Going Unmatched And Re-Applying To Carms Vs. Transferring Programs In Pgy1

[anxious_101]

Hi guys,

 

I'm asking this question on behalf of a number of my classmates and I who were wondering this as we make our ROL. If your heart is 100% set on a given specialty, is it better to only rank programs of that specialty and risk going unmatched and re-apply next year? Versus ranking your "back-up" program and attempt to transfer into your desired program as PGY1 if you only match into your back-up? I guess the question I'm asking is which of the two scenarios is a more realistic and a better option? I've heard going unmatched is a death sentence of sorts. But I've also heard transferring programs as a PGY1 or PGY2 is also next to impossible especially in competitive programs or if the length of training between programs is different (i.e. 2 year vs. 4-5 year).

 

Any thoughts, insights, and comments from residents would be much appreciated, and I think this is a question that many current and future applicants would be interested in.

 

Thank you!

 

 

[bruhh]

Why is going unmatched a "death sentence"? isn't it just similar to getting a rejection as a premed - you just apply next year(?)

[rmorelan]

Hi guys,

 

I'm asking this question on behalf of a number of my classmates and I who were wondering this as we make our ROL. If your heart is 100% set on a given specialty, is it better to only rank programs of that specialty and risk going unmatched and re-apply next year? Versus ranking your "back-up" program and attempt to transfer into your desired program as PGY1 if you only match into your back-up? I guess the question I'm asking is which of the two scenarios is a more realistic and a better option? I've heard going unmatched is a death sentence of sorts. But I've also heard transferring programs as a PGY1 or PGY2 is also next to impossible especially in competitive programs or if the length of training between programs is different (i.e. 2 year vs. 4-5 year).

 

Any thoughts, insights, and comments from residents would be much appreciated, and I think this is a question that many current and future applicants would be interested in.

 

Thank you!

 

This is a complex question - actually depends on the specialty a lot to be honest - all of this is just things I have picked up rather than hard data.

 

The second round match results are not that great for applicants in most fields I have looked at (keeping in mind that I think very few people are going to generally study this completely).  Around 50-60% at best and some fields don't really accept repeat applicants (peds for instance as I understand it from my old schools student affairs director doesn't for instance). There is this idea that somehow you may have something wrong with you I suppose - and if the field is competitive there are certainly alternatives. I know a couple of people now going for round 3 as it were as they didn't match in the second attempt at CARMS.  Other programs like optho actively encourage in ways a second pass with various research positions for the gap year. Shows commitment. Ha - very specialty specific. 

 

Then there is of course what are you going to do for the year? You cannot do observerships or clinical work unless your school is being helpful as you aren't a student anymore if you graduate and have no insurance. It is a bit of a grey area. There is a lot of work to be done just so you don't feel cut off. Those loans pop up with the interest payments, and it is hard to arrange research in short notice (You cannot apply to research until after the match date and you end on a weird time of July 1 etc).

 

Transferring once in is not easy at all either - there has to be space to put you in (the learning of the other residents in the program may suffer if you show up and divide up the work etc. Plus the original program is now short as well. Of course people can transfer but it isn't exactly an easy thing to do and again some programs don't allow it (Rad Onc for instance at Ottawa flat out refuses transfers). Transferring between program of different length is very challenging - there is a funding gap. What has to happen is someone else from a longer program has to drop to a family med spot usually to free up funding that perhaps you can use to extend yours. Messy.

 

It is for these reasons that the match is so serious - there is a lot on the line. All the best stuff is in the first round and it is never the same after that.

 

I would say since this is so field specific this is pretty important to get field specific answers.

[5th time the charm]

It depends on the specialty and I agree with Morelan's advice. Your funding would also go with you so it is much easier to get 5y funding and attempt a transfer between specialties and even locations  than it is to have 2 yr funding i.e. family medicine residency and then have to find out if you could switch to a specialty since the funding gap of 3 yrs may not be available. It also depends if there is some program flexibility with accepting other residents vs whether there are positions unfilled due to attrition, program transfers out etc.  I am speaking of the experience in Ontario.

