switching advanced program before starting

[radoncster]

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Hi All,

So I'm currently doing my intern year and have matched an advanced rad onc spot. I'm certainly thrilled to have even matched into this field. And it's a strong program and I know I'll ultimately be happy there. For personal reasons, the location isn't exactly ideal. I've seen a couple other PGY2 spots open up in other locations and I know this happens from time to time.

My basic question is, what is the risk/benefit of inquiring/applying to other spots when you have one in hand. These other spots would be outside the match, so I imagine match violations aren't so much a concern. I know rad onc is a small field and program directions/chairs talk to each other. I would imagine it's a guarantee that my current spot's program director would certainly find out I was looking to go elsewhere. I would be concerned that if I did apply, but did not successfully get that spot, it would create some tension with my current program.

Ultimately, I doubt I will go forward with this due to the potential drawbacks, but just something that was on my mind.

 

[mpdoc2]

Hi All,

So I'm currently doing my intern year and have matched an advanced rad onc spot. I'm certainly thrilled to have even matched into this field. And it's a strong program and I know I'll ultimately be happy there. For personal reasons, the location isn't exactly ideal. I've seen a couple other PGY2 spots open up in other locations and I know this happens from time to time.

My basic question is, what is the risk/benefit of inquiring/applying to other spots when you have one in hand. These other spots would be outside the match, so I imagine match violations aren't so much a concern. I know rad onc is a small field and program directions/chairs talk to each other. I would imagine it's a guarantee that my current spot's program director would certainly find out I was looking to go elsewhere. I would be concerned that if I did apply, but did not successfully get that spot, it would create some tension with my current program.

Ultimately, I doubt I will go forward with this due to the potential drawbacks, but just something that was on my mind.

You'd be a match violator and both you and the program that accepted you would be in violation of match rules. A program accepting you can potentially be banned for participating in match for several years.

 

[thesauce]

I feel for you, but I wouldn't risk it. You could consider trying for PGY-3 if a spot is open.

 

[kristofer]

As someone who has interviewed for positions outside of the match, I can almost guarantee you that nothing good would come of this. I would give your program a chance and do everything you can to make it work. This is a field where lots of people train in locations they don't want to initially be in, and I've heard so many times senior residents and faculty say "I never thought I'd end up in <x> but I love it here and am going to stay around"

 

[usmlesuccess]

Just curious, what is the worst that could happen if the poster does apply to these off cycle spots?! The worst that could happen is that they just don't reply to your email. If they are serious about taking you they would contact your program director, definitely. I don't see any point why these program directors would just contact your home program with no intention of taking you. Why would they stir the pot and get into these types of affairs? People have a million reasons why they would want to switch. Some posters act as if the thought of switching is like committing a crime. If your application is well regarded both programs would have to agree to the switch anyways.

I see no problem why you would not apply. People switch all the time.

 

[mpdoc2]

Just curious, what is the worst that could happen if the poster does apply to these off cycle spots?! The worst that could happen is that they just don't reply to your email. If they are serious about taking you they would contact your program director, definitely. I don't see any point why these program directors would just contact your home program with no intention of taking you. Why would they stir the pot and get into these types of affairs? People have a million reasons why they would want to switch. Some posters act as if the thought of switching is like committing a crime. If your application is well regarded both programs would have to agree to the switch anyways.

I see no problem why you would not apply. People switch all the time.

A program will never accept him/her. If they do, they will be violating match rules and will trigger an automatic 1-3 year ban on said program from participating in the match. So unless that program is planning on closing in the next 3 years they won't accept him/her.

 

[usmlesuccess]

mpdoc2, I am not sure that you understand how this works. First, these spots are OUTSIDE the match, meaning they are vacant. Second, if his home programs releases him no one is violating match rules. People switch into different specialties all the time or across the same specialty ALL THE TIME. I am not sure that you realize these simple facts. It is only a violation if he entered the match and he didn't ask permission from his home program.

 

[thesauce]

mpdoc2, I am not sure that you understand how this works. First, these spots are OUTSIDE the match, meaning they are vacant. Second, if his home programs releases him no one is violating match rules. People switch into different specialties all the time or across the same specialty ALL THE TIME. I am not sure that you realize these simple facts. It is only a violation if he entered the match and he didn't ask permission from his home program.

