What Does Being A Preliminary Resident Really Mean?

I am a researcher, probably to a degree that is sometimes unhealthy.   I have spent countless hours over the last 4+ years researching online anything and everything about medical school, board exams, residency applications, and residency in general.  There really is an endless amount of information out there on the web.  But, there is NOT very much information regarding being a preliminary resident.  Granted, this is something I had hoped we wouldn't have to deal with.  But now that it is, it's very disappointing to not find much in the way of guidance online for how to navigate this type of situation.

The main issue as a prelim is that it is only a 1 year guarantee.  At the end of this resident year (July-June), Josh will no longer have a job.  One year as a surgical resident does not allow you to practice on your own, become fully licensed, etc.  In short, it's not a situation anyone wants to be in.  At the same time, it is a slightly better situation than not matching at all and having no job for the past year, no new experience, and no income.

The biggest downside for us is the uncertainty that being a preliminary resident brings.  We still don't know where we will be living after this year.  We still don't know if Josh will get to continue on in his quest to become a surgeon.  We don't know if he will have to repeat his PGY1 year or if he can move forward as a PGY2. There are so many unknowns.

Here are a few of our options as "prelims."

1.  Take and hopefully excel on the ABSITE (American Board of Surgery In-Training Examination) and wait for any PGY2 categorical spots that come available across the nation.  Apply to these programs with the backing of his current PD (program director) and hope you can secure a second year spot meaning you have wasted no time. (This is our first choice.)

2.  Reapply to the 2015 Match in General Surgery (because it was oh so fun the first time around).   We are hopeful that with some new experience as a resident, brand new letters from current attendings, an updated CV and Personal Statement, and an ECFMG certification, Josh will be granted more interviews and hopefully match into a PGY1 categorical surgery spot.  He would be repeating his intern year but would have a full residency. (We are doing this.)

** The problem with the above options is that it is likely that many PGY2 open positions will not become available until after the ABSITE scores are in, which is after Rank Order Lists are due for the 2015 Match.  If you enter the Match and do in fact match to a PGY1 spot, that match is a binding contract.  You would then be unable to accept a PGY2 position if one were offered to you.  We plan to see how interview season goes.  If Josh interviews at some programs that seem like a good fit, we would likely move forward ranking programs for the Match and not put all of our eggs into the PGY2 basket.

3. Apply to and take a PGY2 preliminary surgery position.  This is a second year spot, but again is still preliminary leaving us in a similar situation next year as we are in this year.  After a PGY2 prelim year, Josh would be able to apply to PGY3 positions that are available and hopefully secure one.  But again, this is not a guarantee and therefore our last choice.  (We will consider doing this come the Spring if nothing else pans out.)

4.  Reapply to the 2015 Match for a spot in something other than Gen Surg.  For example, Family Medicine, Internal Medicine, or Anesthesia which he is more likely to get.  Match into one of these and be happy we have a job, even if it's not initially what Josh thinks he wants to do. (We are NOT doing this.)  At least not this year.

**Josh and I have discussed it a lot and together we have decided that we are not ready for him to give up on his dream of being a surgeon.  While he could likely match into one of these specialties, doing so would close the door on surgery and we both feel that there are too many other viable options, even with extra years, that would still allow him to pursue a successful surgical career.  IF after this year, he becomes a PGY2 prelim we would likely then decide to apply to some of these specialities for the 2016 Match.  We sure hope we don't get to that point.

As I'm sure you can tell, it is a stressful time with lots of possibilities hanging in the balance.  However, this atmosphere is almost becoming "normal" around here.  Applications are open to be submitted tomorrow for the 2015 Match.  We have been finalizing Josh's application all weekend and are maintaining faith that our outcome will be different this year.  We also wish so many of our friends who are doing this for the first and hopefully only time, a successful Match season.

May the Match be ever in your favor.