Going back for a 2nd residency?

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MedicineZ0Z said:
That's true. So maybe once you shut down all of that first, then you can turn to the problem of unprepared FM doing hospitalist work. A problem which is maybe 1/100th as bad as midlevels who have less far inpatient training than a med student.

Also, I like how we're pretending that hospitalist work is overly challenging. Unless you're managing an open ICU or have to do procedures or have minimal consultant support - then you're a secretary who can treat CHF/COPD/PNA.
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I think you are on point on your first paragraph--not so on your second
 
MedicineZ0Z said:
Also, I like how we're pretending that hospitalist work is overly challenging. Unless you're managing an open ICU or have to do procedures or have minimal consultant support - then you're a secretary who can treat CHF/COPD/PNA.
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Dunning-Kruger. You do realize that the same argument can be made for midlevels masquerading as FM docs in the outpatient setting? Just refer out, am i rite?
 
MedicineZ0Z said:
That's true. So maybe once you shut down all of that first, then you can turn to the problem of unprepared FM doing hospitalist work. A problem which is maybe 1/100th as bad as midlevels who have less far inpatient training than a med student.

Also, I like how we're pretending that hospitalist work is overly challenging. Unless you're managing an open ICU or have to do procedures or have minimal consultant support - then you're a secretary who can treat CHF/COPD/PNA.
Click to expand...
Dude, what is your problem? No one has said that FM can’t do hospital medicine, but it has been pointed out , by FM docs no less, that FM residencies can vary in the amount of inpt rotations...more so than IM residencies since IM must have a certain number of inpt as well as icu rotations for eligibility to sit for the boards...now you say hospitalist are merely secretaries...which shows that you have never done ANY hospitalist work.
 
rokshana said:
Dude, what is your problem? No one has said that FM can’t do hospital medicine, but it has been pointed out , by FM docs no less, that FM residencies can vary in the amount of inpt rotations...more so than IM residencies since IM must have a certain number of inpt as well as icu rotations for eligibility to sit for the boards...now you say hospitalist are merely secretaries...which shows that you have never done ANY hospitalist work.
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That was an obvious joke. And you miss the point. Your biggest concern should be midlevels doing inpatient work. Until you address the alarming issue, its silly to look at relatively minor issues in comparison.
 
MedicineZ0Z said:
That was an obvious joke. And you miss the point. Your biggest concern should be midlevels doing inpatient work. Until you address the alarming issue, its silly to look at relatively minor issues in comparison.
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Everyone agrees midlevels should not practice medicine independently. It's a joke that people are practicing medicine in the US with only 500 hrs preceptorship.
 
MedicineZ0Z said:
That was an obvious joke. And you miss the point. Your biggest concern should be midlevels doing inpatient work. Until you address the alarming issue, its silly to look at relatively minor issues in comparison.
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Really? Since it’s not the first time you have compared hospitalists to secretaries...
 
Splenda88 said:
Everyone agrees midlevels should not practice medicine independently. It's a joke that people are practicing medicine in the US with only 500 hrs preceptorship.
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Right, so lets fix that first before moving onto relatively tiny problems.
 
So I'm going to try to open this thread up back again as I do want some advice/help. I know before I had decided not to go back to residency but I am now really feeling the urge and having that fire/passion to pursue it knowing that I have a long road ahead. Any thoughts on how I should apply/approach this? Just go the typical normal ERAS route and apply for a categorical IM position? or is it worthwhile for me to try to see if I can get a credit for the 4.5 years of hospitalist work I will have done (by the time I start July 2021 it would be 4.5 years)? If the latter should i just email programs and see what they say?
 
Theoretically, you can get credit for your PGY-1 and start at the PGY-2 level. It's listed here, under "Credit in Lieu of Standard Training for Internal Medicine Candidates": Internal Medicine Certification Policies | ABIM.org

This would totally be up to an IM PD, you can't request credit on your own. So, you could contact IM programs looking for a PGY-2 spot and see if any are willing to consider you. It's impossible to tell you what your chances are, but it won't cost anything except for your time, and ego (if unsuccessful). PGY-2 IM positions are not in ERAS.

You could instead try to apply for a PGY-1 spot. You could put an ERAS app together (quickly!) and participate in SOAP, although the quality of program you'd get might be limited. Or you could wait until next year.

Probably the best plan is to try to find a PGY-2 between now and the summer, and if unsuccessful plan to submit an ERAS app. In the app you could mention that youre willing to consider both PGY-1 and PGY-2 positions.

If you have any connections to IM programs, you should use them. if there was an IM program where you trained in FM, that might be an option.

