Am I completely screwed?

[Arrowx7]

Hi there,

I applied to family medicine. Interviewing at all those.

 

However I recently had a huge change of heart, and very interested in anesthesia or ENT (probably anesthesia)... Interviews next week, and I completely screwed now?

 

Is the only option is not doing the match, taking a year off and applying next year? Is that even an option?

 

Are there any options? :S

[rmorelan]

Hi there,

I applied to family medicine. Interviewing at all those.

 

However I recently had a huge change of heart, and very interested in anesthesia or ENT (probably anesthesia)... Interviews next week, and I completely screwed now?

 

Is the only option is not doing the match, taking a year off and applying next year? Is that even an option?

 

Are there any options? :S

 

That is an option - just don't rank anything in round one, apply to what you want in round two this year. If you get something great! If not then you are back in first round again next year.

 

If you aren't sure between ENT and anesthesis do you perhaps need the time anyway to figure out what is going on? What about appropriate letters of reference?

[Hero]

If you don't rank in the first round you could still go into family medicine if the other options don't work out.

 

Have you considered family anaesthesia? Not the perfect solution but definitely an alternative!

 

You could also always match and then try to switch in your PGY-1 year, would be really difficult bc of the funding discrepancy but something to think about.

[1fuzzy2dino3]

Hi there,

I applied to family medicine. Interviewing at all those.

 

However I recently had a huge change of heart, and very interested in anesthesia or ENT (probably anesthesia)... Interviews next week, and I completely screwed now?

 

Is the only option is not doing the match, taking a year off and applying next year? Is that even an option?

 

Are there any options? :S

 

Oh man...such a pickle indeed ...I wish i knew how to help you, but I have no idea. Could you touch base with your school's guidance counselors? Perhaps they know of someone who was in a similar situation in their MD program. I do hope it all works out for you! Sending you good wishes.

[goleafsgochris]

You're screwed. Sorry.

 

Yeah, you pretty much need to wait a year at this point sadly

[PilotMD]

You're screwed. Sorry.

 

Are you screwed? Depends - are you screwed for CARMS this year if your intention is to practice in ENT/Anesthesia - yes, you most definitely are screwed. Are you screwed if your intention is to practice in ENT/Anesthesia eventually and are willing to do whatever it takes to make that happen - not necessarily, though unfortunately most likely.

 

You are in likely the worst situation any final year medical student can find themselves in - a change of heart on a specialty decision RIGHT BEFORE INTERVIEWS. I've frankly never heard of this situation before, but in the current medical training system, I am also not surprised. I don't know enough about your current situation, but I suspect that you have 'recently' had experience with both Anesthesia/ENT (after the CARMS application deadline) and this has prompted the change of heart? This is the unfortunate reality of our current residency training setup - I know many people who had a change of heart at a later stage in the game (not as late as you) because they had not experienced 'said specialty' earlier in their training; and because we no longer have the rotating internship year, once (if) you match in CARMS, you are set on a course that is hard to deviate from.

 

So where does that leave you. Well, you are screwed for the first round of CARMS - you will not match to any specialty other than family medicine (obvious, I know). So what options do you have?

 

1. Well, you can stay in family medicine and try to find something within the specialty that you enjoy - as Hero said, you could do a plus one in GP anesthesia if passing the gas is your thing.

 

2. You could match family medicine and try to transfer out - this is, as stated, a very difficult endeavor, mainly because your family medicine residency only carries two years of funding (vs the 5 years required for ENT/Anesthesia) in addition to the other factors that halt many potential transfers (see below). Is it impossible - NO. I personally know people who have done this - a friend of mine transfered from family medicine into dermatology. So it certainly is possible, but an uphill climb indeed.

 

3. Don't match at all this year and take the year off and try again next year. However, what are you going to do with the year off? I don't believe you can do clinical rotations as you are no longer a medical student (and thus not insured), which won't help with you getting your name out there in your two desired fields. A year of research, sure, it might help, but not as much as building a strong reputation in the field(s) - ie. getting your name out there. Then you apply next year to two competitive fields, vying against people who have likely been building applications for years. What happens if you don't match? Go into family? It's a strong possibility - is a year of your life worth this risk? These are questions only you can answer.

 

4. Don't rank in the first round and see what's left over in the second round (this will likely be very slim pickings). Try to match to a program that gives you five years of funding (pathology for example). Then attempt a transfer out of the program into ENT/Anesthesia. A friend of mine did this - did not match to his program of choice, matched pathology, then transferred into anesthesia. I will tell you though, that transfers once in residency, though possible, are not easy. I know this because I transferred myself. There are many variables that go into a transfer - Does the program want to take you, do they have room to take you, will your program let you go, etc. What happens if you can't transfer out? You could be stuck in a program with five years of training that you enjoy even less than family medicine.

