Primary care track versus categorical?

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ihatescience

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Searches on this came up with threads that aren't recent. Does anyone have info on internal medicine programs with the primary care track, ie: competitiveness, in comparison to categorical?
 
ihatescience said:
Searches on this came up with threads that aren't recent. Does anyone have info on internal medicine programs with the primary care track, ie: competitiveness, in comparison to categorical?
Click to expand...

Less competitive. PC programs have to rank more individuals than categorical tracks considering many people are using the PC track as a back up if they don't get into the categorical track at their preferred location.
 
I am applying solely to the PC tracks. I have been very impressed with the diversity of experience these tracks allow, especially in terms of outpatient clinic opportunities. I was told by PC PDs, that it is actually more competitive if you consider that they have less spots per applicant pool. Yet, I was also informed that the PC tracks are able to spend more time looking at each application and therefore can consider other factors i.e. extracurriculurs, leadership and can be more flexible with step score cutoffs
 
SocJustice said:
I am applying solely to the PC tracks. I have been very impressed with the diversity of experience these tracks allow, especially in terms of outpatient clinic opportunities. I was told by PC PDs, that it is actually more competitive if you consider that they have less spots per applicant pool. Yet, I was also informed that the PC tracks are able to spend more time looking at each application and therefore can consider other factors i.e. extracurriculurs, leadership and can be more flexible with step score cutoffs
Click to expand...

But that applicant pool generally doesn't rank the PC tracks number 1, they tend to rank categoricals first. If you look at the NRMP data, a PC program usually goes down 10 ranks per spot filled. (compared to less than 6 per spot for the categoricals). That doesn't necessarily mean it is less competitive, just that a lot of people apply to it as a back up or as an afterthought as they check boxes.
 
Scaredshizzles said:
But that applicant pool generally doesn't rank the PC tracks number 1, they tend to rank categoricals first. If you look at the NRMP data, a PC program usually goes down 10 ranks per spot filled. (compared to less than 6 per spot for the categoricals). That doesn't necessarily mean it is less competitive, just that a lot of people apply to it as a back up or as an afterthought as they check boxes.
Click to expand...


I believe SocJustice is correct. They can be separate tracks with separate match lists and fewer spots to match.
 
i guess it's hard to say, but does that mean the primary care track is better if you're looking to become a general internist...?
 
Scaredshizzles said:
But that applicant pool generally doesn't rank the PC tracks number 1, they tend to rank categoricals first. If you look at the NRMP data, a PC program usually goes down 10 ranks per spot filled.
Click to expand...

Where is this NRMP data?
 
ihatescience said:
i guess it's hard to say, but does that mean the primary care track is better if you're looking to become a general internist...?
Click to expand...

I assume you mean, "and not a hospitalist" . . . I would say so. PC track will be better at giving you more of a balance between in and out patient. For many categoricals continuity clinic is nothing but a turd floating in the punch bowl of what would otherwise be a very awesome day.
 
glasshouse said:
Where is this NRMP data?
Click to expand...

Google NRMP data; click on the link...look for the report titled 2009 residency data or something (not the more extensive outcomes report which is like a 200 page PDF, but rather a smaller 90 page report.....you will find the table somewhere around page 40 or so...)
 
Scaredshizzles said:
Google NRMP data; click on the link...look for the report titled 2009 residency data or something (not the more extensive outcomes report which is like a 200 page PDF, but rather a smaller 90 page report.....you will find the table somewhere around page 40 or so...)
Click to expand...

thanks! it doesn't break it down by program though, does it?
 
jdh71 said:
I assume you mean, "and not a hospitalist" . . . I would say so. PC track will be better at giving you more of a balance between in and out patient. For many categoricals continuity clinic is nothing but a turd floating in the punch bowl of what would otherwise be a very awesome day.
Click to expand...


Could you also become a hospitalist by doing the PC program? I'm just confused about it's differences with categorical if there is overlap with careers you can have after completing residency...
 
ihatescience said:
i guess it's hard to say, but does that mean the primary care track is better if you're looking to become a general internist...?
Click to expand...

