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Unaccredited Fellowship vs Other Residency
#1
If one left a program for whatever reason as a midlevel resident PGY-3, PGY-4 (forced to resign, quit, fired, etc.) and still want to prove self and pursue their dream of neurosurgery, what do you think would have more value?

1. Pursue an unaccredited neurosurgery fellowship?
- chance to prove overcame deficiencies and can shine at another program
- but if perform poor, then it is just one year, and you get to show yourself and programs that NSG isn't a fit
- the fellowship program can select you into program the next year as a PGY-1 and restart all 7 years of neurosurgery (is it worth to restart ... whats the value of doing intern work when you already been in an operating room and can take call... are you building oneself or just labor at that point and just putting "time in" for times sake or punishment...or can you show a program you meet upper level competency and skip levels to where you would have been?)
- is there a chance to be accepted into a PGY-3, 4 spot at another program?
- feat that it could be a year of cheap labor for a program and not be taken seriously for a NSG position here or elsewhere, and thus is a wasted year

2. Pursue a 2nd residency in other speciality? (gen surg prelim, EM, rads)
- chance to prove self and put in positive years towards another residency
- can hang out with a NSG department at that program and try to do research/volunteer on side if still interested and reapply to neurosurgery
- that way if not selected you still have value in another field, and someone in 6 figures of debt and precious years in 20s/30s is a hard thing to waste

Thoughts?
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#2
These are tough decisions of which you clearly see there are many factors, ultimately comes down to you. It is difficult because there is no ‘good’ option and there is no right answer. Good luck
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#3
(05-31-2020, 12:28 AM)NeuroDream Wrote: If one left a program for whatever reason as a midlevel resident PGY-3, PGY-4 (forced to resign, quit, fired, etc.) and still want to prove self and pursue their dream of neurosurgery, what do you think would have more value?

1. Pursue an unaccredited neurosurgery fellowship?
- chance to prove overcame deficiencies and can shine at another program
- but if perform poor, then it is just one year, and you get to show yourself and programs that NSG isn't a fit
- the fellowship program can select you into program the next year as a PGY-1 and restart all 7 years of neurosurgery (is it worth to restart ... whats the value of doing intern work when you already been in an operating room and can take call... are you building oneself or just labor at that point and just putting "time in" for times sake or punishment...or can you show a program you meet upper level competency and skip levels to where you would have been?)
- is there a chance to be accepted into a PGY-3, 4 spot at another program?
- feat that it could be a year of cheap labor for a program and not be taken seriously for a NSG position here or elsewhere, and thus is a wasted year

2. Pursue a 2nd residency in other speciality? (gen surg prelim, EM, rads)
- chance to prove self and put in positive years towards another residency
- can hang out with a NSG department at that program and try to do research/volunteer on side if still interested and reapply to neurosurgery
- that way if not selected you still have value in another field, and someone in 6 figures of debt and precious years in 20s/30s is a hard thing to waste

Thoughts?

All depends on your original reasons for leaving. If you got fired, you have an uphill battle. If it was for personal reasons, then it'll be only a little easier. Any way you cut it, it's going to be tough.

You need a senior, well-connected surgeon on your side to advocate for you with his/her buddies. And when you apply you need to cast a wide net and be OK with training anywhere you can get it.

If you think NSGY is for you, I'd recommend some research or fellowship (even if unaccredited) with a senior surgeon, somewhere you can absolutely kick ass. If you're competing with another fellow, you're unlikely to stand out.

If you can imagine doing anything else besides NSGY, it's probably not worth the time/investment/struggle for the reasons you stated.

You'll get lots of opinions on this forum, but I don't think anyone will tell you that this is going to be easy.
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#4
Good post.

I don't see what research is going to do, if the problem for leaving was subjective clinical?  

I have seen people do research fellowships without a positive result, and then they cant get into any speciality later on.  Doing research shows you're good at research, it doesn't show you're a good doctor.  And what if you want to be a private practice neurosurgeon who doesn't want to do academics - then it could be a waste.  I think the only way it can help is to get a letter from someone who can back you up....but what is the letter about ... research or clinical skills...if I was a PD and you left a program I would want to be assured you had made growth.

Pursue your passion but I don't think research is going to help.
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#5
I feel like this is the same person that started and posted in multiple prior threads regarding this topic. The answer to your question hasn’t changed. You’re fighting an uphill battle if you decide you want to pursue Neurosurgery.

As others have previously stated, it all depends on the circumstances of your departure from your prior program. If you left on bad terms, which it seems like you did, literally no program is going to take a flyer on you and risk a precious residency spot when they have hundreds of fresh new applicants a year to choose from. If a fellowship applicant turns out to be bad, the program just eats the cost since that person is only around for one year. If a residency applicant ends up being bad, that person is there for 7 years. Having someone established in your corner like a research mentor or attending at your old program can make a big difference, but again you’re going to be hard-pressed to find someone who’s willing to risk his reputation by backing an inadequate candidate. This field is so small that if an attending recommends someone who ends up doing poorly, it could affect recommendations they make in the future. So unless you have a really established relationship with someone, you’re unlikely to find such a person. And your old PD and chair probably aren’t going to be doing you any favors if they were the ones who forced you out.

Having seen/heard of many resident dropouts from our program and others, you’re honestly better off applying for a different specialty. You don’t want to waste years of your life going down a path that may ultimately lead you nowhere, especially when you are thousands of dollars in debt and essentially putting your life on hold. You may not see it now since you’re fresh off of being let go, but your life will move on past Neurosurgery. You’ll find satisfaction and enjoyment regardless of whatever specialty you end up choosing because you’ll still be helping patients and working in a highly academic field. That isn’t going to change. Don’t waste the prime years of your life clinging onto a pipe dream.
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#6
Would a year of performing well in an unaccredited fellowship show you can be a neurosurgeon?  I assume if you do well the new program will back you up and can get letters or phone calls.  Also can apply to open spots to start as pgy-3,4 etc, so not really competing against pgy-1.
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#7
How many open spots a year are there for those positions? Not many. And you’d probably be competing against other residents who are In good standing at their programs looking for a change of scenery/other reasons who don’t have any black marks on their record.

I don’t have much experience regarding these unaccredited fellowships since our program doesn’t have one but they seem like just a way for programs to hire cheap labor who can take call and do basic procedures without having to go through the acgme to expand their resident complement or hire more NPs/PAs. The real question you need to ask is if the people going through these fellowships are matching successfully or filling spots at other programs. My guess is that number is close to zero.
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#8
Is offering the unaccredited spots ethical then?  Why would you use someone for cheap labor who is hoping for a spot but know their chance of getting in is near 0 even if they do well.
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#9
(05-31-2020, 11:03 PM)NeuroDream Wrote: Is offering the unaccredited spots ethical then?  Why would you use someone for cheap labor who is hoping for a spot but know their chance of getting in is near 0 even if they do well.

Because there are a lot of cases and call to be done but you don't want to go through the stress/potential rejection of getting a complement increase? Look at all the pre-residency fellowships out there now. Why would they not take people who are willing to do work for really cheap? I'm sure they justify it to themselves that it ever so slightly increases your chances of getting a residency, from 0 to 0.5%.
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#10
ethical lol...you have so much to learn my friend
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