 

As you can see options 2-4 are far from ideal and have a very low likelihood of success (hence my initial statement that your likely screwed). I'm sorry if these posts are coming across a little harsh, but we would be doing you a disservice by sugar coating it for you. You are in an exceptionally difficult situation and your chances of practicing in ENT/Anesthesia are slim at this point - but not zero. There may be more options - talking with the guidance counsellor at your school is a good idea. Ultimately you have to decide what's best for you - what are you willing to risk? How hard are you willing to fight for this? What happens if you don't succeed?

 

Not an easy position for anyone to be in. I'm sorry you find yourself here. I hope it all works out for you, and that you find something in medicine that gives you passion and fulfillment.

 

an R4 surgical resident

[Arrowx7]

Thanks for advice everyone! Thanks PilotMD.

 

It seems to me that the only viable option is to try to do a year of research, and try to organize some electives with my medical school. It will certainly be messy, but that gives me the most chance of success.

 

Question: how do transfers work? Do you need to apply to carms and do second iteration? or do you just have to convince the anesthesia department to take you and add an extra spot in their program?

[rmorelan]

Thanks for advice everyone! Thanks PilotMD.

 

It seems to me that the only viable option is to try to do a year of research, and try to organize some electives with my medical school. It will certainly be messy, but that gives me the most chance of success.

 

Question: how do transfers work? Do you need to apply to carms and do second iteration? or do you just have to convince the anesthesia department to take you and add an extra spot in their program?

 

Transfers have nothing to do with CARMS - the department you want go into has to have have a spot you can take and let you do it. There are a couple of wrinkles in your case - first is that FM is funded for two years and everything else needs more. Second is if I am remembering this correctly you cannot transfer if you match in the second round for a significant period of time (if you ever can). This is to prevent all the people who didn't get want they want in the first round from just getting anything they can in the second and then immediately bouncing out of it to something else.

 

There very likely won't be something of interest to you in the second round this year but of course check to be sure. Sometimes you can get lucky.

 

Your student affairs office (or whatever they call it at your school) should be able to help with some of this planning, no?

[Lactic Folly]

I met someone who transferred programs by applying to a second iteration spot the following year. It would be improbable that a suitable position would be available then, however.

[Alastriss]

Not that I'm implying anything OP, but I find it very hard to believe that you went through all of medical school up until 4th year without knowing anything about anesthesia and ENT and considering repeating a year to match to them. That development of a passion for fields so quickly is just a very unique situation. ENT and anesthesia aren't even alike!!!!

 

I've heard of a few applicants who take a year off to do research and outside of ophthalmology (which has a specific research stream for such people) this never pans out well. I had a buddy who spent a year doing radiology research after going unmatched his first go - the year he had off led to 0 radiology interviews, his previous year when he went unmatched he had interviews all over.

 

You obviously like family medicine enough to have considered it thus far. I would say go with the match and nail the first iteration. That way, you have the choice of switching. If you tried go to for the second round, you wouldn't be able to switch and you would essentially be banking on a spot going unmatched in competitive specialties which doesn't happen that often.

 

If you still want to reconsider switching, you can try to in your family medicine residency, or do a re-entry which is permitted by the government. They will fund you for the duration of the residency if you get accepted by the program, and you have to do a return of service anywhere in Ontario (of your choosing, provided you land a job).

[medaholic]

I wouldn't say you're screwed if you're eventual goal is to practice anesthesia/ENT. You might be screwed for CaRMS this year, but that does not mean you won't eventually get what you want.

 

Personally, I know of an ENT doctor who was a family doctor before, he finished his residency, and then re-applied for ENT.

 

Similarly, know few anestesiologists that got there through family 2+1.

[tooty]

I had a buddy who spent a year doing radiology research after going unmatched his first go - the year he had off led to 0 radiology interviews, his previous year when he went unmatched he had interviews all over.

 

Did your friend have interviews in radiology in his first try? If so, then it comes as no surprised that he had 0 interviews the year after not matching. OPs situation is different. The anes and ent programs likely don't know that he exists. How is it so bad that an applicant takes a year off to explore the field before applying? Have any of you heard of PDs saying that they will not take applicants who took a year off for any reason?

[nexus]

Did your friend have interviews in radiology in his first try? If so, then it comes as no surprised that he had 0 interviews the year after not matching. OPs situation is different. The anes and ent programs likely don't know that he exists. How is it so bad that an applicant takes a year off to explore the field before applying? Have any of you heard of PDs saying that they will not take applicants who took a year off for any reason?

