Switching from EM to IM

[GolDRoger]

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Hi all,

I hope you are all doing well. I am a current PGY1 in emergency medicine. I soaped into my current program. I applied ortho before and went unmatched. Had a pretty competitive application for it but it is what it is. After having some time to reflect I think I am interested in internal medicine and really did enjoy the rotation in medical school however I had some tunnel vision for ortho at the time and didn't give it a fair shot. After going unmatched made a sporadic decision to soap into EM which really isn't what I want to do. I was really interested in Cardio, Allergy/Immuno, and even general hospitalist work when I was on my IM rotation in medical school. That all being said, I would like to apply for the match this upcoming year and try to get into an IM program. Of course I realize there will be a slight funding issue (have to repeat intern year and therefore I'm -1 year on funding) but from what I've heard some of the larger academic programs can accommodate this no problem (again from what I've heard.... hopefully that's actually true).

I wanted to assess my competitiveness and see what you all think.

Went to an MD school in the midwest, lower tier
3/6 Honors (Honored IM, psych, OB/gyn)
3/6 Pass (Surgery, FM, Peds)
Our school is just honors/pass for clinical. Pre-clinical is all pass/fail and I passed everything.
No AOA/Gold Humanism
No red flags on evals, all my evals were stellar

Step 1: Pass 1st try
Step 2: 259

Tons of ortho research with no research year. ~20 pubs all in prestigious ortho journals. 10 posters, 5 oral presentations. 4/5 Oral presentations won first or second place at big conferences. 5/10 posters won 1st place. Awarded the #1 research award at my medical school for research productivity.

Worked full time throughout medical school from MS1 - MS2 and MS4 as a standardized test prep teacher teaching virtual classes, mainly MCAT. Taught over 3000 students, work for a pretty well known company. MS3 year I was at 30 hours a week or something like that, obviously couldn't do full time that year haha

Letters:
- Will have one from ortho mentor speaking on my research, this was the best letter.
- 1 from PD hopefully, have to speak to her about switching still but will do this in august time.
- 1 from an IM attending I had in medical school
- 1 from an FM attending in med school

I essentially want to see if it would be possible for me to land at a big program where I can be well prepared for matching fellowship if that's the road I want to go down. Right now I'd be pursuing IM with the hopes of trying to match cardio which is my #1 or allergy/immuno which is my #2.

thank you all for the help!

 

[PugsAndHugs]

Wow I’m really sorry you didn’t match into Ortho with all of that research. It’s sad that you can invest years into a specialty to just be rejected like that. I wish you the best of luck!

 

[shouldigomd]

Why not try ortho again? You seem competitive for any specialty. It is great that you found EM isn't for you early. Very high burnout with limited options.

 

[NotAProgDirector]

The main fork in the road here is whether you plan on reapplying to ortho with IM as a backup, or just IM. The latter is much more straightforward. In your application, under the experience section when you're talking about your prior ortho research, you'll state clearly that "my career interests have changed and I now am applying to INternal Medicine". In addition, if your ortho mentor can add to their letter something similar (@GolDRoger would have made a great ortho resident but is now changing to IM, our loss is your gain). Although you'll talk about that more in your PS, your PS can vary from one application to another so there's no way to know whether it's honest or not -- but you only have one application, and most mentors won't lie in a letter. With that, you should be quite competitive in the IM match. Probably not tip top programs, but certainly plenty of high quality options.

 

[GolDRoger]

Wow I’m really sorry you didn’t match into Ortho with all of that research. It’s sad that you can invest years into a specialty to just be rejected like that. I wish you the best of luck!

Thanks so much, sucks but trying to be positive

 

[GolDRoger]

The main fork in the road here is whether you plan on reapplying to ortho with IM as a backup, or just IM. The latter is much more straightforward. In your application, under the experience section when you're talking about your prior ortho research, you'll state clearly that "my career interests have changed and I now am applying to INternal Medicine". In addition, if your ortho mentor can add to their letter something similar (@GolDRoger would have made a great ortho resident but is now changing to IM, our loss is your gain). Although you'll talk about that more in your PS, your PS can vary from one application to another so there's no way to know whether it's honest or not -- but you only have one application, and most mentors won't lie in a letter. With that, you should be quite competitive in the IM match. Probably not tip top programs, but certainly plenty of high quality options.

Thanks for your detailed reply. I’m planning on applying to both after some thinking but probably going to go IM now - will be almost impossible to match ortho at this point if I’m being realistic. Will heed your advice!

 

[collegestud2013]

Based on what you’ve written, I would strongly consider applying IM only rather than applying to both IM and ortho.

Your interests in cardiology, allergy/immunology, and hospitalist medicine all point pretty clearly toward IM, and you already said that you genuinely enjoyed your IM rotation in medical school. In contrast, it sounds like EM was more of a spur-of-the-moment SOAP decision after the disappointment of not matching ortho. If that’s the case, I wouldn’t let the original ortho goal keep you from fully committing to something that may actually fit you better.

Applying to both ortho and IM may also make the IM application harder to sell. Programs are inevitably going to wonder whether IM is truly what you want or simply another backup. If you apply only IM, you have a much cleaner story: you were very focused on ortho in medical school, didn’t match, SOAPed into EM somewhat hastily, and your experience since then helped you realize that the parts of medicine you actually enjoy most are on the IM side. Your 259, Honors in IM, and extensive research background should make you competitive for plenty of very good IM programs, assuming you are doing well in residency and can get strong current letters.

I would also take seriously the lifestyle/career-fit issue with EM. EM consistently has one of the highest reported physician burnout rates on multiple surveys almost every year. Obviously plenty of EM physicians remain happy with their careers, but it also seems relatively common for EM physicians to reduce their number of clinical shifts, go part-time, or move increasingly toward administration, education, consulting, or other nonclinical work earlier in their careers than physicians in many other specialties. The combination of nights, circadian disruption, constant interruptions, front line acuity, high-acuity throughput, and limited control over workload can become difficult to sustain for decades.

IM certainly has burnout too, but it gives you an a lot more potential career paths if your interests or desired lifestyle change: hospital medicine, outpatient medicine, cardiology, allergy/immunology, and numerous other fellowships. Given the interests you listed, that optionality seems particularly valuable for you.

If you still truly want to be an orthopedic surgeon above everything else, then reapplying ortho is a different discussion but would obviously be very risky and matching on the 2nd time would obviously be uncertain. But if you’re already leaning IM as your post suggests, I’d commit to it rather than hedge. You have a strong enough application that I don’t think you need to treat IM as a backup.