Wanting to Transfer Anesthesia Programs

[Mac Miller]

A bit of background. Applied to a competitive specialty, but didn't match. Had to SOAP for a position and landed into a categorical anesthesia spot. Turns out, I really like anesthesia, perhaps even more so than my original specialty. However, the program I SOAPed into a not so good program clinically or for putting people into fellowships and is in a very high CoL area that I definitely will not be practicing in post residency.

My struggle is that I want to transfer into a program that will be closer to my family and SO, one that has the fellowships in-house and has been known to graduate a large percentage of residents into fellowships.
Stats: 235-240/240-245. Bottom quartile. Good LoRs. 4-5 research pubs in non-anesthesia fields.

I regret not exploring anesthesia sooner in my med school career, otherwise I definitely would have applied for this specialty. Could I get into a physician only (R-Position) spot after completing intern year into a more competitive residency program (top 10 - top 25)? I do like the idea of re-entering the match to actually interview at programs and cities that I WANT to be at rather than one I am stuck with.

Any advice?

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[spacegun]

A bit of background. Applied to a competitive specialty, but didn't match. Had to SOAP for a position and landed into a categorical anesthesia spot. Turns out, I really like anesthesia, perhaps even more so than my original specialty. However, the program I SOAPed into a not so good program clinically or for putting people into fellowships and is in a very high CoL area that I definitely will not be practicing in post residency.

My struggle is that I want to transfer into a program that will be closer to my family and SO, one that has the fellowships in-house and has been known to graduate a large percentage of residents into fellowships.
Stats: 235-240/240-245. Bottom quartile. Good LoRs. 4-5 research pubs in non-anesthesia fields.

I do regret not exploring anesthesia sooner in my med school career, otherwise I definitely would have applied for this specialty. Could I get into a physician only (R-Position) spot after completing intern year into a more competitive residency program (top 10 - top 25)? I do like the idea of re-entering the match to actually interview at programs and cities that I WANT to be at rather than one I am stuck with.

Any advice?

Are you married to your SO? If not, my guess is residencies probably will raise their eyebrows if you ask for a transfer because of your SO.

If it's more about prestige (top 10-25 anesthesia residency) or location, can't you do your fellowship at a more prestigious program later and at a program in the place you want to end up?

 

[Psai]

Just do the best you can in your program. The grass is always greener and there's a lot of malignancy in top programs.

 

[AdmiralChz]

So, you’re still a medical student posting this? Transferring before you even start your clinical anesthesia time will be a non-starter as you won’t have anyone really to vouch for you. You have no idea how your program will actually be until you get there and get in the weeds. Plus, you’ll be up against competitive applicants runnning away from surgery and subspecialties.

“Tier” of residency is absolutely in the eye of the beholder. I was in a similar situation as you and was able to scramble into an excellent (to me) program in the South. People often knock my old program on SDN, but it set me up well a so received excellent clinical training got my 1st choice fellowship and PP job. Your program may have some moonlighting opportunities to offset the high COL.

So, give your program a chance (you haven’t even started intern year, right?!). If you really hate it during your CA-1 year transfer can be discussed but transferring just for “prestige” or something like that won’t sell very well with prospective programs. Depending on if you matched advanced, it also might be a match violation to abandon ship before CA-1 year.

 

[Mac Miller]

Are you married to your SO? If not, my guess is residencies probably will raise their eyebrows if you ask for a transfer because of your SO.

If it's more about prestige (top 10-25 anesthesia residency) or location, can't you do your fellowship at a more prestigious program later and at a program in the place you want to end up?

Not yet. TBH, I almost didn't accept it, but gave into pressure from my deans who scared me about the potentially no other offers ever speech (I initially wanted to do a prelim year). And I dont want to do a fellowship. Goal is to practice general anesthesia.

So, you’re still a medical student posting this? Transferring before you even start your clinical anesthesia time will be a non-starter as you won’t have anyone really to vouch for you. You have no idea how your program will actually be until you get there and get in the weeds. Plus, you’ll be up against competitive applicants runnning away from surgery and subspecialties.

