Derm vs IM for foundation year internship

[Med_apple1]

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Im a US IMG studying at a medical school in the EU. In our final year we do a 5 year long “foundation” internship which serves to prepare us for working as a junior doctor.

I was accepted for internal medicine and dermatology, very conflicted what to pick.

On the one hand, if I decide to apply for residency in the US I would definitely apply IM since derm just isn’t feasible. i would then hope to do fellowship in a mostly outpatient specialty as I prefer the outpatient workflow and lifestyle (maybe oncology, endocrinology, rheumatology, or immunology).

if I decide to stay in the EU, dermatology is still competitive in my country but would be feasible since I’m not an img here. Doing this derm foundation elective would also potentially be helpful to make connections and land a residency spot in derm.

dermatology speaks to me because it combines my interests in oncology and immunology nicely. Also pathology. Only thing is I’m not very visual and I’m worried that I only want to do it because of the lifestyle so I’m gaslighting myself into thinking I would like it. haven’t had any experience with dermatology in my rotations.

Did not like my IM rotation at all as I hated rounding and constantly getting interrupting during the day and the chaos and vagueness of the inpatient patients. But I feel like I should push myself to do the IM rotation so I can get more experience with running the wards which would improve my clinical reasoning as a whole. And if I do then apply for residency in the US I would be better prepared to do IM residency.

any thoughts on what makes most sense to pick in my situation? Thanks!

 

[Dral]

I think you need to get some experience to make your decision. I'm very visual and knew on day one of my derm rotation that it is the direction I wanted to go. I'm not saying you'll have an experience like that, but I think you do need to at least see what it's like. I'd also do a rotation with an oncologist or immunologist to see the life of outpatient IM.

Keep in mind that if you land an IM spot in the US, oncology and allergy/immunology are relatively competitive as I understand it. Maybe someone else can chime in on that as I'm not sure exactly how relatively tough they are to get into currently though.

 

[Deecee2DO]

I think you need to get some experience to make your decision. I'm very visual and knew on day one of my derm rotation that it is the direction I wanted to go. I'm not saying you'll have an experience like that, but I think you do need to at least see what it's like. I'd also do a rotation with an oncologist or immunologist to see the life of outpatient IM.

Keep in mind that if you land an IM spot in the US, oncology and allergy/immunology are relatively competitive as I understand it. Maybe someone else can chime in on that as I'm not sure exactly how relatively tough they are to get into currently though.

Yes allergy and Hemonc are both considered competitive subspecialties in IM. Current fellow in one of them. GI Cards are most competitive and then id say hemeonc allergy and maybe PCCM are second most. Both allergy and Hemeonc are outpatient heavy with good lifestyle and high paying lifestyle specialties. A/I on avg (~$400K+ in private practice) makes a little less than Hemeonc ($500-600K+) but A/I works less with better lifestyle. Hemeonc can be stressfull but still less stressfull/better lifestyle than GI and Cards. Rheum is less competitive with great lifestyle (similar to allergy) but pay is less than allergy and hemeonc. Endo is not competitive at all lifestyle is superb similar to rheum and allergy but pay is significantly lower (around what a PCP makes or less)