Hi all, after speaking with the PD of medicine at my home institution, she suggested that I apply to more programs like yesterday..... so I added quite a few more programs to my roster. Costed me a pretty penny, but I'd rather spend the dough than match into advanced and not have prelim year...
Quoting her: "These programs are very competitive because they are "feeder" programs for radiology, derm, neuro, etc and are usually small programs (separate and distinct from categorical IM). Additionally, many programs have informal alliances, for example when I was the PD at SMITH institution I would reserve a certain number of prelim spots for JOHN's neurology residency (without making it public)"
(names were changed by me, but if you just looked at the title of the hospital and local institution you wouldn't have guessed that they had an alliance)
Good luck everyone!