“Tier” of residency is absolutely in the eye of the beholder. I was in a similar situation as you and was able to scramble into an excellent (to me) program in the South. People often knock my old program on SDN, but it set me up well a so received excellent clinical training got my 1st choice fellowship and PP job. Your program may have some moonlighting opportunities to offset the high COL.

So, give your program a chance (you haven’t even started intern year, right?!). If you really hate it during your CA-1 year transfer can be discussed but transferring just for “prestige” or something like that won’t sell very well with prospective programs. Depending on if you matched advanced, it also might be a match violation to abandon ship before CA-1 year.

I'm getting my anesthesia month front loaded so I will have some anesthesia clinical time as an intern. Regarding moonlighting, it doesn't start till CA-2 year and take home pay amounts to less than 35/hour which is ridiculous. I've seen more people transfer after intern year rather than transfer in their CA-1 year, so I didn't know how feasible this option would be.

 

[Status Sciaticus]

Not yet. TBH, I almost didn't accept it, but gave into pressure from my deans who scared me about the potentially no other offers ever speech (I initially wanted to do a prelim year). And I dont want to do a fellowship. Goal is to practice general anesthesia.



I'm getting my anesthesia month front loaded so I will have some anesthesia clinical time as an intern. Regarding moonlighting, it doesn't start till CA-2 year and take home pay amounts to less than 35/hour which is ridiculous. I've seen more people transfer after intern year rather than transfer in their CA-1 year, so I didn't know how feasible this option would be.

To my knowledge, the NRMP grants waivers for two conditions primarily: change of specialty and extenuating hardships. Not sure if your situation would apply, unless being away from your SO/Family is causing you some true form of hardship, and they ask for documentation.

 

[Gern Blansten]

You say that you don't want to do a fellowship, yet you first stated your disappointment that you SOAP'ed into a program that has a poor track record of placing their residents into fellowships. So, you are disappointed that the residency program is not very good at doing something you have no interest in?
Your Dean was correct to tell you to take the offer because every year, students in your situation end up with no residency spot at all. The first round of SOAP is where all of the offers come. If you wait until the second round, you will often be left holding the bag and have no spot at all. It really sucks because your loans become due and you can't defer them because you are no longer in training. Students in the fourth quartile of their class have to be careful because they are the ones at risk of no spot at all.
Take the spot you accepted and work hard while you are there. It would piss me off to know that someone who committed to a spot in my program just a few weeks ago is already trying to weasel out of it.
Your situation in no way qualifies for an NRMP waiver, so you shouldn't even bother.

 

[deleted171991]

I'm getting my anesthesia month front loaded so I will have some anesthesia clinical time as an intern. Regarding moonlighting, it doesn't start till CA-2 year and take home pay amounts to less than 35/hour which is ridiculous. I've seen more people transfer after intern year rather than transfer in their CA-1 year, so I didn't know how feasible this option would be.

And how much would not be ridiculous for a resident? Your regular hourly salary is less than $25.

Btw, why does a bottom quartile student apply to a competitive specialty without having a backup plan?

 

[Mac Miller]

You say that you don't want to do a fellowship, yet you first stated your disappointment that you SOAP'ed into a program that has a poor track record of placing their residents into fellowships. So, you are disappointed that the residency program is not very good at doing something you have no interest in?
Your Dean was correct to tell you to take the offer because every year, students in your situation end up with no residency spot at all. The first round of SOAP is where all of the offers come. If you wait until the second round, you will often be left holding the bag and have no spot at all. It really sucks because your loans become due and you can't defer them because you are no longer in training. Students in the fourth quartile of their class have to be careful because they are the ones at risk of no spot at all.
Take the spot you accepted and work hard while you are there. It would piss me off to know that someone who committed to a spot in my program just a few weeks ago is already trying to weasel out of it.
Your situation in no way qualifies for an NRMP waiver, so you shouldn't even bother.

