What would you do? Prelim vs Categorical

[roast]

I am currently a 3rd year DO student. I am dead set on surgery and I am having difficulty deciding what route to take. I want to pursue the best training possible to me, and I'm not sure if shooting for a categorical spot at a mid to lower tier MD program or a Prelim spot at a bigger name institution would be best. I took the USMLE and scored a 237 which i believe makes me somewhat competitive for surgery even as a DO, but I really want to move to a big city (such as NY). Would it be foolish to shoot for a prelim surg spot at for example NYU or one of the bigger name institutions instead of going to a smaller communiversity program? would a prelim spot at a bigger name place even be possible as a DO with that type of USMLE score? I have NO ONE at my school to talk to about this so any help would be greatly appreciated. Thank you.

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[cpants]

You should pretty much always go for a categorical spot over a prelim spot. Swallow your pride. At the end of PGY-1, the majority of prelims at the big name spots are trying to get categorical spots at the low/midlevel programs where you might be more competitive. You are better off doing that from the get go. You might get lucky, but is it really worth the risk? I know some great prelim residents who have had to do second and third prelim years, even ended up having to repeat internship (one of them twice). The minority of them have gotten categorical spots at all after one year. Honestly, there are some amazing programs out there without an ivy league institution backing them. Rejoice that you have some great options. NYC is even an option if that is your goal.

 

[Dissected]

Agree with above. You have a very competitive step 1 score. Get good letters, shine on a few away surgery rotations 4th year, and take/dominate the usmle step 2. This will put you in a much better position to match somewhere than if you did a prelim. DONT do a prelim year if you don't have to.

 

[Winged Scapula]

1) your residency training is what you make of it; doing a Prelim at a top tier program is not going to make you a Debakey and doing a Categorical at Urban Hospital Program X is not going to make you some surgical schlub;
2) those Prelims at prestigious places, are not matching in Categorical positions are other prestigious places. Like noted above, they are vying for *any* categorical position;
3) doing a Prelim year marks you as "tainted goods", affecting your future ability to match (fair or not, PDs will wonder why you didn't match the first time around)
4) it is awfully hard to interview for a categorical position while an intern

Listen to the others above, and only take a Prelim position as a last resort.

 

[SLUser11]

I am currently a 3rd year DO student. I am dead set on surgery and I am having difficulty deciding what route to take. I want to pursue the best training possible to me, and I'm not sure if shooting for a categorical spot at a mid to lower tier MD program or a Prelim spot at a bigger name institution would be best. I took the USMLE and scored a 237 which i believe makes me somewhat competitive for surgery even as a DO, but I really want to move to a big city (such as NY). Would it be foolish to shoot for a prelim surg spot at for example NYU or one of the bigger name institutions instead of going to a smaller communiversity program? would a prelim spot at a bigger name place even be possible as a DO with that type of USMLE score? I have NO ONE at my school to talk to about this so any help would be greatly appreciated. Thank you.

New York is not exactly the hardest city to land in for surgical residency, as there are a lot of residencies there big and small. I'll leave it to others to opine on the quality of said programs.

For a while, I've given the gentle suggestion that DO SDNers should create a thread of "DO-friendly" programs that would help future applicants through the process. I don't think that ever got done. I think an "IMG-friendly" thread would also be a good idea.

 

[thunder hawk]

Listen to your seniors. Never ever pcik a prelim over a categorical position....

 

[MediCane2006]

Concur with what everyone else has said. SHOOT FOR A CATEGORICAL SPOT. Doing a prelim year should only be a last resort as you will be at a distinct disadvantage when applying next year for a categorical position.

There are plenty of programs at all levels of competitive-ness in the Northeast that will allow you to live in a big city, including NY.

 

[roast]

thanks a lot for the feedback, that was the general feeling I had about the subject but its nice to hear that from so many respected frequent posters on SDN. just gotta work as hard as i can and let the rest take care of itself

 

[jubb]

I wish everybody knew this, because I've interacted with several Medical students thinking a preliminary year bolsters there application for the next year because they'll have more experience.

Being a preliminary and getting out of preliminary status can be incredibly painful and even humiliating.

 

[majik1213]

1) your residency training is what you make of it; doing a Prelim at a top tier program is not going to make you a Debakey and doing a Categorical at Urban Hospital Program X is not going to make you some surgical schlub;
2) those Prelims at prestigious places, are not matching in Categorical positions are other prestigious places. Like noted above, they are vying for *any* categorical position;
3) doing a Prelim year marks you as "tainted goods", affecting your future ability to match (fair or not, PDs will wonder why you didn't match the first time around)
4) it is awfully hard to interview for a categorical position while an intern

Listen to the others above, and only take a Prelim position as a last resort.

do PDs distinguish preliminaries who failed to match into general surgery vs. those who failed to match in more competitive surgical subspecialties? I would guess that if you were a preliminary resident because you failed to match into a surgical subspecialty, had a change of heart during your preliminary year, and are applying strictly to general surgery, then your chances should be as fair as any other U.S. allopathic senior who is interested in general surgery - right?

I do agree. never intentionally choose a preliminary year over categorical. If you are unlucky and end up as a preliminary, I want to say that all hope is not lost. For example, I am a preliminary resident at a big time institution because I did not match into a more competitive specialty and because I was couples matching and did not list all the places at which I interviewed. My program director has made phone calls to big name places on my behalf to advocate, and I doubt any US allopathic senior has experienced a similar advantage.

 

[Dr.LeoSpaceman]

do PDs distinguish preliminaries who failed to match into general surgery vs. those who failed to match in more competitive surgical subspecialties?

You would probably have to ask a PD that question. It might be slightly better than other prelims since your "measureables" will likely be better, but you certainly aren't going to be viewed as equivalent to the first time applicants.

I can tell you that you would then need a pretty good answer to the question "Why general surgery?" Any hint that you're using it as a fallback position because you couldn't match into something else the first time around is probably going to put a dent in your chances.

 

[Winged Scapula]

do PDs distinguish preliminaries who failed to match into general surgery vs. those who failed to match in more competitive surgical subspecialties? I would guess that if you were a preliminary resident because you failed to match into a surgical subspecialty, had a change of heart during your preliminary year, and are applying strictly to general surgery, then your chances should be as fair as any other U.S. allopathic senior who is interested in general surgery - right?

I agree with FaytIND - it will be hard to increase your chances to match those of the 4th year student or first time residency applicant.

The truth is most subspecialty applicants *don't* have a change of heart and it would be a difficult task to try and convince the PD that you aren't gonna jump ship the first time a Uro/ENT/PRS/Ortho position becomes available.

I do agree. never intentionally choose a preliminary year over categorical. If you are unlucky and end up as a preliminary, I want to say that all hope is not lost. For example, I am a preliminary resident at a big time institution because I did not match into a more competitive specialty and because I was couples matching and did not list all the places at which I interviewed. My program director has made phone calls to big name places on my behalf to advocate, and I doubt any US allopathic senior has experienced a similar advantage.[/QUOTE]

Of course not all hope is lost and if you have supportive faculty, then you may be at an advantage ( but I have to wonder why your "big name place" isn't offering you a categorical position themselves. Its a fair question I would ask if interviewing you.) Prelims can and do obtain categorical positions and it is the rare applicant who would choose Prelim (with the exception of our own BlondeDocteur). I wish you the best of luck. 🙂