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psychgirl9

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US-Allo senior applied to Psych, but didn't match. SOAP'ed into FM to have a job but still really want psych. Applied t0 40 programs, 5 invites, all ranked. Steps: 219/246/P. Red flag: Repeat MS-3 b/c clerkship failures, dx and treated for depression. Explained in PS. Genuinely became interested in psych late in MS-4, thus lack of strong psych letters/electives.

1. How/when should I communicate this to my FM program, if at all?
2. What measures can I take to strengthen my application going forward?
3. Since FM is 3 years, how does the medicare funding "clock" work in this case if I manage to get a psych spot?
4. Can I look for pgy-1 vacancies outside the match simultaneously, or is that a violation?
5. Any other advice?

Thank you!! :)
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Sorry to hear that happened to you. You may want to contact the ABPN to confirm this is still true, but back when I was in residency I know that Psych programs could take people who did an internship in Family Medicine as PGY-2 transfers (my program did it several times over the years). Based on that, I think it would probably make the most sense for you to do internship in FM and then try to transfer into Psych as a PGY-2 rather than trying to find a PGY-1 psych spot this year. Do you know if your program might possibly be able to let you do a psych rotation early enough in the year to bolster your application?

Don't despair. It's never a bad thing for a FM doc to have a strong interest in psych OR for a psych doc to have a strong background in primary care medicine. Regardless of whether you transfer into psych or decide to stay with FM, you'll be ok!
 
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We have someone at my residency who transferred into PGY-2 after her intern year of family medicine. She didn't have to repeat any part of her intern year and she will be graduating this year at the same time as her fellow PGY-4s. The PGY-2 position opened up because someone happened to transfer from our program to internal medicine at the same time. I don't know the details of exactly how she pulled it off, but it has worked out well for her. By the time she was a PGY-3, you never would have guessed that her early training was any different. The moral of the story is that there are still paths to become a psychiatrist from here, but the maneuvering gets more complicated.
 
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1. you accepted an FM spot. Thus you communicated to them that you wanted that position. saying "jk, i rly want psych" is not going to endear you to anyone at this point. if you intend to apply for psychiatry positions during residency then you tell them at the last possible moment to get the letter you need to apply and not a moment before (i.e. several months in)
2. be an excellent family medicine resident. you may consider completing the FM residency even. The more of the FM you have done (assuming you are a strong resident) the better.
3. largely irrelevant.
4. You have accepted a position. You now have to show up for the first ?45 days or something otherwise it is a match violation. If you wanted to look for PGY-1 vacancies you shouldn't have accepted the position.
5. It must be devastating to not have matched and I can understand taking a position you didn't want out of desperation. But you have done so, and at this point, the best thing for your psychologically and professionally, is to accept that decision, and at least turn up to work for however long the NRMP mandates, and honor your commitment. Pining over PGY-1 vacancies is not healthy at this point. You need to make the best of a bad situation, and aim to do as well as you can in this residency program, and obtain strong letters of recommendation if you decide to apply for psychiatry. PGY-2 spots are much less competitive than PGY-1 spots (as there are far fewer applicants, and many are of dubious quality) so if you are flexible about it then applying for next year, or the year after, or the year after that, should yield something. Rest assured that any additional FM training you get will not be a waste and will make you a better physician and psychiatrist. What you should not do, should not even think about is backing out of this right now or hunting for PGY-1 vacancies.
 