Valid point. I didn't think I would have to SOAP since I had the requisite number of interviews to statistically match. Given that SOAP occurred over 3 hours, it didn't give me enough time to look at the intricacies of fellowship placement, moonlighting opportunities, etc.. Hell, I didn't even know that the majority of anesthesiologists are now doing fellowships for job security...
All the programs I applied to knew my 4th quartile status, and yet still got interview invites.. so I dont see why it would be relevant.
Regarding your comment about "someone who committed to a spot in my program just a few weeks ago is already trying to weasel out of it. " ---> so I should just chug along and be miserable for 4 years? Maybe I want to try to apply to my original specialty again, and dual apply this time (in which case it would qualify for the NRMP waiver).

And how much would not be ridiculous for a resident? Your regular hourly salary is less than $25.

Btw, why does a bottom quartile student apply to a competitive specialty without having a backup plan?

its not a surgical subspecialty. It was moderately competitive (along the lines of Gen Surg, EM, OB/GYN) and I had enough interviews, so clearly the 4th quartile thing was overlooked (confirmed by some of the PDs I spoke with after the fact).

Looking within the specialty itself... many places moonlight for 100/hr rather than 35... Upon does 130/hr... so comparing that to a paltry 35/hr is ridiculous. Looking outside the specialty, EM residents get 180-250/hr.. so yeah by relative comparison it is ridiculous, even more so because they dont allow external moonlighting.

 

[Psai]

This requires professional personnel to operate, don't joke about life.

What

 

[San Marzano]

This requires professional personnel to operate, don't joke about life.

Is this account a bot? None of his posts make sense.

 

[Gern Blansten]

Valid point. I didn't think I would have to SOAP since I had the requisite number of interviews to statistically match. Given that SOAP occurred over 3 hours, it didn't give me enough time to look at the intricacies of fellowship placement, moonlighting opportunities, etc.. Hell, I didn't even know that the majority of anesthesiologists are now doing fellowships for job security...
All the programs I applied to knew my 4th quartile status, and yet still got interview invites.. so I dont see why it would be relevant.
Regarding your comment about "someone who committed to a spot in my program just a few weeks ago is already trying to weasel out of it. " ---> so I should just chug along and be miserable for 4 years? Maybe I want to try to apply to my original specialty again, and dual apply this time (in which case it would qualify for the NRMP waiver).

If your plan was to reapply for your original specialty, why did you not just SOAP into a preliminary year? By being in the fourth quartile, you are automatically at risk, although your step scores were actually pretty good. Your Dean or advisor ideally would have prepped you for the possibility of not matching so that you could have had time to adequately research a back up specialty.
The number of med students graduating is increasing every year as new schools open and they produce their first graduating classes. The number of residency positions is not keeping pace, so every year, it is more and more competitive. And those that don't match this year go back in the pool to make it even tougher for the next year's class. I would not want to be a fourth quartile student in the coming years as it is getting tougher and tougher to get residency spots.
Many schools hide class rank so that the PD's don't know what it is until they get the MSPE/Dean's letter, so if you got the invites prior to that being released, they may have invited you based on your step scores only. That could explain why you got more invites than expected.
The moonlighting thing may be frustrating, but many programs don't allow it at all and they keep you late anyway. So, getting a small amount is better than getting none at all. In addition, presenting facts to the program on what other programs pay can sometimes help your residency group renegotiate the terms. It should be done in a professional manner without anger or expectation. Just present the data and ask them to reconsider. You never know. They may bump it up to $50 or $60 if presented with data.
With regard to the fellowship issue, there are still a whole lot of people graduating and getting great jobs without fellowships. If that is the route you want to go, that will likely work out just fine.
There are only a handful of truly awful programs in the US and you will likely be well trained when you finish no matter where you go. Each program has its strong points and its weak areas. In a few years, no one will care what program you went to; they will only care how good you are and how easy to get along with you are.
I wish you the best and I would recommend that you go in with a positive attitude and make the best of the training program that took a chance on a guy in the SOAP process. Don't write them off before you ever even darken the doorway of their hospital. You may find yourself pleasantly surprised.
Good luck!

