Would you switch after PGY-2?

[geese]

Hey guys,

Needed some general advice and also personal opinions. Short story is that I'm finishing off my FM intern year and starting pgy2 in July. I've spoken to my PD and a few other faculty and they have given me their "blessing" that I can apply for IM this fall. Question is how many of you would consider switching after 2 years of residency knowing that you just have 1 year left? I've been more interested in inpatient throughout the year and very intrigued by IM sub-specialty fellowships hence the reason I want to switch.

Any input is appreciated!

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[BlondeDocteur]

Those are very good reasons to switch. I would continue on in residency and attempt to find an IM PGY-2 spot outside of the match, while applying through ERAS for a PGY-1 position to cover your bases. People frequently find that, when they're invited to interview as an intern, the program can accommodate a transfer for an R2 spot if they like you.

If possible you can try to load your PGY-2 year with as many IM and inpatient rotations as possible; that way you might even be able to transfer in with as much as 18 months of credit.

Is your current program unopposed? If you have an in-house medicine residency that would be your best bet. There is even a small chance you could slide on in this coming July as a medicine R2.

 

[geese]

Those are very good reasons to switch. I would continue on in residency and attempt to find an IM PGY-2 spot outside of the match, while applying through ERAS for a PGY-1 position to cover your bases. People frequently find that, when they're invited to interview as an intern, the program can accommodate a transfer for an R2 spot if they like you.

If possible you can try to load your PGY-2 year with as many IM and inpatient rotations as possible; that way you might even be able to transfer in with as much as 18 months of credit.

Is your current program unopposed? If you have an in-house medicine residency that would be your best bet. There is even a small chance you could slide on in this coming July as a medicine R2.

Loading my PGY2 year with inpatient roations is out of the questions because we don't have any electives until PGY-3. My program is not unopposed and yes there is a Medicine residency in house. In fact I've already talked to the IM program director as that is what my PD and advisor told me to do. He said at most I'd be able to get 3 months of credits but not much more than that. He said he would definitely vouch for me to IV and even match here if I chose to apply to the in house program since he said doing 2 years of FM would make me stand out and that I'm already in the University system just at a different specialty currently. If I was able to secure a PGY-2 spot it would be a no brainer for me, but starting from scratch from intern year kind of holds me back from pulling the trigger. The IM PD also told me that even to get PGY1 year waived for a fully licensed FM physician who decided to do IM after practicing for a few years was a issue but they were able to get it done in the end. He said for me I would pretty much have to start from PGY-1 with a few months of credits only.

 

[gutonc]

Those are very good reasons to switch. I would continue on in residency and attempt to find an IM PGY-2 spot outside of the match, while applying through ERAS for a PGY-1 position to cover your bases. People frequently find that, when they're invited to interview as an intern, the program can accommodate a transfer for an R2 spot if they like you.

If possible you can try to load your PGY-2 year with as many IM and inpatient rotations as possible; that way you might even be able to transfer in with as much as 18 months of credit.

Is your current program unopposed? If you have an in-house medicine residency that would be your best bet. There is even a small chance you could slide on in this coming July as a medicine R2.

Nope, nope, nope. At best, if the OP completed an entire FM residency, he could get credit for 6-12 months of "time served" in an IM program, and then only at the discretion of the PD. There's no lateral movement from FM --> IM (or vice versa).

If you're certain about this, and you're certain you will get a spot (either at your current institution or elsewhere), no reason not to go for it next year. BUT, if you're interested in a more competitive sub-specialty (Cards, GI, Onc, PCCM) then you need to make sure you get into a "good" IM program. If you don't think you have a shot at a mid-tier or better IM program, IMHO you'd be better off sticking out FM for one more year and then going for IM at that point. That way, if things don't work out for you on the IM side, you've still got a career in medicine.

Good luck.

 

[Winged Scapula]

As gutonc and your local IM PD notes, the chance of you getting a significant amount of IM credit for your FM rotations is slim. Thus you really need to ask yourself whether or not the switch is worth it if you have to start over as an intern (which is sounds as if would be likely). Are there any FM fellowships that would allow you pursue your interests (Hospital/Palliative care?).