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splik said:
1. you accepted an FM spot. Thus you communicated to them that you wanted that position. saying "jk, i rly want psych" is not going to endear you to anyone at this point. if you intend to apply for psychiatry positions during residency then you tell them at the last possible moment to get the letter you need to apply and not a moment before (i.e. several months in)
2. be an excellent family medicine resident. you may consider completing the FM residency even. The more of the FM you have done (assuming you are a strong resident) the better.
3. largely irrelevant.
4. You have accepted a position. You now have to show up for the first ?45 days or something otherwise it is a match violation. If you wanted to look for PGY-1 vacancies you shouldn't have accepted the position.
5. It must be devastating to not have matched and I can understand taking a position you didn't want out of desperation. But you have done so, and at this point, the best thing for your psychologically and professionally, is to accept that decision, and at least turn up to work for however long the NRMP mandates, and honor your commitment. Pining over PGY-1 vacancies is not healthy at this point. You need to make the best of a bad situation, and aim to do as well as you can in this residency program, and obtain strong letters of recommendation if you decide to apply for psychiatry. PGY-2 spots are much less competitive than PGY-1 spots (as there are far fewer applicants, and many are of dubious quality) so if you are flexible about it then applying for next year, or the year after, or the year after that, should yield something. Rest assured that any additional FM training you get will not be a waste and will make you a better physician and psychiatrist. What you should not do, should not even think about is backing out of this right now or hunting for PGY-1 vacancies.
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Since she got her FM position via SOAP, your implication that she'll be seen as dishonest by pursuing psych is not true or relevant. They KNOW she didn't get what she wanted--they'll all have a more enjoyable year if they acknowledge that up front. Different programs will have different philosophies about encouraging individually divergent career paths, but I think she should let the FM PD know from the outset that ideally, she'd transfer into psych at the end of PGY1. I agree, she's committed to 45 days minimum, but seeing the year through and striving to be an excellent FM resident is in her best interest if she is hoping to find a PGY2 transfer.
 
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First of all, thank you so much for offering your input - this receptive and positive attitude in this sub-forum is further validation that I'm in the right profession.

northernpsy said:
Sorry to hear that happened to you. You may want to contact the ABPN to confirm this is still true, but back when I was in residency I know that Psych programs could take people who did an internship in Family Medicine as PGY-2 transfers (my program did it several times over the years). Based on that, I think it would probably make the most sense for you to do internship in FM and then try to transfer into Psych as a PGY-2 rather than trying to find a PGY-1 psych spot this year. Do you know if your program might possibly be able to let you do a psych rotation early enough in the year to bolster your application?

Don't despair. It's never a bad thing for a FM doc to have a strong interest in psych OR for a psych doc to have a strong background in primary care medicine. Regardless of whether you transfer into psych or decide to stay with FM, you'll be ok!
Click to expand...

I will reach out to the ABPN to inquire about this - thanks for pointing it out!

LasVagus said:
We have someone at my residency who transferred into PGY-2 after her intern year of family medicine. She didn't have to repeat any part of her intern year and she will be graduating this year at the same time as her fellow PGY-4s. The PGY-2 position opened up because someone happened to transfer from our program to internal medicine at the same time. I don't know the details of exactly how she pulled it off, but it has worked out well for her. By the time she was a PGY-3, you never would have guessed that her early training was any different. The moral of the story is that there are still paths to become a psychiatrist from here, but the maneuvering gets more complicated.
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That's very fortunate for her! (and encouraging for me :)

splik said:
1. you accepted an FM spot. Thus you communicated to them that you wanted that position. saying "jk, i rly want psych" is not going to endear you to anyone at this point. if you intend to apply for psychiatry positions during residency then you tell them at the last possible moment to get the letter you need to apply and not a moment before (i.e. several months in)
2. be an excellent family medicine resident. you may consider completing the FM residency even. The more of the FM you have done (assuming you are a strong resident) the better.
3. largely irrelevant.
4. You have accepted a position. You now have to show up for the first ?45 days or something otherwise it is a match violation. If you wanted to look for PGY-1 vacancies you shouldn't have accepted the position.
5. It must be devastating to not have matched and I can understand taking a position you didn't want out of desperation. But you have done so, and at this point, the best thing for your psychologically and professionally, is to accept that decision, and at least turn up to work for however long the NRMP mandates, and honor your commitment. Pining over PGY-1 vacancies is not healthy at this point. You need to make the best of a bad situation, and aim to do as well as you can in this residency program, and obtain strong letters of recommendation if you decide to apply for psychiatry. PGY-2 spots are much less competitive than PGY-1 spots (as there are far fewer applicants, and many are of dubious quality) so if you are flexible about it then applying for next year, or the year after, or the year after that, should yield something. Rest assured that any additional FM training you get will not be a waste and will make you a better physician and psychiatrist. What you should not do, should not even think about is backing out of this right now or hunting for PGY-1 vacancies.
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Thank you for addressing those points :) I am actually extremely grateful for having the FM spot, but yeah I do feel enormously guilty inside for essentially using the program as a fallback/stepping stone. Desperation makes one do terrible things. At the same time, I want to be practical and your strategy makes sense. If possible, could you expand on #3, and #5 (specifically, what is a good resource for finding PGY-2 spots)?
 