 

[Mac Miller]

If your plan was to reapply for your original specialty, why did you not just SOAP into a preliminary year? By being in the fourth quartile, you are automatically at risk, although your step scores were actually pretty good. Your Dean or advisor ideally would have prepped you for the possibility of not matching so that you could have had time to adequately research a back up specialty.
The number of med students graduating is increasing every year as new schools open and they produce their first graduating classes. The number of residency positions is not keeping pace, so every year, it is more and more competitive. And those that don't match this year go back in the pool to make it even tougher for the next year's class. I would not want to be a fourth quartile student in the coming years as it is getting tougher and tougher to get residency spots.
Many schools hide class rank so that the PD's don't know what it is until they get the MSPE/Dean's letter, so if you got the invites prior to that being released, they may have invited you based on your step scores only. That could explain why you got more invites than expected.
The moonlighting thing may be frustrating, but many programs don't allow it at all and they keep you late anyway. So, getting a small amount is better than getting none at all. In addition, presenting facts to the program on what other programs pay can sometimes help your residency group renegotiate the terms. It should be done in a professional manner without anger or expectation. Just present the data and ask them to reconsider. You never know. They may bump it up to $50 or $60 if presented with data.
With regard to the fellowship issue, there are still a whole lot of people graduating and getting great jobs without fellowships. If that is the route you want to go, that will likely work out just fine.
There are only a handful of truly awful programs in the US and you will likely be well trained when you finish no matter where you go. Each program has its strong points and its weak areas. In a few years, no one will care what program you went to; they will only care how good you are and how easy to get along with you are.
I wish you the best and I would recommend that you go in with a positive attitude and make the best of the training program that took a chance on a guy in the SOAP process. Don't write them off before you ever even darken the doorway of their hospital. You may find yourself pleasantly surprised.
Good luck!

Because my deans/ advisors said that a categorical was better than a prelim year, even if reapplying to my specialty next year.. I wanted to do prelims, but deferred to their advice since I figured they had done this before. I go to a top 20 school so everybody is naturally very smart, and someones gotta be in the bottom quartile. Invites came weeks after MSPE release, not before with most invites coming in mid november (MSPE goes out Oct 1), so that theory is out. I am going to give it a fair shake for sure, but I am trying to plan contingencies, which is why I wanted to inquire about transferring programs, even a direct transfer rather than entering the match. Thanks anyways.

 

[nimbus]

OP, you asked for and received a lot of advice from experienced people, both at your medical school and here on SDN. You don’t seem to like any of it. And not sure why you think you can transfer into a top program with a very average application.

It is your life and your decision to make.

 

[Mac Miller]

OP, you asked for and received a lot of advice from experienced people, both at your medical school and here on SDN. You don’t seem to like any of it. And not sure why you think you can transfer into a top program with a very average application.

It is your life and your decision to make.

Actually, I didn't ask this at my medical school. The only thing they were involved with were SOAPing. Its not that I dont like it. And their advice is based on faulty assumption (such as me getting interview invites before MSPE coming out and my bottom quartile status not being available when deciding if to interview me or not). Im not trying to get into Duke, MGH, or UCSF, even though their step scores are in line with mine.
I am thinking about reentering the match for my original specialty, but I wanted to know how my app would look to good anesthesia programs if I were to dual apply because I dont expect my PD to hold my spot while I apply into another specialty.

 

[Gern Blansten]

There is almost always a good reason that someone doesn't match. The key is to be introspective enough to examine your application and figure that out. Having an advisor or someone in your Dean's office who will be honest with you is the key.
It's hard to get that from an anonymous message board. If you are fourth quartile and you sought no advice from your school's Deans office until the SOAP process, that was a mistake.

 

[Mac Miller]

There is almost always a good reason that someone doesn't match. The key is to be introspective enough to examine your application and figure that out. Having an advisor or someone in your Dean's office who will be honest with you is the key.
It's hard to get that from an anonymous message board. If you are fourth quartile and you sought no advice from your school's Deans office until the SOAP process, that was a mistake.

I spoke with several PDs of places I interviewed at and they said that one aspect to work on was my interviewing skills, otherwise my app was competitive. I did ask about the bottom quartile ranking and they said it wasn't a big factor in where I ranked since my step scores were up to par. My deans office referred me to our specialty department which is where I got most of my advice. Thanks for the help anyways.