Question about FMG changing residency specialty after PGY-1

[tinyhandsbob]

How would a FMG who matched into Pediatrics or a Transitional Internship as a PGY-1 year switch to another residency specialty (e.g. Psychiatry) after that first year? Is this strategy a feasible option for someone who was unable to match into their residency of choice initially? Any input on this topics would be appreciated (e.g. how common is this; issues to consider etc).

Thanks!

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[gutonc]

Moving to Gen Res.

Also, there are tons of similar threads already. Take a look around.

 

[Raryn]

How would a FMG who matched into Pediatrics or a Transitional Internship as a PGY-1 year switch to another residency specialty (e.g. Psychiatry) after that first year? Is this strategy a feasible option for someone who was unable to match into their residency of choice initially? Any input on this topics would be appreciated (e.g. how common is this; issues to consider etc).

Thanks!

This is going to be a bit variable, but in simple terms:

1) If you match into a PGY1, you have to start it or you'll be permanently banned from the match. So you start the residency you matched. You can theoretically quit after a couple months, but that's a really dumb idea - you should start it and *work hard* so that you can get a good letter of rec from your program director

2) You then apply to the other specialty. You can apply the typical way (through the match) for PGY1 spots and if it's a specialty that will recognize your intern year, you can also apply to any PGY2 spots that start that coming year (R spots) through the match AND apply to any PGY2 spots outside the match that open up (some specialties have listservs for this, otherwise you literally just have to start searching). To be successful in this application, it's damn-near-required to have a letter from your current program director, even if all it says is "tinyhandsbob started residency two months ago and is a resident in good standing. They desire to change specialties due to feeling they would fit better with a different one".

Obviously you'd rather just start as a PGY2 if you can, but there's more PGY1 spots than PGY2 spots typically. Psych is weird, because there's so much elective time, they'll recognize just about any intern year and can just have you start as a PGY2 - still graduating on time, even if you did zero psych at all your first year. Now, they don't *have to*, but they often do.

3) Funding is a question we often get on this forum. More or less, you should just ignore it as a question. It almost always doesn't matter.

4) If you're an FMG, the only extra factor you'll have to consider is visa status. Because if you don't match and thus don't have a residency after your first year... you're very likely to fall out of status and end up being required to leave the US. It's the risk you take by giving up a sure thing (current residency) for potentially changing.

 

[NotAProgDirector]

Totally agree with the above. I'll add:

If you match only into a Transitional year, then your PD will be expecting you to try to match into something else. If you match into Peds, your pD will be expecting you to complete the program. This creates a bit of a problem -- you might not be able to apply for a new spot and keep your old spot. Your PD might start looking for a replacement. Totally program dependent.

Also, if you tried to match into psych and didn't and got peds instead, applying again isn't likely to be more successful.

Last, the easiest solution, if possible, is to switch programs at the same institution.

 

[tinyhandsbob]

Totally agree with the above. I'll add:

If you match only into a Transitional year, then your PD will be expecting you to try to match into something else. If you match into Peds, your pD will be expecting you to complete the program. This creates a bit of a problem -- you might not be able to apply for a new spot and keep your old spot. Your PD might start looking for a replacement. Totally program dependent.

Also, if you tried to match into psych and didn't and got peds instead, applying again isn't likely to be more successful.

Last, the easiest solution, if possible, is to switch programs at the same institution.

This is quite helpful. Regarding trying to transfer from Peds (or another full residency), I assume you may also get some strange looks if you asked for a letter of good standing to apply for another residency 2 months after starting? Or maybe it's common and not that big of a deal?

Regarding not being more successful necessarily when re-applying. My understanding is that the reason it may be hard to match the first time is because you're an FMG and the US grads get priority before FMGs are considered. When reapplying for a new specialty after having already matched into a Transitional Year, is your application still reviewed as an FMGs? I was thinking that after you matched once you would be on even footing with the US grads, but now that you mention it, I could see how that may not be the case.

