Switching to more competitive specialty

[mittahrodgers]

I am an incoming PGY-1 Internal medicine resident wanting to try and see if I can switch into ENT. I realized late that I missed the OR and would be willing to do whatever it takes to try and switch my specialty. Was wondering if anyone had any advice. I don't mind going through with the MATCH again and redoe my intern year as a surgical intern. Please let me know what options I may have including agreeing with a program to do research for them for a year etc.

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[operaman]

What are your stats? That’s going to be the key.

If the numbers are solid, then you would probably want to do a research year unless you already have ent pubs from med school.

It’s insanely competitive though, so you’ll need top numbers and you’ll have to work to build connections who can vouch for you. It’s not going to be easy. If you have any connections with the ent dept at your residency or med school, I would start there.

If your numbers are marginal, no ent pubs, no connections, then you’re looking at 2-3 years to build a sub-average application with a very low chance of matching.

If you’re numbers are stellar and you already have connections, then you could start projects now and possibly even mount an application for this coming cycle assuming you can get 4-5 pubs cranked out in a few months and at least get them submitted.

 

[mrbreakfast]

Please let me know what options I may have

Your most realistic option is completing your medicine residency, then reapplying. Depending where you matched, you might also try completing your intern year, then trying to switch into general surgery at your institute (which would mean starting over), but that wouldn't be guaranteed.

Even assuming you would have been competitive for surgery - let alone ENT, which is the second or third-most competitive specialty - you made many consecutive decisions and gave many people assurances in order to match into internal medicine, all of which you now want to undo.

possibly even mount an application for this coming cycle assuming you can get 4-5 pubs cranked out in a few months and at least get them submitted.

OP would be applying as a reapplicant who vacated a residency spot, which they would have to disclose through NRMP. I doubt any ENT program would consider them.

 

[voxveritatisetlucis]

Unlikely

 

[DrStephenStrange]

I know someone who applied Neurology and matched a strong university program last year. This person gave their letter of resignation to their program (after working for a few months) in an attempt to go back into the match and try to match Psych after realizing that’s what they really wanted. They didn’t match psych this year. OP, you’d do better by finishing your current residency program or trying to switch into GS if possible while in IM instead of entering the match again and trying to match ENT which is one of the most competitive fields out there. My $0.02.

 

[operaman]

Your most realistic option is completing your medicine residency, then reapplying. Depending where you matched, you might also try completing your intern year, then trying to switch into general surgery at your institute (which would mean starting over), but that wouldn't be guaranteed.

Even assuming you would have been competitive for surgery - let alone ENT, which is the second or third-most competitive specialty - you made many consecutive decisions and gave many people assurances in order to match into internal medicine, all of which you now want to undo.


OP would be applying as a reapplicant who vacated a residency spot, which they would have to disclose through NRMP. I doubt any ENT program would consider them.

Yeah the odds of matching would be near zero.

OP would need to have been gunning for ent as a student, had top scores and grades, and then decided last minute to go non surgical and regretted it. I could imagine a rare applicant that might have the right stuff, but even then they’d mainly be aiming for their home program where the connections and being a known and liked person could overcome the field switching thing.

 

[GoSpursGo]

+1, ENT is so competitive there is just no reason to consider someone in your shoes unless you’re literally the most stellar applicant of all time and happened to choose IM.

 

[Dantes]

I know someone who applied Neurology and matched a strong university program last year. This person gave their letter of resignation to their program (after working for a few months) in an attempt to go back into the match and try to match Psych after realizing that’s what they really wanted. They didn’t match psych this year.

That's surprising, re-entering the match gives you the most options if you can't find a PGY-2 opening and neuro->psych seems like a do-able switch. Are they without a job now since they gave up the original spot?

I agree IM->ENT would be a tough hill to climb, but would help to know OP's full stats/background.

 

[DrStephenStrange]

That's surprising, re-entering the match gives you the most options if you can't find a PGY-2 opening and neuro->psych seems like a do-able switch. Are they without a job now since they gave up the original spot?

I agree IM->ENT would be a tough hill to climb, but would help to know OP's full stats/background.

Yep, they are without a job now.

 

[voxveritatisetlucis]

Yep, they are without a job now.

Will they reapply for match why not just apply and see what happens before giving up spot

 

[DrStephenStrange]

Will they reapply for match why not just apply and see what happens before giving up spot

They already gave their resignation in the middle of PGY-1 to apply psych in this year’s match.

