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Hi,

I have always loved plastic surgery and tailored my CV and activities towards it in the hope of being chosen, but I matched into internal medicine instead. While I am happy, I can't help but think I'd like to give it another try...

Would it be possible for me to participate in future carms match cycles as a resident and hopefully transfer into plastic surgery? Or is this the end to that dream?

Thank you for your inputs 

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3 hours ago, Intmed said:

Hi,

I have always loved plastic surgery and tailored my CV and activities towards it in the hope of being chosen, but I matched into internal medicine instead. While I am happy, I can't help but think I'd like to give it another try...

Would it be possible for me to participate in future carms match cycles as a resident and hopefully transfer into plastic surgery? Or is this the end to that dream?

Thank you for your inputs 

1. USMLE --> go to States ?

2. Go to PD, ask for feedback how to improve application and work on it.

3. PGME office inquire about any openings.

4. Do electives in various other cities, b/c u could find a program that's a better fit for you.

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2 hours ago, CaRMS2021 said:

You can only participate in 2nd iteration where there’s never any Plastics spots. A transfer may be probable possible

A transfer is theoretically possible but very unlikely if they did not match in the first place... I'm sure there's a ton of people who would love to transfer into plastics.

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34 minutes ago, bearded frog said:

A transfer is theoretically possible but very unlikely if they did not match in the first place... I'm sure there's a ton of people who would love to transfer into plastics.

Hmmm... not really! I have seen actually people transfer out of plastics to FM.  Over the last few years, I have seen several transfers from surgical specialties to FM. Now, to be honest it is unlikely that transfer from IM to plastics may work. However, I do remember when doing my plastic surgery, I met a surgeon who worked as a GP for several years then completed a plastic surgery residency and eventually became a plastic surgeon ( however, he was quite old, and maybe rules back then were lenient).

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2 hours ago, lovemedicinesomuch said:

Hmmm... not really! I have seen actually people transfer out of plastics to FM.  Over the last few years, I have seen several transfers from surgical specialties to FM. Now, to be honest it is unlikely that transfer from IM to plastics may work. However, I do remember when doing my plastic surgery, I met a surgeon who worked as a GP for several years then completed a plastic surgery residency and eventually became a plastic surgeon ( however, he was quite old, and maybe rules back then were lenient).

I'm basing my assumption on the fact that plastics is consistently one of the most competitive specialties in Canada and there are many more first choice applicants than those who match, so in theory those people would jump at the chance to transfer into plastics. Transferring to FM from royal college specialties is probably the most common transfer, I'm not sure how that affects the OP's question because it's a lot different than the other way around.

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1 minute ago, bearded frog said:

I'm basing my assumption on the fact that plastics is consistently one of the most competitive specialties in Canada and there are many more first choice applicants than those who match, so in theory those people would jump at the chance to transfer into plastics. Transferring to FM from royal college specialties is probably the most common transfer, I'm not sure how that affects the OP's question because it's a lot different than the other way around.

well that's how transfer spots open up - when residents leave the program.

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Back in the days, you could do pretty much anything so the example @lovemedicinesomuchmentioned is pretty much worthless.

While spots in plastic surgery may open up once every 10 years, this is mostly anecdotical and not something that should be relied on. Telling someone they have a realistic (let alone a "probable" one) chance of transferring to plastics is simply harvesting false hopes.

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12 minutes ago, Snowmen said:

Back in the days, you could do pretty much anything so the example @lovemedicinesomuchmentioned is pretty much worthless.

While spots in plastic surgery may open up once every 10 years, this is mostly anecdotical and not something that should be relied on. Telling someone they have a realistic (let alone a "probable" one) chance of transferring to plastics is simply harvesting false hopes.

Although it's unlikely that OP can transfer from IM to plastics in Cda, OP may consider US. It's obviously still very competitive with small success rate- but OP can participate in first iteration in ERAS. 

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I have known of a resident and a (younger) staff that transferred into plastics - not easily at all either from another surgical discipline.  

Transfers even "easy" ones from IM into FM sometimes do not always work out (https://www.cbc.ca/news/canada/nova-scotia/why-n-s-physician-couldn-t-become-rural-family-doctor-1.4703055).

If you are willing to put everything on the line, then I think the US would be your best opportunity.  Very prestigious US plastic surgery programs seem to take IMGs that do multi-year research fellowship with them e.g. Mayo - 2/4 are IMGs that seemed to have spent years in research in the program:

https://www.instagram.com/p/CMnnnMajhAQ/

In the old days, it wasn't possible to match into a specialty directly from medical school - only after some time in general practice.  

