Switching from EM to surgery

[whatsthepoint]

EM PGY-1 here. I switched to EM late in 4th year of medical school after dual applying for a surgical subspecialty. Ever since I have missed the operating room dearly. I never gave gen surg a chance as I had minimal exposure to it until now rotating on Trauma Surgery and ACS. I had a mentor in medical school who tried to get me to do general surgery for 3 years straight and now I see the light.

Am I better off pursuing a preliminary surgery year in the SOAP next month, or apply in the match as an EM PGY-2? I have my PD's support and he is aware.

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[Pir8DeacDoc]

Does your current hospital have general surgery residency? Staying on board at your current place would be the least life disruptive and probably easier to slot into without losing years here or there. Prelim spot is a bit of a gamble. Though it can obviously work out

 

[flightdoc09]

New EM attending here. I switched to EM last minute my 4th year as well. Was a tough decision, as I loved doing stuff in the OR. Even as an intern on gen surg, or a 3rd year on trauma, I would go to the OR and get to assist. Some attendings even let me do quite a bit. I still do miss the OR, and I think if I was younger when I was a med student, gen surg would have been a no-brainer.

But 2 things kept me from pursuing it. One was during one of my audition rotations, I was paired with a preceptor attending that was always saying I did everything wrong, never did anything right, and just made me feel like crap for the first 3.5 weeks. Despite all the residents I worked with saying good things about me. Then my last few days there he changed his tune and on my exit interview actually said I did a lot of things well. But because of that I was miserable the whole month, waking up extra early, going to sleep extra late, I lost weight, etc. Then, I also did a 12 hour thoracic surgery case during my Sub-I in 4th year that about wrecked me physically. I was probably dumb and let myself get dehydrated so I wouldn't have to keep scrubbing out. Both of those got me contemplating about what it would be like doing a 5 year residency going through that. And being older, I thought about what it may be like trying to get married, start a family, while doing that as well.

One of my upper level residents felt similar about doing surgery. She almost switched, but ended up staying and doing a trauma critical care fellowship (as opposed to medical crit care). So a possible different option.

Overall, I'm happy in EM. I think burn out is likely higher, and the state of our medical system doesn't help (as you're aware). But I do still miss the OR. I'm not trying to discourage you. Just giving you some other perspective. And to warn you about getting into a toxic program. If that place I did a Sub-I at was better, or I got paired with a less grumpy/mean preceptor, I would have probably ended up going into surgery.

 

[Dr.LeoSpaceman]

In either case, decent chance you'll be applying in the match for categorical positions next year. Taking the prelim spot gives you another option in that you could take an open PGY2 GS spot, though you shouldn't count on that. The prelim spot also gives you some "street cred" regarding how serious you are about surgery. The downside is that you'll give up a safe backup plan of just continuing in your EM residency if you don't match. If you don't match after a prelim year, it can get dicey.

Where you have an option for a prelim year also is a big part. I would not go to a place that uses a large cohort of prelims as warm bodies. You'd want to try and find a place that has a small group of prelims with a strong track record of placing them in categorical spots.

Ultimately it's a tough decision. If you see any way that you could be happy in EM long-term (including with a fellowship, etc.), I'd probably just apply to categorical positions next year to avoid burning potential bridges.

 

[whatsthepoint]

In either case, decent chance you'll be applying in the match for categorical positions next year. Taking the prelim spot gives you another option in that you could take an open PGY2 GS spot, though you shouldn't count on that. The prelim spot also gives you some "street cred" regarding how serious you are about surgery. The downside is that you'll give up a safe backup plan of just continuing in your EM residency if you don't match. If you don't match after a prelim year, it can get dicey.

Where you have an option for a prelim year also is a big part. I would not go to a place that uses a large cohort of prelims as warm bodies. You'd want to try and find a place that has a small group of prelims with a strong track record of placing them in categorical spots.

Ultimately it's a tough decision. If you see any way that you could be happy in EM long-term (including with a fellowship, etc.), I'd probably just apply to categorical positions next year to avoid burning potential bridges.

