Switching residencies

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medsurg

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Hello everyone. So I am a surgery intern. My first month is in the SICU which I actually really enjoy. I was pretty unhappy on match day when I found out I matched at my 9th choice, but I moved to the area with the complete intention of putting my best foot forward, working hard, and making the best of the situation. However, I am very unhappy at this program. I realize this is just the first few weeks, but I was unsure about surgery from the beginning. I loved it during medical school and thought I would give it a shot because I'd regret not knowing if it was for me or not. I have decided it is not for me. I do not mind the work at all and actually enjoy taking care of pre and post surgical patients, but the environment is horrendous. The residents constantly find something to yell at you about or embarass you in front of everyone. I expected such treatment from attendings, but not from fellow residents. There is not an iota of professionalism in this residency program...at least not amongst residents. I am sure that there are much worse programs than this, but I do not thrive in this environment. Toward the end of my 4th year of medical school, I became more interested in family medicine and love outpatient work. I am pretty sure I'd like to switch into that or IM.

That being said, I would really appreciate hearing from others that have switched residencies how they went about it. When is a good time to tell the PD? Should I go through the match again or try to speak to hospitals individually? Any and all help would be wonderful!

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If you are really set on FP or IM call your school and go back through the match. They need to give you a code to access to the website. If you like surgery and feel it is just where you are then look into transferring. I am doing my residency at a community hospital in ortho and the first 6 months is gen surg/trauma surg. The attitude here is totally different than at big university programs. friendly (for the most part, helpful happy people) That is why I wanted community. Just decide what you really don't like surgery or where you work. good luck
 
but have you given any thoughts to anesthesia? I know it doesnt have the outpatient setting you mentioned liking, but it is still in the OR and you did mention enjoying the your ICU time this month (it would only be a +1 yr fellowship after CA-1-3 years to do Critical care and be an ICU dotc too)... It is also common for gen surg folks to switch in to anesthesia for their PGY-2 year. Most of the people in anesthesia are less malignant as a whole (at least that seems to be common opinion). Anyway, just a thought, and good luck, as an MS4 I can only imagine what you are going through!
 
That being said, I would really appreciate hearing from others that have switched residencies how they went about it. When is a good time to tell the PD? Should I go through the match again or try to speak to hospitals individually? Any and all help would be wonderful!

The ease with which you can transfer out of one program and into another program varies by program and by specialty. Some programs, for example as in psychiatry (eg., Stanford and University of Washington), have set aside a certain number of slots for incoming PGY2 residents; some of the new PGY2's switch from other psychiatry programs whilst others switch from other specialties. The PGY2-4 cohorts at the University of Washington are populated with numerous people who formerly trained in family medicine, internal medicine, ophthalmology, obstetrics/gynecology, and surgery; some of them finished their prior residency programs whilst others finished only the PGY1 year.

That said, I don't know of any internal medicine programs that have spots set aside from incoming PGY2 transfers. If you can't locate any programs with set-aside PGY2 spots, then basically you either (1) cold-call residency programs to inquire about whether or not they anticipate having any open PGY2 spots, or (2) check various clearinghouses that post residency program vacancies. In psychiatry, for example, the APA maintains a Web site with listings of vacant residency positions; I do not know whether there is an analogous site for internal medicine -- you may wish to do some research and check the Web sites of groups like the AMA and the ACP.

In terms of whether it will be easy to transfer out of your present program, it would be hard for anyone to make an objective assessment without more details/history. Sometimes the process can be very easy. At Duke, for example, a few years ago one of the medicine interns started thinking early on that she wanted to switch into psych, and it just so happened that around the same time one of the psych interns was looking for a back door into the Duke medicine residency. So basically what happened is that they met with their respective program directors (medicine and psych), and then met with the program directors of the other programs (psych and medicine) -- and once the program directors signed off on the switch, they did so. I think the switch happened sometime in January. As another example, one of my friends wanted to switch out of his general surgery program near the end of his PGY2 year. It just so happened that around the same time one of the anesthesiology residents dropped out as a CA1. So my friend spoke with the anesthesiology program director, sent in his application materials, and he was accepted some time around April to start as a CA1 (so yes, his PGY2 year basically didn't count) in July.

