Switch IM ---> Gas

[McPoyleRulz]

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Hey all, thanks in advance for any help or insight you can provide.

Currently an M4, finished all my interviews for categorical IM spots. However, now during my anesthesiology rotation I realize I have made a grave mistake and wish I would have done this rotation last year or at the very least earlier this year. However, due to scheduling and personal reasons, I was not able to fit it in.

So, my question now is how to handle this. My plan now is to speak with the PD at my home institution and see if they can point me in the right direction. But, in the mean time to continue on with the medicine match, and then once match contact the gas PD at wherever I match and explain my interest in switching programs after my intern year. My thinking is that it is too late this cycle to get interviews anywhere, save possibly for my home institution. Also, my gut is telling me not to talk to the medicine PD here in fear of burning some kind of bridge.

Does anyone have any experience or advice they could share? Presuming I have to wait until next year, is my best bet to talk to the PD at wherever I match and try to switch into that program, or will I need to plan on interviewing and matching again?

Thanks again.

 

[Noegrus]

Don't talk to either PDs just yet. Go ahead with the medicine match, land a spot, and either complete IM and then go into anesthesia as a ca-1 or apply to the match for the ca-1 start positions during intern year. It is too late inn the game to try and match anesthesia this year. Another option is to take a research year off/defer graduation if your medical school allows it, do a ton of anesthesia research etc and apply in the next match. Two people I know did this.

 

[Idiopathic]

Hey all, thanks in advance for any help or insight you can provide.

Currently an M4, finished all my interviews for categorical IM spots. However, now during my anesthesiology rotation I realize I have made a grave mistake and wish I would have done this rotation last year or at the very least earlier this year. However, due to scheduling and personal reasons, I was not able to fit it in.

So, my question now is how to handle this. My plan now is to speak with the PD at my home institution and see if they can point me in the right direction. But, in the mean time to continue on with the medicine match, and then once match contact the gas PD at wherever I match and explain my interest in switching programs after my intern year. My thinking is that it is too late this cycle to get interviews anywhere, save possibly for my home institution. Also, my gut is telling me not to talk to the medicine PD here in fear of burning some kind of bridge.

Does anyone have any experience or advice they could share? Presuming I have to wait until next year, is my best bet to talk to the PD at wherever I match and try to switch into that program, or will I need to plan on interviewing and matching again?

Thanks again.

tough situation. you could take a chance and tell your home program, especially if you would be interested in staying there...but unless they offered you a high rank you wouldnt gain anything. if you did tell them and they seemed receptive, you could still rank IM programs in addition to that anesthesia program. you could try the scramble, but the numbers suggest you will not get a spot and then you would not have ANY spot next year. I think the best thing is to match IM and revisit this at wherever you match after you have been there a few months and learned some of the system.

 

[McPoyle]

Don't talk to either PDs just yet. Go ahead with the medicine match, land a spot, and either complete IM and then go into anesthesia as a ca-1 or apply to the match for the ca-1 start positions during intern year. It is too late inn the game to try and match anesthesia this year. Another option is to take a research year off/defer graduation if your medical school allows it, do a ton of anesthesia research etc and apply in the next match. Two people I know did this.

I'm curious why you advise NOT to approach my home has PD?

 

[Orin]

I'm curious why you advise NOT to approach my home has PD?

I assume it's so that you don't end up jeopardizing your chances of matching into anything this year. If you want to play that game, wait until rank lists are finalized before discussing your apprehension with PDs from any program. Doing it early, you are just taking a risk that it tanks you on their rank list, and that perhaps word gets out to other PDs.

I think good communication with both IM/Anes PDs is important so I'd talk to them as soon as you feel safe.

 

[Idiopathic]

I'm curious why you advise NOT to approach my home has PD?

honestly, its a big chance. he/she will not be able to promise you anything, and even if they tried to act on your behalf to help you in some way, its very possible that it would affect your chances to match in another specialty. at this point in the game, its probably best to try and match IM or sit out a year and do lab work, trying to match next year in anesthesiology

 

[Noegrus]

Because at this point of time, some programs that I know of have completed their rank lists. So, the chances of them ranking you high enough to match when compared to the 'usual' candidates are not stellar. However, On second thoughts, it might not be a bad idea to talk to your anesthesiology PD. What have you got to lose, right? Ask him for advice on how to do this. Show him your passion. I have gotten some amazing advice by just talking to as many people as i could. Contrary to general belief, PDs generally do not discuss candidates with other PDs at the same institution so that is not likely to hurt your chances at IM at home institution (personal experience on the interview trail - sometimes even animosity between PDs at same institution). Even if you don't match IM at home you would match IM elsewhere.
Edit: I see that your question has been answered quite comprehensively by above posters.

