Mar 20, 2010
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Need some advice on this issue...

So I matched into med/peds at a program that I'm not too thrilled with. I ranked it since I thought it would be better than not matching, but now I'm not too sure.

In thinking about this, another bigger issue has come up. Now, I believe I made a mistake going the med/peds route for my career plans and believe that I should have gone into one of the categorical fields. I want to go into a subspecialty in one of the fields and think that I should have just applied categorical instead of med/peds.

Ideally, I would somehow take next year off and do research and then apply to the categorical program next year.

However, I'm matched at the program. If I'm forced to go to the program so I don't violate the match, I could see myself satisfying my one year contract and then leaving the program to apply to categorical.

Here's my plan...
I think I should apply to get an NRMP waiver to get out of the match. I don't know if I will get it, but it makes sense to grant it for all parties involved.
Benefits for the program - If I got out, instead of losing a resident after PGY1 med/peds year and likely not having a resident for the PGY 2-4 years, they could get someone who didn't match who will stay there for the entire residency (from the huge number of med/peds applicants who did not match since this was a very competitive year for med/peds). This would be much better for the program than having a person leave after 1 year. They would have plenty of time to do this since it's still many months before residency starts.
Benefts for me as above.

I've done some research on here and there have been posts about how if you show up day 1 and quit, then you're technically not in violation of the match. However, this is not an option for me since it's highly unethical. If I couldn't get out of the match, I would just work the year.

Do you think trying to get a waiver is a good plan? Are there any other options?



What about if I don't get the waiver, but the program and I mutually agree on this? Even if they let me go, it's still a match violation without the NRMP giving a waiver. What if I have a letter from the PD of the program saying that despite not getting a waiver, the program was okay with me not going and how I handled it since they had time to get another resident? I would have the match violation, but I would also have a letter in good standing and acting professionally from the PD of the program. How would this combination affect matching next year?
 

MojoRisin

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I hate to be the bearer of bad news, but you are now part of a binding contract. Good luck talking to the PD and getting out of it. I wish I could say something more encouraging, but when you rank those programs and certified your list you gave them a contract to serve their patients
 

Bitsy

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If you did the first year of med-peds, then transferred to categorical IM or categorical peds, wouldn't you only get credit for 6 months of 1st year (since most programs do alternating 3-month periods of IM and peds)? You would only be "ahead" by 6 months versus just doing med-peds then applying for fellowship. I would worry that your tarnished reputation (not honoring your contract, especially if you went the match violator way) would not be worth the 6 months you would gain. Is the extra year the only reason you decided you don't want to do med-peds now? I don't know about the IM side, but peds is somewhat of a small world especially when applying to peds fellowships. Lots of PDs are in close communication with other PDs and may not want to take a chance on someone that screwed over another program. I would really think this over before giving up a spot that somebody else is going to snatch up very quickly. Good luck with your decision!
 
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I am in a similar position of matching into a program I do not want to attend. I only ranked it at the insistence of my dean. I honestly would have rather reapplied next year. I agree with the waiver process and think it is wise for all parties, since, as you said, it benefits the PROGRAM for not losing anyone!

Good luck.
 

Law2Doc

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I hate to be the bearer of bad news, but you are now part of a binding contract. Good luck talking to the PD and getting out of it. I wish I could say something more encouraging, but when you rank those programs and certified your list you gave them a contract to serve their patients
Agreed. No program wants to start a precedent of letting folks out of contracts willy-nilly. If they do it for you, they need to do it for the next guy. And so on. The whole point of making the match a binding contract is that once you match someone you are done with the employee search. You have someone bound for at least a year. You don't have to resort to the scramble (which is now pretty much over), and take chances on folks that other programs passed on. You got the best employee who also ranked your program, so in effect you got the best person who gave some indication he would be happy there. So no, waivers are going to be pretty rare and do not benefit the program in the least. They neither want the bad precedent of letting people bail, nor do they want to incur the time and expense involved in finding a suitable replacement. They just want a warm body to fill that spot and do the work of an intern for a year.
 
