Applying 'R' spot during PGY1 year?

[MacMiller84]

I am an AMG from a top 40 NIH medical school with a 21x Step 1 and 21x Step 2 score/ pass on Step 2 CS.

I matched into a Preliminary IM program and did not secure an advanced spot in Anesthesiology despite 5 Categorical and 4 Advanced interviews. I am obviously going to reapply the next cycle during my intern year for PGY2 - 'R' spots. Does anyone have any experience doing this? How competitive is it? Is it difficult to do? Aside from striving for good LoR from the PD in the first couple months, I am trying to study for and take Step 3 and do well before Intern year begins. What else can I do to be more competitive?

Any advice/comments would be appreciated! I have my heart set on Anesthesiology and deep down, I am not ready to let go of this dream.

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[MacMiller84]

Anyone?

 

[NotAProgDirector]

You can absolutely apply for R positions next year. You can also apply for A or C positions. If you apply for A positions, there really isn't any reason to apply for another prelim year -- you might as well find something else to do with your gap year.

You will run into a couple of problems. The biggest one is time for interviews. Medical schools are very generous -- you basically can take as much time as you like. If I'm your employer, I might not be as generous. You will be scheduled for work, and you might need to use vacation or other leave time for interviews. If your interviews are local, it's less of an issue to miss a day. But when you need to fly across the country and miss 3-5 days (for perhaps 2 interviews) that can be a much bigger problem. And if you're assigned to an inpatient / call block, you may not be allowed to miss any time at all. This is something you should discuss with your PD -- no need to panic about it now, you can talk to them about it after you start in July (or perhaps at orientation).

In any case, you best chance is at your prelim institution. If they have an Anesthesia program, you should try to get as much exposure to them as possible early in the year.

 

[mvenus929]

But when you need to fly across the country and miss 3-5 days (for perhaps 2 interviews) that can be a much bigger problem. And if you're assigned to an inpatient / call block, you may not be allowed to miss any time at all. This is something you should discuss with your PD -- no need to panic about it now, you can talk to them about it after you start in July (or perhaps at orientation).

In continuing this discussion--A lot of chiefs are building the block schedule for next year now, and some programs are not very flexible with changing the block schedule once it has been made. So you should contact your PD and/or chief (whoever is making the schedule) and let them know that you will likely be applying again for additional training this year, and would like lighter blocks, if possible, during the months you plan on interviewing. Some months are more flexible than others (ICU and wards are typically the least flexible, if you do an ED month, you may be able to cluster the majority of your shifts, etc).

 

[MacMiller84]

you best chance is at your prelim institution.

No anesthesia program at prelim institution! ((

Thanks for the advice, it is helpful. I requested lighter months during the interview season.

As someone who failed to match into anesthesia the first time around, what's a good number of programs to apply to? There are around 40 R spots, will that be enough? It is true that fewer people are applying for fewer spots, how does that impact my chances of matching?

 

[rokshana]

No anesthesia program at prelim institution! ((

Thanks for the advice, it is helpful. I requested lighter months during the interview season.

As someone who failed to match into anesthesia the first time around, what's a good number of programs to apply to? There are around 40 R spots, will that be enough? It is true that fewer people are applying for fewer spots, how does that impact my chances of matching?

well you do have red flags so you probably should apply to all of them as well as A and C programs as many as you can get...but more importantly you need to figure out what kept you from matching in the 1st place...your steps score are sub par, but 9 places looked beyond that so there must have been something about how you interviewed...you may want to consider having someone (PD or faculty who interview) do a mock interview with you to see what needs to be improved.

 

[gutonc]

No anesthesia program at prelim institution! ((

Thanks for the advice, it is helpful. I requested lighter months during the interview season.

As someone who failed to match into anesthesia the first time around, what's a good number of programs to apply to? There are around 40 R spots, will that be enough? It is true that fewer people are applying for fewer spots, how does that impact my chances of matching?

You had 9 interviews but didn't mention how many programs you applied to. That would be useful in helping to determine how many apps you need this year. If you applied to 15-20 and had 9 interviews, then applying to the 40 R programs is probably fine. If you applied to 50 spots and only got 9 interviews, then you probably need to up the numbers...by a lot.

 

[MacMiller84]

If you applied to 50 spots and only got 9 interviews

Let's just say I applied VERY broadly (80+) and still received only 9 interviews.

The other side to my story is that I failed two consecutive shelfs during 3rd year (2nd percentile and 8th percentile) after which I took some time off to deal with anxiety/depression issues, but re-took both shelfs and passed both clerkships (the clinical component was never an issue). I got mainly High Pass in 3rd year clerkships once resuming the following year and some honors during 4th year. Very good evals, decent letters.