A good primary care program will give you a well-rounded residency experience with a good mix of inpatient, continuity and specialty clinics in addition to having your typical inpatient consult months. I don't necessarily think that a primary care residency is always better than categorical for a primary care or vice-versa but it is the program what really makes the difference. As we all know residents from categorical and primary care choose careers in hospitalist medicine, fellowships or general medicine interchangeably. The advantage of a primary care program is that they often have a pretty well-defined tract that exposes your to areas like outpatient ent, derm, urgent care, rheum, gyn, etc. as part of your ambulatory block in addition to having special lecture series during that time....the categoricals usually don't have as much exposure to such rotations and didactics. Because the primary care track is usually smaller, you may built stronger one-on-one relationships with your program director and GIM attendings.
Primary care tracks are perceived as less competitive because of the the way we view specialized medicine in the US but in reality getting into e.g. NYU categorical vs. primary care is likely equally competitive.
I matched into the primary care program at my residency and was thrilled I did so. To be honest, I ranked the categorical first and then primary care because of public perception as well. Once I realized what a great program this was I was very happy with the outcome. As a matter of fact, for my particular program, every year there is a tendency for several of the categorical residents to request a transfer to the primary care track because of what it has to offer. It is rare to see primary care residents request to be transferred to the categorical track.
One thing that I would advise is that make sure that the inpatient experience you get as a primary care resident is similar to the one of your categorical counterparts...most great programs will have a comparable inpatient experience among the different IM tracks.
Good luck with your search
 
pedronavaja2005 said:
A good primary care program will give you a well-rounded residency experience with a good mix of inpatient, continuity and specialty clinics in addition to having your typical inpatient consult months. I don't necessarily think that a primary care residency is always better than categorical for a primary care or vice-versa but it is the program what really makes the difference. As we all know residents from categorical and primary care choose careers in hospitalist medicine, fellowships or general medicine interchangeably. The advantage of a primary care program is that they often have a pretty well-defined tract that exposes your to areas like outpatient ent, derm, urgent care, rheum, gyn, etc. as part of your ambulatory block in addition to having special lecture series during that time....the categoricals usually don't have as much exposure to such rotations and didactics. Because the primary care track is usually smaller, you may built stronger one-on-one relationships with your program director and GIM attendings.
Primary care tracks are perceived as less competitive because of the the way we view specialized medicine in the US but in reality getting into e.g. NYU categorical vs. primary care is likely equally competitive.
I matched into the primary care program at my residency and was thrilled I did so. To be honest, I ranked the categorical first and then primary care because of public perception as well. Once I realized what a great program this was I was very happy with the outcome. As a matter of fact, for my particular program, every year there is a tendency for several of the categorical residents to request a transfer to the primary care track because of what it has to offer. It is rare to see primary care residents request to be transferred to the categorical track.
One thing that I would advise is that make sure that the inpatient experience you get as a primary care resident is similar to the one of your categorical counterparts...most great programs will have a comparable inpatient experience among the different IM tracks.
Good luck with your search
Click to expand...

Well I think the inpatient experience has to be pretty similar as is mandated by the ACGME. At programs where they kind of force you to do a couple of extra floor months or whatever, a PC track can save you from that. On the whole, if you know you want to do PC, then the PC track is better and if you know you want to do a fellowship, the categorical track is better. If you're undecided, you will probably do okay with the PC track....you might not get as prestigious a fellowship match as your categorical counterparts (although this is by no means a rule, especially at top programs like UCSF and Harvard programs), but the PC track certainly still allows you to be able to work out your schedule to make you a strong fellowship applicant.
 
ihatescience said:
Could you also become a hospitalist by doing the PC program? I'm just confused about it's differences with categorical if there is overlap with careers you can have after completing residency...
Click to expand...