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Agreed. No program wants to start a precedent of letting folks out of contracts willy-nilly. If they do it for you, they need to do it for the next guy. And so on. The whole point of making the match a binding contract is that once you match someone you are done with the employee search. You have someone bound for at least a year. You don't have to resort to the scramble (which is now pretty much over), and take chances on folks that other programs passed on. You got the best employee who also ranked your program, so in effect you got the best person who gave some indication he would be happy there. So no, waivers are going to be pretty rare and do not benefit the program in the least. They neither want the bad precedent of letting people bail, nor do they want to incur the time and expense involved in finding a suitable replacement. They just want a warm body to fill that spot and do the work of an intern for a year.

I don't understand this. How do waivers not benefit the program in the least?

It seems pretty logical to me that if a program had to choose between 1 of the 2 following options...

1. Have me for 1 year internship, then have an open spot for PGY 2-4 which chances are they probably won't be able to fill.

2. Have another person who will stay there for all 4 years.

It would seem logical to me that the better option for programs is without question option 2.

The time and expense of finding people to fill a spot for a PGY 2 med/peds year would undoubtedly be far higher than the time and expense of finding one of the hundreds of other applicants who did not match in med/peds at all this year.



And when it came to me, a waiver would get me out of a match violation.
 

thedrjojo

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I don't understand this. How do waivers not benefit the program in the least?

It seems pretty logical to me that if a program had to choose between 1 of the 2 following options...

1. Have me for 1 year internship, then have an open spot for PGY 2-4 which chances are they probably won't be able to fill.

2. Have another person who will stay there for all 4 years.

It would seem logical to me that the better option for programs is without question option 2.

The time and expense of finding people to fill a spot for a PGY 2 med/peds year would undoubtedly be far higher than the time and expense of finding one of the hundreds of other applicants who did not match in med/peds at all this year.



And when it came to me, a waiver would get me out of a match violation.
You assume that the PGY2 Med/Peds slot would be hard to fill... it might not be as hard as you assume, plus you might find you actually like your spot and want to stay. All those Med/Peds applicants have possibly scrambled into med or peds and wouldn't be available to scramble into the open med/peds spot.
 

aProgDirector

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Also, from your program's point of view, if you hadn't ranked them they would have gotten the next person on their list, and maybe that person would have been much happier. So there is a big ripple effect. If everyopne who was "unhappy" with their match was able to cancel it if they simply changed their mind, the whole process would fall apart.
 
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Also, from your program's point of view, if you hadn't ranked them they would have gotten the next person on their list, and maybe that person would have been much happier. So there is a big ripple effect. If everyopne who was "unhappy" with their match was able to cancel it if they simply changed their mind, the whole process would fall apart.


I'm not sure if you are saying that I have a good argument or a bad one. The first part of your post about how the next person on the program's list would be much happier seems to support my argument, but the second part about the process falling apart obviously doesn't support it.

You're a medicine PD. Take this hypothetical - If you had an applicant who after match wanted to switch to another field, would rather have them...

-try to get out of it immediately so you can get someone else who will stay with you for an entire residency
or
-have this person come to your residency already knowing that they will be coming to you in 3-4 months telling you that they want to apply to the other field during their internship and only want to keep to their 1 year contract, in which case you may not have a resident for this spot for PGY 2 and 3 (and it's likely that a med/peds PGY2 replacement will most likely be less likely than a categorical replacement at PGY2 just given the numbers)



The easiest thing for me to do is just shut up and start the residency and then go to my PD 3-4 months in and say that I have had a change of heart and that my heart is in one of the categorical fields and that this is what I want to do. I would then apply during my internship to this categorical field. Basically, I sacrifice one year.

However, I feel unethical doing this. If I know this will most likely happen already, then it seems ethically wrong to just start residency knowing this will happen. It seems wrong to do this to the program when they can find somebody else to replace me now before the residency even starts.
 
Mar 20, 2010
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I wanted to get people's thoughts on another issue as a hypothetical. This doesn't really apply to me since I'm talking about switching from med/peds to categorical, but it's more of a curiousity.

What if the situation were differenent and I still wanted to do med/peds and just didn't like where I matched and was not happy there?