The biggest issue I'm facing is that I was taken to my school's honor court during my 3rd year surgery clerkship for being dishonest about leaving the OR. My school basically made me plead guilty for the minimal sanction which is a written apology, but nonetheless goes into the dean's letter. The whole situation paints me to be a bad person, which I am not. This one isolated incident does not reflect my personality whatsoever.

 

[rokshana]

Let's just say I applied VERY broadly (80+) and still received only 9 interviews.

The other side to my story is that I failed two consecutive shelfs during 3rd year (2nd percentile and 8th percentile) after which I took some time off to deal with anxiety/depression issues, but re-took both shelfs and passed both clerkships (the clinical component was never an issue). I got mainly High Pass in 3rd year clerkships once resuming the following year and some honors during 4th year. Very good evals, decent letters.

The biggest issue I'm facing is that I was taken to my school's honor court during my 3rd year surgery clerkship for being dishonest about leaving the for other reasons. My school basically made me plead guilty for the minimal sanction which is a written apology, but nonetheless goes into the dean's letter. The whole situation paints me to be a bad person, which I am not. This one isolated incident does not reflect my personality whatsoever.

but you got the 9 interviews...which means that those 9 places looked beyond your (numerous, not just one) red flags to extend you an invitation to interview...but either did not rank you or rank you high enough to match...maybe taking to an anesthesia PD in general or from one of the places you interviewed to see what flagged you and what you can do to improve your application for this next year...you may want to consider going to ASA this year (or become involved with the regional chapters) to network and maybe find a mentor to help with your application.

did you address your honor code violation in your PS? if not you probably should.

 

[MacMiller84]

but you got the 9 interviews...which means that those 9 places looked beyond your (numerous, not just one) red flags to extend you an invitation to interview...but either did not rank you or rank you high enough to match...maybe taking to an anesthesia PD in general or from one of the places you interviewed to see what flagged you and what you can do to improve your application for this next year...you may want to consider going to ASA this year (or become involved with the regional chapters) to network and maybe find a mentor to help with your application.

did you address your honor code violation in your PS? if not you probably should.

Thanks for the encouragement!

How does one get involved in ASA, especially during intern year?

I spoke with two PDs already and they said the same thing. The honor code was a big deal and if I could do anything to improve my application it would be a new excellent LOR from PD at prelim yr and a good step 3 improvement.

I will address the issue in my PS this time around (didn't the first time) and also I have a letter writer who will basically go to bat vouching for me and the situation I went through.

 

[rokshana]

Thanks for the encouragement!

How does one get involved in ASA, especially during intern year?

I spoke with two PDs already and they said the same thing. The honor code was a big deal and if I could do anything to improve my application it would be a new excellent LOR from PD at prelim yr and a good step 3 improvement.

I will address the issue in my PS this time around (didn't the first time) and also I have a letter writer who will basically go to bat vouching for me and the situation I went through.

https://www.asahq.org/annualmeeting/education/residents
https://www.asahq.org/annualmeeting/education/medicalstudents

probably a good place to start...if your prelim program is asking for when you want time off this might be a good time to be on an elective.

https://www.asahq.org/member-center/membership-eligibility

you're still a med student so can join

 

[MacMiller84]

Thank you rokshana!

 

[MacMiller84]

Thanks for all the advice on this thread.

I was able to get vacation weeks during interview season. I just finished Step 3 yesterday and I am hoping that I did well. Intern year starts a week from today and I will be starting on an ambulatory month.

What other things can I do to help my application? At this point, I would just be ecstatic if my Med school Anesthesia program would just take a chance on meeeee.

 

[gutonc]

What other things can I do to help my application? At this point, I would just be ecstatic if my Med school Anesthesia program would just take a chance on meeeee.

I assume you spent the last two months giving them good reason to do so. If not, figure out a plan B...because that's your new Plan A.

 

[MacMiller84]

I assume you spent the last two months giving them good reason to do so. If not, figure out a plan B...because that's your new Plan A.

Thank you.

What else can I do? Should I apply to the medicine program at my current institution as a backup in case I am not selected for any anesthesia spots?

I really wish someone had some advice on this process. It seems like applying for an R spot is somewhat uncommon and I can't find too much on the topic in terms of my chances or strategies...

 

[NotAProgDirector]

Your plan should be as follows:

1. Apply to R anesthesia spots
2. Apply to A anesthesia spots. If you get one, you have a gap year to fill.
3. Apply to C anesthesia spots. If you get one, you get to repeat your PGY-1 year (note that you might decide this option is better than #2, it's up to you)
4. If you don't match, look at SOAP for anesthesia spots. Apply to them all. Hope for the best. You might also look at what else is in SOAP. You won't have much time, so you should think in advance what you might apply for.
4. Have another plan. If your other plan is continuing in IM, then you will NOT apply in the match. Instead, immediately after the match results come out (and SOAP is over) you will start looking for an IM PGY-2. You will want to get your prelim PD to help. Your home program, if they have an opening, would be the easiest.
5. If your plan is NOT IM, then it's much more complicated. You might then also apply to your other field in the match -- radiology for example. At this point it becomes so complicated, it's impossible to tell you what to do without you narrowing it down.

