Concern about re-applying for fellowship post-residency

[Reubens]

This might seem kind of silly, but I am a med student with a variety of interests but I am definitely very into the procedural aspects of medicine. I have been debating radiology, general surgery (probably not my thing), and IM but while I like the idea of being initially trained to be a quality internist, I have concerns about having to re-apply for a fellowship after. I am genuinely fascinated by the anatomy of the abdomen and doing GI is my absolute dream, yet it is very competitive and it concerns me. I am not opposed to Pulm/CC, Cards, but after that I would be worried about not having the procedural aspect in my career and those are also competitive.

I am more curious about how competitive GI really is...since the stats make it seem that 85% of US MDs do in fact match, but I wasn't sure if its a case of a very selective sample or what. I was wondering if anyone had similar thoughts when going into IM, and how they rationalized it and maybe just for some general advice about the process. I would post in the GI forum but its pretty dead. I am likely competitive for very solid programs and I am willing to let faculty know of my interests very early on in residency in regards to rotations, research, etc. if thats how it works, but I don't really know exactly how it works yet haha. Thanks!

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[Instatewaiter]

First if you are competitive enough for radiology, you are probably competitive enough for a reasonable academic IM program (mid tier or better) which will make your chances of matching GI pretty high- likely higher than the 85%

Second, you insinuate that there is no procedural aspect to cards or pulm? Pulm essentially does what GI does but in the lung (bronchs, biopsies, stenting). Cards can be much more invasive and procedurally based than those two combined. If you want, you can do PCIs, replace valves percutaneously, patch ASDs/VSDs, ECMO, balloon pumps, insertion of pacemakers and ICDs, mapping and ablation of arrhythmias. The list goes on and far beyond a scope that either goes in the mouth or anus.

 

[Reubens]

Oh sorry I meant those would be my other options since they ARE procedural. Thank you though!

 

[Instatewaiter]

Oh sorry I meant those would be my other options since they ARE procedural. Thank you though!

Cool.

Interventional radiology is a reasonable choice as well but there are a few issues. First, you have to go through a full radiology residency which is all nice and good if you want to be stuck in a dark room and like reading XR and CTs but could be painful. With that said, to get to pulm, cards or GI you have to go through 3 years of IM which for many can be much more painful than sitting in a dark room.
The second is that as IR you are not really a clinician and thus don't really have a sink of your own patients. You rely on referrals which is great if you have that referral base. But, you can struggle if you don't. In areas where there is intersections (cardiology, general surgery, vascular surgery and the like) those specialties which have their own patients often outcompete IR because they can get those patients.


Interventional pain is another option for those procedurally inclined

 

[FranzLO]

This may be a paranoia thing too, but I am also wondering about this. I love radiology but gastroenterology is my "dream" job from my experience. How tough is it really for a US MD to match in GI? I just would be considered about matching IM and having to worry about the whole match process again. It is a big gamble to me.

 

[Doctor D]

IR often seems like a sexy specialty to students but 90% or more of the procedures are fairly routine. Think changing biliary or nephrostomy tubes or thoracentesis / paracentesis. It is still a field young in its birth and is searching for an identity. This is why there has been a push for a separate residency and for becoming more "clinical".

 

[Reubens]

I figured I would bump this thread. I think my struggle with IM is that the career paths seem so different depending on the fellowship. I feel this is much different than all other specialties applied through the regular match. I am a US MD and I may be competitive for some good IM programs, but there is something unsettling about having no idea what my daily practice life will be like while I feel all other specialties have a much better idea than IM. I am just kind of hoping for any advice or to see if anyone else felt the same way.

 

[FranzLO]

Is there anyone who chose IM, and did not match into their specialty choice? Should a US MD student that matches into a good program be worried about being competitive for something like cards, pulm/cc or GI? Also, please don't focus on salary etc. since I think I would greatly enjoy a procedural career.

To me, this is not like applying for most fellowships. 3 year fellowships that completely change the trajectory of a career sound like a much larger gamble than in other specialties.

 

[aafisahar]

Is there anyone who chose IM, and did not match into their specialty choice? Should a US MD student that matches into a good program be worried about being competitive for something like cards, pulm/cc or GI? Also, please don't focus on salary etc. since I think I would greatly enjoy a procedural career.

To me, this is not like applying for most fellowships. 3 year fellowships that completely change the trajectory of a career sound like a much larger gamble than in other specialties.

IM is med school part 2; you have to do all that extra stuff (eg suck up, research, case reports, perform better than your peers, etc etc) in order to be competitive for the fellowship of your choice, regardless if you want to do that stuff or not. Not sure how other specialties work though...

 

[tryptophan321]

Is there anyone who chose IM, and did not match into their specialty choice? Should a US MD student that matches into a good program be worried about being competitive for something like cards, pulm/cc or GI? Also, please don't focus on salary etc. since I think I would greatly enjoy a procedural career.

To me, this is not like applying for most fellowships. 3 year fellowships that completely change the trajectory of a career sound like a much larger gamble than in other specialties.

US MD matching into a mid-tier academic program will be fine matching into GI. Maybe not at the best places, but certainly somewhere. You'll have to do productive research in the field, but most residents can find a mentor for that. If you're certain that you want to do this, my advice is to look for some GI research at your med school when you're chillin during fourth year. If you can pump out a couple abstracts before all hell breaks loose in residency, it will help a lot.

 

[IMreshopeful]

Is there anyone who chose IM, and did not match into their specialty choice? Should a US MD student that matches into a good program be worried about being competitive for something like cards, pulm/cc or GI? Also, please don't focus on salary etc. since I think I would greatly enjoy a procedural career.

To me, this is not like applying for most fellowships. 3 year fellowships that completely change the trajectory of a career sound like a much larger gamble than in other specialties.

For what it's worth everybody at my institution for IM matched their fellowship of choice (upper mid tier residency). You should be competitive as long as you match into a reasonable academic residency with a good track record of matching the specialty you are interested in.

However it's also not magic - you have to do the legwork and perform well clinically to get excellent letters, learn good medicine, and get involved in research. Also when applying it's a good idea to check the ego at the door and apply broadly. I know of one person who didn't match their specialty of choice because they only applied to top tier schools and clearly that's a bad idea.

Sure, it's not a ton of fun reapplying and going through the same process as residency. However this time around you will know if you really are competitive and you'll have built yourself up appropriately.

 

[FranzLO]

Appreciate the replies! Definitely makes feel better about it and a little more motivated.