Swapping residencies

[radswap2015]

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Hi,

Just wanted to hear about swapping residencies from someone who has done this before. What exactly are the steps? Does it usually work? How do each of the 2 programs usually react?

Thanks.

 

[radswap2015]

bump

 

[NotAProgDirector]

It is not uncommon to see this question this time of year. I interviewed and picked the people I wanted in my program. If one of them came to me and said they had arranged a swap, I'd be pretty angry. Who says I'm interested in this other person? Have you vetted their training and background? Have you interviewed them? Will you be responsible if they do not perform up to standard?

On a practical basis, it's a match violation to consider other positions if you've matched without first applying for a waiver. Which means you would give up your current spot without a guarantee of a new spot.

 

[Promethean]

There are websites like residentswap.org that advertise positions that came open due to some unfortunate circumstance, or where residents who are truly miserable can seek to find greener grass in each other's fields.

Many of the open positions are gone by the time they are listed, having been filled through back channels by unmatched folks who already had their CVs on file with those PDs, in desperate proactive hope for a seat, anywhere.

If you have a seat, you are incredibly fortunate. You have no idea how cold it is outside those walls. Try to be grateful. Make the best of the fate you had a hand in creating for yourself, conduct yourself with industry and integrity this year, and consider seeking a Match better suited to your dreams next season.

EDIT: I see you wanted to hear from someone who had done it before, and wanted to clarify before any clamor about how as an (accepted) med student, I can't possibly know anything about this process. I do know people, though, including someone quite close to me, who tried for a few years to get back into medicine via off-match and off-cycle positions. I spent many hours helping her research those "opportunities" and send out supplicating letters of interest. I watched her network with other folks in similar positions. She's going to a trade school now.

 

[radswap2015]

It is not uncommon to see this question this time of year. I interviewed and picked the people I wanted in my program. If one of them came to me and said they had arranged a swap, I'd be pretty angry. Who says I'm interested in this other person? Have you vetted their training and background? Have you interviewed them? Will you be responsible if they do not perform up to standard?

On a practical basis, it's a match violation to consider other positions if you've matched without first applying for a waiver. Which means you would give up your current spot without a guarantee of a new spot.

Thank you for your insight. It makes sense what you are saying about swapping. What are your thoughts on switching residencies if there is a vacancy at another hospital system? How about dropping out of the program and reapplying to the same speciality next season to get a better program and/or location?

 

[radswap2015]

What makes you think you will be able to secure a better program the following year?

Nothing at all. I am simply asking a question and trying to obtain other's opinions.

 

[Doctor Bob]

How about dropping out of the program and reapplying to the same speciality next season to get a better program and/or location?

When we look at re-applicants, what we look most closely at is "what did you do between this cycle and the last one to improve your application".
You would have added a red flag (dropping out of a program without a real good reason) and lost a year of clinical experience.

So to me, that means your application got worse from the first time to the second time (there's very little that would offset that red flag of dropping out... I mean, what's to stop you from dropping out of my program for whatever reason). Your application would go in the trash.

 

[NotAProgDirector]

From a legal/process standpoint, there's no problem with resigning your spot and reapplying for a new position in the same field.

From a practical standpoint, it's a very risky option. You could try to get a new PGY1 (or PGY2 for advanced specialties, like radiology) position via the match. This creates a potential funding problem for you, and as mentioned above it's not clear that your application would be any better the second time around. You could try to switch programs at the same PGY level -- i.e. complete a PGY-2 at one program, and then move into a PGY-3 at another. This is always a possibility, involves having a supportive PD since your switch then leaves your first program with an opening.

Bottom line is you could end up losing your current position and not getting a new one. You need to decide whether your current situation is bad enough that it is worth the risk.

 

[bachelorpad]

From a legal/process standpoint, there's no problem with resigning your spot and reapplying for a new position in the same field.

From a practical standpoint, it's a very risky option. You could try to get a new PGY1 (or PGY2 for advanced specialties, like radiology) position via the match. This creates a potential funding problem for you, and as mentioned above it's not clear that your application would be any better the second time around. You could try to switch programs at the same PGY level -- i.e. complete a PGY-2 at one program, and then move into a PGY-3 at another. This is always a possibility, involves having a supportive PD since your switch then leaves your first program with an opening.

