Originally posted by neurogeek
I was wondering what the options are for someone who completes a prelim year in GS and then is unable to get a categorical spot?
I was completing my pre-lim year and offered a PGY2 prelim spot with the promise that if "all went well we will be able to work you into a PGY3 categorical spot in a year". I couldn't take the risk. I applied for surgical spots and got a cold response and only one interview. Ultimately, I ended up in a PCP spot which was more then anything a "back-up" spot that gave me a life and breathing room. However, clearly not surgery. I found my year of intense surgical training was held against me. Attendings when asked a valid question with regards to the choice of patient management would often avoid the question by saying, "your not in surgery anymore".
However that is more then you asked. The space and time medicine provided me with allowed me to make some money, complete step III at my programs expense, re-apply, interview and ultimately match into a categorical spot!!! My route was long and ultimately involves 3 internships. Some people will look for a research spot and take a year or two doing research, publish and re-apply through the match. Others have been successfull in the scramble.
If surgery is what you want then you need to suck-it-up dig in and go for the long hall. If you failed to match out of the gates as it were, it can be difficult to get programs to give you the time of day. You need to start looking at it from the perspective of "what programs will choose me" as opposed to you trying to choose the programs...you rapidly fall into a "beggars" position.
Oh, by the way, jumping programs into a PGY2 spot in surgery elsewhere can be risky. I have seen people go from a pre-lim spot in a unviversity program heavey on scut the first year and into a high end program with more first year OR experience. These individuals had a rough go. They obviously did not have the same experience as their fellow PGY2's that had been in the program for the last year. They had not "earned" the respect or trust of faculty or nursing(especially ICU) since they arrived as a PGY2. They didn't do it "our way". This is tough to defend against as everyone expects you should already know what and how to do what your new program expects.
You can see this same kind of mentality in "in-bred" fellowships. I have seen fellowships that only/preferentially select out of their programs Gsurge grads. In the event that a fellow does succeed to break through this barrier they are invariably set-up to fail because once again the nurses and faculty are not acustomed to them and they have not "earned" the trust.