I've researched on this site that you can't apply in the same specialty after getting a waiver. That's a big no no since you just should have stayed at your old place.

I've heard of plenty of people switching fields after doing 1 year of residency.

However, what if I satisfied my one year contract and applied to med/peds programs again (same field) either during internship or the year after.

Is this allowed to apply again in the same specialty? You wouldn't be applying to the same specialty again after a waiver and you would be satisfying your residency contract. Can this be done?
 

gutonc

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I wanted to get people's thoughts on another issue as a hypothetical. This doesn't really apply to me since I'm talking about switching from med/peds to categorical, but it's more of a curiousity.

What if the situation were differenent and I still wanted to do med/peds and just didn't like where I matched and was not happy there?

I've researched on this site that you can't apply in the same specialty after getting a waiver. That's a big no no since you just should have stayed at your old place.

I've heard of plenty of people switching fields after doing 1 year of residency.

However, what if I satisfied my one year contract and applied to med/peds programs again (same field) either during internship or the year after.

Is this allowed to apply again in the same specialty? You wouldn't be applying to the same specialty again after a waiver and you would be satisfying your residency contract. Can this be done?
There are no regulations or rules (that I'm aware of anyway) standing in your way that would prevent you from doing this. What you will run up against is the following question, some variation of which I assure you will be asked at every single interview you get: "So what's with this gap in your training/previous training program?"

If you answer truthfully, "I hated where I matched." You will be politely shown the door and your app will be immediately round-filed. If you lie and get away with it, you'll be a total douche but probably be OK. If you lie and get caught, you'll probably lose your 2nd spot and be essentially SOL for any future residency opportunities.

WRT your particular predicament, what is stopping you from showing up day 1 (or day 300 for that matter) and saying, "Hey, you know what, I realized that IM (Peds) isn't for me and I only want to continue my training in Peds (IM)."? Assuming you've done well so far, the likelihood that you'll be allowed to go on in the single specialty is pretty high as you're probably not the first person to ever come to this realization.
 
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There are no regulations or rules (that I'm aware of anyway) standing in your way that would prevent you from doing this. What you will run up against is the following question, some variation of which I assure you will be asked at every single interview you get: "So what's with this gap in your training/previous training program?"

If you answer truthfully, "I hated where I matched." You will be politely shown the door and your app will be immediately round-filed. If you lie and get away with it, you'll be a total douche but probably be OK. If you lie and get caught, you'll probably lose your 2nd spot and be essentially SOL for any future residency opportunities.
Why would this be so bad? Why will you be shown the door as you say? At your next round of interviews, one could say that they weren't happy at the location and characteristics of the program that were a mismatch with the person. Now you learned your lesson and only are considering places you really have a passion for.
People make mistakes. They shouldn't be able to ever match again because of this?

WRT your particular predicament, what is stopping you from showing up day 1 (or day 300 for that matter) and saying, "Hey, you know what, I realized that IM (Peds) isn't for me and I only want to continue my training in Peds (IM)."? Assuming you've done well so far, the likelihood that you'll be allowed to go on in the single specialty is pretty high as you're probably not the first person to ever come to this realization.
Do you mean staying in the categorical residency in the same place as the med/peds? I really don't want to do this. I want get a categorical spot at a different place.
 

gutonc

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Why would this be so bad? Why will you be shown the door as you say? At your next round of interviews, one could say that they weren't happy at the location and characteristics of the program that were a mismatch with the person. Now you learned your lesson and only are considering places you really have a passion for.
People make mistakes. They shouldn't be able to ever match again because of this?
Let's say I'm a PD at a program interviewing you round two. What's to say that you won't do the same thing to me if you match at my program that you did at the one where you initially matched? Honestly, unless you are a stellar candidate and I'm desperate for decent residents, I'm going to pass you over as too much of a risk to bail if you match to my program too. Also, how will you know that you have a "passion" for my program?

Do you mean staying in the categorical residency in the same place as the med/peds? I really don't want to do this. I want get a categorical spot at a different place.
Yes, this is what I meant. And it's your best chance of getting a cat position.
 

