Am I Screwed for IM Residency?

[streetcoat]

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I recently received my Step 2 CK score and ended up getting a 236, which is a 19 point drop from my predicted, based off my NBMEs (255 Predicted). Just shocked and extremely disappointed in myself, as I have no idea what happened. Not even sure what to do, as I had planned to apply to a wide range of academic IM/Hybrid programs. I now feel like that is out of the window and have to pivot to a FM only application. Wanted everyone's thoughts on how to navigate this tough time, and how to approach the match with so much uncertainty. I Am US DO.

 

[Med Ed]

Last year there were 11,194 categorical IM position in the match.

4,001 (35.7%) were filled by US MD seniors
1,914 (17.1%) were filled by US DO seniors
537 positions went unfilled

The point is that, overall, IM is not very competitive. Assuming the rest of your application is decent, you are not screwed. But you may have to temper your expectations and focus more on community programs. There are also university programs in less desirable locations that may show interest.

Some community programs are quite good, btw. Training at one is does not portend career stagnation.

 

[thumbz]

You're absolutely competitive for IM still, but as above - plan on applying more hybrid/community than strait academics. You'll struggle to match places with in house GI, Cards, Pulm/CCM and heme/onc fellowships for example.

But no - you don't need to pivot to FM. And yes you can get an amazing career or fellowship coming out of a community program.

Source - I teach at an IM residency

 

[streetcoat]

Last year there were 11,194 categorical IM position in the match.

4,001 (35.7%) were filled by US MD seniors
1,914 (17.1%) were filled by US DO seniors
537 positions went unfilled

The point is that, overall, IM is not very competitive. Assuming the rest of your application is decent, you are not screwed. But you may have to temper your expectations and focus more on community programs. There are also university programs in less desirable locations that may show interest.

Some community programs are quite good, btw. Training at one is does not portend career stagnation.

Yes, I am totally okay with going to a community program. I actually enjoyed my first Sub-I, which was at a community spot, and felt the quality of teaching was quite high. Do you have a rough estimate of the number of programs I should be applying to? I am trying to use the Residency Explorer to make a list that is reasonable.

 

[streetcoat]

You're absolutely competitive for IM still, but as above - plan on applying more hybrid/community than strait academics. You'll struggle to match places with in house GI, Cards, Pulm/CCM and heme/onc fellowships for example.

But no - you don't need to pivot to FM. And yes you can get an amazing career or fellowship coming out of a community program.

Source - I teach at an IM residency

Yes, as of right now I want to be a hospitalist + do a few days a week of clinic. I am totally okay with going to a community program, I was just a bit concerned about matching into any categorical spots, but I will follow your advice and do a full IM application.

 

[thumbz]

You'll be totally fine trust me on that one.

If you want to be a hospitalist I recommend community programs anyways. Academic programs tend to teach you how to run a consult service and rely on fellows. At my shop (a level 1 community hospital with overwhelmed subspecialists) the academic trained hospitalists struggle the first couple months. Yes, we expect you to manage afib with rvr without a cardiologist (don't care if they're also in decomp CHF), no they won't see chest pain rule outs, and good luck getting a nephrologist for an AKI that doesn't need dialysis.