Transfer during/after PGY2

[polynexusmorph]

Hi everyone,

I've posted earlier about my situation.

In summery, I'm PGY1 categorical IM resident with a very difficult PD who's also not very involved with the residents. I would like to switch to neurology but this will result in retaliation, harmful recommendations, non-renwal of contract, disciplinary actions for very subjective reasons "unprofessional, unteachable, disrespectful...etc"

Is it possible to transfer (or start over) during PGY2? This way my program can't deny me PGY1 credit. I have no issues with repeating a year or becoming jobless for a year by resigning in early PGY2.

My main concern is funding. What is my best bet? I can probably survive one year of non-payment by taking a personal loan.

I have LORs from previous attendings, and I would likely get more recommendations from my current attendings (& possibly the chair) if I'm not under the authority of the PD. I'm very well liked by everyone, even by the PD so I expect finishing PGY1 with no issues

I'm open to any ideas as I can't be an internist

Thank you in advance

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[guytakingboards]

if you really don't want to stay in the same specialty, your PD would have to be bitter AF to retaliate.

I understand where you're coming from wanting to bank that PGY1 year but the simplest thing is to finish your intern year and move into an advanced neurology position (if available). That's a clean break for you and a clean break for your program. Ideally they'd be able to backfill your categorical position with a current prelim intern. You attempting to transfer mid PGY2 is bad for everyone.

I don't have experiential advice for you but if you are a good intern with no prior performance issues, i might consider going to an APD or even the chair. Tell them you want to go into another specialty and are concerned with retaliation from the PD. Not saying that'll fix all your problems, but that sorta boxes in the PD. If the PD does some irrational retaliation they'll at least get blowback. If the chair is involved (and likes you) they may personally over see the process.

Definitely get copies of all your current evaluations nothing can be retroactively changed on you.

 

[polynexusmorph]

if you really don't want to stay in the same specialty, your PD would have to be bitter AF to retaliate.

I understand where you're coming from wanting to bank that PGY1 year but the simplest thing is to finish your intern year and move into an advanced neurology position (if available). That's a clean break for you and a clean break for your program. Ideally they'd be able to backfill your categorical position with a current prelim intern. You attempting to transfer mid PGY2 is bad for everyone.

I don't have experiential advice for you but if you are a good intern with no prior performance issues, i might consider going to an APD or even the chair. Tell them you want to go into another specialty and are concerned with retaliation from the PD. Not saying that'll fix all your problems, but that sorta boxes in the PD. If the PD does some irrational retaliation they'll at least get blowback. If the chair is involved (and likes you) they may personally over see the process.

Definitely get copies of all your current evaluations nothing can be retroactively changed on you.

Thanks for responding

I have copies of the evaluations (and other documents that may reveal my identity if I mention)

I'm actually willing to help them fill my spot, even before securing a spot for myself, if they're willing to let me go peacefully

The chair is a very reasonable person, but I don't know if he's willing to stand against the PD. I don't have a personal interaction with him.

The APDs immediately report to the PD when it comes to administrative aspects. The GME is in bed with the PD (it's a small hospital)
Again, our PD is very intimidating and has done crazy things in the past like delayed papers for graduates applying to fellowships, doubling the amount of difficult blocks to some residents, repeatedly calling specific residents from back up...etc.

 

[NotAProgDirector]

I'm not quite certain what you're asking.

Yes, you can start in a neurology program as a PGY-2 after a year of IM. If you can find a neuro program that is willing to take you. You could try to match into an R position that would start July 2024, or an A position that would start July 2025. You could also match into a PGY-1 position for July 2024.

Some times, neuro programs may have an off cycle spot open up, and in that case you don't need to go through the match at all.

You mentioned funding -- I think you're referring to how you would get income to live. There's also the issue of residency funding -- IM is a 3 year program, Neuro is a 4 year program. Because of the way residency funding works, your final year in Neuro would only be partially funded -- and that may be an issue for some programs. See here: Medicare’ Payments for Graduate Medical Education: What Every Medical Student, Resident, and Advisor Needs to Know

 

[polynexusmorph]

I'm not quite certain what you're asking.

