Going into IM after a previous residency: welcome aProgDirector's thoughts

[vkrn]

Would love input, in particular aProgDirector and anyone else with an insider's perspective:

I am seriously considering doing a second residency in internal medicine after completing my dermatology residency. I just talked to a resident at a top-2 Northeastern program in Boston who switched in to internal medicine as a PGY2 after completing intern year and a year of radiology. He said it is extremely difficult to match into a top program. His board scores were stellar, for both Steps, as I gathered.

But I think many people may be interested in getting double boarded, and wonder about the process, particularly if there would be a funding obstacle.

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[glorytaker]

My main question is WHY? You're going backwards!!! I know people who are doing IM first, then do Derm because of how competitive it is.

 

[babyruth]

You are currently in a derm residency I take it? As of now, it seems harder to get into derm programs than IM programs. The top IM programs are going to be competitive no matter what. If you are doing international work, do you really need a top program? Why not go for second or third tier or even those that do international rotations? These would be easier to get into and would still be good for your career choice.

 

[glorytaker]

OK, let me spell it out this way: with IM- you get called all the time, you have to round all the time, going to the hosp at all times of the day, doing admit orders and H&P's, tranfer summaries, etc

Derm: Outpatient, no emergencies, great lifestyle. Everyone I've talked to who did combined residencies (IM/Derm, ER/FP, IM/ER) all are doing the speciality that has a better lifestyle.

 

[mig26x]

OK, let me spell it out this way: with IM- you get called all the time, you have to round all the time, going to the hosp at all times of the day, doing admit orders and H&P's, tranfer summaries, etc

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thats the beauty of IM, real medicine!!

 

[vkrn]

yeah yeah yeah I can't help it. I love IM. Anyway, it's being able to combine them.

 

[glorytaker]

yeah yeah yeah I can't help it. I love IM. Anyway, it's being able to combine them.

Then how about this? You give me your Derm spot and I'll give you my IM spot and everyone's happy!

 

[Jonath00]

starting my internship this summer, then 3 years more of derm. I realize my thoughts might change.

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babyruth I love your moderndilettante link! I now have free NYTimes Select...

VKRN, not to offend you.. but You brag a lot

Consdering how competitive Derm is, I really feel sorry for that 'one' bright med student who could've gotten into a Derm position had a confused and 'entitled' med. student like yourself thought it out during your rotations. Its just such a shame

 

[NotAProgDirector]

Couple of options/ideas:

1. You could certainly finish your derm residency and then start an IM residency. You should be able to get credit for your PGY-1 year, and start at the PGY-2 year. However, realistically whether you'd be comfortable being a PGY-2 in medicine after a PGY-1 year followed by three years of derm is another thing -- you might feel quite rusty!

2. You could ask your home program whether you could do both residencies interwoven. For example, you could do a PGY-1 medicine prelim, and then 4 years of 50% derm and 50% IM, followed by 1 year of derm. Total of 6 years, same as option #1, but perhaps more practical. Would require buy in from both derm and IM in your home program, and there are all sorts of scheduling problems that this causes (like how you continue your IM clinic when rotating on derm, for example).

3. You could really shoot for the moon, and see if your new program is willing to start a med/derm combined program for you. This would save you one year of training (5 total) and would extend your medicare funding for the full 5 years. It would require your program to jump through all sorts of hoops -- writing a curriculum, etc. If they were thinking of starting a med/derm pathway and if you volunteered to help with all the curriculum writing etc, who knows?

Although this kind of training sounds crazy to most, your derm PD may be very excited about it. Academic Derm is a dying field, and people crazy enough to do both med and derm training are often crazy enough to stay in academic derm.

 

[chicamedica]

Why cant you just do PGY2 and PGY3 of IM at the program where you're doing prelim year? If you do a good job as an intern, i'm sure if you talk to the PD, they'd either let you stay or come back in a few years. Often it's v. difficult to get into a PGY2 year at one of the big name IM programs because of the way they're structured. Many are front-loaded and if you didn't do intern year there, it just doesn't work to transfer in at the PGY2 level. As for the funding, i dont know how that would work.

