Difficulty of Entering GI?

Discussion in 'Gastroenterology' started by SoulinNeed, Mar 17, 2014.

  1. SoulinNeed

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    I'm only a first year med student, and just exploring fields, but GI is one that I'm really interested in. I'm not really sure of the competitiveness of the field, though. How hard is it to enter? Do you have to come from a highly ranked IM program? Do you have to score high on your boards? NRMP states that averages Steps are in the 220's. Is this accurate? Do you have to have a lot of research? How hard is it to enter the field? Thanks!
     
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  3. anbuitachi

    anbuitachi ASA Member

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    do you have the link that says 220s? i would like to take a look
     
  4. IM2GI

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    Quoting myself:

    "Imagine ~400 applications, ~40 get invited for interviews, for ~3-4 spots at most programs, of which half will go to internal applicants, so you are typically fighting for ~1-2 external positions. It is brutally competitive these days. A lot of it comes down to a) Where you did your residency b) Letters/personal connections c) Research."

    220s wont get you a top tier IM program, which wont put you in a strong position to get GI.
     
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  5. SoulinNeed

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    Going by your logic, if a 220 won't get you a top tier IM program (and it won't), but yet the average GI accepted applicant scored in the 220's, then a strong IM program isn't necessary or even typical to get into a GI program.
     
  6. IM2GI

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    Goodluck with that.
     
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  7. SoulinNeed

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    There's really no need for that attitude. I'm only asking. You implied that a strong IM program is heavily recommended, but you said that a 220 won't get you into a top IM program. However, that's around the average score of GI accepted applicants. Obviously, GI is competitive. I'm just asking how competitive? If it's not Step 1 score, then what is it? Research? Networking? And how competitive is it compared to other specialties? You don't need to be dismissive, man, honestly. I'm just curious cause I'm interested in the field.
     
  8. jturkel

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    GI is the hardest fellowship to get into out of IM and the second most difficult fellowship to get into behind abdominal transplant surgery. In the 2013 match, there were 707 applicants for 433 positions. 41% of applicants didn't match. only 33% matched their first choice. this isn't GI specific, but in a survey of >500 fellowship program directors of medicine subspecialties (including GI, cards, hemonc, etc), USMLE score came 8th on rank of selection criteria. Regarding highly ranked IM program, "university-based residency" was 4th. Regarding research/publications, "interest in research" was 5th and "publications" was 9th. Again this isnt GI specific, but best I have available.

    I've seen some programs say you must have minimum scores of 200, others say minimum of mid-80 percentile. The fellowship director at my program says the most important thing is research as "everyone who applies is among the best residents." When I asked about step score, he said he didn't really like seeing below 220 or 225. take that for what it's worth/my n= 1.
     
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  9. DermViser

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    For someone whose Soul is in Need, you seem to get quite defensive just bc the facts don't light up with your view. IM2GI is a fellow. I'm sure he would know a little bit more about the process than you.
     
  10. Silent Cool

    Silent Cool Member
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    GI: "There's gold in $hit, boys!"

    :laugh:
     
  11. wjs010

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    For the ppl who are interested in GI. What interests you in GI. Just curious
     
  12. SoulinNeed

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    You must have misunderstood me. I wasn't being defensive. I was genuinely confused, as the average step scores didn't seem to confirm what he was saying, and jturkel's data seems to back up that step scores don't matter.
     
  13. DermViser

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    Try again: "I've seen some programs say you must have minimum scores of 200, others say minimum of mid-80 percentile. The fellowship director at my program says the most important thing is research as "everyone who applies is among the best residents." When I asked about step score, he said he didn't really like seeing below 220 or 225. take that for what it's worth/my n= 1."

    This is the minimum to be realistically considered.
     
    #13 DermViser, Mar 21, 2014
    Last edited: Mar 22, 2014
  14. anbuitachi

    anbuitachi ASA Member

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    What is the #1 most important factor? I'm guessing connections
     
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  16. SoulinNeed

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    Nevermind, misunderstood here.
     
  17. SoulinNeed

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    Thank you so much for answering my question.
     
  18. DermViser

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    Those "connections" are:
    • working with GI faculty
    • doing research and hopefully getting to present/publish that research
    • Networking at your home program and at conferences
    GI is not going to be handed to you on a silver platter. You really have to really earn it as it is one of the most competitive subspecialties in medicine.
     
    #17 DermViser, Mar 22, 2014
    Last edited: Mar 22, 2014
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  19. jturkel

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    Per this survey (which again want to say isn't GI specific but is from PDs from all IM subspecialties), the most important selection criteria is the fellowhsip interview (but you have to get that first), so the next two are LOR from known specialists and LOR from your IM PD. So basically, yah work/network with GI faculty as they are your "connections" as stated above
     
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  20. IMDoc607

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    What's the appeal for GI for all these people? You can make just as much or more in cardiology....is it the lifestyle?