 

[Notanerd]

I have someone very close to me going through the exact same situation and the reality is you are going to lose a year in all but one situation. Because CA-1 spots are matched a year a head and the match is all opt int now, your chances of matching IM leaving and then going in gas next year is like zero unless you do a year of IM and then go into the match again and match at an anesthesia program that is categorical and redue your intern year. their are like 4 programs out their were you can match a ca1 spot for the next year and these are some of the most competitive positions in the country bc you are applying agains people leaving ortho and ent and such. YOUR BEST CHANCE to get into an anesthesia program next year is very risky...its to purposely not match into medicine and try to get an unflled spot through the SOAP. these spots will be limited and who knows where they will be but they will be out there

 

[heronmd]

I have someone very close to me going through the exact same situation and the reality is you are going to lose a year in all but one situation. Because CA-1 spots are matched a year a head and the match is all opt int now, your chances of matching IM leaving and then going in gas next year is like zero unless you do a year of IM and then go into the match again and match at an anesthesia program that is categorical and redue your intern year. their are like 4 programs out their were you can match a ca1 spot for the next year and these are some of the most competitive positions in the country bc you are applying agains people leaving ortho and ent and such. YOUR BEST CHANCE to get into an anesthesia program next year is very risky...its to purposely not match into medicine and try to get an unflled spot through the SOAP. these spots will be limited and who knows where they will be but they will be out there

http://www.nrmp.org/allinpolicyexception.pdf

3. I have a PGY-1 Internal Medicine resident who wants to transfer to my Anesthesiology program at the
end of the academic year. Can I offer him a position outside The Match?

A resident can transfer to a position outside The Match if the position is one for which the NRMP does not offer Matching services. The applicant could transfer to a PGY-2 position in a categorical Anesthesiology program because the NRMP does not offer Matching services for the second-year of training in categorical programs; however, if the program is advanced and thus begins at the PGY-2 level, the applicant and the position must be in The Match because the NRMP provides Matching services for PGY-2 positions in advanced programs, regardless of whether training would begin in the year of The Match or the year after The Match.

 

[Notanerd]

http://www.nrmp.org/allinpolicyexception.pdf

3. I have a PGY-1 Internal Medicine resident who wants to transfer to my Anesthesiology program at the
end of the academic year. Can I offer him a position outside The Match?

A resident can transfer to a position outside The Match if the position is one for which the NRMP does not offer Matching services. The applicant could transfer to a PGY-2 position in a categorical Anesthesiology program because the NRMP does not offer Matching services for the second-year of training in categorical programs; however, if the program is advanced and thus begins at the PGY-2 level, the applicant and the position must be in The Match because the NRMP provides Matching services for PGY-2 positions in advanced programs, regardless of whether training would begin in the year of The Match or the year after The Match.

yea thats exactly right... if its a categorical position it has to be one that was not filled through the regular match or someone who is not going to continue from intern year to PGY-2/CA1 year. but because of the all opt in clause programs do not hold on to empty ca1 spots anymore.so in this potistion if the person wanted in at a program that offered only categorical spots and there were non open as it was this year bc every spot went filled either through match or soap they would have to redue an intern year and go through the match again. If they wanted a advanced position bc all positions were again filled they would have to go through the match match advanced and sit out a year. or call every progam to see if they had a random person leave from their program.

 

[Noegrus]

I am not sure what the above posters are talking about. CA-1 start positions exist and can be applied to during your intern year. They are separate from the categorical and advanced positions. They will have an NRMP code ending with R0. This was discussed in a previous thread about a month ago. When I interviewed at Michigan there were a couple of people interviewing for those. They were by no means stellar candidates and were switching out of IM for a multitude of reasons. The positions are fewer than the categorical or advanced spots but are by no means non-existent or impossible to land. You can email Ted Sanford, the UMich PD and ask him how many spots they have and who else offers them. He is a wonderful guy and I am sure he will be helpful.

 

[Idiopathic]

i think what you arent realizing is the NRMP change for 2013 that mandates all positions be in the match, so while it may not apply for this years CA1 class (since those were technically 2012 positions), it will apply next year

so you would be limited to spots that were vacated by expulsion, transfer, quitting or switching. programs are not supposed to hold out spots anymore.

 

[inspirationmd]

I'm curious why you advise NOT to approach my home has PD?