Take the FM and run with it. You can always make "psych" one of your FM specialties, become the "go to" doc in a group FM practice for the psych referrals.

Regardless, you need to hit the ground running this summer and be fully committed to your FM residency. Thinking of the FM as a fallback or stepping stone is the wrong way to go into this.
 
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Agree with posts above. Focus on being an excellent FM resident and continue to explore your options.

When life hands you a lemon. Make a lemonade.


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You cant start a PGY 1 psych residency until around 2mnths into your FM program.
You can reapply through the match again, apply to more programs. And also look for PGY 1 openings throughout the year.
 
Agree with those above saying that you should make the most of FM. Seriously, became a kicka$$ FP, finish residency in 3 years, and make some coin. I'm a big fan of the everything-happens-for-a-reason motto. Find the reason and capitalize on it.
 
Dharma said:
I'm a big fan of the everything-happens-for-a-reason motto. Find the reason and capitalize on it.
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Whole-heartedly agree...wasn't crazy about the fellowship I landed but ended up meeting my future wife there (and program ended up being better than expected)...took an awful job after fellowship (market was tight for my specialty) in a cold, depressing area, was so miserable ended up doing a 2nd fellowship out in a much better location and ended up landing a really sweet job in that area....so keep a positive attitude, work hard, and enjoy the journey!
 
Hang in there. You can still do psych. You will have an edge in the long run with a whole year or more of FM behind you. You can apply to psych next year, if that's what you still want. You'll only be 6 months "behind" where you'd have been anyway. I agree you don't have to pretend that FM was your dream. You won't be the only person to SOAP into it, not by a long shot, either.
 
Psychotic said:
Take the FM and run with it. You can always make "psych" one of your FM specialties, become the "go to" doc in a group FM practice for the psych referrals.

Regardless, you need to hit the ground running this summer and be fully committed to your FM residency. Thinking of the FM as a fallback or stepping stone is the wrong way to go into this.
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I think the OP should decide for himself/herself what specialty to aim for long term. Matching or SOAPing into something isn't like taking some lifelong vow. People change specialties all the time, most commonly after first year. Being committed is important but so is having options for the future.
 
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To the OP- I feel for you, and it has to be frustrating knowing that you have personally experienced an illness you want to treat, yet PDs seemed to disregard this (not uncommon btw). However, I agree with everyone above about kicking ass during residency. MS3 is mostly a farce at US med schools (seeing it from both sides at my own med school and watching current 3rd years I supervise), but you need to show you can excel in a clinical setting (which should more than make up for MS3 performance).

Also, you will be that much more confident with 1-3 years of FM behind you (yes, you should complete at least your intern year but I'd rec doing all 3 to stay in your program's good graces- no one likes being down a resident). Does your program offer elective time PGY3? Maybe you can do rotations in psych and get letters
 
If you care about patients' mental health, you'll be a much better FM resident than most.
 
Thank you again everyone for chiming in - some really great feedback and advice! :) I'm still quite sure I want to switch, so I'm just working on a strategy going into intern year like getting step 3 out of the way.
 
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So personally not a fan of the everything happens for a reason line of thought and am hoping we pull back on sharing that with patients. 3 year olds dying on the street from ebola happens because of a reason? When you read those rants about what people facing scary diagnoses don't want to hear, this usually tops the list.

OK, that rant aside -- people do transfer residencies and specialties. It happens a lot (although maybe is harder these days). I agree with the above though that I'd focus on doing well in internship as the first priority. Feel out your PD and then make decisions about how to approach it.
 
