Transferring Programs to Be Closer to Family

[thisisathrowaway2016]

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I made this account for this specific question. I am a regular poster on the boards, but don't want to give my identity away. Changing my writing style is also very difficult!

I want to start by saying that I am at a very good program. The PD and fellow residents are all very nice and easy to get along with. The work is as expected, and I'm happy with where I'm living. I also have a nice circle of friends/activities outside of work. It's a good set up.

I matched to my number 1 ranked program, but I'm feeling remorse. I moved 1200 miles from home to do so. I've lived up to 400 miles away before and it wasn't a problem, but now it's really bothering me. For the past few weeks, I've been missing my family, and I feel that it has negatively effected my work. Without going into too many details, my family isn't getting any younger, and I keep thinking, "Only X more years until I go back."

Now, on to my question. I've been considering addressing a transfer to another program, close to home. The problem is that only one program within 2 hours of home is worth its weight in salt. There are a few more programs between 4-6 hours away that I would be willing. This is so profound that, if I were not able to transfer into one of these programs, I would prefer to stay here.

I guess what I'm asking is, how do I go about figuring out if a program would accept me, or would be able to accept a transferring resident at all? I don't want my PD to think that I'm unhappy here, even if that's the case. This is especially the case if I end up staying here! Thanks.

 

[Law2Doc]

There isn't a great way to accomplish this without "outing yourself". The most common way I've seen this play out positively is if you can discretely make friends with residents at those other programs and ask them to let you know if someone your year or the year behind drops out, takes a leave of absence etc. and if that happens ask them to put your name in. Residents don't like to have fewer people in their call pool and are quite good about pitching someone "perfect" they know to the PD.

Second, I don't know how long your residency is but that time really flies by fast when you aren't focusing on "X years" to go. My residency went by in a blink of an eye. So keeping your head down and finishing is probably not as bad an option as you are painting it.

Third, you can always just rack up credit card debt flying home at every opportunity, even if you only get a few hours visit before you have to turn around and come back. Make trades with people to get a few days off in a row whenever possible even if you create brutal schedules for yourself or have to take on more nights, undesirable shifts instead of elective time, etc. The airfare can be expensive but you'll eventually pay it off and it sounds like it's worth it to you.

 

[doc05]

what family do you mean? if it's your spouse/kids, you have a shot at convincing a new program to take you. otherwise, forget it -- it's not gonna happen.

 

[ThoracicGuy]

I made this account for this specific question. I am a regular poster on the boards, but don't want to give my identity away. Changing my writing style is also very difficult!

I want to start by saying that I am at a very good program. The PD and fellow residents are all very nice and easy to get along with. The work is as expected, and I'm happy with where I'm living. I also have a nice circle of friends/activities outside of work. It's a good set up.

I matched to my number 1 ranked program, but I'm feeling remorse. I moved 1200 miles from home to do so. I've lived up to 400 miles away before and it wasn't a problem, but now it's really bothering me. For the past few weeks, I've been missing my family, and I feel that it has negatively effected my work. Without going into too many details, my family isn't getting any younger, and I keep thinking, "Only X more years until I go back."

Now, on to my question. I've been considering addressing a transfer to another program, close to home. The problem is that only one program within 2 hours of home is worth its weight in salt. There are a few more programs between 4-6 hours away that I would be willing. This is so profound that, if I were not able to transfer into one of these programs, I would prefer to stay here.

I guess what I'm asking is, how do I go about figuring out if a program would accept me, or would be able to accept a transferring resident at all? I don't want my PD to think that I'm unhappy here, even if that's the case. This is especially the case if I end up staying here! Thanks.

What you are contemplating could very well be career suicide. There are stories on here of people that quit to move closer to family and never found another spot. You have what you claim to be a good program, your number one even. Don't throw it away because you live further away from your family than you would like. You can always visit on vacation if you'd like. If your PD gets a whiff that you are thinking about this, it could really hurt you. Don't talk about this with anyone at your program and be careful about other programs. How would it look if one of those programs started to consider you and called up their buddy, your PD, to ask how good you were, but your PD never even knew you were looking?

