Switching from ROAD to IM

[leishmaniacc]

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Hey all,

Have a question about switching from a ROAD specialty to internal medicine after my prelim year. I realize that people are often able to stay on after intern year to complete their IM residency but I would be interested in finishing or restarting an IM residency at a different program.

A bit of background: Recent grad from a good American MD school where I did very well, honoring all my clerkships and scoring around 270 on steps 1 and 2. Was AOA and won some other academic awards as well for being at the top of the class. I had a really difficult time deciding which specialty to apply in and was torn between IM and another ROAD specialty. I ultimately chose the ROAD and was able to match into competitive specialty at a top program, however when I was applying/interviewing I couldn't shake the feeling that perhaps I had chosen wrong. I'm now about a month into my internship at a community hospital near my medical school and having a blast. I'm really having second thoughts about my career choice.

At this point I need some input as to what my options are. I am interested in academics and research and feel that if I decided to switch into IM I would really rather train at a large academic tertiary center where I would have access to better teaching, research opportunities, and better opportunities for fellowship placement. I'm not unhappy at my prelim year by any stretch but would prefer a more academic setting for a real IM residency. Would I be able to find a spot in such a program? Would it be possible for me to reapply through the match (assuming I can get permission and be released from my advanced position?). I am not opposed to redoing intern year if it means getting to train at a good program. Is there any chance I could get a spot outside the match by contacting program directors directly? Haven't made any decisions yet but though it couldn't hurt to just gather some information. Would really appreciate any input from current program directors.

 

[Top Gun]

If you're having a blast in your prelim year, great. But how do you know you won't enjoy your advanced position as well?

 

[NotAProgDirector]

As a very competitive USMG, you really have many options.

The first question is whether you want to try your ROAD specialty. As mentioned above, perhaps you'll really like it. Perhaps you won't. But you won't really know until you try it. Since it sounds like your prelim is not at the same location as your advanced match, you probably can't do an elective in it to "try it out". If you decide to switch, you need to do so before Jan 15th. Any request for a match waiver prior to Jan 15 for a change in specialty will be granted, requests after that will not.

Whether or not you decide to try the ROAD, you'll have no problem as a top USMG getting a spot in a good program. Assuming you complete your PGY-1, if you switch programs you might need 3-6 months at a PGY-1 level, but probably not repeat the full year (although you might need to repeat the full year, depending on how you proceed). So, options:

1. Resign from your PGY-2 prior to Jan 15. Start looking for a new program. You could/should apply via the match. If a program has an opening off cycle for the spring, you might be able to resign from your current program and start training as a PGY-1 at your new program (and do less than 12 months). Or, if you actually match into a program, then you will need to do the full 12 months of PGY-1. When you apply in the match, you can mention in your PS that you would be willing to resign from your current program and start off cycle if there is an opening (or you could mention that at interviews). Any program with an open off cycle spot is likely to ask you anyway.

2. Start your ROAD, try it for 4+ months. If you don't like it, apply to IM. Same deal as above -- you can look for off cycle spots, or apply for on cycle spots in the match, and perhaps get an off cycle offer.

Bottom line -- as a top US grad with 270+ on both steps, plenty of programs would be thrilled to get someone dissatisfied with the ROAD. First, you're a very competitive candidate. Second, it makes us feel good when people realize the ROAD ain't all it's cracked up to be.

 

[RadOncDoc21]

It appears you already have a well-respected suitor trying to recruit you over to the dark side 😉!

 

[Gastrapathy]

Come on over..,you might regret it but these always the fellowship escape route (this is also the route to a larger number of jobs with a research focus.

 

[NotAProgDirector]

It appears you already have a well-respected suitor trying to recruit you over to the dark side 😉!

Well, actually.....

 

[Instatewaiter]

Hey all,

Have a question about switching from a ROAD specialty to internal medicine after my prelim year. I realize that people are often able to stay on after intern year to complete their IM residency but I would be interested in finishing or restarting an IM residency at a different program.

