Reapplying to residencies within the same field because I dislike my program—a long shot?

[folgersormh]

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I’m an intern in a four year residency and when I created my rank list I had to rely heavily on location. I ranked a program that wasn’t a good fit for me but in a desirable location over ones that were better fits but far away (sick parent, needed to be close). However, I am having a terrible time here. It’s a community program and no one teaches. I’ve literally looked at UpToDate guidelines and then the attending says no and when I ask why we’re deviating he’d just say “I don’t really have time to explain.” Obviously that’s 1 attending but I’ve worked with 7 others since then and no one actively teaches, not even the med students. I never experienced this at my academic med school. This place is teetering on workhorse program.

I wish I ranked with my brain rather than emotion. I want to leave. Can I apply this upcoming Match to academic places? I’m willing to repeat PGY1 if it means a better place. I genuinely feel like I’m not learning and I’m worried I won’t get the education and training I need to be personally fulfilled. Plus I didn’t realize that research and academia were actually important to me. There are no opportunities here. They even got rid of their research curriculum this year (and didn’t tell us when we were applying). So whatever little support existed is now gutted.

I just want out. Do I just open the application and basically resubmit my material? Like the LORs and essays.

ETA: and it’s not that I fell to this program. It was my top 3 and I had to rank with location in mind. I basically thought I needed to be in the immediate area so had to rank accordingly but I no longer need that and I’m miserable here.

 

[EthylMethylMan]

Are you on good terms with your program? They’re gonna want a letter from your PD. If you can’t get a good PD letter you’ll be in trouble.

 

[DrMetal]

It's only August, so you've only been there 1 or 2 months? You may want to give it some more time.

Nobody teaches all that well in this business. Teach yourself.

 

[NotAProgDirector]

Looking at your post history, you applied and matched to a Neuro program, came from a "top 30" medical school, had a very competitive S2 score, and good clinical grades.

Yes, you can reapply for spots again. You would contact your medical school and they will get you a new ERAS token, you'll be able to get back your application (i.e. you won't have to type it out all again), edit to update, and reapply.

But it's more complicated than that. You will be better off if you have a letter from your current PD, stating that your performance is fine - so it will be difficult (if not impossible) to hide what you're doing from your current program. You'll be competitive in the neuro match again. Since you'll already have completed a PGY-1, and because in Neuro the PGY-1 is often very IM heavy (some programs still have an IM prelim year), you can also look for Neuro PGY-2 spots that might be open. Some of those will be in the match as R positions (if they fill their program with A positions), some will not (if they fill their program with C positions). Applying in the match and stating in your PS that you'd be interested in exploring a PGY-2 position if it was open is a great way to find a spot.

The biggest danger here is that once you tell your program that you're trying to leave, your experience there may go further downhill. And, they may start to recruit for a new PGY-2 for next year to replace you -- a very reasonable plan on their part. If they find someone before the match actually happens, you may lose your PGY-2 there before you know if you have a spot elsewhere. Given your posted background I think your chances of getting a different spot is quite good, but it can be worrying.

You could also reach out to programs that interviewed you that you ranked below this one, with interest in a PGY-2. They met you and reviewed your app already, and perhaps one of them may already have a planned open position.

 

[folgersormh]

It's only August, so you've only been there 1 or 2 months? You may want to give it some more time.

Nobody teaches all that well in this business. Teach yourself.

The teaching is a major part, but also the absence of research and getting rid of their research curriculum this year without telling us is a big part too. I knew research would be harder to get, but they had at least a very small team working to connect you to researchers that now no longer exists.

 

[folgersormh]

Looking at your post history, you applied and matched to a Neuro program, came from a "top 30" medical school, had a very competitive S2 score, and good clinical grades.

Yes, you can reapply for spots again. You would contact your medical school and they will get you a new ERAS token, you'll be able to get back your application (i.e. you won't have to type it out all again), edit to update, and reapply.

But it's more complicated than that. You will be better off if you have a letter from your current PD, stating that your performance is fine - so it will be difficult (if not impossible) to hide what you're doing from your current program. You'll be competitive in the neuro match again. Since you'll already have completed a PGY-1, and because in Neuro the PGY-1 is often very IM heavy (some programs still have an IM prelim year), you can also look for Neuro PGY-2 spots that might be open. Some of those will be in the match as R positions (if they fill their program with A positions), some will not (if they fill their program with C positions). Applying in the match and stating in your PS that you'd be interested in exploring a PGY-2 position if it was open is a great way to find a spot.

