When Your Match Is a Mistake

In just 5 days, Khaled Abdelghany, MD, packed up his life, finished his shifts, broke his lease, and drove across the country. He started the week as an internal medicine resident in Spring Hill, Florida. Seven days later, he reported for duty as a general surgery resident at the University of Washington (UW) in Seattle.

On one hand, the young doctor couldn’t believe his luck — his career goals were suddenly back on track. On the other hand, he was terrified — there’d been no time to second guess or reevaluate, and he had very little idea of what he was walking into.

Abdelghany is one of a small pool of medical residents who take on the gargantuan hurdle of transferring residency programs each year. For personal, professional, and family reasons, these doctors find their initial residency unsustainable. Although the Accreditation Council for Graduate Medical Education (ACGME) allows them to make a change, it’s a nebulous process rife with obstacles.

Residents must find a rare open position, convince their current program to help them leave, and make the move without missing a day of work at either residency. They’ll also make the change, risking that the next program will be no better fit than the last.

About 1000 residents each year decide they’ve made a mistake or their residency fit wasn’t what they hoped and seek to transfer.

Risking Everything to Keep Family Together

“Transfers are relatively uncommon,” said John Andrews, MD, vice president of graduate medical education for the American Medical Association (AMA). The process is pretty inconvenient for everyone involved. Programs face losing an employee or having to onboard a new doctor. Trainees have to find a new spot, broach an awkward conversation about leaving with their supervisor, and uproot their lives in a matter of days.

The most compelling and reasonable reasons for transfer tend to be family related, Andrews said. Maybe a spouse gets a job in another city, or there’s an illness in the family.

Ali Assaker, MD, transferred from a residency in Boston to New York City to be with his wife. “Our plan was to couples match, but we couldn’t be together,” he said. Three years apart wasn’t sustainable, so they both planned to attempt a transfer after their intern year. But Assaker got word in late July — just a few weeks into residency — that his hospital was closing. His wife, also an internal medicine resident, spoke to her program director about getting him a spot at Queens Hospital Center. Both programs okayed the switch, and Assaker began his move.

The paperwork, however, turned out to be far more stressful. Because he’s on a visa, Assaker only had 30 days to officially begin his new residency. Otherwise, he’d be forced to leave the United States, his training, and his wife for 2 years. For weeks, he called and waited on the transfer to be approved and finalized by the ACGME. With only 6 days to spare, the paperwork was cleared, and he started the new role. “I was very afraid this 30-day grace period would end, and I would not be able to finish my residency,” he said. Still, he added that the high-stakes transition was worth it to be back in the same place as his wife and going through residency together.

Residency Roadblocks

“Less often,” Andrews said, “residents transfer because the program isn’t a good fit.”

For Abdelghany, his prelim program in Florida included great doctors and people, but it couldn’t springboard him into a radiology program he was eyeing. He talked to his program director, and the supervisor agreed.

“I wouldn’t suggest transferring unless you are at a program that it’s clear — indisputable — that they aren’t able to advance your career,” Abdelghany said. He started reaching out to general surgery programs and got a response from UW. He finished his intern year there while applying to match a second time. In March 2024, he was successfully matched to radiology, and the position starts this July.

For other residents, the need to transfer is less about the program and more an issue of specialty.

The pandemic cut short Amanda Mengotto, MD’s third-year clinical rounds. “It turned out my experience of surgery as a medical student was very different than my experience as a resident,” she said.

She matched to general surgery at one of her top choices in Pasadena. At first, she thought her doubts about surgery were just a product of long shifts and late nights — she’d get through it. But the more time she spent in the operating room, the more she dreaded it. She could get through the 5 years of training, but she was increasingly sure she didn’t want the career at the end of it. She even considered leaving clinical practice altogether. 

Josh Insler, MD, had a nearly identical experience. He matched into his dream surgical program at Cleveland Clinic, which happened to be near family. But one day, a year into training, he visited his father and sister and was immediately peppered with questions. “What was wrong? Why did he look so bad? Was he losing weight?”

Insler was burnt out, and it showed. He wasn’t enjoying the work. He wasn’t himself. “Almost all my colleagues really loved what they were doing…It was tough to be the one person to speak up and say, ‘I don’t like any of this,’” Insler said. Like Mengotto, his 3-year rotations had also been cut short by COVID-19, and he believes that was part of the reason he’d been so mistaken about surgery.

