Direct primary care program vs pursuing the match

[parquetshorts]

Hey everyone, third year medical student at a mid-tier MD program looking for honest advice. I have my sights set on IM, and my school offers the option of applying for a direct primary care program in which your fourth year is tailored towards residency preparation and is more similar to an intern year than a typical fourth year. Tuition is also free, they offer a living stipend, and you are guaranteed a spot in their match the following year. I do have some interest in primary care, but I think I may want to pursue one of the less-competitive specialties down the road (rheumatology, allergy/immunology, etc.)

The main reason that I ask for advice, is that I have a criminal record that I know will affect my abilities to match. I got a DUI in college, but have fortunately been sober since this happened 5 years ago. Given the competitiveness of the match, my concern is that my best chances at matching at an academic program, and later pursuing fellowship, would be to pursue this primary care program and essentially forego the match. I am torn because I wouldn't mind staying at my home program, but part of me would also like to see what's out there and give the match a shot. I know that I need to be realistic about my chances, but I am looking for honest advice. I am otherwise a fairly good student, did well in pre-clinicals, and have honored 2/3 of my rotations so far, one of which being IM. Thank you in advance.

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[PathNeuroIMorFM]

If your home program is halfway decent, I would sign up for the primary care program. I'm pretty risk averse and a DUI is just too much of a risk in the match. Reminds me of Leigh Sundem.

As for wanting to leave for another program, IM is a short 3 years and you could always go somewhere else for fellowship. Keep in mind that the match might send you somewhere worse than your current location, assuming you do match in the first place. Not everyone ends up in desirable locations, even good applicants.

 

[parquetshorts]

If your home program is halfway decent, I would sign up for the primary care program. I'm pretty risk averse and a DUI is just too much of a risk in the match. Reminds me of Leigh Sundem.

As for wanting to leave for another program, IM is a short 3 years and you could always go somewhere else for fellowship. Keep in mind that the match might send you somewhere worse than your current location, assuming you do match in the first place. Not everyone ends up in desirable locations, even good applicants.

Thank you for your honest assessment, I greatly appreciate the insight

 

[NotAProgDirector]

Although the story of Leigh Sundem is very sad, it has absolutely nothing to do with this. There's a big thread here about her story. Which is now especially sad given the state of the EM match the last 2 years.

The OP's situation is completely different. A DUI is no laughing matter, but it will be many years in the past, and a good number of programs may be OK with it.

In any case, the OP may be in a "no lose" situation. If you "accept" the position, they will guarantee you a match. But you can still apply to other programs (? I think) and rank them as you please. If you match somewhere else, you might need to pay back the stipend, and perhaps the tuition also? You should check the contract and see what you'd be on the hook for.

Rheumatology is mid-competitive. It's not a walk in the park, you'd need Rheum research to be reasonably competitive.

A/I is somewhat unique, most programs are very research focused. I wouldn't call it non-competitive at all.

 

[PathNeuroIMorFM]

Although the story of Leigh Sundem is very sad, it has absolutely nothing to do with this. There's a big thread here about her story. Which is now especially sad given the state of the EM match the last 2 years.

The OP's situation is completely different. A DUI is no laughing matter, but it will be many years in the past, and a good number of programs may be OK with it.

In any case, the OP may be in a "no lose" situation. If you "accept" the position, they will guarantee you a match. But you can still apply to other programs (? I think) and rank them as you please. If you match somewhere else, you might need to pay back the stipend, and perhaps the tuition also? You should check the contract and see what you'd be on the hook for.

Rheumatology is mid-competitive. It's not a walk in the park, you'd need Rheum research to be reasonably competitive.

A/I is somewhat unique, most programs are very research focused. I wouldn't call it non-competitive at all.

Not saying it's a 1:1 of Leigh Sundem. She had at least one felony, whereas OP probably doesn't, but DUIs are still pretty serious offenses.

I'm just saying it reminds me of her and how seriously criminal sentences are taken. In pivotal decisions like this, I like to bet on the safest options.

