questions

[Residentcool]

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2 questions here. 1-Why do some programs have a concern as to gap years/time since graduation?
2-If you do have gap year, how do you explain it? Unfortunately sometimes when you apply to an advanced position a gap year happens. Any suggestions?

 

[molten]

I don't think one gap year is a worry if you've filled it with meaningful clinical or research experience.

 

[Residentcool]

I don't think one gap year is a worry if you've filled it with meaningful clinical or research experience.

I still don't quite understand why there's a concern honestly.

 

[Stellar Clouds]

I still don't quite understand why there's a concern honestly.

It is because the vast majority of people don't have gaps...therefore any time taken off seems like an anomaly, even if you have a perfectly good reason for taking time off.

 

[gutonc]

It is because the vast majority of people don't have gaps...therefore any time taken off seems like an anomaly, even if you have a perfectly good reason for taking time off.

This.

You don't want your application to stand out for negative reasons.

Feel free to "rage against the dying of the light" and all that, but this is the reality of the situation.

 

[Residentcool]

This.

You don't want your application to stand out for negative reasons.

Feel free to "rage against the dying of the light" and all that, but this is the reality of the situation.

So what do you do if you do have gaps? I currently do have a position but will be applying again. I am concerned because some things will be confusing but I don't have any idea how to fix them at this point.

 

[Top Gun]

They have a concern about gap years because it means you've been away from clinical training for a while, and may be rusty when you start internship. One gap year probably won't be a big deal, but the longer you are out of medical school, the more your clinical skills and knowledge deteriorate. That is why programs look askance at candidates who apply after they've been out of medical school for a year or two. Having said that, no, it is not impossible to match if you have a gap year or even two as long as you can show that you have been doing something productive during that time and you have done some things to keep current clinically. If there were family reasons for a gap year, that is also understandable. Be sure to have a good explanation as to why you are applying later, and what you have been doing to maintain your clinical knowledge and skills.

 

[Residentcool]

They have a concern about gap years because it means you've been away from clinical training for a while, and may be rusty when you start internship. One gap year probably won't be a big deal, but the longer you are out of medical school, the more your clinical skills and knowledge deteriorate. That is why programs look askance at candidates who apply after they've been out of medical school for a year or two. Having said that, no, it is not impossible to match if you have a gap year or even two as long as you can show that you have been doing something productive during that time and you have done some things to keep current clinically. If there were family reasons for a gap year, that is also understandable. Be sure to have a good explanation as to why you are applying later, and what you have been doing to maintain your clinical knowledge and skills.

Thanks. Well, I applied/matched last year but I was off cycle because I had to start internship off cycle, which put me off cycle for the next application cycle. So once you start off cycle everything is screwed up kind of for advanced positions. I applied during internship and successfully matched to an advanced position, but obviously that gave me a gap from internship off cycle to advanced position. I have been working for most of the time, but i'm concerned that when I apply again they'll look at me funny. It is a very reasonable explanation but it looks horrific on paper! I am reapplying to a less competitive specialty. Would it be valuable to contact PDs and explain?

 

[gutonc]

Thanks. Well, I applied/matched last year but I was off cycle because I had to start internship off cycle, which put me off cycle for the next application cycle. So once you start off cycle everything is screwed up kind of for advanced positions. I applied during internship and successfully matched to an advanced position, but obviously that gave me a gap from internship off cycle to advanced position. I have been working for most of the time, but i'm concerned that when I apply again they'll look at me funny. It is a very reasonable explanation but it looks horrific on paper! I am reapplying to a less competitive specialty. Would it be valuable to contact PDs and explain?

Let's clarify this situation. You started (and completed) an internship off-cycle. Then you matched to (and started) an advanced position, again, off-cycle. Now you're planning to bag that specialty and apply for yet another one after a gap in training?

Do I have it straight?

If so, your training gap is probably the least of your worries.

 

[Residentcool]

Let's clarify this situation. You started (and completed) an internship off-cycle. Then you matched to (and started) an advanced position, again, off-cycle. Now you're planning to bag that specialty and apply for yet another one after a gap in training?

