Applying to multiple specialties

[gutonc]

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Maybe in your ivory tower of academic internal medicine where you can't fathom that an applicant who is interested in primary care would apply to both specialties, this would be the case. I can actually think of very few colleagues who haven't applied to two specialties. Also, as @Raryn stated, the data is in charting outcomes. Table 5.

Tell me about my ivory tower. I'd love to hear about it.

 

[Crayola227]

"Screen out", as in, you catch them, and don't interview them, but, if they slip through, you often rank them? Or, is it "screen out", as in, you identify these folks, and try to "poach" them (for lack of a better term) from the other specialty, or get to them first? This is just to clarify.

Lords no there is no "poaching" of interviewees between specialties by PDs. They all get plenty of apps from people 100% committed to their specialty no one is trying to win a student over. "If only I could get this optho applicant to consider IM more strongly" no that does not happen.

It's less complicated then that. It's an LOR that says you're applying to XXX when you apply to IM. It's research activity and SubI's in a different field. It's being president of the XXX interest club when applying to IM. It's away rotations in XXX.

Right, that's why students who may read this need to know a few things. If you are considering something competitive, have a back up specialty & plan accordingly. You should pave the way for FM or psych regardless in case something horrific happens to you during med school and your whole app is ****ed for the match. It doesn't take much to become an undesirable, and once it happens, you need to match first time around or your whole future may be toileted.

If you are torn between specialties, plan for both.

For example, I was torn between IM & EM. So I was signed up for ACP, EMRA, the EM & IM specialty interest groups, interest groups that can look good for both like say the Students for Diversity, Interest Group for Addiction Medicine, etc When I applied to one specialty, I just left off the stuff that didn't apply. You don't have to list every extracurricular activity, professional organization, club, etc that you ever did.

I got letters for IM & EM, and fields adjacent. Get letters from anyone who will write you a good letter as you go if those get held in your dean's office. Some of your mentors can write generic letters, others you can tell them you are interested in both fields and they can tailor them for either program (if you know they are the sort to be OK with this). For example, I got a psych letter because it was good. When I knew which specialty I was going for, I let them know. A psych can make a good case for you to be in IM or EM in that they can go on and on about how you deal with noncompliant crazy drug addicted patients thay never get better with their chronic disease, and your interpersonal skills and professsionalism and nerves of steel, as those obviously are good for either specialty (of course you need other letters just illustrating how to multitask here).

Do a generic research project that is short term that doesn't pigeonhole you into one specialty interest. Then you can do a more committed longitudinal one that is specialty specific. If you change your mind later, you can emphasize the first project and talk about how the second one taught you research skills but also taught you why that specialty isn't for you.

When people have late changes of heart, it's not having the right letters that usually is the main problem.

Your PS statement can explain things you can't hide so well from tipping off you had a change of heart. Your PS has to address why you the specialty and are a good fit.

In your interviews you can talk about why your experiences with the other specialty made you grow to hate it and love the one you're interviewing for more.

If you have any concerns about matching to your specialty of choice, and are creating a back up, have your 4th year rotations include that specialty later in the year. People always try to take 4th yr electives related to specialty but you don't have to. Say you want optho but you're in denial its a longshot. Having some FM rotations in spring is going to help you if you don't match and have to try a rematch into FM. That will be your proof that yes you have real interest and have experience in FM and thank God you saw the light about optho.

I can certainly understand the point of view of the PD--essentially, the PD wants an applicant who is committed to the specialty, and not going to decide sometime later "Oops--this specialty isn't for me, I'm leaving."

For an applicant who is well aware of the (often significant) differences between FM and IM, however, isn't it also possible that the applicant is also interested in seeing which program is a good fit?

Let's not kid ourselves--as residency positions become more and more competitive, many applicants are applying to two specialties these days. And I think we could all agree that both the PD and the applicant are looking for the right fit (hence, interviews.) Screening out a person who is truly limited by geography, but also not quite sure if he would be a better fit in IM vs. FM within that geography, would never even give the PD a chance to hear what the applicant has to say about their situation in the first place! So, for this very compelling situation, what is an applicant to do?

You don't go on interviews to figure out if a specialty is the one for you. You better figure that out some other way otherewise you are wasting your money and worse, program time.

If you mean you are truly split and you're going to see if the program qualities are going to determine which way to go, again, you are making a mistake. Programs come and go in your career. **** hole NY for IM vs Super nice somewhere for FM is not going to predict your satisfaction with specialty & its hard to see that it would.

Being torn between specialties and trying to see which individual program interview is going to break your tie for you does not sound compelling at all.

The PDs give no ****s about your torn interests and do not want to waste a breath on why their specialty. That's what clerkship directors and other mentors in med school are for.

