Transfer Residency, Same Specialty

[deleted1163359]

Hi everyone,

I’m a current PGY-1 in FM thinking about transferring residency programs. USMD, Step 1 21X, Step 2 23X. Currently at an unopposed rural program that I ranked #2. I really liked the program because it had great exposure to OB while also being a 3 hour drive from where my parents live. When I started out, I thought that I wanted to do an OB/Womens Health fellowship. Turns out, I really only liked OB during my medical school rotation lol. More importantly, my interests have shifted more towards LGBT health and potentially addiction medicine. I am gay myself but it is something that took a really long time for me to accept due to conservative religious upbringing. Now that I've done a lot of legwork in overcoming that hurdle myself, I find that my interest within FM is gearing more towards working with marginalized demographics with a big community health focus. Unfortunately, I'm really not getting the opportunity here. There are no electives available at my current program focused LGBT care and the community healthcare rotation is kind of a joke (it's rotating through the 7 million nursing homes we have in town and that's it). Obviously, I am really hesitant to leave my residency since I get along well with everyone here and enjoy the other learning opportunities I've had. I ranked it #2 for a reason! So I thought hey, let me just do a fellowship after in order to get more experience. The problem is, I've talked to my advisor from medical school as well as a trusted faculty member here about pursuing LGBT Healthcare Fellowships and both of them have told me the same thing - my chances of securing a spot with those fellowships with limited (and possibly no) experience within residency is virtually zero. Both of them have encouraged me to look into transferring to a residency that will provide more exposure. My medical school advisor told me to look specifically at urban based residencies. I've attended virtual seminars held my a few of my top fellowship programs as well and all of them emphasized that the top things they look for in applicants are LORs followed by exposure/experience. The faculty member I spoke to also hinted heavily that it might be difficult for me to secure LORs due to the prejudice held by many faculty members. This is a small town, where I think 93% of residents voted for Trump during the last election. I just wanted to get everybody's thoughts and opinions on this matter and any advice on how to broach this topic with my PD. Thanks for taking the time to read and help!

Sidebar: I have been in a relationship with a wonderful partner for 7 months now and she has helped me tremendously on this path to self acceptance. She lives in a city about 3 hours away from where I'm currently doing residency. She can't and won't move to where I am because her job is not transferable and she doesn't feel safe being out in a small town. I know 7 months might not be a long to many people but we are both in our 30s and we are lesbians so our relationships notoriously move pretty fast lol. If I'm transferring, ideally I'd like to move to where she is BUT I don't know if that's something to bring up with my PD as a reason, since we're not married or starting a family or anything like that.

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[smq123]

Hi everyone,

I’m a current PGY-1 in FM thinking about transferring residency programs. USMD, Step 1 21X, Step 2 23X. Currently at an unopposed rural program that I ranked #2. I really liked the program because it had great exposure to OB while also being a 3 hour drive from where my parents live. When I started out, I thought that I wanted to do an OB/Womens Health fellowship. Turns out, I really only liked OB during my medical school rotation lol. More importantly, my interests have shifted more towards LGBT health and potentially addiction medicine. I am gay myself but it is something that took a really long time for me to accept due to conservative religious upbringing. Now that I've done a lot of legwork in overcoming that hurdle myself, I find that my interest within FM is gearing more towards working with marginalized demographics with a big community health focus. Unfortunately, I'm really not getting the opportunity here. There are no electives available at my current program focused LGBT care and the community healthcare rotation is kind of a joke (it's rotating through the 7 million nursing homes we have in town and that's it). Obviously, I am really hesitant to leave my residency since I get along well with everyone here and enjoy the other learning opportunities I've had. I ranked it #2 for a reason! So I thought hey, let me just do a fellowship after in order to get more experience. The problem is, I've talked to my advisor from medical school as well as a trusted faculty member here about pursuing LGBT Healthcare Fellowships and both of them have told me the same thing - my chances of securing a spot with those fellowships with limited (and possibly no) experience within residency is virtually zero. Both of them have encouraged me to look into transferring to a residency that will provide more exposure. My medical school advisor told me to look specifically at urban based residencies. I've attended virtual seminars held my a few of my top fellowship programs as well and all of them emphasized that the top things they look for in applicants are LORs followed by exposure/experience. The faculty member I spoke to also hinted heavily that it might be difficult for me to secure LORs due to the prejudice held by many faculty members. This is a small town, where I think 93% of residents voted for Trump during the last election. I just wanted to get everybody's thoughts and opinions on this matter and any advice on how to broach this topic with my PD. Thanks for taking the time to read and help!

Sidebar: I have been in a relationship with a wonderful partner for 7 months now and she has helped me tremendously on this path to self acceptance. She lives in a city about 3 hours away from where I'm currently doing residency. She can't and won't move to where I am because her job is not transferable and she doesn't feel safe being out in a small town. I know 7 months might not be a long to many people but we are both in our 30s and we are lesbians so our relationships notoriously move pretty fast lol. If I'm transferring, ideally I'd like to move to where she is BUT I don't know if that's something to bring up with my PD as a reason, since we're not married or starting a family or anything like that.

The issue with transferring now is that the ACGME/ABFM require that you complete the final two years of residency in the same program, so that you can demonstrate that you have had adequate patient continuity. Since we’re currently already halfway through May, you have about six weeks to find a program willing to take you and then coordinate that move. Otherwise, you’re looking at graduating off cycle (not the worst thing in the world, but obviously another thing to consider).

I’m surprised that the fellowship programs paint themselves as being competitive. Most people in family medicine don’t do fellowships anyway, and, as you said, many urban/suburban programs get pretty good LGBTQ experience just from their clinic patients. The only fellowship that is at all competitive is sports medicine, and that’s partly because it is procedure heavy and has the potential to significantly improve your income. Otherwise, FM fellowships are just not at all popular - most FM grads are chomping at the bit to make attending money.

 

[deleted1163359]

Very true; it's really unfortunate that this all came to my attention so late in PGY-1 year but everything was so busy I feel like I didn't really get the chance to sit down and sort out how I feel. Truthfully, I don't mind repeating a year or graduating off cycle if I have to! I'm already in my early 30s so some more time doesn't bother me much lol. There is an urban program near by me currently listed on FREIDA that I have reached out to and they do have an open spot I will apply to, I just need to broach the topic with my PD.

I hear you! I thought the same thing - that the applicants would be individuals like me, who are seeking more exposure because we didn't get it in residency. After doing more research, it appears I'm wrong and it's made me quite nervous. Current fellows of the programs I've seen are coming from Kaiser Sacramento, UCLA, Icahn Mt. Sinai, and other urban residencies. Many of the programs require "advocacy and community service relevant to LGBTQ+ populations" as well as "academic work with preference given to contributions in LGBTQ+ health or relevant health equity activities." Many of these things are not accessible to me, or won't be until I can begin doing away electives in PGY-3 but by then it may be too late. From my understanding, the veneer of competitiveness comes from limited number of programs. The LGBT primary care fellowships are fairly new so there are only a handful of them (under 10 currently I believe), each only accepting one fellow. My faculty advisor believes that my limited experience will put me at a significant disadvantage, even when compared to average or similar candidates, and especially if some personal prejudices lead to less than glowing LORs.
That's why I think it would be in my best interest to transfer. I am hoping my PD will approve even though it's not a "traditional" reason that people seek transfer.

Thanks for your insight smq123!