Do I have it straight?

If so, your training gap is probably the least of your worries.

No. Your first statement is correct. Your second is not. I have not started my advanced training yet. The advanced position will start ON cycle, but obviously because advanced positions have to be applied to in advance I have a gap between internship and advanced position that will be started soon. I am not planning on leaving the specialty unless I find something else.

With that info in mind, why do you say the training gap is the least of my worries? What additional worry should I have?

 

[gutonc]

No. Your first statement is correct. Your second is not. I have not started my advanced training yet. The advanced position will start ON cycle, but obviously because advanced positions have to be applied to in advance I have a gap between internship and advanced position that will be started soon. I am not planning on leaving the specialty unless I find something else.

With that info in mind, why do you say the training gap is the least of my worries? What additional worry should I have?

Gotcha. You weren't very clear.

So you've done internship and now you're interviewing for advanced positions that won't start until 2014?

There's not much you can do about that. "I graduated off cycle, the end."

 

[Residentcool]

Gotcha. You weren't very clear.

So you've done internship and now you're interviewing for advanced positions that won't start until 2014?

There's not much you can do about that. "I graduated off cycle, the end."

No, sorry you are not correct. Sorry if I'm not being clear here. I graduated off cycle due to health issues. Matched for internship which I started off cycle and obviously finished off cycle. Applied during internship and MATCHED for advanced position that starts in 2013. Clearly though I have a gap between the already completed internship and the position that starts this July 2013. I hope that's more clear.

I would like to go into a different specialty though. I have to comply with my match committment this July and obviously won't leave the position if I can't find something else, whether during anything that pops up during the year or through the match. My question is-do you think programs will be concerned that I had a gap between my intern year and the advanced position?

 

[gutonc]

No, sorry you are not correct. Sorry if I'm not being clear here. I graduated off cycle due to health issues. Matched for internship which I started off cycle and obviously finished off cycle. Applied during internship and MATCHED for advanced position that starts in 2013. Clearly though I have a gap between the already completed internship and the position that starts this July 2013. I hope that's more clear.

I would like to go into a different specialty though. I have to comply with my match committment this July and obviously won't leave the position if I can't find something else, whether during anything that pops up during the year or through the match. My question is-do you think programs will be concerned that I had a gap between my intern year and the advanced position?

Wow...next time try to obfuscate a little more. My first assessment of your situation was basically correct then, the timing was just off. If you want useful help you need to be more forthcoming and honest.

So...the training gap is a minor (basically non-) issue. The real issue is that you can't make up your damn mind. If I was a PD I wouldn't give a crap about your gap "year" but would care mightily that you'd bail out of my program just like you did the last one. That's your biggest problem now.

 

[Residentcool]

Wow...next time try to obfuscate a little more. My first assessment of your situation was basically correct then, the timing was just off. If you want useful help you need to be more forthcoming and honest.

So...the training gap is a minor (basically non-) issue. The real issue is that you can't make up your damn mind. If I was a PD I wouldn't give a crap about your gap "year" but would care mightily that you'd bail out of my program just like you did the last one. That's your biggest problem now.

I'm trying to be as clear as possible. I think a lot of people switch residencies, not sure why that is an issue. I don't want to change programs, but specialties. Why do you think the training gap is a non issue? It's still a gap between the internship I already completed and the advanced position I will start. The internship is a requirement, and I did not bail out of the internship. I was sick as a dog and had to start later.

How do other people switch specialty programs then? I thought it was rather common.

 

[NotAProgDirector]

Switching programs is not common, or at least not as common as you think.

In addition, you've decided to switch fields before you even start in your current field. I can see how that would be concerning. Let's say that your program that you're starting in 2013 contacted you and tells you that they've had a change of heart, decided that they don't really want you anymore. They know you've matched and so of course they'll take you for a year, but basically at the end of the year they're not going to renew you. You wouldn't be very happy, I expect.