 

[tinyhandsbob]

This is going to be a bit variable, but in simple terms:

1) If you match into a PGY1, you have to start it or you'll be permanently banned from the match. So you start the residency you matched. You can theoretically quit after a couple months, but that's a really dumb idea - you should start it and *work hard* so that you can get a good letter of rec from your program director

2) You then apply to the other specialty. You can apply the typical way (through the match) for PGY1 spots and if it's a specialty that will recognize your intern year, you can also apply to any PGY2 spots that start that coming year (R spots) through the match AND apply to any PGY2 spots outside the match that open up (some specialties have listservs for this, otherwise you literally just have to start searching). To be successful in this application, it's damn-near-required to have a letter from your current program director, even if all it says is "tinyhandsbob started residency two months ago and is a resident in good standing. They desire to change specialties due to feeling they would fit better with a different one".

Obviously you'd rather just start as a PGY2 if you can, but there's more PGY1 spots than PGY2 spots typically. Psych is weird, because there's so much elective time, they'll recognize just about any intern year and can just have you start as a PGY2 - still graduating on time, even if you did zero psych at all your first year. Now, they don't *have to*, but they often do.

3) Funding is a question we often get on this forum. More or less, you should just ignore it as a question. It almost always doesn't matter.

4) If you're an FMG, the only extra factor you'll have to consider is visa status. Because if you don't match and thus don't have a residency after your first year... you're very likely to fall out of status and end up being required to leave the US. It's the risk you take by giving up a sure thing (current residency) for potentially changing.

Thank you for the great response. I have two follow-up questions: 1) Are there any stats available for the % of FMG who are successful at matching into a Transitional Year? (I've see data for FMGs matching into specific residencies but it did not include Transitional year info). 2) Same question for stats on matching into an R-spot after Transitional Year or matching again as a PGY 1 in a different specialty. I'm basically trying to get an idea of how feasible this strategy is probability wise.

 

[Raryn]

Thank you for the great response. I have two follow-up questions: 1) Are there any stats available for the % of FMG who are successful at matching into a Transitional Year? (I've see data for FMGs matching into specific residencies but it did not include Transitional year info). 2) Same question for stats on matching into an R-spot after Transitional Year or matching again as a PGY 1 in a different specialty. I'm basically trying to get an idea of how feasible this strategy is probability wise.

No statistics available.

This is quite helpful. Regarding trying to transfer from Peds (or another full residency), I assume you may also get some strange looks if you asked for a letter of good standing to apply for another residency 2 months after starting? Or maybe it's common and not that big of a deal?

Regarding not being more successful necessarily when re-applying. My understanding is that the reason it may be hard to match the first time is because you're an FMG and the US grads get priority before FMGs are considered. When reapplying for a new specialty after having already matched into a Transitional Year, is your application still reviewed as an FMGs? I was thinking that after you matched once you would be on even footing with the US grads, but now that you mention it, I could see how that may not be the case.

Asking for a letter of good standing two months after you start isn't THAT unusual, and is basically what you have to do due to the timing of residency applications. That said, it is a gamble, because they'll likely give your existing pgy2 spot away.

It's not an advantage to be a current resident when you apply. You're still not a US senior - and now your year of graduation is one year older and you have much less flexibility to schedule interviews (though this year, with all interviews being virtual, that's probably less of an issue). Yours odds are almost always best the first year that you apply, unless you screwed up the first time in a way that's easily fixable (like an FMG not having step 1/2/CS passed in time to get interviews)

 

[NotAProgDirector]

Regarding not being more successful necessarily when re-applying. My understanding is that the reason it may be hard to match the first time is because you're an FMG and the US grads get priority before FMGs are considered. When reapplying for a new specialty after having already matched into a Transitional Year, is your application still reviewed as an FMGs? I was thinking that after you matched once you would be on even footing with the US grads, but now that you mention it, I could see how that may not be the case.

Basically, what Raryn said. Absolutely not. You'll still be evaluated as an FMG, and no matter what you'll be less competitive now. If you didn't get a spot last year, you're not going to get one this year.

It MIGHT be possible to complete an entire residency first, and then try to match into a new but related field. So if you complete peds and then try to match into pedi psych, that might be successful. There are plenty of reasons why it might not, but if not successful then you get to be a pediatrician which isn't a booby prize.