Since you're interested in Cards, you'd need to look at any programs you're considering and how successful their grads have been in Cards.

Your background is really important. US MD, US DO, or IMG? USMLE scores?
 
aProgDirector said:
Theoretically, you can get credit for your PGY-1 and start at the PGY-2 level. It's listed here, under "Credit in Lieu of Standard Training for Internal Medicine Candidates": Internal Medicine Certification Policies | ABIM.org

This would totally be up to an IM PD, you can't request credit on your own. So, you could contact IM programs looking for a PGY-2 spot and see if any are willing to consider you. It's impossible to tell you what your chances are, but it won't cost anything except for your time, and ego (if unsuccessful). PGY-2 IM positions are not in ERAS.

You could instead try to apply for a PGY-1 spot. You could put an ERAS app together (quickly!) and participate in SOAP, although the quality of program you'd get might be limited. Or you could wait until next year.

Probably the best plan is to try to find a PGY-2 between now and the summer, and if unsuccessful plan to submit an ERAS app. In the app you could mention that youre willing to consider both PGY-1 and PGY-2 positions.

If you have any connections to IM programs, you should use them. if there was an IM program where you trained in FM, that might be an option.

Since you're interested in Cards, you'd need to look at any programs you're considering and how successful their grads have been in Cards.

Your background is really important. US MD, US DO, or IMG? USMLE scores?
Click to expand...
Thanks for that policy thread it helped make me aware of the possibility of credits.

So this may be a dumb question but where can I check to see open PGY-2 spots?

I don't have direct connections but friends I work with do, so far the one PD she asked on my behalf say it was "likely I'd have to do 3 years due to funding but it's a case by case situation they assess"

Definitely want a quality program as since my goal is fellowship in cards it wouldn't make sense to apply to any random place and not have a good chance at fellowship after.

They have a IM program where I trained, I actually almost switched out of PGY-2 FM to join them and at that time I think the PD was giving me 3 months credit or something like that? (it's been a while). At that time I didn't want to leave 1 year left on FM so I decided to complete it then started working and here I am now.

Been many years since I did them, but the scores off the top of my head are 225/215/210. I'm a IMG canadian citizen.
 
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There is no place to check for open IM PGY-2 spots. You just have to find one. They don't open often because they only exist if someone else drops out / fails out / etc.

With USMLE scores like that, as an IMG, your chances of getting Cards isn't very good.

If you're still on some sort of visa, it's even worse.

You'll need to decide whether it's worth trying to do this.

Funding is a whole other issue -- you'll have decreased funding because this is a second residency. Whether or not prgrams will care is variable.
 
aProgDirector said:
There is no place to check for open IM PGY-2 spots. You just have to find one. They don't open often because they only exist if someone else drops out / fails out / etc.

With USMLE scores like that, as an IMG, your chances of getting Cards isn't very good.

If you're still on some sort of visa, it's even worse.

You'll need to decide whether it's worth trying to do this.

Funding is a whole other issue -- you'll have decreased funding because this is a second residency. Whether or not prgrams will care is variable.
Click to expand...
Well that's good ot know before hand on making a decision like this. So I thought score would be more important for the primary care residencies and fellowships want to look at all the extra stuff like research publications that you do for the respective fields?

My employer applied for my green card so will have it by June.

Definitely will think more into it if the scores are going to weight that heavily. Might not be worth the effort and money lost then.
 
If you’re gonna be a green card holder that’s definitely a plus!

off topic: what about someone who wants to go for derm after completing a fm residency? Will they be given some credit?
 
Is it too late in the season to apply for IM programs? Ideally I'd still want a 2nd year spot but I'm totally open to applying and discussing it during my interviews to see what the respective programs can offer for credit. Other option I was thinking is I could apply next year September to maximize my opportunities since I fear it may be too late in the season now.
 
It's very late to be applying. You have a relatively weak application to start with, so you really want to maximize everything else. Of course, it's only money and you're making a good salary. But I'm assuming you haven't even started yet -- it will stll take you 2 weeks to get LORs written and uploaded, your medical school transcript and MSPE, etc. So really not a good idea.

Earlier in the thread you mentioned you were doing this to get a cardiology spot. You really need the best program you can get to do this. IMG's with step scores in your ranges had about a 50% chance of matching in Cardiology -- so it's possible but a big risk. You need a program with an in-house Cardiology fellowship. "Just any IM spot" is a bad idea.

