Switching into PGY-2 Medicine?

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MedicalDoctorV

MedicalDoctorV

Internal Medicine Hospitalist
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I have decided that I want to leave Ophthalmology and go back to Internal Medicine as a PGY2 (I already completed a Medicine PGY1 last year 2008-2009 as a prelim for entering into ophtho). I am a MD from a US Medical School. I completed my PGY1 Medicine year at a university affiliated program in Manhattan and now am at an upper tier ophtho program in Manhattan.

Problem is, no one seems to have any PGY2 medicine openings starting this coming July... I must have sent out 50+ emails and I am not being picky with respect to university vs community programs - nor am I binding myself to any particular city (yes, I have only been exploring East-Coast programs). All the responses I have received have been some variation of "great CV, sorry I have nothing to offer you."

Is is just too early in the year for program directors to know if they will have openings? Or am I doomed to having to take a year off, and applying through the match for PGY1 spots?
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Ophtho8 said:
I have decided that I want to leave Ophthalmology and go back to Internal Medicine as a PGY2 (I already completed a Medicine PGY1 last year 2008-2009 as a prelim for entering into ophtho). I am a MD from a US Medical School. I completed my PGY1 Medicine year at a university affiliated program in Manhattan and now am at an upper tier ophtho program in Manhattan.

Problem is, no one seems to have any PGY2 medicine openings starting this coming July... I must have sent out 50+ emails and I am not being picky with respect to university vs community programs - nor am I binding myself to any particular city (yes, I have only been exploring East-Coast programs). All the responses I have received have been some variation of "great CV, sorry I have nothing to offer you."

Is is just too early in the year for program directors to know if they will have openings? Or am I doomed to having to take a year off, and applying through the match for PGY1 spots?
Click to expand...

Why drop out of ophthalmology, out of curiosity? How do you know so early on? I assume you've only been doing ophtho stuff for only these 7+ months now...It just seems to me that perhaps it is too early to tell...it takes a lot of work to match to a top tier ophtho program, I assume you had strong reasons for wanting to enter the field in the first place. Are you 100% sure you want to give that up, has your experience been that bad? Did you enjoy intern year medicine so much? Were you perhaps doing a very cush prelim year?
 
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Ophtho8 said:
I have decided that I want to leave Ophthalmology and go back to Internal Medicine as a PGY2 (I already completed a Medicine PGY1 last year 2008-2009 as a prelim for entering into ophtho). I am a MD from a US Medical School. I completed my PGY1 Medicine year at a university affiliated program in Manhattan and now am at an upper tier ophtho program in Manhattan.

Problem is, no one seems to have any PGY2 medicine openings starting this coming July... I must have sent out 50+ emails and I am not being picky with respect to university vs community programs - nor am I binding myself to any particular city (yes, I have only been exploring East-Coast programs). All the responses I have received have been some variation of "great CV, sorry I have nothing to offer you."

Is is just too early in the year for program directors to know if they will have openings? Or am I doomed to having to take a year off, and applying through the match for PGY1 spots?
Click to expand...

Contracts come up pretty soon. You should have a better idea by April/May.
 
I agree with above.
You better be darned sure you want to leave before you do, b/c you ain't gonna get another optho spot if you change your mind again.
That said, I think IM is a good field (admittedly I'm biased). If you want to do it, I really think you should shoot for a decent program and not settle for some lousy program that I think will probably disappoint you. I'm not saying don't go to a community program, b/c there are some good and/or cushy ones...I'm just saying don't settle for any old program.

Can you network by contacting your medical school...perhaps the chair of IM there? You could ask him/her to keep an eye out, let you know if he/she hears of any open spots. And what about the hospital where you are doing your ophtho training?

If you are willing to go out of the northeast, you could cold-call some other programs on the east coast (Duke, U of North Carolina,etc. and I even consider Emory sort of Eastern because they have a fair number of NE people there). You could broaden your search to places like Ohio, Washington U in St Louis, Vanderbilt, etc. if you are willing ot move.

You could wait for the scramble, but there probably won't be a lot of good spots left. However, strange things do happen...such as Duke having several open spots in IM a couple years ago. You are the kind of person that likely would do well in the scramble, relative to many others, because you are going to have good scores, LOR's, etc. and are not leaving some other IM program with a black mark on your record such as being fired. The scramble is just a crap shoot, though, and IMHO the best positions often go unadvertised. We had a couple IM residents join my program while I was there...one transferred from a famous uni IM program because it was in a crappy city, and another bailed out of radiology residency back to IM because she ended up being bored.
 
