Switching from surg prelim to med prelim

reallycannot

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Aug 7, 2017
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I really hate my current prelim surgery program because it is super malignant and abusive. Every single day I come home and non-stop cry myself to sleep due to the horrible environment and bullying and feel I definitely cannot go on. Its not the hours (which are also horrible) but just the environment. I already have a pgy2 spot for my advanced residency next year(its a ROAD spot) and I have heard of many pgy-1 med prelim year openings. So my questions are:
1.Would it be possible for me to switch from the surg year to a med prelim instead?
2. What consequences would there be?
3. Would I need to tell my surg PD before even applying for the medicine vacancies?
4. Would I mention the malignancy of my current program to the med programs or just the fact that I hate surgery and ended up in this position due to SOAP (didnt apply to enough med prelims)
5. How would I ask my advanced program if this would affect my spot?
6. Does the 45 day rule of NRMP apply here?
7. I've heard that if I leave, I'll be required to state on all future licencing documents that I was unable to finish a training program. How much of an effect does this really have given it wasn't my primary categorical program?

Please offer any advice you can. Thanks.
 

ThoracicGuy

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Jun 11, 2013
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I really hate my current prelim surgery program because it is super malignant and abusive. Every single day I come home and non-stop cry myself to sleep due to the horrible environment and bullying and feel I definitely cannot go on. Its not the hours (which are also horrible) but just the environment. I already have a pgy2 spot for my advanced residency next year(its a ROAD spot) and I have heard of many pgy-1 med prelim year openings. So my questions are:
1.Would it be possible for me to switch from the surg year to a med prelim instead?
2. What consequences would there be?
3. Would I need to tell my surg PD before even applying for the medicine vacancies?
4. Would I mention the malignancy of my current program to the med programs or just the fact that I hate surgery and ended up in this position due to SOAP (didnt apply to enough med prelims)
5. How would I ask my advanced program if this would affect my spot?
6. Does the 45 day rule of NRMP apply here?
7. I've heard that if I leave, I'll be required to state on all future licencing documents that I was unable to finish a training program. How much of an effect does this really have given it wasn't my primary categorical program?

Please offer any advice you can. Thanks.

1. No, you'd likely be delayed graduation and thus unable to start your advanced position
2. See #1
3. That would be appropriate.
4. Talking down on your program like that probably would raise a few eyebrows.
5. If you can't start your advanced program on time then it would affect your spot.
6. Yes, of course it does.
7. You will have to explain it in all license and privilege applications.

Basically, you ended up getting a prelim spot that will allow you to do your chosen training. Yeah, it may suck and you may hate it. You also really have no options of switching without putting your advanced spot in jeopardy. So, suck it up and finish your year.
 
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AdmiralChz

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Your story is not unique and you are not alone, unfortunately. This is why those not interested in surgery should consider steering clear from surgical prelims if at all possible - I am sure there are some (or many!) programs out there that offer a wide collection of rotations and experiences with good working conditions, but the stereotype of these types of programs are exactly what you describe, OP and stereotypes exist for a reason. The surgical prelim year at my residency was particularly bad, they had difficulty filling giving its poor reputation and essentially just took die-hard surgical applicants (unfortunately largely IMGs) who are surgery or bust. The worst is that some even continue the dead-end road into prelim PGY-2 year.

But to cut to the chase, there isn't much you can do. Honestly this is why you interview and fully evaluate a program (even prelim) before you rank them highly or accept the SOAP offer (if this was your only choice, I apologize). It would take too long to train you up at a new institution, get you credentialed/EMR trained/possibly different state license/etc... Plus, advanced positions require completion of a 12 month ACGME internship so any delays could risk you losing your advanced spot depending on how nice they are. You are better just doing the best you can to finish the year - remember, it is only one year and then you have a landing spot where you will never have to look back. Plus, all internships have different rotations so perhaps your next one won't be quite as bad.

Finally, you could consider talking to someone about the malignant environment (you left it pretty vague, actually, only a couple sentences) if it is affecting your ability to care for patients. You are a warm body to write H&Ps/notes/(and especially)discharge summaries so it is in their best interest to keep you around - that someone could be a chief resident, attending or even PD. But keep in mind surgeons are probably the least sympathetic to complaints about workplace environments/hours, even if it isn't "allowed" a formal complaint from you could land you in their crosshairs making the rest of the year even worse.
 
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