My advice is the same as earlier on the thread. Look for a PGY-2 position from now through the summer. They are not easy to find, but you can try. If there's a local program you should talk to the PD -- if they won't consider you (or simply don't have a spot), they may hear of others and forward that information to you. Failing that, you may just want to reach out to programs and see. Don't bother with big academic programs - they are not taking you. Play up your clinical experience as a strength. If your current position is outpatient, find a way to get more inpatient experience. Get new LOR's from internists for the next match cycle. If you don't find a PGY-2 spot, then you apply in the match as a PGY-1. Programs that have an open PGY-2 position and might be interested will reach out to you -- that's how I filled many of my open PGY-2 positions.
 
OP sounds like he/she made their decision but man. I had the radiology itch when I did 2 attending yrs of EM. Back them Rad was not competitive and I am sure I could have gotten a spot. Needless to say, I am so glad I didn't torture myself for another 5 yrs.

Problem with Ops decision is you have no clue what will happen to a field in 5-10 yrs. Assuming everything goes well and you do get into Cards, you still have no clue what it will be like in 5-10 yrs. Cards could easily have their legs cut off by the carriers/Medicare, then you will be stuck working 2x as hard for less money.

Good luck and I hope to hear an update in 7-10yrs but giving up 3M is a hard pill to swallow. Ask yourself this. If I came to you and said, "You will get a 1/2 chance to get into cards and you have to pay me $3M", would you take it?
 
Do you have what it takes to match to ELITE IM residencies? I’m talking Hopkins, Mayo, Harvard, etc. Because that is the only way I’d even consider it. There is no guarantee that you’ll get interventional cards...but coming from a residency like that would help. Frankly, if you do consider this insane plan, I’d only apply to those type of programs.

If you aren’t good enough to get THOSE residencies you will highly unlikely be competitive enough for interventional cardiology. As an IMG in FM...I have to guess that you aren’t competitive...even with the job experience. Using that strategy could very well save you. The last thing you want to do is get into anything less than elite residency...that would do nothing more than take years off your life and cost over $500k.
 
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905doc said:
So I'm going to try to open this thread up back again as I do want some advice/help. I know before I had decided not to go back to residency but I am now really feeling the urge and having that fire/passion to pursue it knowing that I have a long road ahead.
Click to expand...

This may sound like I'm asking a stupid question, but where exactly is this "urge/fire/passion" coming from? Is it from working with colleagues in cardiology and saying "hey, I want to do that"? The reason I ask is because I feel like your decision to put yourself through this time/money sacrifice (which is not at all insignificant) again should be based more on a good understanding of what cardiologists do on a day-to-day basis so you have an idea of what your life would look like after you're done; not everything about the day-to-day job is glamorous and exciting.
 
NotAProgDirector said:
It's very late to be applying. You have a relatively weak application to start with, so you really want to maximize everything else. Of course, it's only money and you're making a good salary. But I'm assuming you haven't even started yet -- it will stll take you 2 weeks to get LORs written and uploaded, your medical school transcript and MSPE, etc. So really not a good idea.

Earlier in the thread you mentioned you were doing this to get a cardiology spot. You really need the best program you can get to do this. IMG's with step scores in your ranges had about a 50% chance of matching in Cardiology -- so it's possible but a big risk. You need a program with an in-house Cardiology fellowship. "Just any IM spot" is a bad idea.

My advice is the same as earlier on the thread. Look for a PGY-2 position from now through the summer. They are not easy to find, but you can try. If there's a local program you should talk to the PD -- if they won't consider you (or simply don't have a spot), they may hear of others and forward that information to you. Failing that, you may just want to reach out to programs and see. Don't bother with big academic programs - they are not taking you. Play up your clinical experience as a strength. If your current position is outpatient, find a way to get more inpatient experience. Get new LOR's from internists for the next match cycle. If you don't find a PGY-2 spot, then you apply in the match as a PGY-1. Programs that have an open PGY-2 position and might be interested will reach out to you -- that's how I filled many of my open PGY-2 positions.
Click to expand...
I had a feeling it was too late but just thought I'd ask get some feedback just in case. I appreciate your response. I have been looking for PGY-2 spots over the last few months, not easy at all like you said. Even had colleagues refer me to their programs etc. Most the replies I got where that ACGME would not allow them which contraindicated a link you had provided me earlier saying they could if they wanted to but they'd have to file a case for me to get credit, others said that they can't guarantee it and where wishy washy and most said they don't have PGY-2 spots right now. Yes I only contacted programs that have in house subspecialty programs for cards, GI, crit care. (those are 3 I'm interested in). Most programs I reached out to are local. I've been working as a Hospitalist since I graduated for 4 years now at a busy hospital so getting LOR's from internists, directors, subspecialties won't be hard since most are my colleagues. So really the only way to look for PGY-2 spots is to cold call?
 
emergentmd said:
OP sounds like he/she made their decision but man. I had the radiology itch when I did 2 attending yrs of EM. Back them Rad was not competitive and I am sure I could have gotten a spot. Needless to say, I am so glad I didn't torture myself for another 5 yrs.