    Forgetting IM subspecialties, you can get into anesthesia with just as good pay and even better lifestyle than GI. So what is it that so many people are going for GI? From what I gather from my GI friends are and these are their words not mine.... Scope or not to scope thats the question. So when GI takes the cuts cardio has what's going to happen? I don't see the field expanding like cardiology continues to allowing them to absorb some of the reimbursement cuts.
     
    #19 IMDoc607, Mar 23, 2014
    Last edited: Mar 23, 2014
  21. IM2GI

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    So you are a cards fellow? I find it hard to believe someone who has gone through IM training does not see the appeal of GI. Even if it is not for you, there are clear perks to the field.

    Re: Anesthesia, go check out their forum for the doom and gloom. CRNAs taking over their entire speciality, you are treated as a service worker, no thanks.
     
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  22. anbuitachi

    anbuitachi ASA Member

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    I don't get it. Cardio focuses on 1 organ, GI focuses on an entire system of GI organs. why isn't there going to be more field expansion in GI vs cardio?
    And anesthesia is dying, and GI has more flexiblility with opening clinics, see a wider range of illnesses etc so different preferences =\
     
  23. wjs010

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    For incoming students like me, it's the physiology. That's all for now. I'll see the rest in a few years. I like the science of GI. Maybe I'll hate the practice. Probably not though.
     
  24. IMDoc607

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    Agree there are definite perks to the field. I guess it's all personal. I find the excitement of a STEMI and new evolving treatments awesome.

    Good for those that enjoy GI as we need you guys and I'm definitely not capable of doing it.
     
  25. IMDoc607

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    From my GI friends it seems like IBD might get big in GI but like I said before. According to them, their consult answers are scope or no scope. I think hepatology is interesting but most GI folks (correct me if I'm wrong) don't want to go into because there's no money in it.
     
  26. Gastrapathy

    Gastrapathy no longer apathetic
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    There is plenty of money in liver. Most GIs don't want to go into it because it's not endoscopy focused.


    Sent from my iPhone using Tapatalk
     
  27. IMDoc607

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    What kind of things in liver generate money? I thought for GI it was pretty much scopes. My buddies want to learn enough hepatology in fellowship and be done with it.
     
  28. Flavivirus

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    I think not everyone in medicine chooses their field for the salary, although from reading these forums that doesn't appear to be the majority of physicians. I am an academic hepatologist and to be honest, salary really has never been something that I've been highly focused on. I make a comfortable living. I really like the range of liver disease, the balance between acute and chronic care, the fact that you can actually offer important interventions for many liver diseases, and yes there is a reasonable amount of endoscopy. Also hepatologists really don't have to deal much with functional disorders (IBS in GI, noncardiac chest pain for cardiologists). Either you do or you don't have a significant liver disease, and I can figure out pretty quickly if you don't.
     
  29. IMDoc607

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    Got ya....I was mistaken. I will admit that those that enter the more competitive fields are driven by salary as well. I always hear GI fellows talk about how much money they make doing scopes and no one picks hepatology for that reason. I love cardiology where I make it a point to read 6 ECG's before I go to bed at night and learn from them. When I am kept up at night, I read guidelines and cases....I just enjoy it a lot. However, I will say that if it was not a lucrative field I am not sure I would enter it due to the lifestyle that comes along with it. Its easier for you to say that you make a comfortable living being a hepatologist and enjoy just being a doctor. With that being said, after your fifth STEMI in a night or long calls job satisfaction is not enough to keep you going. There needs to be incentive.
     
  30. Flavivirus

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    So for you (and many physicians), "incentive" = $. That's fine. But IMO there's more to incentive than that.

    Not sure where the "it's easier for you to say..." part came from. I did a GI fellowship, and yes I had my share of rough calls too. Maybe your perspective will change a bit once your fellowship is over. Good luck!
     
  31. IMDoc607

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    In retrospect I don't know where that came from either.....my apologies.

    I'm sure you had rough calls but as an attending interventionalist getting called in 5 times wouldn't you want to get paid?
     
  32. milktuth

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    GI
     
    #31 milktuth, Jan 13, 2015
    Last edited: Jul 24, 2015
  33. Reubens

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    I posted in another thread mentioning how I really want to go to into GI but am a little concerned because of the competitiveness (still kind of like radiology but I think IM is highly likely), but it seems that 84-85% of US MDs matched last year, unless I made a mistake. I would take these odds especially since I will motivated from the beginning, or is there selective bias or something at work? I also mentioned that many aspects of internal medicine, mostly Cards, Pulm/CCM (due to procedures) fascinate me but that GI is by far my dream gig. How have other IM residents established connections, research opportunities early on in GI to prepare for their application? Just let faculty know my interests early on or wait until a GI rotation or something? Any advice on what the best approach is?
     
