Switching Specialty during Prelim year

[ShroedingersMatch]

Hey everyone,

I am currently completing a surgical prelim year. I have an advanced position in anesthesia next year but would like to switch into a surgical residency. Can anyone comment on the steps to go about switching residency specialty without getting an NRMP violation? Does this difference in length of residencies between Anesthesia(4yrs) and Surgery(5yrs) really hurt my chances at matching? Also, any advice on this topic would be greatly appreciated.

Thanks!

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[ThoracicGuy]

Hey everyone,

I am currently completing a surgical prelim year. I have an advanced position in anesthesia next year but would like to switch into a surgical residency. Can anyone comment on the steps to go about switching residency specialty without getting an NRMP violation? Does this difference in length of residencies between Anesthesia(4yrs) and Surgery(5yrs) really hurt my chances at matching? Also, any advice on this topic would be greatly appreciated.

Thanks!

Have you talked to your current PD to see if you are a viable candidate for a spot? If you are a strong candidate, then maybe go for it. If not, then you still have anesthesia.

 

[ddjamb]

Have you talked to your current PD to see if you are a viable candidate for a spot? If you are a strong candidate, then maybe go for it. If not, then you still have anesthesia.

Even if he is a viable candidate for a spot in surgery, he still needs a waiver as he has a commitment in an advanced position.
Sorry, to my knowledge, I don't see any way out without a Waiver.

 

[gutonc]

Even if he is a viable candidate for a spot in surgery, he still needs a waiver as he has a commitment in an advanced position.
Sorry, to my knowledge, I don't see any way out without a Waiver.

Incorrect. If you are switching from an advanced Match spot to a completely different specialty, the waiver is automatic. So, if the OP changes to Gen Surg (or Rads, PMR, Psych...anything but Anesthesia), the waiver is not an issue.

 

[NotAProgDirector]

I'm assuming you're currently a prelim GS resident, presumably just started 2 months ago, matched to Anesthesia for July 2019.
In that case:

1. You request a match waiver by December, due to specialty change. The waiver is automatic, you will get it as long as you apply in time.
2. It's a match violation to look for a new spot prior to the waiver. So, although it may be terrifying, what you're supposed to do is get the waiver now, then look for PGY-2 surgery positions.
3. If your plan is to apply in the match for PGY-1 surgery positions, then you need the waiver first.

What you can't do is hold onto your Anesthesia spot "just in case" while looking for a surgery spot. You probably can do this up until December, as it's unlikely the NRMP would be able to figure out that you were looking for a new spot. But if they do find out, you could get a match violation. Would that matter? Unclear, since you wouldn't need to match again for 5 years, and most match bans are only 3 years long.

 

[GoSpursGo]

Honestly, I think talking with the surgery PD at your prelim location is probably step 1. If he thinks you're a viable candidate/would consider you for a PGY-2 if he had a position or PGY-1 if you applied via ERAS, then you can think harder about whether to move on with your waiver plan. While that might be skirting around the edges of what is and isn't "legal," I don't think you're going to get in trouble for expressing interest in a surgical specialty to your surgical PD. Realistically, given that you are in a surgical TY that isn't going to afford you a lot of time to fly around on interviews, your best chance to find a spot is probably at your current institution, provided that they have a categorical program.

If even the PD at your home institution thinks it's a bad idea, then it's probably a bad idea and you should move on.

 

[ddjamb]

@gutonic. How is that incorrect. Even if it is automatic, he still needs to request a waiver right?

Per 2.5 Waiver of the Match Results: Applicants The NRMP, in its sole discretion, may grant to an applicant a waiver of the binding commitment to a program if the NRMP determines that the fulfillment of the commitment to the results of the Main Residency Match would cause serious and extreme hardship to the applicant. An applicant who matched to or accepted an advanced position also may request a waiver if the applicant has elected to change specialties, provided the waiver is requested no later than December 15 prior to the start of training. The applicant must request the waiver in writing and must send the request to the NRMP with a copy to the program to which the applicant matched or in which the applicant accepted a position. The NRMP will investigate the waiver request to determine whether or not the waiver shall be granted.

I also found this:
Per Section 2.5 below, the NRMP will approve a waiver based on change of specialty provided the request is made for an advanced PGY-2 position that commences the year after the Match. Applicants who match to PGY-1 categorical or preliminary programs in the year of the Match do not qualify for waivers based on change of specialty.

The example they were given was an applicant who matched into Pediatrics and after the match requested a waiver for a Ortho position and it was denied.

 

[NotAProgDirector]

You're both correct. He needs a waiver, but the application process is straightforward and the reason "change of specialty" will be accepted as long as he applies before Dec 15th. I think gutonc was just trying to say that getting the waiver is the easy part of the process.

 

[gutonc]

You're both correct. He needs a waiver, but the application process is straightforward and the reason "change of specialty" will be accepted as long as he applies before Dec 15th. I think gutonc was just trying to say that getting the waiver is the easy part of the process.

Correct. The waiver must be requested. But it will be more or less automatic...assuming it’s done on schedule.

 

[ShroedingersMatch]

Thanks so much for all of your help everyone! I was also wondering if anyone knows about how the discrepancy in training length, switching from anesthesia (4yrs) to gen surg (5yrs) will affect my funding? My PD has expressed that I am a viable applicant but they do not seem to know much about the difference in funding. I would like to inform them so that they can inform me now if my funding would be an issue, instead of finding out in March that they can't actually take me because of funding.

 

[gutonc]

Thanks so much for all of your help everyone! I was also wondering if anyone knows about how the discrepancy in training length, switching from anesthesia (4yrs) to gen surg (5yrs) will affect my funding? My PD has expressed that I am a viable applicant but they do not seem to know much about the difference in funding. I would like to inform them so that they can inform me now if my funding would be an issue, instead of finding out in March that they can't actually take me because of funding.

Your funding clock doesn't start until you begin a categorical position, so that's not an issue.

And it's depressing as hell that the PD has no clue about this.

 

[NotAProgDirector]

Your funding clock doesn't start until you begin a categorical position, so that's not an issue.

And it's depressing as hell that the PD has no clue about this.

https://members.aamc.org/eweb/upload/Medicare Payments for Graduate Medical Education 2013.pdf

It's complicated. According to this, your IRP is set when you match, not when you start. Worst case scenario, you'd have 4 full years of funding and the last year would be 50% IME, assuming you don't have to repeat the PGY-1. If you re-match into a surgical PGY-1, then you'll have 2 years of decreased funding.

 

[frustrated IMG]

Hello.. i am an img from pakistan in my final year.
Failed ck .. i have a 220 on step1 ... will i ever be able to get into preliminary surgery?
If i apply next year with 240 on ck nd step3 as well.
I just need a shot at prelim surgery to prove that i am capable enough.