Oh, of course!! PC will train you to be a hospitalist as well. All I'm saying if you're thinking traditional GIM, they had clinic during the day and occasionally had to admit patients which they'd round on in the AM before clinic or PM after clinic. You probably get a little better feel for that in a PC track with all the extra out-pt oppourtunities
 
jdh71 said:
I assume you mean, "and not a hospitalist" . . . I would say so. PC track will be better at giving you more of a balance between in and out patient. For many categoricals continuity clinic is nothing but a turd floating in the punch bowl of what would otherwise be a very awesome day.
Click to expand...
:laugh::laugh::laugh::laugh::laugh::laugh::laugh::laugh:
 
....you might not get as prestigious a fellowship match as your categorical counterparts (although this is by no means a rule, especially at top programs like UCSF and Harvard programs), but the PC track certainly still allows you to be able to work out your schedule to make you a strong fellowship applicant.[/QUOTE]

This is an interesting statement. I wonder what makes you say that a primary care resident within the same program will have a harder time landing comparable strong fellowships as their categorical counterparts...is it because of the perception that primary care residents are less qualified or because of how people view primary care as a non-competitive career. The only advantage I see in a categorical vs primary care track is having more elective time throughout your training. There are some programs that give you 2 months of elective during the first year which gives you a clear advantage b/c you can start making those connections a little bit early. You may also have some more freedom on how you want to spend your elective months as opposed to a primary care track in which your elective time is more structured to complete a well rounded ambulatory curriculum/block.
Ultimately I think fellowship programs will want to train residents who have a solid foundation in both inpatient and outpatient medicine independently of whether someone did a primary care or categorical residency. I'm curious to find out what are the reasons people perceive primary care applicants within the same program as less competitive fellowship applicants.
For my fellow categorical residents it always came as a surprise to find out that someone was from the primary care because unless you would mention it during interview season or they saw your doing a GIM specific task, they really never knew who were the primary care residents.
I am a graduate of the GIM program at my residency and now work as a hospitalist in a highly ranked/regarded academic hospital in the northeast and will be starting a renal fellowship at a top nationally ranked academic hospital. I wasn't AOA, mdphd or chief resident or had crazy high exam scores if you are wondering if I am the exception. I did not match my first time applying mainly because of the # of places ranked and geographical limitations rather than for being from a GIM track
 
This is an interesting statement. I wonder what makes you say that a primary care resident within the same program will have a harder time landing comparable strong fellowships as their categorical counterparts...is it because of the perception that primary care residents are less qualified or because of how people view primary care as a non-competitive career. The only advantage I see in a categorical vs primary care track is having more elective time throughout your training. There are some programs that give you 2 months of elective during the first year which gives you a clear advantage b/c you can start making those connections a little bit early. You may also have some more freedom on how you want to spend your elective months as opposed to a primary care track in which your elective time is more structured to complete a well rounded ambulatory curriculum/block.
Click to expand...

I think a number of factors play into this, not the least of which might just be because phone calls/letters to fellowship directors from your PD might be coming from a different, less well known person...unless the categorical PD agrees to help with your fellowship match process.
 
Scaredshizzles said:
I think a number of factors play into this, not the least of which might just be because phone calls/letters to fellowship directors from your PD might be coming from a different, less well known person...unless the categorical PD agrees to help with your fellowship match process.
Click to expand...

This is actually an important point. Many of the primary care tracks have been around less time than the categorical tracks and the program directors might be the new kid on the block and not be as well connected as Scaredshizzles pointed. You can get a general sense based on where people go for work/fellowhip after they graduate. Again, I can only speak for my program...where all the program directors, categorical, primary care and med peds and even the Medicine Chair knew the residents pretty well. All the categoricals and primary care residents that choose to go into a specialty will have worked with many of the same people during their rotation, gone through the same hospitals and the letters will generally come from the same faculty. At my program, my medicine chair was friends with the medicine chair of one of the places I applied to and one of the categorical PDs also was friends with one of the renal program directors at a different place. I could easily go to them and say I'm interested in this program (which I did) and they would call their contacts at all those places. My point is that at my particular program all the residents worked with many of the same attendings, the program directors precept in clinic, wards, go to morning report so everybody gets to really see you perform and knows you at a more personal level. So my bottom line is that my program was pretty well integrated so the differences between categorical and primary care was not very noticeable (same attendings and hospitals) which was the selling point for me.
It might be a different experience at places like Yale in which the categorical and primary care programs are two different programs all together (each with prelim spots) but I can't comment much on them since I haven't really asked my friends from there how does it compare to Yale categorical
 
ihatescience said:
Searches on this came up with threads that aren't recent. Does anyone have info on internal medicine programs with the primary care track, ie: competitiveness, in comparison to categorical?
Click to expand...