The biggest danger here is that once you tell your program that you're trying to leave, your experience there may go further downhill. And, they may start to recruit for a new PGY-2 for next year to replace you -- a very reasonable plan on their part. If they find someone before the match actually happens, you may lose your PGY-2 there before you know if you have a spot elsewhere. Given your posted background I think your chances of getting a different spot is quite good, but it can be worrying.

You could also reach out to programs that interviewed you that you ranked below this one, with interest in a PGY-2. They met you and reviewed your app already, and perhaps one of them may already have a planned open position.

Who do I contact at my school for it? I know it sounds dumb but do I reach out to a dean, or?

I’m scared to tell my PD for that reason. I’m miserable and want to leave but job > no job, and if I don’t match and I lose my spot then I’m screwed. And I’m scared that if I don’t match but keep the spot I’ll always be the “problem resident.” Ugh, just ranting

 

[comp1]

I just had a viscerally negative reaction to the idea of planning a switch so early into residency. It seems other posters think you have the stats to maybe make it work, but being miserable at the start of residency is not unique or new (particularly in neuro) and you are DARN correct that job > no job. It's nice that you came from a med school that really prioritized didactics, but it's not the only or even the best way to learn and it is a heck of a lot less important in residency. For example, with the attending that deviated from some sort of clinical guidelines you read, it's a lot more important to observe what happened when your team did what they did than to have the attending explain their specific reasoning. Honestly the attending probably didn't have great conscious reasons for doing it, it's what they've done before in roughly similar situations. Less workhorse oriented programs will have time for everybody to backtrack and figure out what the actual reason was, but honestly a lot of places will not. You might even make this transfer sort of work and find you end up at a program that is an even poorer fit for you because you're going to be taking whatever you can get. The focus of residency is not research pretty much anywhere. I would say the only possible good reason for switching would be if you have a strong need to live somewhere else geographically (not just that you no longer need to live where you are geographically). That is the sort of reason that keeps you still on good terms with your current PD, but that doesn't appear to be the case for you. "I just don't like the program" isn't a great argument for such a risky endeavor, IMO and it's definitely not one the current PD will like. Further, entering as a PGY2 kind of sucks. You're going to have to function at a higher level clinically while also having to learn a whole new system and trying to socially interact with a bunch of coresidents who already know each other.

 

[mistafab]

It is possible to transfer within specialty, and I know specifically of someone who transferred well.

Some key factors:

1) This person was liked in our program (and likeable)
2) this person did well clinically in our program
3) this person did not "make a stink" in our program
4) this person was at a "top" program, and switched to another "top" program elsewhere
5) this person essentially lined it all up himself, then let our PD know his plans, and our PD helped to make it happen
6) Our PD lined up a replacement for the following year, who started as a PGY2

So if you're going through with it, make sure all this is good. I don't know if it will go well for you if any of these are false. It is a lot of energy for all parties involved, so it helps if you are liked.

Good luck

 

[DrMetal]

The teaching is a major part, but also the absence of research and getting rid of their research curriculum this year without telling us is a big part too. I knew research would be harder to get, but they had at least a very small team working to connect you to researchers that now no longer exists.

You know the sad truth is, nobody does great teaching in medicine. The way most of us learn---memorize, regurgitate, spit, rinse, repeat---doesn't really require great teaching. We don't derive things, we don't learn things from first principles. To get by, you just need resources and the ability to teach yourself (which you've already demonstrated an ability to do, if you have an MD). Don't get me wrong: a good teacher is always welcomed and desired, but it's not strictly necessary.

You probably made the right decision, in picking a residency that satisfies your emotional needs (being close to family, having social support, etc). In the end, this is probably more valuable than being at a program with great "teaching". Again, teach yourself.

Research? For what purpose? Do you want to become an academic? If Yes, then ok, you need to be at a strong academic program. But if you don't care about becoming a professor, if you're just looking to dabble, you can probably find a project and get some research done. This is not a great reason to leave a program.

Attendings not complying with guidelines? The heck you say! Every headache patient getting a non-con head CT, despite guidelines stating it's not necessary? Of course. This is called CYA ('real-world') medicine, which often goes against that which is taught in GME. Welcome to the world kiddo . . . Just roll with it. Also not a good reason to leave a program. You will encounter this everywhere!

 

[Dral]

Is the experience you speak of on internal medicine or other rotations? If may be that you may not get the best training during intern year, but maybe your advanced program will have better training. In that case, just make it through the year.

