Making the Rounds
Meet Your Match | How to transfer residency programs, with David Savage, MD
May 7, 2024
Featured topic and speakers
David Savage, MD, a hematology-oncology fellow at Scripps Clinic in California talks about the process of transferring residency programs. Dr. Savage draws from personal experience to offers insights on how those considering a transfer should approach that decision.
Speakers
- David Savage, MD, hematology-oncology fellow, Scripps Clinic
- Brendan Murphy, senior news writer, American Medical Association
Host
- Todd Unger, chief experience officer, American Medical Association
Listen on the go to the full episode on Apple Podcasts, Spotify or anywhere podcasts are available.
Transcript
Dr. Savage: You have to be thinking the whole time along, am I gonna thrive and be successful in this new place? Is it gonna provide me equivalent training? And then I think equally important, do both sides of the training spectrum, have they thought about how they're going to facilitate your transfer to make it successful?
Unger: That is Dr. David Savage, hematology-oncology fellow at Scripps Clinic in California. On today’s episode of Making the Rounds, Dr. Savage talks about his experience transferring residency programs after two years. He also walks through the steps of how to do it, in case you find yourself in similar circumstances. Here’s AMA senior news writer, Brendan Murphy.
Murphy: Hello and welcome to Making the Rounds. I'm Brendan Murphy, senior writer at the AMA. Today, I'm talking with Dr. David Savage, a hematology-oncology fellow at Scripps Clinic in California. He is an AMA member who serves as speaker of the Resident Fellows Section. Welcome to the show, Dr. Savage. How are you today?
Dr. Savage: I'm doing really well. Thanks for having me.
Murphy: We're excited to have you. Today we're going to be talking about how to transfer residency programs, which Dr. Savage is uniquely qualified to discuss having done it. Give us a little background. What prompted your desire to change residency programs and how did that process work?
Dr. Savage: Well, it was not part of my original plan. I was really happy with the program that I was in. I was at the Cleveland Clinic in Northern Ohio, and I was nearly at the end of my second year of an internal medicine program. But my spouse was applying to graduate schools across the country in public health. And she got into her preferred program, which was at UC San Diego. She was accepted in March of 2020, and it was a really great opportunity for her. So, we were trying to navigate how we could get her to her goal of getting in to be able to move to San Diego to do this program. And we also recognize that there could be a lot of stress if we try to be in two different places throughout the following year. So, I started exploring ways to try to transfer to a program closer to where she was going to be a student.
Murphy: This is an episode of the Meet Your Match series on Making the Rounds. And frequently the episodes discuss matching in the context of a formal process through the NRMP, which has rank order lists and Match Day and facilitates the process. What is a significant difference is there's no Match for transfers. Compared to the traditional process, how did the transfer process work for you?
Dr. Savage: Well, it's a totally different process entirely. You know, even two years into my program, I was still bound by the NRMP Match agreement. And so, when I reached out to the program in San Diego, which was the medicine program at UC San Diego, I got a response from the program director pretty quickly. But I remember the first thing she said was, we do have a spot we are willing to talk with you, but before we can even talk further, you need to talk with your program director, get her buy-in on this and make sure she's okay with us talking about a transfer. And so, then I went back to my program director, explained our family situation, she was very supportive and she said, “I'm happy for you to move forward with this if it's the right thing for you.” So, then I reached back out to the program in San Diego and told them that my program director had agreed. At which point the PD in San Diego asked me to put her in touch with my program director in Cleveland, which I did. The next two weeks was largely out of my control. It was just people from Cleveland talking to the program director in San Diego and exchanging information about me and talking on the phone to one another to make sure that this was the right thing for both them and for me as a trainee.
I had to send in my transcripts and my letters of recommendation from back when I applied at residency to the UCSD program so that they could look at everything and vet me as a candidate just as they do with all the people who are matching. And then finally at the end of two weeks, the program director at the receiving program reached out to me and asked for a weekend meeting so that we could do an interview, both so that we could get to know one another and so that she could share information about the program to make sure that this was really a good fit for me.
And then about two days after we had that interview, I got an email that said, welcome to UCSD. And they offered a spot in their program.
Murphy: So, what were the most difficult parts of the process for you?