 

[Tenk]

Yep, they are without a job now.

Why didn’t you look into the future and tell them?

 

[DrStephenStrange]

Why didn’t you look into the future and tell them?

I did and out of millions of possibilities, there was only one where they would actually succeed. Guess this wasn’t it. The eye of Agamotto isn’t perfect lol.

 

[mrbreakfast]

Will they reapply for match why not just apply and see what happens before giving up spot

The two are mutually exclusive. If you apply for the match, you are telling your program you do not intend to complete your residency. They'll advertise a PGY2 spot and replace you whether or not you match elsewhere.

The only people I have successfully seen switch specialties are a) ortho -> IM, b) neurosurgery -> neuro, c) IM -> neuro, and d) someone who matched prelim surgery with no advanced follow-up and then applied neuro while completing their prelim year. The latter person was able to get recommendations from their surgery program, which I think is what saved them.

 

[mittahrodgers]

What are your stats? That’s going to be the key.

250+/260+ with 3 publications. AOA member as well

 

[operaman]

250+/260+ with 3 publications. AOA member as well

Ok that’s better. Assuming your clinical grades match that, you may have a shot. If you have any ent connections at all, now is the time to leverage them.

Your biggest fixable issues are your lack of ent pubs ( I assume those 3 are not ent) and lack of ent letters. You can address both with a good research year but you need to act fast since unmatched applicants are snapping up those slots as I’m typing this. If you have ent contacts at either your school or residency, use those. Your best bet is a place that knows and likes you already.

You basically have five months to put something together if you want to apply next cycle.

 

[Tenk]

I did and out of millions of possibilities, there was only one where they would actually succeed. Guess this wasn’t it. The eye of Agamotto isn’t perfect lol.

It’s probably cause you didn’t give him the finger.

 

[mrbreakfast]

You can address both with a good research year but you need to act fast since unmatched applicants are snapping up those slots as I’m typing this.

This would be fine advice if OP hadn't matched. Unfortunately, OP signed an agreement stating they in good faith intend to attend whatever residency program they match to for a minimum of 45 days after the start date, and anything they do prior to that date to put their good faith in question (e.g. trying to set up a research year, reaching out to other programs about the prospect of joining, etc) would violate that agreement, i.e. a match violation, which may result in a ban from participation in the NRMP in the future.

The by-the-book way of doing this is submitting a specialty change waiver request after those 45 days, then either applying to ERAS after that waiver is approved (which would entail submitting to ERAS after the deadline), or (more feasibly) completing your PGY1 year, then taking a research year or completing your PGY2 year while applying to the match that year (2025). Of course, once you submit that waiver, you program can decide to fire you.

Maybe someone who has actually done this can comment, but I would strongly recommend OP review NRMP policies before making any decisions. My advice remains to complete the residency in which you matched, then reapply.

 

[mittahrodgers]

Maybe someone who has actually done this can comment, but I would strongly recommend OP review NRMP policies before making any decisions. My advice remains to complete the residency in which you matched, then reapply.

Thank you for your advice. I am definitely considering doing this if I'm not too burnt out at the end of this residency lol. Has anyone ever actually completed a different specialty after completing one?

 

[Tenk]

Thank you for your advice. I am definitely considering doing this if I'm not too burnt out at the end of this residency lol. Has anyone ever actually completed a different specialty after completing one?

Yeah, lots of people do. It’s brutal and all the guys I knew doing a second residency seemed to hate every minute. The problem with your situation is this is an uphill battle. For instance, if you had matched ENT and then wanted to do IM, it would be no problem and you could probably match next year. Instead you’re trying to get into a specialty that is not only more competitive but also has just a fraction of the IM spots in the US. You’re also a red flag in that you’re trying to switch specialties. Put yourself in a PD’s perspective: Why would they want you when they have 10+ other applicants with your stats but didn’t start a different specialty first?

My advice: find something in IM that interests you. For instance, my hospitalists at my small site intubate, put in lines and do thoras and other small things. You could also just do a fellowship. I think the ENT ship has sailed for you unless you become golf buddies with a program director somewhere.

 

[Slack3r]

They already gave their resignation in the middle of PGY-1 to apply psych in this year’s match.

This probably had a lot to do with it. Should’ve finished the year, then applied. Quitting halfway through is a very bad look.

 

[mrbreakfast]

Thank you for your advice. I am definitely considering doing this if I'm not too burnt out at the end of this residency lol. Has anyone ever actually completed a different specialty after completing one?