 

[22031 Alum]

I had a close family member, who was in poor health when I matched, become ill and die during my residency. My program was a thousand miles from home, but was large and had a very robust backup system. I was able to spend a lot of time at home. It disrupted the schedule, of course, but the effect was spread over many different residents (and didn't even touch others). When I came back and tried to figure out exactly who covered what, my co-residents kept this information from me so I couldn't try to pay them back.

I currently work for a much smaller program very close to my hometown. When someone needs time off for an emergency it is nearly crippling to the schedule, wreaks havoc in every other resident's life and creates more ill will than I'd like to see. It's easy to say "Don't pay me back" when you took one extra call, less so if you took six. I can't imagine how much more stressful my relative's illness would have been in that environment, even though I would have been physically closer.

It sounds like OP's issue is more simple homesickness and wanting to be able to make quick trips, than it is about needing to be close for actual family responsibilities or emergencies. Either way, I'm giving my own story to say, be careful about assuming closer is automatically better. There are a lot of program characteristics to consider aside from simple distance.

 

[RadOncDoc21]

20/20 hindsight here but location probably should have been more of a major factor in determining your rank list. I'm just saying this to emphasize or to question what changed significantly over the past 6 months?

 

[Crayola227]

There isn't a great way to accomplish this without "outing yourself". The most common way I've seen this play out positively is if you can discretely make friends with residents at those other programs and ask them to let you know if someone your year or the year behind drops out, takes a leave of absence etc. and if that happens ask them to put your name in. Residents don't like to have fewer people in their call pool and are quite good about pitching someone "perfect" they know to the PD.

Wait a minute, this suggests that sometimes when a resident goes on an LOA... that the PD starts to take names to replace you! No way! Of course this is always what I am suggesting is a risk to anyone who makes waves or gets ill or needs maternity leave, but I'm just paranoid.

What you are contemplating could very well be career suicide. There are stories on here of people that quit to move closer to family and never found another spot. You have what you claim to be a good program, your number one even. Don't throw it away because you live further away from your family than you would like. You can always visit on vacation if you'd like. If your PD gets a whiff that you are thinking about this, it could really hurt you. Don't talk about this with anyone at your program and be careful about other programs. How would it look if one of those programs started to consider you and called up their buddy, your PD, to ask how good you were, but your PD never even knew you were looking?

To be fair OP, and to the others, part of what I suspect has happened as well is that as an intern, your rotations are likely putting you face to face with more morbidity and mortality than ever before, and you're seeing a lot more gomers, etc, than you were as a med student. Truly, the further I got in training, experience, the older my relatives, and the more fear I felt. So some of this doesn't have to be intern blues or SAD moment although it could be. Nothing like intern year to make you appreciate life or the lack of the one you're living.

The risk of career suicide is too high. Unless you have a mother/father/sister/brother with a terminal illness that is expected to last for 1-2 years, it is tough to make a case for your transfer to your PD that isn't risking the serious baditude of the above.

Like others have said, you'll need to put a high priority on visiting family. If you are thinking of regrets now, than be sure your 2-4 weeks of vacation you're spending every minute with those relatives, not going to Maui with the new SO. Talk and text daily, it can be done. Skype. Don't rely on facebook that's silly. Set these relatives up to do this with you. Maybe they'll try to brush you off when you're insisting they need the latest tech and training them to do this with you, but insist on it. Don't make it about their frailties, make it about you being lonely and NEEDING family support in the hard spot you're in and I'm betting they will cooperate.

Talking on the phone can get you further than you might think in making use of the time you have with them on this planet. Insist on sending pictures back and forth, even if it's just a picture of the dinner you or your mom made or you sending a picture of your messy room (mom I want to say how much I appreciate you cleaning up after me as a kid!) since you don't have a lot of personal life to share with them as resident typically. Look up long-distance relationship strategies they can be adapted from the romantic to the more family loving kind.