This is such a tough decision. I am struggling a lot with it.

Wouldn't applying from my categorical spot potentially burn bridges too though?

 

[Dr.LeoSpaceman]

This is such a tough decision. I am struggling a lot with it.

Wouldn't applying from my categorical spot potentially burn bridges too though?

It shouldn't be, but you would need to have that direct and unambiguous conversation with your current PD. If your PD is expecting you are leaving the program regardless of the outcome of the match next year, that obviously complicates things.

 

[whatsthepoint]

It shouldn't be, but you would need to have that direct and unambiguous conversation with your current PD. If your PD is expecting you are leaving the program regardless of the outcome of the match next year, that obviously complicates things.

Update: Somehow I made it through this intern year, and I am finishing my last month in the ED as an intern. My program is aware of my desire to switch but is giving me the option to stay if I want to finish out the 3-year program. However, if I decide I want to switch, then I have to leave after this intern year ends. I know the logical answer is to stay. But I truly feel miserable here and feel like I don't belong. I miss the operating room so much.
I'm a USMD with 24x step 2. Can I leave my program after June 30, and take the next academic year off to apply to surgery? Or will this be career suicide?

 

[Dr.LeoSpaceman]

Update: Somehow I made it through this intern year, and I am finishing my last month in the ED as an intern. My program is aware of my desire to switch but is giving me the option to stay if I want to finish out the 3-year program. However, if I decide I want to switch, then I have to leave after this intern year ends. I know the logical answer is to stay. But I truly feel miserable here and feel like I don't belong. I miss the operating room so much.
I'm a USMD with 24x step 2. Can I leave my program after June 30, and take the next academic year off to apply to surgery? Or will this be career suicide?

Can you leave and try to match into surgery? Of course you can. But I think it would be an enormous gamble. You'd have to 100% be willing to accept an outcome that means you don't end up in clinical medicine at all. Or that you knock around in a few prelim years and still end up in something that isn't surgery. Whether those outcomes are still better than slogging through to finish EM is something only you can answer.

Is your current PD willing to write you a strong letter? Where are your other letters coming from? Those are key questions. But in my mind it's a bit of a red flag (whether real or perceived) that you aren't going to be in a program while applying.

 

[Smurfette]

Update: Somehow I made it through this intern year, and I am finishing my last month in the ED as an intern. My program is aware of my desire to switch but is giving me the option to stay if I want to finish out the 3-year program. However, if I decide I want to switch, then I have to leave after this intern year ends. I know the logical answer is to stay. But I truly feel miserable here and feel like I don't belong. I miss the operating room so much.
I'm a USMD with 24x step 2. Can I leave my program after June 30, and take the next academic year off to apply to surgery? Or will this be career suicide?

IMO You're better off staying in your current program and applying next year for a surgery spot. That way you maintain an income, keep active clinically and if you don't match into a surgery spot, you can reassess whether you want to try for something else or finish and become board certified to give you some long-term options.

 

[Apollyon]

This dude started 3 threads in the Gen Res forum about this same thing. Nothing has changed except as above.

 

[whatsthepoint]

This dude started 3 threads in the Gen Res forum about this same thing. Nothing has changed except as above.

God forbid. I was told to come to my old thread. Get the **** over it. What value does your comment add to this conversation? Nothing.

 

[ThoracicGuy]

God forbid. I was told to come to my old thread. Get the **** over it. What value does your comment add to this conversation? Nothing.

 

[Apollyon]

God forbid. I was told to come to my old thread. Get the **** over it. What value does your comment add to this conversation? Nothing.

Dude, this is why people don't help.

 

[eyeeye_captain]

Grand scheme you’re almost certainly going to be better off sticking with EM. Get out, tailor your gig to something tolerable, and keep it moving.

As above, I worry significantly about your letters. If the PD is already telling you to get out the door if you’re going to apply, which then gives them a scheduling headache for 2 years instead of 1, I don’t suspect that one will be rosy. Miserable residents often have performance issues, which may come up if you happen to fit the bill. I don’t think you applied surgery originally, so who will remember you from third year rotations to help you out?

