Emotional Stress
HealthMarch 17, 2020

Should you consider transferring residency programs?

By: Heidi Moawad, MD

Transferring residency programs has crossed virtually every resident's mind at one time or another. But the decision to actually switch to a new residency program can be gut-wrenching. You may worry about prolonging your training, making the wrong decision or remaining stuck in a program with people who know that you were trying to leave.

As you reflect on the idea of leaving your residency program to join another, you need to weigh your short-term concerns with the long-term upshots — as well as the attainability of what you're trying to achieve.

What are your motives?

While defining goals may seem obvious to some, the reasons for wanting to transfer from one residency to another can be elusive, especially if you're exhausted or trying to cope with a toxic work environment.

You may want to transfer to a different residency to be closer to family. Maybe you realize that another specialty offers better earning potential. Harassment or other stresses might be interfering with your peace of mind.

These are just a few of the reasons that residents seek program transfers. Identifying your issues honestly with yourself will help you stay focused on the ultimate goal of achieving a healthy professional life in the long run.

If your reason is that you don't like being on call, you might not find a solution in any program. And if you feel that you aren't as competent or as knowledgeable as you wish you were, switching residencies won't help — only experience will.

Is another specialty a better fit for you?

During residency, you naturally experience more of your specialty than ever before. This could lead to a gnawing sense that it isn't a great fit for you. You're also likely to become newly exposed to specialties that you didn't have much experience with during medical school. Once you get a taste of specialties that weren't part of your pre-Match world, you might realize that you really like something besides your current field.

In terms of where your specialty and your long-term goals align, you might be thinking about income, work-life balance or job availability. Or you might simply have decided that you find the work in a different specialty to be more interesting or compatible with your personality. In other cases, residents are encouraged (asked) to switch to another specialty after underperforming either clinically or on competency exams.

Keep in mind that while leaving one specialty in favor of another isn't the norm, it isn't rare either. For example, according to research published in JAMA Surgery, the attrition rate among general surgery residents is 18%; the most commonly cited cause was lifestyle.

Do you want (or need) to move?

If you want to transfer to another residency program in your specialty, you might have practical reasons, such as moving for your spouse's job or to be near family for help with child care. Other residents simply feel that the city where the residency is located isn't a good fit.

The advantage of switching within the same specialty is that you're unlikely to get behind in training. Depending on your specialty, your chances of finding a spot vary. For example, it's rare to find an open spot in a dermatology residency program, as there are fewer dermatology programs than most specialties, often with just a few residents per year. According to the Journal of Graduate Medical Education, emergency medicine (EM) programs have a residency attrition rate of less than 1%, but an average of 23% of EM training programs experienced attrition annually. The size and prevalence of EM programs make the likelihood of finding a spot at your level of training somewhat more promising if you want to switch from one EM program to another.

Are you experiencing personality conflicts?

If you're looking to leave because your program is toxic, you may need to do so for your own well-being. Even programs in specialties that don't have notorious reputations can become damaging for some residents. And sometimes you may be the only obvious target.

According to JAMA, approximately 14% of internal medicine residents surveyed experienced bullying, with consequences ranging from worsened performance to burnout and depression. Sometimes leaving a poisonous situation is the best way to survive.

Where can you find allies?

As you begin to search for another residency program, you might feel isolated. A good first step could be to talk to the program director of your current residency and the program director of the residency you would like to switch to. Of course, you have to balance this with the personalities involved. For example, if your program director is known to be vindictive or to block residents from getting a fair shake, you might want to reach out to someone who is more even-handed, professional and restrained.

The program director of the specialty you want to transfer to can give you an idea of the strength of your candidacy and whether it's realistic to find a PGY-2 position (or even a more senior-level spot) or whether you would need to start your training over again.

If you think you aren't in the right program, transferring can pay off in the long run. After completing your remaining months before transferring residency programs — possibly amidst some awkwardness — you should find yourself on the path to more satisfaction, greater well-being and a better career outlook.

Heidi Moawad, MD