A residency swap or residency transfer is a rare, but sometimes necessary step for first-year medical residents. Some residents find themselves in the position of wanting to change their specialty or needing to transfer to a different program in a new location. Even if you’ve matched to the best residency programs in the US or the best residency program in Canada, external circumstances or a wrong program fit can prompt a residency swap or transfer. In this blog, we’ll explore what a residency swap and residency transfer is, how to swap your residency, and what you need to know to make a successful residency swap.
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What is a Residency Swap?
A residency swap happens when a resident doctor decides to leave their residency program and switch places with another resident, either in another program or another medical specialty. Residency swaps are relatively rare, but they do happen.
According to the Accreditation Council for Graduate Medical Education (ACGME), around 1,000 residency swaps happen each year. Compared to the around 40,000 residents who are matched into ACGME-accredited residency programs through the Main Residency Match each year, this means only around 2.5% of residents choose to do a residency swap.
Percentage of First-year Residents who Swap or Transfer
Residents who participate in the match enter a binding agreement, meaning that if a match occurs, they are obligated to accept the position. If for some reason a resident cannot or won’t accept the match, they must ask the National Resident Matching Program (NRMP), which oversees the match, for a waiver or deferral. Of course, you will need to provide a strong reason why you cannot accept the match results if you choose to do so.
The other option is to accept the match results and start your PGY1 as a new resident in your chosen specialty. For some residents, their residency match is a success, even if they are not matched to their top-choice program through the match.
For others, they might consider a residency swap or residency transfer. Both are acceptable options, but it’s important to note that residency swaps and transfer happen outside the match. This means if you decide to leave your residency option for another one, you will be doing the work of finding a new position on your own. The other thing to keep in mind is that a residency swap or transfer is not guaranteed.
Why do residency swaps happen?
Residency swaps and residency transfers happen for a few different reasons. The top reason that residents switch is due to personal reasons such as family obligations, a desire to switch your medical specialty or because a residency program is not a good fit for you.
- Personal obligations – Residents may find that the location of a program is not a good fit for them or their family, either for personal obligations or preference. For instance, if you prefer an urban to a rural residency and want to find a position in a big city. Or you might need to change locations and therefore find a new position closer to you.
- Changing specialty – One of the most common reasons for a swap is to change specialties. Maybe you’ve decided a general surgery residency is not for you and want to switch to an anesthesiology residency. Or shift from a pediatrics residency to an OB/GYN residency.
- Wrong fit – Another common reason is that residents find the program they matched with is not as good a fit as they had hoped or is not living up to expectations. In this case, they might consider transferring to a new institution.
What is a residency transfer?
A residency transfer is similar to a residency swap, but there is no exchange. A transfer resident is any resident who chooses to transfer to a different position at the same institution where they are completing their residency, or transfers to a different institution entirely. A residency transfer happens for much the same reasons as a residency swap.
Note that PGY2 residents who completed a preliminary or transitional year residency are also referred to as “transfer residents”, even if they were already matched to their PGY2 program during the match.
How to Do a Residency Swap
Before you get started on a residency swap or residency transfer, keep in mind that this is not a decision to be made lightly, nor is it a quick process. For most jobs, it’s relatively straightforward to start job hunting and put in your notice. For residency programs, it takes more time and patience. Finding an open residency position after the match is finished requires a little detective work. And you’ll still be expected to fulfill your obligations to your current program before transferring or swapping to a new program, and it can take some time for the new program to evaluate you and decide whether or not to accept you.
To orient you on the process of applying for a residency swap or residency transfer, we’ve included a step-by-step guide below:
1. Be sure a residency swap is right for you
Before you commit to a residency swap, be very sure that it is necessary. Residency programs are challenging, and residents might think they need to switch to a different program or specialty because they are experiencing burnout. However, the relative difficulty level of a residency will not change with a transfer or swap. You should consider why you want to switch: is it a desire to switch your medical specialty? Is the program not benefitting you or giving you the experience you wanted? Do changes in your personal life necessitate a move? If so, a swap is a viable option.