So I am going to actually say what you should do depends on a few things.

1) How did you do in your Anesthesia rotation? How strong an application do you have?

If you did very well and got outstanding feedback then I would consider speaking to the Anesthesia PD particularly if you have someone who is willing to advocate for you to them. It is late in the game but one of my classmates was in a similar position and they gave him an interview in late January and ranked him to match. He is now categorical Anesthesia at our home institution. He ranked all the categorical IM interviews he had done and planned to switch if it didn't work out. More often than not, your med school will work to take care of you particularly if you are a strong applicant and people want you to stay. They know you, you just did presumably great work, and they know the product they are getting.

You do not need to post your numbers but you can take a look at Charting outcomes and ballpark where your scores lie as well as talk to your friends interviewing for Anesthesia and here about the trail. Also the usual WAMC threads can give you an idea too.

2) How risk adverse are you?
As others have said, you run the risk of upsetting the IM department if you are seen as someone who used them as a backup. It doesn't sound like this is the case but politics can be a b**** and perception is everything a lot of times. Is there a IM mentor who you can talk to confidently? They may be able to guide you while also ensuring things do get ruffled at your home institution and you match there with some thinking you do not want to be there and will not work hard.

They way the match is getting I would not advise scrambling if you can avoid it. You are never as competitive as you are coming out of med school and there is frequently a reason why spots remain unfilled. You should have at least some idea about what you are signing up for rather than actively thinking to jump on what is offered to you. Also, I would think it is better for you to have a categorical bird in hand spot than hanging out in the SOAP hoping to get picked up. Switching is easier than applying as a grad from what I have observed.

Personally, I would have a conversation with the Anesthesia PD and see what he/she thoughts are.

 

[Noegrus]

i think what you arent realizing is the NRMP change for 2013 that mandates all positions be in the match, so while it may not apply for this years CA1 class (since those were technically 2012 positions), it will apply next year

so you would be limited to spots that were vacated by expulsion, transfer, quitting or switching. programs are not supposed to hold out spots anymore.

My understanding is that those positions were also in the match and the candidates were going through the interview process. I did meet a gentleman at Mich (ca2 i think) who had matched to urology and during his surgery intern year decided he didn't want to be a surgeon. He basically walked into the anesthesia PD's office, told him he wanted to switch to anesthesia, they shook hands, and he was give the contract. This scenario is no longer possible due to the all-in policy. Programs cant offer spots outside of the match but they can hold some back due yo funding/staffing concerns. Also, programs may have funding for more spots than they fill (Mich is approved for 30/yr but haven't had more than 25-26 people, bwh is approved for 32 but is cutting the class size to 24). So, some CA-1 spots may have been placed in the match this year with the R0 designation. I don't think that these are transfer/drop out spots. I do see your point and I might be wrong in my conclusions. It is a grey area for sure, because in yesteryears recruitment to those spots was always out of the match. Now they have an nrmp designation number, and that makes me think that they will also be in the match year and subsequently . There is no harm in checking, I guess.

 

[Bostonredsox]

check me if im wrong but all gas programs require a PGY 1 in something else correct? If so, my advice is complete your IM intern year, and apply for a CA-1 slot during it. We had one of those. Categorical IM with me intern year, left at end of year to be a Ca-1 somewhere else. And I would do categorical over prelim/transitional. If you are a good intern, and you do not get the Ca-1 slot, you can finish your IM 2 years and have a job to fall back on. Can also reapply after each year of IM. I know the funding thing can be messy but when i interviewed as an MS4, there was a first year EM at a program that had gon Gsurg4-->EM1. he got to the end of year 4/5 of GS and decided he could not be a surgeon for 30 years. if you are good, they will take you regardless of funding. And as a GS4, you know he was obviously a badass EM 1. Anywa, keep doors open, complete the IM intern year and then you at bare minimum can get a license and do urgent care to feed yourself if all else falls apart while still having an option to complete 3 years for board eligibility while you are reapplying to gas.

 

[Noegrus]

if you are good, they will take you regardless of funding.

BWH anesthesiology has a guy who completed FM and is now a CA1. So, I think programs can manage funding issues.

 

[Idiopathic]

I don't think funding becomes an issue until like pgy9 but maybe I'm wrong

 

[mikey014]

I don't think funding becomes an issue until like pgy9 but maybe I'm wrong

I think each resident is allowed 5 years of GME funding for an approved residency slot. Otherwise, if it's not an approved slot or if it's for training beyond the 5 years I think the resident or the department has to secure the funding independently.