 

Some people who matched to a specialty for example, then decide family med may be for them and that opens up some possibilities, I have seen this happen with residents in internal medicine or psychiatry deciding to do family med instead. Some residents when they get into PGY-1 find out how gruelling a 5 Yr or + residency (if you consider further fellowship training) can potentially be and feel they may be better suited to a shorter residency based on factors at that time that make this the best decision for them.

 

Hard to know how the rank lists and matching will go so this is a hard one to really answer and every year may be different. 

[fugacity]

Only MSI 2 here, and I do not intend to derail the thread. How far down do you have to go down your rank list until you are effectively "not backing up at all"?  For a competitive speciality like rads or opthal, I have heard many people rank almost all programs in the country, and that will eat up 10 to 11 spots.   Their 12th rank might be say, Internal, which is becoming more popular these days.  Is there much point in having internal at 12th place? I am assuming most people what want internal would have it much higher, and it would be rare for someone going for internal to match to their 12th choice for the program?

[A-Stark]

"Applying next year" should never be your plan. 

 

Transferring isn't necessarily easy or a sure thing, but it's really a lot more doable than you might think. People even transfer from one province to another. I don't mean to suggest that you'd definitely be able to transfer to the more competitive program if you ended up in your "backup" - but I've seen more than a few people do just that. 

 

You are always better off if you are working as a resident, not just because of the income but because of the experience and the fact that you now have a clinical track record which is a lot more relevant and important than CC4 electives.

 

Anyway I might send you a PM tomorrow. 

[rmorelan]

Only MSI 2 here, and I do not intend to derail the thread. How far down do you have to go down your rank list until you are effectively "not backing up at all"?  For a competitive speciality like rads or opthal, I have heard many people rank almost all programs in the country, and that will eat up 10 to 11 spots.   Their 12th rank might be say, Internal, which is becoming more popular these days.  Is there much point in having internal at 12th place? I am assuming most people what want internal would have it much higher, and it would be rare for someone going for internal to match to their 12th choice for the program?

 

No worries - you will learn about the algorithm CARMS uses but basically it doesn't matter that you ranked it 12th and they say put it higher - if you don't match anywhere say for rads and it comes down to your 12th slot (internal) the school you applied to well be checked to see if they like you more than the other guy who ranked it higher. If so you take their place.

 

That is exactly way you are free to rank things in the order of your preferences. The fact you put something down low won't hurt you if that is your true preference.

 

It would be rare to go down to your 12th spot in anything as well most people do match. Still for anyone that didn't match, or applied broadly to specialty X, didn't match and then got their backup then going through a large number of things on their rank list is exactly would have happened. I know (as does any resident) people that didn't match after zipping through 10+ choices etc. Any gunner that didn't match would have applied to every program in the country, likely interviewed at many, ranked them all, and yet some still don't match. 

[rmorelan]

"Applying next year" should never be your plan. 

 

Transferring isn't necessarily easy or a sure thing, but it's really a lot more doable than you might think. People even transfer from one province to another. I don't mean to suggest that you'd definitely be able to transfer to the more competitive program if you ended up in your "backup" - but I've seen more than a few people do just that. 

 

You are always better off if you are working as a resident, not just because of the income but because of the experience and the fact that you now have a clinical track record which is a lot more relevant and important than CC4 electives.

 

Anyway I might send you a PM tomorrow. 

 

You think that is always true? I mean I know optho gunners that are kicking themselves for matching to family as a backup and are locked out it seems from being in the game. Ha - I guess I question the universality of that statement (although there are clear advantages to being on the other side of the fence)

[Patho_Medicus]

it certainly is a stressful time.  Has anyone heard of successful stories RE transferring? Especially if its a specialty you interviewed and just did not match because of the competition? Any success stories RE 5 yr programs --> 5 yr program transfers, and we are talking a primary care specialty to a competitive specialty. 