Talk with your family about this. I'm guessing they will reiterate to you how proud they are of you and how glad they are you are pursuing your dreams, at your #1 program, etc. Let them make you feel better about this if that is what they are likely to do (mine did). Hindsight or not, you are where you are, and moving just isn't that feasible. That's OK. Don't beat yourself up for putting yourself 1200 miles away. I'm guessing your family wouldn't have wanted you to compromise your career to be closer if that was really why you were going to stay closer. You are where you are and I hope you can accept just doing the best you can knowing whatever you know now, because that's all anyone can do.

One of my very closest relative died during my training, and some of the peace I had was that I knew there was no where else I could be unless I had made sacrifices that I know they WOULDN'T have wanted me to make. That relative would not have wanted me to do a darn thing different with my training, and I did the best I could to talk/text/go home for the holidays. OK, maybe I could have done better, but you can always say that. I, like you, had some foresight and made an effort and it was enough for me to have some peace with myself. Everything is a trade off, but at the end of the day I feel I did what was right by them, myself, my career, and that's all you can ever strive for. It wasn't ideal but life isn't.

Maybe your family was the type to say "why go so far away?" The people who came before us do their best, but from my perspective, well, their job is to support you doing what's best for you even if it takes you far away. You're doing what you're supposed to do as the younger person by taking the best care you can of yourself and career. If you're feeling guilty, what any younger person really owes family is visits and phone calls, not career suicide. Visits and phone calls? That you can do.

I hope this can give you some useful ideas on keeping in touch and a measure of peace. Do what you can to mitigate future regrets, get through your training, and hope for the best. Make the best use of whatever time you have now and hope for more. You know the importance of family however you've come by that now, and just keep it in mind when you get to attending, although your job will always pull at you, then you will have more choices then should you choose to make them. As long as you move forward from here on out showing the importance of family, you'll be honoring them

 

[Crayola227]

Also, especially if you can foot the bill, they have more "free time", and they understand you have less "free time" even on a light rotation, have them come visit you! Invest in pull out couch for you to sleep on or whatever.

People forget that as a resident a lot of times it's easier for them to come to you than the other way around. I don't know why people don't think of this more, I guess it is a bit more traditional for the youngster to "come home" but a lot of times it's actually easier for non-residents to find time.

When I was on a clinic schedule that had us work some Saturdays and Sundays (but not all), I had a relative come stay for a little over a week, and I managed 4 days off in a row (of course I had to pay for that while they weren't there) but that was plenty of time for a lot of quality time! Coffee and dinner together every day and night!

You've been in school full time since you were like 7 years old, these people are used to their interactions with you being after work hours and weekends. Be sure there is some way to entertain them during the day if they are able to make the travel to see you while on a light rotation.

If you're on a light rotation and depending on your colleagues, heck I even had the attendings helping to get me home just a little bit sooner cuz they knew I had an out of town relative waiting back at home for me.

 

[Law2Doc]

Wait a minute, this suggests that sometimes when a resident goes on an LOA... that the PD starts to take names to replace you! No way! ...

If you take a LOA that will put you into a different residency class, a program absolutely can fill the spot. Some programs need a certain number of people per class to function well, so if someone takes a year off they will want to fill that spot. That doesn't mean they might not be legally obligated to hold a spot for you in the subsequent year in some cases, or offer it to you when they aren't legally obligated, but I stand by my statement. Ive seen more than a couple people take a LOA of a year, and there's no reason a PD wouldn't try to fill that spot and let such person rejoin the class behind (if there's room.) I've also seen people take LOA and never come back, so I'm not sure keeping a spot open helped anyone.

 

[NotAProgDirector]

Despite all of the warnings of doom, transfers like this can happen without creating a catastrophe. You would finish out the year at your current program, they would have plenty of time to find a PGY-2 replacement, and you could start as a new PGY-2 somewhere else.

