what to do if you don't match in IM?

[irlandesa]

OK, I know the above scenario is pretty unlikely, especially for a US grad like myself who ranked 9 programs (none of the MGH, BWH, JHU variety, and 2 "community" programs), but just curious as to what tactics people applying in IM who found themselves in this situation used. Would it be better to directly scramble into a lesser known categorical program with available spots, or to scramble into a prelim position at a higher ranked program with hopes of getting bumped up to categorical the next year (at the same or similar hospital)? I actually know some people who were in a prelim year at really strong programs, planning to either reapply for or go into Rads, Optho, etc, and ended up joining a categorical program as a PGY-2 (e.g. Maryland, UPenn, Wash U!) because they enjoyed IM so much. Any thoughts? Personally, I'd go with the direct categorical scramble, but I'm not a big risk taker.. Also, there are often really good categorical positions available via the scramble (Pitt, UNM, Vandy, UVM, WFU, Maine, and Carolinas this past year); does anyone know someone that scrambled successfully into such programs?

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[carol ann]

I'm with you - I'd go for the direct scramble...but I also know it is pretty easy to transition from a prelim to a categorical at strong programs. I know two people who scrambled into Carolinas but are just doing prelims. Carolinas was actually picky about the people they accepted in the scramble and chose to have empty spaces instead of picking unqualified people.

Truthfully, I know that neither of us are going to have a problem with that. You got interviews at great programs and have a very reasonable match list - so don't worry about that contingency. It's not going to happen.

 

[samsoccer7]

This is a great post. I know some people who are very interested in location, and they would be willing to scramble into a program as a prelim or categorical in order to move to that city (mostly for signif. other reasons). I would imagine that if you took a prelim position somewhere and really worked your butt off, they would allow you to stay for the next 2 years. Also, if you took a prelim spot, you could reapply or maybe transfer somewhere as a PGY-2. Not sure how this all works.

Also, what if you want to just take a year and do something else medically related, but not an intern? Could you still make some decent money, enough to live and start paying off some loans?

 

[speyeder]

Does anyone know how easy or hard it is to jump into the categorical track at a program if you went there as a prelim, assuming you worked hard and they like you? Are programs allowed to add an extra resident into a pgy2 or pgy3 class? I thought IM programs are ACGME approved for a certain # of residency spots. If they allow a prelim to continue on as a categorical resident, do they have to take a position away from the entering intern class?

OK, I know the above scenario is pretty unlikely, especially for a US grad like myself who ranked 9 programs (none of the MGH, BWH, JHU variety, and 2 "community" programs), but just curious as to what tactics people applying in IM who found themselves in this situation used. Would it be better to directly scramble into a lesser known categorical program with available spots, or to scramble into a prelim position at a higher ranked program with hopes of getting bumped up to categorical the next year (at the same or similar hospital)? I actually know some people who were in a prelim year at really strong programs, planning to either reapply for or go into Rads, Optho, etc, and ended up joining a categorical program as a PGY-2 (e.g. Maryland, UPenn, Wash U!) because they enjoyed IM so much. Any thoughts? Personally, I'd go with the direct categorical scramble, but I'm not a big risk taker.. Also, there are often really good categorical positions available via the scramble (Pitt, UNM, Vandy, UVM, WFU, Maine, and Carolinas this past year); does anyone know someone that scrambled successfully into such programs?

 

[P Diddy]

Does anyone know how easy or hard it is to jump into the categorical track at a program if you went there as a prelim, assuming you worked hard and they like you? Are programs allowed to add an extra resident into a pgy2 or pgy3 class? I thought IM programs are ACGME approved for a certain # of residency spots. If they allow a prelim to continue on as a categorical resident, do they have to take a position away from the entering intern class?

Here at Stanford IM we've had two prelims cross over into categorical positions in my 3 years. One was going into Rad-Onc at Harvard but ended up staying at Stanford and short tracking into cardiology (he was published in Nature). The other was a prelim in Radiology and went to UW in Seattle after internship but hated Radiology and came back as a PGY2 this year. Either this says something about Radiology or about the strength of our IM program!

Typically there are 1-2 spots available in the PGY2 and 3 slots for IM residencies, but this varies by institution and by year. If one year a large portion of the intern class short tracks, for example, the program will have to recruit PGY3s to replace them eventually (or increase the size of the PGY2 class) as these residents will be gone after PGY2. In my program, the two interns who were offered categorical slots were strong clinically and in terms of research. we're glad to have them. other prelims wanted to stay on as well but were unable to obtain positions. PM with questions about tjs topic or Stanford IM.

P Diddy

 

[germanIMG]

just out of curiosity: how would one apply for PGY 2? through ERAS? not sure if I understand how this works?

 

[doc05]

for a US grad going for IM, you won't be scrambling. trust me. nonmatchers are usually those who've applied for supercompetitive specialties, like rads, ortho, derm, etc. Best of luck.

 

[irlandesa]

thanks for the input.. I am not too worried as I did a pretty good job with my rank list, but just wondering.. I know one intern at U of Maryland who started as a prelim wanting to do rads (didn't match in the latter), but decided to stay on as a PGY-2. UMD just got funding for an additional intern and junior resident position, so I guess it worked well for him. I also know another intern who graduated from U Penn, did a prelim year for Radiology at another hospital, then decided to return to Penn for a PGY-2 year in medicine. I think it is definitely feasible to from prelim IM->categorical in some capacity, given that 20% of residents change programs and/or specialties after the intern year, but open PGY-2 spots are by no means guaranteed.