Thursday, September 1, 2016

The prospects for switching to a different specialty

Could you comment on how an applicant switching into general surgery compares to one that applied directly from medical school would be viewed? I had a very difficult time choosing between specialties and have been regretting my decision not to apply into surgery. I am currently in a prelim year in medicine and am currently matched into radiology. I want to reenter the match process this year but am nervous to give up my guaranteed radiology position at a top program for an unknown where I can go unmatched or matched into an undesirable program. I graduated from a US med school. My USMLE Step 1 score was 235, Step 2 252, and I have published 2 articles in a surgical sub-specialty field.

You are what is known to the National Resident Matching Program (NRMP) as an "independent applicant" (graduate of a US med school going back into the match).

Go to the NRMP website, download the PDF "Main match results and data 2016" and look at Figure 6, you will find that 52.2% of independent applicants in general surgery failed to match compared to only 9.9% of US seniors.
This holds true for most specialties. Note that 43% of independent grads did not match in neurology.

Your USMLE scores are quite good, and the fact that you have published to articles will probably help a little. However, the reality is that you probably have about a 50-50 chance of matching in general surgery.

I wish I could explain why this is. All I know is it has been this way for years.

I can't tell you what to do. I suggest you give this some serious thought. It is probably not ethical for you to reenter the match and not tell your anesthesia program that you are doing so, but I suppose that is an option. If you don't match in general surgery, you would still have your anesthesia spot, but if you do match, you will leave your anesthesia program high and dry.

If you decide to apply to general surgery, you should go with mostly community hospital programs and send out lots of applications. By lots, I mean more than 50 or as many as you can afford.

You will be able to better assess your chances as you see how many interviews you are offered.

Good luck with your decision and please let me know how it turns out.



artiger said...

To the prospective radiologist/surgeon: Stick with the bird in will regret the ones in the bush, even if you manage to capture them.

Phil said...

As a current radiology resident, I will say that if you think you will miss the OR as a radiologist, there are plenty of opportunities to do procedures in radiology. Of course, there is IR, where procedures are your primary focus. There are also a lot of procedures to be done in body and breast imaging. Procedures are a great part of my day, and I've found that I can have really great interactions with patients with just my focused time with them during and surrounding the procedure. I enjoy these patient encounters way more than I ever did when I was in my intern year (I did a TY).

Depending on your subspecialty, you may also have a lot of interaction with your surgical colleagues during weekly/monthly interdepartmental conferences. If you can't imagine your life as anything other than a surgeon, then by all means go for it, with the caveat that Skeptical Scalpel already mentioned that your statistical chances aren't great. I think residency programs in general are wary of people who switch programs/specialties. How do they know that their program is really what you want, versus just an attempt to try to find something better than what you have now? How do they know you won't leave them in a lurch in a couple years by changing programs again? Also, keep in mind that depending on the program you match into, you might need to repeat your intern year. That will likely add to the total number of years you have for your training compared to staying the course with radiology, which can impact your financial future (more interest piles up on your loans while you push back when you start making staff salary). Money isn't everything, of course. If you know for sure surgery will make you happy, then go for it, but if you're not sure, it's an awfully expensive risk to take.

I wish you luck with whatever you choose.

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