an advanced one at a big center and suffer looking for prelim

Good for you? You didn't ask about for yourself. You posed the question in general. I gave you an answer that extended beyond the theoretical tier of the program. Obviously having to apply to prelims is a huge downside. But its a bad situation that some of us have no choice but to deal with.

 

[smmypnts]

Cornell announced that they were switching to offering a mix of both categorical and advanced. And still Columbia and Cornell are only 2 programs in city with 8+ programs (and several more if you count programs in the suburbs that are a bit of a commute away). So anyone looking in nyc should apply to prelims

 

[2heavy]

There is a lot of misinformation on this thread. First, advanced vs categorical really comes down to personal preference and other factors such as being in the same city all 4 years, significant other, etc. You need to read the specifics on each program website to determine exactly how many prelim spots they offer, if they are guaranteed, and if they are at a good hospital or at some small affiliate. Regarding "would you go to program X over Harvard?", YES if you are referring to BIDMC as it's not top-tier and there is no guaranteed pre-lim, and YES if Program X is top-tier and a better fit. There are categorical options within the best programs, you just have to do your homework and determine the details. I only ranked Categorical spots at Partners, Wash U (all categorical), Columbia, and Penn with Hopkins being the exception. You can now add UCSF to those offering categorical spots. In retrospect, I'm glad that I had a solid/intense year of medicine to prepare for my institution's large inpatient neurology service.