Not Backing Up Am I Making the Wrong Choice?

[RicardoKaká]

Hello,

I am applying to a moderately competitive surgical speciality this year. I have received positive feedback on my suitability for the program at my home school from many of my preceptors who serve on the committee and have positive working relations with virtually all those I’ve worked with in the specialty.  This led me to feeling relatively confident on going “all in” and not backing up. 
 

However, as application submission day looms nearer I am feeling anxious about the potential, albeit hopefully unlikely scenario of not receiving a spot in the specialty. My logic at this point in the worse case scenario situation would be to apply to FM in the second iteration. 
 

Is there any sense in scrambling to write letters now and get references from core rotations for FM or should I just stick to my original plan? 
 

appreciate the insight  

[rmorelan]

14 hours ago, RicardoKaká said:

Hello,

I am applying to a moderately competitive surgical speciality this year. I have received positive feedback on my suitability for the program at my home school from many of my preceptors who serve on the committee and have positive working relations with virtually all those I’ve worked with in the specialty.  This led me to feeling relatively confident on going “all in” and not backing up. 
 

However, as application submission day looms nearer I am feeling anxious about the potential, albeit hopefully unlikely scenario of not receiving a spot in the specialty. My logic at this point in the worse case scenario situation would be to apply to FM in the second iteration. 
 

Is there any sense in scrambling to write letters now and get references from core rotations for FM or should I just stick to my original plan? 
 

appreciate the insight  

Hey - first of good luck!

So I should ask - will you or will you not apply to family programs in round 2 if you don't get anything in round 1? I think if at all possible you have to answer that question now. 

Because if you would, then there little no reason not to do it in first round - you would just rank all your family medicine sites dead last in your rank order. The only way you would ever be considered for family medicine then is if you would already completely rejected from all surgery programs you are targeting. The difference is you would dramatically increase the odds of getting family medicine (or whatever) again if and only if you were already rejected from surgery. Only way that doesn't make sense is if you are hoping you could possible get whatever surgery program is left in round 2 (which I can say is almost none, and even the ones that look like they are there typically are extremely hard to get). Those spots would not be in your moderately competitive field of choice almost certainly - as you would have been rejected from that school already in round 1 in some fashion either pre or post interview - or you wouldn't be unmatched with an open spot. 

 It is often better to just pretend the second round doesn't exist. 

I probably know the stress you are enduring - personally I went all in for radiology which is moderately competitive I would say. I also didn't back up because I was willing to reapply the following year rather than do any other field of medicine (or so I thought - how I would have felt actually going unmatched and reacting to it would have been a true test). CARMS is stressful - not backing up makes it even more so. 

Edited January 12, 2021 by rmorelan

[Bambi]

rmorelan gave you the answer that makes the most sense. In my opinion. there is no downside following his sage advice. Good luck!

[unmatch]

You have to decide whether you like family medicine and would be happy with that for the rest of your life, and divorce that from the anxiety surrounding going unmatched. If you would not like to be a family doctor, don't do it. 

[rmorelan]

2 hours ago, unmatch said:

You have to decide whether you like family medicine and would be happy with that for the rest of your life, and divorce that from the anxiety surrounding going unmatched. If you would not like to be a family doctor, don't do it. 

Yes that is true - there is a push and pull on whether to backup or not, and above is the question. Never rank anything you wouldn't want to do for the rest of your life, but also there is no reason not to rank somewhere something you would be willing to do either (even if again it is ranked at the rock bottom of your choices). The second round has never been a good place to be, and it has only become less so over time. 

[blah1234]

I've seen too many cases of students going unmatched and falling through the cracks due to a increasingly competitive second round to recommend students to not back up. Although, it is truly a minority of students who have issues with applications in subsequent years the fact remains that your chances of success generally decrease the further away you are from medical school graduation. However much you may hate doing family medicine it is still in my mind far better than having a medical degree with no residency. One at least gives you the opportunity to find work and find other avenues of passion while the other is a very tough situation to be in. I know that's more pessimistic than what others have posted but I do want to give that perspective even if the majority of students do end up doing well. Being unlucky at this critical juncture could be gambling with the rest of your future.

