Is this a crazy idea or is it possible to transfer residencies for PGY4 year?

[ladysmanfelpz]

Reasons I have thought this over and don't think it too crazy. I am a PGY2 and am fairly certain that I do not want to go to a fellowship. I initially thought child and thought that the transition to another program would be good for relocation, experience, different patient population, etc. Now I am thinking against that. The good news is is that many other senior residents are doing just that leaving many open PGY4 spots open. Some programs even select from within so a PGY3 transitions into the child, CL fellowship, whatever at the program, but leaves that PGY4 spot open that you can transfer into.

Some preferences I have for transferring even late is that you get to have all new experiences. A new hospital system, new EMR, new demographics and pathology and new attendings. You are senior level so your knowledge may be valued, but I'm guessing your lack of experience on their systems may be a negative as I know our program likes to use senior level residents to train interns, pairing them up on our core difficult rotations so they can learn to interview and chart. You may require a break in period for the first month or two, but after that should be good to train some of the new interns.

I really like the idea of new experience with new attendings as our PGY4 year is mainly a repeat of our earlier years. This will help you transition into your attending role to learn to move and adapt. Plus I feel like moving to the location you desire to work will be beneficial to show your seriousness and commitment making it that much easier to land a job there. Lastly my girlfriend will finish her residency in two years, so it would be easier to move to desired location for her to start career instead of picking up an interim job for a year while I complete my residency.

So are their any negatives to this? Is it looked down upon when it comes down to applications, like "Oh I see you transferred". Or is it simply the most qualified will get the job? Is it not done more frequently because people are already settled and say why transfer and move cities for one lousy year of residency?

I have nothing against my program and in fact would be bummed not to finish with them, but for the reasons listed I just see pros outweighing cons unless you all inform me of some major detrimental factor. And after seeing that our fourth year is repeat rotations from prior training really sparked my interest to experience something new as I moved 3 times in medical school (for rotations; still at same school). I see it as a prime opportunity with so many PGY4 spots opening especially if you did not match where you desired.

---

Members don't see this ad.

 

[Nudexta]

I have a colleague who did in pgy4. He enjoyed going to a new program especially that one was more prestigious than ours. I wouldn’t do it though just because I am lazy 😊

 

[ladysmanfelpz]

The only thing I was thinking is that you never see them advertised. My thought is that programs don't expect it and also may not want it as they may want their seniors for training or just experience and seniority roles in the program. I'm guessing if you are serious about it you will have to reach out to programs yourself to see if they will accept you.

 

[TexasPhysician]

Couple reasons why I believe it is rarely done:
1. Many programs have a mostly elective PGY-4 year to help you explore your preferred niches. You arent “mandatory labor” there anymore, so the incentive is low.

2. Your final program signs off on your completion of residency. Your current program may state you acquired sufficient knowledge, but a new program could disagree. A new PD is in an awkward position to certify that you are adequately trained after you complete PGY4 electives that are less rigorous and involve less oversight.

 

[MacDonaldTriad]

TexasPhysician has it right. I would never consider backfilling PGY-IV spots and I lost half of my PGY-IV class to fast tracking this year. Asking to take someone in who has no required call and certify that they are ready to "practice independently without supervision" bothers me a lot. We have very little reason to depend on our PGY-IVs for service needs and our PGY-IVs like this to be this way. Graduating someone I have only had 12 months with seems dangerous and not worth my taking the risk. Honestly, why would I do this since I don't have too? I suppose that there might be a compelling argument as to why someone would change programs after being 3/4th the way through, but it would have to be very compelling to convince me that this is a safe move. I don't inherit other people's problems willingly and I'm sure there are good people out there, but understand how this looks to our side of the equation. It will be an uphill battle at best.

 

[forchinet121]

TexasPhysician has it right. I would never consider backfilling PGY-IV spots and I lost half of my PGY-IV class to fast tracking this year. Asking to take someone in who has no required call and certify that they are ready to "practice independently without supervision" bothers me a lot. We have very little reason to depend on our PGY-IVs for service needs and our PGY-IVs like this to be this way. Graduating someone I have only had 12 months with seems dangerous and not worth my taking the risk. Honestly, why would I do this since I don't have too? I suppose that there might be a compelling argument as to why someone would change programs after being 3/4th the way through, but it would have to be very compelling to convince me that this is a safe move. I don't inherit other people's problems willingly and I'm sure there are good people out there, but understand how this looks to our side of the equation. It will be an uphill battle at best.

