Switching specialties during residency: What you need to know

Jared Ramsey, DO, didn’t feel satisfied at the end of his surgery shifts.  His discontent went beyond the difficulty of his residency program and long hours. He didn’t like spending all his time in the OR and wanted to get to know his patients more.

“I couldn’t figure out why I wasn’t happy until I looked back on why I wanted to be a doctor in the first place,” Dr. Ramsey says.

Because Dr. Ramsey was in a preliminary intern year of general surgery, he was preparing to go through the match again. At the last minute, he switched gears and applied to family medicine programs.

“Going through medical school, there’s this stigma that once you were in a program, you weren’t allowed to switch. But it’s possible and happens quite frequently,” Dr. Ramsey says.

ACGME reported that 1,020 residents transferred programs during the 2015-2016 academic year. About 4% of residents don’t complete their initial residency program.

The process for switching specialties can be difficult and confusing. Here’s where to start.

1. Talk to your current program director

As soon as Sara Wemlinger, DO, realized she wanted to leave her ob-gyn program, she discussed her concerns with her program director. “I did fear that I was giving up and quitting, but you have to do whatever you feel is best, and thank goodness my program director was supportive,” Dr. Wemlinger says.

Talking to your program director about your plans will allow your program to find a replacement resident and alert them that you’ll be asking for time off to travel to interview at other programs, Dr. Ramsey adds.

“My program director was great in helping me to decide what I wanted to do and that if my heart wasn’t in it, it was time to go,” he says.

Still, the decision came with a cost. Although Dr. Ramsey was expected to apply to programs after the intern year, some of his colleagues and attendings perceived that he wouldn’t put his full effort into finishing up the academic year.

“If I did something they didn’t approve of or like, they attributed it to me not caring and switching, but for the most part my program was pretty reasonable,” Dr. Ramsey says.

2. Strategies for finding a new program

Residents looking for positions in a different specialty have a couple of options. Depending on the time of year, residents can go through the match again.

Vacant residency spots can also be found on the AOA site, the American Medical Association site, the Association of American Medical Colleges site, and ResidentSwap.org.

Many residents looking to switch programs will cold-call program directors in that specialty to inquire about open positions. While it can be disheartening to hear a program doesn’t have openings, making the right connection can help get your foot in the door for a future position.

Joey Mancuso, DO, switched from neurosurgery to anesthesiology. After reaching out to an anesthesiology program director who initially didn’t have an open slot for the current residency cycle, she inquired about research projects and started her anesthesiology residency with that program a year later.

“I had the experience required to help get the [research] project off the ground and he told me he would gladly offer me a spot in his program during a future application cycle,” Dr. Mancuso says.

Dr. Wemlinger began her search at the program where she completed her transitional intern year. She successfully switched from ob-gyn to family medicine and is now finishing a sports medicine fellowship at that institution.

“I knew I would be happy here, and I wouldn’t have switched as quickly as I did if I didn’t know the program,” Dr. Wemlinger says. “Question why a program has an opening in the first place.”

3. GME funding

Every resident is assigned an initial residency period (IRP), which is equal to the number of years required for the training program a resident is about to start. The IRP is different for every specialty and your assigned IRP code stays with you forever.

A program’s GME office may look at a transferring candidate’s IRP as part of their decision to take on a resident.

“The decision to take a resident past their IRP depends on the receiving program and every circumstance is different,” says Douglas McGee, DO, chief academic officer at Einstein Healthcare Network. “It shouldn’t impact a transferring candidate after they signed a contract with a program.”

For example, an internal medicine program has an IRP of three years. If an internal medicine resident decides to switch into a surgery program, with a six-year IRP,  the teaching hospital would receive half of the usual Medicare Direct GME payments because the resident will exceed their three-year IRP.

4. Getting advanced standing

Specialty colleges and program directors determine advanced standing, or credit for previous GME, on a case-by-case basis. Your new program director will recommend an amount of credit a resident should receive to the specialty college.

Some specialty colleges limit the amount of credit a switching resident can receive. For example, The American College of Osteopathic Emergency Physicians allows a maximum of six months of credit, even if you completed two years in another specialty.

Kathryn Graham, DO, switched to internal medicine after completing two years of a general surgery program. Dr. Graham entered an internal medicine residency at the same teaching institution as a PGY-2.

But James Davis, DO, switched programs twice and received no credit for his surgery intern year. While he is in his third year of GME training–after switching from general surgery to family medicine to internal medicine–he is officially a PGY-2.

“Don’t be afraid to repeat a year. It seems like a lot when you’re going through it, but it always works out and it’ll make you a more well-rounded physician,” Dr. Davis says. “Don’t fear putting in extra time when you’ll get to do something you truly want.”

Further reading:

Advice for incoming residents: 8 tips on professionalism, work-life balance, and more

9 tips for better sleep during residency