Monday, March 14, 2016

Switching programs or specialties

What happens if you matched at one of your least-favorite programs? What happens if you matched into your second-choice specialty? Is it possible to transfer?

Matching anywhere isn't easy, so congratulations to everyone who received good news on Match Day! But maybe it's not the result that you dreamed of. For example, you interviewed at a dozen family medicine programs, but matched into your last choice. Or you really wanted to train in anesthesiology, but matched into your backup specialty of internal medicine instead. Or you were chosen for a position after using SOAP, but it's not what you were hoping for at all.

I want to strongly caution you: reapplying might hurt you more than it helps, unless you are very careful. Remember, if you leave, that will create a vacancy in your current program, and if your program director wants to fill it starting next summer, that means he/she has to interview people this year -- at the same time you're applying and interviewing. And if you don't match into a new program, but your program director finds someone, how does that get resolved? It might mean that your contract doesn't get renewed. That's why you and your director need to work this out together before you start applying (or you decide not to reapply, which is usually the best option). In short, would you prefer to complete your training where you already matched, or risk getting discharged after your first year and then not have anywhere new to train?

If you're absolutely determined to reapply, it's incredibly important to have the support of your new program director, and you should get most (perhaps all) of your LORs from your new attendings. After all, you didn't match into the particular program/specialty you desired with your old LORs, so you need to upgrade them to have a better chance. Plus, applying without the backing of your current program would look suspicious. If you don't use any LORs from your current program, you'll still need to include your current program's contact information in ERAS, and if I were a residency committee reviewing your application, that would be my first email or phone call. I can't imagine most applicants successfully transferring to a new residency program without the support of their current training program.

If you can't tell by now, I think that trying to switch is usually not worth the risk. But if you are completely convinced that you need a change, you should sit down with your program director to talk about the situation before you apply or even work on any documents. You would need a very flexible schedule so you can travel for interviews; the other residents will need to pick up the slack when you're not there, and that might cause some tension. If you take too much time off for interviews and second look visits, you might even be violating the terms of your residency contract! Being honest and upfront about this now will help you and your program director develop a good plan. But it also might convince you to stay where you matched and make the best of it, instead of trying to switch before ever giving your program a real chance.

If you need more information, please contact me for a free consultation.