Switching residencies

[obamasutra]

I am a pgy1. I am sure that I want to switch out of my program. But I matched desperately in the 2nd round and have been told that there is a policy that prevents 2nd round matchers from switching in PGY1.

 

I think that is stupid and unfair. I want to challenge it legally because its a very coercive policy.

 

Is this policy national provinical or school-based?

 

Has anyone gotten around it?

[007]

I've never heard of that, but I also haven't investigated it either.

[Mourning Cloak]

I am a pgy1. I am sure that I want to switch out of my program. But I matched desperately in the 2nd round and have been told that there is a policy that prevents 2nd round matchers from switching in PGY1.

 

It's written into the CaRMS applicant contract.

 

Item 11 - Match Iterations

 

An Applicant matched in the first iteration of the matching process, or matched in the U.S. or other program not part of the Matching Program, is not eligible to register and participate in the second iteration of the matching process. If for any reason an Applicant is released from a contract in the first iteration of the matching process or released from a contract in the U.S., the Applicant is not eligible for registration in the second iteration of the matching process.

 

I don't think that this necessarily forbids you from switching after the second round if the spot is still open (e.g. the post-second-match-scramble). But your best bet is probably to stick tight and switch in PGY-2. Some people do make switches in PGY-2 (particularly if you're shooting for a specialty that has vacancies in the second round).

[bnface]

It's written into the CaRMS applicant contract.

 

Item 11 - Match Iterations

 

An Applicant matched in the first iteration of the matching process, or matched in the U.S. or other program not part of the Matching Program, is not eligible to register and participate in the second iteration of the matching process. If for any reason an Applicant is released from a contract in the first iteration of the matching process or released from a contract in the U.S., the Applicant is not eligible for registration in the second iteration of the matching process.

 

I do not believe that this the question being asked. OP's question pertains to the policy of people matched in the 2nd iteration not being allowed to switch specialty programs in their R1/PGY1 year. I agree that this policy is quite unfair. Whether it has been challenged, i am also curious....

[Mourning Cloak]

That is an interesting question. There's nothing in CaRMS (i.e. nationally) to forbid it.

 

It must be provincial/school based. Maybe it's part of your ROS contract (Ontario's ROS does not specifically forbid changes in programs/schools, not sure about other provinces). What's your province/school?

[Satsuma]

It does seem a little unfair, but it is the case. But you can at least still transfer after PGY1 so all is not lost and you could still get to your end goal.

 

My understading from the brief info in our residents handbook is that it is a provincial policy since that is from where we get our funding. I suspect each province each has their own similar policy.

 

In ON it seems whatever PGM:COFM is , is what sets out the policy that Ontario schools follow. They are also the ones that list whatever specialties "designated" as preferential for residents to transfer to, based on projected need. But no idea what that stands for.

 

Good luck!

[Halcyon]

obama sutra? That's one interesting username, haha!

 

[gerd]

Transfer policies are established by the PGME office at each university. However, I think it's pretty much the same everywhere. Basically, you have to complete 6 months of PGY1 before you can try to transfer, IF you matched during the 1st iteration. If you matched in the 2nd iteration, then you cannot transfer until after finishing PGY1.

 

I can understand that you're in a very frustrating situation, but I would have to disagree that this kind of policy is unfair and coercive.

 

There are reasons for this. One, this is to try and prevent people from subverting the CARMS process by matching to a "backup" program with the sole intent of transfering out right away. This is especially true for those who matched during the 2nd iteration. It has been emphasized over and over again, that if you have no intent of training at a specific program, then you should not rank it.

 

Also, for those who actually DID have interest in a given program but decided to change their mind, the 6-month period is to give the trainee some time to think about whether they've really chosen the "wrong" specialty or if they are just having issues with adjusting to residency.

[obamasutra]

Transfer policies are established by the PGME office at each university. However, I think it's pretty much the same everywhere. Basically, you have to complete 6 months of PGY1 before you can try to transfer, IF you matched during the 1st iteration. If you matched in the 2nd iteration, then you cannot transfer until after finishing PGY1.

 

I can understand that you're in a very frustrating situation, but I would have to disagree that this kind of policy is unfair and coercive.

 

There are reasons for this. One, this is to try and prevent people from subverting the CARMS process by matching to a "backup" program with the sole intent of transfering out right away. This is especially true for those who matched during the 2nd iteration. It has been emphasized over and over again, that if you have no intent of training at a specific program, then you should not rank it.

 

Also, for those who actually DID have interest in a given program but decided to change their mind, the 6-month period is to give the trainee some time to think about whether they've really chosen the "wrong" specialty or if they are just having issues with adjusting to residency.