[rmorelan]

4 hours ago, blah1234 said:

I've seen too many cases of students going unmatched and falling through the cracks due to a increasingly competitive second round to recommend students to not back up. Although, it is truly a minority of students who have issues with applications in subsequent years the fact remains that your chances of success generally decrease the further away you are from medical school graduation. However much you may hate doing family medicine it is still in my mind far better than having a medical degree with no residency. One at least gives you the opportunity to find work and find other avenues of passion while the other is a very tough situation to be in. I know that's more pessimistic than what others have posted but I do want to give that perspective even if the majority of students do end up doing well. Being unlucky at this critical juncture could be gambling with the rest of your future.

True - the more I see of this the more cautious I get. Plus if you hate family that isn't obviously the only option . Say like internal - which in theory at least would even let you potentially switch to another 5 year problem. Not that you should plan on that of course. No back up is guaranteed but if you build that into your plan you can significantly boost your chances. Ideally no backup should be some last minute style thought - better to know you are backing up in some areas early enough to get proper LORs while on service etc and to make sure that you would be willing to go into that field even if it is choice #2.  

I would REALLY hate the idea that I didn't backup personally to cloud people's approach even if it technically follows my general advise of apply to anything you would be willing to do and nothing you wouldn't be willing to do. It was a bit bold even back then when it was not as brutal (and in my case I had an alternative career I could park myself if needed for a bit as an AI programmer in medical imaging). 

Now 8 years later the second round has just gotten worse and worse, and on top of that I can why the government isn't in a hurry to fix that - it is their primary and maybe only way of forcing people to go into fields that otherwise they have a hard time getting people into (and it isn't like they didn't try - the upped family meds income, and pushed the benefits of that field hard for a decade. You couldn't move without running into the need for family medicine when I was in medical school. Yet nothing really worked the way they wanted it to. Well cutting the spots just removes all choice really - problem solved.). 

[blah1234]

51 minutes ago, rmorelan said:

True - the more I see of this the more cautious I get. Plus if you hate family that isn't obviously the only option . Say like internal - which in theory at least would even let you potentially switch to another 5 year problem. Not that you should plan on that of course. No back up is guaranteed but if you build that into your plan you can significantly boost your chances. Ideally no backup should be some last minute style thought - better to know you are backing up in some areas early enough to get proper LORs while on service etc and to make sure that you would be willing to go into that field even if it is choice #2.  

I would REALLY hate the idea that I didn't backup personally to cloud people's approach even if it technically follows my general advise of apply to anything you would be willing to do and nothing you wouldn't be willing to do. It was a bit bold even back then when it was not as brutal (and in my case I had an alternative career I could park myself if needed for a bit as an AI programmer in medical imaging). 

Now 8 years later the second round has just gotten worse and worse, and on top of that I can why the government isn't in a hurry to fix that - it is their primary and maybe only way of forcing people to go into fields that otherwise they have a hard time getting people into (and it isn't like they didn't try - the upped family meds income, and pushed the benefits of that field hard for a decade. You couldn't move without running into the need for family medicine when I was in medical school. Yet nothing really worked the way they wanted it to. Well cutting the spots just removes all choice really - problem solved.). 

I agree that the government isn't in any hurry to fix things and probably has no incentive to anytime soon. This means that things will likely continue to get worse along the current trajectory.

My advice to students is to accept that you may end up in your backup. Everyone's pretty talented, hardworking, and dedicated at this point. Unfortunately, luck plays a disproportionate role at this juncture and sometimes that means you don't get your dream scenario. There's more than one path to success and happiness in life and sometimes life has a funny way of working out even if it doesn't appear to be the case at the time.

A lot of students say they would rather do nothing, or leave, or whatever compared to doing a backup (e.g. FM, IM, etc.) but that attitude can quickly change when you're staring at reality and at the limited path forward. Having worked with some of these students in real life it's not an enviable situation to be in and it is probably more stressful than anything you'll face in medical school or residency. I can't force people to do anything in CaRMS but I really don't want to see any more students fall through the cracks as it's quite heartbreaking.