Yes, you can start in a neurology program as a PGY-2 after a year of IM. If you can find a neuro program that is willing to take you. You could try to match into an R position that would start July 2024, or an A position that would start July 2025. You could also match into a PGY-1 position for July 2024.

Some times, neuro programs may have an off cycle spot open up, and in that case you don't need to go through the match at all.

You mentioned funding -- I think you're referring to how you would get income to live. There's also the issue of residency funding -- IM is a 3 year program, Neuro is a 4 year program. Because of the way residency funding works, your final year in Neuro would only be partially funded -- and that may be an issue for some programs. See here: Medicare’ Payments for Graduate Medical Education: What Every Medical Student, Resident, and Advisor Needs to Know

Thank you for your response. The button within the link is returning an 404 error

I'll simplify my situation

I want to switch to neurology. My PD is vindictive, so I can't "safely" apply until I'm almost done with PGY1 and have at least a copy of my PGY2 contract (around April 2024 maybe?), this way my PGY1 credit is undeniable

After that, I have the following scenarios in mind for the next match cycle, but I'm not sure how funding will work for each:

While working as a PGY2 in IM:
1-apply for an R position
2-apply for an A position (meaning that I'll finish my IM residency before joining the neuro program)

While taking a year off (and probably working in research):
3-apply for an R position
4-apply for an A position
5-apply for a C position


My goal is to have as many funded years as possible (balanced with the shortest pathway to finish neurology residency)

 

[Smurfette]

Thank you for your response. The button within the link is returning an 404 error

I'll simplify my situation

I want to switch to neurology. My PD is vindictive, so I can't "safely" apply until I'm almost done with PGY1 and have at least a copy of my PGY2 contract (around April 2024 maybe?), this way my PGY1 credit is undeniable

After that, I have the following scenarios in mind for the next match cycle, but I'm not sure how funding will work for each:

While working as a PGY2 in IM:
1-apply for an R position
2-apply for an A position (meaning that I'll finish my IM residency before joining the neuro program)

While taking a year off (and probably working in research):
3-apply for an R position
4-apply for an A position
5-apply for a C position


My goal is to have as many funded years as possible (balanced with the shortest pathway to finish neurology residency)

A copy of a PGY 2 contract is not what gives you credit for intern year and doesn't make things undeniable. Your PD actually has to document you passed all your blocks, etc. if you aren't repeating intern year.

 

[polynexusmorph]

A copy of a PGY 2 contract is not what gives you credit for intern year and doesn't make things undeniable. Your PD actually has to document you passed all your blocks, etc. if you aren't repeating intern year.

Oh wow!

Doesn't promotion to (and starting) PGY2 mean that I passed all my PGY1 rotations?

 

[Smurfette]

Oh wow!

Doesn't promotion to (and starting) PGY2 mean that I passed all my PGY1 rotations?

You get the contract ahead of time, often in March or April, but it doesn't mean you automatically pass at that time. You still have to complete all 12 months successfully per your PD. They can decide to hold you back or not pass you up until you are officially a PGY2 on July 1 (or whatever date everyone levels up).

 

[NotAProgDirector]

As others have already mentioned, the concept of "credit" for PGY years is very complicated. It's not like a school course where you take a class, pass, and end up with credit on a transcript. Instead, the only concept of credit in GME is when you want to take the ABMS exam -- before that, your program will need to attest that you have completed training and are ready to take the exam. They will also generate a document stating that you've completed the program to be used for licensing and credentialing.

In your case, should you switch from IM to Neuro, it's actually your neuro PD who will do the attestation to your PGY-1 training, the information of which they will obtain from your prior program.

In all cases, any future license application will require a statement from your IM program about your performance. Sadly, if they write something negative, no matter how much you've completed, it will cause you all sorts of problems.

