Malakai

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I hate to bring up the sore subject of scrambling so early, but a few things have come up on the interview trail that have me thinking about doing it. I interviewed at only two advanced programs. Everything else is categorical. At each of the advanced programs I interviewed for either transitional or preliminary medicine years as a PGY1. I am VERY confident in my ability to match into the proper PGY1 year depending on which advanced program I might match to which is why I didn't apply to additional PGY1 programs.

However...

At least one of the categorical programs in my top 5 is offering advanced positions as well. I'm seriously considering ranking these advanced positions in order to increase my chances of matching at one of my top anesthesia programs even if I can't do my PGY1 year with them. However, I'm left with only two programs in the supplimental list and I don't really want to do either of them unless it's with the corresponding anesthesia program in that city. Do you think I would be hanging myself if I didn't rank PGY1 programs for these other advanced programs? What is the fate of people scrambling into PGY1 years? The safe choice is to rank the two prelim interviews I did even though I would rather not do them (they are a means to an end, since I like the advanced programs they are associated with). Am I just talkin' stupid??
 

sublimazerules

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You might want to check out how the PGY1 programs in the area did last year. If there were a lot of unfilled spots, you might consider taking the chance and not ranking any PGY1 years for that advanced Anesthesia position. Mind you, transitional years are almost impossible to come by after the match, and prelim medicine can be difficult to scramble into as well. You might end up with prelim surgery (yuck). You need to weigh the risk of not finding a program to scramble into if you match for an advanced position with the inconvenience of doing your internship at a "third city". I personally applied to a number of prelim/transitional years in my home city, even though I am not planning on staying at my home prgram for this very reason. (I REALLY don't want to do a year of gen. surgery!)
I also know some people in your same position who are simply ranking the advanced positions much lower than the categorical ones. That is they'd rather end up at their 4th or 5th choice for 4 years than at their 3rd choice for only 3 and then have to scramble.
 

Swaydaa

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Someone I knew last year took that gamble and had to do a preliminary surgery year in a Different State!!! He was/is still pissed about his mistake.
 

hoyden

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Hmmm, what's so bad with prelim surgery? At programs I've interviewed they have night float system and, since you are only prelim, do not torture you too much. And it's always good to try to be on the other side of the table. Especially, when the head side you already know. A little :D
On the other hand, I would die from the boredom in IM...
 

VentdependenT

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hoyden said:
Hmmm, what's so bad with prelim surgery? At programs I've interviewed they have night float system and, since you are only prelim, do not torture you too much. And it's always good to try to be on the other side of the table. Especially, when the head side you already know. A little :D
On the other hand, I would die from the boredom in IM...
Go for a TY! Prelim surg is fine if you really enjoy surgery or if you truely couldn't stand doing prelim IM. No matter what you are still a friggen intern.
 

rhinosp_33

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regarding scrambling for prelim positions.....

can someone explain what the process is like? lets say i want to scramble for prelim surg.... would i need a letter of recommendation from a surgeon ready to fax to the progs? or do they just require a CV plus transcripts...

thanks
 
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Malakai

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gasman2005 said:
A prelim year is just that - a single year. Sure, some are easier than others, but it's still just one year! There are going to be a number of programs on my rank list in areas where I didn't interview prelim positions (mainly because I didn't have the time or $$$$ to go on any more interviews). Plus, in the end I decided that I'd rather do a prelim surgery year than a year of prelim medicine (I didn't apply to prelim medicine on ERAS)

I would not alter your rank list (i.e. drop one of favorite advanced programs down on your list, and put it below a categorical position at which you would be less happy/less well trained).

If I end up at a program where I didn't interview for a prelim, I'll just scramble. It's not that big of a risk at all (despite what others may tell you). Yes, you may have to end up doing a prelim surgery year, but there are tons of open prelim surgery spots every year - even in the top "desirable" locations (NYC, Boston, California). With the 80 hour workweek, you probably will only average slightly more hours than in a prelim medicine program.

That's my view anyway.
Well, you're either the voice of reason, or you're just as stupid as I am. Either way, we're thinking the same. If I had KNOWN that I would be applying to an advanced position at these programs I certainly would have at least interviewed a prelim or two in the area. However, it wasn't until I got there that I was "updated" on their plans for the match. Now I'm caught with my pants down, but I agree that I would endure nearly anything for the first year in order to end up training in anesthesiology at the program I want. I guess my worst fear is scrambling into a horrible year at a third city since I figure I'll at least find a spot somewhere.

sublimazerules, the prelim surgery programs at these places always have unfilled spots. That makes me both nervous and reassured. But I'm with hoyden on this one...a full year of medicine, no matter what the hours, would drive me mad. I think there's something to be said for doing a prelim surgery year at the same hospital where you will do anesthesiology. At least I get to meet the surgery attendings and make friends with the surgery residents (a few of them, anyway, I'm easy to get along with).
 

cchoukal

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For what it's worth, I've asked a couple PDs which intern year is most useful, and they've all come back and said surgery is the least useful, and medicine overwhelmingly is the most. In addition, and I can only speak for the 2 surgery programs in my hometown, but no one is sticking to the 80 hr work week. Many residents openly admit that they lie on the time sheets. Like I said, I can only speak for my home programs, but I guess I'd be leery of leaving surgery as my only PGY1 option thinking it would only be 80 hrs/week.

I liked the point about doing a PGY1 surgery year in the program you'd be matching in for anesthesia. I think that'd be a nice way to make connections, and it's something I hadn't thought of. Of course, if I understand the system correctly, you'd find out on monday of match week that you matched in an advanced program (you won't know where), but that you didn't match for a PGY1 year, forcing you to scramble for an intern year without knowing where you matched for your advanced years. Am I wrong about this?
 

jtw

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cchoukal said:
I liked the point about doing a PGY1 surgery year in the program you'd be matching in for anesthesia. I think that'd be a nice way to make connections, and it's something I hadn't thought of. Of course, if I understand the system correctly, you'd find out on monday of match week that you matched in an advanced program (you won't know where), but that you didn't match for a PGY1 year, forcing you to scramble for an intern year without knowing where you matched for your advanced years. Am I wrong about this?

I think that if you match advanced but not PGY1, then the NRMP will tell you early what city you matched in, but not necessarily which specific program, so that you can at least try to look for a spot in the same location. This is what I have heard.
 

Zeffer

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jtw said:
I think that if you match advanced but not PGY1, then the NRMP will tell you early what city you matched in, but not necessarily which specific program, so that you can at least try to look for a spot in the same location. This is what I have heard.
I've heard something very similar to this only rather than being NRMP dependant I have heard it is school dependent. Anyone know for certain?