Switching Specialties From IM to Patho

[mat7702]

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Hello everyone.

I wanted to get y'alls advise. I am a non-US IMG who recently matched into IM (which was my backup option, with Patho being my priority) on a J1 visa. I had 6 IM IVs and 2 Patho IV. I should have been clear on what I wanted to pursue prior to ranking and not applied IM solely just to match but reality has hit and it is clear to me IM is not something I want to do for my whole career. I wanted to ask if anyone has switched specialties before and what the process is like.
Some credential info : Step 1 Pass, Step 2 248, Step 225, YOG 2023, 7 months USCE (with only one month of it being for Patho)

- How significant is the funding issue since pathology is a longer residency?
- If I apply for the 2026 Match during my PGY1, is that a NRMP violation (since I would be able to submit the waiver before the 15th of Jan)
- If I apply for the NRMP waiver after 45 days, is there a possibility to re-sign as a PGY2 IM if my PD wants to keep me onboard?
- If I left after PGY1 and haven't secured a Patho residency, what happens with the J1 visa?

Any help would be greatly appreciated, thank you.

 

[gutonc]

Hello everyone.

I wanted to get y'alls advise. I am a non-US IMG who recently matched into IM (which was my backup option, with Patho being my priority) on a J1 visa. I had 6 IM IVs and 2 Patho IV. I should have been clear on what I wanted to pursue prior to ranking and not applied IM solely just to match but reality has hit and it is clear to me IM is not something I want to do for my whole career. I wanted to ask if anyone has switched specialties before and what the process is like.

Switching specialties is just like applying the first time. Only you'll be doing it as an intern with limited time off for interviews.

Some credential info : Step 1 Pass, Step 2 248, Step 225, YOG 2023, 7 months USCE (with only one month of it being for Patho)

A few more questions. How many path programs did you apply to? Interview at? What have you been doing since graduation?

- How significant is the funding issue since pathology is a longer residency?

Not really that big of an issue and by far the least of your concerns.

- If I apply for the 2026 Match during my PGY1, is that a NRMP violation (since I would be able to submit the waiver before the 15th of Jan)

No

- If I apply for the NRMP waiver after 45 days, is there a possibility to re-sign as a PGY2 IM if my PD wants to keep me onboard?

Once you finish 45d in your IM program, you've technically fulfilled your match contract and no waiver is required. Whether or not your PD will want to keep you on after you've told them you don't want to be an internist is a different question and one that nobody here can answer.

- If I left after PGY1 and haven't secured a Patho residency, what happens with the J1 visa?

It's gone and then you're gone.

 

[mat7702]

Switching specialties is just like applying the first time. Only you'll be doing it as an intern with limited time off for interviews.

A few more questions. How many path programs did you apply to? Interview at? What have you been doing since graduation?

Not really that big of an issue and by far the least of your concerns.

No

Once you finish 45d in your IM program, you've technically fulfilled your match contract and no waiver is required. Whether or not your PD will want to keep you on after you've told them you don't want to be an internist is a different question and one that nobody here can answer.

It's gone and then you're gone.

Thank you so much for responding, I really appreciate it.

I applied to 70ish path programs, interviewing with 2. I knew going in to the match my application was IM heavy so the liklihood of IVs was going to be limiited but I wanted to give it a shot. I am planning on doing a rotation for patho before residency starts inorder to strenghten my CV and get another LOR.
Since grad, I had been doing 4 months of USCE, Step 3 and some research projects.

 

[NotAProgDirector]

Your story is atypical because in general pathology is considered less competitive than IM. So usually if you're a reasonably competitive IM candidate, you'd have no problem matching in pathology.

As already stated, you won't need a waiver. But applying again while a PGY-1 can be complicated. Your program may give you time off to interview, or they may require that you use your vacation / PTO. The biggest problem you can run into is that the match is in late March, and your program may want you to commit to a PGY-2 prior to that. If you don't, then they will work to refill your spot with someone else. Then if you don't match, you will be scrambling for something new.

As mentioned, if your training comes to an end, you will need to leave the US as your J visa will also come to an end. You do get a 30 day grace period.

Also, on a J visa you can only switch specialties once, and only before the PGY-2. So any switch to pathology is irreversible.

So the bottom line comes down to why you only got 2 Path interviews. Perhaps programs felt you were applying to Pathology as a backup to IM - this is the danger when you try to craft your application to cover more than one field. Perhaps another application round will be more successful. Your IM program might, or might not, support this plan. If not, then you're risking quite a bit by pursuing it -- but it's your choice.

 

[mat7702]

Your story is atypical because in general pathology is considered less competitive than IM. So usually if you're a reasonably competitive IM candidate, you'd have no problem matching in pathology.

As already stated, you won't need a waiver. But applying again while a PGY-1 can be complicated. Your program may give you time off to interview, or they may require that you use your vacation / PTO. The biggest problem you can run into is that the match is in late March, and your program may want you to commit to a PGY-2 prior to that. If you don't, then they will work to refill your spot with someone else. Then if you don't match, you will be scrambling for something new.

As mentioned, if your training comes to an end, you will need to leave the US as your J visa will also come to an end. You do get a 30 day grace period.

Also, on a J visa you can only switch specialties once, and only before the PGY-2. So any switch to pathology is irreversible.

So the bottom line comes down to why you only got 2 Path interviews. Perhaps programs felt you were applying to Pathology as a backup to IM - this is the danger when you try to craft your application to cover more than one field. Perhaps another application round will be more successful. Your IM program might, or might not, support this plan. If not, then you're risking quite a bit by pursuing it -- but it's your choice.

Thank you for answer. I think you're right about programs feeling I was applying to them as a back up since my application was crafted for both. I had naively hoped that all the USCE (even the IM ones) might help me out for Patho. Since I am still within the 5 year YOG criteria, I felt this was my last shot to go big or go home but definitely it is a big risk considering the IM program probably won't be thrilled if I go down this route.

If I have a gap between residencies, does it create challenges for applying for a J1 again?


Additionally I'm also not sure if PDs will see me leaving a program as a red flag.

 

[airwaycart169]

Interesting…when i was applying I wanted IM more than Pathology but got the latter…then was able to reapply and switch after…