 

This is honestly not great advice. Other than perhaps ophtho, you shouldn't take a year off to "explore" the field (i.e. research, etc.). Definitely try to match this year. If you want a specialty bad enough and willing to go anywhere for it, you'll make it. It'll probably take some extra time compared to others who matched directly into it, but it's better than giving up a match for it altogether.

 

Just because PDs never spoke against it, doesn't mean it's not a disadvantage. Have you ever heard of PDs say that they prefer an applicant to take a year off to explore the field before applying? I highly doubt it, especially for the more competitive specialties.

[rmorelan]

I wouldn't say you're screwed if you're eventual goal is to practice anesthesia/ENT. You might be screwed for CaRMS this year, but that does not mean you won't eventually get what you want.

 

Personally, I know of an ENT doctor who was a family doctor before, he finished his residency, and then re-applied for ENT.

 

Similarly, know few anestesiologists that got there through family 2+1.

 

I know two family docs that went back and did ortho and gen surg after completing - there doesn't seem to be as much stigma against that I think. Maybe because the person actually never was rejected from any program(?)

[rmorelan]

Did your friend have interviews in radiology in his first try? If so, then it comes as no surprised that he had 0 interviews the year after not matching. OPs situation is different. The anes and ent programs likely don't know that he exists. How is it so bad that an applicant takes a year off to explore the field before applying? Have any of you heard of PDs saying that they will not take applicants who took a year off for any reason?

 

I am a little surprised (or maybe just horrified as someone applying to rads) that he/she got absolutely no interviews. So much for networking and finding some support during that year. The creator of this site originally went unmatched in Canada and did apply and get in the US. I suppose that is a possible option as well but just don't ask me what the odds are

[KennethToronto]

This is what you do:

 

1) match to FM

2) do ENT or anesthesia electives. You have to pick one specialty.

3) do 2+1 Anesthesia. It means you will likely only work in rural settings, but at least it opens the door to potentially switching into a 5 year stream from there. Alternately, you can try to transfer, difficult as it is.

 

Don't do something stupid like dropping out of the match. That would be stupid.

[PilotMD]

This is what you do:

 

Don't do something stupid like dropping out of the match. That would be stupid.

 

I definitely agree with this. I personally don't know anyone who has dropped out (not matched) in CARMS, took a year off to strengthen their application, and matched successfully (ie. to their specialty of choice) the following year. I know many who have taken a year off and been disappointed again the following year. Make sure you are thinking this through properly (and you have time - do all your CARMS interviews and then after you have some time to decide if you want to rank (how to rank)).

 

Brooksbane offers some harsh critiques (and I suspect has been burned by the system him/herself), but there is a lot of truth here. Your chances are slim, but they certainly aren't zero (which is why I said you MAY be screwed if you ultimately want to practice as an ENT/Anesthetist). Your best chance and most efficient way of matching to any specialty is in your final year of medicine after building a strong application over the last 4 years - this is not an option for you. So anything you do from this point on to try and achieve your goal will be a difficult, uphill battle with no guarantee of success.

 

I agree with others here that you best option is to match to family and consider a 2+1. You obviously like family (or did at some point) - you may find you actual enjoy it as a resident and save yourself years of training in a difficult specialty like ENT (every surgical residency is difficult- long hours, increasing pressure for advanced degrees (I'm going to be an R7 when I graduate - MSc = better fellowship/job opportunities), and have you seen the job situation for ENT at present? Many people end up leaving surgical disciplines (all of them, not just general surgery) for these reasons). If your considering anesthesia, then a 2 + 1 might just do it for you. (Note - you need to decide WHICH specialty you want to go for - ENT or Anesthesia).

 

In the end it's your life and your decision - talk with your schools people, be well informed of your options, interview all over the place in CARMS to keep your options open, and come to an informed decision.

 

Good luck

[KennethToronto]

It has never worked out for anyone. I would love to find someone who can prove us wrong.

 

I know one example that would prove you wrong. But I think sitting out and matching into something competitive the following year is the exception rather than the norm.

[rmorelan]

I know one example that would prove you wrong. But I think sitting out and matching into something competitive the following year is the exception rather than the norm.

 

At Western people have a 50% (approx) success rate doing that overall according to talk we had with student affairs and it was only done when people were gunner for something competitive. That says little of course about any particular program though.

[NLengr]

I definitely agree with this. I personally don't know anyone who has dropped out (not matched) in CARMS, took a year off to strengthen their application, and matched successfully (ie. to their specialty of choice) the following year. I know many who have taken a year off and been disappointed again the following year. Make sure you are thinking this through properly (and you have time - do all your CARMS interviews and then after you have some time to decide if you want to rank (how to rank)).

