Seeking advice for reapplication to diagnostic radiology after SOAPing into pathology

[Maester_Jon]

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[Redpancreas]

Hi all,

This year I failed to match into diagnostic radiology and ended up accepting a categorical pathology residency during the SOAP. However, after a lot of thought, I realized that I still want to be a radiologist, so I want to reapply to the match during my PGY1 year in pathology. SOAP week was a very difficult time for me, as I felt that I had so little time to make decisions that would affect the rest of my life. I was desperate to have a future career without uncertainty, and at the time I felt that I could see myself doing pathology, so I accepted the offer. I also had an offer for a transitional year, which I now see would have been the better option since I want to reapply for DR. Nevertheless, I am in this position and I want to seek advice and ask what you guys think my chances are for succeeding a second time around.

I'm from a mid/low tier USMD school, 250/250 Steps, AOA, and I had a single radiology publication, a couple unpublished research experiences, and multiple volunteering experiences. I applied to around 60 programs out of 150 or so, and I interviewed at and ranked 15 places (half top tier and half mid-low tier in desirable places). I definitely didn't interview as well as I should have, and my plan now is to devote a lot of time to interview practice. However, maybe COVID and virtual interviews have played a role as well? A handful of my classmates with similar stats and number of interviews also did not match into DR. I don't think I had any red flags on my application.

Right now, my plan is to prepare for reapplication before residency starts by practicing interviews, rewriting personal statements, and updating LoRs. I want to try to keep an open mind about pathology once I start. However, I'm pretty sure I will still be adamant about radiology. Once I start, I want to keep my plans to myself for awhile and work very hard to make a good impression without bias. Soon before ERAs opens on 9/1 is when I think I should inform my program. I'm really worried about this part. Do you think they would be understanding? Assuming that they would be understanding, how difficult would it be to find time for interviews as a path intern?

Also, I understand that GME funding may be an issue, as there would two years unaccounted for if I make the switch. I have read mixed things online though, like during those two years the DR program would receive half of normal GME funding. Also, I have read that matching again would reset my GME funding years. I am really hoping that it's not as much of a problem as it looks it will be, but I want to hear your thoughts. There are so many unknowns about this process that really concern me.

Thanks for any input.

It seems like a lot of people are in this situation.

1.) You're obligated to be at that Path residency for the first 45 days. You forfeited the TY by default as you know, probably would have been a better idea to keep that since you're so set on Rads for reasons you've alluded to.

2.) Something's wrong here. Ruin the chances of a dual 250/AOA/published Rads applicant, a subpar interview experience does not...Unless you are incredibly socially awkward which if anything Zoom would have helped. I highly doubt that was the lone issue. Regardless, set up mock interviews with some people. Not those too close to you, but someone with an outside perspective who cares enough to give it to you straight if there's an issue. Also, contact someone in admissions at your home program to see if they're willing to share if one of your letters was suspect and throw it out and refrain from contacting that letter writer.

3.) GME funding issues are not the biggest obstacle here. Even after the years run out, it's more like you'll be funded at 75%+ . In fact, at some large programs are already over cap funding would be a non-issue.

4.) I'm not too familiar with path residency but if you plan vacation accordingly (November/December) and maximize days off at that time you may find enough time to schedule interviews. It will be tough given you'll be interviewing for TYs and Advanced Radiology programs. You're ultimately going to need some support from your current program director which will have to be one of your new letters and you will need their support to find time to plan out these interviews as most residencies give only 3-4 weeks off +/- a certain number of personal days. I advise you to at least give Pathology your best shot now because 1) you may be fine with it 2) you need to be on good terms with your PD so that you can notify them right around the time you proposed (September-ish) so it at least seems like you gave the residency a fair shot. You would also do well to network if your current radiology program has a path department.

Ultimately in these situations you have to commit. You have a path to a job lined up. If you feel risking it to reapply any radiology program is worth risking that (and potentially losing the ability to fall back on Path again) then do it. This time definitely apply more broadly to Radiology programs. 60 was enough but I some may screen you out or deem you less competitive since you were unmatched at their program last year.

Keep your head up OP. If you manage to make it into a situation where your Path PD is supportive and you reapply for the match, I think there's a good chance you can match Radiology if you are not too picky about a location.

 

[Spikebd]

Hi all,

This year I failed to match into diagnostic radiology and ended up accepting a categorical pathology residency during the SOAP. However, after a lot of thought, I realized that I still want to be a radiologist, so I want to reapply to the match during my PGY1 year in pathology. SOAP week was a very difficult time for me, as I felt that I had so little time to make decisions that would affect the rest of my life. I was desperate to have a future career without uncertainty, and at the time I felt that I could see myself doing pathology, so I accepted the offer. I also had an offer for a transitional year, which I now see would have been the better option since I want to reapply for DR. Nevertheless, I am in this position and I want to seek advice and ask what you guys think my chances are for succeeding a second time around.

I'm from a mid/low tier USMD school, 250/250 Steps, AOA, and I had a single radiology publication, a couple unpublished research experiences, and multiple volunteering experiences. I applied to around 60 programs out of 150 or so, and I interviewed at and ranked 15 places (half top tier and half mid-low tier in desirable places). I definitely didn't interview as well as I should have, and my plan now is to devote a lot of time to interview practice. However, maybe COVID and virtual interviews have played a role as well? A handful of my classmates with similar stats and number of interviews also did not match into DR. I don't think I had any red flags on my application.

Right now, my plan is to prepare for reapplication before residency starts by practicing interviews, rewriting personal statements, and updating LoRs. I want to try to keep an open mind about pathology once I start. However, I'm pretty sure I will still be adamant about radiology. Once I start, I want to keep my plans to myself for awhile and work very hard to make a good impression without bias. Soon before ERAs opens on 9/1 is when I think I should inform my program. I'm really worried about this part. Do you think they would be understanding? Assuming that they would be understanding, how difficult would it be to find time for interviews as a path intern?

