if one applies to IM with intentions to sub-specialize and you are upfront with that during interviews,will program directors tend to hold that against you?

if one applies to IM with intentions to sub-specialize and you are upfront with that during interviews,will program directors tend to hold that against you?

Do you mean like cards, GI, etc...

If so, then that is VERY common, not looked down on at all. I was actually looked at funny when I told program directors that I wanted to do general IM.

if one applies to IM with intentions to sub-specialize and you are upfront with that during interviews,will program directors tend to hold that against you?

My PS for IM basically said "I want to do IM because it's the only way to get an Oncology fellowship and I have every intention of forgetting everything I ever learned about heart disease, ID and pulm the second I match to my fellowship."

My PS for IM basically said "I want to do IM because it's the only way to get an Oncology fellowship and I have every intention of forgetting everything I ever learned about heart disease, ID and pulm the second I match to my fellowship."

lol

At some of the more academic places, if you say that you do NOT want to specialize, it may hurt your chances to get in. The place where I did residency was not like that - they actually respected people who wanted to do general IM/traditional IM. However, my med school's IM program was that way...their thinking would be that they want to produce fellows who go on to become academic researchers (mostly basic scientists) and that generally goes along with being some sort of subspecialist. They also were interested in furthering the reputation of the institution, which generally goes along with having more fellows and jr. faculty publishing things. Not that there isn't research in general IM, but there isn't as much (particularly not bench research).

The vast majority of PD's would NOT look down on you for intending to specialize. For some med/peds programs, and perhaps a handful of IM programs, they may prefer someone who plans to do straight IM (though I can't personally think of any IM programs that would feel this way). You shouldn't go into the interview and say, "I don't care about general IM" because it may make them wonder about your commitment to working hard during your residency, and also it is just generally not said (even if true for some people). A well-formed and stated interest in something like hem/onc or cards or ID, etc. will generally not hurt as long as you don't seem like someone who intends to blow off your residency duties as soon as you get your fellowship.

At some of the more academic places, if you say that you do NOT want to specialize, it may hurt your chances to get in. The place where I did residency was not like that - they actually respected people who wanted to do general IM/traditional IM. However, my med school's IM program was that way...their thinking would be that they want to produce fellows who go on to become academic researchers (mostly basic scientists) and that generally goes along with being some sort of subspecialist. They also were interested in furthering the reputation of the institution, which generally goes along with having more fellows and jr. faculty publishing things. Not that there isn't research in general IM, but there isn't as much (particularly not bench research).

The vast majority of PD's would NOT look down on you for intending to specialize. For some med/peds programs, and perhaps a handful of IM programs, they may prefer someone who plans to do straight IM (though I can't personally think of any IM programs that would feel this way). You shouldn't go into the interview and say, "I don't care about general IM" because it may make them wonder about your commitment to working hard during your residency, and also it is just generally not said (even if true for some people). A well-formed and stated interest in something like hem/onc or cards or ID, etc. will generally not hurt as long as you don't seem like someone who intends to blow off your residency duties as soon as you get your fellowship.

Why don't they shift to direct matching into residency+fellowship at once, sort of like how they do the advanced residencies with the prelim year? It would relieve us of the tiresome people who are solely interested in ga$troenterology and cardiology (oh I love how everyone is so interested in particularly these two specialties, even though there isn't much to connect them either in the pathologies or the therapies).

Well, some people are still undecided about whether to subspecialize (and/or which medical specialty to pursue) at the beginning of 4th year of med school when they start applying to residency. Also, having people apply during 2nd or 3rd year of IM allows the faculty to observe how we perform clinically. Yes, it is stressful to have to apply twice but I think it ultimately leads to trainees making better choices, since we have longer to actually work in the hospital and find out what we like and are good at. I don't know that I would have applied to cardiology, had I had to apply during 4th year of med school, but I think it was definitely the best specialty for me.
p.s. I think that GI and cards definitely require a solid background in general medicine...at least as much so as some of the other specialties (allergy/immuno for example...). A lot of patients with cardiovascular disease have multiple comorbidities (a lot have diabetes and/or pulmonary dz, for example, and many are elderly) so the more IM you know, the better.

Why don't they shift to direct matching into residency+fellowship at once, sort of like how they do the advanced residencies with the prelim year? It would relieve us of the tiresome people who are solely interested in ga$troenterology and cardiology (oh I love how everyone is so interested in particularly these two specialties, even though there isn't much to connect them either in the pathologies or the therapies).
That's exactly how the ABIM Research Track residency interviews are. Most of mine were two-day interviews - IM on day one, and 4-5 sub-specialty interviews (cardiology in my case) on day two for fellowship. You match into both right out of medical school. There are not that many positions for those, however; at least, compared to categorical medicine.....

What subspecialties or fellowships can a Gastroenterologist do? I only think of Hepatology and Advanced Endoscopy.

Gastroenterology IS a subspecialty. Assuming you already knew that, the "4th year" is becoming increasingly common. There are 4th years in Transplant Hepatology, Advanced Endoscopy (some for both ERCP and EUS, others for just one or the other), IBD, and nutrition. The only one that is required for an additional board certification is transplant. These are all PGY 7 (or for 2 year advanced endoscopy, PGY7-8).

I got some n=1, but firm advice that at interviews, one should insist that they are interested in general IM. This came from an IM resident, who argued that if you seem like you are willing to alleviate some of the primary care shortage, that you are more likely to be ranked.
But, I'd think that if you did go into residency saying that you were interested in general IM, and then actually show an interest in a particular specialty early on, that you are headed for trouble. I think DF99 said, last time this topic came up, that you are better off just being honest.

I got some n=1, but firm advice that at interviews, one should insist that they are interested in general IM. This came from an IM resident, who argued that if you seem like you are willing to alleviate some of the primary care shortage, that you are more likely to be ranked.
But, I'd think that if you did go into residency saying that you were interested in general IM, and then actually show an interest in a particular specialty early on, that you are headed for trouble. I think DF99 said, last time this topic came up, that you are better off just being honest.

i think i will follow this advice when the time comes and just be honest. i have found that this has worked for me in the past in alot of life situations.:thumbup:

copacetic,
I think your plan is good.
I think you might be overthinking this.
I went to fairly high tier (though not Harvard-level) IM residency and I honestly don't think they cared whether someone wanted to specialize vs. do general IM. They know a lot of us plan to specialize, or at least are thinking of doing so. If you apply to a very primary care oriented IM residency, such as some community programs, etc. then it might possibly hurt you if you state you are aiming for cards or GI. Similarly, if you are interviewing at Mass. General or Washington U., they might look askance at someone who stated they were looking for a laid back, private practice general IM outpatient practice...they might feel they were "wasting a spot" on someone who isn't going to make their institutional reputation greater by publishing research and becoming an academic. I'm not saying it's right, I'm just saying...
For most places, I think that as long as you can explain your career goals and they seem reasonable and you seem like you will be a hard worker while you are a resident and will fit in well there, you should have an = chance to get in whether you say you want some subspecialty or general IM.

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