 

[geese]

Nope, nope, nope. At best, if the OP completed an entire FM residency, he could get credit for 6-12 months of "time served" in an IM program, and then only at the discretion of the PD. There's no lateral movement from FM --> IM (or vice versa).

If you're certain about this, and you're certain you will get a spot (either at your current institution or elsewhere), no reason not to go for it next year. BUT, if you're interested in a more competitive sub-specialty (Cards, GI, Onc, PCCM) then you need to make sure you get into a "good" IM program. If you don't think you have a shot at a mid-tier or better IM program, IMHO you'd be better off sticking out FM for one more year and then going for IM at that point. That way, if things don't work out for you on the IM side, you've still got a career in medicine.

Good luck.

I'm interested in a competitive sub-specialty hence the reason I even want to switch. That's my plan for now, is to apply this fall and see what kind of Interviews I get, hopefully mid-tier or better like you mentioned. At the end of interview season if I feel that the places I interviewed at will not give me a good chance to get a competitive fellowship then I'll just withdraw from the match and finish my FM residency.

 

[geese]

As gutonc and your local IM PD notes, the chance of you getting a significant amount of IM credit for your FM rotations is slim. Thus you really need to ask yourself whether or not the switch is worth it if you have to start over as an intern (which is sounds as if would be likely). Are there any FM fellowships that would allow you pursue your interests (Hospital/Palliative care?).

Maybe Hospital or ER. But still way more interested in IM fellowships if I had to compare.

 

[Winged Scapula]

Maybe Hospital or ER. But still way more interested in IM fellowships if I had to compare.

Have you decided about the issue of repeating PGY1?

 

[maygrl110]

Feel like I'm reading this message frequently...unfortunately you sound just like me. I will be completing a FM residency and then redoing some IM in July. I did it through the match this year and was able to get my top choice (mid tier, academic). Of course, having some training makes you more attractive especially if you have a compelling reason.
Would you consider staying at your local IM program bc sounds like an easy switch. Also, do you guys have fellowship in house? Other options are of course ERAS (time consuming, expensive) for PGY1 spots; other options are: residency swap, open residency.com, find a resident (AMA). If you are determined to do this, now is not a bad time bc you still have 1 yr left of full funding (CMS only reimburses full for three years of your first specialty, any time after that will be reduced to the program). Some programs might find the funding issue to be an issue, but a lot don't and it certainly won't keep you from a spot if you are determined. However, you need to be aware of it.
My advice is to do it now so you're not thinking about this 5 yrs into practice b/c it will be harder to switch then.

 

[geese]

Have you decided about the issue of repeating PGY1?

Honestly that's probably the only thing that makes me cringe when I think about making the switch. I mean nobody whats to start from intern year again. If however I was sure that I'd get into a good program that give me a great chance at landing a fellowship then I really don't mind starting from intern year again.

 

[geese]

Feel like I'm reading this message frequently...unfortunately you sound just like me. I will be completing a FM residency and then redoing some IM in July. I did it through the match this year and was able to get my top choice (mid tier, academic). Of course, having some training makes you more attractive especially if you have a compelling reason.
Would you consider staying at your local IM program bc sounds like an easy switch. Also, do you guys have fellowship in house? Other options are of course ERAS (time consuming, expensive) for PGY1 spots; other options are: residency swap, open residency.com, find a resident (AMA). If you are determined to do this, now is not a bad time bc you still have 1 yr left of full funding (CMS only reimburses full for three years of your first specialty, any time after that will be reduced to the program). Some programs might find the funding issue to be an issue, but a lot don't and it certainly won't keep you from a spot if you are determined. However, you need to be aware of it.
My advice is to do it now so you're not thinking about this 5 yrs into practice b/c it will be harder to switch then.

How much credit are they giving you when you start IM? The only fellowship they got here is Nephrology which I'm not interested in so I would not like to stay here. I've tried residency swap but I mostly just find expired openings or places I'm not interested in. As for now I'm just planning on the eras match this fall since I think that would give me the best opportunity of getting into a place that I would like and I'll see what IV's I get. I pretty much have to do PGY2 here since I already signed my contract. So won't be starting anywhere new in July...

