Thinking about switching residencies--need advice

[soccernut]

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hey guys,

i need some good'ol SDN advice. I'm currently a PGY2 resident at a great program--it's top 10, ivy league, nothing wrong with the program at all. I also did my prelim IM year at the same place. My problem? I think I like IM better. I loved it last year and i'm not sure my current specialty is doing it for me anymore. I thought about switching last year, but ultimately decided that I went into this for a reason and should stick with it. Not sure that's working anymore. So, I have a lot of thinking to do.
A major part of my stress is thinking how to find a PGY2 IM spot starting in 2007. How does one go about doing that? Do good spots open up? I'm sure there would be something, somewhere in the US, but I would feel horrible leaving what I have now and going to a 2nd or 3rd tier IM program. I know that sounds wierd. I guess I need to decide if I love IM enough to do it anywhere, no matter where it is, or if I should be practical about this and just stick it out. I thought about looking for a spot and sealing one at a good program and then letting my program know I'd be leaving. That would probably be too hard though, considering that I might not know until march or april and would not give my program much lead time to replace me. The IM program at my current institution knows me as a prelim and likes me--there's some chance I might be able to secure a spot for next year but cannot be guaranteed. also, i wouldn't be able to approach the IM PD without my current PD finding out, since the departments are pretty close.
what i'm afraid of is telling my PD i want out, looking for an IM spot, then ending up at a weak program, or even worse, being out of a job. I'm sure that once i tell my PD i'm leaving, they'll start the replacement search within an hour and once I say I'm out, I will be out, regardless of whether I find something good or not.
I guess it's hard because my current program is great--it's top notch, good people, etc. I'm just not sure it's for me. (Like my family member said, it's like being married to a rich guy you like, but don't love) I'm not sure if I would be stupid risking what i have to go into something that might satisfy me more. so, i'm looking for things in my specialty that would make me happy, because leaving would start off a very scary chain of events, where i would be in job limbo for potentially months and might end up on the losing end of the gamble.
has anyone else gone through anything similar? anyone know of PGY2 IM spots for july 2007?
Thanks for reading the whole darn post😛

 

[mlw03]

i can't offer anything but support to ya. it sounds like you've analyzed this pretty well. ultimately you have to decide what specialty you want to do, and if it's IM can you tolerate being at a lesser program to make it happen. i would suggest perhaps asking your old med school student affairs office to make some calls on your behalf, but without revealing who you are, and finding out if there are any spots open in 2007. this way you don't risk making anyone mad until you at least know there's a possibility of switching. best of luck to ya.

 

[soccernut]

thanks for your support. the other thing i didn't mention is that i'm actually a foreign grad, so don't have my med school here to help me out. another reason why this is such a hard decision is that i worked so hard to get into this program in the first place and was really fortunate, so it's a huge gamble to try switching.
has anyone switched into IM in their PGY2 year?

 

[speyeder]

Just out of curiosity, what specialty are you currently in? My understanding is that it would be pretty difficult to find an open PGY-2 spot in a good program. I too was a prelim last year in IM and there was a prelim in my program who had no PGY-2 position lined up. He went looking on his own for one but couldn't find anything better than a community program. Our PD also routinely emailed all of the prelims PGY-2 openings in IM. From what I saw, none of the programs were any good. And according to my friend, 90% of the openings our PD emailed us were not advertised (he didn't come across them in his search).

I think programs usually do not openly advertise spots for fear that it may raise some red flags and make the program look bad. Instead, they contact other PDs to find if there are any qualified prelim or transitional candidates who might be interested. So I think it would be highly unlikely that you would be able to find a good spot 1st and then tell your PD that you would like to switch since 90% of the openings would not be advertised. What you could do is contact the IM dept where you did a prelim year and let them know that you've had a change of heart and would like to switch into IM. But even under this scenario, you would need the blessing of your current chairman/PD, especially if the IM dept and your specialty are in the same hospital. Good luck with your decision.

 

[RuralMedicine]

Your best bet might actually be seeing if you could switch into IM at the same program. If you did you prelim there and were a good intern they may be able to find/create a spot for you. They also may not but it can't hurt to ask. A few years ago one of our interns (who had been predestined for anesthesiology) decided that he really was more interested in IM (and now from what I hear is applying to fellowships in hematology) and managed to transition from prelim to categorical. Our program had filled in the match completely and did not have residents leaving but the program director/ medicine chair had the numbers flexibility to add an additional spot and opted to.

 

[soccernut]

thanks for your replies. i'm currently a neuro resident. yup, thinking about giving up my tuning fork. i did my prelim year at the same place and i was considered a good intern. it would be my absolute best case scenario if the IM dept made a place for me. i just can't talk to them without telling my PD first and once i do that, there's no turning back.

 

[alphaagonist]

hey soccer nut i am a pgy 2 in IM .... would you like to swap programs..very interested in neuro..PM me...

alpha

 

[leaves of grass]

Why can't you email the IM PD and tell him what you're thinking about. There is no crime in that. Lord knows I've done it!

 

[kenfused]

Do not email your old IM PD... emails can get forwarded all over the hospital...
I'd make an appointment or drop by and talk.
You can say you are CONSIDERING changing back to IM, and was inquiring about a possible IM spot at your current hospital, or maybe your PD has some local connections, and can call in a favor. Depends on your relationship to your PD.

But either way, once you get the ball rolling, EVERYONE will know, and you will need their blessing in most cases to get a transfer done.

 

[blahblahblah]

Hey Soccernut,

I'm in the same boat. I'm contemplating switching into IM. But I'm having HUGE cold feet. I'm afraid that I might be making a decision just based on my view of residency vs. how it'll be as an attending. I don't know whether to go through with this, but it seems we have a lot in common.

I was wondering if you or anyone else had any advice on how to figure out if this really is the right choice?

Any advice at all would be appreciated. This is very stressful.