[fugacity]

You think that is always true? I mean I know optho gunners that are kicking themselves for matching to family as a backup and are locked out it seems from being in the game. Ha - I guess I question the universality of that statement (although there are clear advantages to being on the other side of the fence)

Thanks for your reply, it is most helpful.  For the optho gunners that went into family, can they finish family and go into carms again in hopes of getting optho? I have personally met family docs that got tired and decided to do a second radiology or anesthesiology residency.  I know they go into second round of carms, but neither of the specialties I listed are likely to have viable second round spots.  How is this done, and can OP do this as a back up instead of going unmatched?

[keith_015]

Thanks for your reply, it is most helpful.  For the optho gunners that went into family, can they finish family and go into carms again in hopes of getting optho? I have personally met family docs that got tired and decided to do a second radiology or anesthesiology residency.  I know they go into second round of carms, but neither of the specialties I listed are likely to have viable second round spots.  How is this done, and can OP do this as a back up instead of going unmatched?

 

Any postgraduate training either in Canada or the US excludes participating in further First Iterations - meaning leftover spots in the Second Iteration; rarely to never anything competitive.

[rmorelan]

oh here is the paro guide to all of this if you are interested:

 

http://www.myparo.ca/Program_Transfer_Guide

[NLengr]

"Applying next year" should never be your plan.

 

Transferring isn't necessarily easy or a sure thing, but it's really a lot more doable than you might think. People even transfer from one province to another. I don't mean to suggest that you'd definitely be able to transfer to the more competitive program if you ended up in your "backup" - but I've seen more than a few people do just that.

 

You are always better off if you are working as a resident, not just because of the income but because of the experience and the fact that you now have a clinical track record which is a lot more relevant and important than CC4 electives.

 

Anyway I might send you a PM tomorrow.

 

I agree with this. Its easier to work from within the system to get to your goal than from outside of it.

 

And you never know, you could love your back-up in the end. I know someone who didn't get ENT, got their back-up position and is happy as a clam now.

[A-Stark]

Some transfers I've seen: 

 

Ortho -> Plastics

IM -> Anesthesia

FM -> Obs

Ortho -> Anesthesia

Gen Surg -> Anesthesia (x2)

Psych -> Gen Surg (seriously!)

Obs -> Psych

Neuro -> IM

Path -> IM

FM -> IM

 

And pretty much anything to FM. I've also known people who transferred from one province to another (IM and Psych were the disciplines). 

[tigars53]

I have no idea how you can think transferring is easier than applying to carms on the second year.

Here in Sherbrooke to be able to transfert there much be a resident from the speciality we wish to transfer in ready to take our place. I have also seen three-ways transfert done (Neurosurg->anesthesia, anesthesia -> general surgery, general surgery -> neurosurg, or something like that).

 

I think the reason why there are so many unmatched applicants on the second year is that they apply to really competitive speciality and lot of them just don't have the academic records and references to get into that speciality.

 

Being an unmatched from last year who just finished doing this year carms, and judging by the number of interviews I got this year and their receptiveness during the interview, I do not feel that the fact I was unmatched last year hindered my chances this year. In fact I think my research experiences gave me more chances this year as I was invited to places I was not invited last year.

[A-Stark]

Policies will differ according to school. But I've known lots of people who transferred. That doesn't make it easy, but there's a world of difference between seeking to change programs while still having a place in one. 

[johndoe88]

Any postgraduate training either in Canada or the US excludes participating in further First Iterations - meaning leftover spots in the Second Iteration; rarely to never anything competitive.

Are you sure? I don't recall ever reading this and have heard of people who did fam med and the went back into the match. 

[hkmedic]

Are you sure? I don't recall ever reading this and have heard of people who did fam med and the went back into the match. 

