Switching from IM to Emergency.

[WestClinton]

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Hey Guys, thanks for all your help. I have posted this in EM section but no one seems to be replying. I am currently an IM intern in a Northeast School. My program is great, but i have had questions about IM recently. I wanted to specialize but currently feel that i do not like IM and may not survive second year. I did a month of EM as a medical student and really enjoyed it.
I am thinking about switching to EM this year if possible. How do i go about this?. Should i contact programs directly? How will my current program react or help me since i do not want to do this behind their back.
Your reply will be greatly appreciated

 

[BADMD]

I am thinking about switching to EM this year if possible.

Essentially impossible. We are well beyond the match and new interns are starting in 2 weeks. Unless someone doesn't show for their program, you don't have any options to start this year. As far as I know, all EM programs in the US have filled.

How do i go about this?. Should i contact programs directly? How will my current program react or help me since i do not want to do this behind their back.
Your reply will be greatly appreciated

Some programs are supportive and some get pissed off. It will strongly depend on the program and your relationship to it and the PD. Your program director will have to write you a letter of recommendation and release you from current program in order to go to another program.

Keep in mind, that you will probably need to come in as an intern, though you may get some credit for months that overlap between EM and IM in the intern year.

The best way is for an intern to drop out and you slide into their spot. That requires watching the websites that list open positions and being ready to dive on any available spot. You have to be willing to move at a moments notice and go pretty much anywhere. Things will have to be primed if you want to do this, so you will have to have things squared away with your program.

I don't know the Match rules well enough to know if you could get an extra match position. However, I don't think you would be eligible.

That basically leaves going through the match again. You have used up two years of your funding, so you will either need to be an excellent candidate, so that a program is willing to give up money to take you or find a hospital system that is over cap and less concerned about how much funding you bring with you. You will need to get a bunch of letters of recommendation, including one from your PD, and they will need to be good. A letter from a known Emergency Physician that you have worked with would also help. Your personal statement will need to address why you a much better fit for EM than you are for IM.

 

[WestClinton]

Thanks for your reply. What of programs that took candidates outside the match?. I know of a program that started this year and never participated in match but took candidates. Do you think i have a chance with such a program? I know the program well and actually applied and interviewd there 2yrs ago.
ProgDirector, please, i need your help.

 

[NotAProgDirector]

The advice above is quite valid.

Presumably, you haven;t told your program director yet about this. Hence, they've probably already worked you into the schedule, and you've signed a contract for next year. Simply leaving at the end of the year with little notice would not go over well (and likely violate your contract). Your PD will not be pleased, and your LOR might reflect that.

At this point, the best thing to do is likely to start your PGY-2 position in IM as planned. Tell your PD that you're interested in EM. Start looking this summer into the fall. That's when EM programs will be interviewing for new PGY-1's, and they could start you off cycle. You do not need to use the match, but you certainly can (if you don't find a spot by the ROL deadline). You should consider looking at 2-4 EM programs, as they start residents after a separate internship (although most programs are now 1-3). A newly started program is always worth talking to, as they may have extra spots open that they are willing to be flexible with.

 

[WestClinton]

Sorry for asking but what are 2-4 and 1-3 programs? I have not actually signed a contract because i just came back from my vacation. I will be signing it this friday or next monday presumably. I plan on sending out letters tomorrow to the new programs and other programs. I will also talk to my PD about my home EM program this wek though i will prefer to completely have a new start elsewhere.
Any extra advise will greatly help.

 

[NotAProgDirector]

ED has an interesting history. It started as a three year residency after a prelim year. So, programs were "2-4" -- i.e. they were PGY2-PGY4 after a prelim year. Then, programs started integrating the intern year and became "1-4". Then, ED changed to a three year program, so most are now "1-3".

Even though you have not signed a contract, you have probably implied that you will be there next year. I expect they asked you for schedule / vacation requests, etc. Although legally you can argue that you have not signed a contract, professionally you have an implied commitment to the program (at least IMHO). Besides, you'll need to either sign it or resign long before you hear from ED programs at this point.

 

[Apollyon]

ED has an interesting history. It started as a three year residency after a prelim year. So, programs were "2-4" -- i.e. they were PGY2-PGY4 after a prelim year. Then, programs started integrating the intern year and became "1-4". Then, ED changed to a three year program, so most are now "1-3".

Actually, way back when - like, the 70s - it was 2 years (an intern year and a residency year), or the intern year then 2 years, and it was only through arm-twisting by ABMS that got it to be 3 years all under the aegis of the Emergency Department. It was much less organized and "off the cuff" than your clean example. Hell, many places openly questioned why med students would choose to "throw your career away before you have one". One of my attendings when I was a resident graduated in 1981 or 1982, and she has a total of 2 PGYs - that's it. There's accounts of residents from the 70s who were off-service and learned what they thought they needed to know (as the services themselves didn't know what to teach them). The board (ABEM) was recognized in 1979, but, as a requirement, was conjoint with FM, IM, and Peds (which harkens back to why EM-Peds can't sit for Peds EM boards, and why EM residents can't sit for CCM boards through ABIM - deals made in relative antiquity) and the practice track was open until 1988.