Hi there,
Changing residency programs is not typical and highly unusual. I am leaving UVa primarily because it is a seven year program to finish General Surgery and I wanted to finish in five-years. I am planning on doing a Vascular Surgery fellowship so that would add another one to two years to a seven-year program. While I loved the teaching and experiences at UVa, I did not need to spend two years in the research lab as I have completed a Ph.D in Biochemistry and Molecular Biology.
I spoke with my residency director who fully supported my decision to look for a position in another program. I was very fortunate to have a former classmate who is doing a Neurosurgery residency in the Cleveland Clinic Health Systems who alerted me to a vacancy PGY-3 slot in Cleveland. I applied for the slot and was selected by unanimous vote of the teaching faculty.
I was not completely happy living in Charlottesville which is a very small college town. I really missed the big city and the urban patient population which is my first love. Mary R. can attest to my making plenty of trips up to DC for a “culture” infusion. Again, many folks are completely happy with living in a small college town but I was not.
It can be very difficult to change programs. First, your program director may not want to allow you to leave because he or she will have to re-place you. Since UVa has lab years for residents, one of the current first-years will only do one year of research. I am sure that they will not be upset to move forward early. 
Unless you are in a very strong program to begin with, many residency directors will not even look at taking you. Since UVa is a very strong program with nationally known faculty, I did not have this problem. I am going to miss seeing some of the best residents and faculty in the country on a daily basis but I will always count them as my colleagues and I figure that I will have more folks to party with at the national meetings. 
I am going to a very well-known, well-endowed program with excellent teaching and excellent facilities. Cleveland C is always among the top five hospitals in the country and is a top vascular program. I will be finished with my residency and fellowship before my colleagues here at UVa are done with residency. I have left one strong program for another that is more tailored to my likes plus I get some urban-life thrown in. I can’t lose unless the movers lose my stuff between Charlottesville and Cleveland. 
Natalie
Thanks for this post Nat. Being absent from OPM for most of the previous semester I missed out on a lot of stuff. I sort of pieced things together but wasn’t quite clear. Congratulations on the move! CC is lucky to get you.
Aha, thanks, and absolutely the best wishes to you! I think I’m speaking for many when I say we enjoy your posts, and keep them coming!
Hi Folks,
This post marks my third year of being a physician. I cannot believe all of the things that are just second-nature to me at this point. Last Saturday, I scrubbed a craniotomy and subdural hematoma evacuation. Usually, a neurosurgery resident would snap this case up in a second but I was in the right place at the right time. The neurosurgeon reviewed opening the skull with me and I did it! Sawing through the skull is much finer and easier than sawing through the femur on my usual amputations and the like. I also got to close the skull, complete with drill and screwdriver after I put in an intracranial pressure monitor all through the operating scope. It was a sweet case but I can’t get too excited about neurosurgery. It was fun for a case or two but overall, it is just not for me.
These days, I am doing lots of laparoscopic cases like cholecystectomies, signoid resections and hernia repairs. While I really miss doing the lap cases with Dr. Schirmer at Virginia, I am enjoying operating with Dr. Smith and Lee here. They are great guys to operate with.
I miss my vascular cases too. The last vascular case that I did was a carotid from skin to skin. I really love sewing up those arteries. I have even mastered tying suture that is as thin as a human hair.
Now my goals are to keep honing the fine points of surgery. I still use about six or seven basic skills but knowing when and how much to use them is the key to being a competent technical surgeon. Every closure for me has to be 100 percent perfect and every suture has to lie perfect.
Later this year, I am going to take a Microsurgery course at the Cleveland Clinic main campus. For a vascular surgeon, microsurgery is a real coup and Cleveland Clinic has a great course. With these skills, I will be able to close the tiniest of arteries and veins under the scope. It will help me with my pediatric cases too.
My other challenges are to keep my knowledge base up. I have been meticulous about reading and study. There are so many nuances to even day to day things like wound healing and smooth muscle growth. It has been a challenge to keep up with all of the changes in basic science.
At the end of General Surgery residency, we have to take both oral and written boards. Our ABSITE (American Board of Surgery In-Training Exam) is generally a predictor of how we will score on our specialty boards. It isn’t so much that I want to ace my boards as pass comfortably on both oral and written.
Well, most of my classmates will be finishing their residencies this year. Only the surgery and surgical specialty folks will be still plugging away. I often think of John, my medical school classmate who was 53 when he started medical school. This year, he finishes his Family Practice residency and it’s off to the Native American reservation in South Dakota for him. Oh, I would so love to be done in many ways.
Natalie
I’m so glad just posted, Natalie–it allowed me to find your yearly posts.
Have you ever been a writer? Your posts are lovely prose.
Barb