Montefiore has a really good primary care track.

Definitely less competitive than the categorical track.
 
I got a quick question on whether applying to both PC and categorical improves your chances at getting an interview and matching since you will be eligible for more spots ?

Also is pc versus categorical separate interviews?

thanks!
 
bigj626 said:
I got a quick question on whether applying to both PC and categorical improves your chances at getting an interview and matching since you will be eligible for more spots ?

Also is pc versus categorical separate interviews?

thanks!
Click to expand...


so youre applying to both tracks in the same program?
 
Raryn said:
It would be a much worse idea to only apply for the primary care track.
Click to expand...

Just finished interviewing, I applied to all PC tracks for schools that had them, and applied to all the categoricals as well. There is no reason not to apply to categoricals as well. If you are really tied to an institution, then you can rank both programs.

I interviewed at some of the better programs, and can say that almost all the PC applicants also applied to the categorical tracks for the reason above. Some folks planned to rank programs based on institution (1) PC track at program A, 2) categorical track at program A, 3) PC track at program B, 4) cat track at program B, etc) while others were very tied to the PC programs and planned to rank all of the PC tracks first and then all of the cat tracks. Unless there was pervasive lying to me in side conversations on the interview trail, all of them were definitely interested in Primary Care, had compelling reasons for this interest, and were planning on ranking primary care tracks above categorical tracks.

Keep in mind that you CAN structure a strong primary care experience at many of the programs without being in the tracks, as you can just set up most of your elective time in 2nd and 3rd year to be in clinics. You will not get the sense of community in the tracks, the didactics they offer, some unique clinic experiences, and occasionally a few extra months of outpatient offered. For the most part the amount of inpatient time in intern year does not vary (maybe 1 month extra outpatient) between PC and cat tracks. I heard a lot of residents tell me though that you will want that strong inpatient training during your intern year. It is a unique year in your training to be on inpatient teams as you are basically the primary manager of patient care, something that you won't get in the same way as an R2/R3, whereas your clinic experiences will be similar whether you are an R1 or R2/3.

If you are NOT interested in Primary Care and you apply to these tracks, be prepared to spend an entire afternoon or even a whole day (some PC tracks host a separate day before or after the cat track day) and usually a dinner with the primary care program people, lying to them about how you are interested in primary care. Doesnt sound fun to me.

The primary care tracks at good programs are competitive than the categorical tracks. Many residents and PDs told me this. That's because there are only 4-10 spots in the PC tracks, compared to 30-60 in the categorical tracks.

Of course all of this information is solely based on my experience interviewing at PC tracks traditionally considered 'top 10' by USNWR. May be different at other programs.
 
Scaredshizzles said:
Less competitive. PC programs have to rank more individuals than categorical tracks considering many people are using the PC track as a back up if they don't get into the categorical track at their preferred location.
Click to expand...

What is the main difference between a PC program and categorical?

Also, can you not do a fellowship in subspeciality of IM if you do PC?
 
SocJustice said:
I am applying solely to the PC tracks. I have been very impressed with the diversity of experience these tracks allow, especially in terms of outpatient clinic opportunities. I was told by PC PDs, that it is actually more competitive if you consider that they have less spots per applicant pool. Yet, I was also informed that the PC tracks are able to spend more time looking at each application and therefore can consider other factors i.e. extracurriculurs, leadership and can be more flexible with step score cutoffs
Click to expand...

What did you end up doing? Are you happy with your deicision?
 
How does the interviewing for the categorical vs primary care tracks work, especially if you applied for both? Is it usually the same or different days? Are most people who apply for both invited for both?
 
Can anyone please tell me the main differences between PC and categorical programs? Like in terms of inpatient vs. outpatient? Ability to continue fellowship or not? Hospitalist job or not?
 
Shunnar said:
Can anyone please tell me the main differences between PC and categorical programs? Like in terms of inpatient vs. outpatient? Ability to continue fellowship or not? Hospitalist job or not?
Click to expand...

