What Are the Advantages and Disadvantages of Completing a PGY1 and PGY2 at Different Institutions?

Admittedly, very few of us like change. Many consider it difficult and even painful. And thus, most of us, including me, tend to avoid it. However, change is a crucial part of being productive. Lacking the ability to adapt and grow limits productivity. Without exception, big growth requires big change. Both advantages and disadvantages exist to completing PGY1 and PGY2 residencies at different institutions, some of which are listed below. One could easily make a compelling case for either side of this equation. However, the most undeniable benefit to making this change is the need to adapt and grow.

First, a couple of myths to debunk about completing a PGY2 at a different institution:

• Myth: It looks bad on an application not to have early committed to a PGY2 program at the same institution where you received your PGY1. In reality, having multiple institutions on your CV could be leveraged on your application because of the advantages listed below. You may even find that your PGY1 institution does not have the specific specialty you are interested in or that the specialty program offered does not align with your specific training goals (e.g., limited teaching opportunities).
• Myth: Completing a PGY2 at a different institution will “burn bridges” with your PGY1 program. In reality, preceptors with whom you have developed relationships during your PGY1 training will want you to seek training in a program and institution that is the best fit for your career goals. They have been in your shoes and will understand the difficult decisions that come with deciding to pursue a PGY2.

Advantages

• New perspective. Whether it is modes of patient care delivery, teaching pedagogy, or research methodology, you will most likely be exposed to different philosophies and methods at different institutions. It is healthy to gain unique perspectives because this will allow you to better develop and define your own personal style, enhance the overall level at which you perform, and ease your transition into future environments.
• Grow your inner circle. Some believe it takes a village to raise a child, and one could argue it also takes a village to develop a resident. Changing institutions will allow you to grow your village and expand your support structure. Identify mentors whom you can rely on throughout your residency training and reach out to again later in your career for advice. This network can assist with navigating immediate career opportunities or later career transitions or with connecting to professional development opportunities in local/national organizations. On a more personal level, the village can be relied on as a sounding board when professional or personal challenges require a unique perspective and outside advice. The PGY2 interview process will also provide a unique networking opportunity with multiple institutions. Getting to interact and meet with pharmacists in your specialty area of interest who are practicing across the country is a great initial introduction into the professional network you are joining. There is a high likelihood that you will cross paths again and perhaps even have an opportunity to collaborate with these individuals.
• Clean slate. Transitioning between programs will allow for a fresh start with new expectations and can minimize the feeling that the PGY2 year is simply an extension of the PGY1 year. In addition, the change can serve to prevent existing projects from dragging out. Finally, the tendency to front-load projects for a “returning” resident can be avoided. Of importance, one could easily view the converse of these arguments as advantages of staying at the same institution (e.g., continuation or completion of existing projects, front-loading start-up on projects).
• Personal growth. Beyond the chance for greater professional growth, there is no better avenue for personal growth than being forced out of your comfort zone Making new acquaintances will provide you with greater appreciation for the many different types of personalities with which you will someday work. Figuring out how to manage and maximize these relationships (i.e., playing friendly in the sandbox) early in your career will pay huge dividends later. In addition, residency is arguably the last time in your life where you can pick up and move someplace totally new for a very defined period. It brings an opportunity to explore a new city and offers a personal growth opportunity.
• Adaptability. After you graduate from residency, yet again there will be a large transition as you move to another institution or new location. Having done it all before, and most likely more than once, you will have a deeper understanding of how to do it effectively and efficiently, making the experience less daunting.

Disadvantages 

• Cost and inconvenience. In addition to the costs of traveling for an interview (e.g., airfare, hotel) and fees through the match, relocation costs will be incurred. Neither is routinely covered by the residency program.
• Repeating the match. There will also be the added hassle and stress of having to go through the application and match process a second time. Needless to say, this entire process is very time-consuming and even exhausting. Luckily, having already gone through the process for PGY1, the second time around will be much less daunting.
• Re-licensure requirement. Speaking of inconvenience … of course, this potential exists only if you complete your PGY2 in a different state. It is important to put considerable thought into where your “home” licensure will reside. Actually, this should be considered before starting your PGY1 residency. If you ultimately intend to practice in a state different from either your PGY1 or PGY2 residency, then consider having your initial licensure in that state, with reciprocation to the states where you will complete your residency. Remember that not all states reciprocate NAPLEX scores.
• Transition downtime. Orientation to a new work environment could translate into learning a new electronic medical record system, education management system, institutional review board system, and so on. In many respects, you could be starting over yet again. Good grief, where are those darn bathrooms?!!! This change would also require navigating new personal spaces, with the potential for a new public transport system, bank, grocery store, health care providers – and even a new social circle. This type of transition would definitely take time and energy. To some, this might be an adventure, but to others, it might be a nightmare.
• Early momentum lost. In addition to avoiding transition downtime, staying at the same institution could facilitate an early start on PGY2 projects. The best example of such is early identification of a research project with protocol development and even submission to the institutional review board before the start of the PGY2 year. This would in turn facilitate more time for patient recruitment or data collection. On the flip side, the excitement of a new institution can bring energy and motivation into the start of the year, compared with the comfort and familiarity of being at the same institution.
• Depth of relationships. Just as moving to a new institution allows you to grow the number of individuals in your network of supporters, staying at the same institution allows existing relationships to deepen and become more enriched. Entering a new institution as a PGY2 will also require you to be more intentional about building relationships with preceptors outside your specialty. Now that rotations will primarily be within your specialty, there will naturally be fewer interactions and opportunities to spend time with preceptors outside your program.
• Early-commit closeout. Perhaps the institution where you wish to complete your PGY2 residency training offers an early-commit option to internal candidates. This might result in your being completely closed out with no opportunity to even interview.

Submitted by:

Jo E. Rodgers, Pharm.D., FCCP, BCPS, BCCP
Professor
UNC Eshelman School of Pharmacy

Rachel M. Sickley, Pharm.D.
PGY2 Cardiology Pharmacy Resident
UNC Medical Center