residency: if you get your second choice, are you stuck with it?

[LackingPhysics]

I don't know if this is in the right forum...

 

I'm not even in med school, but I'm trying to find out as much info as possible and I'm just wondering if, when you are matched to a residency, you are "stuck" there. In other words, if you don't get your first choice, will you be stuck with your second or even third choice forever?

[Kirsteen]

Hi there,

 

It is not unusual for residents who match to switch residency programs if they prefer another career path. So no, you're not necessarily "stuck" there forever.

 

Cheers,

Kirsteen

[EMD]

I don't know if this is in the right forum...

 

I'm not even in med school, but I'm trying to find out as much info as possible and I'm just wondering if, when you are matched to a residency, you are "stuck" there. In other words, if you don't get your first choice, will you be stuck with your second or even third choice forever?

To qualify Kirsteen's statement a bit more-- people do switch residency programs... but choices are limited. Programs that are "competitive" (i.e. many want do it relative to the number of spots) are more difficult to switch into... or may even be impossible to switch into. This is why CaRMS is an anxious time. In any case, from a statistical perspective-- jumping the hurdle into medical school is a much larger leap (or that's what I keep trying to tell myself). The application process (CaRMS vs med school) is quite different; there is nothing similar to the MCAT in Canada (the MCCQE is written after the match) and some schools are just pass/fail while most of the others are honours/pass/fail.

[aneliz]

It is *sometimes* possible to switch, however, there are never any guarantees. If you are really, really struggling in the discipline that you matched to, then you will not usually be 'held' there and forced to continue. However, what is available for you to switch to may not exactly be your first choice either.

 

When you apply for residency, you have complete freedom as to how many programs you apply to and in what order you rank them. You could apply to one program only (ie Paediatrics in Toronto), one discipline only (Internal Medicine at many different schools) or a combination of different variables (ie apply to 5 Internal medicine programs in Ontario + family medicine at two schools). There is no limit on how many programs/disciplines you apply to (except the application fee and the cost of attending interviews). However, most people find it rather hard to justify that they are truly committed enough to >2 disciplines to warrant an interview. (Most programs look at the number of electives you have done in that area to see if you are 'committed' to their area of medicine. With only 12-16 weeks of elective time during med school, it is hard to cover more than 2 disciplines so that you look convincing).

 

Once you have applied, the programs will decide who they want to interview. After the interviews, you rank the programs that have interviewed you in the order in which you would like to match to them. (ie most desirable program #1, then next most desirable, etc, etc). You are not required to rank all of the programs that you applied to. So, you could interview at several programs and then decide that one or more of them are not for you. (ie you would be miserable if you matched there). If that is the case, you should NOT rank that program. By ranking a program, you are committing to going there if you should match there - and while uncommon, it IS possible to match to your 6th, 7th, 12th choice program.

 

Switching is meant to accomodate people whose circumstances change AFTER the match is over. (ie partner/spouse moves to a different city, parent is dying in a different province, find out they are allergic to latex and are in a surgical field, discover they truly can't stand X specialty that they loved before). While attempts are made to accomodate transfer requests, it is a long process. While your application may be approved in principal (ie we don't have a problem with you switching to x program because of y reason), they often sit waiting for there to be a) space in the receiving program (ie somebody from your year in your desired program needs to leave) or funding (they need money to pay you - and it isn't as simple as taking the funding you already have with you - especially if you are trying to transfer locations) for months if not years. Many residents end up finishing the program before their transfer goes through.

 

That is not to say that transfers don't happen, because they do. But it is difficult to get exactly what you want from a transfer - especially if you are trying to move into a 'desirable' specialty. And, people are always on the lookout for people trying to get around the CaRMS process - ie move into something that they ranked higher in the match and didn't get.

[TimmyMax]

Hey,

 

Don't forget the fact that the residency program that you are looking to transfer into at the location you want has to accept you as well- it's not like you can just transfer into anything anywhere you want if you decide that you don't like where you matched. If your "target" program and location doesn't want you, you won't be able to transfer there, it's as simple as that. Why? For the simple reason that aneliz mentioned- people who try to circumvent the whole CaRMS process. In fact, there were a few people a couple years ago who matched into a certain low-demand program in a certain city with the full intention of transferring into a more highly competitive program (that they failed to match to via CaRMS) in that same city.

It's not like free agency in sports where you can just take your services to the highest bidder without owing anything to anyone, especially not to the team that you used to play for. Just something to keep in mind.

So in closing, to quote the Grail Knight from Indiana Jones and the Last Crusade: "You must choose...but choose wisely!"

[LackingPhysics]

Many thanks to everyone for all the information.

 

I guess once you are in medical school (if that ever happens for me) it is likely that you will be particularly drawn to one or two disciplines. And hopefully one of those isn't as competitive as the other in case you can't get into the more competitive one!

 

It's good to know that you can rank your preferences AFTER your interviews.

[Kirsteen]

I guess once you are in medical school (if that ever happens for me) it is likely that you will be particularly drawn to one or two disciplines. And hopefully one of those isn't as competitive as the other in case you can't get into the more competitive one!

 

Unfortunately, not necessarily. Although there are people who might be hell-bent on a specialty from day one of medical school and end up matching there, there are also a good number of folks who remain drawn to two competitive specialties or others who end up sending in applications to greater than two disciplines. As with many things, there is a spectrum of possibilities or combinations.

 

Cheers,

Kirsteen

[LackingPhysics]

I have another question about residency: What if you don't get into any of your choices? Are you just placed in a program that has a lot of unoccupied spots?

[avenir001]

I have another question about residency: What if you don't get into any of your choices? Are you just placed in a program that has a lot of unoccupied spots?

