What you should know about switching residencies

I am in IM and have been helping residents switch residency programs since 2021. I often see variations in the quality of advice about feasibility, resources, and contracts. So it would be helpful to list a collection of resources and questions to consider if you are worried that a switch might be in your best interest.

I will provide general information about the process, but I am happy to discuss specifics one-on-one. Every situation is unique, and sometimes switching is not a good option; please bear that in mind when reading this advice.

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1/ What is the state of residents switching?

  • According to the ACGME figures, there are about 1000 switches yearly. Looking deeper into numbers: general surgery as a field has the highest count at an 18% attrition rate (AR). EM has an AR of 23% during residency, but the field experiences a 1% AR overall. 14% of IM residents experience toxicity and cite leaving as a consequence. (JAMA surgery, Journal of GME, JAMA)
  • From my experience, the people with the quickest success are those making lateral transitions e.g. a surgical specialty into a non-surgical specialty.

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2/ What should you consider before deciding if switching suits you?

  • Make sure it is not a temporary external factor such as burnout or dissatisfaction with residency in general. Sometimes it takes a week to a month to realize you were just pissed tired.
  • But sometimes, it's not working out so...
  • Questions to ask yourself:
    • What are your motives? Exhaustion? Program toxicity? Family, location, earning potential?
    • Do you have a "good" reason for moving? (helps if you have a less than supportive PD) Good reasons will elicit willingness from others when you ask for their sponsorship. Examples: moving for a spouse, a family situation, lack of specialty-fit.
    • Is your PD supportive? Although not 100% necessary it really helps to have your PD. They can advocate for you in finding opportunities, and you will need them to write a letter of good standing.
    • When is the right time to switch? Tomorrow? Can you wait a year? Are you okay taking a gap year?

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3/ When should I switch?

  • There are two timelines: within The Match and direct to programs.
  • The Match
    • While designed to place residents starting with first-year positions, The Match has subcategories (Physician-R) reserved for applicants with a previous residency experience and (Advanced) for residents going into PGY-2 positions.
    • When to prepare: the fall/winter before switching. It is generally more successful and streamlined than going outside The Match.
  • Direct to Programs (aka swap)
    • Most vacancies occur during later winter and early spring, requiring you to apply directly to programs with vacancies. This is the road less traveled, but the benefit of The Match is that this takes place all year, and if you prepare the materials well enough, you can find success here.
    • When to prepare: 1-3 months before you intend to begin the process.

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4/ What resources are there?

  • FREIDA = The AMA residency program database
  • ResidencySwap = ($60/month) a database to pair up with other residents looking to switch with you.
  • FindAResident = a "position board" from the AMA to help residents find programs with open spots
  • Insidethematch = a twitter page that often posts open positions
  • Online forums = SDN, Reddit, etc
  • Networking
  • Your PD

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5/ Step-by-step advice

  • Make sure that switching is right for you - eliminate any doubt of burnout as contributing.
  • Talk with PD if possible - they can be a great sponsor to getting you into other programs.
    • Get a couple of people to be your advocate (they can ease a PD relationship if needed)
  • Start collecting resources
    • Letter of good standing from PD
    • Letters of Recommendations x2
    • Board scores and medical school diploma
    • Sponsors = people who will vouch for you + help you stay sane
    • Draft up and send emails of inquiry to program directors
      • Brief is best. Include your CV and your reason for transfer.
  • Remain in good standing as a resident. This will help in all directions.

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Troubleshooting

  • Moonlighting can be an option between residencies if you pass STEP3 and have your state medical license.
  • Pay attention to GME funding if you are switching specialties: you are given a certain number of years of funding per your starting specialty. E.g. If you started in a 4 year residency and want to switch to a 7 year one (jeebus!) those extra 3 years are on the healthcare system, which could hurt your negotiation efforts.

I hope that helps, and good luck, everyone!