Trying to choose a new specialty while working a full-time job is daunting. Residents don’t have the time off to shadow and explore different options. “You’re kind of making these choices based on past experiences [in medical school],” Mengotto said. She ultimately landed on psychiatry, a field in which she had some interest but little experience or connections. In fact, she only had one letter of recommendation from a psychiatrist, which limited where she could apply.

And even if you know your preferred specialty, the process isn’t straightforward. “There’s no transfer application,” Abdelghany said. “Open spots aren’t advertised. It’s like finding a needle in a haystack.” 

Abdelghany emailed every single general surgery program in the country that he thought could be a fit. Insler, who opted for anesthesiology, started going to conferences and emailed more than 80 anesthesiology programs to try and expand his network. 

Insler ultimately connected with Yale’s program director and matched there last March. UW responded to one of Abdelghany’s many emails, offering him an immediate start date. And Mengotto applied to match in psychiatry but got a second-year transfer spot at University of California Los Angeles soon after interviews.

These three doctors took very different paths to transfer, but they all started with the same “irreversible” conversation.

One Essential Ally

Mengotto weighed the decision to transfer for months, talking to mentors, other surgeons, and professionals in different specialties. “The day it felt irreversible was the day I told my program I didn’t think surgery was a good fit. That was a really scary conversation,” she said.

In the transfer process, residents must garner the support of their existing program director.

“I would not consider a transfer from another categorical program without the full support of the program director of that program,” said Mark Siegel, MD, program director for Yale’s internal medicine residency. Because Yale’s program allows doctors on a physician-scientist track to complete their internal medicine in 2 years, Siegel regularly has a few open transfer spots. According to Siegel, there’s an unspoken code among program directors, “You don’t take residents from other peer programs unless you have program director support.”

Andrews at AMA said, “The ACGME requires that when you transfer from one program to another, the issuing program provides an assessment of the milestone development of the resident.” They have to pass on an evaluation of your skills; there’s no way around including them, he added.

Plus, some postings for open transfer positions are made through professional organizations for program directors. Residents often need their program directors’ help to even find an open spot. “It puts applicants in an awkward position to talk about transfer without knowing if the transfer is going to go as they hoped,” Siegel said. 

For residents, this can feel extremely vulnerable — confessing you want to leave and breaking your agreement before you know if it will work out. But all the residents interviewed for this story agreed that program directors are more supportive than you’d think.

Abdelghany’s program director not only supported his transfer but also later wrote his letter of recommendation for the radiology match. Insler’s program director at Cleveland Clinic wrote him a letter of support and took phone calls from prospective programs. And Mengotto’s program director in Pasadena connected her to other surgeons who had left the profession. “He said he’d rather see me transfer and be happy than finish training and not want to be a surgeon,” she said of her former program director.

However, a resident cannot use the transfer process to get out of a jam, Andrews noted. If a resident is in bad standing, that will quickly come to light.

In a recent YouTube video, Abdelghany described a fellow resident who called him for transfer advice. The resident was months from finishing, but looking to leave immediately because he had a challenging relationship with the program director. To his surprise, Abdelghany tried to talk him out transferring.

“I wouldn’t suggest transferring because your personality doesn’t click with your program director. That’s not something that is going to impact your whole life,” Abdelghany said.

For residents struggling with a leadership relationship, Insler advised going to your program’s Graduate Medical Education office first, before broaching the irreversible transfer conversation. 

Help Is Out There

Ultimately, residents should view their program as a 3-year or more commitment. Siegel said that transfers must be limited for the sake of patients. “People transferring all over would cause great instability for the delivery of healthcare.” 

But there are options for those who truly need them — even though they may be difficult.

In fact, there are probably more people who have transferred from your program or specialty than you think, Mengotto said. General surgery, for instance, has a 12%-20% attrition rate. “So I wasn’t the first person to go through this,” she said. Some of those transfer veterans helped her, and now she hears from and helps other doctors considering a transfer.

“I would hope that going forward we can reduce the stigma around switching programs or specialties. It’s just someone realizing early in their career that something isn’t a good fit,” Mengotto said. “…[T]hat’s a good thing.” 

Donavyn Coffey is a Kentucky-based journalist reporting on healthcare, the environment, and anything that affects the way we eat. She has a master’s degree from NYU’s Arthur L. Carter Journalism Institute and a master’s in molecular nutrition from Aarhus University in Denmark. You can see more of her work in Wired, Teen Vogue, Scientific American, and elsewhere.