Changing specialty (help needed)

[polynexusmorph]

Hi everyone,
New to the forum. Excuse my ignorance if the post doesn't fit the required format.

I'm a US-IMG that applied last year. My desired specialty was neurology but due to financial reasons, I also applied to IM thinking I'll like either, matched into IM at an average program, and now I realized what a big mistake I've made.

My program is decent. I'm liked by seniors & attendings and received excellent feedback. However I'm hating internal medicine and sometimes come back home just to cry because I feel I'm stuck.
That's why I'm looking to transfer. My seniors advised me not to bring it up to the PD ever (which is not involved in the program thankfully) as they will not provide a letter of good standing and will retaliate instead. The chair is a reasonable person but is unlikely to stand up to the PD in such an issue. They may release me if there's a swap (again, per seniors/graduates). The GME office is in a good relationship with the PD and will not take action against them. My hospital doesn't have a neurology program.

Is there any option around that? Can I apply to advanced positions via ERAS without a letter of good standing? I have excellent LORs from reputable neurology attendings, and may secure one from my program. I'm willing to decline signing my PGY2 contract and stay one year without residency if that's what it takes. It's taking a huge toll on me and I don't think it's safe for me or the patients to continue in IM.

I feel like I'm imprisoned for 3 years and will be a miserable physician for the rest of my life.

Any idea/suggestion/advice is highly appreciated.

Thanks

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[Small Cell Carcinoma]

I felt the same way in residency landing in my backup field. Sometimes in life you need to just accept the reality of things not going exactly the way you had hoped and make the best of the situation. It could have been far worse in the sense that you may have not matched at all, but you were wise to have applied/matched into a backup specialty and it payed off. Sure you can reapply for PGY2 spots in neurology but it is realistically too late to do that now as the season has already started and as an IMG, you are unlikely to be successful attempting this at this current time. If you apply next year, you will start neurology residency after pgy2 IM year and effectively lose a year of your life starting back at PGY2 in neurology. Whether this could be worth it or not is up to you. After going the IMG route too, I thought about switching fields after being dissapointed on match day, but was too exhausted mentally to go through ERAS again.

You may also benefit from therapy. Intern year especially in the beginning is really tough especially the upcoming winter months, but it gets better as you approach PGY2 year. I agree with your seniors to not bring up wanting to transfer to attendings. I wouldn't have even brought it up with other residents as they could retaliate or spread rumors about you, but it looks like it's too late for that. I saw this happen to my girlfriend in residency when she applied to another specialty as a PGY3 at our program. She was treated so badly by attedenings/other residents as soon as word spread that she was applying to another field (and word like that spreads quickly). To do it as an intern will make the rest of the year for you even more miserable and will have dire consequences should you not match and be stuck there for another 2 years with the same people you tried to run from. Good luck.

 

[polynexusmorph]

I felt the same way in residency landing in my backup field. Sometimes in life you need to just accept the reality of things not going exactly the way you had hoped and make the best of the situation. It could have been far worse in the sense that you may have not matched at all, but you were wise to have applied/matched into a backup specialty and it payed off. Sure you can reapply for PGY2 spots in neurology but it is realistically too late to do that now as the season has already started and as an IMG, you are unlikely to be successful attempting this at this current time. If you apply next year, you will start neurology residency after pgy2 IM year and effectively lose a year of your life starting back at PGY2 in neurology. Whether this could be worth it or not is up to you. After going the IMG route too, I thought about switching fields after being dissapointed on match day, but was too exhausted mentally to go through ERAS again.

You may also benefit from therapy. Intern year especially in the beginning is really tough especially the upcoming winter months, but it gets better as you approach PGY2 year. I agree with your seniors to not bring up wanting to transfer to attendings. I wouldn't have even brought it up with other residents as they could retaliate or spread rumors about you, but it looks like it's too late for that. I saw this happen to my girlfriend in residency when she applied to another specialty as a PGY3 at our program. She was treated so badly by attedenings/other residents as soon as word spread that she was applying to another field (and word like that spreads quickly). To do it as an intern will make the rest of the year for you even more miserable and will have dire consequences should you not match and be stuck there for another 2 years with the same people you tried to run from. Good luck.

Thanks a lot for your comment. I greatly appreciate it.
Does that mean I can still apply without a letter from my PD?

To be honest, at this point I wish I didn't match. At least I wouldn't have been at the mercy of this evil PD.
I don't mind losing a year of my life to change the specialty, rather than being miserable for the rest of my life.
However I can't do two residencies as I wouldn't have the energy to do so

 

[NotAProgDirector]

There's no "right" answer.

It is late to start putting in an application. On the other hand, you're going to be applying for R positions in the Neuro match -- there aren't many of them, but there also aren't that many applicants for them. If you were to get an ERAS application together reasonably quickly and submit it, and probably reach out to programs, you might get some nibbles.

Whether anyone will consider your without a letter from your PD is unclear. Many programs will not -- for fear that you're doing poorly in your current program and looking to bail out. No one wants to inherit someone else's problem. It's unfortunate that your PD would not be supportive.

From your initial post, it sounds like you applied to neuro and didn't get a spot? If so, it's not clear that you will the second time around.

