A medical student let me know that he was offered a Surgery preliminary spot outside the match to start 2012. He is studying at a school outside the US and doing a rotation in the US. My student friend is lucky in a way. I have known candidates in the past who were offered pre-match positions, I told them to take them as only 41% of people with interviews match. This pre-match business is about to end.
At a recent meeting, The NRMP voted to require programs participating in the Main Residency Match to place all positions in the Match. This is known as the “All-In” Policy and will become effective for the 2013 Match and will affect all PGY-1 positions. This is a good thing. Pre-match favors the program as they can get who they want. It is unfair to the integrity of the interview and match process and I am glad to see pre-match go away.
The bigger issue for the student is does he accept a preliminary surgery position? The preliminary position gives the program time to see him in action and gives solid USCE (US clinical experience) but does not guarantee him a spot as a categorical resident. In other words when he is done with his PGY-1 surgery year he may be without a position. Preliminary years are needed for certain programs but most of these are not very IMG friendly.
Preliminary surgery programs are the most unfilled per the NRMP with only 62.3% filled, leaving 444 unfilled spots. 37% of the filled spots go to IMGs so it is not unheard of for IMGs to match in preliminary surgery. So if you have had trouble in the past getting interviews in your chosen field and you have to stay in the US, you might want to think about applying for preliminary surgery. The only downside if that a minority of Preliminary surgery candidates are offered a PGY-2 surgery spot.
Options after a Preliminary Surgery Intern Year:
1) Do research a that program hoping that a PGY-2 spot will be offered
2) Match into the program as a Categorical resident either repeating intern year one or two more times or taking a PGY-2 spot if someone leaves.
3) Match into Anesthesiology (18% of positions go to IMGs) or Radiology (15% of positions go to IMGs).
4) Repeat the intern year after matching at another program as a PGY-1.
5) Go home…