 

Brooksbane offers some harsh critiques (and I suspect has been burned by the system him/herself), but there is a lot of truth here. Your chances are slim, but they certainly aren't zero (which is why I said you MAY be screwed if you ultimately want to practice as an ENT/Anesthetist). Your best chance and most efficient way of matching to any specialty is in your final year of medicine after building a strong application over the last 4 years - this is not an option for you. So anything you do from this point on to try and achieve your goal will be a difficult, uphill battle with no guarantee of success.

 

I agree with others here that you best option is to match to family and consider a 2+1. You obviously like family (or did at some point) - you may find you actual enjoy it as a resident and save yourself years of training in a difficult specialty like ENT (every surgical residency is difficult- long hours, increasing pressure for advanced degrees (I'm going to be an R7 when I graduate - MSc = better fellowship/job opportunities), and have you seen the job situation for ENT at present? Many people end up leaving surgical disciplines (all of them, not just general surgery) for these reasons). If your considering anesthesia, then a 2 + 1 might just do it for you. (Note - you need to decide WHICH specialty you want to go for - ENT or Anesthesia).

 

In the end it's your life and your decision - talk with your schools people, be well informed of your options, interview all over the place in CARMS to keep your options open, and come to an informed decision.

 

Good luck

 

On the over-training note, if we keep going at the rate we are going in 20 years time surgeons will have to have a good 10 years post residency training to work a community job. 3 fellowships plus PhD. It's getting completely ridiculous.

 

Over training is a symptom of the fact that we are creating too many surgeons and not enough jobs for them. It's a huge waste of tax payer money for little to no benifit for patient care.

[tooty]

Just because PDs never spoke against it, doesn't mean it's not a disadvantage. Have you ever heard of PDs say that they prefer an applicant to take a year off to explore the field before applying? I highly doubt it, especially for the more competitive specialties.

 

the OP's entire situation is a disadvantage. i'm just hoping that the advice thrown around here is based on words from PDs and committee members, not med students and residents.

[NLengr]

the OP's entire situation is a disadvantage. i'm just hoping that the advice thrown around here is based on words from PDs and committee members, not med students and residents.

 

Residents are frequently committee members or have a good knowledge of the matching process especially in smaller programs.

[tooty]

i should say i respect the opinions of you residents here. my last post sounds rather offensive. sometimes i have a hard time accepting certain 'rules' of the carms game.

[sarakj]

If you r an Ontario medical student, you have a 5 year funding put a side for you to do residency as long as residency is also in Ontario. Not a lot of people know that. I know b/c one of my good friend wanted ophtho, did not get in. Waited for the second round, did not like the options. Then the dean of the medical school told her about the funding and told her to rank a few programs of her choice and he will call the PD and see what he can get for her. She ended up matching to GS which was very competitive on that year. If you are not from Ontario, check the trend on Carms website to see if there were unfilled spots in either ENT or anesthesia.. Do not rank family thinking you can transfer to something else. It is extremely hard

 

Thanks for advice everyone! Thanks PilotMD.

 

It seems to me that the only viable option is to try to do a year of research, and try to organize some electives with my medical school. It will certainly be messy, but that gives me the most chance of success.

 

Question: how do transfers work? Do you need to apply to carms and do second iteration? or do you just have to convince the anesthesia department to take you and add an extra spot in their program?

[Alastriss]

If you r an Ontario medical student, you have a 5 year funding put a side for you to do residency as long as residency is also in Ontario. Not a lot of people know that. I know b/c one of my good friend wanted ophtho, did not get in. Waited for the second round, did not like the options. Then the dean of the medical school told her about the funding and told her to rank a few programs of her choice and he will call the PD and see what he can get for her. She ended up matching to GS which was very competitive on that year. If you are not from Ontario, check the trend on Carms website to see if there were unfilled spots in either ENT or anesthesia.. Do not rank family thinking you can transfer to something else. It is extremely hard

 

yes, but funding is certainly an issue but there is an inherent risk in that because you transferring also depends on availability of spots in that residency training program and willingness to take you. I've seen people in FM transfer to 5 year residencies, despite it being harder without the funding. However if you go into a 5 year specialty you risk not enjoying what you do altogether, and the OP had an interest in FM for quite a while so it might not be as bad a choice.

 

Do consider that there are 5 seats for specialty training that you can do, as long as you do a RoS anywhere in Ontario (and by anywhere I mean it is your choice, not the gov't choice).