Quoted: Unhappy with residency

[Doodledog]

Tildy is going to put up the "Bat signal" for aProgDirector on this one. Of course others can comment too.

I'm in a difficult situation and can really use some advice. I started my residency a month ago and now regret ranking this program. I'll refrain from discussing specific instituational problems in order to preserve my anonymity. In a nutshell, the residents are not getting adequate training and are not prepared for practice after residency. My specialty is one where you need to "learn by doing" and we are not given enough experience at my current program. I've talked to a few residents at my program who, like me, felt "fooled" at the interview. Facts about the program are carefully phrased or omitted during the interview.

I have discussed the specific problems with attendings from my medical school in the same specialty. They all agree that my concerns are valid and that the problems are serious enough that I should transfer out.

I have not started contacting program directors yet. But from what I hear, it is difficult to transfer within this specialty because programs are small. A program may not be able to fit a new PGY-2 into their schedule if there isn’t an empty spot.

Is re-entering the Match this year and starting all over as a first year an option? That is, does doing first year twice within the same specialty but at different programs violate any rules by ACGME or otherwise? I have searched and have not been able to find an answer.

How strong of an applicant will I be? I was a solid candidate last year with high Step 1/2, AOA, and strong letters of recommendation. My main weakness was lack of research/publication during medical school. My medical school is mid-tier so its reputation did not help or hurt. My specialty is moderately competitive. Will the fact that I am currently at a program and trying to get into another one reflect negatively on my candidacy? I do not think that my program director will actively hinder my transfer but I do not think I'll be supported either.

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[NotAProgDirector]

I completely understand the lack of details in your post. Medicine is a small world, and it sounds like you've chosen a small program in a small field. The lack of details makes it somewhat difficult to answer, but here goes:

1. Is there a problem with simply repeating your PGY-1?

The answer is "maybe". Let's start with the problems:

First, Medicare "caps" the amount it will pay for any one resident to train to the minimum number of years to gain board eligibility. Regardless of what you do, if you repeat your PGY-1 year you will "run out of funding" in your last PGY year. This is not completely true -- Medicare pays 50% of the DME and 100% of the IME for residents beyond their initial residency period, and that's still quite a bit of money. But as GME budgets get tighter, some programs may refuse to take you for financial reasons.

Second, some Boards or RRC's frown on residents repeating a year unless the prior attempt was unsatsifactory. No one that I know of prevents this from happening, but it's not supposed to.

Third, it can be somewhat difficult as a new PGY-1 to start next to someone who has a year of GME experience under their belt, hence some PD's will avoid this.

Fourth, despite a supportive letter from your PD, some programs will worry that your program is trying to "dump a problem".

On the good side:

If your PD is willing to help, functioning well in a GME program might be seen as a real positive.

Sounds like this is a competitive field. Your PD should have little problem finding someone to fill your hole, even if the program sucks, which is good.

Also, you wil be able to sign outside the match this year.

Theoretically, this is do-able. However, you'll need to get a letter from your PD (which is unlikely to make you terribly popular with your classmates or program), and you'll need to find a way to interview this year. Remember how much time you spent interviewing last year? How do you expect to get that from your current program?

2. Can you find another PGY-1 now, or a PGY-2 spot for July?

This is your best option, if you can pull it off. Finding a PGY-2 is difficult, as there is no central application service nor match nor listing of programs. Again, if you have your PD's support, you will be much better off. if they contact programs for you, you might get many more responses (although from your description this seems unlikely).

One of the best way to find PGY2 spots is to apply for PGY-1 spots, and then state in your PS "I am fully committed to repeating my PGY-1 should I match, I would be happy to explore any PGY-2 openings you may have".