Transferring chances / release from matched position?

[mvttmv]

Recently R-1 applicant that matched into a moderately competitive specialty. I dropped on my rank list and ended up in a tough location where I know I will struggle immensely for the duration of residency due to distance from family (and desire to be near a parent that has progressively worse health issues with minimal support network). The expected likelihood of me completing residency in this location is very, very low.  I know I should not have ranked a location I did not want to live in but hindsight is 20/20. 

Some specific questions:

1. What are the chances of inter-province transfer, staying in the same specialty, if you are from a less desirable province? From reading elsewhere on the forum ,it seems very unlikely given the sheer attrition that's bound to exist from this province and the same-specialty transfer.

How early do you tell your PD that you don't think the location is a strong fit and there is a low likelihood of you finishing the residency (they seem to be very reasonable and supportive)?  Do you engage your PD to help them advocate for you (if you think they are an ally) or do you blindside them once the PGME office has checked to see if the transfer request is feasible? Can you only apply to one specialty when requesting inter-province transfer?  

2. What are the chances of being released by PD by explaining the need to be closer to family for health reasons?  Is it worse to not be currently in a residency program when attempting to match for R-1 (if successfully released) or R-2 (if not released) spots?

3. What is the correct strategy of navigating a transfer? Do you discreetly reach out to PDs at programs you'd be interested in transferring to prior to notifying your PD that you are unhappy (due to location) and are looking to leave? 

4. Can I apply to US residencies? Is it better to be currently employed in your Canadian residency while proceeding with the NRMP match or does it not have any impact (especially if you were employed when you submitted the application in September)

Thanks for the assistance. Will give the current spot 110% and go in with a positive outlook but realistically, I am relatively certain that this is not a location I will succeed in or complete residency in.  I'd be willing to stay in the specialty (ideal) or consider other specialties (except FM) in order to leave this province. 

[robclem21]

Sorry to hear you arrived at a situation that you are unhappy with. I am going to caveat what I say with the fact that many people are often unhappy initially with the match results and then once residency starts and they meet their colleagues and start working, they end up really enjoying it and being very happy with the outcome. You should actually go in with a positive outlook (instead of just saying it) because despite you saying that you will give 110%, you already are not. You might be surprised.

Now, without knowing the exact specialty, or location this is a difficult question to answer. Admittedly, I don't know the legality/rules of re-entering the match once CaRMS has been completed (or entering the US match after a successful CaRMS match). I suspect the chance of re-entering R1 is not possible, even if your PD agrees to let you break your contract prior to starting. Additionally, not sure how many competitive programs would want you after that happens, especially after you fell so far down your rank list to begin with that you ended up in this situation. It would be a major red flag. I don't believe "quitting" is a realistic option if you still choose to complete a residency program.

To transfer, you will ultimately need to the support of both the PD of the accepting program and the PD of your current program. The order you approach them doesn't particularly matter but in general if you want support it's best not to blindside people. Also, all the PDs know each other and talk often. With that being said, you would be hard-pressed to find a PD who will accept or support you (on both old and new program side) without first completing at least 12 months of residency. That would be giving it a realistic shot. Inter-province transfers are very difficult or impossible for competitive specialties. Your best bet would be to transfer from RC program to family.

My suggestion would be to relocate, start residency and try for at least a year, and then if you're still unhappy, discuss a possible transfer.

[Anon_67]

I am in the same boat. I matched to a moderately competitive RC specialty but in a province far away from my spouse and family. I know I should be grateful that I matched but I can’t help but feel disappointed in myself for not being able to match where I wanted. I fell really far down my rank list where I actually had multiple programs which were better geographically for me in a different supposedly non competitive specialty ahead of this one. 
 

I ideally also want to transfer to the same specialty in my province but know it is very unlikely. I am going to stick it out for the first 6 months as is required and look into transfer into my speciality or possibly family.

[GH0ST]

Hi there I hope you are doing ok. 

First off I still want to congratulate you on matching. It's still an important accomplishment worth respect and celebration. 

