Hi everyone, I’m an M1 that’s very interested in gastroenterology. Since that requires completing an IM residency, I was wondering if program directors frown upon applicants who are interested in specializing, or if questions about an applicant’s interest in fellowship even come up during interviews? Do you think a program director would rank applicants differently based on who does and doesn’t want to specialize? Thank you all for any advice or opinions!
Bad to mention fellowship interest during interview?
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M1, as in you started med school 3 months ago?
If so, I truly recommend (and I'm not being snarky here):
1. Finish your year 1 and 2 courses
2. Do well on step 1 to maximize your chances of a good IM residency
3. Do well on your medicine core rotation
4. Try to do a GI elective before you go on medicine interviews - yes see the inpatient consults but more importantly see lots of scopes
And then think about your interest in GI and worry about whether residency directors care about expressing fellowship interest or not.
But to answer your question, the answer is how you phrase your interest in the field. I think casually bringing up that you want to to GI ultimately when asked about career plans is fine, but I would not harp solely on it for the whole interview as there is a lot of internal medicine that is not GI, and you gotta get through the 3 years of general medicine first. And second, I don't think PDs really care what your plan is (as long as you don't shoot yourself in the foot and come across as someone that can only do one thing or bust) because people change their minds all the time in residency and they know to assess your application more comprehensively than purely based on your expressed sub-specialty interest.
TBH though, there's a lot of stuff that you have to get through before you even get to an IM interview and a lot of things to see in med school. Make sure you fully explore your options and don't pigeonhole yourself this early. You literally can go into any specialty at the moment. In general for all competitive IM stuff, as long as you maximize your board scores and honor your IM rotations, you should get a decent IM residency which then opens doors for you for fellowship.
Hi and thank you for the response, I really appreciate it. Yes just started med school a few months ago. I’m definitely focusing right now on doing great in all me classes, and plan to keep my options open until I’m more immersed during 3rd year. I’m also quite interested in hospital medicine and I’m excited about the 3+ years of IM residency, I’ve enjoyed rounding on patients during early clinicals as an M1. But my whole family has Lynch Syndrome, I grew up in the GI’s office and shadowed GI as a premed, so at this point I doubt anything would compare to the fulfillment of screening patients for colon and esophageal cancers and removing polyps etc.. like gastroenterologists have done for my family. Furthermore, the scope of GI practice and the vast amount of pathology seen is very intriguing.
They don't care. Interests in potential fellowships come up regularly on IM interviews, just keep an open mind of course. Many academic places will match you with a mentor of your fellowship of interest right from the start of PGY-1, if that's what you'd like. It's something everyone thinks about, especially with competitive fields like GI which may require more early prep.
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Keep an open mind. You have ways to go before you get to decide what you want to do for life. GI being very competitive, there are plenty of hard and soft stops before you have enough information to decide whether it is right for you or not.
It’s very very very early in your career.
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Depends on the program. If it’s a primary care focused program, they will care. Otherwise, if it’s a typical university program (which is what you want for GI), no one would believe you if you said you wanted to do primary care.
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Don’t get all up in arms...you are 3 months into a very long haul...75% of 1st years go into something other what they originally thought they would do. And as noted, GI is very competitive, so you are best served to focus on being the best student you can, honor basics, get outstanding usmle scores, AOA, line up some research instead of worrying g about what is going to be asked on the interview trail 4 years from now.
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I would not mention it if the program doesn’t have in house fellowship or have good track for sending people to fellowship. This is why I only applied to programs that have in-house fellowship
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If you interview at university programs, they expect that you want to specialize. One of my interviewers straight up told me that his program was not a good fit for applicants trying to do primary care.
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This is not blanketly true at all. It absolutely depends on the institution itself. There are plenty of academic institutions with strong primary care tracks for IM.
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If you’re not specifically interviewing for the primary care track and you’re interviewing at a top 30 IM program, they are expecting that you will specialize.
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As crayola said, not necessarily so...programs are different.