 

[MacMiller84]

Your plan should be as follows:

1. Apply to R anesthesia spots
2. Apply to A anesthesia spots. If you get one, you have a gap year to fill.
3. Apply to C anesthesia spots. If you get one, you get to repeat your PGY-1 year (note that you might decide this option is better than #2, it's up to you)
4. If you don't match, look at SOAP for anesthesia spots. Apply to them all. Hope for the best. You might also look at what else is in SOAP. You won't have much time, so you should think in advance what you might apply for.
4. Have another plan. If your other plan is continuing in IM, then you will NOT apply in the match. Instead, immediately after the match results come out (and SOAP is over) you will start looking for an IM PGY-2. You will want to get your prelim PD to help. Your home program, if they have an opening, would be the easiest.
5. If your plan is NOT IM, then it's much more complicated. You might then also apply to your other field in the match -- radiology for example. At this point it becomes so complicated, it's impossible to tell you what to do without you narrowing it down.

Thank you. I still need help in knowing which specific programs to apply. I was thinking it might be a good idea to apply to the categorical programs that gave me an interview the first time around as well as their advanced and physician spots if they have one. That decision is easy. In terms of categorical and advanced programs, I was thinking I should apply more in my region of the country (south/east coast). What are your thoughts? Should I still apply extremely broadly or just have a good mix or C,A,R spots?

I am in really dire need of advice. It doesn't seem like many people go through this process and even fewer are in my unique position. Step 3 scores come out tomorrow :/

 

[gutonc]

Thank you. I still need help in knowing which specific programs to apply. I was thinking it might be a good idea to apply to the categorical programs that gave me an interview the first time around as well as their advanced and physician spots if they have one. That decision is easy. In terms of categorical and advanced programs, I was thinking I should apply more in my region of the country (south/east coast). What are your thoughts? Should I still apply extremely broadly or just have a good mix or C,A,R spots?

I am in really dire need of advice. It doesn't seem like many people go through this process and even fewer are in my unique position. Step 3 scores come out tomorrow :/

This is actually the easiest question to answer.

All of them.

You failed to match once. You can't take that chance again. If you fail this year, it's more or less over for you, at least for your preferred specialty.

Throw down the cash now, or get used to the idea of psych or peds.

 

[AdmiralChz]

Speaking from someone at a current large university-based anesthesiology program, I can tell you that you are in a very different category now which may or may not be helpful. You are interested in A/R spots as opposed to just categorical/C so you are different than 90% of the applicants, we have great difficulty at our program getting much interest in A (advanced) spots - and this is very much true around the country as programs have struggled to fill them and have turned to the SOAP. As a result, A spots are slowly being converted to C spots, but this will take several years it seems. Did you try to SOAP into any open anesthesiology A spots after this year's match, I know many were available.

As far as R spots your primary competition will be individuals who are switching specialties, and the competition will be higher as we have people switching from Ortho, ENT, surgery etc... with fairly high stats. The rest we get from the military who have done time abroad after intern year. That being said, there simply aren't as many R spots around the country as A spots, so it's a consideration.

Also - keep your ear close to the ground for spots that open up if all else fails, large programs with 20+ residents a class usually average 1 or 2 dropouts every year or so. We usually fill them with people from the R pool.

Finally, be realistic with yourself. You can definitely make this work, but you have a few red flags on your application that will make this an uphill battle. Get in the good graces of your current PD and get some letters from internship. Keep in touch with your program from your med school and sweet talk the office staff (something that never hurts ). Hopefully this all works out for you.

 

[MacMiller84]

Speaking from someone at a current large university-based anesthesiology program, I can tell you that you are in a very different category now which may or may not be helpful. You are interested in A/R spots as opposed to just categorical/C so you are different than 90% of the applicants, we have great difficulty at our program getting much interest in A (advanced) spots - and this is very much true around the country as programs have struggled to fill them and have turned to the SOAP. As a result, A spots are slowly being converted to C spots, but this will take several years it seems. Did you try to SOAP into any open anesthesiology A spots after this year's match, I know many were available.

As far as R spots your primary competition will be individuals who are switching specialties, and the competition will be higher as we have people switching from Ortho, ENT, surgery etc... with fairly high stats. The rest we get from the military who have done time abroad after intern year. That being said, there simply aren't as many R spots around the country as A spots, so it's a consideration.