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Another, albeit very long and hard, option is to transfer into a General Surgery or ENT program in Canada/US  followed by a 3 year independent plastics fellowship in the US. I think General Surgery in particular should be relatively easier to transfer into. The Royal College accepts American Plastics Board eligibility to be equivalent since even integrated plastics training in the US is a year longer than in Canada. It's not an easy match though. I think McGill used to have a 3 year independent fellowship as well but I can't find it on their website.

An interesting note is that the American Boards will accept literally any other surgical residency as a prerequisite to the three year independent pathway. They literally say: General Surgery, Vascular Surgery, Neurological Surgery, Orthopaedic, ENT, Cardiac surgery, Thoracic Surgery and Urology would work as well. So you could theoretically transfer to those specialties and not be limited to the more traditional choices of ENT or General Surgery. Sounds insane to me but I think that's their policy. Johns Hopkins' prerequisites for their independent program echoes this.

Link for their policies is below and this is described as "Alternate Pathway: Prerequisite training in other ABMS specialty".

https://www.abplasticsurgery.org/media/18332/2020-21-BOI-Training-Section.pdf

https://www.hopkinsmedicine.org/plastic_reconstructive_surgery/education/residency_programs/independent_residency_program.html#prereq

Edit: I would love to see someone get double board certified in Neurosurgery and Plastics. If it were me, I'd go around yelling:"My name is zoxymandias surgeon of surgeons/ look on my works ye mighty and despair".

Edited by zoxy
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5 hours ago, lovemedicinesomuch said:

well that's how transfer spots open up - when residents leave the program.

Right, but for every spot that opens there will be a lot of competition, perhaps from established residents in other surgical specialties demonstrating proficiency on rotations in plastics, which potentially would be preferable to someone who didn't match to plastics the first time around, which is the point I was I was trying to make in the first place!

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On 4/25/2021 at 12:18 AM, zoxy said:

Another, albeit very long and hard, option is to transfer into a General Surgery or ENT program in Canada/US  followed by a 3 year independent plastics fellowship in the US. I think General Surgery in particular should be relatively easier to transfer into. The Royal College accepts American Plastics Board eligibility to be equivalent since even integrated plastics training in the US is a year longer than in Canada. It's not an easy match though. I think McGill used to have a 3 year independent fellowship as well but I can't find it on their website.

An interesting note is that the American Boards will accept literally any other surgical residency as a prerequisite to the three year independent pathway. They literally say: General Surgery, Vascular Surgery, Neurological Surgery, Orthopaedic, ENT, Cardiac surgery, Thoracic Surgery and Urology would work as well. So you could theoretically transfer to those specialties and not be limited to the more traditional choices of ENT or General Surgery. Sounds insane to me but I think that's their policy. Johns Hopkins' prerequisites for their independent program echoes this.

Link for their policies is below and this is described as "Alternate Pathway: Prerequisite training in other ABMS specialty".

https://www.abplasticsurgery.org/media/18332/2020-21-BOI-Training-Section.pdf

https://www.hopkinsmedicine.org/plastic_reconstructive_surgery/education/residency_programs/independent_residency_program.html#prereq

Edit: I would love to see someone get double board certified in Neurosurgery and Plastics. If it were me, I'd go around yelling:"My name is zoxymandias surgeon of surgeons/ look on my works ye mighty and despair".

Very valid point - not sure how viable the independent pathway would be in 5 years.  I would think doing a 5-year RC surgical residency for the opportunity of possibly transferring or matching only to be denied at the end would be disappointing..  but I've heard of residents doing even multiple transfers - could depend on the school.  

Haha - I like the modern "twist" on the classic and I think it is indeed fitting - partly probably due to its likely uniqueness (as well as its apt historical context).

Neurosurgeons do make $$$$ in the US (but 7 year training) and the Canadian RC training is not recognized as equivalent by the American Boards.  But, perhaps Canadian Neurosurgery training would be recognized as a surgical residency training for the purposes of matching?

https://www.cmaj.ca/content/re-new-neurosurgeons-left-jobless-wheres-plan-15-year-review

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1 hour ago, indefatigable said:

Very valid point - not sure how viable the independent pathway would be in 5 years.  I would think doing a 5-year RC surgical residency for the opportunity of possibly transferring only to be denied at the end would be disappointing..  but I've heard of residents doing even multiple transfers - could depend on the school.