I know several people who have completed both neurology residency and another residency, as well as IM -> psych, medicine (with fellowship) -> EM, and IM + two unrelated fellowships (which I'd count as two residencies). I know multiple people who completed full PhD programs (not MD/PhD) prior to residency, and people who started residency in their late 30s-early 40s. Anything can be done if you like. In the grand scheme of subspecialty surgery, being a PGY9 as a resident isn't that uncommon.

I'd at least give IM a try. There are procedural subspecialties, and while this situation might be frustrating to you, you're clearly an accomplished person who is three years away from a $200-300K job, and perhaps 6 years away from a job that pays much more. If nothing else, a practicing internist/hospitalist is likely going to be a very attractive candidate to a surgical residency program.

 

[operaman]

This would be fine advice if OP hadn't matched. Unfortunately, OP signed an agreement stating they in good faith intend to attend whatever residency program they match to for a minimum of 45 days after the start date, and anything they do prior to that date to put their good faith in question (e.g. trying to set up a research year, reaching out to other programs about the prospect of joining, etc) would violate that agreement, i.e. a match violation, which may result in a ban from participation in the NRMP in the future.

The by-the-book way of doing this is submitting a specialty change waiver request after those 45 days, then either applying to ERAS after that waiver is approved (which would entail submitting to ERAS after the deadline), or (more feasibly) completing your PGY1 year, then taking a research year or completing your PGY2 year while applying to the match that year (2025). Of course, once you submit that waiver, you program can decide to fire you.

Maybe someone who has actually done this can comment, but I would strongly recommend OP review NRMP policies before making any decisions. My advice remains to complete the residency in which you matched, then reapply.

Oh crap you are so right. In my quick reading I missed the fast he hadn’t started intern year yet. I was writing as though he were an intern already and regretting his specialty choice.

Yeah OP needs to stick it out for now and avoid a match violation. At least do the first year so he can get licensed while reapplying ent.

 

[ACSurgeon]

I am an incoming PGY-1 Internal medicine resident wanting to try and see if I can switch into ENT. I realized late that I missed the OR and would be willing to do whatever it takes to try and switch my specialty. Was wondering if anyone had any advice. I don't mind going through with the MATCH again and redoe my intern year as a surgical intern. Please let me know what options I may have including agreeing with a program to do research for them for a year etc.

No one knows the future. The best we can do is give you our guesses and our experiences.

The grass is always greener. You think you made a mistake. You don’t know that. You could have gone to a surgical specialty and quit a couple years in. Many people do.

How much of this second guessing that you’re experiencing is because you have good steps and AOA and feel like you could have “done better”. Dig deep; if this is the case stick with IM and do a fellowship that can give you enough money or prestige etc

You spent a lot of time doing IM rotations and putting together an application. I have a hard time that you just made a huge error. I think more likely you had mixed feelings and ended up going with IM for whatever reason. But there were good reasons I’m sure. Realize, as life goes on you’ll have priorities and responsibilities outside of work, so as long as you don’t nuc your career, what specialty you’re in will matter a lot less down the road.

If you are confident you made an error, you probably have to start at the program you matched and then reapply knowing you most likely won’t get ENT. Your most likely scenario is a surgery prelim and a very uphill battle to a categorical general surgery spot. This might be your only viable path to becoming a surgeon. Still, high risk of leaving one program for a prelim that might take you nowhere.

 

[mistafab]

Bro even with the best stats on the planet, I'd say your chances are slim to none of jumping ship now and switching to ENT. I think ACSurgeon was right in that jumping ship to a surg prelim is most likely scenario to try to get ANYTHING in being an actual surgeon. However, the shot of being a surgeon after one of those dead end slots is not great, and the attrition is terrible. Plus, at least at my alma-mater, prelims/TY year folks got treated like garbage compared to categorical, and everyone knew it.

I would say if you can stomach any procedural specialty from IM that would be your best bet to get back into the OR. With your grades i'm sure you'd be a strong candidate for something like cards -> interventional (3+1 or 3+2) after you complete residency. I think ENT is just such a pipe dream in your situation, unfortunately, I would probably just give that dream up. You don't have a surgical prelim year under your belt, so you're hope is only to jump into a fresh PGY1 slot, which is competing with high caliber MS4s with no breaks in training who likely had ENT specific research/experiences/LORs.