Transferring specialties

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I am currently matched to a family medicine program, but I took several IM electives my fourth year of medical school and realized I should have done that instead. I am thinking of transferring to an IM program at some point. How would I go about doing that? How easy is this to do? I would even consider applying to a family medicine/IM combined residency program, but I'm not sure what my chances are of getting into one of those.

Originally Posted by SAPenguin

I am currently matched to a family medicine program, but I took several IM electives my fourth year of medical school and realized I should have done that instead. I am thinking of transferring to an IM program at some point. How would I go about doing that? How easy is this to do? I would even consider applying to a family medicine/IM combined residency program, but I'm not sure what my chances are of getting into one of those.

You'd start over. The ABIM will probably accept no more than 3 months of FP internship towards IM. If its what you want, complete the FP internship and reapply during internship.

Don't think of it as transferring. Think of it as "quitting FM and starting IM." It will make it less painful for you when you have to complete an additional 3 years of training.

If you complete an entire FM residency and then match to an IM residency, the most credit that an IM PD has to give you for your prior training is 1 year...and that is at their discretion...they don't have to give you any credit at all.

For completing an intern year in FM you'd likely get out of a inpatient month and an ICU month as a medicine resident. You'd still do the entire 3 years of IM, but might get an extra month or 3 of elective time.

I do realize that it would be a whole new residency, and I'm prepared to receive very little to no credit for the year I end up doing. But my question is: where would I start in order to get into one of those programs? Do I just start calling PD's in a few months? Do I go through the match again? Do I have to start collecting the requisite 3 LOR's from my new residency program?

Originally Posted by SAPenguin

I do realize that it would be a whole new residency, and I'm prepared to receive very little to no credit for the year I end up doing. But my question is: where would I start in order to get into one of those programs? Do I just start calling PD's in a few months? Do I go through the match again? Do I have to start collecting the requisite 3 LOR's from my new residency program?

You will re-enter the match for PGY1 spots if that's what you choose to do.

You will be a less competitive candidate for IM next year than you would have been this year, simply by virtue of being out of school for a year. Apply accordingly.

You will need at least 1 (preferably 2) LOR from your FM program. One from your FM PD and hopefully one from an attending who you had a good relationship with.

Its not at the PDs discretion. They make a recommendation but the ABIM determines credit.

Originally Posted by SAPenguin

I am currently matched to a family medicine program, but I took several IM electives my fourth year of medical school and realized I should have done that instead. I am thinking of transferring to an IM program at some point. How would I go about doing that? How easy is this to do? I would even consider applying to a family medicine/IM combined residency program, but I'm not sure what my chances are of getting into one of those.

Trying to get credit for FM residency time is like trying to join the NFL because you play Madden regularly. FM isn't really taken all that seriously by essentially every other field.

I'd GTFO ASAP.

Would you mind sharing some of your long-term career plans? Do you have any specific career goals based on those IM electives you mentioned?

I ask because I am on an outpatient IM rotation right now, and the attending has argued (almost daily) that FM programs provide better training for general outpatient medicine, especially for outpatient procedures .

Take it with a grain of salt I suppose, because this physician also refuses to treat chronic pain, refers patients with newly diagnosed A fib, hypothyroidism, depression, any dermatologic condition that isn't responsive to hydrocortisone, ............I think you get the idea.

However, my opinion is that internal medicine is the better option if you have aspirations for fellowships. If outpatient medicine is your passion, there are certainly arguments for FM versus IM.

Most of these replies are way way too harsh..... You might get a year, you might not, but you should get a year.

You will not necessarily be less competitive next year. That depends on what you do this year. If you get a job at an academic place and start some type of project, your application will look a lot better than if you do nothing or something very easy.

First, don't quit your fp internship.
If you like treating adults more, and/or like critical care/ICU stuff more, and don't care to treat peds and ob/gyn patients, or you want to do a fellowship, I think switching is a good idea.
I actually think the best way to do this would be call up the career placement people @your med school first (especially if it's not @same place you are doing fp). Tell them what you want to do and see whether there is any chance that a spot might open up there, or at an affiliated hospital. If you feel safe doing so at your current program, you could talk to your program director about wanting to switch to IM, and see whether the IM program @your current place also might have a spot open (either prelim year or categorical). Unfortunately I think you missed out on the Match for this year, so the best option to find a spot is networking. You could also look on sites like the NRMP site or Openspots (not sure how reliable those sites are right now and how much they cost, but IM is one of the specialties more likely to have spots). Also you could just cold call places that you are interested in and see if they think they might have a spot somehow.

One thing need to decide ASAP is how much can you trust your family med program? Especially the PD. If the person is reasonable, he/she might help you to transfer within your own institution. If they want to not be helpful, or even get angry, that makes your job harder.

I think you'll probably end up with 1-3 months credit from your intern year. It isn't much, but your experience will help you in the sense that your 2nd internship will be easier than your current one.

If you can't get a spot in IM before July, you have to decide quick whether you would quit your internship to do research or something for a year. It's nonideal and has some risk, but if you go through year 2 of fp then you'll be at the point where it would almost be better to just finish the whole thing...and you'll be using up your Medicare funding.

I have matched at an unopposed program, so it does not have an internal medicine residency that I can just switch to. I also don't want to switch to my school's program because it was so malignant. Is there any way I can just apply through ERAS to random programs? I won't be applying to the most competitive programs because,. as someone pointed out, I chose another residency first, and so I won't be very competitive.

Originally Posted by SAPenguin

I have matched at an unopposed program, so it does not have an internal medicine residency that I can just switch to. I also don't want to switch to my school's program because it was so malignant. Is there any way I can just apply through ERAS to random programs? I won't be applying to the most competitive programs because,. as someone pointed out, I chose another residency first, and so I won't be very competitive.

Yes, you can reapply in ERAS. In fact, I'm the one who pointed out that you won't be the most competitive candidate and answered this question here.

Originally Posted by Substance

Trying to get credit for FM residency time is like trying to join the NFL because you play Madden regularly. FM isn't really taken all that seriously by essentially every other field.

I'd GTFO ASAP.

We didn't have IM at our FM program. We moonlighted in the ER and urgent care. We didn't have intensivist in our ICU. We didn't have infectious disease. We didnt have pulmonology until they decided to round the next morning. We were the doctors and it was essentially not different than my current hospitalist position except now there is an intensivist and ID. Half out program went hospitalist or ER and the other half did in and outpatient. Inpatient is just a continuation of outpatient problems and if anything FM hospitalist have a better idea of what should really be outpatient and what legitamately should be inpatient. A fundamental skill a hospitalist needs to shorten length of stay.

Most internal med programs require three letters from internists, correct? This might be difficult since my program next year is at an FM-run hospital. I could get a letter from my FM PD and I have one IM letter from MS3 year. The third IM letter--I am not sure, but I think the ICU where I am going to start residency has internists working there, so I figure I can get one from there. If I can't get enough IM letters, would letters from FM docs be acceptable?

Any other input?

Also, what are my chances of getting into a low-ranked university program, as opposed to just a community program?

You do not necessarily need IM LOR's. One IM LOR from medical school is fine, but the rest of your LOR's should be from your residency program. The key hurdle is to convince programs that 1) you're doing fine in your FP internship and not trying to switch programs because you are failing, and 2) you're sure that you want to do IM.

What aprogramdirector said. You don't have to have 3 IM letters, or probably even 2. Use your one from med school but try to get a couple of good ones from your fp year. Try to get a letter from someone who likes you and will write a good one, and hopefully has some sort of rank. Just be honest and say you realized that you like treating adults >>kids and ob/gyn. You have a good reason for wanting to switch.