Regardless of how the PGY2 spots are open, you generally send in your application by September, which is about the time you would apply if applying as a new intern in the regular Match. Some programs take PGY2 transfer applications through the Match process whereas others do not.

Scheduling your interviews as an intern is fraught with difficulty. The people I know who switched out of internal medicine programs basically scheduled their interviews during a clinic block and begged their attendings to look past their absences. If scheduling interviews was that difficult for my internal medicine colleagues, I can only imagine that it would be even more difficult for you as a general surgery intern.

I would recommend that you let your program director know of your intentions early on. From your program director's perspective, losing a resident is a pain in the ass, especially if the wards are resident-dependent; because then s/he will need to find a new resident to cover the quitting resident's duties. High-quality residency programs generally don't have a problem finding new residents to transfer in. But it's kind of like the global market for doctors: the U.S. poaches doctors from Canada and the U.K., Canada and the U.K. poach doctors from South Africa, and so forth. So programs at the bottom of the barrel in terms of quality tend to get the shaft. However, it can be difficult even for top programs to replace a departing PGYII, i.e., a 3-year program will need to find a new PGYIII. For example, Stanford's emergency medicine residency recently lost one of its PGYII's (who transferred out to follow her husband geographically), and they were unable to recruit a resident who would join as a PGYIII -- so last year, all of the PGYIII's had to give up their "research week" (read: under the table vacation week) because the program director needed them to cover the shifts.

Aside from the obvious reason that you should be a nice person and let your program director know as soon as possible about your intentions to transfer, there is also nothing to be gained by keeping it from your program director. You will have to let her know sooner or later. And besides, most programs will require you to provide a letter from your program director that is at least a letter of good standing ("Dr. So-and-So is a resident in our program and he hasn't been kicked out yet") or better yet is a letter of recommendation ("Dr. So-and-So is a resident in our program and I was sorry to hear that she wanted to transfer out, but I think she would be an asset to your program").

In the worst case scenario, your program director will be extremely unhappy that you have decided to transfer out, and he will be so pissy that you won't want a letter of recommendation and would prefer that he simply write a letter of good standing instead.

If you begin the process of applying to transfer, you do not necessarily have to resign your PGYII slot at your original program. Again, that may vary from program to program, but I haven't heard of it happening. But it depends on the timing. An important issue for you to consider is that around January is when residents generally sign their contracts for the PGY2 year. There is a possibility that by then you will not have heard back from the programs to which you are applying to transfer. In such a situation, you would be faced with the terrible decision: (A) sign the PGY2 contract and prematurely forfeit the opportunity to transfer out; or (B) do not sign the PGY2 contract and take the risk of not getting accepted as a transfer, in which case you will not be in any program at all come July.

-AT.
 
I would probably gear up to re-apply through the match and definitely get another ERAS token to use the web site to upload your application. But at the same time, put out a bunch of feelers (call, email, etc) to potential programs you could be interested in. It's family medicine -- you probably have a good chance at getting an outside-the-match offer and signing on right away without going through the match. That way, if you receive an out-of-match offer and it appeals to you, you can take it -- but if you don't get one, or if you don't like the offers you get, you can suck it up and go through the match.

Keeping in mind that you are still in your first two weeks, your feelings about your current residency will change a lot over the next few months. I am not surprised that you feel awful all the time -- you barely even know where the bathrooms are right now, and you can barely do anything without asking someone whether this is the right thing to do. You are at a time in your career when you are especially vulnerable to criticism, whether constructive or not. Because of your newness to the job, at best you'll be told what to do (which is often humbling), and at worst you'll be yelled at (which is usually humiliating). To some degree or another, every one of us has this experience.

As you learn the ropes, you will know better when to be cautious, when to speak up, and when it's best not to mention anything or ask questions at all. This takes time. You will learn the medicine fast (you know, what to do for chest pain / abdominal pain / fever / etc) but it will take weeks to months to become smart about the workplace politics. You are in a large organization and, especially having been a student previously, it is not uncommon for you to misstep without knowing it and to raise some ire. You can't do anything about this, you will get better at avoiding sparks later on, you'll grow some thicker skin, and in a few weeks you will have things more or less down to a routine and it won't be as scary or overwhelming.

Your internship will almost definitely get better -- but if you like FM, don't let it sway you -- I doubt you will look back and regret going into FM if you do it now.
 
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