 

[collegestud2013]

Hey everyone, third year medical student at a mid-tier MD program looking for honest advice. I have my sights set on IM, and my school offers the option of applying for a direct primary care program in which your fourth year is tailored towards residency preparation and is more similar to an intern year than a typical fourth year. Tuition is also free, they offer a living stipend, and you are guaranteed a spot in their match the following year. I do have some interest in primary care, but I think I may want to pursue one of the less-competitive specialties down the road (rheumatology, allergy/immunology, etc.)

The main reason that I ask for advice, is that I have a criminal record that I know will affect my abilities to match. I got a DUI in college, but have fortunately been sober since this happened 5 years ago. Given the competitiveness of the match, my concern is that my best chances at matching at an academic program, and later pursuing fellowship, would be to pursue this primary care program and essentially forego the match. I am torn because I wouldn't mind staying at my home program, but part of me would also like to see what's out there and give the match a shot. I know that I need to be realistic about my chances, but I am looking for honest advice. I am otherwise a fairly good student, did well in pre-clinicals, and have honored 2/3 of my rotations so far, one of which being IM. Thank you in advance.

Seems like a reasonable plan to avoid all the headaches and risks of the Match. Just make sure you read the fine print on what terms you have to fulfil as part of this program; for example, are you required to be working in primary care after you graduate to keep the free tuition and stipend (does it otherwise have to be re-paid as a loan if you don't)? Given all the issues with primary care and overall adversity to it by many physicians it's possible you may change your mind during training and do something else. Note that AI and rheum are both semi-competitive with even fair amount of USMD grads not matching each year, and will require some research, specialty-specific LORs, making connections.

 

[Styrene]

Hey everyone, third year medical student at a mid-tier MD program looking for honest advice. I have my sights set on IM, and my school offers the option of applying for a direct primary care program in which your fourth year is tailored towards residency preparation and is more similar to an intern year than a typical fourth year. Tuition is also free, they offer a living stipend, and you are guaranteed a spot in their match the following year. I do have some interest in primary care, but I think I may want to pursue one of the less-competitive specialties down the road (rheumatology, allergy/immunology, etc.)

The main reason that I ask for advice, is that I have a criminal record that I know will affect my abilities to match. I got a DUI in college, but have fortunately been sober since this happened 5 years ago. Given the competitiveness of the match, my concern is that my best chances at matching at an academic program, and later pursuing fellowship, would be to pursue this primary care program and essentially forego the match. I am torn because I wouldn't mind staying at my home program, but part of me would also like to see what's out there and give the match a shot. I know that I need to be realistic about my chances, but I am looking for honest advice. I am otherwise a fairly good student, did well in pre-clinicals, and have honored 2/3 of my rotations so far, one of which being IM. Thank you in advance.

I was convicted of DUI eight or nine years before the match. Yes, I turned my life around, never drank again, etc. No other record or problems of any kind. I've posted it elsewhere. I was actually in a similar situation to you, as well, with a "guaranteed match" agreement possibility in the form of a scholarship, that kind of thing. Ended up going that route for the assuredness of it and because I love the program. Worked out perfectly for me. Best decision I ever made. I had really good letters, research, solid grades but nothing great, and 95%ile Step 1.

I've found that an isolated DUI matters less as time goes on. But every time it comes up (jobs, medical license), I go through my own personal hell all over again, just hating myself for that. Luckily it's always worked out for me. It had the biggest impact on getting into medical school. I had really good stats and tons of EC/research but only got three interviews (luckily one of those was my in-state dream school and was ultimately accepted there). I still interviewed at other residency programs as part of the whole process later on, and PD responses ranged from never bringing up the DUI and some never even noticing it on ERAS, to others asking how they should justify to the institutional GME accepting me to their program. I know because I brought it up myself at every PD interview if it wasn't mentioned by them first.