  34. Brigade4Radiant

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    Honestly you can jump up your odds to nearly 100% by just doing a chief year.
     
  35. DNM

    DNM

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    This is something I always wondered about, and maybe a resident or fellow can give some insight. When is it worth it to do a chief year, as opposed to just taking your chances with the regular fellowship match? Is chief year something you can decide to do if you failed to match, or do you have to commit early? Is a chief year worth doing for someone with a reasonable shot at matching?
     
  36. nycscope

    nycscope fuerte con la grasa, suave en las manos

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    1. When is it worth it to do a chief year, as opposed to just taking your chances with the regular fellowship match?
    Depends on the program. Some places require commitment before fellowship applications, others after. If you are in the before camp, then you need to be very, very realistic about your chances...do you *think* you are a competitive applicant or *hope* you are one? If you hope, hedge your bets, do the chief year. If you really, really think you can do it, go for it.

    2. Is chief year something you can decide to do if you failed to match, or do you have to commit early?
    Depends on the program. My program asked me early, I said no thanks, and by the grace of the Almighty and the skin of the skin of my teeth, I matched and didn't have to regret the decision. My friend was applying for cards, was asked after me, and he took it with a wink and a nod that he'd be very competitive to match at the program for next year.

    3. Is a chief year worth doing for someone with a reasonable shot at matching?
    Well, now it becomes a personal question. A chief year is not by any means fun. At some places, you are a bobblehead... yes sir, thank you sir for the PD and you carry out their edicts. At others, you are given more free reign as to how you will engineer the residents' schedules, conferences, etc. You also play mother, father, pastor, referee, and any other role you can think of to residents who will often complain, seldom thank you. You do, however, get to see how the sausage is made, and it does get you bumped up some lists.

    Chief year is the Ribavirin of fellowship applications...it won't guarantee sustained response on its own, but it can sure help!
     
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  37. Reubens

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    This sub forum obviously isn't very active but I appreciate your responses! Do most of you agree that going into IM is best if we at least want to entertain the idea of being a general internist, or do most use it just as a stepping stone to get into fellowship? Even though the match rate isn't that bad for a US MD into GI, I still think I am going to struggle with the idea that I am matching into a residency with really no idea of what my day-to-day work will be. It has been posted before, but what things do you guys think are the most important in being competitive?
     
  38. JRoc_123

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    How about advice for those who matched into a mid-tier university based internal medicine program?
     
  39. nycscope

    nycscope fuerte con la grasa, suave en las manos

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    Whaddaya mean? It's the same wherever you go, really. Standard of care is standard of care (I understand why the term mid-tier exists...I dislike it, but it's warranted, as different hospitals are capable of different treatment modalities and are conducting different research...if any, which is what the tiers really refer to).

    I also understand that brand name recognition softens the road ahead...MGH residency + 1 poster presentation vs Community Hospital X + 1 presentation are not equivalent on paper. Safest bet is to be an excellent doctor of IM first, network at your home program, get in on case reports early and often, see if you can help with any ongoing research (data mining, qi projects, excel spreadsheet cleaner-upper...whatever) and pursue an idea of your own to the best of your ability research-wise...and that's probably the best shot you can give yourself.

    Source: I matched and am a resident at a "mid-tier" university program...lower 1/2 (one of the last ones actually) of the top 50 on US News for whatever that's worth.
     
    #38 nycscope, Apr 20, 2015
    Last edited: Apr 20, 2015
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  40. Leo Aquarius

    Leo Aquarius Anxiety.org Schizophrenia.com DepressionHealth.net

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    I don't see the appeal of GI. I worked for a GI clinic for a summer and you couldn't make me scope 5 cases before lunch and 5 cases after lunch every day. No thanks.
     
  41. wjs010

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    Since I'm only coming from a very green, naive point of view and I only know the basic physiology (I like it quite a lot) of GI , may I ask why?
     
  42. Leo Aquarius

    Leo Aquarius Anxiety.org Schizophrenia.com DepressionHealth.net

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    Hey I really enjoy studying hepatic/gastric/intestinal physiology and disease. There's a huge difference between books and clinical work. I recommend spending a week in a high-end private practice GI clinic. I personally don't enjoy inserting scopes up people's behinds 10 times a day with irrigation and insufflation. Try it. Maybe you'll like it.
     
  43. IM2GI

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    You come off like a child. And that's right, you did not enjoy it, because you just watched someone else do it.

    GI is one of/the most popular and competitive subspecialty for a reason: Wide variety of clinical practice, multiple diverse organ systems, procedural aspect, good reimbursement.