Thoughts:

1. If there's only one program that's really close enough to make a real difference, you could simply contact them. I'd tell them, directly, that you haven't mentioned this to your PD and all you want to know is if they think they will have a pGY-2 position next year, and you'd rather not mention it to your PD unless it looks like a possibility. Stress that you're only applying to this program because of family. If not, thank them and stay where you are. If so, then you need to talk to your PD.

Could this backfire? Of course. But even if I found out about something like this, I wouldn't be angry. It's perfectly reasonable that your priorities have changed. You still like your current program, you just want to be closer to home.

But could someone get really angry and it blow back onto you? I'm sure there are stories. But if you're in a healthy program with a reasonable program director, you're probably fine.

2. As above, make sure this isn't just buyer's remorse. I have had residents transfer to other programs who then want to come back. That never happens.

3. Do no underestimate how difficult it can be to start as a PGY-2 in a new program. You know none of the people, and none of the system. It's very challenging. Expect to not do well.

 

[Crayola227]

Despite all of the warnings of doom, transfers like this can happen without creating a catastrophe. You would finish out the year at your current program, they would have plenty of time to find a PGY-2 replacement, and you could start as a new PGY-2 somewhere else.

Thoughts:

1. If there's only one program that's really close enough to make a real difference, you could simply contact them. I'd tell them, directly, that you haven't mentioned this to your PD and all you want to know is if they think they will have a pGY-2 position next year, and you'd rather not mention it to your PD unless it looks like a possibility. Stress that you're only applying to this program because of family. If not, thank them and stay where you are. If so, then you need to talk to your PD.

Could this backfire? Of course. But even if I found out about something like this, I wouldn't be angry. It's perfectly reasonable that your priorities have changed. You still like your current program, you just want to be closer to home.

But could someone get really angry and it blow back onto you? I'm sure there are stories. But if you're in a healthy program with a reasonable program director, you're probably fine.

2. As above, make sure this isn't just buyer's remorse. I have had residents transfer to other programs who then want to come back. That never happens.

3. Do no underestimate how difficult it can be to start as a PGY-2 in a new program. You know none of the people, and none of the system. It's very challenging. Expect to not do well.

As usual a nice balanced post from aPD.

The idea for how to approach the other PD while trying to keep it from backfiring I think is a great idea.

Starting at another program as a PGY2 is really tough if it's not an advanced position (although still could be if the one you're going to is categorical or bunches it all together where the other PGY2s will now the system and you will stick out like a sore thumb). Honestly if you're moving to be 4-6 hours away I'm not sure that really translates to seeing your family that much more realistically. I mean, if you're 1200 miles away that's usually what most direct flights are, although sure maybe the flights are longer for you I don't know where you are.

I do really worry that transferring will be worse than just sticking it out another two (shoot, you didn't say how many years, did you?) years. I don't know how your family members are doing healthwise or how reasonable it is to think they'll be around for a while after you finish. What about fellowship? Does that factor in here?

It probably doesn't help to point out anyone can go anytime, so again, I question the wisdom of making this move. You might not use the opportunity being close to see them as much as you think you will, your family may be around for a long time after your training which is when you REALLY might have time to be with them in which case in hindsight the trouble of transferring might not seem worth it, or you make the move and something bad happens and again, you might feel bad you made the move for not much gain, although you would have the comfort of knowing you tried.

Only you can answer these questions.

Also, is there any way for some of these family members to move to you? It seems like the oldies never can do this, too stuck in their ways, the house, etc etc but I feel like retirees should be just as interested in moving to spend more time with family as the young ones building a future and a career. I dunno, maybe they would be delighted for the invite. Or do the snowbird thing and come stay for good stretches of time.

 

[Doctor Bagel]

I've known more residents that I would have expected who have transferred residencies for all sorts of reasons and been fine. It's certainly not guaranteed to be career suicide, and in my field, I think it's quite doable. You can't trust all the doom and gloom that you read on SDN.

 

[ThoracicGuy]

I've known more residents that I would have expected who have transferred residencies for all sorts of reasons and been fine. It's certainly not guaranteed to be career suicide, and in my field, I think it's quite doable. You can't trust all the doom and gloom that you read on SDN.

