Switching to surgery after PGY1

[n618ft]

I'm doing well at my medicine program but after spending a few weeks in the OR, I realized I missed my true calling - general surgery. I absolutely need to apply to surgery at some point, but having missed this match season, I'm left with a few suboptimal options:

1. Attempt to SOAP into a prelim spot and give up my categorical position with hope of getting an R2 spot the next year.
2. Continue at my program and reapply next year
3. Continue at my program and apply during my 3rd year
4. Are there other options?

I'm AMG with competitive board scores, good/current letters, work experience.

Would truly appreciate some positive input as to what, if any, of the experiences here have been.

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[bashwell]

Don't do it man, please just...no.

 

[n618ft]

Don't do it man, please just...no.

Noted - but why? I'm never as happy as I am when I'm doing a procedure or being in the OR or working a 16hr - 36hr shifts (med school not intern year for the latter lol). My program currently is great but knowing myself, I will regret not doing this for the rest of my career.

 

[Rippy087]

Take a look at this thread. Same idea, with good discussion. Should answer all of your questions.

https://forums.studentdoctor.net/threads/considering-switching-from-em-to-surgery.1235654/

 

[n618ft]

Some good insight there but I'm not debating whether or not to do this - I've made up my mind and application to follow through with those options.

 

[gutonc]

Some good insight there but I'm not thinking of whether or not to do this - I've made up my mind and application to do so.

Then what do you need us for?

I think Option 3 is the best.

You're only going to get a s***ty prelim in SOAP this year, which, even if you perform in a stellar manner, has a 50% chance of being a dead end for you. I'm not sure what you're going to/already have in the way of Surgery specific LORs, but they better be good and they better be current. If you apply next year and fail to Match, you will already have passed the date to sign your PGY3 IM contract so you'll be stuck with no GS and no IM spot. If you go ahead and continue your current program, with a plan to apply during your PGY3 year, worst case scenario, you'll have a completed residency and can get a job.

 

[n618ft]

Then what do you need us for?

I think Option 3 is the best.

You're only going to get a s***ty prelim in SOAP this year, which, even if you perform in a stellar manner, has a 50% chance of being a dead end for you. I'm not sure what you're going to/already have in the way of Surgery specific LORs, but they better be good and they better be current. If you apply next year and fail to Match, you will already have passed the date to sign your PGY3 IM contract so you'll be stuck with no GS and no IM spot. If you go ahead and continue your current program, with a plan to apply during your PGY3 year, worst case scenario, you'll have a completed residency and can get a job.

I don't plan on signing a contract if I try to SOAP. At this point, I think I'd rather take the risk of a prelim spot. Maybe we're reading different research but an otherwise competitive AMG has a much higher chance of getting categorical or at least an advanced prelim than that. None of this is a dead end - medical license on its way, fallback career to do that I can combine with medicine.

 

[TraumaLlamaMD]

You're also going to need a good, well thought answer to the inevitable question of "why didn't you apply to surgery the first time?"

I'd make it something more substantial than "I realized how much I missed the OR after a few weeks" - when you're an intern working hard, a break from your regular floor work duties seems like heaven. You need to demonstrate a real commitment to surgery even after the novelty wears off again and the reality of another year as a surgical intern sets in, and - fairly or not - you're already behind the gate there by having applied elsewhere in the first place.

 

[rokshana]

I don't plan on signing a contract if I try to SOAP. At this point, I think I'd rather take the risk of a prelim spot. Maybe we're reading different research but an otherwise competitive AMG has a much higher chance of getting categorical or at least an advanced prelim than that. None of this is a dead end - medical license on its way, fallback career to do that I can combine with medicine.

in the SOAP there are rarely more than 2-4 cat GS spots, so the likelihood of getting a cat GS spot is very very low, even for an AMG, so the best you could do is get a prelim spot...there are plenty of those and you should be able to get one of those...but you need to look at the bigger picture...what are the chances that your prelim spot will translate into a permanent spot? that is going to depend on what is out there and how willing you prelim program is going to be to help you get a categorical spot (meaning LoRs fairly quickly and giving you time off to actually interview)...eh? coin flip at best...the best shot at having a job to fall back on is to finish out the IM residency , get to know the surgical people at your current institution and see if they will take you on and apply to the Match in your 3rd year...you may find that you do like IM and all else fails, you can apply to more procedure heavy IM fellowships such as GI, CC, or Cards to give you some satisfaction.

