SOAPed - now want to reapply to Gen Surg

[moanforthebone]

Hi all, I am looking for some advice

I originally applied in a subspecialty surgery and unfortunately did not match. I managed to SOAP into a preliminary surgery spot (community program, but a good one) and an advanced position in radiology.

Unfortunately, the advanced position is in an area of the country that is very very far away from both my family and my significant other's. Long story short, after 2 months of dwelling on it, we have both agreed that it is a move that we cannot make work.

I am planning on filing an NRMP waiver for change of specialty and reapplying to the upcoming match in general surgery.

I had some questions:
1) letters of recommendation? i would assume my prelim program director and 2 other surgeons, how about the chair of surgery? the chair of surgery at my new preliminary program is actually a different subspecialty of surgery, I was told by my incoming chiefs that I would not need a letter from him unless I was applying in that subspecialty
2) what are my chances of matching? Top 40 allopathic medical school in Midwest, I have 250+ on both steps, but my clinical grades during third year are poor (all high pass or pass, passed both surgery and IM), class rank is solidly middle of the pack, all my research is in surgical subspecialty and it is in and of itself unsubstantial (chart review, making phone calls, etc - no publications or presentations with my name on it)
3) what things should i be doing to put myself in the best situation possible? I am assuming rock the ABSITE and let my program director know ASAP of my intentions (he is under the impression that I will be going to this advanced position) anything else I should be doing? should I be reaching out to all my classmates going into surgery to keep me in the loop if one of their classmates drops out?
4) how many interviews do i need to be going on to feel relatively assured to match? obviously i will go on as many as possible but i can only assume time is going to be a huge issue for me, and probably the limiting factor in terms of how many interviews I can go on.
5) I am going to assume that beyond just my poor clinical grades, that I have poor interviewing skills. I would say I am too laidback and did really have awesome well thought out well rehearsed answers to common questions. Any online resources to prepare? or should I just write down answers to common questions and talk to myself in a mirror? I probably should have done that this time around but hey, hindsight is 20/20
6) I want to only apply to general surgery but I am terrified of getting an email saying sorry I did not match again. Should I dual apply? The one general surgery faculty I met with said I should be fine, but that's what my subspecialty faculty told me too.
7) what resources are there for being an awesome gen surg intern? I keep seeing Fiser? Board weapon or something? I am looking to kill the ABSITE

I would love to stay at the program that I will be at for preliminary surgery. however, I am not going to hold my breath for that. I am going to be putting in every effort to be absolutely stellar but I am sure many others before me have said the exact same thing and I am sure there are a million ways I can screw it up. also, it would be nice to not have to repeat intern year, but it is something I am willing to do.

Thanks for any response, and sorry for the wall of text.

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[bannie22]

1) Chair, PD, GS x2

2) Good as long as you apply broadly

3) Do well on Absite. APDS. Residentswap.

4) 20

5) No idea

6) Dual sure.

7) Trulearn

 

[moanforthebone]

thank you for the response bannie

in regards to the chair letter, the chair of surgery (this is a community program) is not a general surgeon, he is a different subspecialty (ortho), and i will not be rotating on ortho

is this going to be a problem? like what are gen surg programs going to think when i have a chair letter coming from an orthopedic surgeon?

im not sure if it is possible or even reasonable to ask for a letter from my home institution (unlikely to be able to schedule and he would probably laugh in my face and tell me to quit)

thanks

 

[thedrjojo]

thank you for the response bannie

in regards to the chair letter, the chair of surgery (this is a community program) is not a general surgeon, he is a different subspecialty (ortho), and i will not be rotating on ortho

is this going to be a problem? like what are gen surg programs going to think when i have a chair letter coming from an orthopedic surgeon?

im not sure if it is possible or even reasonable to ask for a letter from my home institution (unlikely to be able to schedule and he would probably laugh in my face and tell me to quit)

thanks

Division chief of general surgery would probably be more appropriate than ortho chair imo.