Problem with Ops decision is you have no clue what will happen to a field in 5-10 yrs. Assuming everything goes well and you do get into Cards, you still have no clue what it will be like in 5-10 yrs. Cards could easily have their legs cut off by the carriers/Medicare, then you will be stuck working 2x as hard for less money.

Good luck and I hope to hear an update in 7-10yrs but giving up 3M is a hard pill to swallow. Ask yourself this. If I came to you and said, "You will get a 1/2 chance to get into cards and you have to pay me $3M", would you take it?
Click to expand...
Not doing it for the money, in my first few years of working as a Hospitalist and moon lighting a ton I made more than a lot of the consultants at my facility. Also I don't count the fellowship years as lost income as I would've had to do those anyways had I gone through IM.
 
j4pac said:
Do you have what it takes to match to ELITE IM residencies? I’m talking Hopkins, Mayo, Harvard, etc. Because that is the only way I’d even consider it. There is no guarantee that you’ll get interventional cards...but coming from a residency like that would help. Frankly, if you do consider this insane plan, I’d only apply to those type of programs.

If you aren’t good enough to get THOSE residencies you will highly unlikely be competitive enough for interventional cardiology. As an IMG in FM...I have to guess that you aren’t competitive...even with the job experience. Using that strategy could very well save you. The last thing you want to do is get into anything less than elite residency...that would do nothing more than take years off your life and cost over $500k.
Click to expand...
I'm only going to try to get into a good program that would give me a shot at a fellowship. Anything less and I don't plan to do it.
 
greatnt249 said:
This may sound like I'm asking a stupid question, but where exactly is this "urge/fire/passion" coming from? Is it from working with colleagues in cardiology and saying "hey, I want to do that"? The reason I ask is because I feel like your decision to put yourself through this time/money sacrifice (which is not at all insignificant) again should be based more on a good understanding of what cardiologists do on a day-to-day basis so you have an idea of what your life would look like after you're done; not everything about the day-to-day job is glamorous and exciting.
Click to expand...
I almost switched during FM residency after 2nd year but I didn't want to leave FM undone with 1 year left plus knowing I could still work as a Hospitalist figured that would satisfy my appetite for wanting to do a fellowship. I don't hate being a hospitalist but that void is still there for me enough to ask for advice on the process on this forum and pursue it.
 
Going back for IM with OPs stats and IMG status dead set on interventional cards is crazy. Just going back for a second residency is bad enough, but likely missing the fellowship too is just too much. I can’t see why this would be done. He would have better luck trying to get/pay someone to teach him caths now and get cath privileges at a rural hosp if he really wants to do it IMO.
 
Sorry for hijacking this thread. I am a IM hospitalist who graduated from residency 2 years ago. I love the variety in hospital medicine and the work I do, I love doing bedside echos and ultrasounds. I get worried when I hear few colleagues tell me that we will soon be replaced by cheap midlevels. I know my quality of care is much better than midlevels but since hospitalists are mostly employed, our employers don't care about the quality we provide compared to cost savings from hiring midlevel monkeys.

Lately I am having an urge to apply to Anesthesia as opposed to an IM fellowship. I like inpatient work without clinic and every anesthesiologist I met seem to love their job. I got burnout doing ICU mainly from social and ethical issues during residency and I know I can't be a full time intensivists for more than few years hence not so keen on PCCM. Isn't 3 more years in Anesthesia similar or better financially compared any other 3 yr IM fellowship (other than GI, cards). Is anesthesia a good career with long term job security compared to general IM ? Anesthesia subs keep saying the CRNA issue is overblown and they have been talking about that for the last 20 yrs but still they have great jobs with good demand.

So far I am living like a resident in case I lose my job to midlevels whenever that happens. Is it a good idea to consider anesthesia or IM fellowship for job security considering the flood of midlevels graduating every year (and depreciating primary care jobs) ?
 
@blue.jay

You want to leave IM because you are afraid of midlevel encroachment and your plan is to go into anesthesia. Seriously!


Work 10 more years and save some big $$$ so you can become financially independent. You will be able to do anything when the s... hit the fan.
 
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@blue.jay it is very common for IM to do anesthesia for a 2nd residency and most programs love having board certified IM physicians as residents. Like you said, the time commitment is the same as an IM fellowship.
 
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