 

[dozitgetchahi]

I just had a viscerally negative reaction to the idea of planning a switch so early into residency. It seems other posters think you have the stats to maybe make it work, but being miserable at the start of residency is not unique or new (particularly in neuro) and you are DARN correct that job > no job. It's nice that you came from a med school that really prioritized didactics, but it's not the only or even the best way to learn and it is a heck of a lot less important in residency. For example, with the attending that deviated from some sort of clinical guidelines you read, it's a lot more important to observe what happened when your team did what they did than to have the attending explain their specific reasoning. Honestly the attending probably didn't have great conscious reasons for doing it, it's what they've done before in roughly similar situations. Less workhorse oriented programs will have time for everybody to backtrack and figure out what the actual reason was, but honestly a lot of places will not. You might even make this transfer sort of work and find you end up at a program that is an even poorer fit for you because you're going to be taking whatever you can get. The focus of residency is not research pretty much anywhere. I would say the only possible good reason for switching would be if you have a strong need to live somewhere else geographically (not just that you no longer need to live where you are geographically). That is the sort of reason that keeps you still on good terms with your current PD, but that doesn't appear to be the case for you. "I just don't like the program" isn't a great argument for such a risky endeavor, IMO and it's definitely not one the current PD will like. Further, entering as a PGY2 kind of sucks. You're going to have to function at a higher level clinically while also having to learn a whole new system and trying to socially interact with a bunch of coresidents who already know each other.

I completely agree with this.

Despite good stats or whatever, I think OP is much better off playing the card he was dealt and just finishing training where he is.

OP should not discredit how many places something could go wrong with this process. Plus, in this case, “something going wrong” means potentially no spot to finish training. Which is bad. And I agree with the above point that you could end up somewhere where the culture and teaching are even worse.

With regards to “successfully transferring within your specialty” - the only times I’ve heard of this happening are when someone is a) a good resident who is b) transferring to a program of similar or lower quality (usually lower), and who c) has a good reason for wanting to transfer. “I’m a good resident at a good program who wants to transfer to be closer to family” is something that may be looked at favorably. “I matched a crappy program because I thought I had to be in this location, and now I want to switch to a better program that I ranked lower in my list” is likely to get much less traction.

 

[Apollyon]

Looking at your post history, you applied and matched to a Neuro program, came from a "top 30" medical school, had a very competitive S2 score, and good clinical grades.

Yes, you can reapply for spots again. You would contact your medical school and they will get you a new ERAS token, you'll be able to get back your application (i.e. you won't have to type it out all again), edit to update, and reapply.

But it's more complicated than that. You will be better off if you have a letter from your current PD, stating that your performance is fine - so it will be difficult (if not impossible) to hide what you're doing from your current program. You'll be competitive in the neuro match again. Since you'll already have completed a PGY-1, and because in Neuro the PGY-1 is often very IM heavy (some programs still have an IM prelim year), you can also look for Neuro PGY-2 spots that might be open. Some of those will be in the match as R positions (if they fill their program with A positions), some will not (if they fill their program with C positions). Applying in the match and stating in your PS that you'd be interested in exploring a PGY-2 position if it was open is a great way to find a spot.

The biggest danger here is that once you tell your program that you're trying to leave, your experience there may go further downhill. And, they may start to recruit for a new PGY-2 for next year to replace you -- a very reasonable plan on their part. If they find someone before the match actually happens, you may lose your PGY-2 there before you know if you have a spot elsewhere. Given your posted background I think your chances of getting a different spot is quite good, but it can be worrying.

You could also reach out to programs that interviewed you that you ranked below this one, with interest in a PGY-2. They met you and reviewed your app already, and perhaps one of them may already have a planned open position.

If I could give you a dollar for every time you have good, solid advice, you would be, not peds, but IM rich!!

 

[NotAProgDirector]

Who do I contact at my school for it? I know it sounds dumb but do I reach out to a dean, or?

I’m scared to tell my PD for that reason. I’m miserable and want to leave but job > no job, and if I don’t match and I lose my spot then I’m screwed. And I’m scared that if I don’t match but keep the spot I’ll always be the “problem resident.” Ugh, just ranting

Should you decide to pursue this, you would contact the Dean of Students office and they would get you the token. You won't need to speak to an actual Dean - just someone in the office.

Should you proceed, better to frame it as "my interest in research doesn't match the resources of my program" rather than "the teaching sucks".

Impossible for us to know how your PD will respond. Your PD probably has zero interest in research, so explaining that this is something you are looking for might make them support you. Or they might just be an all around nice person. Or not. You're probably in the best position to assess that.