NonLinearPath
New Member
- Joined
- Jun 16, 2021
- Messages
- 1
- Reaction score
- 0
I'm a recent MD grad from an east coast med school who matched into an academic West Coast emergency medicine program. This application cycle was particularly hard for me because I hadn't been able to visit programs and cities. I unfortunately ended up prioritizing reputation and program length over location. On top of that I'd been split between EM vs IM. Because of COVID and scheduling, I completed my IM sub-I in January 2021. I really enjoyed my IM sub-I and could envision a career in heme/onc (I have a research background in onc).
After the match, I realized that proximity to family is my number one value. I understand I haven't yet experienced residency, but I can't imagine three years in a city a 5+ hour flight from my closest family with a 3 hour time change. It's been a pretty dark couple of weeks. We are into orientation month, and I can already tell that the vibe of my program and cohort is more family centric. The majority of my co-residents are from the area. Many also have kids, and we haven't had social events understandably so with COVID restrictions and their family obligations. I already feel isolated without my family and friends on the East coast, and I haven't even started shifts yet.
I have given myself to mid/late-August to decide a course of action. The following are some of the options I am considering, and I'd love any feedback from folks who have heard of or gone through similar experiences. I've read most previous threads and articles from SDN and reddit, but I'd appreciate advice specific to my situation.
After the match, I realized that proximity to family is my number one value. I understand I haven't yet experienced residency, but I can't imagine three years in a city a 5+ hour flight from my closest family with a 3 hour time change. It's been a pretty dark couple of weeks. We are into orientation month, and I can already tell that the vibe of my program and cohort is more family centric. The majority of my co-residents are from the area. Many also have kids, and we haven't had social events understandably so with COVID restrictions and their family obligations. I already feel isolated without my family and friends on the East coast, and I haven't even started shifts yet.
I have given myself to mid/late-August to decide a course of action. The following are some of the options I am considering, and I'd love any feedback from folks who have heard of or gone through similar experiences. I've read most previous threads and articles from SDN and reddit, but I'd appreciate advice specific to my situation.
- I end up loving my first 3 months, and stick to completing the residency. Even thought the EM job market looks abysmal, I'm hoping to land any job in Chicago or NYC.
- Re-entering the match: applying to Mid West & East Coast internal medicine programs
- this option seems like a lot of work because I'll need to get my med school to give me an ERAS token, submit a MSPE, and get a medicine chair letter together (I did well on medicine rotations). I'll also need to get a letter from a medicine doctor during my ICU rotation at my current residency. Fortunately one of my medical school mentors who wrote a letter for my EM app is an IM hospitalist, and I plan on reaching out to him to see what he thinks/if he'll write me another letter. I'm also very close with my med school advising dean, and I think he'll back me no matter what I decide. Mid/late-august is my decision deadline because ERAS needs to be in by September 29th this year.
- I understand that ultimately I'll need to have a PD letter supporting my decision. There is conflicting advice out there about telling your PD. I'd probably tell my PD in September. However, September is early, and my PD won't know me very well. I'd prefer to be upfront about my thought process with my PD. I'm not sure how realistic it would be to tell my PD what I'm thinking and frame it like "With the limitations of a majority virtual MS4, I'm not certain EM is the right fit for me. I'm interested in IM and passionate about oncology. Could I apply to IM this cycle and delay the decision until rank list is due? That way I have until March 2022 to make a decision." - obviously I'd word it better than that. The number of interviews I'd get could also affect my decision, since I don't want to be left without any residency spot. I have a family connection to a community IM program in my preferred geographic area. I'm not concerned about prestige, so I'd be happy to land there if they'd take me.
- I plan on taking and passing Step 3 in November. I hit the median on Step 1 and 2, so I don't have good or bad board scores. I'm going buckle down and make sure I pass step 3. I figure that may be a concern for some IM PDs.
- Am I damaged goods re-applying in the match? Is this option even viable? I just don't want to complete intern year and then have to re-enter the match as a EM PGY-2. At that point I'd just complete my residency.
- Transfer: Waiting until November/December and then emailing EM and IM PDs in my geographic areas of interest for PGY-2 positions. I'll avoid emailing PDs at the same institutions.
- The retention rate for EM is pretty high, so I don't think this is a viable option. I'll email 4 year EM programs in my area of interest first. From advice I read online, I'll email only one program at a time and wait for their response. Then I'll continue down my prioritized list of programs. I'm going to talk to my EM med school mentor in August once I make a decision to see what he/she thinks.
- The IM drop out rate seems higher and there are more spots. I'd love to be able to slide into a PGY-2 position which counts some of my EM intern experience towards IM requirements. I don't mind taking 3.5-4 years to finish IM. It would be 4 years anyway if I reapplied via the match. I'll start with this list after I've exhausted EM transfer options.
- I know the odds of either are low, but it’s not impossible. I know someone who switched geographic areas in the same specialty. Again, should I be upfront with my PD or only talk to my PD once I know there is an open position somewhere. I'm hoping to not completely light the bridge on fire, and my PD seems like an understanding and supportive individual. Alternatively I can bring it up to my class specific APD first - the APD mentioned thinking about leaving medicine during residency when we were on an intro call.
- In both the re-apply and transfer scenarios, I’m uncertain how CMS funding will work since I’ll have used one year of funding.
- Complete my intern year and leave for industry: I have a business background from before medical school. If I’m truly not happy by the end of my 1st year of residency, I’m confident I can get a job in consulting, equity research, or the life sciences industry. It puts the kibosh on any future as a clinician, but at least I’d be happy. I also enjoy the macro healthcare work. By completing intern year I'll honor my contract and be a licensed physician (non-boarded) able to prescribe meds.