I don't think these facts are as "simple" as you believe. At least, not anymore. This was posted not long ago and describes a nightmare story from someone who did exactly as you are proposing:

I am a current pgy-1 also starting a residency in radiology in july. Our stories our pretty similar so let me share with you the roller coaster I've been through this past yr. In last year's match i applied to rad onc and did not match so I used the SOAP to get into a radiology residency. (I thought radiology was a good choice, maybe I could do IR, get into IR oncology, who knows). However, after starting my prelim year I decided radiology is not for me- I hate procedures and the thought of sitting in a reading room all day is terrible. This past october a spot opened up outside of the match that i applied for and got. When I told my program director at the radiology residency that i intended to break my contract with them and take the rad onc spot, she informed me that technically what i did was a match violation. i had an NRMP contract through the SOAP with the radiology program and talking to another program constituted a match violation. Obviously all of this was accidental on my part. I had talked to multiple program directors as my current prelim program as well as the dean of student affairs at my med school. they all encouraged me to apply for the spot.

Long story short, the NRMP found out and not only did they ban me from going to this rad onc program, they are currently investigating my case and will most likely be giving me at least a 1 yr penalty where I cannot apply in the match and cannot take any job at an NRMP affiliated institution during the penalty time. (meaning, staying at my current program to continue medicine and hopefully do heme onc is not an option). My only choice is going to my radiology residency in July or be unemployed.
Some "fun facts" I have learned during this whole process. This year the NRMP instituted an "all in" policy. this policy states that no program is allowed to offer spots outside of the match for pgy-2 advanced spots. all of these need to go through the match. So the program that offered me the spot technically should have never been offering the spot in the first place.

The NRMP allows you to submit a waiver request to release you from your contract. This must be completed by Jan 15 of the year you start training. So it is too late now to get such a waiver. So what i should have done is applied for the waiver and never told my radiology program anything. it's obviously too late to get the waiver now. It seems like it would make sense if a)the program you have a contract with agrees to release you, b)the program you want to go to wants you to come and c)the applicant is agreeable to everything. These three things were all the case with my situation and yet the NRMP stepped in and will not allow me to go to the rad onc program. (the way that the NRMP found out about the whole thing is a very long story, so i will spare you that.) but they were very agreeable to letting me out of my radiology waiver. they basically told me they would let me out of it, I just couldn't go to any NRMP-affiliated program. so basically my options were urology, optho, or unemployment.
so bottom line, my advice would be to reapply in the match next year and not to apply to anything right now in fear of getting a match violation.

I don't pretend to know all of the latest details about the match, but it seems to me that this is the last scenario that I would want: being barred from taking a spot outside of the match, being barred from the match, and having to enter a program where they know you don't want to be there.

 

[medgator]

You'd be a match violator and both you and the program that accepted you would be in violation of match rules. A program accepting you can potentially be banned for participating in match for several years.

On top of that, it's my understanding that the "scramble" is gone, and has been replaced by the SOAP? thesauce nailed it perfectly. Basically under the new system, no pgy2 spots are allowed outside the match.

This makes no sense to me as the program will also have to wait over a full year to get an ms4 into their program. Lose-lose for everyone.

 

[mpdoc2]

mpdoc2, I am not sure that you understand how this works. First, these spots are OUTSIDE the match, meaning they are vacant. Second, if his home programs releases him no one is violating match rules. People switch into different specialties all the time or across the same specialty ALL THE TIME. I am not sure that you realize these simple facts. It is only a violation if he entered the match and he didn't ask permission from his home program.

Actually I understand it perfectly well and believe you don't understand what this involves. Programs that accept candidates that have matched to other programs are match violators, even though that spot was offered outside the match. So it doesn't matter that the program's position is outside of the match. Because that candidate has a "matched" position, anyone accepting them will be match violators and hence will be banned from participating in the match for 1-3 years. The only exception to this would be if said candidate is released from the program they matched to before accepting the new position and have written documentation of this.

Trust me on this one, most likely the candidate won't find a position in a more desirable city and almost certainly will cause significant dislike in the program they were accepted to. That's a bad way of starting radonc residency which are usually very small. Word would go around the department in 1 week and all the attendings would think of their new PGY-2 as a flake from the get-go.