Dr. Savage: Well, the actual interview and application process was very, very quick compared to the NRMP program. With the NRMP process, you submit your applications in the summertime, you interview over about a four-month period of time, and you don't actually find out where you matched until March. So, start to finish, it's almost a year.
Whereas in my case, start to finish between sending my initial email of inquiry to getting an offer was about three weeks. So that part went very, very quickly. I think that I wasn't sure if this was ever going to work out because it's such an unusual thing to transfer programs. And so, I was very hopeful about it. But I try not to put too much hope in it because I didn't want to be disappointed. So, I think I kind of like was a little hands off during the application process because I thought, you know, this sounds almost too good to be true. So, you know, I don't want to, I don't want to get too emotionally invested in it, but I'm going to try to be as serious as I can about it. So that made it a really nice thing when it finally worked out.
The real difficult part was the transition because I found out that I was accepted early April and then I needed to be in San Diego over 2000 miles away to start in this new program less than three months later. So, figuring out how to make the logistics of that happen, that was really the tricky part. But I think the thing that really helped was having the commitment from both sides of the spectrum. So, the program in Cleveland was really willing to make this as easy of a process as possible and the receiving program in San Diego reacted in the same way. And so that tried to minimize some of the stress, but we had to figure out how to get out of our lease for a home that we had planned to stay in for a whole other year. We had to make moving arrangements to move across the country in very short order. I had to reach out to my chief residents at my existing program because at that point they hadn't known about all of this happening behind the scenes, so I had to let them know that I was accepted to a new program and I made the request to see if they could change my schedule for the end of the year to give me a little extra time at the end of the year to move. And then at the receiving program, the new chiefs had to take me into account with building their schedule. They were already in the process of building the schedule at the time I reached out. So, this was an accommodation from them too. They had to figure out how to make me work into the scheduling plans for the next year.
And I think in May, I got an email from my new program director, and she sent me my schedule for the year, and she put a lot of thought into how the year schedule would be structured so that I could kind of learn their system before I got into the harder inpatient and ICU rotations of the year. So, I really appreciated that. So, I guess to go back to your original question, what were some of the hard parts? It was figuring out how to move, figuring out how to say goodbye to the people that I had really grown to love over two years of my residency, figuring out how to become a new resident in a new program again and get adjusted to a whole new system, that was a big challenge. But I think there was a lot of forethought at both my prior program and my new program to make that as easy as it could possibly be.
Murphy: In speaking to residents who might be considering this, is this a commitment you have to be all in on from the start? Can you dip your toe in the water?
Dr. Savage: Well, it's really once you make the decision to move, you just have to move forward with it. Once I said that I was moving, the program I was going to started planning a whole year schedule just for me to fit into their program.
And the program I was leaving took me off of all the schedule for the next year. So, I don't think I could have gone and tried it for a few months and said, “This is not for me. I need to go back.” I fully was aware of that and accepted that, that this was a permanent commitment to finish my residency program in a different place. One of the things that I did to figure out if this was a good idea was I reached out to some trusted mentors in Cleveland. And I said, you know, I want to transfer programs, but I've honestly never met somebody that's done this before. Do you have any suggestions of who I should talk to? And it turns out there's a lot of residents that do transfer programs. It's more common than you would think.
And so, my mentors in Cleveland could think of several people off the top of their head who had moved usually for family reasons. And they put me in touch with a couple of them and I spoke with them on the phone, and they provided their wisdom. And a lot of them said, “Well, you know, like you, we never thought of ourselves moving mid-residency, but life happens and circumstances change.” And in several cases, people needed to move because they needed to be closer to family. Sometimes they had a child and needed to be closer for family support.
And they said, you know, it's always going to be hard. It's hard to leave people that you really have grown to love. It's hard to leave a program when you're happy with it and you're comfortable. It's hard mid-course to go to a program that is an unknown entity that you don't know if you're going to fit in there or how the system works. And they said that if you just acknowledge that's a challenge, you can work through each of those challenges and things will work out okay. And the people that I spoke with were one or more years out of a transfer. And they said that generally it was a really positive experience and they wouldn't have done it any other way. And that gave me a lot of confidence that this was the right choice for me.
