Starting Gen surg Prelim and I want to get started on my app for next cycle. Suggestions appreciated

[General Surgeon]

Quick version: 244 step 1 259 step 2. One plastics publication. Need advice on applying gen surg categorical and anesthesia. Does my PS need to include stuff in my prelim year or can I rewrite it now while I have free time? And if I am also doing anesthesia, how hard do I need to sell the "i love anesthesia" view and what letters can I use for that?

Long version: I was originally interested in plastic surgery, did my rotation in July, and realized the day to day/real world wasn't for me, so I switched to gen surg. I got 5 interview invites, went to all 5, and ended up going to my home program for a prelim year in gen surg. The invites I got were from great schools (3 in the doximity top 20) but I wasn't competitive enough I suppose. All the schools also asked me if I was doing plastics as a backup as well on my interviews. I was told one of my letter writers was ambiguous in whether I was interested in general vs plastic surgery, and I also submitted a plastics abstract in the fall of 2016, which may have come off as odd when looking at my app for gen surg positions. I spoke with my APD briefly and he said that there was a question of whether or not I was truly committed to gen surg based on how my application looked and if a spot opens up in my own institution, assuming I do well, I have a good shot at it.

I like gen surg, and I am fine with staying with my home institution, but I can't bank on that. I want to apply broadly and make sure I get a chance to see other institutions too because I need to match this time. I also want to apply to anesthesia because I do not want to deal with the application process a third time. I know i can be happy doing either so I'm fine with doing anesthesia if surgery doesn't work out.

I know I need new letters and a new PS. How do I format the new PS? Do I acknowledge that I'm a prelim reapplying? I have a good idea of how I wanna write it but I'm wondering if it is weird to acknowledge that I'm a prelim. And is it important to include experience from rotations that I will be on? Or can I go ahead and get it hashed out now while I have time?

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[AdmiralChz]

You can have multiple PS and I would probably encourage you to do that - one for gen surg, one for anesthesiology. I would definitely dress that you are a prelim reapplying (they will be able to see it by just reviewing your application), and put in there your change of heart with plastic surgery as it is a very important part of your development and application. Keep in mind you'll also need an LOR from your PD (or someone affiliated with your prelim year).

You otherwise have a strong application, did you apply late to GS in the cycle? If you have an ambiguous letter, see if your program will let you know which one so you can avoid using it this round.

 

[General Surgeon]

I applied not too late during the cycle, but definitely not on time. It was maybe about 2 weeks in because I was stressing about getting all my recs together. I will make sure I speak with my program about the LOR situation. I know one of my letters last cycle was really strong, and I have kept in touch with the writer throughout the year, is it ok if I reuse that? IDK if it looks like it is poor taste to programs if I ask the same writer again for a second year again. I know i need to get letters from attendings I work with these next few months, but I did an ICU rotation a few months back with an attending that has mentored me since day 1 of medical school (my school has a formal mentoring program). Could I use that too even though I don't have an official rotation with him until November as a real intern?

I am trying to sort out some stuff now while I have time, but I'm going to meet with my PD/APD in 2 weeks and will try and pick their brains some more for a better plan of attack. I really appreciate the input thus far though.

 

[NotAProgDirector]

If I'm understanding your situation correctly, the main problem is that your application was somewhat late, and looked too "plasticy". GS programs were probably worried that you were applying to GS as a backup, not that you had decided it really wasn't for you.

So, I think you're worried about nothing. You're a very competitive candidate for a GS position, assuming you're an AMG (which seems likely from your post). I don't think you really need to apply to Anesthesia as a backup. What you need to do is make it 100% clear that you're not applying to plastics, and apply on time. Applying on time is easy. Making it 100% clear you're not applying to plastics -- ask one of your plastics docs to write a letter saying that you're not applying to plastics. Or your PD can write it into their letter.

Honestly, I think you're going to get a PGY-2 position in GS, and won't need to match again. Make sure you do well on the ABSITE. Be a hard worker in your program. Let the PD know you're committed to GS. A PGY-2 spot is going to open at a good program, and you're going to snag it. Worst case scenario, you'll match again into a PGY-1 GS program. I highly doubt you'll need anesthesia as a backup -- and are you even sure you'd be happy in anesthesia?

 

[General Surgeon]

I think that was the main concern of my application. That was the feel I got from places I interviewed at, and some program coordinators even emailed me asking about whether or not I was dual applying during the application season, only to not give me an interview. That, coupled with one PD at a different school telling me one letter was ambiguous about my intentions, was the main reason why I latched onto the whole "plastics is holding me back" idea. I'll try and sit down with my PD and get a formal list of things to do before reapplication just to know how to not mess up this go around.

The whole reason I suggested anesthesia was because I was told by an advisor that if people don't match a second time around, then it starts looking bad. And I really don't wanna have to deal with applying a 3rd year in a row. I know beggars can't be choosers, but based off the 5 interviews I got, I thought I had opportunities at great institutions, and I'd really like for me to get the same looks from similar places this upcoming year. I know that is a long shot and I need to take what I can get though. I am fine doing intern year again, and if I get a 2nd year spot somewhere good, I'll take that too. I've come to realize that life isn't a race, and even if it takes me longer to get where I need to go, eventually I'll get there, hopefully.

 

[AdmiralChz]

The whole reason I suggested anesthesia was because I was told by an advisor that if people don't match a second time around, then it starts looking bad. And I really don't wanna have to deal with applying a 3rd year in a row. I know beggars can't be choosers, but based off the 5 interviews I got, I thought I had opportunities at great institutions, and I'd really like for me to get the same looks from similar places this upcoming year. I know that is a long shot and I need to take what I can get though. I am fine doing intern year again, and if I get a 2nd year spot somewhere good, I'll take that too. I've come to realize that life isn't a race, and even if it takes me longer to get where I need to go, eventually I'll get there, hopefully.

This is very true, but many (most?) prelim surgery residents don't have near the stats you do. I agree with aPD here - I bet you secure a PGY-2 spot, you'll look so much better on paper than many of your peers. But like he said you'll need to put in some serious work this year, don't think your application alone will let you coast on in.

If you want to do anesthesiology, awesome come on down. But if your heart is set on surgery than by all means go for it. You'd be surprised how easy it is to tell in an in-person interview who is really interested in the field. Much of the transfers we get are categorical surgery residents who decide it isn't the specialty for them, and they end up being great physicians.

 

[General Surgeon]

Sounds good. I was planning on hitting the ground running and wow-ing everyone, or at least trying to. The anesthesia thing was more for whether or not I'm OK with surgery. I like it a lot, but I don't know how this year will go for me, and I don't want to pigeon hole myself again like I did with plastics. I'm just trying to keep an open eye.

 

[Hemorrage]

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