Why would your current chair laugh in your face and tell you to quit? Would there be merit (they think you don't have a chance and everyone else that has been telling you do is blowing smoke up your ass?) or is he just a dingus? Chair people write letters, it's what they do, and if this chair knows you, is well ish known, etc, they might be a good source, especially coming from an academic center (you said top 40 med school, still trying to figure out what this means or why every what are my chances thread posts this like residency people care how much primary care research a med school does) vs a community residency that, generally speaking, no one will know your surgeons 10 miles away from the hospital

 

[moanforthebone]

Division chief of general surgery would probably be more appropriate than ortho chair imo.

Why would your current chair laugh in your face and tell you to quit? Would there be merit (they think you don't have a chance and everyone else that has been telling you do is blowing smoke up your ass?) or is he just a dingus? Chair people write letters, it's what they do, and if this chair knows you, is well ish known, etc, they might be a good source, especially coming from an academic center (you said top 40 med school, still trying to figure out what this means or why every what are my chances thread posts this like residency people care how much primary care research a med school does) vs a community residency that, generally speaking, no one will know your surgeons 10 miles away from the hospital

my current chair is the type who would say that i dont deserve a spot in general surgery because i should have chosen it during third year instead of aiming for ortho

also, according to an n=1, a faculty member advised me against asking him for a LOR because of the above reasoning (he would probably say "too bad, you shouldve picked gen surg in the first place, you made your own bed now sleep in it")

the reasoning for not asking him (because really, i have nothing to lose if i applied only gen surg) is because i am not confident in applying to only gen surg and thus i will probably dual apply to anesthesia and gen surg, so if i were to ask my chair of surgery for a POSSIBLE LOR, i would essentially be burning my chance of dual applying, and i am not sure if taking that sort of leap of faith is a smart thing to do, considering i have already not matched once

the reason i am not confident in only applying to gen surg is for 2 main reasons
1) passed third year surgery - not high pass or honor, i PASSED it - i am under the impression some programs i will be screened out of simply because of this
2) hurdles in acquiring a chair of surgery letter - the chair of surgery at my new program is an orthopedist and the chair of surgery at my home program is very old school. i am not sure who the division chief is, i would think it is my program director - i am under the impression that i will be screened out of other programs because of not having a chair of surgery letter

i want to point out i dont think my current chair of surgery is a dingus or anything, i actually respect him more than probably anyone else in medicine, he is old school and charismatic, hell he made me seriously consider doing general surgery just from hearing him speak

thanks for your response btw

 

[thedrjojo]

my current chair is the type who would say that i dont deserve a spot in general surgery because i should have chosen it during third year instead of aiming for ortho

also, according to an n=1, a faculty member advised me against asking him for a LOR because of the above reasoning (he would probably say "too bad, you shouldve picked gen surg in the first place, you made your own bed now sleep in it")

the reasoning for not asking him (because really, i have nothing to lose if i applied only gen surg) is because i am not confident in applying to only gen surg and thus i will probably dual apply to anesthesia and gen surg, so if i were to ask my chair of surgery for a POSSIBLE LOR, i would essentially be burning my chance of dual applying, and i am not sure if taking that sort of leap of faith is a smart thing to do, considering i have already not matched once

the reason i am not confident in only applying to gen surg is for 2 main reasons
1) passed third year surgery - not high pass or honor, i PASSED it - i am under the impression some programs i will be screened out of simply because of this
2) hurdles in acquiring a chair of surgery letter - the chair of surgery at my new program is an orthopedist and the chair of surgery at my home program is very old school. i am not sure who the division chief is, i would think it is my program director - i am under the impression that i will be screened out of other programs because of not having a chair of surgery letter

i want to point out i dont think my current chair of surgery is a dingus or anything, i actually respect him more than probably anyone else in medicine, he is old school and charismatic, hell he made me seriously consider doing general surgery just from hearing him speak

thanks for your response btw

I wouldn't just assume your pd is the chief of division of Surgery... Pd is a busy job and usually a middle of career type job, while division chief is also a busy job but more of an end of career job, and often different (more likely a chair of Surgery is division of general surgery chief)... These are generalities (my pd is also division of Surgery chief and in likely his last job before he retires being a pgy37 as he likes to claim), but sounds reasonable and you can always ask your new pd what they think regarding who to get letters from... You being a prelim is going to be a bigger hurdle than a chair letter imo.

