Scramble vs Reapply (from another surgical subspecialty)

[Lese]

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My situation is complicated. I'm an MS4 who applied to urology and did not match. I knew in October that there was a possibility that I would not match, as I did not get enough interviews to feel comfortable. I didn't get enough interviews due to the fact that one of my LOR came in quite late, and this negatively impacted the number of interviews I did get (this was confirmed by several programs who I corresponded with). In late October, I had a come to Jesus moment about my chances and reached out to my urology PD, school advisor, etc, and applied to a bunch of surgical prelims on the side with the thinking that if I didn't match, I would be able to avoid SOAP and have some time to recoup and decide if I would rather reapply to another specialty (anes, rads) or back to urology.

In late Jan, I found out I didn't match, with mixed feelings. While I would have been thrilled to match, during the last few months, I've also had a lot of time to come around to the idea that I could be happy in other fields. I also decided I did NOT want to reapply to urology, because as much as I love it, frankly the last few months have been an emotional nightmare and the reapply success rate is ~15%. I've spent a lot of time researching anes vs rads and I really think rads would also be a great field for me--I like having a broad base of knowledge, how heavily visual the field is (in my spare time, I'm a freelance graphic designer), and the procedures in IR. I also always preferred the shorter pediatric cases and percs to 10 hour neobladder surgeries anyway, and you can't argue with the lifestyle.

My stats are 235 Step 1, Step 2 score not yet back, grades/clinicals mostly HP, a current urological research project with lots of rads overtones (half my data is FNA, core biopsies, etc).

Here is my current thinking as far as getting into rads:

1 - SOAP into an advanced position
I'm pretty sure I will match into one of my prelims, and after lots of research/confirming with NBME it appears that despite not applying to any categorical positions this year, as long as I rank a categorical program (ANY categorical program) I will be considered "partially matched" by the system, and thus eligible for SOAP. I absolutely plan on doing this. I understand that it's usually the less desirable programs that end up in SOAP (I looked at all the vacancies in the last few years and then looked up those programs individually), and I have a preference for matching in the NE due to SO (am not from NE), so right now I'd be happy to reapply as well, but depending on what advice I get I may reconsider.

What should I be doing other than updating my CV? Do I need other LOR, or should I use the urological ones that I already have (one in particular very strong, from a Harvard program)? Should I rewrite my PS to reflect a more radiological POV?

2 - Apply to a clinical/DIRECT pathway program
I just wanted to throw this out there for those of you who might suggest it. Did a ton of research/outreach, basically almost none of those programs are still functioning/open due to upcoming changes to IR residency. Well, I tried.

3 - Reapply in the next cycle
If I don't SOAP, I have a free month in May wherein I plan on picking up a radiology rotation/special project. I also ended up applying to only "non-malignant" surgical prelims, and feel confident in stating that if I reapply next year I would be supported by whichever PD I have, with adequate time off to interview, etc. PDs I've talked to have also been willing to help get elective rotations in early should I want to go into XYZ field and need letters.

Is there bias against applicants who are not MS4s? How many programs should I reapply to in order to get a good amount of interviews?

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I'd also like to add here that I did meet up with my radiology PD recently, and they were not particularly helpful, although I can't fault them, because they've never had a situation like me before. They did bring up the funding issue (I can only get 5 years of residency funded), so if for some reason I don't scramble and end up reapplying, I'd probably have to take off a year to do research after my intern year, or find a program that could get more funding.

Bottom line, I'm looking for any helpful advice on what people think is my best option going forward (is scramble way better than reapplying?), any other anticipatory guidance, and any personal experience. My apologies if I come off at all as "oh OP is just picking rads as a hasty backup," I promise I've thought long and hard about this!

 

[shark2000]

The bigger question is to make sure that your interest in radiology is something real rather than result of a short emotional pressure. I can understand the emotional stress of not getting matched.

It may not seem helpful to you, but I feel obliged to tell you this. The first thing that I have a lot of doubt about is your interest in radiology. Honestly, I can not believe that someone can be interested in Urology and radiology at the same time. The first day that I did my urology rotation, I was sure that I will not be able to do it. There is nothing, nothing common between these two fields. Urology is a heavily surgical field with minimal diagnostic workup and relatively narrow knowledge and radiology is the exact opposite.
The reasons that you mentioned for liking radiology are the exact things that do not exist in urology.