Also, I understand that GME funding may be an issue, as there would two years unaccounted for if I make the switch. I have read mixed things online though, like during those two years the DR program would receive half of normal GME funding. Also, I have read that matching again would reset my GME funding years. I am really hoping that it's not as much of a problem as it looks it will be, but I want to hear your thoughts. There are so many unknowns about this process that really concern me.

Thanks for any input.

1. Be open to path, it’s better than most people think. Perfect blend of clinical medicine and basic science. However, If it’s a bad program you scrambled into, I would understand switching. If it’s a good program, you’ll have plenty of career options and just realize how nice you could have it.

2. Do you think it was your letters of recommendation? If so, try to really make friends with radiology residents or attendings who will vouch for you in a rank list meeting. Those lists can be pretty arbitrary so having an in can easily be the difference between a “meh” and a higher spot on a rank list. If you’re convinced about radiology you have to really reach out to people that you’re interested.

3. Most pathology people would be understanding, but keep it pretty quiet and get your work done in the meantime as you apply. Once you officially decide to switch, I would meet with the PD and tell them your plans. If you are honest most PD’s should understand and try to help you, as long as you do a good job as a PGY1 and are pleasant and professional.

Good luck and sorry this happened, but you’ll be ok.

 

[NotAProgDirector]

You've gotten good advice here.

You mentioned that several classmates with equal credentials did not match. If your school has a bunch of 250/250/AOA people not matching to radiology, that suggests a system problem somewhere. Seems like something is wrong.

A potential big issue not yet discussed is the timing and support from your Path PD. You apply and get some interviews. You won't know if you have a spot until mid March. The question is: will your PD hold your spot for you until then so that, should you not match, you can continue in Path, or will they find and hire a replacement such that if you don't match, you now have nothing? In general, a Path spot is better than an IM spot since it's relatively easy to find an IM PGY-2 (any prelim IM can fill that spot). But this depends on whether you like Path at all -- if you decide you just don't like it, you might drop the spot anyway and try to match Rads with some other backup plan in the match.

Getting enough time to interview can be a problem, will be much easier if virtual recruiting continues.

Agree that getting a spot at your same institution is always a good idea.

And this will teach the Path program to seriously consider picking someone who was actually interested. They saw your great scores and performance and thought they had won the lottery. Will be a lesson for them.

 

[NotAProgDirector]

The systemic issue I'm hinting at is something that is school specific. I have no idea what it might be.

They might hold the spot for you -- but understand that you're putting them in a very tough position. If they hold the spot for you and you match into a new program, it's mid March and now they are 3 months away from having an open position. Trying to fill it at that point might be impossible. Hence why they might try to fill it sooner than that.

But I don't know how pathology programs fill open PGY-2 positions. I don't know if they can just take someone who completed a prelim PGY-1 and put them into a path PGY-2.

 

[Lawpy]

I'm really lost a 250/AOA went unmatched in rads and had to SOAP. Something went seriously wrong somewhere and i don't think it's just because of interviews.

 

[ACSurgeon]

I think they would have to find a path pgy1 who wants to switch programs for their pgy2.

Sometimes programs are able to get an exception from ACGME to expand the following class to make up for the lost resident. So, they’d be down a PGY-2 and up a PGY-1 and at least have enough bodies.

 

[Lem0nz]

Maybe I'm just being naive, and I freely admit I know nothing of path or rads as far as residency. Like at all.

But since these aren't forward facing residencies seeing patients - if you're a person down does it really affect the work flows that much? Don't all of the reads for both path and rads have to be re-read by an attending anyway (and in path, the specimens are often processed by non-MD staff too boot). Can't they run a person down and really have minimal negative impacts? Genuinely interested in the answer to this if there's a path and/or rads resident lurking.

 

[Jillofalltrades]

Maybe I'm just being naive, and I freely admit I know nothing of path or rads as far as residency. Like at all.

But since these aren't forward facing residencies seeing patients - if you're a person down does it really affect the work flows that much? Don't all of the reads for both path and rads have to be re-read by an attending anyway (and in path, the specimens are often processed by non-MD staff too boot). Can't they run a person down and really have minimal negative impacts? Genuinely interested in the answer to this if there's a path and/or rads resident lurking.

Not yet a path resident but I will chime in with what I know. It is very program-dependent - some path programs can actually say they are resident-independent, where there is enough support staff to deal with the specimen and the health system is large where attendings can sign out their own cases. For others, it is the opposite where residents are just cheap labor - malignant programs are often "grossing mills" where the resident is responsible for grossing 10/12+ hrs a day and their education is often neglected. Everywhere in between, it'll be a spectrum of resident-dependency to run the services. Since this program had to SOAP, I'm going to guess that we may be more on the "undesirable" side of things. I hope the PD will be supportive of OP's wishes but if we are truly dealing with a malignant program here, I don't know what the response might be.

On any given day, residents can be grossing, previewing, writing up all the reports so the attendings can just sign-off, signing out with attendings, working the blood bank or chemistry lab calls, resolving coagulation questions, doing autopsies, running the apheresis service (seeing patients, ordering products, etc). There is unfortunately a breadth of responsibilities, depending on what rotation one is on, where there may or may not be a lot of flexibility in redistributing the workload. This will especially be compounded at smaller programs where there may already be not enough bodies to do the work.

 

[Lem0nz]

Running the apheresis service (seeing patients, ordering products, etc).

Oh, I didn't even know this was a path thing. I thought this was some weird combo of neuro/nephrology. That's kind of neat.