Finally even though people switch programs ALL THE TIME, none of these switches happen during the beginning of their PGY-2 position in a matched position without getting written authorized release from their program.

 

[kristofer]

mpdoc2, I am not sure that you understand how this works. First, these spots are OUTSIDE the match, meaning they are vacant. Second, if his home programs releases him no one is violating match rules. People switch into different specialties all the time or across the same specialty ALL THE TIME. I am not sure that you realize these simple facts. It is only a violation if he entered the match and he didn't ask permission from his home program.

Not sure where you're coming from, rad onc or another field, but matching into a PGY-2 spot is a binding commitment. You need a waiver to get out of the position otherwise you will be a match violator. The chances you will get a waiver so that you can join a program in a more desirable location are very low. Additionally, there is a considerably more than nonzero chance that the program you are applying to would notify the PD at the program you are currently matched to with an FYI email or text. Not exactly the best way to start off. It's a super small field and not like internal med or something where there are 30 residents at a program.

Even though he would not be entering the match, he would need "permission" from his home program. In fact, he would need more than this, he would need a match waiver.

 

[Sheldor]

Not sure where you're coming from, rad onc or another field, but matching into a PGY-2 spot is a binding commitment. You need a waiver to get out of the position otherwise you will be a match violator. The chances you will get a waiver so that you can join a program in a more desirable location are very low. Additionally, there is a considerably more than nonzero chance that the program you are applying to would notify the PD at the program you are currently matched to with an FYI email or text. Not exactly the best way to start off. It's a super small field and not like internal med or something where there are 30 residents at a program.

Even though he would not be entering the match, he would need "permission" from his home program. In fact, he would need more than this, he would need a match waiver.

I believe getting a waiver is "automatic" before a certain date in December/January. In other words, before that date its a simple matter of applying for a waiver I believe.

 

[mpdoc2]

I believe getting a waiver is "automatic" before a certain date in December/January. In other words, before that date its a simple matter of applying for a waiver I believe.

I doubt that's true. Please source.

 

[laserbeams]

Per the NRMP, waivers are granted for "serious and extreme hardship or for change of specialty". The whole waiver policy is spelled out in a separate document which can be found here.

The TL;DR version is this:
1) Everyone (programs and matchees) need waivers to get out of binding match commitments (includes SOAP positions)
2) Waivers must be requested prior to any discussion about new placements, or opening up a position to other candidates
3) Discussing positions without getting a waiver is a match violation (see this thread for the sad reality this entails)
3) The requestor must demonstrate that "serious and extreme hardship" in order to qualify for a waiver
4) If a waiver isn't obtained and one party leaves it's binding commitment, it will face penalties (1 year exclusion, 3 year exclusion, permanent ban from future matches)

OP: I'm sure it's tough to have landed a spot in this competitive field, only to feel like you won't enjoy your new city. I think giving it a year and keeping an eye out for PGY3 spots is your best course of action. This will give you a chance to have the support of your PD/chairman (after you've shown them how hard you work, etc) which can only improve your chances of a successful transition. Best of luck!

 

[RSAOaky]

Just give it a shot and do your best. I surprisingly matched at a program very low down my list in an area I really wasn't thrilled about. Spent intern year at a pretty easy prelim in a city that I loved and from match day till PGY-2 year I was really dreading the move. I've found that a place becomes home and comfortable very quickly, and I like the city far more than I expected to. It could be better, but it could be far worse. Go into it with an open mind. You'll probably have less free time than you envision PGY-2 year anyways so I think it's important that you think you'll enjoy the actual work environment. Stay positive, everything works out in the end and if you really hate it after a year then you can look into transferring.

 

[thepretender67]

Can you actually get a waiver without having your home program find out? That way you don't jeopardize your original match until you have actually interviewed at other programs without having violated the nrmp

 

[xrthopeful]

There are switches all the time.

lol at people earlier in this thread acting like it's unthinkable. Get your head out of the sand!

 

[Chartreuse Wombat]

Can you actually get a waiver without having your home program find out? That way you don't jeopardize your original match until you have actually interviewed at other programs without having violated the nrmp

This is a match violation> see post by laserbeams above

 

[thepretender67]

This is a match violation> see post by laserbeams above

what about if you inquire about positions that are not being filled through the match?