    Want to be a pseudo-surgeon? Do advanced endo and you can do all kinds of cool stuff.

    More cerebral? Do hepatology

    Someone who likes anxiety as much as you would love GI; I have tons of IBS patients for you to meet.
     
  44. JRoc_123

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    That is encouraging :)
     
  45. FranzLO

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    Would like to hear some more opinions on this since I am concerned about the same thing
     
  46. nycscope

    nycscope fuerte con la grasa, suave en las manos

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    The match rate "isn't that bad for US grads" is a myth. It's hard (for everyone). I lived it.

    What they DON'T tell you in the end of match stats are the number of applicants who were Chiefs, Hepatologists, Hospitalists for a few years BEFORE applying.

    Say there are about 450 seats nationwide into 170 programs...about 2.5 seats a program. Many of those are promised to chiefs...even being generous let's say there are only 2 seats a program, although I think it's less than that honestly. Now, you are in mix with those Hepatologists and Hospitalists who have had more time to prove they are capable physicians and have had time to pad their CV's.

    Additionally, the match can be very regional. Why should a Cali program take me, a lifelong NYer, with no family or ties to Cali? I'm probably just going to up and go when I'm done...so they would rather have the Cali local who is going to stick around to help their program grow. I will say that this "advantage" doesn't necessarily hold up in more metropolitan places.

    Of the few interviews you get, what are the odds that YOU are going to be in those top two spots out of the forty-fifty interviewees? What are the odds you are THAT good on paper, THAT good during your interviews, and you click with the program constituents MORESO than the other fine applicants there? Let's not even mention the kind of networking that goes on behind the scenes...

    Your best bet is your home program, or some really, really impressive acclaims/credentials making you SUCH an exceptional candidate the programs have to take you otherwise you are missing out.

    There are lies, damn lies, and then there are statistics. Don't be fooled...it's damn hard getting a fellowship and there is absolutely no guarantee that you will get one, even if you are a stellar resident. Make sure you like IM just in case, because chances are good that's what you will be.

    Source: I was a scared throughout my residency because I really didn't enjoy IM (well, until later...I liked it more in my 3rd year...but it still would have been a distant second life choice compared to GI...that's a scary thought, living out a "plan B") and I believe that I matched by the skin of my teeth...I had to face the reality that I would either have to reapply and take another chance or stick with IM.
     
    #45 nycscope, Jun 4, 2015
    Last edited: Jun 4, 2015
  47. FranzLO

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    I appreciate the response. I am sure there are quite a few posts addressing my questions on here and I am reading a lot of them, but I was wondering how feasible you think being a hospitalist for a year or more is while reapplying. Can connections increase during this time or do you think it usually gets harder? Also, is the Chief situation really a "guarantee" or how to close to one is it? Also, how common is it for a Chief to grab a GI spot like that if you had to guess from your own experience?
     
  48. nycscope

    nycscope fuerte con la grasa, suave en las manos

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    Connections can increase, sure. It depends on where you are a hospitalist and what you are doing. At an academic center with a fellowship, teaching residents, involving yourself in GI research at that place? Awesome. Over at Hospital X w/ no residency/fellowship program, no active research? Less great.

    RoT is that it's harder after 3 years...so you want to try and match within 3 years of finishing residency.

    Chief is no guarantee at all. It DOES put you in a separate category, and most programs will likely keep their own chief...they get to that position for a reason, and it can look pretty bad for a program if they don't take care of their own after an extra year of, ahem, indentured servitude. It is very, very commonly that this happens.
     
  49. Hepatastic

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    Agreed. Chief year does help but not that much for GI particularly. I am a chief resident and just applied this past year. What nyscope said is spot on.
     
  50. Leo Aquarius

    Leo Aquarius Anxiety.org Schizophrenia.com DepressionHealth.net

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    People told me that. So I tried it. Get out of academics into the real world. Colonoscopies and EGDs are bread and butter for GI docs in non-academic practices. Simple. And guess what, looking at half-cleaned colons all day long for polyps is not only a turn-off for me, but for 99.99% of the population. But feel free, judge.

    Medical students and residents are like buffalo. They chase what's most competitive even if it's off a cliff. Do GI if you truly enjoy it. But don't pretend it's so amazing that it warrants its competitive bent.
     
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  51. Silent Cool

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    I agree. GI is a one-trick pony and is popular only because medical students have the perception of scoping = $$$. If reimbursements are cut (which they probably will be), then GI would be no more popular than Endo or Rheum. Also see the rise of nurse endoscopists, which makes sense because much of GI is a relatively simple technical procedure. The physician is needed mostly to evaluate an image of the colon.

    [​IMG]
     

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