Bottom line is you could end up losing your current position and not getting a new one. You need to decide whether your current situation is bad enough that it is worth the risk.

First, I'd like to say I really appreciate your perspective. I have been going through a lot of depression and soul searching - 3 months into my advanced specialty and really not happy with it. I did a prelim year in medicine and loved it - and really want to continue with medicine. Does that make me a red flag - knowing that I want medicine and don't want to pursue the advanced field I am in? I want to go to my program director where I did my prelim year and just discuss my options, no match violation stuff, but can he or she tell me that they would definitely consider me highly? It is just so risky for me to black list myself from my current program directors without a solid plan in place or at least a hope or glimmer of light ...

 

[gutonc]

First, I'd like to say I really appreciate your perspective. I have been going through a lot of depression and soul searching - 3 months into my advanced specialty and really not happy with it. I did a prelim year in medicine and loved it - and really want to continue with medicine. Does that make me a red flag - knowing that I want medicine and don't want to pursue the advanced field I am in? I want to go to my program director where I did my prelim year and just discuss my options, no match violation stuff, but can he or she tell me that they would definitely consider me highly? It is just so risky for me to black list myself from my current program directors without a solid plan in place or at least a hope or glimmer of light ...

Go to your prelim PD and tell him/her that you changed your mind and want to do IM. That's your best hope. Best case scenario, s/he has a spot (or the flexibility to make one for you) and you're in, either this year or next. 2nd best, s/he wants you back and holds out a spot for you (i.e. they have 30 R1 spots but only put 29 in the Match). Worst case, s/he writes you a glowing LOR that you can use for a new app cycle. (All of this assumes that s/he liked you and thought you did well as a prelim.)

Of all the "switching specialty" issues, this one (IM Prelim-->Advanced but realized IM was a better match) is the most common and least fraught with future problems. You're unlikely to burn any bridges and since this is October, you're outside Match violation territory.

 

[bachelorpad]

Go to your prelim PD and tell him/her that you changed your mind and want to do IM. That's your best hope. Best case scenario, s/he has a spot (or the flexibility to make one for you) and you're in, either this year or next. 2nd best, s/he wants you back and holds out a spot for you (i.e. they have 30 R1 spots but only put 29 in the Match). Worst case, s/he writes you a glowing LOR that you can use for a new app cycle. (All of this assumes that s/he liked you and thought you did well as a prelim.)

Of all the "switching specialty" issues, this one (IM Prelim-->Advanced but realized IM was a better match) is the most common and least fraught with future problems. You're unlikely to burn any bridges and since this is October, you're outside Match violation territory.

Thank you for replying, this gives me hope! 🙂

 

[Raryn]

Go to your prelim PD and tell him/her that you changed your mind and want to do IM. That's your best hope. Best case scenario, s/he has a spot (or the flexibility to make one for you) and you're in, either this year or next. 2nd best, s/he wants you back and holds out a spot for you (i.e. they have 30 R1 spots but only put 29 in the Match). Worst case, s/he writes you a glowing LOR that you can use for a new app cycle. (All of this assumes that s/he liked you and thought you did well as a prelim.)

Of all the "switching specialty" issues, this one (IM Prelim-->Advanced but realized IM was a better match) is the most common and least fraught with future problems. You're unlikely to burn any bridges and since this is October, you're outside Match violation territory.

This advice is absolutely spot on. I know several people who did IM prelims at my institution and came back and are doing the remainder of an IM residency after disliking their advanced program.

That said, the "put only 29 spots in the match" is actually no longer possible. Programs are required by the NRMP for the last 3-4 years to put all spots in the match, assuming they start anytime close to in July. What that means is if the OP goes off cycle and restarts as a PGY1 in January or (I'm fairly certain for IM) as a PGY2 anytime he can go outside the match... but if he restarts as a PGY1 in July, it will be required to go through the match for formalities sake. Not generally a problem unless the PD is out to screw you.