Depends on program, but most PC programs have 1-2 more outpatient months than categoricals. Usually, those months replace electives and maybe 1 service month (max). There should be no real difference in fellowship placement as long as you're a strong resident. As far as hospitalist jobs, there is zero difference.
 
bronx43 said:
Depends on program, but most PC programs have 1-2 more outpatient months than categoricals. Usually, those months replace electives and maybe 1 service month (max). There should be no real difference in fellowship placement as long as you're a strong resident. As far as hospitalist jobs, there is zero difference.
Click to expand...
Thanks for your reply, very helpful it was
 
Shunnar said:
Can anyone please tell me the main differences between PC and categorical programs? Like in terms of inpatient vs. outpatient? Ability to continue fellowship or not? Hospitalist job or not?
Click to expand...

Agree with the others. But I knew I wanted to do primary care/be a general internist. If you're thinking of being a hospitalist or doing fellowship, you should probably stick to categorical programs. You need the elective time to do research and rotations in the fields you are interested in. Worrying about not matching in the catergorical program is not a good enough reason to rank a primary care program...there are plenty of good categorical programs, and you will match into one of them.
 
Last edited:
not so calm now said:
How does the interviewing for the categorical vs primary care tracks work, especially if you applied for both? Is it usually the same or different days? Are most people who apply for both invited for both?
Click to expand...

When I interviewed, I had applied to both PC tracks and categorical tracks. I preferred PC, but cared a lot about location, so also ranked the categorical tracks at the same programs. Anyway, if you apply for both categorical and PC track at the same institution, you will most likely be interviewed by PC track faculty, esp if the PC track is big at that institution. And if you're invited for one, you're basically invited for both.
 
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Now let's assume I apply to both PC and cat. in the same institute, would I get 2 interviews or it is only 1 for both programs? And isn't it a bad idea to apply to both since PDs will see this as 'not sure what to do'?
 
Shunnar said:
Now let's assume I apply to both PC and cat. in the same institute, would I get 2 interviews or it is only 1 for both programs? And isn't it a bad idea to apply to both since PDs will see this as 'not sure what to do'?
Click to expand...

Well, I applied to both, but my personal statement was focused on primary care/general internal medicine. So it was clear what my preference/career goal was. When you apply to both categorical and primary care programs at one institution, you'll have one interview day, most likely with the PC residency faculty.
 
I matched to a primary care track (it was my #1, the categorical program at the same institution was #2) and I couldn't be happier! My electives are awesome - I can do Cardiology consults too, but I can also go on Geriatric home visits and work with homeless patients literally on the street. And hey, even the categoricals can do some of that stuff too.

Ary Lall said:
What is the main difference between a PC program and categorical?

Also, can you not do a fellowship in subspeciality of IM if you do PC?
Click to expand...

I think we have like one less wards block and use elective time on primary care-specific lecture series and electives. We also have a second site clinic in addition to continuity clinic starting second year. Basically one of your continuity clinic blocks is replaced by time at another site (prison, homeless shelter, addiction clinic, HIV clinic, etc)

Of course you can match into a fellowship. You have less time to do subspecialty electives - but "less time" doesn't mean "no time" or "not enough time."

Shunnar said:
Now let's assume I apply to both PC and cat. in the same institute, would I get 2 interviews or it is only 1 for both programs? And isn't it a bad idea to apply to both since PDs will see this as 'not sure what to do'?
Click to expand...

It's pretty much expected that you are applying to the Categorical program at that place as well. No one thinks you're trying to "double dip" as long as it's quite obvious from your application that you want to be a PCP/general internist. If you have five cards pubs, you might be a little more transparent.

Also, no, you don't have a separate categorical interview or something. You'll probably be interviewed by someone from the PC program though.
 
Last edited:
machomed said:
Just finished interviewing, I applied to all PC tracks for schools that had them, and applied to all the categoricals as well. There is no reason not to apply to categoricals as well. If you are really tied to an institution, then you can rank both programs.

