Step 1: Do some soul searching and make absolutely sure that you do not want to become a surgeon. If so, then you need to find the right field as an alternative. Are you sure that anesthesiology is the right choice? Did you explore any other specialties as a medical student that you enjoyed? With your credentials, you would be competitive for a wide variety of fields. Radiation oncology, radiology, dermatology...there's a lot of great specialty choices out there. The key right now is to make a smart, informed decision about your switch. Also, don't forget about some of the subspecialties in internal medicine that are very procedurally oriented. Have you shadowed an interventional cardiologist or EP doc? The latter is fairly surgical in nature with frequent implantation of AICDs & pacemakers. What about a GI doc with advanced endoscopy training? Tons of cool procedures. Check out all of the structural stuff that cardiologists are doing these days (percutaneous valve replacements, PFO repairs, etc.). It's pretty amazing. If you have a surgical inclination, a procedural subspecialty of internal medicine may be a solid choice for you. High income, high demand, reasonable workload, and virtually no midlevel encroachment issues in GI and cards.
Step 2: If you're sure you want to become an anesthesiologist, contact the program director for the anesthesiology residency where you went to medical school. I assume you rotated on anesthesia as a medical student and so they already know you. Tell them your situation. Be honest. Don't worry about them contacting your current program. They will keep things confidential. This is a great way to explore your options. Undoubtedly the program director will know of open PGY-2 positions around the country and get you in touch with the appropriate people.
Step 3: Once you have some promising leads established (i.e., anesthesiology programs that seem genuinely interested in you joining the program as a CA-1), approach your current program director and explain your situation. You have to be careful with this meeting, however. Do NOT give them the impression that you never had any genuine interest in internal medicine. The simplest approach is to say that you were on the fence between anesthesia and internal medicine when you were in medical school. Now that you're an intern, you've realized that you made a mistake in choosing internal medicine. Have some solid reasons for why you wouldn't be happy in internal medicine and feel that anesthesia is a better fit for you professionally. Do NOT bring up your failed match into a surgical subspecialty. Unless your current program director is a complete d-bag, I'm sure he/she will be very supportive in your transition. Most program directors just want people to succeed professionally and understand that people often switch fields. Not a big deal.
Step 4: Interview for CA-1 positions and secure a spot outside the match. Choose wisely. With your credentials you can be picky. Don't settle for a crappy program somewhere. If I were you, I would contact the following programs: University of Michigan, UCSF, Stanford, Hopkins, MGH, Brigham, Duke, Cornell, Columbia, Vanderbilt, WashU, UCLA, and University of Washington. All of these programs are relatively large with excellent reputations nationally. I'm sure you'll find a spot at one of these programs.
Good luck.