Out of curiosity what is the risk to you other than professional disgrace if you do graduate an incompetent individual? Is there a legal risk?

 

[MacDonaldTriad]

Out of curiosity what is the risk to you other than professional disgrace if you do graduate an incompetent individual? Is there a legal risk?

Yes, there is a legal risk.

 

[comp1]

There's legal risk in walking across the street. However, there are a lot more practical reasons why a PD wouldn't want this. I'm sure it's done, probably even successfully some places, but's it's far from common. In terms of the OP, is there some reason you can't just moonlight and then do locums to get most of what you described? The whole idea of literally switching residencies 75% in somehow being easier than getting a locums job after residency is...not accurate.

 

[Merovinge]

Yes, there is a legal risk.

Did anything ever happen with Dr. Death and his (reportedly) horrendous spine fellowship where he did 1% of the cases as was average?

 

[shoomer]

It would be easier to pick up a locums job or do a fellowship year rather than switch residencies entirely.

Is it possible to do away electives or anything of that sort in your 4th year? Moonlighting will also be helpful in terms of new experiences.

I see kind of where you're coming from, since I'm fast tracking into CAP and value the training I can get from another program. And 4th year also seems to be less crucial due to its repetition of clinical experiences at certain programs. But I feel like experience is going to be gained from working in different settings and locations, and you'll have to grow a lot on your own. Many of my attendings have told me about how they learned more in the first year out of residency than in any year of their training. If you really feel that you need to build upon your expertise before complete independence, then fellowship is the answer.

 

[splik]

There aren’t many PGY4 openings but yale routinely accepts PGY4s as does the NIMH. Other programs usually contingent on openings. You can also do a public psych fellowship as a pgy4 and there may be some others.

 

[TexasPhysician]

There aren’t many PGY4 openings but yale routinely accepts PGY4s as does the NIMH. Other programs usually contingent on openings. You can also do a public psych fellowship as a pgy4 and there may be some others.

Aren’t there tons of PGY-4 openings? Every resident that fast tracks into child opens a PGY-4 slot.

 

[JKinSC]

One of the issues I can see with this, though I certainly don't know if it's generalizable:

Where I did residency, outside of electives, we spent eight weeks of 4th year as "junior attending" in the outpatient clinic and eight weeks doing the same in inpatient. During those rotations, you were there to mentor junior residents, both in medical stuff and logistical stuff. I'd imagine one would have a hell of a time doing the latter if you were learning it all for yourself.

 

[OldPsychDoc]

As you see, every program manages this differently, because every program does PGY4 a bit differently. As a program without its own CAP fellowship, we make sure that all requirements are done by end of PGY3, so PGY4 is all elective for those that stick around--but we do rely on their experience, and have a lot of opportunities for career exploration. It's sad that your perception is that 4th year is just repetition--I have a feeling that your PD wouldn't agree, and that once you're there, you'll see that you've actually learned a few things...

We've both sent and accepted 4th year transfers, with close communication and approval of their admins, and both for family reasons. As most folks have implied here, there are really not that many compelling academic or clinical reasons to make the switch--and these moves are costly for you, an administrative pain in the butt for both programs, and as my senior colleague has pointed out, a legal liability for programs. We rely on our fellow PDs to not be trying to pawn off their problem children onto us!

 

[ladysmanfelpz]

Understood @OldPsychDoc . Obviously is a pain in the butt for both programs, but if I really feel compelled to do it and am up for the hassle of reapplying and moving, can it be done? I don't see 4th year entirely as repetition, but a lot with some electives as your choice. There are other factors like my GF completing residency, living in an undesired area far from family, and planning to move back across the country at completion of residency closer to area I want to practice that make the effort bearable.

Aren’t there tons of PGY-4 openings? Every resident that fast tracks into child opens a PGY-4 slot.

That is my thought as well. Should be easy if you want to move, right?