Anyway, I just want to make sure that you won't be miserable the rest of your life regretting your choice now. Just imaging it is a Sunday 10 PM. Do you prefer to have 30 CTs left on the list to read from head to toe or do you want want to plan your tomorrow's 2 OR cases? Don't get me wrong. None is better or worse than the other. It depends on your interests. You can not convince me that Urology is even half as good as radiology, but this is a personal opinion.

Now if you want to go for radiology I recommend you to find an unfilled spot during scramble or even during your internship. However, at the same time also apply during your internship. To my best knowledge, at this point you don't have any funding issues since it starts with your advanced program and prelim doesn't count.

If your internship has a radiology department, try to work with them or do a project with them. It can be very helpful.

 

[Dumpstarrian]

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[jwal]

Hey Lese,

This happened to me last year and it is really tough. I applied into urology, did not match and started to look into radiology. About half way through the summer I was set on radiology and a uro program I interviewed called me up saying someone was not going to show up to their position and they wanted to give it to me. It was a tough choice, but by that time I knew radiology was a much better fit for me. I think the exposure to radiology may be so limited for some students; it's very possible it could be a good fit for you, so don't be offended when people say it has nothing in common with Uro, I think there are many similarities, as you mentioned, particularly in IR.

One of my friends did not match Uro this year, so I recently went through this experience with them as well. You are not alone! It is going to be a rough time, but you have lots of options and it sounds like you're getting a feel for it. I think one of the worst for me was going through match day with my friends and seeing how happy they were and feeling cheated and robbed because I felt like I had done everything right and it just didn't work out.

My school has an awesome 1-yr MPH program and a ton of med students do it, so for me this was a great opportunity to stay in school another year and consider my options in reapplying. You might consider this option too. This may not be possible financially for some (my school is public and very affordable). If you are dead set on getting into residency the SOAP is the best option, it might suit you better than reapplying during your prelim year if you can go ahead and get a categorical spot. Like you said, reapplying in Uro is an extreme long shot and I think you'd have a better getting a surgery prelim and going into another specialty and transferring if you must be in Uro.

If you want to SOAP I would try to get a letter from someone in that specialty, or at least get an updated letter explaining your situation and how you want to proceed in your career. These spots are still competitive and most of them get filled in this process, so nothing is guaranteed and you need to be ready to compete against other ortho, plastics, rad-onc, derm studs that didn't match. You have to convince programs that you really want to be their resident, which is probably going to be hard.

I wish you the best, I know personally how hard this is and it's so frustrating that no one seems to know how to help and it's very confusing. Hang in there and keep your options open, you will find something you love, it will just take time.

 

[DermViser]

The bigger question is to make sure that your interest in radiology is something real rather than result of a short emotional pressure. I can understand the emotional stress of not getting matched.

It may not seem helpful to you, but I feel obliged to tell you this. The first thing that I have a lot of doubt about is your interest in radiology. Honestly, I can not believe that someone can be interested in Urology and radiology at the same time. The first day that I did my urology rotation, I was sure that I will not be able to do it. There is nothing, nothing common between these two fields. Urology is a heavily surgical field with minimal diagnostic workup and relatively narrow knowledge and radiology is the exact opposite. The reasons that you mentioned for liking radiology are the exact things that do not exist in urology.

Anyway, I just want to make sure that you won't be miserable the rest of your life regretting your choice now. Just imaging it is a Sunday 10 PM. Do you prefer to have 30 CTs left on the list to read from head to toe or do you want want to plan your tomorrow's 2 OR cases? Don't get me wrong. None is better or worse than the other. It depends on your interests. You can not convince me that Urology is even half as good as radiology, but this is a personal opinion.

Now if you want to go for radiology I recommend you to find an unfilled spot during scramble or even during your internship. However, at the same time also apply during your internship. To my best knowledge, at this point you don't have any funding issues since it starts with your advanced program and prelim doesn't count.

If your internship has a radiology department, try to work with them or do a project with them. It can be very helpful.

There are TONS of former neurosurgery and orthopedic residents who enter those residencies and then transfer into Radiology all the time.

 

[shark2000]

There are TONS of former neurosurgery and orthopedic residents who enter those residencies and then transfer into Radiology all the time.

I just wanted to make sure that he is interested in this field. I deeply believe that radiologists are one of the happiest and most satisfied physicians (probably along with Dermatologists). However it is not the rule for everyone. I have many colleagues, most of them are happy in radiology. But one of my colleagues is clearly miserable in this profession. Sitting behind a screen and reading 100 studies is not for everyone. The same for OR or clinic or every other profession.