A bit of background: Recent grad from a good American MD school where I did very well, honoring all my clerkships and scoring around 270 on steps 1 and 2. Was AOA and won some other academic awards as well for being at the top of the class. I had a really difficult time deciding which specialty to apply in and was torn between IM and another ROAD specialty. I ultimately chose the ROAD and was able to match into competitive specialty at a top program, however when I was applying/interviewing I couldn't shake the feeling that perhaps I had chosen wrong. I'm now about a month into my internship at a community hospital near my medical school and having a blast. I'm really having second thoughts about my career choice.

At this point I need some input as to what my options are. I am interested in academics and research and feel that if I decided to switch into IM I would really rather train at a large academic tertiary center where I would have access to better teaching, research opportunities, and better opportunities for fellowship placement. I'm not unhappy at my prelim year by any stretch but would prefer a more academic setting for a real IM residency. Would I be able to find a spot in such a program? Would it be possible for me to reapply through the match (assuming I can get permission and be released from my advanced position?). I am not opposed to redoing intern year if it means getting to train at a good program. Is there any chance I could get a spot outside the match by contacting program directors directly? Haven't made any decisions yet but though it couldn't hurt to just gather some information. Would really appreciate any input from current program directors.

Which ROAD specialty if you don't mind me asking?

 

[DermViser]

Which ROAD specialty if you don't mind me asking?

Based on prior post, likely Radiology.

 

[Instatewaiter]

Based on prior post, likely Radiology.

Well then it's not that unrealistic to change. If you want to do patient care, radiology is not the place to do it.

 

[DermViser]

Well then it's not that unrealistic to change. If you want to do patient care, radiology is not the place to do it.

Unless you do Interventional Radiology.

 

[residencyswitch]

If we apply to another specialty now, can we wait until December to apply for the waiver since the deadline is January 15?

 

[NotAProgDirector]

If we apply to another specialty now, can we wait until December to apply for the waiver since the deadline is January 15?

It's theoretically a match violation to look for another position while committed to your first. That said, I expect people do this all the time -- apply to some other field, see what happens with invites, and then decide whether or not to resign your spot.

PD's can look up your match history -- in fact we're supposed to prior to ranking.

 

[medicineluva]

If you don't mind me asking what is the "match waiver" that must be completed prior to Jan 15? From my understanding from research online, you must submit this waiver before you can re-enter the match this year (apply in Aug)?

I am a PGY 1 in IM, interested in switching specialities. But just to get things straight because I was a little confused: say I want to switch from IM to Gen surg.

1) I apply for the match this year (submit app in Aug).
a - how the heck do I get letters? I just ask the IM PD and my IM attendings for letters? I didn't do any rotations with surgeons.
2) When I say in PS that i am willing to do off cycle; if there is position available I can actually resign from my current position and start at the gen surg program? Doesn't this violate the match contract where you are required to stay for 1 year at the program you matched at?
3) Then where does this "match waiver" come into play? I need to complete this before doing step 1 above?

To the OP:
Im in medicine and would love to go into radiology...i'll trade ya lol

 

[gutonc]

If you don't mind me asking what is the "match waiver" that must be completed prior to Jan 15? From my understanding from research online, you must submit this waiver before you can re-enter the match this year (apply in Aug)?

I am a PGY 1 in IM, interested in switching specialities. But just to get things straight because I was a little confused: say I want to switch from IM to Gen surg.

1) I apply for the match this year (submit app in Aug).
a - how the heck do I get letters? I just ask the IM PD and my IM attendings for letters? I didn't do any rotations with surgeons.
2) When I say in PS that i am willing to do off cycle; if there is position available I can actually resign from my current position and start at the gen surg program? Doesn't this violate the match contract where you are required to stay for 1 year at the program you matched at?
3) Then where does this "match waiver" come into play? I need to complete this before doing step 1 above?

To the OP:
Im in medicine and would love to go into radiology...i'll trade ya lol

1a) Well that's really the crux of the matter, isn't it? You ask people you work with currently (and hope they don't submarine you) but that will do f*** all for letters specific to the new specialty...it's on you to figure that one out.