General surgery has gotten more competitive with what looks like a 74.5% match rate in 2025 (1114/1496) for MD seniors for categorical. That would be bumping up against the subspecialties for difficulty, and graduates fare worse than seniors. Do you think your app has what it takes?

There are programs out there that are prelim mills and would be happy to put a warm body to work without any real path forward. If you’re hurting now, that potential option hurts worse. If you can slog through a prelim maybe you can find a PGY-2 opening since more people leave surgery than jump in, but programs like that aren’t going to give you many interview days.

Training gaps aren’t super common outside of research years, so that would probably raise an eyebrow or two.

I feel for you. The last year or so hasn’t worked out anything like you expected or wanted. If you’re willing to take the very real risk of chasing yourself out of clinical medicine, then I hope you beat what look like really tough odds with switching.

When you’re forced to eat a turd sandwich, pick the smaller one. In this case I think that’s staying in EM.

 

[Crayola227]

IMO You're better off staying in your current program and applying next year for a surgery spot. That way you maintain an income, keep active clinically and if you don't match into a surgery spot, you can reassess whether you want to try for something else or finish and become board certified to give you some long-term options.

This

 

[Crayola227]

God forbid. I was told to come to my old thread. Get the **** over it. What value does your comment add to this conversation? Nothing.

I understand you're emotional and also that comment may have made you feel picked on. But seriously, try not to directly tell someone to **** off here.

 

[Crayola227]

Grand scheme you’re almost certainly going to be better off sticking with EM. Get out, tailor your gig to something tolerable, and keep it moving.

As above, I worry significantly about your letters. If the PD is already telling you to get out the door if you’re going to apply, which then gives them a scheduling headache for 2 years instead of 1, I don’t suspect that one will be rosy. Miserable residents often have performance issues, which may come up if you happen to fit the bill. I don’t think you applied surgery originally, so who will remember you from third year rotations to help you out?

General surgery has gotten more competitive with what looks like a 74.5% match rate in 2025 (1114/1496) for MD seniors for categorical. That would be bumping up against the subspecialties for difficulty, and graduates fare worse than seniors. Do you think your app has what it takes?

There are programs out there that are prelim mills and would be happy to put a warm body to work without any real path forward. If you’re hurting now, that potential option hurts worse. If you can slog through a prelim maybe you can find a PGY-2 opening since more people leave surgery than jump in, but programs like that aren’t going to give you many interview days.

Training gaps aren’t super common outside of research years, so that would probably raise an eyebrow or two.

I feel for you. The last year or so hasn’t worked out anything like you expected or wanted. If you’re willing to take the very real risk of chasing yourself out of clinical medicine, then I hope you beat what look like really tough odds with switching.

When you’re forced to eat a turd sandwich, pick the smaller one. In this case I think that’s staying in EM.

Also this.

I think I caught somewhere the OP took the step 2 USMLE 24 times? That can't possibly be right.

 

[Dr.LeoSpaceman]

IMO You're better off staying in your current program and applying next year for a surgery spot. That way you maintain an income, keep active clinically and if you don't match into a surgery spot, you can reassess whether you want to try for something else or finish and become board certified to give you some long-term options.

The problem is that (apparently) this isn't an option. If I read it correctly, the PD is telling the OP they have to choose to stay in the program for year 2 (and not apply to GS) or leave after PGY1 and apply while in a gap year.

Obviously the PD of the EM can't technically stop OP from staying and then applying to GS, but they can functionally make it near impossible to be successful if they restrict time for interviews or won't provide a (strong letter). The fact that this is the PD's position means either one or both of two things: the PD is kind of a jerk and/or there are existing red flags for OP that make the PD less-than-sympathetic to the situation. Neither one of these are positives as it relates to chances of matching into GS.

EDIT: Though I suppose the other issue may be that if EM is like surgery, the PD won't be able to fill an empty PGY3 spot if it's the final year. In which case, they don't want to risk OP sticking around, matching into surgery, then being stuck short a PGY3.