I can speak to my personal experience attempting to transfer once (more to see if it was possible). Now with the benefit of hindsight, I truly feel privileged to be here and have the opportunities I've had. I would be happy to explore with you my story, approach, and thought process in more detail. 

Now as some people know, public health and preventive medicine can be done with family medicine, so in an ideal world for me, if I wanted to make the change it would be just after finishing FM and transitioning to PHPM at a different university. It would be the cleanest break. 

I did hesitate initially when I matched to Northern Ontario due to my limited knowledge of the geography, being away from family, and worried about the training. I did not doubt my interest in address societal issues or working in rural/remote environments, but I wasn't sure if I made the best decision. 

When I went through the process, I did not initially let me PD know (and to be fair, most of my initial contact was with the FM program first) but there's a formalized transfer process between universities and between provinces. You do need to give your post-graduate medical education dean or the relevant people in post-grad generally a heads up so they can prepare you for the process. I spoke to my post-grad dean and we had an initial meeting to discuss what the steps will be and what documentation I will require. In general, the chance of provincial transfer within the same specialty is low... especially in programs with few spots (some programs only have 1 spot for example)

The next step after the 2nd step match is that universities will communicate if there's any left over spots or opportunities to take on new residents into their program. Even if you wish to transfer, if the program you wish to transfer to does not have adequate funding or enough positions the process will stop right there. 

Assuming that you do go through the process and the other program does have capacity and they don't have anyone on their own , then there may or may not be a meeting with that program to discuss details, particularly exploring why you want to return or go to X program. Assuming things work out, then you will eventually need your home PD to sign off on the transfer and get the process formally rolling so you can start clean by the next academic year. 

You need to do the minimum 12 months first... don't bother thinking of transferring when you first start. Just focus on doing the best you can in your residency program. 

I will say that for me, not getting the chance was actually a blessing in disguise... I had amazing opportunities to do electives elsewhere throughout Ontario (office of the chief medical officer of health, office of the chief coroner, PHO, etc) and I wouldn't have had the same access if I left Ontario. I also learned a lot about myself doing remote medicine and combining that with my urban experiences. Thinking back and thinking of what I could have transferred to, I would have limited my own horizons. I really do think it was the best thing for me that I remained with NOSM and I'm grateful for the experience. 

I will say that personally, I maintained a long distance relationship and got married during residency. It's possible to still have a personal life and connect with those far away. 

For now, focus on being the best doctor you can be. You can do a great job, regardless of where you are. 

Hope this helps, 

- G

[bearded frog]

On 3/22/2024 at 1:49 AM, mvttmv said:

What are the chances of inter-province transfer, staying in the same specialty, if you are from an undesirable province? 

Generally low. There is a formal process as described by an above poster, and you don't initially have to discuss it with your PD. Being in an undesirable province isn't as much as an issue, because the transfers are not direct exchange (you don't need to directly swap with someone), it would more be a situation where a resident leaves a program or takes an unpaid LOA and then a spot opens up in second year that they can't fill in CaRMS, for example. Being in a moderately compeditive specialty makes things more difficult vs FM, because the programs in the specialty are likely smaller and so less potential for spots to open up, and theoretically competing with local residents that want to switch into your specialty from a different specialty and are more of a known factor.

On 3/22/2024 at 1:49 AM, mvttmv said:

How early do you tell your PD that you don't think the location is a strong fit and there is a low likelihood of you finishing the residency (they seem to be very reasonable and supportive)?

Having a reasonable and supportive PD helps. In my experience PDs don't want unhappy residents that don't want to be in their program. That being said, the obvious question is why did you rank somewhere you couldn't actually attend, and now you're causing a problem for the program. Regardless YOU SHOULD 100% SHOW UP AND START YOUR RESIDENCY. Not doing so is a CaRMS contract violation and could prevent you from participating in CaRMS in the future. The best course of action is to start your residency and put your 100% into it. You want glowing evaluations, you want to be the best first year resident in the program, you want to be seen as someone who gave it their all. Then, a few months in, approach your PD with your concerns. You want them to love you and if you are an exemplary resident, to advocate on your behalf. You will need a reference letter from your PD regardless of what path you take, including withdrawing from residency to apply for future matches, and you want it to say you were an amazing resident who unfortunately had to withdraw due to circumstances XYZ. You do not want to have a letter that says you were struggling in residency, because programs are leery of residents trying to transfer out of programs where they are struggling performance-wise.