You should probably sign up for Findaresident. There are always open IM and family practice spots showing up on there.
 
gutonc said:
Something I just realized is that the OP is an ophtho resident in NYC. If I had to guess, this is the reason s/he wants out:
http://more.studentdoctor.net/showthread.php?p=9247684
http://www.nytimes.com/2010/02/03/nyregion/03vincents.html?ref=health

But maybe not.
Click to expand...

Nice guess, but no i am not at St Vincent's for Ophtho. Sad but apparently all the ophtho folks there HAVE to make arrangements effective Feb 28th - they all got letters two weeks ago stating that they no longer had positions. I am looking to finish out my year, my contrast for my first year ophtho position is until June 30th.

I can't bail for multiple reasons - one being rent and loan repayments to make. More than that though, I think it's unprofessional to bail on a program midway through the year AND I don't see how you would get hired into any other field every in the future.

Someone asked why do I want to switch from ophtho? I am actually not miserable in my program, I find the hours/call/workload all to be manageable. I just don't find it interesting - and I just can't see myself in this field next year, let alone 10 years from now as an attending... I think I have seen enough people in various fields that truly LOVE their jobs that I want to be one of those people - and I feel I CAN be in Medicine. As for more concrete reasons:

1. Clinic - can't believe i did not realize i hate clinic while I was in medical school, and now have entered a field where 80% of it (at least) is clinic time
2. Being a super-specialist - it feels kind of odd to have thrown out the window all that I learned in med school and internship
3. I am not interested in the material - I have no motivation to read, I don't find any of the didactics interesting, and I feel that the surgeries I thought would be so fulfilling and "cool" simply are not - granted as a first year you're not really doing the surgeries - more watching/watering the cornea.
 
dragonfly99 said:
I agree with above.
You better be darned sure you want to leave before you do, b/c you ain't gonna get another optho spot if you change your mind again.
That said, I think IM is a good field (admittedly I'm biased). If you want to do it, I really think you should shoot for a decent program and not settle for some lousy program that I think will probably disappoint you. I'm not saying don't go to a community program, b/c there are some good and/or cushy ones...I'm just saying don't settle for any old program.

Can you network by contacting your medical school...perhaps the chair of IM there? You could ask him/her to keep an eye out, let you know if he/she hears of any open spots. And what about the hospital where you are doing your ophtho training?

If you are willing to go out of the northeast, you could cold-call some other programs on the east coast (Duke, U of North Carolina,etc. and I even consider Emory sort of Eastern because they have a fair number of NE people there). You could broaden your search to places like Ohio, Washington U in St Louis, Vanderbilt, etc. if you are willing ot move.

You could wait for the scramble, but there probably won't be a lot of good spots left. However, strange things do happen...such as Duke having several open spots in IM a couple years ago. You are the kind of person that likely would do well in the scramble, relative to many others, because you are going to have good scores, LOR's, etc. and are not leaving some other IM program with a black mark on your record such as being fired. The scramble is just a crap shoot, though, and IMHO the best positions often go unadvertised. We had a couple IM residents join my program while I was there...one transferred from a famous uni IM program because it was in a crappy city, and another bailed out of radiology residency back to IM because she ended up being bored.
Click to expand...

What do you mean scramble? Through ERAS? I was under the impression that the Scramble was only for PGY1 positions? I have already done a prelim internal medicine year, and was looking for a PGY2 medicine spot...
 
OK, well your reasons for leaving ophthalmology sound reaonsable.
You are right, most of the open positions after match day are PGY1. But is seems like there would be some PGY 2 spots open also...but I guess you are right would not be PGY2 IM spots. If you were looking for a neurology spot or something, there might be some open after the Match (thus you could "scramble" for PGY 2 spots also, in theory).

I don't think people were suggesting you bail out in the middle of the year. I agree that wouldn't be so professional and would be burning bridges most likely. However, I think that you need to start looking ASAP for July 1st for IM.

The experience of people who I know who have used Openspots is that a lot of the things posted on there are very out of date, and that is why there are so many. I think Findaresident is more up to date, and fairly cheap. But I still think that the best positions are often word-of-mouth...therefore it might be good to come clean with your current PD and the IM chairmain and/or program director at your current hospital...maybe they know a good place that would have or make a PGY2 spot for you in medicine.
 
hey i am interested in ophthal and am doing PGY1 in internal medicine in the mid west. I actually have the opposite problem, i am a big fan of ophthal and want to do it.
 
loveophthal77 said:
hey i am interested in ophthal and am doing PGY1 in internal medicine in the mid west. I actually have the opposite problem, i am a big fan of ophthal and want to do it.
Click to expand...