 

 

Oftentimes unmatched grads have no choice but to rank something. The stats show that wasting a year of learning and income and reapplying the next year of carms is essentially worthless. If your loans and debt are deep and you need a way to pay them back then you have to rank something and get a source of income. Theres lots of reasons why people rank something in the 2nd round that are not because they want to do the field. The very nature of carms forces unmatched graduates to do this. programs that accept unmatched candidates should expect some of them to switch out. After all, its their careers. I know I didnt work this hard and this long to end up doing something I dont care about.

 

Are the stats for 2nd round switchers that much higher than for 1st round? Even if they are, it should not matter.

 

It is a coercive policy because it forces me to continue in a program that I do not want to be in. In other words Im forced to be here and i had no choice in the matter other than to not train in medicine this year, wasting valuable training time and losing knowledge and good habits. No actual job aside from the military would penalize anyones time like this. Even if another program would want to accept me i couldnt go because of this stupid rule, so theyd have to take someone else and Id lose my spot.

[gerd]

I can see where you're coming from. We've all been through the carms process and know how frustrating it can be.

 

Although to think about it from the other side, what would then be considered a reasonable policy? Residency programs obviously need to protect their interest also. They accepted candidates with the belief that they have an intent on completing training in that area of specialty. No program will accept a candidate who they know have no interest and actually expect them to transfer out. For every resident that transfers out of the program, they would have to either find someone else to fill the spot or have that spot (and the funding that comes with it) basically go to waste. And of course it could also potentially mean more workload/call for the other residents!

 

So, what can we do to balance the needs of both residents and the programs?

[Mourning Cloak]

And, if nothing else, this whole discussion emphasizes the importance of the cardinal CaRMS rule:

 

If you wouldn't want to do it, don't rank it.

[Satsuma]

And, if nothing else, this whole discussion emphasizes the importance of the cardinal CaRMS rule:

 

If you wouldn't want to do it, don't rank it.

 

It is true this is what Carms tells you. But everyone knows it is harder to go unmatched and try to match the following year, than it is to match to a program and transfer.

 

The very fact that there are obviously enough people in this predicament that there are policies that limit transfers under those conditions, should prompt a re-evaluation of how medical students chose their specialties and the craziness of carms...rather than simply limiting a resident's choices.

[blinknoodle]

I know Toronto doesn't allow people to transfer programs if they matched in round 2, which seems to be an institutional policy.

[Calgarymed]

Everyone goes through Carms and everyone knows how frustrating it can be. You were told that this is a legal binding contract and NOT to rank places/programs you would not/could not go/do. Any job in the real world would not allow you to break such a contract, especially if you knew from the beginning that, that was your intent so they are not "holding you against your will". Many programs have general first years so even finishing a whole year of whatever you are doing would likely not hold you back in the overall bigger scheme of things.

[obamasutra]

Everyone goes through Carms and everyone knows how frustrating it can be. You were told that this is a legal binding contract and NOT to rank places/programs you would not/could not go/do. Any job in the real world would not allow you to break such a contract, especially if you knew from the beginning that, that was your intent so they are not "holding you against your will". Many programs have general first years so even finishing a whole year of whatever you are doing would likely not hold you back in the overall bigger scheme of things.

 

Thanks for your patriarchial tone. I really appreciate it.

 

If I could have afforded it I would have definitely not have applied to the 2nd round but that was not an option for me. It's easy to say not to rank something..

 

But the issue is not that I matched to the 2nd round. The issue is that there are policies in place that penalize those who matched in the 2nd round that are unfair. These policies close windows of opportunity that are open to people who matched in the 1st round. These policies are also not part of carms itself. Rather, they are regional. Why not prohibit any switching in pgy1 for everyone regardless of iteration in which they matched?

 

There cant be enough second iteration grads to cause that much of a service problem from switching out of their programs. I bet more first iteration people switch.

 

I also fail to see how having a disaffected physician doing a residency, and ultimately a job, he or she cares nothing for is good for canadians. Youd think with all of the shortages across the board one would be able to train congruent with whatever ones interests were.

[Mourning Cloak]

should prompt a re-evaluation of how medical students chose their specialties and the craziness of carms...rather than simply limiting a resident's choices.

 

I think that the basic problem is that we run so close to a 1:1 ratio of residency spots and Canadian grads. There's no wiggle room. There's tons of wiggle room in the US (although it's rapidly shrinking, I understand).

 

But there never has been any wiggle room in the Canadian system. The Canadian Federation of Medical Students has publicly made a case of increasing the ratio to 1:1.5. On the other hand, I've heard it said (somewhat cynically) that this will only decrease the number of family med grads by 50% (in other words, the system needs to keep the ratio low to force grads into family medicine).

 

Clearly the most important thing is making the grads going through CaRMS aware of the existant rules so that there aren't any unpleasant surprises. I suspect that Obamasutra might have made different decisions if s/he had known about these limitations beforehand; or, at least, s/he would have been able to make an informed decision when ranking.