On 3/22/2024 at 1:49 AM, mvttmv said:

Can you only apply to one specialty when requesting inter-province transfer? 

You can apply to anything, but you need to have a solid reason for transfer. It would not be unreasonable to say "I really would like to be in southern Ontario to support my family. I would prefer to stay in specialty X at McMaster or UofT or whatever, but I would consider transferring to a different specialist if that is not possible and there was availability (ie FM).

On 3/22/2024 at 1:49 AM, mvttmv said:

What are the chances of being released by PD by explaining the need to be closer to family for health reasons?

You are not going to be able to be released from your CaRMS contract. Tons of people fall to their lowest rank for various reasons and would love to be able to apply to the first round match again and for obvious reasons this is not tolerated. Even if you are diagnosed with a significant illness they will let you defer your start year but won't let you re-do CaRMS fresh. If you mean just be released from residency, once you start you can withdraw and the program can't force you to stay. I don't know how long you have to stay for it not to be a match violation (in the US it's 40 days or so). That being said, you will need a LOR from your matched PD and you want it to be a positive one. You will also be a much more attractive applicant for future second round matches if you have LORs and performance evals showing that you can perform well in residency, and had to leave due to unforeseen circumstances, because you are more of a "sure thing" than an unmatched med student applicant. You might also be able to do electives in residency at places where you can establish relationships which could significantly increase your chances of transferring/matching there.

On 3/22/2024 at 1:49 AM, mvttmv said:

What is the correct strategy of navigating a transfer?

You have two options to transfer to a different institution than your own. Note that you realistically won't be able to transfer until the end of first year at the earliest. You have said you want to transfer out of your current province, so transfers within an institution to a different specialty, and some provinces have ways to transfer to different institutions within the same province, don't apply here. The two options are the national transfer program, or applying for an available second round CaRMS spot. The first requires that you stay in your program during the process. Realistically, you should do both. It is true that you don't need to talk to your program to start the national transfer process (you meet with your post-graduate dean and they will usually keep it confidential from your program), but it's easier if your PD/program is on board, and you will eventually have to notify them and ask for a LOR regardless. And while you technically apply to CaRMS without your program knowing, your application will be quickly tossed without a letter from your PD or someone else with stature in your program saying positive things about you. The best strategy stems from my advice above: be an amazing resident then approach your program/PD after a certain time (before the winter for sure) and explain that while you love the field and you love the program due to family circumstances or whatever you really would prefer to be closer to home. Hopefully your PD will then go to bat for you and write you glowing LORs, let you do electives at places where you would like to go, let you take absences for CaRMS interviews, perhaps even reach out to other programs on your behalf, etc. Then go through your post-grad program for the national transfer program, and at the same time prepare an application for second round CaRMS, if there are any spots available that would be acceptable.

You don't discuss this, but potentially switching to FM at your own program might be easier, if you could tolerate only having to do 2 years instead of more.

On 3/22/2024 at 1:49 AM, mvttmv said:

I have the ability to apply to US residencies (completed USMLE exams, US clinical experience + letters). Is it better to be currently employed in your Canadian residency while proceeding with the NRMP match or does it not have any impact (especially if you were employed when you submitted the application in September)

If you truly want to be closer to home I don't see how going to the US would help (Unless home is Windsor and you match to Wayne State). In any case, it's similar to second round CaRMS, you will have to toggle a flag saying that you have previously been accepted to a residency, and so will basically need a PD LOR and LORs saying that you are a great resident, would excel at a different program, etc. Even with good medical school letters, once you have started residency you need residency letters, otherwise it is a red flag (again, trying to avoid people who are being forced out of their program for performance problems). This is a very narrow timeline between starting in July and applying for the upcoming NRMP match. You might be able to do an elective at a US institution as well but this is more difficult.