2) Your match contract is for 45 days. Your residency contract is for 1 year. You can violate the latter without violating the former.

3) The Match Waiver doesn't apply to you. It's only for people who match prelim/advanced and choose a different specialty for their PGY2 year.

And there's no reason you can't swap with the OP, other than the fact that the 2 programs say no. It's otherwise, from an NRMP standpoint anyway, totally legit.

 

[medicineluva]

1a) Well that's really the crux of the matter, isn't it? You ask people you work with currently (and hope they don't submarine you) but that will do f*** all for letters specific to the new specialty...it's on you to figure that one out.

2) Your match contract is for 45 days. Your residency contract is for 1 year. You can violate the latter without violating the former.

3) The Match Waiver doesn't apply to you. It's only for people who match prelim/advanced and choose a different specialty for their PGY2 year.

And there's no reason you can't swap with the OP, other than the fact that the 2 programs say no. It's otherwise, from an NRMP standpoint anyway, totally legit.

Sweet, so I can just re-enter the match as if I were a 4th year med student again, aside from needing a PD letter?

From people's past experiences, what the chances of matching into a specialty WITHOUT having a letter from a faculty in that field, in this situation? Should I perhaps use this year to do research and build connections, then re-enter match next year?

 

[gutonc]

Sweet, so I can just re-enter the match as if I were a 4th year med student again, aside from needing a PD letter?

From people's past experiences, what the chances of matching into a specialty WITHOUT having a letter from a faculty in that field, in this situation? Should I perhaps use this year to do research and build connections, then re-enter match next year?

I'm not sure I'd go so far as to call it "sweet", but whatever. You will have virtually no chance of matching if you don't have at least one LOR relevant to the field you're interested in.

 

[medicineluva]

I'm not sure I'd go so far as to call it "sweet", but whatever. You will have virtually no chance of matching if you don't have at least one LOR relevant to the field you're interested in.

Good to know, thanks!

 

[NotAProgDirector]

Especially in surgery. Without surgery letters, you won't get much love.

Resigning your spot, doing "research", might not change matters. Remember that assuming you don't match this year, and they apply again next year, it will be Aug-Sept and you'll be 1-2 months into your research. Good luck getting much in letters for that. So it might take 2 years of research. But then you might still not get a surgery spot -- and then you might not get a medicine spot again. So consider wisely your options.

 

[medicineluva]

Especially in surgery. Without surgery letters, you won't get much love.

Resigning your spot, doing "research", might not change matters. Remember that assuming you don't match this year, and they apply again next year, it will be Aug-Sept and you'll be 1-2 months into your research. Good luck getting much in letters for that. So it might take 2 years of research. But then you might still not get a surgery spot -- and then you might not get a medicine spot again. So consider wisely your options.

Yes this really sucks. Never thought I would be in such a difficult position (maybe because I'm risk averse and don't want to be without a residency spot).

If it MAY take 2 years of research then I might as well complete my medicine residency while doing research on the side, then reapply for surgery after. Will being an IM attending be detrimental or beneficial to the application process? Will PDs look at me differently compared to MS4's? I'm guessing maybe I can do research with the general surgery department at my institution to try to build relationships that way throughout my IM residency (although I am concerned how this will make me look in front of my peers and current PD lol)

 

[leishmaniacc]

Thank you to all who responded, especially Aprogdirector! Some really useful advice and information here. At this point I'll most likely give my advanced postion a try and see how I like it. But its good to know that I have options if I decide IM is where I want to be. Thanks again everyone

 

[galactus]

Thank you to all who responded, especially Aprogdirector! Some really useful advice and information here. At this point I'll most likely give my advanced postion a try and see how I like it. But its good to know that I have options if I decide IM is where I want to be. Thanks again everyone

One of my real good friends just changed from radiology back to medicine after one year. His prelim program gave him a categorical spot as a pgy-2. So can ROAD to IM happen? Definitely yes.