 

[anonperson]

Hi everyone,
New to the forum. Excuse my ignorance if the post doesn't fit the required format.

I'm a US-IMG that applied last year. My desired specialty was neurology but due to financial reasons, I also applied to IM thinking I'll like either, matched into IM at an average program, and now I realized what a big mistake I've made.

My program is decent. I'm liked by seniors & attendings and received excellent feedback. However I'm hating internal medicine and sometimes come back home just to cry because I feel I'm stuck.
That's why I'm looking to transfer. My seniors advised me not to bring it up to the PD ever (which is not involved in the program thankfully) as they will not provide a letter of good standing and will retaliate instead. The chair is a reasonable person but is unlikely to stand up to the PD in such an issue. They may release me if there's a swap (again, per seniors/graduates). The GME office is in a good relationship with the PD and will not take action against them. My hospital doesn't have a neurology program.

Is there any option around that? Can I apply to advanced positions via ERAS without a letter of good standing? I have excellent LORs from reputable neurology attendings, and may secure one from my program. I'm willing to decline signing my PGY2 contract and stay one year without residency if that's what it takes. It's taking a huge toll on me and I don't think it's safe for me or the patients to continue in IM.

I feel like I'm imprisoned for 3 years and will be a miserable physician for the rest of my life.

Any idea/suggestion/advice is highly appreciated.

Thanks

What's the problem with the IM residency?

Intern year is terrible regardless of specialty.

 

[DeadCactus]

Intern year (and residency in general) sucks and sadly depression and burnout are common - though some programs are worse than others. The second two years are typically better with more elective time and a more enjoyable role on required rotations. You didn't match the first time, are late in the process the second time, and are concerned about a lack of support from your leadership. I would strongly consider just finishing the IM residency and re-evaluating as you go into your 3rd year whether you still want to do Neurology, do an IM subspecialty, or just go practice IM. You'll be able to make a more informed decision, you'll have the safety net of a completed residency in your back pocket, and it sounds like you'll have better institutional support.

 

[polynexusmorph]

Thank you everyone for your replies.

Just a few points to clarify:

1-I'm not hating my intern year. There's nothing wrong with my program (except the PD who's not involved in it). The work load is reasonable, people are nice, seniors and attendings like me. I just realized that I don't like IM after thinking I would be fine as long as I match

2-I didn't consider IM to be a backup, I had neuro programs on the list lower than where I matched. But again I realized that was a bad idea.

3-I can get an application relatively quickly (within days). The reason I'm late is because I couldn't, yet, find information on how to navigate this process. I still don't know if applying to R positions would expose me right away. My PD is literally CRAZY and I don't want to have them end my career. On the 1st day of orientation, they threatened to cancel IMGs' visas!!

I'm looking for a way to switch. Unfortunately I'm an older graduate and won't have the energy to do two residencies.

 

[NotAProgDirector]

These clarifications are helpful. Since you had more neuro programs on your list, it's quite possible that you could match at one. Had you listed all of the neuro first, and then IM second, it would suggest this would be less successful.

Navigating all this will be tricky. Keeping your PD out of the loop may be impossible. Without a PD letter, some programs simply won't consider you at all. Worst case scenario, some program decides to call up your PD to get the real story. if they are as crazy as you suggest, I expect finding out about it that way will end very badly for you.

 

[deleted1078679]

I haven’t done this myself as yet, I’m an intern too. You explained it better in some response.
I plan to switch too, I have an upcoming interview outside of match-
I do think it’s important to let the PD know(easier said than done).
Because I was told(via internet) it can affect you later on when applying for license and it’s good not to burn bridges. I understand your fear tho, I have the same
I haven’t told any of the residents or attendings I work with- nobody. I don’t have support from my cointerns but attendings have told me I am a high performer. I think at end of the day only you know you and you should do the best for yourself and try to navigate ur options.
I’m deciding when I should tell my PD- before or after the match. Oh also my interviewer said they want to speak to PD on phone and A PD LOR

 

[mvenus929]

FWIW, contract renewals for the next PGY are usually in February or so--Match is in March. If you apply via the match, it's very likely your PD will find out in some way (after all, you will have to get out of clinical duties to interview unless you're just extremely lucky, and it's reasonable for the programs you're applying to to reach out to your PD to get an assessment), and may not renew your contract and then if you don't match, you'll be stuck without a contract and without a match and have to go back to your home country after intern year (depending on your visa, I suppose).

 

[polynexusmorph]

FWIW, contract renewals for the next PGY are usually in February or so--Match is in March. If you apply via the match, it's very likely your PD will find out in some way (after all, you will have to get out of clinical duties to interview unless you're just extremely lucky, and it's reasonable for the programs you're applying to to reach out to your PD to get an assessment), and may not renew your contract and then if you don't match, you'll be stuck without a contract and without a match and have to go back to your home country after intern year (depending on your visa, I suppose).

Thank you for your response. I see what you're saying.
It's VERY possible (I would say guaranteed) that my current PD won't renew my contract if they find out.

On the other hand, I have a way of arranging for interviews. I'm a US citizen so the PD can't kick me out of the country. I reached out to a coordinator at a program I worked at and she said the only way to skip the PD is by applying to PGY1 all over, which is too late now.

So it looks like I'm being held as a prisoner