 

[secants]

I'm curious, would you still sit for the FM board for certification? Is there any benefit having dual board status in this case?

 

[maygrl110]

Unfortunately, max is as stated before 6-12 months credit even for 3 yrs b/c most of my training was not with internists-this is per ABIM. I did take the boards which is a requirement for my graduation. Not sure being double board certified will be much benefit since I don't intend to practice FM ever, even moonlighting. However, having the prior training I'm sure will help somewhere down the line.
Back to your situation, check with ERAS if you need a waiver for switching out prior to completing your contract-I don't think you do, but just be sure. Also, make sure you at least pass step 3. Sure it's not a big deal, but it would be embarrassing to have a fail on your record while applying. Would not stress about it either, I only did q bank questions and did well since FM is so geared towards that test.

 

[gutonc]

Back to your situation, check with ERAS if you need a waiver for switching out prior to completing your contract-I don't think you do, but just be sure.

You don't. The ERAS contract is for 45 days only. After that it's down to the contract you have with the program which is year-to-year anyway.

 

[geese]

Unfortunately, max is as stated before 6-12 months credit even for 3 yrs b/c most of my training was not with internists-this is per ABIM. I did take the boards which is a requirement for my graduation. Not sure being double board certified will be much benefit since I don't intend to practice FM ever, even moonlighting. However, having the prior training I'm sure will help somewhere down the line.
Back to your situation, check with ERAS if you need a waiver for switching out prior to completing your contract-I don't think you do, but just be sure. Also, make sure you at least pass step 3. Sure it's not a big deal, but it would be embarrassing to have a fail on your record while applying. Would not stress about it either, I only did q bank questions and did well since FM is so geared towards that test.

I've done and passed step 3. I told my program that I'll finish pgy-2 since I'll be applying this fall to IM and they're okay with that. However my situation is a bit more complicated since I'm on a J-1 visa. J-1 is only valid for 7 years after that you have to go back to your home country (Canada in my instance) for 2 years or you can get a J-1 waiver job here in the states then apply for greencard after. I'll have done 2 years FM then 3 years IM and if I do a fellowship (which is why I'm switching in the first place) I'll be 1 year short on my visa because 7 years will only take me to the end of my 2nd year of fellowship. I've talked to ECFMG about this and they said that if I get to that point there are ways to get that 1 year extension. They would would have to open a case on my behalf and present it to whatever organization/department is in charge of Visas. They say it shouldn't be a problem but at the same time don't give any sort of guarantee. That's another thing I ponder if I decide to go through with all this.

 

[geese]

Nope, nope, nope. At best, if the OP completed an entire FM residency, he could get credit for 6-12 months of "time served" in an IM program, and then only at the discretion of the PD. There's no lateral movement from FM --> IM (or vice versa).

If you're certain about this, and you're certain you will get a spot (either at your current institution or elsewhere), no reason not to go for it next year. BUT, if you're interested in a more competitive sub-specialty (Cards, GI, Onc, PCCM) then you need to make sure you get into a "good" IM program. If you don't think you have a shot at a mid-tier or better IM program, IMHO you'd be better off sticking out FM for one more year and then going for IM at that point. That way, if things don't work out for you on the IM side, you've still got a career in medicine.

Good luck.

This maybe a stupid question but is there a list somewhere that states which programs are mid-tier or better? If not, is there a way to find out?

 

[Doctor Bob]

This maybe a stupid question but is there a list somewhere that states which programs are mid-tier or better? If not, is there a way to find out?

You will never find consensus as to program's tierage. Every year there are 20+ threads trying to determine which programs are "top tier" for various specialties and they never agree. Sure there might be programs which most people would consider to be good programs, but the idea of a list for tierage will never come about because there's no consensus.

Amongst undergrad programs there are the big ranking lists, but they do so based on various objective metrics, many of which may or may not be relevant to a particular individual. Until we come up with a generally-agreed upon set of ranking metrics, there won't be any good way to make a tiered list. And even if we do, people will still argue about the lists.