 

[Law2Doc]

... but if he restarts as a PGY1 in July, it will be required to go through the match for formalities sake. Not generally a problem unless the PD is out to screw you.

It wouldn't necesarilly be about him wanting to screw you. But what if he interviews some people he doubts will come but they are too good not to put at the top of his list above you? What if he can't justify to his committee putting you at the top of the list and instead puts you somewhere on the list that he's guessing ought to match? Or what if you get interviews you like better. Deals can fall apart in the match process because everyone has to do what's best for them.

 

[bachelorpad]

That's nerve wracking, and I guess he cannot give me any affirmation that he would for sure 100% take me, because that would be unethical, according the match rules. So this scares me a little, especially being on a J1 visa and not really able to risk being out of job...

 

[NotAProgDirector]

That's nerve wracking, and I guess he cannot give me any affirmation that he would for sure 100% take me, because that would be unethical, according the match rules. So this scares me a little, especially being on a J1 visa and not really able to risk being out of job...

It's not a match violation to tell you that I'm ranking you at the top of my list, so that you're guaranteed to get a spot. It's not a match violation to tell me that you're ranking me #1. It is a match violation if I "I'll rank you #1 if you rank me #1". It's also not a match violation for you to tell me that you're ranking me #1, and then rank me something else.

 

[bachelorpad]

okay, but isn't it considered unethical - for me to talk to the prelim PD, ask for a guarantee spot - then go back to my program PD and tell them my plans for resigning at the end of the year? I know that it is considered as "sleazy" to do that - but my program PD does not appear to be supportive to criticism of even the most minute details of the program, I am really fearing having to tell the PD first before going and securing a spot ...because if I don't have a spot with the prelim program, I will most likely stay with this program and learn to love it...because my significant other is here as well.

 

[gutonc]

okay, but isn't it considered unethical - for me to talk to the prelim PD, ask for a guarantee spot - then go back to my program PD and tell them my plans for resigning at the end of the year? I know that it is considered as "sleazy" to do that - but my program PD does not appear to be supportive to criticism of even the most minute details of the program, I am really fearing having to tell the PD first before going and securing a spot ...because if I don't have a spot with the prelim program, I will most likely stay with this program and learn to love it...because my significant other is here as well.

How is that in any way unethical? You're being honest with all involved parties. That's the dictionary definition of ethical.

I would argue that the opposite (putting on your game face and lying to your current PD while secretly plotting his death and the demise of your advanced specialty) is the unethical thing. The timing is of course an issue but what can you do about that? (Rhetorical question...the answer is "nothing".) Go to your prelim PD yesterday (last week would have been better but my time machine is broken) and start the discussion. That will give you some idea of how things will go for you.

Once you've been an adult about all this, come back and tell us how it went.

 

[bachelorpad]

lol, I guess I deserve the tough love.

 

[bachelorpad]

The only reason I asked that question, is that a resident colleague of mine switched residencies - she confirmed a spot with another position in another state before telling her PD that she was going; she of course sat down and had the discussion that she was leaving but with an already secured position .... and he mentioned that "this was a match violation and unethical in NRMP guidelines" - so that being said, I am a little weary of not stepping on toes.

 

[Raryn]

The only reason I asked that question, is that a resident colleague of mine switched residencies - she confirmed a spot with another position in another state before telling her PD that she was going; she of course sat down and had the discussion that she was leaving but with an already secured position .... and he mentioned that "this was a match violation and unethical in NRMP guidelines" - so that being said, I am a little weary of not stepping on toes.

The only violation to the match is if you leave within 45 days of starting work. After ~August 15, from the NRMP side of things, you have no obligation to your current program.

Now, your contract may say otherwise, but that's a completely separate issue.

 

[Law2Doc]

...

Now, your contract may say otherwise, but that's a completely separate issue.

This is potentially the "unethical" part. You are under contract for the year. You probably can only quit contractually after giving notice in a specific way and after a certain defined period. So saying "I've already accepted another job -- See ya." is sure to upset people.

Additionally it might be regarded by your PD as not so kosher for other specialties' PDs to "poach" residents from his program. I know a guy who was outright poached from one program to another specialty's program in the same hospital and it essentially started a huge interdepartmental war.