Match season came to a close last month – and with that, some 17,000 U.S. medical school seniors earned a PGY-1 position. Most will go on to complete these programs and have happy, successful careers in their chosen specialty. But for a small number, second thoughts will creep in during residency. Maybe a life event changes the way a resident looks at his or her role in providing care; or perhaps exposure to another specialty – EM for example – occurred late in the fourth year of medical school. For these atypical applicants, there is a dearth of resources to help guide a re-match, if you will, and no guide for navigating the policies and politics associated with changing one’s mind.
To explore this topic through an EM lens, Dr. Michael Gisondi facilitated the latest installment of EM Match Advice Series, with sage panelists Dr. Steven Byrd, Dr. Eric Nadel, Dr. Michelle Lin and 2 current EM residents who came in from other specialties, Dr. Emily Cleveland and Dr. Derek Monette. We provide a text-based synopsis of the discussion.
YouTube Live Discussion
Podcast Version (Edited)
Considerations when making your decision to re-match
Deciding to change course mid-way through a residency program is a daunting and stressful process. There are many different ways to go about making this decision, but there are a few questions everyone must consider:
- What are your motivations for transitioning to a new specialty?
- Are you primarily motivated by leaving your current program, or are you running towards an exciting new career – in EM or another specialty – that you never had the opportunity to explore the first time around?
- What will your new career offer that your current trajectory cannot?
- What are the personal sacrifices you are willing to make – in terms of location, additional years of training, risking professional and personal relationships – in order to pursue your new career?
Take time to answer these questions carefully and thoroughly before moving forward with the process of applying to a new specialty. You will need a clear, concise and compelling answer to each of these questions in order to successfully transfer into a new field. Moreover, once you start having conversations with your mentors and friends about this switch, it’s difficult to backtrack. You want to be as sure about your choice as possible before you start the process!
Basic Timeline and Strategy
There are 2 main paths into a new specialty:
- Re-apply with all of the traditional deadlines (ERAS in September, NRMP rank and Match in February/March). If going through the formal re-application process, cast a wide net. For both funding reasons (see below) and concern about a resident changing his or her mind (again) in the future, some programs are leery of re-Matching interns into their coveted spots. You will likely need to apply widely in order to ensure you have enough options to successfully match.
- Find a program with a vacancy and be offered the opportunity to transfer into that position. These openings are advertised through the SAEM Residency Vacancy Service, and prospective residents typically contact the residency program directly. Positions tend to open up and concentrate in late winter and early spring, but check the website because it is updated regularly. Of course, word of mouth is also important, and be mindful on interviews that there may be an impending spot yet to be advertised. Every interaction counts!
Establish Your Team, Find a “Champion”
Before you re-apply to the Match or explore programs with a vacancy, the first, and perhaps most important step, is to get your current non-EM program director (PD) on board. Establish transparency: explain your narrative and focus on the positive — all of the reasons why EM is right for you. Not only is his or her support required for your application (in the form of a letter of recommendation) but you will eventually need to be released from your current NRMP agreement (below) in order to start training in a different program. Your PD may also be able to provide objective evidence of success, with in-service exam scores and results from clinical competency meetings.
With PD support, you should identify EM faculty who can vouch for your conviction to become an EM physician. If you haven’t spent dedicated time in the ED before, you should do so in order to build your application and demonstrate that you will be a successful EM resident. If possible, find your champion. This is someone within the EM community from your current institution who will advise and support you through the process. However, it may be necessary to involve EM faculty from your medical school. Think of this process from the mindset of an EM program director: a friend or colleague from the EM community who supports an applicant is best positioned to convince current EM PDs that you are making a sound decision and allay any residual concerns about your reasons for changing careers.
Your personal statement should absolutely be different from your previous application. PDs read thousands of personal statements, but will pay particularly close attention in this situation given that it is unique. The personal statement is one of the only opportunities for you to convincingly explain your decision to pursue a new specialty. Be authentic, truthful, and as transparent as possible. Generic statements will not cut it.
Letters of Recommendation
One letter absolutely must come from your current non-EM PD and at least 2 letters should be written by EM faculty (either from your current institution or, if not possible, from your medical school). You should attempt to get a standardized letter of evaluation (SLOE), but recognize that this may be difficult if you did not recently complete a formal EM rotation either as a medical student or trainee. This should not preclude you from finding a spot in EM.
Funding, Transfer, and NRMP Policies
When you matched into your original program from medical school, you are assigned a set number of years of GME funding from the federal government. This number matches the anticipated length of your residency and stays with you even if you switch specialties. So, for example, if you match into Internal Medicine (IM), you are allocated 3 years of federal funding for your training. If you complete one year of IM and then begin an EM residency, you only have 2 years of funding left. The affiliated hospital of your new residency is then responsible for the remaining year(s) of funding, if it is a 4-year program. From a practical financial standpoint, some residency programs and associated hospital systems simply may not have the funding to take on such resident applicant. For other (often larger) programs, this is not an issue, and many residents successfully transfer into EM despite not being “fully funded”.
ABEM and Transfer Credit
If you match into a PGY-2 position or you obtain a position outside of the Match, you can apply for transfer credit if your previous training was in an ACGME residency. If you completed 2 years of a residency program, you can obtain, at maximum, 1 year of credit. Your accepting residency will need to submit a request for transfer credit, which will count towards your graduation requirements in EM. If you (re)Match into a PGY-1 position, you will be a PGY-1 no matter how many years of previous training you’ve already completed.
There is detailed policy regarding your current Match commitment, and some applicants may need to request a waiver from the NRMP before applying to an EM program (either through ERAS or out of the Match). To see if you fall into this category, review the NRMP policies early, and consider calling the NRMP to confirm your understanding. Here is a sample FAQ from their site:
|As an applicant, how long must I remain in my program?|
|Applicants who give notice of resignation, resign, or vacate a position within 45 days of the start date specified in the appointment contract are presumed to have breached NRMP policy unless they can demonstrate, through the NRMP waiver process, that they entered into the program in good faith and the NRMP determines they have a reasonable basis to be released from the binding commitment to the program.|
Interviews – Sell It
After you have completed the application process and solidified your story, get ready to interview! You will be asked – both directly and indirectly, over and over again – why you are now applying into EM. You will be asked by faculty at pre-interview gatherings, during down-time waiting in between interviews, and at various activities. You will admittedly stand out, and you should be confident in and enthusiastic about telling your story every place, every time. You may be asked what you liked best or least about your current specialty; if you considered EM as a medical student; and if you have limited EM experience, how do you know it is right for you? Stay positive and put the focus on why EM is a fit for you, instead of why your current specialty is not. These answers should be congruous with your personal statement and letters of support from EM faculty.
- Your entire application – personal statement, letters of recommendation, and interview answers – must demonstrate that you know what EM is about and you are willing to go anywhere in the country in order to become an EM physician.
- Find EM physicians at your current hospital and/or from your medical school to advocate on your behalf.
- Think about your application from the mindset of the accepting/interviewing PD. What will convince them that you will not try to switch again in 12 months? Find a way to allay those fears.
Useful Resources for Additional Reading
- The Match Commitment: What you need to know