If you don't match...

If you don't match, think carefully before signing up to do a prelim surgery year if you are still committed to entering orthopaedics.I landed a prelim spot through the scramble two years ago based on the need to make a quick decision and the advice I received at the time, but would not do it again for the following reasons. (I would do a research year or two instead).

1. Its tough to improve your ortho resume (research)/build relationships with ortho attendings who can go to bat for you next year when you are working 80hrs/week on general surgery services.
2. PGY-2 spot openings are far and few between, and even harder to find out about. They are not widely advertised and usually filled internally or through connections.
3. With the increase in number of months ortho interns will actually be on orthopedic services (increasing from 3 to I believe 6), prelim interns will be at an even greater disadvantage and I'm not certain some ortho programs will even take them into PGY-2 openings anymore (I was able to do 3 months on ortho services but most prelims probably aren't as lucky).
4. There may be an issue with funding: the federal government will only fully pay for 5 years of your training once you start a prelim surgery year, any additional years they will only pay half. I think they normally compensate a teaching hospital/residency program around $150,000 a year per resident, ~$50k is passed on to you as your salary. I am not sure how big of a role it plays with trying to re-match into PGY-1 spot, but I'm guessing the residency program/hospital would have to sacrifice $75,000 of income during your PGY-5 year. I would imagine this makes them think twice about taking you over other applicants who have not used up 1 year of their funding (and as you probably know there are plenty of qualified applicants). See the links below for more details. I did not know about this funding issue until I tried to figure out why was invited to less interviews this time around than 2 years ago, while I have only improved my resume.


5. Surgery intern years range from not fun to awful - you are the one getting in an hour before all the other residents to get numbers etc and often leaving later. Not something you want to do twice, even if you get lucky enough to match into a PGY-1 spot the next year.
6. Research years are on the opposite end of the spectrum - you are learning about things you are interested in and working with people who share similar interests. You are also building relationships with people who can help you match the next time around. I am currently doing a research year and have learned a ton and had more free time than my prelim year to enjoy life. There are positions at great institutions if you look around, many are posted on orthogate as the one above.

Hope this helps the people who get the bad news in a month from now.