From Residency to Fellowship

[KarmaIsTruth]

I was speaking with medical students who are in the military scholarship.

They told me that it's very rare nowadays for people to go from a civilian residency directly into a civilian fellowship due to competitiveness.

I want internal medicine and go directly to fellowship (probably rheumatology or immunology) - without working as a hospitalist for a year or two.

The military med students told me I would have to be exceptional to do this.

Is this true?

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[DubVille]

Are you in the military?

A civilian resident doing a fellowship immediately after internal medicine is super common (i think 50% or so). Rheum is not competitive, i think allergy still is fairly competitive.

 

[Doctor Bob]

I was speaking with medical students who are in the military scholarship.
They told me that it's very rare nowadays for people to go from a civilian residency directly into a civilian fellowship due to competitiveness.
I want internal medicine and go directly to fellowship (probably rheumatology or immunology) - without working as a hospitalist for a year or two.
The military med students told me I would have to be exceptional to do this.
Is this true?

This varies year to year.
Every year the military brass gets together and projects how many docs in each specialty they need in ~5 years. They then base the number of available slots in each specialty on that long term assessment. If there is more need than they have positions at an active duty facility, then a civilian deferred slot is created. The same happens for fellowship.
When it comes time to apply for residency and fellowship you have to compete (so to speak) for the spots and the competitiveness depends on the number of spots and the number of people applying. So it varies year to year.

 

[KarmaIsTruth]

I am not in the military. I am strictly speaking about civilian residencies and fellowships.

 

[karayaa]

If you know what you want to do, you shouldn't have a problem going to fellowship directly afterwards.
Gaps exist when someone decides late, and doesn't have time to prepare or apply for fellowship, or when they don't prioritize building a strong application (because of legitimate other priorities like family) and need to devote extra time, or when they want to take a break from school for a while, etc etc

Of course, if someone tells you that it is uncommon to start fellowship directly after residency, what would that change for you?

 

[KarmaIsTruth]

If you know what you want to do, you shouldn't have a problem going to fellowship directly afterwards.
Gaps exist when someone decides late, and doesn't have time to prepare or apply for fellowship, or when they don't prioritize building a strong application (because of legitimate other priorities like family) and need to devote extra time, or when they want to take a break from school for a while, etc etc

Of course, if someone tells you that it is uncommon to start fellowship directly after residency, what would that change for you?

I suppose I could consider the military scholarship.

I would have to serve 3 years post-residency.

Hence this question. But I guess what those med students said was false?

I'd rather just go straight to fellowship. I challenged them saying it wasn't possible in the military - since the military needs IM docs more than specialists. They said it wasn't exactly possible in the civilian world either - due to competitiveness or something.

 

[karayaa]

I suppose I could consider the military scholarship.

I would have to serve 3 years post-residency.

Hence this question. But I guess what those med students said was false?

I'd rather just go straight to fellowship. I challenged them saying it wasn't possible in the military - since the military needs IM docs more than specialists. They said it wasn't exactly possible in the civilian world either - due to competitiveness or something.

If you're not competitive, you might not get in right away. That makes sense, right?
Sometimes people focus and become competitive during residency, and sometimes they take more time.

 

[DubVille]

If you dont want to go to the "top places" you wont need to do much to get into rheumatology besides apply. Again 50% or more of all medicine residents do a fellowship, most of them go directly after residency. With the exception of a few specialties getting a fellowship doesnt require much application building.

 

[235009]

It's not surprising that the military recruiters lied to your friends. Going straight into fellowship is very common and for people doing specialties that aren't competitive (like rheum) you would only take time off for personal reasons. Taking 3+ years between residency and fellowship (as you would be forced to do in the military) is very rare and typically is due to personal reasons. The military scholarship takes advantage of the shortsightedness of some med students. Someone on military scholarship I know was forced to do FM Instead of anesthesia. Once you've taken their money they essentially own you and you're no longer making your own career decisions.

 

[IlDestriero]

Someone on military scholarship I know was forced to do FM Instead of anesthesia. Once you've taken their money they essentially own you and you're no longer making your own career decisions.