Also - keep your ear close to the ground for spots that open up if all else fails, large programs with 20+ residents a class usually average 1 or 2 dropouts every year or so. We usually fill them with people from the R pool.

Finally, be realistic with yourself. You can definitely make this work, but you have a few red flags on your application that will make this an uphill battle. Get in the good graces of your current PD and get some letters from internship. Keep in touch with your program from your med school and sweet talk the office staff (something that never hurts ). Hopefully this all works out for you.

Thank you for the advice! So in your opinion, is it OK to match into an advanced spot and have a gap year?

Hopefully I will have a decent shot at my home medical school institution.

In terms of spots opening up, is ResidentSwap a good site to join? Is it worth the money?

 

[gutonc]

Thank you for the advice! So in your opinion, is it OK to match into an advanced spot and have a gap year?

Beats the hell out of going unmatched...again...and having a gap career.

 

[AdmiralChz]

Thank you for the advice! So in your opinion, is it OK to match into an advanced spot and have a gap year?

I am NOT the authority on this, but I think interrupted clinical training may be a problem and you need to fill in time with at least something in medicine (for example, we have had people here come on right away but do the "gap" year in the lab). I could be totally wrong about this and it may be fine, but going and doing random job X in the middle of training is a red flag licensure-wise.

 

[NotAProgDirector]

I am NOT the authority on this, but I think interrupted clinical training may be a problem and you need to fill in time with at least something in medicine (for example, we have had people here come on right away but do the "gap" year in the lab). I could be totally wrong about this and it may be fine, but going and doing random job X in the middle of training is a red flag licensure-wise.

This really isn't a big deal. Anytime there's a gap on a CV, people will ask questions about it -- mainly to find out if the gap is caused by a stint in prison, etc. But you'll have a fine explanation for the 1 year gap. So the OP could fill that gap with something medical (perhaps even a paid job if they qualify for a medical license), or they could hike the AT, or just watch TV for a year. Doing something more impressive with the gap year might help future job prospects, but doing nothing won't cause a problem.

 

[MacMiller84]

Appreciate all the help once again!

Step 3 score came back at 215... my scores are 213/215/215. At least they didn't go down!! And my Step 3 score is actually closest to the averages for each step. I was really low on the CCS portion but that was the part I thought I did the best on. Wondering if they will look at this at all when considering my score considering I took it before intern year started. Just a thought.

I got good feedback from my home med school's anesthesia program and they said get a good LoR and apply again. Wondering if it's worth it to really prioritize their school above everything else. Example, Rank #1 = PGY2 spot at home med school, Rank #2= (A) Advanced spot at home school, Rank# = Categorical spot at home school.... Thoughts?

Or would I have better chances ranking all PGY2 (R) spots ahead of all Advanced ahead of all Categorical?

 

[NotAProgDirector]

You should rank the programs in the order you're interested in them. You cannot "lose out" on a spot because you ranked it too low. That's the benefit of the match. So if you'd rather not have a gap year, you'd rank the R programs first, then the A's and C's. If you'd rather be in NYC, you'd rank all the NYC programs regardless of type first.

If the program you rank last puts you at their #1 position, one of two things will happen: A) you will match there; or B) you will match somewhere higher on your list. The order of your list does not change whether you match or not, only where you match. As long as you rank all the programs.

 

[MacMiller84]

So after a lot of advice, I am going to target geographically close programs in addition to the programs last year that were so kind as to interview me (even though some were far away). I will be prepared to discuss in my interviews how I am willing and able to complete another intern year via a categorical program because I want to do anesthesiology that badly...

Wish me luck!!

 

[AdmiralChz]

Awesome - strong letters of support from the clinical realm will help your cause if you obtain some! Best of luck.

 

[evilbooyaa]

So after a lot of advice, I am going to target geographically close programs in addition to the programs last year that were so kind as to interview me (even though some were far away). I will be prepared to discuss in my interviews how I am willing and able to complete another intern year via a categorical program because I want to do anesthesiology that badly...

Wish me luck!!

My response to this:

This is actually the easiest question to answer.

All of them.

You failed to match once. You can't take that chance again. If you fail this year, it's more or less over for you, at least for your preferred specialty.

Throw down the cash now, or get used to the idea of psych or peds.

Agree 100% with gutonc.

 

[MacMiller84]

I appreciate all the advice given to me here on this thread.

Wanted to update you all and let you know I matched into an 'R' spot at great program. I am very grateful and blessed to have been given this opportunity!!

 

[rokshana]

I appreciate all the advice given to me here on this thread.

Wanted to update you all and let you know I matched into an 'R' spot at great program. I am very grateful and blessed to have been given this opportunity!!

nice! and thank you for coming back to update us.