Murphy: You had a limiting factor in your search and that was that you wanted to move to a certain geography. How did that impact your approach to it? And was there a part of you that said there just might not be an opportunity here?
Dr. Savage: Yes and yes. I really wouldn't have even considered a transfer had our family circumstance not changed. I was really happy where I was, and I never even considered a transfer when I started residency. But I didn't really want to be separated as a family for a year. So that really pushed me to think about moving to the same city as my partner.
It was really a happenstance thing. I have a friend who a long time ago did his residency training in San Diego. And he's been a 20-year friend since college. And he just happened to call me at the time that we had gotten my wife's acceptance letter to UC San Diego. And he's actually the one who threw out the idea of me reaching out to his old program to see if they had a spot. I had at that point, not met many people who had transferred. So, it didn't even occur to me that that's something that I could initiate on my own. And it was really my friend saying, oh, you know, it's worth a shot. You should try. That made me send the initial email. Because I think about that interaction a lot. Like if this guy had not reached out to me for just the reason of catching up, and if I had not mentioned this to him, I probably never would have emailed the receiving program to see if they had a vacancy for me. So that really limited where I chose to target my search. But overall, once I reached out, things went pretty smoothly after that.
Murphy: What are the timelines residents who are considering a transfer should be aware of?
Dr. Savage: Well, I think if you need a transfer for whatever reason, the sooner you can reach out, the better. I got doubly lucky that about three or four weeks before I reached out to UC San Diego, they had a resident unexpectedly leave their program because she was offered a position in a specialty that she had wanted to transfer into. So, they had this unexpected vacancy that they had not anticipated.
Normally, if a resident's leaving a program, that position that's vacated would be put into the Match and would be filled through the Match. So, in any other circumstance, there wouldn't have been a vacancy for me to move into. And I just got very, very lucky that a vacancy had presented itself at just the right time. So, in other words, if somebody needs to transfer and knows maybe a year in advance that this is something that they need to do for whatever reason. It behooves them to go ahead and reach out to programs where they're looking to see if that program anticipates a vacancy in the next year and that way that spot doesn't get filled through the Match process.
Murphy: You transferred because of family circumstances, it sounded like the person you replaced transferred because they weren't in the specialty of their choice. Is there a bad reason to transfer?
Dr. Savage: I'm sure there are. I could imagine somebody maybe moving because they think the prestige of one place is superior than the place they are. I would say that is not a strong reason to transfer, because as I've learned to appreciate through three different training programs, what really, really matters, besides the clinical training you're getting, is what the community is like in the program that you're in. So if I were in a program that I was really happy with, like Cleveland Clinic or like UC San Diego, and there was another program that, I don't know, had some perceived prestige factor that was higher, I personally wouldn't try to initiate a transfer for that reason alone, because if you find a place that you're really happy and the community treats you really well, I mean, that is priceless.
And that can make three or more years of training really comfortable if you have people that you enjoy working with.
Murphy: Did transferring disrupt your training?
Dr. Savage: It did not, actually. I was worried about that. I was going to be applying to oncology fellowship the year that I moved, because just like residencies, you apply for fellowships a whole year in advance. And the program director of the program I was going to, she was acutely aware of that, too. So, I remember during our conversation, she said, “I can see from your CV that your plan is to apply to oncology fellowship.” And she said, “Have you thought about how this move could affect things for you?” And I said, “Well, I've already begun working on my personal statement. I've already reached out to people for letters of support.” I said I can ask for a letter of support from my program director from my prior program, since she has had the chance to get to know me for a couple of years.
And on account of that, I felt like my application wasn't slowed down at all because of the transfer. In addition to that, at the program I was going to, because they knew I was applying for fellowships, they did a lot of work to make sure that my schedule was set up for success. My first month of my third year, I did an inpatient rotation just to get to learn the system.
But then the next two months, I had these very immersive oncology and hematology rotations so that I could meet the HEMONC faculty at my new program and so that I could do a lot more career exploration to make sure that HEMONC was the right choice for me. It also gave me time to take time away to do interviews for fellowship. So overall, you know, I was in the process, a year-long process of getting to my next step, which was a fellowship. But I felt like...things moved along very smoothly and were not interrupted just because I transferred.