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For matchquestion: If I'm reading between the lines correctly it seems that you basically matched at a place for med-peds that you don't like...but you also don't like it for Med alone or Peds alone...

If you reapply in Med Or Peds then PD's are simply going to ask "why didn't you just stay at your original Med-Peds program and drop the Med or Peds?"

It seems that you are using a changing of heart in Med-Peds as a smokescreen for actually being unhappy with the location/program itself. Of course I'm not trying to seem harsh, but if you are contemplating pulling a switch you should know what it appears like.

I would advise that you give the place a shot, it may suprise you. Worst case scenario if you discover you love Peds or Med then you just drop the other half and finish out in 3.5 years. Anyway, good luck to you. I changed specialties myself and didn't stay at my original program location.
 
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For matchquestion: If I'm reading between the lines correctly it seems that you basically matched at a place for med-peds that you don't like...but you also don't like it for Med alone or Peds alone...

If you reapply in Med Or Peds then PD's are simply going to ask "why didn't you just stay at your original Med-Peds program and drop the Med or Peds?"

It seems that you are using a changing of heart in Med-Peds as a smokescreen for actually being unhappy with the location/program itself. Of course I'm not trying to seem harsh, but if you are contemplating pulling a switch you should know what it appears like.

I would advise that you give the place a shot, it may suprise you. Worst case scenario if you discover you love Peds or Med then you just drop the other half and finish out in 3.5 years. Anyway, good luck to you. I changed specialties myself and didn't stay at my original program location.

Sure, it definitely comes off like that. No question. To be completely open and honest, that's part of it. I would be lying if I said it wasn't. If I imagine myself in the scenario of being happy with my match, I may still have the same mindset of wanting to get out of it and go categorical, but I probably would have just said to myself that I'm happy with my match, I should go and just do the 2 years of the opposite categorical field that I want and just deal with it since it's only 1 extra year on top of a categorical field.

If I really wanted to do med/peds, I would definitely go since it's not a bad program by any means.

In a way, being unhappy with the match has forced me to reevaluate whether med/peds was the correct decision and has made me realize that it wasn't. So it may be a good thing in the end (if I can get a waiver or get out of the match in some way).


I don't want to do the categorical program at this place. Also, I would think it's not as easy as you say to just go into a categorical residency at the same place. They have all of their spots filled. They can't just take another person, not to mention leaving the med/peds interns with one less in their class.



It just feels ethically and morally wrong to do the easier route of going to the residency already knowing on day 1 that I would be going to them after 3-4 months saying that I'm applying all over again in ERAS to the categorical field and that I would only be satisfying my 1 year contract in this particular residency. If I do this now with a waiver, the program can get another person who will be there all 4 years.




Do you guys realistically think I can get a waiver for changing fields? It's by the far the most logical thing that benefits every single entitity involved. I would even say that it benefits the program even more than me! It's far less hardship as the NRMP calls it for all parties involved.

Like I said in my original post, said benefits for me, but moreover the program doesn't have a blank spot for PGY 2-4, which contrary to what a previous poster said, is likely to happen. This is at least according my interview trail, in which programs that lost a resident to categorical where unable to get a replacement for the rest of the residency.
 
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For matchquestion: If I'm reading between the lines correctly it seems that you basically matched at a place for med-peds that you don't like...but you also don't like it for Med alone or Peds alone...

If you reapply in Med Or Peds then PD's are simply going to ask "why didn't you just stay at your original Med-Peds program and drop the Med or Peds?"

It seems that you are using a changing of heart in Med-Peds as a smokescreen for actually being unhappy with the location/program itself. Of course I'm not trying to seem harsh, but if you are contemplating pulling a switch you should know what it appears like.

I would advise that you give the place a shot, it may suprise you. Worst case scenario if you discover you love Peds or Med then you just drop the other half and finish out in 3.5 years. Anyway, good luck to you. I changed specialties myself and didn't stay at my original program location.

I forgot to ask, can you PM how your experience was with changing specialties to a different location? Info such as how you went about doing it, whether you applied to during internship, how interviewing was during internship, support or lack thereof of your program, etc.