 

[Crayola227]

It's not only about not chasing yourself out of clinical medicine, it's that a lack of board certification is just an awful thing long term. Having an unrestricted license is like, OK but still bad (if you have the opportunity to take step 3 and get it with your program's blessing, do it  ASAP). Get it on lockdown before any relations with the program can sour and become a barrier.

Not having a license = unspeakable badness for job prospects.

Having a license and no board cert = yeah, there's jobs but again, you've restricted your options so much, it's going to be worse for you than toughing out 2 years and being in a much better place.

The right answer is always going to be finishing a residency no matter the cost. The right thing to do is whatever makes that the surest bet. I don't know much about how things get viewed, but my guess is that sticking it out with finishing a residency in something you don't want is going to help you more in making a switch, although you won't have funding left. You'll probably get more support from your PD. You show surgery stick-to-it-iveness, because a worry is always will the unhappy resident not sticking it out, switch and not repeat the pattern of being unhappy and uninterested.

You're better off making it such that you have a board cert before you go off chasing the unknown. It doesn't seem to me like your odds of matching surg are worse if you go forward with EM. That someone is turning down 6 figures for more training after completing training.... but if you don't succeed matching you'll be glad you did the training.

Ultimately a job is a job, there's a reason one must be paid to do it. I would see it as just something you have to do now to set yourself up later, like O chem was for med school. Don't let 2 years of EM ruin the rest of your life and career.

I know suck it up is never what a suffering resident wants to hear, especially when you can imagine saving yourself a lot of painful work. The trade off is not worth it if it goes south though imho.

 

[RockClimberMed]

Also this.

I think I caught somewhere the OP took the step 2 USMLE 24 times? That can't possibly be right.

If youre referring to the 24x Step 2 in OPs comment...It means they scored anywhere from 240-249..not sure why ppl feel the need to obfuscate the exact number when asking for advice, but who knows.

 

[Crayola227]

If youre referring to the 24x Step 2 in OPs comment...It means they scored anywhere from 240-249..not sure why ppl feel the need to obfuscate the exact number when asking for advice, but who knows.

Could just as easily use a number a couple points off without having a practical effect on advice given, if they don't want the exact real score out there.

 

[Crayola227]

24 times, really? lmao,

We see people who indicate they took the USMLE as follows: "I'm an IMG, 2x Step 2" to indicate how many attempts they have taken the step to get a pass. They usually don't bother to mention a score at that point because they understand the number of times they retook (aka failed) a step is more relevant to their chances than any score they may have received subsequently. We've see some truly shocking number of attempts on this board. Usually FMGs not US, which made what I thought you wrote make even less sense. We also get trolls that make posts that seem real enough and make sense except they'll slip on one ridiculous element to see who notices and takes bait.

I assumed you had made a typo. I see people say "240s" or "low 240s" more commonly, not really 23x or some such. But I haven't been to allo in a while maybe WAMC threads have changed.

Obviously the PD of the EM can't technically stop OP from staying and then applying to GS, but they can functionally make it near impossible to be successful if they restrict time for interviews or won't provide a (strong letter). The fact that this is the PD's position means either one or both of two things: the PD is kind of a jerk and/or there are existing red flags for OP that make the PD less-than-sympathetic to the situation. Neither one of these are positives as it relates to chances of matching into GSGS.

The PD can also sink your boat entirely even if you do interview, not just through a letter but a simple phone call from one PD to another, which isn't uncommon in a situation like this.

The PD holds enormous power on every single thing that transpires here moving forward. Really the odds are good that whatever results the PD wants is what they get.

 

[operaman]

Agree with the others - stick it out. You’re only losing one year on your surgery career and you’re keeping options open. Just apply during your pgy3 year and if you match, start gen Surg after you graduate EM.

Your PD shouldn’t mind since you’ll complete won’t be leaving him in the lurch. If you don’t match, then take an EM attending job and make good money while you apply again or figure out a next move.

Bailing now is a lot of risk for a maximum payout of one extra year as a surgeon.