Question about swapping before starting PGY1

[Suture15]

Hello,

Congratulations to everyone who matched yesterday! I also matched into a PGY1 IM categorical program, and while very grateful, it is extremely far from where I intended to be. I have been distressed about this since yesterday as I had made up my mind and hyped myself up to be closer to family and my fiance. While this may be irrational, I looked into the NRMP waiver, resident swap and all that jazz.

My question is, is it even possible to swap prior to starting your PGY1 year if both parties are willing? I see a number of "postings" on resident swap of PGY1 so not sure how that works. Or is it people who are actually in PGY1 right now who wanna swap?

Thank you for all your help!

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[Raryn]

Hello,

Congratulations to everyone who matched yesterday! I also matched into a PGY1 IM categorical program, and while very grateful, it is extremely far from where I intended to be. I have been distressed about this since yesterday as I had made up my mind and hyped myself up to be closer to family and my fiance. While this may be irrational, I looked into the NRMP waiver, resident swap and all that jazz.

My question is, is it even possible to swap prior to starting your PGY1 year if both parties are willing? I see a number of "postings" on resident swap of PGY1 so not sure how that works. Or is it people who are actually in PGY1 right now who wanna swap?

Thank you for all your help!

No. It isn't. You are obligated by the match to start the program where you matched (for a minimum of 45 days). Even if you, your program, the other guy, and his program all agreed, the NRMP won't typically grant a waiver for something like that.

 

[Suture15]

No. It isn't. You are obligated by the match to start the program where you matched (for a minimum of 45 days). Even if you, your program, the other guy, and his program all agreed, the NRMP won't typically grant a waiver for something like that.

Thanks for your reply.

In case I did get an NRMP waiver, could I then get in elsewhere IF they had an opening for PGY1 for this year? Obviously I run the risk of not getting in and having to apply in September again for 2018 and it's probably better to just do the 45 days and then try switching or applying for a PGY2 in IM?

And for PGY2 IM is that through ERAS or more externally, i.e. directly to the program in question?

 

[ThoracicGuy]

Thanks for your reply.

In case I did get an NRMP waiver, could I then get in elsewhere IF they had an opening for PGY1 for this year? Obviously I run the risk of not getting in and having to apply in September again for 2018 and it's probably better to just do the 45 days and then try switching or applying for a PGY2 in IM?

And for PGY2 IM is that through ERAS or more externally, i.e. directly to the program in question?

The chances of this happening approach zero.

 

[leadhead]

Why in the world did you apply to, interview at, and most importantly RANK a program with a location that was so undesirable to you?

 

[Raryn]

Thanks for your reply.

In case I did get an NRMP waiver, could I then get in elsewhere IF they had an opening for PGY1 for this year? Obviously I run the risk of not getting in and having to apply in September again for 2018 and it's probably better to just do the 45 days and then try switching or applying for a PGY2 in IM?

And for PGY2 IM is that through ERAS or more externally, i.e. directly to the program in question?

You will not get an NRMP waiver, but if you somehow managed it, you can go wherever you want this year.

From what I recall, PGY2 spots that start in July must be put through ERAS/the NRMP. PGY2 spots significantly off cycle (i.e. lets say starting in December or something) can be done outside of the match.

 

[NotAProgDirector]

You will not get a waiver, unless you declare that you are no longer interested in IM. And once you do that, you will be unable to get a new IM spot. The NRMP will tell you that if you didn't want to be so far away from your fiance, then you shouldn't have ranked it. And if you think that ranking the program was a mistake, you should look at the SOAP thread as see how horrible that process can be -- you could easily have ended up with nothing at all, or a program of lower quality that is equally far from your family.

Here's the honest truth: You should seriously consider engaging with your new program and plan to complete all three years there. Sure, you can quit in 45 days and not have an NRMP problem. But your contract probably requires advance notice of resigning, and even if it doesn't, this isn't McDonalds -- you can't just walk in one day and quit. You are a professional, and you should give your program adequate notice which is at least 60 days, and more reasonably 90 days.

Remember that you'll need support from all programs in your past going forward. If you "screw" this program, it can cause you lots of trouble going forward.

You also seem to suggest that you could just resign and then match again next year. It won't be so easy. You'll be one year farther from graduation. And you'll have resigned from a program immediately after matching there. Programs might be worried you'd do it again.

This program is 3 years. After that, you can move anywhere you want. Sure, it's not exactly what you wanted. But it's the best you could do, and next year's match will be worse. Perhaps your fiance can move.