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I know I'm a lowly non-medicine person, but after reading this I wanted to let you know about my PCP (a family physician). I never had a pediatrician (went random clinics) and so he's the first regular doctor I've had, and he's followed me well over 10 years now. He vacillated between psych and FM but ultimately chose FM. He is the most intellectually curious doctor I have. Very engaging, very creative. Has a strong interest in people's lives outside of numbers. Prescribes things like sunshine, walking, etc. Has kept up with whether I'm working or taking classes and always very encouraging. I don't want to write a hagiography as it might sound like some boundary-crossing, but he's really the tops. Because of my particular situation, I also see a psychiatrist, but I do know he treats other people for mental health issues, and he he helps out when psychiatrists retire or move. He has an amazing knowledge base too. I'm one of those patients doctors seem to not like because I come in asking about the risks of unopposed alpha effect taking a beta blocker and tea, for example, and he's one of the rare birds who knows what the hell I'm talking about and doesn't tell me not to go to "Dr. Google." He actually found a drug interaction had been missed by my cardiologist, psychiatrist, and the ER that was causing hypertension, low-grade fever, and constant sweating, and it turned out to be mild serotonin syndrome that resolved when I cut out that drug.
 
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How the hell does a USMD not match at least somewhere in psych with a 220 step 1 and 245 step 2? Did you just not apply to enough places or something?
 
Merely said:
How the hell does a USMD not match at least somewhere in psych with a 220 step 1 and 245 step 2? Did you just not apply to enough places or something?
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The OP mentioned several red flags in the, umm, OP. Also, many psych programs have a filter at step 1 = 220 (OP actually got 219), according to FREIDA.

The OP got an interview:application ratio of 1:8, which seems about right compared to my stronger application's ratio being 1 invite : 4 applications.

To secure a comfortable 10 interviews this season it would have taken 80 applications in ERAS, or over $3,000 in application fees alone.
 
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Merely said:
How the hell does a USMD not match at least somewhere in psych with a 220 step 1 and 245 step 2? Did you just not apply to enough places or something?
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Have you read the OP? (S)he had to repeat 3d year because of clerkship failures (plural). It's not all about Step scores - clerkship grades can be subjective and hard to compare between schools etc (though the overall pictures of your clinical grades, as opposed to any individual grade, does tell you something) - but failing even one clerkship is a certain red flag, especially in the context of a decent Step 1 and a strong Step 2 scores, which raises a concern about clinical performance. A very unfortunate depressive episode can certainly explain that and can give hope that the OP can perform well when not depressed - however, the disclosure of history of depression can by itself turn off some selection committees. (Plus the lack of strong psych letters and, I'm assuming, a track record of interest in psychiatry given that the OP decided on psychiatry late - though these are minor issues in comparison.)

I'm not saying this to kick the OP while (s)he's down - I actually feel bad for him/her, as it seems like the situation was not entirely under his/her control (i.e. being depressed) - in fact, (s)he did everything right by getting treated and knocking Step 2 out of the water. I'm just saying that Step scores by themselves, while important, don't predict one's success. Anecdotally, out of five people who matched to Derm from my school this year, two had Step 1 scores less than 220 and matched at two prestigious academic medical centers, our home program and one of our neighbors (to be honest, I don't exactly know how good these programs are, as I don't know much about Derm, but to the best of my knowledge they don't suck and are competitive by the virtue of their name and location, if nothing else). Surely, these students worked their connections, but that's not the point. The point is, there are things other than Step scores that can decide match outcomes.
 
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Merely said:
How the hell does a USMD not match at least somewhere in psych with a 220 step 1 and 245 step 2? Did you just not apply to enough places or something?
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Multiple clerkship failures + disclosure of mental illness. Psychiatrists don't like their colleagues to be open about the illnesses they treat (even though a lot do). I was initially wary (see my older posts on this) about people who come forward and disclose their own histories because a lot of time it just reads false bravado (mostly among the addictions doctors who are in Recovery), but stories like this from last week's NEJM http://www.nejm.org/doi/full/10.1056/NEJMp1615974 can really send a powerful message.

I feel for the OP especially because she did everything right after a her setback that she couldn't control/didn't ask for, but the culture of shame and stigma were working against her. If she excels in FM, however, she would be a very desirably candidate.
 
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It's quite unfortunate that psychiatrists who treat depression and know that depression is not a choice would reject a candidate for that reason. If we can't count on psychiatrists out of all people to accept mental illness how the hell are we supposed to tell the laymen to not stigmatize?
 
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Merely said:
It's quite unfortunate that psychiatrists who treat depression and know that depression is not a choice would reject a candidate for that reason. If we can't count on psychiatrists out of all people to accept mental illness how the hell are we supposed to tell the laymen to not stigmatize?
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it's called a double standard. Happens everywhere in life.
 