 

From the CaRMS website:

 

Only applicants without previous Canadian or US postgraduate training are eligible to attain a position through CaRMS in the first iteration. If you have previous Canadian or US postgraduate training or plan to participate only in the second iteration of the match for another reason, please review the second iteration eligibility information. 

 

Maybe it was different in the past.

[tigars53]

From the CaRMS website:

 

Only applicants without previous Canadian or US postgraduate training are eligible to attain a position through CaRMS in the first iteration. If you have previous Canadian or US postgraduate training or plan to participate only in the second iteration of the match for another reason, please review the second iteration eligibility information. 

 

Maybe it was different in the past.

 

In fact there are two ways of switching residency:

1. Apply to second round of carms, which will end up breaking your contract with the hospital if you match

2. Use the internal system in your university with no breach of contract (exchange with another student in my school for example)

[H.Lancaster]

In terms of radiology, which choice would be better? I've heard going unmatched from rads after round one is a death sentence (as indicated by last year's match when most of the unmatched spots went to people who originally went unmatched from a different specialty), however, has anyone ever managed to transfer into rads after pgy1?

[hkmedic]

In fact there are two ways of switching residency:

1. Apply to second round of carms, which will end up breaking your contract with the hospital if you match

2. Use the internal system in your university with no breach of contract (exchange with another student in my school for example)

I'm aware of that. But one of the previous posters was asking specifically about entering first iteration after completing an entire residency program, like family medicine.

[NLengr]

I have no idea how you can think transferring is easier than applying to carms on the second year.

Here in Sherbrooke to be able to transfert there much be a resident from the speciality we wish to transfer in ready to take our place. I have also seen three-ways transfert done (Neurosurg->anesthesia, anesthesia -> general surgery, general surgery -> neurosurg, or something like that).

 

I think the reason why there are so many unmatched applicants on the second year is that they apply to really competitive speciality and lot of them just don't have the academic records and references to get into that speciality.

 

Being an unmatched from last year who just finished doing this year carms, and judging by the number of interviews I got this year and their receptiveness during the interview, I do not feel that the fact I was unmatched last year hindered my chances this year. In fact I think my research experiences gave me more chances this year as I was invited to places I was not invited last year.

It's hard to compare French schools to English to be honest. The postgrad situations will likely be much different in Quebec French schools vs. the ROC + McGill.

[tigars53]

It's hard to compare French schools to English to be honest. The postgrad situations will likely be much different in Quebec French schools vs. the ROC + McGill.

 

I applied Canada-wide this year. 

[bloh]

Given the state of our economy, it's probably not a safe bet to assume that it'll be easy to get extra funding to switch from a 2 to a 5 year residency, FYI (particularly in Alberta). I think I'm very biased because I just can't see myself ever being 100% set on anything to risk going unmatched and unemployed while my loans keep accruing. There's no guarantees with anything and while it does work out for some people, keep in mind that you don't get to hear about the horror stories that fail to accomplish the next years match. It's not something that people happily publicize.

 

From what I've gathered from the few people that went unmatched in first round, they wouldn't wish that nightmare on anyone.

[fugacity]

Given the state of our economy, it's probably not a safe bet to assume that it'll be easy to get extra funding to switch from a 2 to a 5 year residency, FYI (particularly in Alberta). I think I'm very biased because I just can't see myself ever being 100% set on anything to risk going unmatched and unemployed while my loans keep accruing. There's no guarantees with anything and while it does work out for some people, keep in mind that you don't get to hear about the horror stories that fail to accomplish the next years match. It's not something that people happily publicize.

 

From what I've gathered from the few people that went unmatched in first round, they wouldn't wish that nightmare on anyone.

 

But then again, I just met an R1 resident in ophthalmology that did not match in round 1, did a M.Sc, and is now incredibly happy to be an R1 opthal resident.  If someone is so extreme (hopefully a very minor group) that they will ONLY do one specialty, it might be a worthwhile gamble.  Granted, it is not the most reasonable/rational approach, but often the competitive specialties attract perfectionists that accept nothing else.