Murphy: What advice would you offer residents who are transferring or considering the process even?
Dr. Savage: Well, I think there are a lot of factors to consider. One is you really have to think about why am I transferring, and you know, is that an essential thing for me? For us, it felt pretty essential because getting to be in the same place and training in the same city was super helpful. And in hindsight, I wouldn't have done it any other way. So, I think first you have to establish is moving either across town or across the state or across the country, is it something that's vital for me to do?
Number two is I would have a conversation with your home program first because everybody has this binding agreement with NRMP and the last thing you want to do is just go reaching out to programs outside of your home program and be accused of violating your Match agreement. So, it would be best to talk to your program director at home and make sure that he or she is totally fine with you reaching out to other programs. Also, if you reach out to your home program first, they may know of other programs within your specialty that are seeking a transferring resident because I think a lot of people would be surprised to know that transfers happen more often than you can imagine.
And the program directors speak to each other through mailing lists, and they might be advertising vacancies that they're trying to fill. So, it might save you a lot of time and effort if you talk to your home person first and that person puts you in touch with programs that are looking for transfers. And then if you go down the process of reaching out to a program, you initiate the process like I did of interviewing for a transfer and let's say that they offer you a spot.
You have to be thinking the whole time along, am I going to thrive and be successful in this new place? Is it going to provide me equivalent training? And then I think equally important, do both sides of the training spectrum, have they thought about how they're going to facilitate your transfer to make it successful? I felt like, especially when I was speaking with my receiving program, they were putting a lot of thought into how to help me adjust into a whole new health system, how to integrate me into a whole new residency class, how to build a schedule to help me learn the ropes before I had to lead a team as a senior resident.
And I could imagine a lot of ways that could have been set up in a way without a lot of forethought that would have made the whole process so much harder. So, I think about my whole journey a lot and how thankful I am that it went as smoothly as it did, but it wasn't just because of me, it was because of a whole lot of other people really thinking about how to help me thrive as a trainee. And they took care of a lot of logistical details that I didn't have to worry about. So, for a transferring person, really kind of scrutinizing how much help the new program can provide to help the transfer go successfully is really, really important.
Murphy: Do you have any other thoughts on this topic for our audience?
Dr. Savage: I remember when I went through this journey about three years ago, it seemed pretty intimidating because I hadn't met many people who had transferred, and I was really comfortable where I was and I really liked my program. And the idea of kind of going down this road that few people had gone down, at least from my perspective, it was scary and it was intimidating. I think that change is always going to be that way. Some of the best advice I got a long time ago from a mentor was, when life presents you with an opportunity, you should vet that opportunity. You should scrutinize it based on all the information you have at the time. If the pros generally outweigh the cons, don't be afraid of taking a risk.
And that's really the mindset that I went into this with. And I knew it was going to be stressful at times, and I knew there was going to be some uncertainty about how things were going to work out. But I kind of surrendered myself to the process and had a lot of trust in everybody involved, the program taking me on, the program helping me leave. And I said, you know, if they have talked to each other behind the scenes, if they think that based on my profile as a physician and as a trainee, they can help me be successful.
They have been in this game a lot longer than me and I should just trust and have confidence in them. And that's what I did. And in hindsight, it really worked out great and I wouldn't have done it any differently. So, to the person who is listening to this podcast, who is contemplating a transfer for whatever reason, if you get so lucky to be offered a spot to transfer, I think you will have the same insecurities about it.
You'll have some regret about leaving where you are. You'll have some fear about where you're going to and how that's going to all work out. But it's okay to have those feelings. I felt them. But I can safely say a few months in, I felt right at home and felt very comfortable and was happy I did what I did. And I hope that anybody listening to this who does this feels the same after you do your own transfer.
Murphy: Well, I'm sure our listeners will be glad at those reassuring words. Thank you so much for joining us today, Dr. Savage.
Dr. Savage: You're very welcome. Thanks for taking the time to hear my story.
Murphy: This has been Making the Rounds. I'm AMA Senior News Writer, Brendan Murphy. Thanks for listening.
Unger: The AMA is here to help you master the process to secure a residency match. Learn more at ama-assn.org/meetyourmatch. Thanks for listening.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