2. Research open residency positions
Check to see if there are any open residency positions, either in your desired specialty, location or institution. If there isn’t, this doesn’t mean a spot won’t open up, but it’s always good to see what your immediate options are. Keep in mind that it is rare for a top-ranked residency program to have a vacancy. You might find plenty of open spots, but these may not be in your dream program.
If you’re planning to pursue a new specialty, it’s a good idea to do your due diligence and research the specialty, as well. This way, you’ll have a better idea of what to expect from changing specialties and it may give you a clearer idea of whether it is the right specialty for you. It’s also beneficial to know what residency program directors are looking for in said specialty, so you can tailor your application to match.
3. Talk to your current program director
One of the first things you should do is discuss your desire for a residency swap or transfer with your current program director. Not only will you need their help and cooperation to complete the swap, but they can advise you on the process and help you make a successful transfer. It’s unwise to try and swap without your program director’s knowledge, as this can negatively impact your relationship and chances of switching.
Be prepared to explain why you want to transfer and how long you have wanted to make a residency swap. Your program director may want to discuss your transfer with you beforehand.
4. Prepare your documents
Once you have the blessing of your program director, start gathering the documents you need to apply to a new program.
The new residency program you transfer to will want to contact your current program director to gauge whether you are in good standing with your current program and any resident evaluations they can provide. You might also ask your program director for a letter of good standing or letter of recommendation, so it’s vital to keep these lines of communication open and transparent.
You should also craft a residency letter of intent and update your residency CV. Both are common documents that the new residency program will ask for. The letter of intent will highlight why you’ve chosen their program and your CV should be updated with any new and relevant experiences.
Once you have your documents together, start emailing programs with open positions!
5. Prepare for interviews
Just like the match, you’ll likely need to interview for any residency swap positions. Since these can be virtual interviews or in-person, be prepared for the possibility of travel. Brush up on common residency interview questions or invest in some residency interview coaching if you would benefit from some expert feedback.
If you decide to do a residency swap or transfer, be prepared to restart your residency interviews!
Where to Find Residency Swap or Residency Transfer Opportunities
When searching for residency swaps or open residency positions to transfer into, there are some key resources you can use to make the process easier. Here are some of the top resources for residents who want to swap or transfer:
How to Make a Successful Residency Swap
The key to making a successful residency swap or transfer hinges on good communication and transparency. Which is why one of your first steps should be talking with your current program director. Not only will you need to consult them at some point to get any necessary documents, it ensures you remain a resident in good standing and maintains a positive relationship with your director and colleagues, even if you’re choosing to leave a residency program.
It's also important to keep up with your work with your current program and don’t neglect your responsibilities. Finding a residency swap can take some time, so you need to exercise patience and continue to keep a high standard of work in your current position. This is about more than maintaining professionalism, it’s about keeping in good standing in the eyes of your program director, who will be communicating directly with any potential new programs you transfer into. If the feedback from your program director is strong and positive, your residency transfer is more likely to be a success.
The second key to making a successful residency swap is to be well prepared, research your target programs thoroughly and ask plenty of questions. Be prepared by gathering all the necessary materials you need in a timely and organized way. Be sure anything a program asks for or requires before accepting you is duly received.
Next, thoroughly vet any program you’re thinking of transferring into. You don’t want to be stuck in the position of needing to transfer yet again or finding out too late that the swap isn’t as good as you thought it’d be. Manage your expectations and set clear goals and deal-breakers for yourself. Ask yourself what you are looking for most in a residency program and what you hope to gain from a residency program, especially. Don’t start the transfer process unless you’re sure it is the right move for you.
In the same vein, it doesn’t hurt to look at the new location if your new residency program is in another city or region. Plan a short visit or look into what the new location is like. Can you see yourself living there? Is it the type of environment you want to live and work in?
Pros and Cons of a Residency Swap
If you’re considering doing a residency swap or a residency transfer, it’s important to consider what this means for you and your journey to becoming a physician. Think about the following pros and cons of doing a residency swap or transfer before making a final decision.
