switching to anesthesiology vs double applying

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Mar 9, 2002
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Does anyone know how hard it would be to find an anes spot if I matched in peds but decided to switch to anes after my peds internship?
I'm trying to decide if its better to double apply right now in peds and anes, or to just match in peds and try to switch after intern year if I'm not happy (by then I'll have done nicu, which is what I'm trying to compare with peds anesthesiology).
Advice anyone? Thank you.

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it might be easier to ask a NICU attending if you can shadow/work with them NOW even if it is on the weekends, on call, whatever, to get that experience and comparison before you start the match process. it might not be feasible to schedule a month elective now but if you approach an attending and explain your situation you might get a chance to work a couple of shifts there with other residents, and will surely get some insight regarding the differences between NICU and peds gas, if only from what the attending has to share from his/her experiences.

while theoretically you can use your peds internship as the first year for anesthesiology, you might not meet all the requirements and find yourself doing extra months before graduation as well.
Trying to switch to anesthesia during your prelim year will be more difficult that matching outright because there are fewer spots available. Some programs have spots open, but the number is substantially less. The other option is to reapply through the match and figure out what to do with that extra year you would have to wait.

Another option would be to do a pediatrics prelim year. MCW offers one, and other institutions may also. It would likely be easier to do the peds prelim year and then choose to stay in peds than start a peds residency and get an anesthesia spot at a good program outside the match. I know I could have easily stayed in internal medicine after my internship had I chosen to do so.

The best option is to figure out now what you want to do. I'd suggest an anesthesia rotation with a little time in peds anesthesia (not a ton because you won't get to do as much, but enough to see if you like it), if that's what really interests you, and a NICU rotation.

The ACGME web site has info regarding the clinical base year (internship).

"At least 6 months of the CBY rotations must include experience in
caring for inpatients in internal medicine, pediatrics, surgery, or
any of the surgical specialties, obstetrics and gynecology,
neurology, family medicine, or any combination of these. In
addition, there should be rotations in critical care and emergency
medicine, with at least one month, but no more than two months,
devoted to each. Up to one month may be taken in anesthesiology.
Rotations should ensure continuity of teaching and clinical
experience. Each month of training may be counted only once.
For example, a rotation in a pediatric intensive care unit may count
as either a month in pediatrics or a month in critical care medicine."
The above posts are correct. Although many people do obtain a spot in anesthesia by switching (there are lots of open spots) and your chances of being successful are good, it is much easier to match in anesthesia in the first place than to switch to it. Here are some factors to think about:
  • The most desirable programs will fill most of their spots in the Match and it will be very difficult to score one of their permanent outside-the-Match positions unless you are a really special candidate (top academic in a foreign country, etc).
  • The range of available open spots is much smaller and you would almost certainly end up at a less desirable program than if you matched as a student.
  • It is NOT easy to get time off to interview as an intern, and if you're in a categorical peds program it's also politically awkward to have to say you want to leave.
  • The sheer amount of work it requires to apply and interview during your internship makes it unlikely that you will go through and complete the applications unless you REALLY dislike your current place and specialty. It will definitely be much easier to stay where you are.

If you still cannot decide right now and money is not an issue, I would recommend double applying in ERAS and just declining the interviews later. You'll probably be pissed that you wasted so much money by the time you decide, but this situation is still much easier than applying/interviewing to any specialty at all (not just anesthesia) as an intern. If you end up applying for a switch as an intern, you can probably successfully get a spot but you will kick yourself for the sheer amount of effort you have to put in.