 

[ThoracicGuy]

Thank you for your response. The button within the link is returning an 404 error

I'll simplify my situation

I want to switch to neurology. My PD is vindictive, so I can't "safely" apply until I'm almost done with PGY1 and have at least a copy of my PGY2 contract (around April 2024 maybe?), this way my PGY1 credit is undeniable

After that, I have the following scenarios in mind for the next match cycle, but I'm not sure how funding will work for each:

While working as a PGY2 in IM:
1-apply for an R position
2-apply for an A position (meaning that I'll finish my IM residency before joining the neuro program)

While taking a year off (and probably working in research):
3-apply for an R position
4-apply for an A position
5-apply for a C position


My goal is to have as many funded years as possible (balanced with the shortest pathway to finish neurology residency)

Resigning without another position in hand in your situation could potentially lead you into not ever finishing residency. I would not recommend this course. Neurology programs will be less likely to take someone that is out of medicine, even if its doing research. If you're wanting to wait until you have PGY1 completed and you're into PGY2, you're almost at the point where you should just finish and apply to start Neuro after IM is completed.

 

[polynexusmorph]

You get the contract ahead of time, often in March or April, but it doesn't mean you automatically pass at that time. You still have to complete all 12 months successfully per your PD. They can decide to hold you back or not pass you up until you are officially a PGY2 on July 1 (or whatever date everyone levels up).

Thanks. I understand that. I'm thinking that maybe my PD would just let me go if I had a copy of the contract in hand. It's more difficult to justify retaliation against a good resident who was offered a contract. I don't know if they can change records/evaluations retrospectively.
I'm totally aware they can still just come up with a false story to put it on my records and destroy my career forever if I bring anything up before starting pgy2.

 

[polynexusmorph]

Resigning without another position in hand in your situation could potentially lead you into not ever finishing residency. I would not recommend this course. Neurology programs will be less likely to take someone that is out of medicine, even if its doing research. If you're wanting to wait until you have PGY1 completed and you're into PGY2, you're almost at the point where you should just finish and apply to start Neuro after IM is completed.

I'm aware of that risk. Unfortunately, I don't see the power in myself to do two residencies.

The issue is, how can any program consider without a letter from my program?
Almost all PDs don't want to take a chance on a resident with an unknown performance.

 

[polynexusmorph]

As others have already mentioned, the concept of "credit" for PGY years is very complicated. It's not like a school course where you take a class, pass, and end up with credit on a transcript. Instead, the only concept of credit in GME is when you want to take the ABMS exam -- before that, your program will need to attest that you have completed training and are ready to take the exam. They will also generate a document stating that you've completed the program to be used for licensing and credentialing.

In your case, should you switch from IM to Neuro, it's actually your neuro PD who will do the attestation to your PGY-1 training, the information of which they will obtain from your prior program.

In all cases, any future license application will require a statement from your IM program about your performance. Sadly, if they write something negative, no matter how much you've completed, it will cause you all sorts of problems.

Thanks for explaining. Can the chair sign this statement? Our chair is a fair and reasonable person and will (likely) assist if I'm out of the program; however, they won't stand against the PD and help me leave

Also, should I switch successfully to neuro at any point, I'll need credit for one year of medicine+3 years of neuro. Does my performance during PGY2 of IM matter to neurology boards?

I'm assuming that by starting PGY2 at my current institution, they are less likely to deny my PGY1 credit as that would contradict allowing me to progress to and start PGY2. Is this assumption reasonable?

 

[NotAProgDirector]

Thanks for explaining. Can the chair sign this statement? Our chair is a fair and reasonable person and will (likely) assist if I'm out of the program; however, they won't stand against the PD and help me leave

The PD will generate a summary at the end of your training.

Also, should I switch successfully to neuro at any point, I'll need credit for one year of medicine+3 years of neuro. Does my performance during PGY2 of IM matter to neurology boards?

Complaints / concerns about professionalism are always a concern.

I'm assuming that by starting PGY2 at my current institution, they are less likely to deny my PGY1 credit as that would contradict allowing me to progress to and start PGY2. Is this assumption reasonable?

You're thinking about this incorrectly. Your current program won't really approve or deny your PGY-1 credit. Your fture neuro program will do that.

In general, most programs would rather that you resign at the end of a PGY year, and gve them enough notice to hire someone new. Staying for your PGY-2 only to resign in the first month would be just about the worst thing you could do in most situations.

 

[ThoracicGuy]

I'm aware of that risk. Unfortunately, I don't see the power in myself to do two residencies.

The issue is, how can any program consider without a letter from my program?
Almost all PDs don't want to take a chance on a resident with an unknown performance.

If you really want Neuro with the least risks to your future career, this is the way.