Hey -
I wish we could just switch. The problem is that I'm currently in my first year of ophtho and come July 1st I will be a pgy3 (second year ophtho resident). Unfortunately this is the PGY-level that my program is going to want to replace me with.
You're going to have to find an ophtho program where someone in their preliminary year (currently) changes their mind between now and July 1st and decides not to pursue ophtho at all - leaving you with an open first year ophtho spot.
Best of luck! They don't make it easy for any of us once we've chosen a field...
 
hi ophtho 8, yes i know I am actually an ophthalmologist in my home country and thus the interest. It is too bad for i would love to switch. best of luck.
 
Those sound like valid reasons.

Just out of curiousity, were are you leaning right now in internal medicine. Are you thinking strict hospitalist or any of the subspecialities.

Ophtho8 said:
Nice guess, but no i am not at St Vincent's for Ophtho. Sad but apparently all the ophtho folks there HAVE to make arrangements effective Feb 28th - they all got letters two weeks ago stating that they no longer had positions. I am looking to finish out my year, my contrast for my first year ophtho position is until June 30th.

I can't bail for multiple reasons - one being rent and loan repayments to make. More than that though, I think it's unprofessional to bail on a program midway through the year AND I don't see how you would get hired into any other field every in the future.

Someone asked why do I want to switch from ophtho? I am actually not miserable in my program, I find the hours/call/workload all to be manageable. I just don't find it interesting - and I just can't see myself in this field next year, let alone 10 years from now as an attending... I think I have seen enough people in various fields that truly LOVE their jobs that I want to be one of those people - and I feel I CAN be in Medicine. As for more concrete reasons:

1. Clinic - can't believe i did not realize i hate clinic while I was in medical school, and now have entered a field where 80% of it (at least) is clinic time
2. Being a super-specialist - it feels kind of odd to have thrown out the window all that I learned in med school and internship
3. I am not interested in the material - I have no motivation to read, I don't find any of the didactics interesting, and I feel that the surgeries I thought would be so fulfilling and "cool" simply are not - granted as a first year you're not really doing the surgeries - more watching/watering the cornea.
Click to expand...
 
BlueManGroup said:
Those sound like valid reasons.

Just out of curiousity, were are you leaning right now in internal medicine. Are you thinking strict hospitalist or any of the subspecialities.
Click to expand...

So I feel that I will face similar frustrations in GI or Cards. I think I need to go with a broad/head-to-toe specialty like Heme-Onc or Critical Care. I guess hospitalist works also.

What are your thoughts? I am someone that can clearly not be a specialist doing the same 3 procedures over and over again for the rest of my life (no matter how imperative to the patient's health)
 
Ophtho8 said:
So I feel that I will face similar frustrations in GI or Cards. I think I need to go with a broad/head-to-toe specialty like Heme-Onc or Critical Care. I guess hospitalist works also.

What are your thoughts? I am someone that can clearly not be a specialist doing the same 3 procedures over and over again for the rest of my life (no matter how imperative to the patient's health)
Click to expand...

Given your distaste for for clinic, you should consider specialties that will allow you to eventually tailor your practice toward inpatient work. The two most obvious ones would be hospitalist and PCCM, though during training you will still do a fair amount of clinics for both.

I have also seen cardiology-trained hospitalists, covering inpatients for their cardiology group. Also, endocrinologists who only does inpatient consults, and do not see clinic patients. These were both in academic hospital settings, though. It may be more difficult to arrange for this in private practice.

Do you remain interested in procedures? Then cardiology, GI, PCCM. The remainder of the specialties are not so procedure-driven. This could be a deal-breaker for you in terms of heme one.

Finally, GI is still worth exploring, even if you just give it a quick glance before deciding it's not for you. GI is not exactly a single-organ specialty. Hepatology is quite different from general GI. In terms of lumenal GI, if you are in academic setting upper GI (motility, advanced endoscopy/ERCP/EUS) can be different from lower GI (surveillance cscopes, IBD) also.
 
even if there are unmatched PGY1 spots, the program could choose to use the money to hire her as a PGY2.
 
Tons of pgy-2 spots out there. There were 5 this year in California, and I think Kaiser SF hasn't filled their's yet. They are relatively easy to get because demand >>> supply.
 
does Kaiser SF really have open PGY2 positions? does anyone know anything about this program? thanks.
 
Hey ophtho8, just came across this thread and am wondering what became. I'm actually in a similar situation, and have exactly the same reasons as you for leaving ophtho. I've signed up on the 2 resident websites, and yes, there are lots of openings, but no cake at least for me (as everyone's probably wondering why the hell after several years of research in ophtho Im deciding to switch).

I'm also considering applying through ERAS, for PGY 1 positions, but dont know how that would stack up in terms of Medicare funding. Both ophtho8 and I will have used up 2 of our 4 (PGY 1 and PGY2 ophtho) years. Opinions anyone?!
 
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