That's not correct. They can't force you to accept any residency against your will. You can always ride out your time as a GMO and apply for civilian training when your commitment ends.
It is possible that they convinced this person that they are not competitive for anesthesia and they then applied to and were accepted to a FM residency.

 

[235009]

That's not correct. They can't force you to accept any residency against your will. You can always ride out your time as a GMO and apply for civilian training when your commitment ends.
It is possible that they convinced this person that they are not competitive for anesthesia and they then applied to and were accepted to a FM residency.

I don't know the specifics here but "civilian" anesthesia residency programs are really easy to match into and this person would've easily matched

 

[BigRedBeta]

I was speaking with medical students who are in the military scholarship.

They told me that it's very rare nowadays for people to go from a civilian residency directly into a civilian fellowship due to competitiveness.

I want internal medicine and go directly to fellowship (probably rheumatology or immunology) - without working as a hospitalist for a year or two.

The military med students told me I would have to be exceptional to do this.

Is this true?

I've not heard this, but my end is coming from pediatrics. That's what makes this sort of statement extremely misleading. I can come up with examples in which doing a standard residency with no extra time and getting into a particular fellowship would require an exceptional individual - pediatric surgery comes to mind. But that's not every single fellowship out of general surgery, just one. For a specialty like pediatrics - it is extremely common to go straight from residency to fellowship. An extra year may help land a spot at a "top" fellowship program depending on the field, but is not necessary if you've planned ahead.

You shouldn't consider taking a year or two as a hospitalist to be problematic though - it may end up being the right thing for you and/or your family. You may find out that you actually don't like rheum or immuno and be left trying to figure out your next step. You may need to have an exceptional CV to get into a program that fits your needs the best. There are lots of scenarios where an extra year or two would mean a lot to you...

 

[KarmaIsTruth]

If you dont want to go to the "top places" you wont need to do much to get into rheumatology besides apply. Again 50% or more of all medicine residents do a fellowship, most of them go directly after residency. With the exception of a few specialties getting a fellowship doesnt require much application building.

Just out of curiosity:
Which fellowships DO require "application building"?

 

[DubVille]

Well "knowing" the right people or being at a residency that has fellowships that take alot of in house residents could be all you need. I would estimate even for competitive fellowships you don't need to do a ton of extra "stuff" to match somewhere. I am not in IM, so I may not be exactly right, but here is my best guess:

Most competitive:
GI (I think its firmly the hardest over cardiology now)
Cardiology

Pretty competitive: (I know some people who matched at non top places by being well liked and doing elective at the place they went)
Heme/onc
Pulmonology/Critical Care
Allergy??? Its a tiny field honestly idk for sure

Not competitive: if you dont care where you go, could probably just apply.
Nephrology
Rheumatology
Endocrinology
Geriatrics
Infectious Disease

Again if you want to stay in NYC, San Fran, etc.... Or want a top place any field can be harder to match. Any medicine residents/attendings may be able to give more details.

 

[----------12c]

OP I think the problem is you talked to students who are in the military. Of course they will make up crap and hope you will believe them and join. Obviously if you are in medical school you are smarter than most. If you put in the work you can get a fellowship.

 

[KarmaIsTruth]

Well "knowing" the right people or being at a residency that has fellowships that take alot of in house residents could be all you need. I would estimate even for competitive fellowships you don't need to do a ton of extra "stuff" to match somewhere. I am not in IM, so I may not be exactly right, but here is my best guess:

Most competitive:
GI (I think its firmly the hardest over cardiology now)
Cardiology

Pretty competitive: (I know some people who matched at non top places by being well liked and doing elective at the place they went)
Heme/onc
Pulmonology/Critical Care
Allergy??? Its a tiny field honestly idk for sure

Not competitive: if you dont care where you go, could probably just apply.
Nephrology
Rheumatology
Endocrinology
Geriatrics
Infectious Disease

Again if you want to stay in NYC, San Fran, etc.... Or want a top place any field can be harder to match. Any medicine residents/attendings may be able to give more details.

Very cool.

Thank you.

I'm definitely aiming for the least competitive ones.