It's possible, but also high risk. And there's a chance that your geographical ideal spot is much worse training than the current spot. Not sure I would risk it personally.

 

[Doctor Bagel]

It's possible, but also high risk. And there's a chance that your geographical ideal spot is much worse training than the current spot. Not sure I would risk it personally.

It's probably specialty and program dependent how high of risk it is. The general SDN advice is that transferring is always bad, which doesn't fit with the fact that I've seen it successfully done numerous times.

 

[ThoracicGuy]

It's probably specialty and program dependent how high of risk it is. The general SDN advice is that transferring is always bad, which doesn't fit with the fact that I've seen it successfully done numerous times.

I've also seen it done successfully before in general surgery. I would still say that it is a pretty risky thing to do, especially just because you feel homesick.

 

[Law2Doc]

I've known more residents that I would have expected who have transferred residencies for all sorts of reasons and been fine. It's certainly not guaranteed to be career suicide, and in my field, I think it's quite doable. You can't trust all the doom and gloom that you read on SDN.

While I think the "career suicide" term is a bit of an exaggeration, I think some of us have seen unsuccessful attempts to seek out a transfer backfire for people, and so calling it risky is not inappropriate. we are talking about finite periods of training and sometimes suffering through a couple of years really does leave you in a better place, career wise.

 

[evilbooyaa]

I've also seen it done successfully before in general surgery. I would still say that it is a pretty risky thing to do, especially just because you feel homesick.

Given the attrition rate in general surgery residencies, I'm not surprised that it would be most prevalent there.

 

[ThoracicGuy]

Given the attrition rate in general surgery residencies, I'm not surprised that it would be most prevalent there.

Probably because many programs don't want to risk a spot on a troubled resident... which is what many transferees often are.

 

[koikisi]

To the OP, do you have a significant other at all?

Having one makes it much more doable. I think it's totally unfair for program directors to be holding wanting to transfer against you.

You realize a lot about a program once you're actually working in it and it's a huge adjustment living in a different city from where one was raised.

 

[WingedOx]

It's probably specialty and program dependent how high of risk it is. The general SDN advice is that transferring is always bad, which doesn't fit with the fact that I've seen it successfully done numerous times.

Yeah, Psych is kind of a special case. Transferring is REALLY easy for PG4, though trickier earlier. We lost a very good rising PG4 resident last year when her husband moved across the country. Pretty sure she actually ended up with multiple offers.

By contrast, the year we had an open PG2 spot we had at least 3 really solid applicants gunning for that one spot (as well as several not so solid ones)

 

[thisisathrowaway2016]

Wanted to bump this real quick. Sorry.

Weird development in this mini saga.

I took the threads advice. I have mentioned this issue to no one. I also scheduled a few trips home (one of which I completed, one of which is upcoming) and it's not so bad. I have lots of air miles, and tickets are pretty cheap. That has really helped to ease my issues.

Anyway, our program picked up an extra resident. A program near home is losing a resident. I would say they're about the same level as far as training. That would make a pretty seamless transition, don't you guys think? The weird part is that I might be able to visit more even with being farther away

I appreciate all of the advice and warnings. Thanks, all.

 

[ThoracicGuy]

Wanted to bump this real quick. Sorry.

Weird development in this mini saga.

I took the threads advice. I have mentioned this issue to no one. I also scheduled a few trips home (one of which I completed, one of which is upcoming) and it's not so bad. I have lots of air miles, and tickets are pretty cheap. That has really helped to ease my issues.

Anyway, our program picked up an extra resident. A program near home is losing a resident. I would say they're about the same level as far as training. That would make a pretty seamless transition, don't you guys think? The weird part is that I might be able to visit more even with being farther away

I appreciate all of the advice and warnings. Thanks, all.

Personally, I think this is a risky option. You don't know if you would be wanted to fill that spot in the other program. You also don't really know the real details of that program. Maybe it's worse than where you are at and you'd be more unhappy there than your current place.

I would stick with where you are and keep up with those trips back home to boost your spirits as needed.