 

[Gastrapathy]

What about your home surgery program? Anyone quit yet?

 

[gutonc]

I don't plan on signing a contract if I try to SOAP. At this point, I think I'd rather take the risk of a prelim spot. Maybe we're reading different research but an otherwise competitive AMG has a much higher chance of getting categorical or at least an advanced prelim than that. None of this is a dead end - medical license on its way, fallback career to do that I can combine with medicine.

Ah yes...I should have recognized this for the thread that it is.

1. User comes more or less out of nowhere and says: "I've made up my mind to do something that, while not impossible, sounds crazy and has a high likelihood of not going well. But I'm going to ask a bunch of randos on the internet what they think I should do. And for good measure, I'll offer up several fake alternative scenarios to make it seem like this is just something I'm considering doing".
2. Every single post, from people on all sides of the issue suggest that, at a minimum, this may not work out as you hope it would.
3. "Screw you, I'm doing it and you're all wrong."

But good luck nonetheless.

 

[NotAProgDirector]

I don't think the OP's situation is quite as doom-and-gloom as suggested on the thread.

If your application is competitive for GS, then this can certainly work out. Given the lateness in the season, I agree that talking to the surgical PD at your current institution is Step 2. To be fair, talking to your own PD is step 1. You want to ask the Surgical PD if they will consider you for a categorical spot in this year's match. Your IM PD can share your ERAS app from last year, along with your USMLE transcript. You've been "interviewing" there since July. You might arrange to work with surgery for a few weeks between now and when rank lists are due, if you're lucky. There's no guarantee, but you really have nothing to lose. If your institution is part of a "network" with other hospitals that have training programs, then there's also a chance at those programs. Might as well ask.

The next question is whether you want your home program to consider you for a prelim GS spot. You'd want to talk to the surgical PD, get some sense of how successful they have been at getting people with prelim GS spots into categorical spots. But my overall sense is that if you're competitive enough for GS such that you would have matched had you applied fresh out of school, you'll probably get a spot -- hopefully a PGY-2, possibly matching again into a PGY-1 in next year's match. Your local surgical PD will be invaluable at looking at your app and being honest with you.

Assuming that doesn't work, then SOAP is the next step. Obviously you'll apply for any categorical spots that are open. The rest of your apps would be for surgical prelims (again, assuming your home surgical PD thinks this is a viable plan).

Major problems with all of this? If you haven't been honest with us and aren't really competitive for GS, or your performance in your IM residency is poor, you could get dead-ended -- drop your IM program, complete a surgery PGY-1 prelim, and then not get another spot. Now you'll find it much harder to continue -- IM programs may not be excited about offering you a PGY-2, and starting again as a PGY-1 in a new field seems really crazy (and would probably make you miserable). Plus you'll run into funding problems which shouldn't stop you from getting a spot, but may limit your choices further.

So, homework for next week:

1. Tell your IM PD. Don't let them find out about this via the grapevine.
2. Talk to your local surgery PD. Bring your ERAS app, evaluations. Have your IM PD speak to them first about your performance. Ask for very honest feedback about your chances in categorical surgery.
3. Complete as much surgical experience as you can between now and match. Make whatever swaps are necessary. Cancel vacation if necessary.
4. You seem certain that this is the right move for you. That said, try to make sure this is the right move for you. Switching to surgery, becoming disillusioned with it, and trying to switch back to IM would be a disaster.

 

[caffeinemia]

I know someone who did IM then GS. It was 8 years total, but in the scheme of some lengthy training courses, it's not unheard of. That's a potentially far safer route, as you'll always have good standing with your current program and a fallback.