Why would you asking your med school chair for a letter burn the anesthesia bridge. You would NOT ask him for an anesthesia letter, just surgery letter

 

[bannie22]

"Unfortunately, the advanced position is in an area of the country that is very very far away from both my family and my significant other's. Long story short, after 2 months of dwelling on it, we have both agreed that it is a move that we cannot make work."

This is the only issue I would be concerned about that might lead to you not matching Gen Surg.
all the best.

 

[moanforthebone]

I wouldn't just assume your pd is the chief of division of Surgery... Pd is a busy job and usually a middle of career type job, while division chief is also a busy job but more of an end of career job, and often different (more likely a chair of Surgery is division of general surgery chief)... These are generalities (my pd is also division of Surgery chief and in likely his last job before he retires being a pgy37 as he likes to claim), but sounds reasonable and you can always ask your new pd what they think regarding who to get letters from... You being a prelim is going to be a bigger hurdle than a chair letter imo.

Why would you asking your med school chair for a letter burn the anesthesia bridge. You would NOT ask him for an anesthesia letter, just surgery letter

I guess it wouldn't hurt to ask for a LOR (more like ask for a possible LOR)

what would hurt is if i interviewed for BOTH anesthesia and surgery at my home institution, because then neither would take me. they dont take kindly to dual applying

hmm i will need to figure out who the division chief of gen surg is, that info is not readily available online

also, elaborating on how being a preliminary is bad, ive always known it was an overall negative, but is it that terrible a negative? like am i chasing a pipe dream right now?

 

[moanforthebone]

"Unfortunately, the advanced position is in an area of the country that is very very far away from both my family and my significant other's. Long story short, after 2 months of dwelling on it, we have both agreed that it is a move that we cannot make work."

This is the only issue I would be concerned about that might lead to you not matching Gen Surg.
all the best.

could you elaborate on this? i would assume you are referring to commitment to gen surg?

i guess where i am coming from is i am not crazy about the advanced position field, nor am i crazy about the area of the country

but i am crazy about the OR, and i have spent many nights having dreams about 20 years in the future wishing i was a surgeon, and then waking up and being relieved its not 20 years in the future. i believe that i SOAPed under duress (school administration pressures you to take anything) and i regret not having the personal integrity to say no.

i think i spent 2 months trying to figure out whether it was my subspecialty that i loved, or just the OR. I have come to the conclusion, perhaps naively, that it is the OR, and i have come to the point where i am willing to accept the possibility of not matching, albeit it scares the hell out of me, and i am leaning towards dual applying in order to mitigate those kinds of outcomes. the fact that i will have deficits in my application (poor surgery grade, no chair letter, being a preliminary) are significant contributing factors.

 

[Prince Wednesday]

Many people match into general surgery without honors in surgery or a chair letter. Is being a prelim really that much of a disadvantage?

 

[thedrjojo]

Many people match into general surgery without honors in surgery or a chair letter. Is being a prelim really that much of a disadvantage?

Yes. Match rate for us allo grads is greater than 90-95%. Match rate for the rest, including reapplicants, is like 50%. Major red flags of why didn't you match the first time.

 

[thedrjojo]

could you elaborate on this? i would assume you are referring to commitment to gen surg?

i guess where i am coming from is i am not crazy about the advanced position field, nor am i crazy about the area of the country

but i am crazy about the OR, and i have spent many nights having dreams about 20 years in the future wishing i was a surgeon, and then waking up and being relieved its not 20 years in the future. i believe that i SOAPed under duress (school administration pressures you to take anything) and i regret not having the personal integrity to say no.

i think i spent 2 months trying to figure out whether it was my subspecialty that i loved, or just the OR. I have come to the conclusion, perhaps naively, that it is the OR, and i have come to the point where i am willing to accept the possibility of not matching, albeit it scares the hell out of me, and i am leaning towards dual applying in order to mitigate those kinds of outcomes. the fact that i will have deficits in my application (poor surgery grade, no chair letter, being a preliminary) are significant contributing factors.