That is a solid point although I'd be incredibly surprised if the independent plastics pathway disappeared completely in the US.  While there has been a decrease in the number of independent programs since the inception of integrated residencies, the decline in the number of independent spots has plateaued quite a bit. There were 97 independent positions in 2010 (12 of which didn't fill!), 70 in 2015, and 64 in 2020. Match rate seems to have held steady as well, hovering between 75-86 percent for 2010-2020. I'd imagine doing a general surgery residency at an academic program in Canada with a plastics program that you could collaborate with on research would give you a leg up.

I would wager that there will still be a decent number of independent training spots in 5 years time. Many programs actually have both independent and integrated paths(Links below). Also plastics isn't that much better than other surgical specialties in the US. The pay is comparable and they all have good job markets. Nothing like the situation Canadian Neurosurgeons, Cardiac Surgeons and Orthopedic Surgeons find themselves in right now.

Something that I've read is that many program directors for integrated residencies are aware that many applicants aren't necessarily exposed to different surgical specialties during medical school. So they'll always want to leave an option for those folks who change their mind during residency. Not like Canada where the independent pathway for Cardiac and Plastics has essentially disappeared. Guess Canada has little tolerance for those changing their minds, you better know what you want after turning 12.

https://www.sciencedirect.com/science/article/abs/pii/S1931720419301291

https://sfmatch.org/SpecialtyInsideAll.aspx?id=19&typ=2&name=Plastic Surgery

 

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1 hour ago, zoxy said:

That is a solid point although I'd be incredibly surprised if the independent plastics pathway disappeared completely in the US.  While there has been a decrease in the number of independent programs since the inception of integrated residencies, the decline in the number of independent spots has plateaued quite a bit. There were 97 independent positions in 2010 (12 of which didn't fill!), 70 in 2015, and 64 in 2020. Match rate seems to have held steady as well, hovering between 75-86 percent for 2010-2020. I'd imagine doing a general surgery residency at an academic program in Canada with a plastics program that you could collaborate with on research would give you a leg up.

I would wager that there will still be a decent number of independent training spots in 5 years time. Many programs actually have both independent and integrated paths(Links below). Also plastics isn't that much better than other surgical specialties in the US. The pay is comparable and they all have good job markets. Nothing like the situation Canadian Neurosurgeons, Cardiac Surgeons and Orthopedic Surgeons find themselves in right now.

Something that I've read is that many program directors for integrated residencies are aware that many applicants aren't necessarily exposed to different surgical specialties during medical school. So they'll always want to leave an option for those folks who change their mind during residency. Not like Canada where the independent pathway for Cardiac and Plastics has essentially disappeared. Guess Canada has little tolerance for those changing their minds, you better know what you want after turning 12.

https://www.sciencedirect.com/science/article/abs/pii/S1931720419301291

https://sfmatch.org/SpecialtyInsideAll.aspx?id=19&typ=2&name=Plastic Surgery

 

Good points - thanks for looking up the numbers.  

If research collaboration with a US plastic surgery program were indeed possible during a busy General Surgery residency, then I would agree the Canadian route seems viable as one could also look for opportunities to transfer within Canada before finishing.. although that in itself could be somewhat tricky given the ambiguousness of how transferring is viewed.  And transferring to general surgery in the first place might be viewed as suspicious by the program given a history in plastics.

 One may need to create solid links with a US program to count on such an outcome.  The main weakness is counting on the match itself, as Canadians are both: i) in Canada; ii) not American citizens.  It would possibly be a ground-breaking approach, however.   

On the other hand, the "pure" research route is a proven pathway for IMGs - not sure how easy it is to obtain those positions or how many attempt the approach and do not succeed.  

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4 hours ago, indefatigable said:

 One one would need to create solid links with a US program to count on such an outcome.  The main weakness is counting on the transfer itself, as Canadians are both: i) in Canada; ii) not American citizens.  It would possibly be a ground-breaking approach, however.  

I mean, it's through the SF match, so it's not a transfer. You would be doing your surgical residency and applying for the SF match during your 4th year. This would be like many other surgical sub specialties like vascular, cardio-thoracic, surgical oncology, abdominal transplant, etc.

I can't speak to the drawbacks of being an applicant from a Canadian GenSx program and trying to get an independent plastics fellowship since the SF match doesn't report any data. However, the NRMP thoracic and vascular fellowship match does report Canadian applicant data. Canadians were 1 for 2 in 2020, 1 for 1 in 2019, 1 for 1 in 2018, 2 for 4 in 2017, for  cardio-thoracic and vascular fellowships in the past 4 years. So 5/8 in the past four years for those two specialties. Three of the five matched in cardio-thoracics and the other two matched to vascular.