PDs can afford to screen you out based on geography, or any other thing they feel like. They are not at the disadvantage here, and don't think for a minute they are desperate to have you. They may seem obsequious interview day, but it's because they would love nothing better for all 100 people they interviewed for 10 spots rank them #1, and they don't care if that meant the 90 people lower on their rank list don't match.

 

[smq123]

For an applicant who is well aware of the (often significant) differences between FM and IM, however, isn't it also possible that the applicant is also interested in seeing which program is a good fit?

Let's not kid ourselves--as residency positions become more and more competitive, many applicants are applying to two specialties these days. And I think we could all agree that both the PD and the applicant are looking for the right fit (hence, interviews.) Screening out a person who is truly limited by geography, but also not quite sure if he would be a better fit in IM vs. FM within that geography, would never even give the PD a chance to hear what the applicant has to say about their situation in the first place! So, for this very compelling situation, what is an applicant to do?

My experience in FM is that most people don't apply to FM and IM together. The main people who seemed to do that were IMGs/FMGs, honestly - for obvious reasons.

My experience in FM is that people interested in IM are rarely interested in FM, and vice versa. Many people in FM who are also applying to other specialties seem to be applying for the more specialized ones. It's not uncommon, for instance, to hear of someone applying to both FM and OB (because they're interested mainly in maternal care, and the plan is to do FM -> OB fellowship) or FM and ortho (with the plan being to do FM -> Sports Med if ortho doesn't work out). FM and psych are fairly common, too. But FM and IM are sufficiently different that there seems to be very very little overlap.

What you've described is not a compelling situation, by the way.

 

[Mad Jack]

Never really got the whole "Everyone has to apply to just one thing to prove they want to do exactly that and no one takes you seriously if it looks like you might want to do something else" mentality of residency PDs. There's like, half a dozen things I'd be really happy doing.

 

[Crayola227]

Geographical limitations are a lot less compelling to PDs than to you. Unless your spouse/SO is the Governor or US Senator of the state you claim to need to be in, nobody will really care all that much about your geographical desires (don't lie and say that it's a need).

You are completely wrong about this.

90% of my interview time (I went on 30+ interviews nationwide) were about what ties I had to the area geographically, experiences with that type of weather, what hobbies I had that related to the region, if I liked the state flower. 90% of the program materials, powerpoint, talks, were about the geography, local cuisine, etc.

For ****'s sake, a lot of them were passing out meterological data charts of number of inches of snow & average daily temp.

More than one program loaded us in vans/buses and drove us around the city pointing out shopping malls. Some of them had a real estate agent show up to talk to us!!

Whenever I said "I want to be here because my parents live here" or some such they got very excited and I saw them scribbling that kind of stuff done and underlining it, getting out a yellow highlighter, LOL.

So yeah, they care. They care even when you say "I love Denver for the skiing." I know they do. They tell me they do.

 

[Crayola227]

@Mad Jack you are right that people are multitalented and can be happy doing more than one thing. But it must be kept secret from PDs and other docs and their love of black & white thinking.

@smq123 I don't agree with you about people not being torn that much between FM & IM. I do think that enough people are smart enough to look hard enough at the differences & ask themselves what's really inportant to them.

My advising is usually to tell people figure out if you have to be a cutter or not. Then, if IM vs FM, how attached to peds and preggos are you? I was a little loathe to give that up until I realized that medicine is a job & preggos a pain in the ass, and I didn't really want to get up in the middle of the night for a potential malpractice nightmare. And that peds in FM is mostly child wellness visits, shots, and sniffles (boring). That FM essentially traps you in the outpt world these days and that IM has a built in escape hatch called fellowship if change of specialty is needed.

But to do IM you must have a hefty tolerance for endless rounds, pages, notes, an attention to details and numbers to an insane degree to keep your wonk colleagues happy, gomers galore, inpt medicine nightmares, and say goodbye to most procedures unless you really focus on outpt, hospitalist in open ICU, or do fellowship. Also be prepared to analyze studies and their numbers until you think you almost qualify for a stats degree. Also see my signature.

In any case, FM vs IM is a question of giving up some aspects or medicine vs being stuck in the outpt world as I see it. There's exceptions to that what I've said but there you have it.

 

[mcl]

You are completely wrong about this.

90% of my interview time (I went on 30+ interviews nationwide) were about what ties I had to the area geographically, experiences with that type of weather, what hobbies I had that related to the region, if I liked the state flower. 90% of the program materials, powerpoint, talks, were about the geography, local cuisine, etc.

For ****'s sake, a lot of them were passing out meterological data charts of number of inches of snow & average daily temp.

More than one program loaded us in vans/buses and drove us around the city pointing out shopping malls. Some of them had a real estate agent show up to talk to us!!

