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.

BlueBird said...

I had similar question and ordeal last year. The problem is You cannot go through match without blessing of your program and the main problem is that you have to sign the next year contract usually in december-january maximum, before match results are out. which make your current training program as an outside match contract which itself is violation of the match. So bottom line is unless you feel comfortable talking to your faculty, describe your feelings an struggle there is no smooth way of getting out. In the best scenario if you sign net year contract not to disclose that you are in match you better pray not to match not to violate the match as you might end up being banned from everything. Correct me if I am wrong, this is what I have found out on forum and this is what made me make decisions I have made. Which is completing my training and going through residency match again in last year.
I do not know what my chances hold in surgery, despite being fully trained in my country and one of the best residents in my different specialty, but this is the crucial decision and very hard. and I do not wish anyone being unhappy in training and dreaming of being able to get to/back to OR

Skeptical Scalpel said...

Unknown, you are correct that most contracts are renewed before the match results are available. I think it would be better to tell your current program you want to change your specialty. When I was a PD, I would not have considered taking an applicant who was already in a residency program who could not provide a letter of recommendation from her current PD or chairman.

I'm not sure why you would re-enter the match and then pray not to match.

Anon321 said...

I was told that of the things working against you is funding. The powers that be (government) allot a certain amount of money for training for each resident, based on the anticipated length of their residency. When you switch specialties, the original amount of money follows you, so if the training period for your new specialty is longer than that you originally entered, the program has to eat the difference and they are generally unwilling or unable to do so. This is why my program director (EM residency), often advises weak applicants who want to try an internship year in something else with the plan being to shine and then reapply to EM, to match in surgery. This way they'll be budgeted for a 5 year residency, so even though their prelim year won't count (because EM doesn't do a prelim year) the entire residency will be covered. This is in opposition to doing a family medicine year and then switching, because then you only have 2 government funded years remaining, not enough to complete the minimum 3 year residency.

Skeptical Scalpel said...

Anon321, you raise an interesting point. I have heard something similar to what you wrote about funding but am unable to confirm it.

The average USMLE Step 1 score for applicants matching in categorical 5-year general surgery is >230. I find it hard to believe that weak applicants to EM can simply match in surgery unless you mean for preliminary surgery (one year) positions which are abundant. Those positions would not be funded for 5 years.

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