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Merely said:
It's quite unfortunate that psychiatrists who treat depression and know that depression is not a choice would reject a candidate for that reason. If we can't count on psychiatrists out of all people to accept mental illness how the hell are we supposed to tell the laymen to not stigmatize?
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I don't think it's the perfect analogy, but it's like an amputee applying to gen surg and not matching bc he doesn't have a hand. Doesn't sound too politically correct, but his job as a surgeon is compromised by the lack of hand. It's unfortunate, and I can't speak from experience, but having a mental illness might make it more difficult to work / treat those with mental illnesses.
 
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redbandit said:
I don't think it's the perfect analogy, but it's like an amputee applying to gen surg and not matching bc he doesn't have a hand. Doesn't sound too politically correct, but his job as a surgeon is compromised by the lack of hand. It's unfortunate, and I can't speak from experience, but having a mental illness might make it more difficult to work / treat those with mental illnesses.
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It's a terrible analogy. you cannot be a surgeon without a hand whereas psychopathology is extremely common in psychiatrists. I know psychiatrists with anxiety, depressive, bipolar, eating, attentional, substance use, psychotic, and the full range of cluster B personality disorders (from histrionic to psychopathic). Part of the internalized stigma comes from shame as a common refrain is that psychiatrists are all nuts, as well as the fact that psychiatrists have seen the very worst of people with serious mental health problems and thus tend to overestimate the possible problems that serious mental illness in their colleagues may bring up. It's more acceptable for psychiatrists to have neurotic disorders, and to be in psychotherapy (in fact it may well be encouraged or in some places required as part of your training). Some residency programs are more enlightened and enthusiastically receive high performing applicants with a history of serious mental illness. I know of one program has has actively solicited applicants from those in recovery from addiction. At the same time there are many people in the field who react very negatively towards other psychiatrists with mental illness. These tend to be less psychologically minded sorts who falsely erect boundaries between themselves and their patients and find exploding the binary opposition between patient and healer too unnerving or narcissistically injuring. Others still are more pragmatic. They want to fill their program with people who will turn up, won't cause trouble, won't create scheduling difficulties with absences, won't need additional support, won't need accommodations etc. If they have the luxury of choosing, the pragmatists are likely to choose without "baggage." It's discrimination pure and simple but it is also an unfortunate reality that neither begins nor ends with psychiatry.
 
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redbandit said:
I don't think it's the perfect analogy, but it's like an amputee applying to gen surg and not matching bc he doesn't have a hand. Doesn't sound too politically correct, but his job as a surgeon is compromised by the lack of hand. It's unfortunate, and I can't speak from experience, but having a mental illness might make it more difficult to work / treat those with mental illnesses.
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Or they could be Marsha Linehan and create an entire career around tackling problems few before her care to tackle in any organized or systemic fashion, right?
 
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Doctor Bagel said:
So personally not a fan of the everything happens for a reason line of thought and am hoping we pull back on sharing that with patients. 3 year olds dying on the street from ebola happens because of a reason? When you read those rants about what people facing scary diagnoses don't want to hear, this usually tops the list.

OK, that rant aside -- people do transfer residencies and specialties. It happens a lot (although maybe is harder these days). I agree with the above though that I'd focus on doing well in internship as the first priority. Feel out your PD and then make decisions about how to approach it.
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I find it wise to find- or should I say give- meaning to circumstances that befall upon one's life. Not to say that is something that everyone needs to hear as advice, especially during the most tragic of circumstances. It is more a matter of perspective and a method to find opportunity during those moments where an opportunity may be found... or missed otherwise.
 
To add some realistic bad news: A very difficult obstacle to securing a psych position will be funding. Last year, I was in a meeting where it was decided across the university system that no program can accept anyone without full funding or the money will be pulled from the program's direct budget (basically will never happen now). FM to psych does not have full funding. The university system I am talking about is associated with multiple residency programs.

This decision to accept only fully funded applicants is spreading. I'd wager that roughly 50% of all programs are unmatchable for you now.

Apply very broadly, pass step 3, and be willing to go anywhere if psych is truly your calling.
 
TexasPhysician said:
To add some realistic bad news: A very difficult obstacle to securing a psych position will be funding. Last year, I was in a meeting where it was decided across the university system that no program can accept anyone without full funding or the money will be pulled from the program's direct budget (basically will never happen now). FM to psych does not have full funding. The university system I am talking about is associated with multiple residency programs.