Thanks, I would really appreciate it.
 

aProgDirector

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I'm not sure if you are saying that I have a good argument or a bad one. The first part of your post about how the next person on the program's list would be much happier seems to support my argument, but the second part about the process falling apart obviously doesn't support it.
You misunderstood my post. I'm saying you have a bad argument, all around.

What I was saying is this: if you had not ranked this Med/Peds program, someone else would have matched there. They would have matched higher on their match list, so they would have been happier. Dropping out now does them no good -- they are matched somewhere else, so they can't move. And, if you somehow think the NRMP could fix this by simply looking and seeing who the next person would have been to fill your slot and giving it to them, you should see that won't work -- as now whatever that program that person matched at has an open slot, which would mean essentially rerunning the whole match and seeing how many people get switched, which is not reasonable. (And in the end, some program may end up with an opening they didn't expect, and now the scramble is over, etc).

You're a medicine PD. Take this hypothetical - If you had an applicant who after match wanted to switch to another field, would rather have them...

-try to get out of it immediately so you can get someone else who will stay with you for an entire residency
or
-have this person come to your residency already knowing that they will be coming to you in 3-4 months telling you that they want to apply to the other field during their internship and only want to keep to their 1 year contract, in which case you may not have a resident for this spot for PGY 2 and 3 (and it's likely that a med/peds PGY2 replacement will most likely be less likely than a categorical replacement at PGY2 just given the numbers)
I'd rather have them come and work for 1 year. I can always work to find a PGY-2 -- someone like yourself who is unhappy in their program who is looking for a change. At this point the quality of PGY-1 candidates who are not matched is not great, and the chances of me finding an unmatched Med/peds person I would be happy with is small.

Also, there is some chance that you will actually be very happy in Med/Peds and/or at this program. In that case, trying to get out of it would be a big mistake.

The easiest thing for me to do is just shut up and start the residency and then go to my PD 3-4 months in and say that I have had a change of heart and that my heart is in one of the categorical fields and that this is what I want to do. I would then apply during my internship to this categorical field. Basically, I sacrifice one year.
Nope. You should go to your PD in 3-4 months and say you've had a change of heart (assuming that you don't really fall in love with your field/program). Then, instead of applying to the match again, you look for a PGY-2 position in whatever field you're interested in. If you're interested in Cat IM or Peds, you'd need to make up 6 months of PGY-1 work -- maybe less if your internship has electives and you do all of them in your chosen field. You might end up 4-6 months off cycle.

However, I feel unethical doing this. If I know this will most likely happen already, then it seems ethically wrong to just start residency knowing this will happen. It seems wrong to do this to the program when they can find somebody else to replace me now before the residency even starts.
It's not ethically wrong. As I mentioned, you might really like it and want to stay. If not, you finish the year and move on. No harm, no foul.

I wanted to get people's thoughts on another issue as a hypothetical. This doesn't really apply to me since I'm talking about switching from med/peds to categorical, but it's more of a curiousity.

What if the situation were differenent and I still wanted to do med/peds and just didn't like where I matched and was not happy there?

I've researched on this site that you can't apply in the same specialty after getting a waiver. That's a big no no since you just should have stayed at your old place.

I've heard of plenty of people switching fields after doing 1 year of residency.

However, what if I satisfied my one year contract and applied to med/peds programs again (same field) either during internship or the year after.

Is this allowed to apply again in the same specialty? You wouldn't be applying to the same specialty again after a waiver and you would be satisfying your residency contract. Can this be done?
Again, you'd apply for a pGY-2 spot elsewhere. As long as you're doing well, you'd likely find a spot elsewhere (although you might not have you're complete pick of programs, as someone would have to have an opening to take you)

It just feels ethically and morally wrong to do the easier route of going to the residency already knowing on day 1 that I would be going to them after 3-4 months saying that I'm applying all over again in ERAS to the categorical field and that I would only be satisfying my 1 year contract in this particular residency. If I do this now with a waiver, the program can get another person who will be there all 4 years.
As I mentioned above, your Med/peds program is not likely to get another person of the same quality to fill your spot.

This is at least according my interview trail, in which programs that lost a resident to categorical where unable to get a replacement for the rest of the residency.
Although it can be challenging, it is possible to find PGY-2's looking for spots.
 

