Switching speciality during or after PGY-1

[kazeekm]

I'm under a lot of stress over this question for the past several days. I had always wanted IM but due to a very weak profile, I was encouraged to apply Peds, FM too. I only got 1 IM IV and matched Peds, to start in July this year.

I want to participate in the Match again (and also look for open/off-cycle positions) to try IM one last time.

My concern:
If I don't match again (more likley outcome) and my PD fills with someone else for PGY2.

My profile in 2024 when I applied:
US Citizen IMG
YOG: 2013
Step 1: Pass (1st attempt)
Step 2: 223 (1st attempt)
USCE: 0

Since then, I've done 1 UCSE in Jan and my plan is to complete 1 outpatient in April and 1 inpatient USCE in May (before starting peds residency). And pass Step 3 before next cycle. I don't know whether my other 2 red flags (2013 YOG and 223 Step 2) have permanently sealed my fate out of IM.

1) Has someone done something similar? Please share your thoughts/advice.
2) Any guidance/feedback on how to attempt IM one final time while minimizing risk with my current peds program/PD.
I'll be extremely grateful for any advice 🙏

NotAProgDirector was gracious enough to share thoughts over DM.

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[GoSpursGo]

Quite frankly, it’s miraculous you matched at all 12 years after graduation with no USCE. I think you got your answer on your level of competitiveness for IM last time. If you were not willing to be a pediatrician then you shouldn’t have applied.

I would take your match and run with it. I think your concern that you could lose your spot by trying to reapply during pgy1 is valid

 

[smq123]

The 2013 year of graduation isn’t a red flag - it’s an enormous red cape being waved in a bullfight.

The fact that you matched at all is a gift. As GoSpurs said - take it and run.

 

[LucidSplash]

As others have said, but to put it bluntly: Don’t be a fool. Nothing has changed about your application since you applied and only got one solitary IM interview. A second attempt will yield worse, not better, results. Take the gift you were given in peds and don’t look back.

 

[kazeekm]

I think you got your answer on your level of competitiveness for IM last time.

Yes, it's a miracle for me, I agree.

Last time I applied with 0 USCE and no Step 3. And applied around 70 programs. This year I can apply with 3 month USCE and Step 3. And can do 150-200 programs.

That would be the only difference. Other things are out of my control.

 

[smq123]

Yes, it's a miracle for me, I agree.

Last time I applied with 0 USCE and no Step 3. And applied around 70 programs. This year I can apply with 3 month USCE and Step 3. And can do 150-200 programs.

That would be the only difference. Other things are out of my control.

An additional year out from med school doesn't do you any favors.

 

[kazeekm]

The 2013 year of graduation isn’t a red flag - it’s an enormous red cape being waved in a bullfight.

Yes I agree fully. I fully understand that

 

[GoSpursGo]

Yes, it's a miracle for me, I agree.

Last time I applied with 0 USCE and no Step 3. And applied around 70 programs. This year I can apply with 3 month USCE and Step 3. And can do 150-200 programs.

That would be the only difference. Other things are out of my control.

One more thing is in control—you can choose to not reapply.

Ultimately it is your career, but I think it would be a mistake to try again

 

[NotAProgDirector]

The best plan is to complete your peds program, and put your full effort into that. if you get distracted by trying to apply to 200 IM programs, start missing work for interviews, etc, you could really run into trouble.

When you are a PGY-3 in peds, perhaps you'll discover you're really happy in it. Then, you get a job and move on. If you still pine for IM, then you apply in your PGY-3 year. Now you have a whole residency behind you, your PD can write you a great letter. If you match - you complete an IM residency. If not, you work in peds. This is the path forwards.

 

[NotAProgDirector]

The above assumes you don't need a visa. If you do, then you're doing peds and that's it. You can't change specialty on a J visa after the PGY-2, and if you're on an H you need to use that to get a job to start the GC process.

 

[kazeekm]

As others have said, but to put it bluntly: Don’t be a fool. Nothing has changed about your application since you applied and only got one solitary IM interview. A second attempt will yield worse, not better, results. Take the gift you were given in peds and don’t look back.

Not being a fool is my intent, which is why I was seeking advice on this.

In terms of change: Last time I applied with 0 USCE and no Step 3. Applied around 70 programs. This year, I can apply with 3 month USCE and Step 3. And can apply 150-200 programs. That would be the only changes since last year.

 

[kazeekm]

The above assumes you don't need a visa. If you do, then you're doing peds and that's it. You can't change specialty on a J visa after the PGY-2, and if you're on an H you need to use that to get a job to start the GC process.

Yes, no visa needed. I'm US citizen IMG.

 

[Apollyon]

I have lived my entire life as emergency medicine - I have driven an ambulance more miles than you likely have driven. Then, med school and EM. And the only thing that ever nearly took my eye off EM? Peds. I even did a prelim IM year, and, like Jim McMahon said of BYU, "the best view of IM was in the rear view mirror".

You're in, and either amazingly lucky or God blessed or whatever, but, take your spot with gratitude and "Git 'er dun"!!

 

[kazeekm]

I have lived my entire life as emergency medicine - I have driven an ambulance more miles than you likely have driven. Then, med school and EM. And the only thing that ever nearly took my eye off EM? Peds. I even did a prelim IM year, and, like Jim McMahon said of BYU, "the best view of IM was in the rear view mirror".

You're in, and either amazingly lucky or God blessed or whatever, but, take your spot with gratitude and "Git 'er dun"!!

Seeing all the comments here, I appreciate them all. It's a very emotional moment for me right now, to accept and come to terms.

I really wish I had not applied last year and then applied this year with USCE + Step 3 + more programs.

The counterfactual thinking in a small part of me keeps telling me that had I applied with USCE+S3+more programs, I might have matched IM ---- AND if I still had not matched, then I would know that there is nothing else I could have done.

(I think this phenomenon is known in psychology. If we can't imagine anything we could have done differently, it's easier to accept an unfavored outcome.)