As for PGY-2 spots, in IM they are not in the match. You have to hunt them down. That might be another option - finish PGY-1 in this program, then try to transfer for a PGY-2. But that's complicated also.

 

[Suture15]

Thank you everyone for their honest advice. I had to rank it since I did not get enough IM interviews, but I was very confident I would match in the ones I ranked above it and it fell through, for whatever reason. I totally understand, it is on me, but just wanted to know all my options and felt like this was the best place to go.

I will give it my best shot and you are right, it is only 3 years in the long run and it could've been much worse. Thank you!

 

[Suture15]

As for PGY-2 spots, in IM they are not in the match. You have to hunt them down. That might be another option - finish PGY-1 in this program, then try to transfer for a PGY-2. But that's complicated also.

Just regarding this point. How does that work though. I know you can use external websites to find open PGY2 spots but why is it complicated? Thanks

 

[gutonc]

Just regarding this point. How does that work though. I know you can use external websites to find open PGY2 spots but why is it complicated? Thanks

It's complicated because there's no universal way that these spots are advertised, at least in IM. It requires a lot of work on your part to find programs, and there's no universal application system. You'll need to have your app stuff in hand, including LORs, when you talk to them.

And I think you've already come to accept this, but just in case, to reiterate what everyone above who knows what they're talking about has already said, forget the idea of a "swap"...it doesn't really exist as an option.

 

[Raryn]

As for PGY-2 spots, in IM they are not in the match. You have to hunt them down. That might be another option - finish PGY-1 in this program, then try to transfer for a PGY-2. But that's complicated also.

Has the NRMP clarified this?

From what I last recall, they said if you know ahead of time you'll have an on-cycle PGY2 spot in any specialty (non-"advanced" specialties such as IM included) this coming year, you're required to put it in to the match as an "R" spot. Only if it's a last minute thing or an off-cycle spot did they allow out-of-match.

 

[NotAProgDirector]

Has the NRMP clarified this?

From what I last recall, they said if you know ahead of time you'll have an on-cycle PGY2 spot in any specialty (non-"advanced" specialties such as IM included) this coming year, you're required to put it in to the match as an "R" spot. Only if it's a last minute thing or an off-cycle spot did they allow out-of-match.

Yep.

From the NRMP Site:

Positions Not Subject to the All In Policy
Positions not subject to the All In Policy include:

• PGY-2 or higher positions in specialties accredited to begin only at the PGY-1 level
• PGY-3 or higher positions (excepting Child Neurology) in specialties accredited to begin at either the PGY-1 or PGY-2 level
• Positions in ACGME/AOA® dually-accredited programs that are unfilled at the conclusion of the American Osteopathic Association Match

Since IM starts only as a PGY-1, PGY-2 spots are not in the match.

 

[Raryn]

Yep.

From the NRMP Site:

Positions Not Subject to the All In Policy
Positions not subject to the All In Policy include:

• PGY-2 or higher positions in specialties accredited to begin only at the PGY-1 level
• PGY-3 or higher positions (excepting Child Neurology) in specialties accredited to begin at either the PGY-1 or PGY-2 level
• Positions in ACGME/AOA® dually-accredited programs that are unfilled at the conclusion of the American Osteopathic Association Match

Since IM starts only as a PGY-1, PGY-2 spots are not in the match.

Good. My information was out of date and they've since clarified the rules in a way that actually makes sense. Happy to learn that

 

[Suture15]

Yep.

From the NRMP Site:

Positions Not Subject to the All In Policy
Positions not subject to the All In Policy include:

• PGY-2 or higher positions in specialties accredited to begin only at the PGY-1 level
• PGY-3 or higher positions (excepting Child Neurology) in specialties accredited to begin at either the PGY-1 or PGY-2 level
• Positions in ACGME/AOA® dually-accredited programs that are unfilled at the conclusion of the American Osteopathic Association Match

Since IM starts only as a PGY-1, PGY-2 spots are not in the match.

Ah okay, very helpful. The PGY2 being out of the match is something I have seen elsewhere as well, so it is an option in case I am truly miserable, lol.

I did want to ask one more annoying question, which may have been sidetracked by my own irrationality and emotional outburst earlier. Is it technically possible to swap after the 45d commitment in a PGY1 setting? So not applying to a diff PGY1 spot through ERAS, or PGY2 spot outside the match but literally like a pure swap PGY1 to PGY1? I have come across people wanting to do this NOW, but I know till the 45d thing is over, it is LEGALLY (for NRMP purposes) impossible.

Thank you once again. It is helpful to have people tease our your thoughts and provide much needed advice without being overtly judgmental