[obamasutra]

I think that the basic problem is that we run so close to a 1:1 ratio of residency spots and Canadian grads. There's no wiggle room. There's tons of wiggle room in the US (although it's rapidly shrinking, I understand).

 

But there never has been any wiggle room in the Canadian system. The Canadian Federation of Medical Students has publicly made a case of increasing the ratio to 1:1.5. On the other hand, I've heard it said (somewhat cynically) that this will only decrease the number of family med grads by 50% (in other words, the system needs to keep the ratio low to force grads into family medicine).

 

Clearly the most important thing is making the grads going through CaRMS aware of the existant rules so that there aren't any unpleasant surprises. I suspect that Obamasutra might have made different decisions if s/he had known about these limitations beforehand; or, at least, s/he would have been able to make an informed decision when ranking.

 

 

If things keep going the way they are and I cant switch, ill practice in my crappy field as long as it takes me to accumulate enough capital to stop practicing and do something else not medical. Im not gonna work a job I hate forever. Just long enough to make enough cash before i split.

 

Sad state but this isnt the right way to get people into fields with shortages. theyll just quit.

[ellen]

If things keep going the way they are and I cant switch, ill practice in my crappy field as long as it takes me to accumulate enough capital to stop practicing and do something else not medical. Im not gonna work a job I hate forever. Just long enough to make enough cash before i split.

 

Sad state but this isnt the right way to get people into fields with shortages. theyll just quit.

 

Sorry, is there a reason you can't just transfer after finishing PGY-1? I was under the impression that was allowed for everyone, regardless of which iteration they matched during.

 

I agree that working a job you hate forever is a terrible option, but what about all the other options? I get the feeling there is another specialty you'd be happy in, so why not transfer after PGY-1, or even after completing residency or practicing for a few years (if you need a more substantial income)?

[physiology]

UBC - I know at least 5 people who have switched programs. Usually Royal college specialty to family medicine. There are some who go the other way.

 

If you want to switch, consider doing an elective in that specialty during your PGY1 year. Work hard, publish, etc, and aim to get noticed so that when you talk to the program director, they'll know of you. Familiar faces are good faces.

 

At UBC -

OB/GYN to neurosurg, family to psych, family to community medicine

Psych to family, peds to family,

 

At U of T, I heard PGY1s get emails in the middle of their year to see if they are happy in their specialty. If they are not, they can request a switch and will be accommodated if there is space and the department accepts.

[trymeover]

UBC - I know at least 5 people who have switched programs. Usually Royal college specialty to family medicine. There are some who go the other way.

 

If you want to switch, consider doing an elective in that specialty during your PGY1 year. Work hard, publish, etc, and aim to get noticed so that when you talk to the program director, they'll know of you. Familiar faces are good faces.

 

At UBC -

OB/GYN to neurosurg, family to psych, family to community medicine

Psych to family, peds to family,

 

At U of T, I heard PGY1s get emails in the middle of their year to see if they are happy in their specialty. If they are not, they can request a switch and will be accommodated if there is space and the department accepts.

 

Most of these switches you stated seem to be from a competitive specialty to a less competitive specialty. I thought the problem is usually where one would want to go from a less competitive residency to a more competitive one. (Like family to orthopedic surgery, you hear anyone do anything along the lines of that?)

[estairella]

Oftentimes unmatched grads have no choice but to rank something. The stats show that wasting a year of learning and income and reapplying the next year of carms is essentially worthless. If your loans and debt are deep and you need a way to pay them back then you have to rank something and get a source of income. Theres lots of reasons why people rank something in the 2nd round that are not because they want to do the field.

 

Okay, you're saying you need a source of income. Any residency will provide you with a source of income and eventually lead you to becoming a rich doctor, correct? Then what's the problem? My God, even though you're knee-high in debt, you still have the attitude to whine that you're not doing the lucrative field you want, but a lucrative field you don't want? I wonder what unemployed debt-ridden people would feel about your attitude. (Here's a hint: it's disgusting)

 

The very nature of carms forces unmatched graduates to do this. programs that accept unmatched candidates should expect some of them to switch out. After all, its their careers. I know I didnt work this hard and this long to end up doing something I dont care about.

 

Uhh, CaRMS doesn't force you to do sh1t. Does it really need to be mentioned again that Ian Wong (the person who owns and runs premed101), went unmatched in the 1st round, did not choose to participate in the 2nd round match, spent a year doing other things and went to the U.S. for residency afterwards?