Good luck

 

[mvenus929]

Read the fine print on the primary care track. Is it that you are guaranteed a position but can still apply in the match elsewhere? What happens if you do and match elsewhere? Or is it that you are integrated into the residency program and have to stay? Do you have any post-graduation requirements of working in primary care? Is the residency in IM or FM? Where do you anticipate working after training?

 

[esob]

I know for our program, "red flags" are auto-rejection. I'm not saying I agree with this; I'm just saying that I think it is standard practice for a lot of places (mostly because it is an easy way to help winnow down the applicant pool. Thus, if I could secure a guaranteed spot in a field that I was interested in, I would probably choose that route because I am also risk averse and I've seen some really good applicants not match.

 

[parquetshorts]

I was convicted of DUI eight or nine years before the match. Yes, I turned my life around, never drank again, etc. No other record or problems of any kind. I've posted it elsewhere. I was actually in a similar situation to you, as well, with a "guaranteed match" agreement possibility in the form of a scholarship, that kind of thing. Ended up going that route for the assuredness of it and because I love the program. Worked out perfectly for me. Best decision I ever made. I had really good letters, research, solid grades but nothing great, and 95%ile Step 1.

I've found that an isolated DUI matters less as time goes on. But every time it comes up (jobs, medical license), I go through my own personal hell all over again, just hating myself for that. Luckily it's always worked out for me. It had the biggest impact on getting into medical school. I had really good stats and tons of EC/research but only got three interviews (luckily one of those was my in-state dream school and was ultimately accepted there). I still interviewed at other residency programs as part of the whole process later on, and PD responses ranged from never bringing up the DUI and some never even noticing it on ERAS, to others asking how they should justify to the institutional GME accepting me to their program. I know because I brought it up myself at every PD interview if it wasn't mentioned by them first.

Good luck

Thank you so much for your response and for sharing your story. It is reassuring to know there have been others in similar positions that have found success. I think that it would probably be in my best interest to pursue the primary care program, but am planning to talk it over with my advisors and our IM PD before making a final decision.

 

[parquetshorts]

Read the fine print on the primary care track. Is it that you are guaranteed a position but can still apply in the match elsewhere? What happens if you do and match elsewhere? Or is it that you are integrated into the residency program and have to stay? Do you have any post-graduation requirements of working in primary care? Is the residency in IM or FM? Where do you anticipate working after training?

From what I understand, I would be guaranteed a position in the match at my institution in either the FM or IM department. I think I may be able to apply elsewhere, but I have never heard of someone doing this from the program, and if I did then I would have to payback my stipend and tuition waiver. I'll also be required to work in an "underserved" hospital in a primary care (PCP, hospitalist) role for I believe 3 years in my state to fulfill the program's requirements after graduation, which I believe would just mean I would have to work within a 501c organization locally, of which there are plenty where I'm at. If not, again I would just be required to pay back the stipend and tuition waiver. I believe I could still technically apply for fellowship after these requirements are fulfilled and not have to worry about paying anything back. I could also apply for fellowship prior to completing the requirements and just pay back the stipend and waiver if I wanted, but that doesn't seem like an honest move so I don't plan on doing that as of right now.

 

[PathNeuroIMorFM]

From what I understand, I would be guaranteed a position in the match at my institution in either the FM or IM department. I think I may be able to apply elsewhere, but I have never heard of someone doing this from the program, and if I did then I would have to payback my stipend and tuition waiver. I'll also be required to work in an "underserved" hospital in a primary care (PCP, hospitalist) role for I believe 3 years in my state to fulfill the program's requirements after graduation, which I believe would just mean I would have to work within a 501c organization locally, of which there are plenty where I'm at. If not, again I would just be required to pay back the stipend and tuition waiver. I believe I could still technically apply for fellowship after these requirements are fulfilled and not have to worry about paying anything back. I could also apply for fellowship prior to completing the requirements and just pay back the stipend and waiver if I wanted, but that doesn't seem like an honest move so I don't plan on doing that as of right now.

Assuming you truly want to do FM or IM, this honestly seems like a really solid deal even for someone without the DUI. I would take it if I were in your shoes.