Whenever I said "I want to be here because my parents live here" or some such they got very excited and I saw them scribbling that kind of stuff done and underlining it, getting out a yellow highlighter, LOL.

So yeah, they care. They care even when you say "I love Denver for the skiing." I know they do. They tell me they do.

I care when you are an applicant pursuing my specialty with a strong application who I'm going to invite to visit my program. If you already have a strong geographic tie, I don't have to spend a lot of effort convincing you that this is a nice place to live (or at least a tolerable place to live for the duration of your residency). In fact, you often become my ally in reassuring other applicants that this location has a lot to offer.

I care moderately if you are a borderline candidate who could go either way on the invite/regret spectrum, and your geographic tie would likely secure the invitation. Even if these applicants wouldn't make the best fit for our program, they serve as "safety" candidates on the ROL--a safeguard against having to participate in SOAP. If they do end up matching with us, we have some assurance that they will be able to succeed in residency due to having a local support system in place.

I don't care about your geographic needs/local ties if you aren't a strong enough applicant to warrant an invitation. I'll feel bad for a moment as I'm sending the "regret" notice.

I really won't care if I discover that you are interviewing for multiple specialties and plan to settle on whichever one you match with, just as long as you get to be in/near this location. It feels like inviting disaster.

 

[mvenus929]

My experience in FM is that most people don't apply to FM and IM together. The main people who seemed to do that were IMGs/FMGs, honestly - for obvious reasons.

My experience in FM is that people interested in IM are rarely interested in FM, and vice versa. Many people in FM who are also applying to other specialties seem to be applying for the more specialized ones. It's not uncommon, for instance, to hear of someone applying to both FM and OB (because they're interested mainly in maternal care, and the plan is to do FM -> OB fellowship) or FM and ortho (with the plan being to do FM -> Sports Med if ortho doesn't work out). FM and psych are fairly common, too. But FM and IM are sufficiently different that there seems to be very very little overlap.

What you've described is not a compelling situation, by the way.

I actually know of a few people that applied to both IM and FM, and I'm from a US school. They applied to northeast programs and primary care tracks. Not sure which was their ultimate interest, but they must've seen something in the programs they applied to that interested them, as I heard their rank list was varied.

 

[Crayola227]

I actually know of a few people that applied to both IM and FM, and I'm from a US school. They applied to northeast programs and primary care tracks. Not sure which was their ultimate interest, but they must've seen something in the programs they applied to that interested them, as I heard their rank list was varied.

This interest you speak of sounds like indecisiveness to me LOL.

 

[Keep Exploring]

Tell me about my ivory tower. I'd love to hear about it.

OHSU IM primarily sends graduates off to specialties. Only about 20-25% of IM residents remain in primary care. I'm not here to get in a pissing contest with you, as you have made it abundantly clear that you really don't give two sh**s about factors people consider when applying to IM and FP residencies. Your (mostly rude) comments have been noted.

 

[Keep Exploring]

Are you going to tell the principal????

@gutonc has been helping applicants for years and gives great advice, sometimes with a side of sarcasm

LOL--this is getting childish. I'm a grown-up. I can see gutonc's post history is extensive. I have also read many a post where gutonc has dished out MORE than a side of sarcasm.

The compelling situations I have come across have been many and varied, including:
-Applicant who preferred to stay in a geographic area due to an uncooperative ex-spouse not willing to share custody of children if applicant were to match in a different state.
-Applicant who preferred to stay in a geographical area due to SO with a serious life-threatening illness.
-Applicant who preferred to stay in a geographical area because applicant has children, and applicant's family/support system would be able to help take care of children.

 

[the argus]

LOL--this is getting childish. I'm a grown-up. I can see gutonc's post history is extensive. I have also read many a post where gutonc has dished out MORE than a side of sarcasm.

The compelling situations I have come across have been many and varied, including:
-Applicant who preferred to stay in a geographic area due to an uncooperative ex-spouse not willing to share custody of children if applicant were to match in a different state.
-Applicant who preferred to stay in a geographical area due to SO with a serious life-threatening illness.
-Applicant who preferred to stay in a geographical area because applicant has children, and applicant's family/support system would be able to help take care of children.

Dude, you have your answer. You had your answer 30 posts ago.

Yes, those are very compelling and legit reasons that someone might value geographic location over specialty when applying for residency. Lots of people apply in 2 specialties, for those reasons and many others I assume. That's OK, no one is really disputing this.

The issue is, you won't give up on the idea that you should broadcast to PDs that geographic preference is more important to you than specialty choice. Basically everyone has told you that this is a very bad idea, including many people directly involved in choosing residents and many other people who have gone through the match process. So do what you wanna do, and good luck, seriously. Applying to residency is super stressful by itself, not to mention if you also have tough personal situations to deal with.