@shoomer - Its not just looking for more experience as I can do that as a locum, but desired location, starting a practice, overall getting a move on my life. I could get some of that experience from a late transfer rather than a year of locums.

Did anything ever happen with Dr. Death and his (reportedly) horrendous spine fellowship where he did 1% of the cases as was average?

Curious to this as well.

 

[G Sheb]

Quite a few programs accept PGY4 transfers. Please see the APA website for vacancies. Every year there are several vacancies that are advertised including in top programs.
It all depends on whether your program supports you. Mine did. PGY-4 along with 2 is probably the best time to transfer as your schedule is supposed to be mostly electives anyhow. I would say my experience transferring from a community program to a top academic program was absolutely priceless. I practiced in a different environment, learned a lot simply from the change.

I find the programs who completely frown on transfers quite regressive and frankly borderline malignant. This isn't slavery for Christ's sake.
Obviously for some programs, 'losing residents' is a headache they don't want to deal with. But imo residents should be allowed to explore their options, like in any job.

 

[theduderino]

I transferred programs as a PGY-IV, though it was entirely because my partner matched a fellowship in a particular city. Landing the general psych position required some back-channel stuff between my PD/mentors at my original program, the new psych department, and my wife's new PD.

Keep in mind the (hopefully) positive inertia you can capitalize on at your original program - continuing with therapy patients, finishing up projects, etc which will be harder to start up at a new program. The program I transferred to was more prestigious than my original program but those differences did not impact my education much as a pgy-iv (though both were university based academic programs). From a training perspective, I would have preferred to finish things up at my original program, though family considerations are much more important to me than minor training differences so it worked out well given my priorities.

If the new program is in the exact same location you are planning to live long-term, it could be a useful leg up in learning the job market or networking to learn about the private practice environment. You could do most of these things virtually/long distance but nothing beats actually forming a relationship with an attending/co-worker to get honest appraisals of different organizations/jobs/insurance payers/etc.

 

[ladysmanfelpz]

I transferred programs as a PGY-IV, though it was entirely because my partner matched a fellowship in a particular city. Landing the general psych position required some back-channel stuff between my PD/mentors at my original program, the new psych department, and my wife's new PD.

Keep in mind the (hopefully) positive inertia you can capitalize on at your original program - continuing with therapy patients, finishing up projects, etc which will be harder to start up at a new program. The program I transferred to was more prestigious than my original program but those differences did not impact my education much as a pgy-iv (though both were university based academic programs). From a training perspective, I would have preferred to finish things up at my original program, though family considerations are much more important to me than minor training differences so it worked out well given my priorities.

If the new program is in the exact same location you are planning to live long-term, it could be a useful leg up in learning the job market or networking to learn about the private practice environment. You could do most of these things virtually/long distance but nothing beats actually forming a relationship with an attending/co-worker to get honest appraisals of different organizations/jobs/insurance payers/etc.

This is exactly what I was looking for. Significant other will leaving residency at my time of PGY4 so may be a good time to move. Would like to move to area of work to network and try to get best job opportunity.

Great advice on thoughts and how it felt to lose continuity patients and projects. I have nothing against my program and would feel bad leaving them, but you have to do what is best for you. This would still be a couple years out, but these are all good things to consider.

 

[slowlysurely]

Would you then list your PGY-4 institution as your training ground when advertising in private practice etc?

 

[comp1]

You could put where you did a weekend seminar for how much it would mean to most private practice patients...

 

[slowlysurely]

You could put where you did a weekend seminar for how much it would mean to most private practice patients...

Really? I thought for cash-based PP being able to say you went somewhere prestigious-sounding was helpful? All the better if that's not the case, honestly.

 

[EarlyCareerAcademicPsych]

Like having children, I think that you can't know what it means to fully complete a psychiatry residency until you do it. From my personal experience during training and from the perspective as a clinician educator, the PGY4 year - when done right! - is qualitatively different from the PGY3 year. You might not be able to see it yet from your current vantage point.

But I am the gut who thinks of the PGY3 as a "second intern year" because the transition to outpatient work requires a lot of new knowledge, addtiional skills and changing attitudes, even in programs which have a half-day outpatient clinic as PGY2s.