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It seems to be that the OP is trying to use a logical argument to get his/her way out of a legal one. I'm not going to comment on this argument other than to say that there are a few leaps.

However, the legal question is available on the NRMP website. Because I'm having insomnia, I looked it up and:
1. From the Match Participation Agreement you agreed to when you submitted your application and certified rank order list: http://www.nrmp.org/res_match/policies/map_main.html#apps_waiver

Applicants and programs are not authorized to release each other from their binding match commitment. Once a party has matched, a waiver of the binding match commitment may be obtained only from the NRMP. The NRMP's decision to grant or deny the waiver is at the sole discretion of the NRMP and is not subject to arbitration.
In other words, even if the PD wanted to release you from your legal obligation to commit to the residency program you matched to -- which you agreed to do when you entered the match -- the program is not allowed to do so.

2. The procedures for a match waiver are set forth, again, on the NRMP webpage at http://www.nrmp.org/res_match/policies/waivers.html.

Most relevant is this section:
An applicant or program may request a waiver if he/she/it believes the fulfillment of the commitment to the results of the Matching Program would cause serious and extreme hardship. The burden shall be on the requestor to demonstrate serious and extreme hardship. For purposes of the waiver process, the term serious and extreme hardship means the significant adversity that honoring the match would bear upon the requestor's case.
If matchquestion can somehow prove that matching at a program he or she doesn't like is going to lead to a serious and extreme hardship that would bring significant adversity to the requestor..... well, then, by all means, go for it.

Any advice that recommends that you "listen to your heart" or the like, or gives anecdotal evidence of a single unnamed, unknown person who managed to achieve their match goals in a similar fashion, should be taken with a grain of salt. You will be seriously jeopardizing your career changes because you don't want to spend 4 years (out of maybe 40 years of your medical career) at a particular program.

Don't do it. Go to your program with an open mind. If it becomes obvious that this program really isn't working out, then there are avenues to switch residencies -- residentswap, for one -- that can be done without running afoul of the NRMP.

3. Also, from the first post:
So I matched into med/peds at a program that I'm not too thrilled with. I ranked it since I thought it would be better than not matching, but now I'm not too sure.
Let me tell you this. Last year I applied into a competitive specialty, had a decent number of interviews. I almost didn't rank my last choice program. I ended up ranking it -- and still didn't match. After not matching, I would have given my firstborn child to get into that program.

The grass is not always greener.
 
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Thanks for the advice everyone. I just wanted to get information about the options I had. I learned a great deal from the information here, from aprogdirector, and from people who have switched.

I think there are so many more options and less downside and risk if I just go to my residency and give it a shot.

-Maybe I'll like it and stay.

-Maybe a PGY 2 position will open up at another instution.

-Maybe a PGY 2 swap position will open as well.

-Or I could apply to peds if I feel med/peds wasn't for me. I could either start my internship over or come in off cycle, whatever the situation dictates. Not to mention that I can accept a position outside the match if possible since I won't be a US senior. After going through this match nonsense, that would definitely be a nice luxury!

I definitely do not want to appear as a person who makes rash and off the cuff gut decisions if I apply again. As many have mentioned, this is what I would look like if I tried to get out this year. The irony of this is what I'm completely on the other side the spectrum. I'm very logical and methodical in my thinking, hence the fact I was using logic arguments in my previous posts. This is why I came here in the first place, because it would be the reasoned thing to do to get options before making any rash decision.

My apologies to the 3-4 people who private messaged me about wanting to take my spot, but this is the right thing for me to do.

Thanks again. I appreciate it.
 

aProgDirector

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One other option to add to your list is to decide to do only IM or Peds, and stay at your current program. Many programs will work with you to do this, should you decide the combined program is not right for you.
 

gutonc

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Attending Physician
One other option to add to your list is to decide to do only IM or Peds, and stay at your current program. Many programs will work with you to do this, should you decide the combined program is not right for you.
I offered this as the easiest option earlier in the thread, but the OP dismissed it out of hand. The arguments were flimsy at best but I decided not to point that out at the time.