Edited by zoxy
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8 minutes ago, zoxy said:

I mean, it's through the SF match, so it's not a transfer. You would be doing your surgical residency and applying for the SF match during your 4th year. This would be like many other surgical sub specialties like vascular, cardio-thoracic, surgical oncology, abdominal transplant, etc.

I can't speak to the drawbacks of being a Canadian and trying to get an independent plastics fellowship since the SF match doesn't report any data. However, the NRMP thoracic and vascular fellowship match does report Canadian applicant data. Canadians were 1 for 2 in 2020, 1 for 1 in 2019, 1 for 1 in 2018, 2 for 4 in 2017, for  cardio-thoracic and vascular fellowships in the past 4 years. So 5/8 in the past four years for those two specialties. Three of the five matched in cardio-thoracics and the other two matched to vascular.

Thanks for clarification and looking up more data - yes I see what you’re saying.  I edited the previous post for clarity.  To ensure the desired outcome, I think research in plastics would still be necessary, however.

I also think starting the whole process could be a weak point.. but maybe gen surg wouldn’t care as long they got some service out of the transfer resident.

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What's interesting when discussing residency transfers is how frequently it is mentioned how "easy" it is to switch into Family Medicine, when experiences at my school speak to the opposite. Our post-graduate dean, who does talks on residency transfers, has stated multiple times the most common requests for transfers she gets are from RC residences to FM, and that there is a lot of competition for the few spots that are available. It is not just about funding--it also needs to take into account the capacity of the residency program to train the residents with suitable clinic sites / preceptors. This obviously varies from school to school, but with the high attrition rates in Gen Surg and IM where I'm from, it can be easier to switch into those programs as a resident than it is to switch into FM. OP, I would recommend reaching out to the post-graduate office at whatever school you matched to regarding their experiences with resident transfers. 

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On 4/24/2021 at 4:44 PM, bearded frog said:

A transfer is theoretically possible but very unlikely if they did not match in the first place... I'm sure there's a ton of people who would love to transfer into plastics.

I agree. The degree of likelihood is more closely approximates "highly unlikely, near impossible" with regards to finding a plastic surgery position in Canada unless you have very special connections.

I think you'll probably be happier in life if you take what you have or do family med. Unless you'd be happy doing general surgery you're probably better off avoiding looking into transferring into an American GSx program and applying for plastics after. I suspect pedigree would be important in such cases, so you wouldn't just be looking for any unfilled program.

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43 minutes ago, 1D7 said:

I agree. The degree of likelihood is more closely approximates "highly unlikely, near impossible" with regards to finding a plastic surgery position in Canada unless you have very special connections.

I think you'll probably be happier in life if you take what you have or do family med. Unless you'd be happy doing general surgery you're probably better off avoiding looking into transferring into an American GSx program and applying for plastics after. I suspect pedigree would be important in such cases, so you wouldn't just be looking for any unfilled program.

Getting into the US and getting into General Surgery are two separate problems.  Cross-border "transfers" don't happen - and any transfers, as has been discussed above, are far from guaranteed.  

Ultimately getting into Plastic Surgery is a separate, but related, problem.  

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Thank you everyone for your answers.

I know how hard / very unlikely to be able to transfer to plastic surgery, I guess I just needed a wake-up call to be able to move on.. I'll continue down the lane in internal med and will contact the pgme in case I truly don't like it or if there are spots open in general surgery (which would probably be a bit more realistic than plastic surgery).

Talking to friends and family has really helped me these past couple days. (and reading your messages too)

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Couple things to think about:

1. What do you like about plastics? Can you scratch that itch elsewhere (Ie. Family + Cosmetics/botox etc.; Internal-GI for procedures)?
2. What does attrition look like in plastics, in some surg specialties it's common for people to switch out into family after the first few years, opening up spots for second round/second year transfers. But if that's not the case, the likelihood is low that spots will open up.
3. What don't you like about IM? You're already in the pipeline for IM and leaving and reentering somewhere else will always be more difficult than adapting/tailoring your current path that's already guaranteed.
4. Think about options in the states if you TRULY need to be plastics. In that case, using the time right now to write the STEPs may be a prudent next step to keep your doors open.

Good luck!

 

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