The lifestyle and pay per hour for derm still can't be beat compared to just about any IM subspecialty in 2026; I would rank the derm programs over the categorical IM spots and hope you match into derm, but obviously not guaranteed due to its competitiveness. While midlevel encroachment is real for derm, I don' think AI will make enough of an impact on the derm job market to rank it lower. At the end of the day derm is still a patient-facing and procedural specialty, these make it harder for AI to replace (as opposed to diagnostic radiology or pathology which likely have much larger job market impacts from AI as they are non-patient facing).
IM to GI is not bad idea, but the training is at least another 6 years after med school instead of 4 for derm. Also GI is very competitive too and there's no guarantee you will match into it from IM residency (though chances overall are still high if you are an U.S. MD grad from a solid academic IM residency program). Pay per hr may be comparable but this is after 2 more years of training, and GI lifestyle tends to be more call-heavy than derm.
Also, I assume you applied to prelim IM programs as well (required for derm); if that's the case note you may match into just a prelim IM program without a derm residency spot (unless you specifcy you don't want this on your rank list). Also note that IM programs will see all your derm research on your ERAS app and many will suspect you are applying to them as a backup (they usually assume the more competitive specialty you are applying is your preferred, and the less competitive is your backup; and it's not easy to convince them otherwise); this alone will in may cases lead to IM programs ranking you lower (though if you are still a strong applicant they definitely won't unrank you altogether).
If you match into categorical IM, note it is possible to to do a derrm residency down the line after a 3-year IM residency; some have done this, but this obviously adds 2 extra years to your training.