 

No, I think you just go unmatched for the year and can try again the year after. But in the meantime, can you work anywhere, like in a pharmaceutical company or something?

 

Edit: Oh actually, I remember there's a second round where you can try & match into positions left over after the first iteration...but if you fail to match in both rounds, then you wait for the next year, I think.

[Kirsteen]

I have another question about residency: What if you don't get into any of your choices? Are you just placed in a program that has a lot of unoccupied spots?

 

No, I think you just go unmatched for the year and can try again the year after. But in the meantime, can you work anywhere, like in a pharmaceutical company or something?

 

Edit: Oh actually, I remember there's a second round where you can try & match into positions left over after the first iteration...but if you fail to match in both rounds, then you wait for the next year, I think.

 

Hi there,

 

This is where application strategies are important, including to where you apply and at which programs you ultimately choose to interview and rank. The more broadly you apply, interview and rank, the better the chance you have of matching. However, there are folks out there who are adamant about matching into their specialty of choice and no others, thus, would prefer to go unmatched as opposed to entering any other program. In the end, the decisions surrounding whether to apply broadly or not, are very personal ones.

 

If an applicant doesn't match in a given year's first round then they have the option of applying to the second round spots, which are a lot fewer in number and much more restricted re: specialties and locations in which spots are offered. If you choose not to participate in the second round then you must wait until the following residency application cycle to apply. At that time, some applicants choose to widen their application net considerably and apply to US programs as well.

 

Cheers,

Kirsteen

[TimmyMax]

Hey,

 

Don't forget the old adage that we are told at UWO regarding the match that one should never rank a program that one is not interested in attending. Remember that you cannot be matched to a program that you did not rank as part of your final rank-order list. Hence, the choice of programs not to rank is also as much of the ranking strategy as programs that are ranked (by the applicant).

Although I did not agree with the assertion of my current PD at the time of the Match, he always held that in the end, the Match favours the applicant because the applicant ultimately is able to choose where they can and cannot be assigned. Personally, I believe that my PD's assertion is true so long as there are as many or fewer applicants than there are spots, after which, the program's rank order list becomes extremely important in determining who gets the spots, especially if everyone ranked said program as their number one pick.

Anyway, just thought that I'd share a few ideas on the Match that we were exposed to as part of our (stress and ulcer-inducing) Match preparation sessions at UWO.

[Kirsteen]

Don't forget the old adage that we are told at UWO regarding the match that one should never rank a program that one is not interested in attending. Remember that you cannot be matched to a program that you did not rank as part of your final rank-order list. Hence, the choice of programs not to rank is also as much of the ranking strategy as programs that are ranked (by the applicant).

 

Hi there,

 

It's funny how schools' and administrations' opinions differ re: matching strategies. Here at UofC we have often been encouraged to choose Family Medicine as a back-up plan, which is contrary to what some of the UWO administration seems to offer as counsel.

 

I agree with Timmy re: the programs' lists being more important than the applicants' when it comes to programs that have a surplus of interviewees to rank. When that point is met, our rank lists certainly seem to come second in priority.

 

Cheers,

Kirsteen

[TimmyMax]

Hey,

 

Here at UofC we have often been encouraged to choose Family Medicine as a back-up plan, which is contrary to what some of the UWO administration seems to offer as counsel.

I would beg to disagree with the last part of this assertion. What our clerkship director is saying is that one should not rank something that they are not prepared to match to. Although it may make some sense to rank family as a backup plan, one must be fully prepared to accept their fate should they match to family as opposed to some other field that they really wanted. In my opinion, it doesn't end up doing the system much good to have someone match to family as a backup, 3rd backup or 4th backup specialty choice because the poor family medicine residency program in question ends up with a resident who doesn't want to be there (as opposed to someone else who does), and the population is stuck with a family doc whose heart isn't really in that field and thus will either be looking to transfer out at the first opportunity or potentially not care as much about his or her patients as someone who is truly passionate about the field of family medicine. No matter how you slice it, the public isn't getting a good family physician, which isn't what anyone wants. Family medicine spots are very valuable and should not be looked down upon or viewed as leftovers or a consolation prize. I think the mentality that "one can always back up with family medicine" devalues the field as a whole and makes it seem second-rate, especially in the eyes of those who want to be specialists.

While it may make sense, in this day and age of more applicants than residency spots, to match somewhere rather than risk going unmatched in the first round, I think that some candidates are potentially selling themselves short in the end. Often, there are a few specialty spots left over after the first round, and these may prove to be in fields that the candidate originally wanted. You never know what is going to happen with the Match. I guess at the end of the day, it is better to have a job (or a residency spot) than to not have one, but at what price? I guess that is the choice that the individual applicant has to make.

[lost__in__space]

just a question......

 

if i want to match to neurology-adult and nothing else, and i don't match the 1st and 2nd rounds and end up unmatched (because i didn't choose anything else), what do I do with my year "off" while I wait to try again?

[BlackJack]

just a question......

 

if i want to match to neurology-adult and nothing else, and i don't match the 1st and 2nd rounds and end up unmatched (because i didn't choose anything else), what do I do with my year "off" while I wait to try again?

 

As fas as I know, anything you want.

 

Of course, I have heard a little rumor about having to go through a gauntlet of Royal College competency exams to get back into the system if you graduate from medicine yet do not have formal training for a year. Apparently this whole problem can be avoided by deferring graduation; however, the deadline for doing that may be school specific. Can anyone else confirm this?

 

As for the above discussion between TimmyMax and Kirsteen regarding Family Med as a back-up choice, I would have to agree with what students are told at UWO. I have met family residents who selected FM as a back-up spot in case they didn't get their first choice, and for the most part they are miserable and regret the decision they've made.