1. A residency swap takes time
First and foremost, a residency swap or transfer is not instantaneous and it is not the easiest path. It can take months to find the right transfer position for you or for a suitable position to open up. By the time a residency position opens up, it might be time for the main match once again. If you don’t successfully transfer, this means you will have to keep playing the waiting game, since it’s not likely you’re prepared to re-enter the match and try again with your desired specialty or program. This means waiting another year for the next match or continuing to wait for ideal positions to open up.
2. A swap is not guaranteed or might not be an advantage
Finding a successful residency swap or getting a transfer is not a guaranteed thing. Just because a spot is open doesn’t mean you will be accepted. You might not be the only resident applying for a position, or a swap agreement with another resident might fall through. It’s important to keep in mind that since these transfers happen outside the match, there is no binding agreement in place.
Furthermore, transferring your residency or swapping your residency doesn’t mean you will be able to get into a higher ranked or more prestigious program. If you’re hoping to transfer to a coveted residency position after not matching to your desired top program, this is an unlikely outcome. Usually, you will match to a lower “ranked” residency program or a similar one, whether you are switching specialties or not. The likelihood of a spot in a top-ranked or competitive residency program opening up for transfer residents is slim.
3. A swap can reduce dissatisfaction, not difficulty
Doing a residency swap can reduce your dissatisfaction with a program or specialty, and it can reduce your stress and potential for burnout. However, changing your residency does not mean it gets any “easier”. Residency programs are challenging, no matter the specialty, so if you are looking to get into an “easier” residency, a swap is not the best answer.
4. A residency swap can put you on a better path
On the other hand, doing a residency swap or transfer can be just the right thing for you. If you transfer to a new specialty that suits you better, or to a new location and program that’s a better fit for you, it can be worth it to go through the process of switching. Rather than completing your current residency and then going back through the match process to complete a second residency in your desired specialty, this saves you time. Many residents will realize soon after starting in a residency program whether it’s the right fit for them or whether a specialty is not what they wanted, so it’s best to start the process of swapping or transferring early. It’s recommended to start looking for a swap in the fall or winter of your first residency year.
FAQs
1. What is a residency swap?
A residency swap is essentially switching places with another resident in another specialty or residency program. A residency transfer happens when a resident decides to transfer to a different residency program or to a new position within the same institution.
2. Is residency swap legitimate?
Yes, residency swaps and residency transfers are completely acceptable and legitimate, although they are rare. To transfer or swap your residency, you may need to fulfill certain requirements or obligations to your current program.
3. How easy is it to transfer in residency?
Transferring to a new specialty or residency program is not a simple process. It can be time-consuming, and rather than relying on the match to find you a position, you will have to do the work yourself. You’ll need to carefully consider whether a residency swap is the right move for you and whether it is worth it.
4. Is it possible to transfer in residency?
Yes, it is possible to complete a residency transfer, either by accepting a new position at your current institution or transferring to a position in a new residency program or institution somewhere else.
5. Do residency spots go unfilled?
Yes, every year there are residency spots that remain unfilled through the match process. The Supplemental Offer and Acceptance Program (SOAP) attempts to fill these positions with residents who went unmatched in the main residency match. Even after SOAP, however, some positions remain unfilled for the year or may open up again later in the year.
6. What is a SOAP residency?
A SOAP residency is a position that is filled through the Supplemental Offer and Acceptance Program. If you went unmatched when applying for residency positions, SOAP can match you with one of the unfilled positions available after the match is concluded.
7. How does a residency swap affect me?
A residency swap or residency transfer does not adversely affect you. As a transfer resident, it can mean you switch into a specialty or position that is a better fit for you and puts you on a better path to achieve your goals. Some of the cons of doing a residency swap are that it can add to how long it takes to become a doctor. A residency swap is also not guaranteed and does not mean your residency training will be any easier.
8. Can you switch residency programs in Canada?
Yes, it is possible to swap residency programs in Canada or transfer to another program or position. Much like in the US, residency swaps in Canada are done outside of the CaRMS residency match and can take some time to complete.
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