For the gs application, you need to apply to a million places, and will get a few interviews at where ever you get offers. Limiting geography will hurt your chances even more

 

[moanforthebone]

Thanks for the response drjojo

I guess what I was getting at is that I am much more willing to go anywhere in the United States if it means that I will be able to do surgery in the future.

I am much less willing to move for an advanced position that I am not crazy about the specialty and is far away from home

How many programs do you think I should be applying to? Someone told me 80, another told me all of them?!

I also was told that I will essentially not be considered by academic programs due to my being a reapplicant as well as my next year being a prelim at a community program

Thanks for your advice I really appreciate it

 

[bannie22]

Thanks for the response drjojo

I guess what I was getting at is that I am much more willing to go anywhere in the United States if it means that I will be able to do surgery in the future.

I am much less willing to move for an advanced position that I am not crazy about the specialty and is far away from home

How many programs do you think I should be applying to? Someone told me 80, another told me all of them?!

I also was told that I will essentially not be considered by academic programs due to my being a reapplicant as well as my next year being a prelim at a community program

Thanks for your advice I really appreciate it

As many as financially possible

Not true

 

[thedrjojo]

Thanks for the response drjojo

I guess what I was getting at is that I am much more willing to go anywhere in the United States if it means that I will be able to do surgery in the future.

I am much less willing to move for an advanced position that I am not crazy about the specialty and is far away from home

How many programs do you think I should be applying to? Someone told me 80, another told me all of them?!

I also was told that I will essentially not be considered by academic programs due to my being a reapplicant as well as my next year being a prelim at a community program

Thanks for your advice I really appreciate it

I'm at an academic center (not the most prestigious one, but we have a good reputation among programs). We have people in every year that were prelims (granted, most were prelims here, but one of my coadmin chiefs was prelim elsewhere, who just matched plastics, the other guy in my class who matched plastics did a prelim elsewhere. The girl who was a med stud here, then prelim here, then kept as categorical 1 is applying breast. And that's just my class, and this is just my program. Others will run the whole gambit.

 

[moanforthebone]

Why don't you reapply to ortho again as well? What do you lose? Just a thought.

I have definitely considered it. I think that given my situation and not having an ortho rotation during my preliminary, I can only feasibly apply to one type of surgery residency, both in terms of getting LOR and financially. I believe that I have the best chance at matching in general surgery. I believe ortho is much more an uphill battle, and one that I will realistically lose. It really came down to whether it was ortho I couldn't give up or being in the OR. I might be being foolish, but I think it is the OR.

 

[moanforthebone]

I'm at an academic center (not the most prestigious one, but we have a good reputation among programs). We have people in every year that were prelims (granted, most were prelims here, but one of my coadmin chiefs was prelim elsewhere, who just matched plastics, the other guy in my class who matched plastics did a prelim elsewhere. The girl who was a med stud here, then prelim here, then kept as categorical 1 is applying breast. And that's just my class, and this is just my program. Others will run the whole gambit.

That is definitely news that gives me hope, haha

Sorry I am honestly just very nervous given what I need to do this upcoming year, the stakes are high and there are no guarantees

In regards to my being a prelim being the largest hurdle, I absolutely agree. With this in mind, do you think the personal statement is an area where I should be explaining why I didn't match the first time? Or is that something I should leave for the interview? I can definitely see pluses and minuses to both and have heard arguments for both, with most leaning towards explaining the unsuccessful match in the personal statement

Thanks

 

[ProfMD]

The advice given above sounds reasonable. As someone who interviews residency applicants, here are my thoughts:
1) Make sure you are introspective and figure out why you did not match the first time. Make efforts to fix it. You will be asked on interviews why you think you failed to match, and what you have done to fix this.
2) The other red flag I see is the specialty-hopping. Ortho->radiology->general surgery, ?anesthesia. You will be asked about this too. If you are committed to general surgery, great - just make sure you can demonstrate this. Otherwise, interviewers may assume that general surgery is your backup plan to ortho and that you are just looking for a way out of radiology. No one likes being someones backup.

 

[Gastrapathy]

Reconsider this entire process. Do your rads residency and then an IR fellowship. You're gambling with any other plan.