This decision to accept only fully funded applicants is spreading. I'd wager that roughly 50% of all programs are unmatchable for you now.

Apply very broadly, pass step 3, and be willing to go anywhere if psych is truly your calling.
Click to expand...


Can you explain this a little more? What applicants have full funding vs. those that don't?
 
This funding issue has always been true here. What is worse is that Deans are forever trying to balance the number of positions. If someone on Surgery goes off cycle due to a maternity leave, we might not be able to replace a psych opening until that surgeon graduates mid year. The converse is true more often because psych residents tend to be more reproductive than surgery residents.
 
MacDonaldTriad said:
This funding issue has always been true here. What is worse is that Deans are forever trying to balance the number of positions. If someone on Surgery goes off cycle due to a maternity leave, we might not be able to replace a psych opening until that surgeon graduates mid year. The converse is true more often because psych residents tend to be more reproductive than surgery residents.
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latest
 
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Is there a good place online we can go to better understand how GME and residency funding in general works?
 
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vitamin H said:
Can you explain this a little more? What applicants have full funding vs. those that don't?
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You have funding for the amount of years from your FIRST residency. So, if you matched into FM, you get 3 years of funding. If you'd like to switch into psychiatry after your intern year, and you apply to PGY2 psychiatry spots, you wont have funding for your pgy4 year. If you match psych and want to switch to FM after intern year, and apply to PGY1 positions in FM, you don't have any issues with funding, bc psych covers you for 4 years, and switching to FM with a psych intern year is equivalent. Hopefully that made sense
 
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Apply to LSU Shreveport, they will kick out an fmg to make room for an amg, Not a joke.


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TexasPhysician said:
To add some realistic bad news: A very difficult obstacle to securing a psych position will be funding. Last year, I was in a meeting where it was decided across the university system that no program can accept anyone without full funding or the money will be pulled from the program's direct budget (basically will never happen now). FM to psych does not have full funding. The university system I am talking about is associated with multiple residency programs.

This decision to accept only fully funded applicants is spreading. I'd wager that roughly 50% of all programs are unmatchable for you now.

Apply very broadly, pass step 3, and be willing to go anywhere if psych is truly your calling.
Click to expand...


So what happens if someone wants to do a second residency (e.g. Obgyn and then Psych)? Are they not funded at all?
 
Some programs don't use CMS funding. Try VAs or public systems.
 
Dharma said:
I find it wise to find- or should I say give- meaning to circumstances that befall upon one's life. Not to say that is something that everyone needs to hear as advice, especially during the most tragic of circumstances. It is more a matter of perspective and a method to find opportunity during those moments where an opportunity may be found... or missed otherwise.
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Encouraging someone to find meaning or perspective from something is different from telling them what the meaning is. Everything happens for a reason is a trite statement that actually invalidates other belief systems and doesn't really leave space for reflection or thought. It's a silly thing we say probably because it makes us feel good. It might make some listeners feel better but is alienating to other listeners.
 
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Doctor Bagel said:
Encouraging someone to find meaning or perspective from something is different from telling them what the meaning is. Everything happens for a reason is a trite statement that actually invalidates other belief systems and doesn't really leave space for reflection or thought. It's a silly thing we say probably because it makes us feel good. It might make some listeners feel better but is alienating to other listeners.
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I see your perspective. There are certainly many ways to look at it. Encouraging one to find meaning is necessary. Dropping a simple meme lacks substance.
 
I agree to make the most of the FP residency but I disagree with those saying to just make a lemon out of a lemonade. I would let the director know up front (no need to broadcast it to everyone) and continue to explore your options in psych. Many residents switch to psych after their first year, I was a traditional rotating intern (D.O.) and was able to scramble into a 2nd year spot and there are at least 2 or 3 residents in the residency who also started as 2nd years after a TRI or family medicine residency. It happens more often than you'd think. Just reapply to the match anyway, what do you have to lose. Also there are psych residencies out there (mine included) that don't use government funding so that would be less of a concern. Keep pushing for what you want!
 
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Be a really good intern and they'll probably help you unless they're total dirtbags.
 
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