[rmorelan]

12 minutes ago, blah1234 said:

I agree that the government isn't in any hurry to fix things and probably has no incentive to anytime soon. This means that things will likely continue to get worse along the current trajectory.

My advice to students is to accept that you may end up in your backup. Everyone's pretty talented, hardworking, and dedicated at this point. Unfortunately, luck plays a disproportionate role at this juncture and sometimes that means you don't get your dream scenario. There's more than one path to success and happiness in life and sometimes life has a funny way of working out even if it doesn't appear to be the case at the time.

A lot of students say they would rather do nothing, or leave, or whatever compared to doing a backup (e.g. FM, IM, etc.) but that attitude can quickly change when you're staring at reality and at the limited path forward. Having worked with some of these students in real life it's not an enviable situation to be in and it is probably more stressful than anything you'll face in medical school or residency. I can't force people to do anything in CaRMS but I really don't want to see any more students fall through the cracks as it's quite heartbreaking.

Ha - that is my point I guess - I am not sure the government even thinks there is anything that needs fixing. 

[gogogo]

1 hour ago, blah1234 said:

I agree that the government isn't in any hurry to fix things and probably has no incentive to anytime soon. This means that things will likely continue to get worse along the current trajectory.

My advice to students is to accept that you may end up in your backup. Everyone's pretty talented, hardworking, and dedicated at this point. Unfortunately, luck plays a disproportionate role at this juncture and sometimes that means you don't get your dream scenario. There's more than one path to success and happiness in life and sometimes life has a funny way of working out even if it doesn't appear to be the case at the time.

A lot of students say they would rather do nothing, or leave, or whatever compared to doing a backup (e.g. FM, IM, etc.) but that attitude can quickly change when you're staring at reality and at the limited path forward. Having worked with some of these students in real life it's not an enviable situation to be in and it is probably more stressful than anything you'll face in medical school or residency. I can't force people to do anything in CaRMS but I really don't want to see any more students fall through the cracks as it's quite heartbreaking.

When you say fall through the cracks, do you mean they end up leaving medicine entirely (because they couldn't get into residency)? What do they end up doing instead with their MD?

[JohnGrisham]

8 hours ago, gogogo said:

When you say fall through the cracks, do you mean they end up leaving medicine entirely (because they couldn't get into residency)? What do they end up doing instead with their MD?

Your guess is as good as mine - often find some research coordinator job. The opportunities for those with only an MD are not as glamorous as people often make it seem. The average medical student often doesn't have much real world translatable experience in the business world/consulting world etc.  Sure many do, but those that often do, aren't the ones going unmatched - because they realize how powerful any residency is from making an income stream and then slowly building up lateral interests. 

I.e. a colleague of mine left a surgical residency after 2 years, and went into FM. Now has his license, works part-time while building up a side business(and painfully learning the ropes, and trials/errors). Much easier to do that when you have a gauranteed source of income from the clinic job that is servicing your debt, keeping you afloat and funding your side business. 

[blah1234]

11 hours ago, gogogo said:

When you say fall through the cracks, do you mean they end up leaving medicine entirely (because they couldn't get into residency)? What do they end up doing instead with their MD?

Some aren't able to continue in medicine. Some find a path forward (e.g. business, law, research, etc.) others aren't as fortunate or I've lost contact with them. Luckily you don't always need a residency to be successful in other endeavours but it's not like the career escalator that you see in medicine with residency. However, it's also not 100% rosy if you do residency either as you just have to look at the number of specialists that are stuck in perpetual clinical associateships or fellowships or graduate degrees.

People can feel bitter with their second choice because they often feel like they got the short end of the stick but it really is the lesser evil compared to not finishing your training.

[W0lfgang]

I backed up with FM and went to a few interviews. In the end, I decided I'd rather go unmatched than do FM, and didn't rank any FM programs. I generally don't like the idea of backing up. You spread yourself thinner than your competition.