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OK, so your advice only really applies to top 30 programs then, and there's around 150 last time I checked. Last time I checked, only 30% of students going into IM ended up at a true academic program in any case. So again, this advice will only apply to a minority of students at a minority of programs.
Also, last time I checked, only about a 3rd of IM grads went on to subspecialize. The rest end up as general internists, either inpt or outpt. Again, this means that subspecialization is a concern that affects a minority, not taking into account that there is a greater number that enter IM with plans to subspecialize. The reality is that many won't.
The obsession with subspecialization begins and ends with those who subspecialize, in my experience.
Also, keep in mind, that even at top programs, a lot of the people interviewing you will be general internists. Try not to offend them with an elitist attitude regarding subspecialization.
What probably makes the biggest difference has to do with how academically active residents will be. It's true that those aiming for a subspecialty do more research and such. Between that and having an impressive fellowship match list, is where I think programs care about whether or not you subspecialize. At least that's what I was told being someone who was outspoken about not subspecializing.
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That's all fair, definitely don't want to come off as bringing an elitist attitude about subspecializing. I'm not the guy that looks at IM residency as simply a stepping stone. I actually want to learn internal medicine and be a real doctor.
But the idea that only 33% of IM grads subspecialize is just not true factually. It's more like 75-80% according to this ACP article. And it's reasonable to assume that number is quite a bit less at the 150 university programs compared to the ~250 community programs. And you can imagine that at top 30 programs it maybe even less than that (especially amongst the non-primary care track residents). I don't know what those exact numbers are, it's just an assumption.
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hmmm, yeah, lol, 1/3 do something! I'll have to double check all those numbers
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Wait so if someone is interviewing at academic/university programs, it’s okay for them to express interests in fellowship, so long as the programs have a good record of sending people to fellowships?
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again, it depends on the program and how you address it. Some programs will ask you if you are interested in fellowship so they can have one if your interviewer come from the specialty you are interested in...if you make it sound like IM is just your stepping stone to something else, most programs will not like hearing that, since they want residents that will be engaged and interested in IM as well.
if they ask, tell them. If not asked, then stick to IM as the topic of discussion.
I would think that it is better to express what you really want. Provide coherent rationales of why you want fellowship, why you want that fellowship, or why you want primary care. Be yourself. Be the better part of your true self. This means when you say you want fellowship, you don't say PCPs are stupid. This also means when you say you want to be PCP, you don't say subspecialist only lives in the ivory tower.
Oh also, it is perfectly OK if you don't have a solid plan. The next question will be: how do you plan to find your interest during residency?
Oh also, it is perfectly OK if you don't have a solid plan. The next question will be: how do you plan to find your interest during residency?
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I was actually pretty open about wanting to do fellowship during my residency interviews and I backed it up with my research interests at the time (GI and pulm/cc). I always mentioned however that my goal as a resident was to have a strong foundation in GIM and that ultimately my experiences would inform me further. Most of my classmates did similar. I think for academic programs they generally expect that most residents end up doing fellowship - usually about 70% on average. Obviously if you’re applying for a primary care track probably not a great idea to express an interest in a subspecialty lol
For fellowship I ended up having to be surprisingly a lot more specific (I expressed an interest in a specific subspecialty of cardiology... interestingly not the one I ended up doing!) because they will expect that, at an academic institution, whatever you end up doing you want to pursue a specific interest. For example even if pursuing general cardiology, might mention specific interest in echo, mitral disease, etc. That being said I think very few folks actually come in knowing for a fact what they want to do further and it’s just something you have to give an idea for
For fellowship I ended up having to be surprisingly a lot more specific (I expressed an interest in a specific subspecialty of cardiology... interestingly not the one I ended up doing!) because they will expect that, at an academic institution, whatever you end up doing you want to pursue a specific interest. For example even if pursuing general cardiology, might mention specific interest in echo, mitral disease, etc. That being said I think very few folks actually come in knowing for a fact what they want to do further and it’s just something you have to give an idea for
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