I interviewed at some of the better programs, and can say that almost all the PC applicants also applied to the categorical tracks for the reason above. Some folks planned to rank programs based on institution (1) PC track at program A, 2) categorical track at program A, 3) PC track at program B, 4) cat track at program B, etc) while others were very tied to the PC programs and planned to rank all of the PC tracks first and then all of the cat tracks. Unless there was pervasive lying to me in side conversations on the interview trail, all of them were definitely interested in Primary Care, had compelling reasons for this interest, and were planning on ranking primary care tracks above categorical tracks.

Keep in mind that you CAN structure a strong primary care experience at many of the programs without being in the tracks, as you can just set up most of your elective time in 2nd and 3rd year to be in clinics. You will not get the sense of community in the tracks, the didactics they offer, some unique clinic experiences, and occasionally a few extra months of outpatient offered. For the most part the amount of inpatient time in intern year does not vary (maybe 1 month extra outpatient) between PC and cat tracks. I heard a lot of residents tell me though that you will want that strong inpatient training during your intern year. It is a unique year in your training to be on inpatient teams as you are basically the primary manager of patient care, something that you won't get in the same way as an R2/R3, whereas your clinic experiences will be similar whether you are an R1 or R2/3.

If you are NOT interested in Primary Care and you apply to these tracks, be prepared to spend an entire afternoon or even a whole day (some PC tracks host a separate day before or after the cat track day) and usually a dinner with the primary care program people, lying to them about how you are interested in primary care. Doesnt sound fun to me.

The primary care tracks at good programs are competitive than the categorical tracks. Many residents and PDs told me this. That's because there are only 4-10 spots in the PC tracks, compared to 30-60 in the categorical tracks.

Of course all of this information is solely based on my experience interviewing at PC tracks traditionally considered 'top 10' by USNWR. May be different at other programs.
Click to expand...

1. What is the main difference between primary care track and categorical track?
2. Can you not do a fellowship in endocrine or cardio if you choose IM primary care?
3. Is hospitalist your only option after you choose internal med primary track?
 
Is it frowned upon to apply to a primary care track yet be leaning more strongly toward fellowship with large outpatient components (allergy, rheum)? I don't think I would be "lying" as I am very interested in primary care as a field and in medicine on a larger scale (I am interested in things like health promotion, preventive care, health information technology, medical homes, and systems of healthcare). I would love to have emphasis on this as part of my education. BUT I also definitely see myself happily practicing subspecialty outpatient medicine, and would like to start making connections with allergy faculty at my program, do research, etc--and then, at the end of residency, have the freedom to make my choice of primary care vs. subspecialty. I realize I would have this choice even in a categorical program, but I am attracted the idea of a primary care-oriented curriculum. Bottom line, at this point, I think I am 90% likely to do outpatient subspecialty vs. primary care. The only thing that would change my mind is if I further develop my existing interest in primary care topics into a full-blown passion. Would this be seen as contradictory to do a primary care track anyway?
 
Can one apply to the primary care track with IM LORs and PS?

Thanks.
 
molten said:
Can one apply to the primary care track with IM LORs and PS?

Thanks.
Click to expand...

Yes. It is assumed that you would have IM LORs and PS. PC track does not mean it is no longer IM. It just means the emphasis is on primary care (still IM).
 
doctah123 said:
Is it frowned upon to apply to a primary care track yet be leaning more strongly toward fellowship with large outpatient components (allergy, rheum)? I don't think I would be "lying" as I am very interested in primary care as a field and in medicine on a larger scale (I am interested in things like health promotion, preventive care, health information technology, medical homes, and systems of healthcare). I would love to have emphasis on this as part of my education. BUT I also definitely see myself happily practicing subspecialty outpatient medicine, and would like to start making connections with allergy faculty at my program, do research, etc--and then, at the end of residency, have the freedom to make my choice of primary care vs. subspecialty. I realize I would have this choice even in a categorical program, but I am attracted the idea of a primary care-oriented curriculum. Bottom line, at this point, I think I am 90% likely to do outpatient subspecialty vs. primary care. The only thing that would change my mind is if I further develop my existing interest in primary care topics into a full-blown passion. Would this be seen as contradictory to do a primary care track anyway?
Click to expand...
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