 

[Cirrus83]

You know, while the OP might seem kinda crazy, my mother feels like all the IM stuff is what being a doctor is all about, so she told me I should do an IM residency even if I go into a specialty that doesn't require it...so I guess the OP isn't the only person who thinks this way =p

 

[Adcadet]

You know, while the OP might seem kinda crazy, my mother feels like all the IM stuff is what being a doctor is all about, so she told me I should do an IM residency even if I go into a specialty that doesn't require it...so I guess the OP isn't the only person who thinks this way =p

I think many people think this way. I do. Not that other specialists aren't doctors, of course, by the core of being a doctor is IM to me. I'm guessing you haven't applied to residency programs yet, but when you do, I suggest not using the "my mother said" line.

 

[E Yorrick Davis]

I think many people think this way. I do. Not that other specialists aren't doctors, of course, by the core of being a doctor is IM to me. I'm guessing you haven't applied to residency programs yet, but when you do, I suggest not using the "my mother said" line.

i fully agree. and it definitely wouldn't hurt when you see periorbital petechiae to remember what rheumatologic condition it goes with--the link between derm and IM is strong. might even be stronger than some of the IM subspecialties.

vkrm, my understanding is that it is difficult to be funded for the additional training because government grants have pre-set limits on how many years of training they will fund a specific resident for training after graduation (i believe they get something around 100k per resident, they pay part as your salary, and keep the remainder for 'training fees').

i remember a colleague of mine who had this issue when trying to go into derm after a full medicine residency. i'm sure aprogdirector would have far more insight about this than i.

 

[vkrn]

Am working in sub-Saharan Africa now, and am witnessing how tightly derm is related to IM, and how I really want that IM training. Am also acutely aware of the funding issue, although someone told me that IM programs are more flexible? Would have to work it out with the program, I'm sure.

 

[ChildNeuro]

Wow, I think that your plans to combine dermatology and internal medicine are an excellent strategy. I get the feeling that in internal health it is good to have general competence in internal medicine, pediatrics, or emergency medicine. It would be very helpful internationally speaking to have the dermatology training as there are alot skin diseases that may manifest and the near dermatologist may be 500 miles away. I would concur that you should talk to your program director about your desire to add on internal medicine training to dermatology training. I would suspect that people trained in both are top dermatologists. I would wager that if you had to finish your dermatology residency without any special deal from the department for doing an internal medicine residency there, that you would be able to easily find another IM residency for PGY-2, PGY-3. I would strongly recommend that you research international health residency in IM, they allow sometime i.e. months, for international work during residency and you get alot contacts in IH during the residency. Often these are done in prestigious institutions too:

INTERNAL MEDICINE
Brown University
Internal Medicine International Health Tract
UMN Global Health Pathway
Contact: Holly J. Heisler, MPH
Duke University Durham, NC
Contact: Ralph Corey, MD
Indiana University Indianapolis, IN
Contact: Robert Einterz, MD
University of Pittsburgh Global Health Track
Contact: Thuy Bui, MD
West Virginia University
International Health Program, Byrd Health Sciences Center, Morgantown, WV
Tel: (304) 293-5916
Yale Internal Medicine/Primary Care Medicine
International Health Elective Program

I don't know alot about IM, but I think that Duke is not too shaby a program!

 

[vkrn]

AWESOME list---I did not realize there were specific international health programs differentiated among the IM crowd.

I was also thinking of doing a family medicine residency, because that would be very useful in general as well.

The most efficient way, probably, is to tack on a couple more training years at my home derm institution.

In dermatology clinic the other day, saw leprosy for the first time. Lots of pathology here, but also lots of bread-and-butter: Eczema, atopic dermatitis...

 

[ChildNeuro]

Interesting experience to say the least, I have seen eczema in the US, but no leprosy. Definitely "tacking on" a couple of years IM residency at your home institution would probably be the easiest. Obviously, even if you don't do an IH geared IM residency there are still many wonderful opportunities for working in the IH field, if someone is already dedicated to IH I am not sure what advantage the IH residencies offer, but would be alot of fun.