Now imagine that happened to someone last year, and you had heard all about it. Chances are you wouldn't be very excited to go to that program any more.

This is the way PD's will see it. Believe it or not, residents are an investment. We want our PGY-1's to become PGY-2's, and so on. PD's might see you as flaky. Maybe you'll start some new field, then decide the initial field was more to your liking and change back again.

Also, when we see someone change fields over and over, we worry that you're actually failing out of each program. Sometimes it's easier to let someone gracefully resign than to fail them.

 

[Residentcool]

Switching programs is not common, or at least not as common as you think.

In addition, you've decided to switch fields before you even start in your current field. I can see how that would be concerning. Let's say that your program that you're starting in 2013 contacted you and tells you that they've had a change of heart, decided that they don't really want you anymore. They know you've matched and so of course they'll take you for a year, but basically at the end of the year they're not going to renew you. You wouldn't be very happy, I expect.

Now imagine that happened to someone last year, and you had heard all about it. Chances are you wouldn't be very excited to go to that program any more.

This is the way PD's will see it. Believe it or not, residents are an investment. We want our PGY-1's to become PGY-2's, and so on. PD's might see you as flaky. Maybe you'll start some new field, then decide the initial field was more to your liking and change back again.

Also, when we see someone change fields over and over, we worry that you're actually failing out of each program. Sometimes it's easier to let someone gracefully resign than to fail them.

I agree that changing over and over is a concern. I don't see myself in that situation though. I had a life changing experience and reason why I'm changing specialties. Had what happened not happened, I would have never thought about changing likely.

 

[Doctor Bob]

I agree that changing over and over is a concern. I don't see myself in that situation though. I had a life changing experience and reason why I'm changing specialties. Had what happened not happened, I would have never thought about changing likely.

Be that as it may, now you should see the kinds of perceptions you will be working against. It will be up to you to address those perceptions during the interview/application process, because if you don't they will work against you.

 

[Residentcool]

Well I find that kind of odd to be honest, given that a lot of people switch residencies. There are certain specialties that even keep some outside the match, or used to keep I should say outside match positions for people who wanted to switch. I find it surpriring that some of you mention that it would be perceived poorly. I don't really see it that way and know of a good number of people who have switched. But ok.

 

[VMSmith]

So let's see.

You graduated off-cycle, and have a hard time accepting that programs want an explanation about this - in your mind this should not be a big deal.

Now, before even starting your residency, you want to switch fields. Again, you seem to have a hard time accepting that programs might view this negatively in any way, and that this happens all the time (despite many people, including a program director, informing you that this is not the case,)

At this point, I should hope that you'd realize that it's less about "being right" about your assertions, and more about realizing that whatever you think is right or not, there is a widespread perception that what you've described your situation to be is not a favorable one, and you need to be able to explain it well.

 

[gutonc]

Well I find that kind of odd to be honest, given that a lot of people switch residencies. There are certain specialties that even keep some outside the match, or used to keep I should say outside match positions for people who wanted to switch. I find it surpriring that some of you mention that it would be perceived poorly. I don't really see it that way and know of a good number of people who have switched. But ok.

Again. Not "a lot" of people switch residencies. Some do. A relatively small fraction of the 24K or so residents each year do so. (Anecdotally, in my time in residency, paying attention to the 120 or so residents in my class and the ones immediately ahead and behind me, 3 people switched over those 3 years. <3%...not a lot.)

And feel free to be upset about the perception. But that doesn't change it. You're better off accepting it and moving on. If you really have a compelling story for why you're switching, as you claim to have, then your chances are improved. But don't pretend they're the same they would have been if you'd applied for that specialty straight out of school.

Also, since you're being vague on the specialties (which is fine, I understand wanting the anonymity), you should be certain that you're competitive for whatever the new specialty is. If you originally matched in Neuro and your new love is now Rad Onc, you've got problems. If you initially matched in Rads and now you want to do PM&R well then you're probably in a good position. Also, what - besides your personal medical experience - qualifications/experience do you have with the new specialty? Do you have LORs in it?