 

I think you are confused about what the 2nd round scramble implies. Schools have spots they want filled. Applicants want to fill spots. It's not gonna be a perfect fit for either you or the school, but what the school is saying is "well, you kinda suck cuz you didn't match in the 1st round, but we're kinda desperate, so we'll take you anyways". I underlined that for a reason - if you worked this hard and long and didn't match in the 1st round, there's something fundamentally wrong with you (hey, maybe all you did was rank 3 super-competitive location/specialties... but that's still poor judgment on your part).

 

It is a coercive policy because it forces me to continue in a program that I do not want to be in. In other words Im forced to be here and i had no choice in the matter other than to not train in medicine this year, wasting valuable training time and losing knowledge and good habits. No actual job aside from the military would penalize anyones time like this. Even if another program would want to accept me i couldnt go because of this stupid rule, so theyd have to take someone else and Id lose my spot.

 

So either you can stay in your residency (choice 1), take a year off (choice 2) or throw yourself off a bridge and save us all the trouble of responding to a self-deluded narcissist (choice 3). Yeah, you really have "no choice in the matter".

 

Here's a newsflash - the world doesn't revolve around your wants and needs. It's scary that you made it all the way to residency without knowing this.

[NLengr]

I think you are confused about what the 2nd round scramble implies. Schools have spots they want filled. Applicants want to fill spots. It's not gonna be a perfect fit for either you or the school, but what the school is saying is "well, you kinda suck cuz you didn't match in the 1st round, but we're kinda desperate, so we'll take you anyways". I underlined that for a reason - if you worked this hard and long and didn't match in the 1st round, there's something fundamentally wrong with you (hey, maybe all you did was rank 3 super-competitive location/specialties... but that's still poor judgment on your part).

 

Very few people would agree with you that people who don't match first round "kinda suck". Almost everyone in medicine knows someone who didn't match even though they seemed like a high quality candidate.

 

I'm not sure why you are being so harsh on the guy. He makes a couple valuable points (even if you think it comes off like he's whining). Everyone involved in CARMS knows it can be a total crapshoot for applicants and the system isn't as good as it could be. And everyone knows there is massive pressure to match second round if you go un-matched. Taking a year off does not improve your chances of matching the next year in Canada.

 

He also makes a valuable point that if you are stuck doing a job you dislike just because you are in debt, there is no reason not to try and:

1. Switch out as soon as possible into another field.

2. Get the hell out of said disliked field and do something you like to do as soon as you work enough to pay down the debt.

 

Personally I disagree with different switching policies for 1st and 2nd round matchers. Everyone should be getting the same opportunity to switch if they can find programs that will let them.

[1357]

estairella have you actually gone through Carms?

[ubcredfox]

I wonder if the harsh poster really has gone through Carms, or spoken with many residents who have switched, who contemplated switching, and those who are perfectly happy in their specialties.

 

My take on the Carms switch policy is such: I believe everyone should have the opportunity to switch.

 

Look at our current system of medical education. The rotating internship is long gone, and some schools (Mac, Calgary) demand students to make up their minds in under three years. There are many people I know who were exposed to the field they are matching too late in their third year, or even early on in their fourth year. That's life - not people "sucking". Unfortunately, if you found out that you absolutely love Optho in your fourth year, you're hosed for Carms. So you'll have to try to get into it another way.

 

Further, how can you possibly know what it entails to be a radiologist, or an internist or a surgeon from a couple months of electives or your clerkship? You scramble to study for exams, learn new material, and learn the very basics of a specialty....you're pulled in a 1001 directions during the last years of medical school, and I don't think that it's an ideal time to decide what you want to do with your life. Try a residency on. Try surgery for six months or a year. Try optho or radiology. If you don't like it, switch. If you love it, stay.

 

Finally, this is your life. I absolutely refuse to believe that after dedicating nearly 9 years of post secondary education, hundreds of hours of studying, and now over $120,000 of debt that I'm going to be forced to take a job that I don't like based on the proclivities of a computer system and some sort of "match." Yes, it works for most people, but that's not good enough in my opinion. It should work for all people.

 

So, if Carms doesn't work for you, make it work for yourself. There are many options. Many people switch.

 

Oh, and a bit of advice I heard from someone who switched himself - if you are planning to undertake this, then by all means get to know the right people, but don't bread animosity in your original program. Burning bridges is always a bad idea.

[lalabel]

It's not gonna be a perfect fit for either you or the school, but what the school is saying is "well, you kinda suck cuz you didn't match in the 1st round, but we're kinda desperate, so we'll take you anyways". I underlined that for a reason - if you worked this hard and long and didn't match in the 1st round, there's something fundamentally wrong with you (hey, maybe all you did was rank 3 super-competitive location/specialties... but that's still poor judgment on your part).

 

Wow, that was an awful thing to say. Did you actually go through CaRMS?

I know plenty of straight-A classmates with great attitudes who actually didn't match on first round. Let's see what happens when it'll be your turn.