 

[mcl]

Again. Not "a lot" of people switch residencies. Some do. A relatively small fraction of the 24K or so residents each year do so. (Anecdotally, in my time in residency, paying attention to the 120 or so residents in my class and the ones immediately ahead and behind me, 3 people switched over those 3 years. <3%...not a lot.)

Just for fun, I did the math for my program and also came up with a 3% switch rate over the last 17 years (the duration of my tenure as PC).

To the OP...I think that a lot of medical students change their minds about the specialty they want to pursue. Many start their clinical rotations with a strong inclination but have one of those "life changing" experiences as they complete their rotations and find themselves pursuing a field then never would have expected. But generally, once someone reaches residency he/she is committed to it. Certainly, switches do happen, and I hope you pursue the field that makes you happy. But from the program's point of view, it does raise a red flag and you can definitely expect to account for your change of interest.

 

[Residentcool]

Again. Not "a lot" of people switch residencies. Some do. A relatively small fraction of the 24K or so residents each year do so. (Anecdotally, in my time in residency, paying attention to the 120 or so residents in my class and the ones immediately ahead and behind me, 3 people switched over those 3 years. <3%...not a lot.)

And feel free to be upset about the perception. But that doesn't change it. You're better off accepting it and moving on. If you really have a compelling story for why you're switching, as you claim to have, then your chances are improved. But don't pretend they're the same they would have been if you'd applied for that specialty straight out of school.

Also, since you're being vague on the specialties (which is fine, I understand wanting the anonymity), you should be certain that you're competitive for whatever the new specialty is. If you originally matched in Neuro and your new love is now Rad Onc, you've got problems. If you initially matched in Rads and now you want to do PM&R well then you're probably in a good position. Also, what - besides your personal medical experience - qualifications/experience do you have with the new specialty? Do you have LORs in it?

Creepy but yes the end goal is PMR.

 

[NotAProgDirector]

PM&R is very uncompetitive. If you're a US grad with decent scores, they will see your change of heart as "seeing the light" rather than "waffling". This changes everything.

 

[gutonc]

PM&R is very uncompetitive. If you're a US grad with decent scores, they will see your change of heart as "seeing the light" rather than "waffling". This changes everything.

As usual...I absolutely agree with aPD. PM&R makes FM look like integrated plastics on the "competitiveness" scale. The vast majority of PM&R residents come to it late because they have no experience with it in med school. A gap year is virtually de rigueur.

 

[Residentcool]

double post

 

[Residentcool]

As usual...I absolutely agree with aPD. PM&R makes FM look like integrated plastics on the "competitiveness" scale. The vast majority of PM&R residents come to it late because they have no experience with it in med school. A gap year is virtually de rigueur.

You think FM is more competitive than PMR? Really?

I don't see how that's possible. I think as long as you have a pulse, IM/FM/Peds/psych/path are a guarantee. From my understanding, PMR has a very small # of spots, and as you mention, few people have exposure to the field in med school. I sure as heck did not. They also seem to care very much about experience, a rotation in the field and a letter. Many programs say they won't interview someone without that. I think FM interviews anyone who has gone to med school that applies. But if you guys think it's not too competitive, I kinda feel better. I am coming from rads btw, I don't know if that will give me any benefit of the doubt or brownie points sort of speak given that rads is still more competitive.

 

[LucidSplash]

I never understand people who start threads with questions and then are argumentative with those who respond with answers to their questions. Why ask the question if you are going to be dismissive of the responses?

 

[Residentcool]

I never understand people who start threads with questions and then are argumentative with those who respond with answers to their questions. Why ask the question if you are going to be dismissive of the responses?

Meh, I don't think I'm being "argumentative." I was mostly interested in getting ideas about how to address the gap for the most part. I also can get opinions but not necessarily agree with them. That's the beauty of it-they are people's thoughts/opinions.

As I said, I am comforted by knowing that aPD and gutonc think PM&R is not competitive and is likely easy to get into. Hopefully I can snatch up a spot without major issues.