Help needed from a soon-to-be med student...

[DocKat]

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Hey guys

I am currently in the process of choosing medical schools (I will be part of the class of 2010 🙂 ) but I just realized how much I don’t know! Many people say to compare match list of schools that you get into and see how competitive the match lists are…but I just get more and more confused from reading the lists, so I desperately need some help from all you med experts out there in deciphering them. Here are my questions:

1) For a school that I am interested in, many people match into internal medicine…but does this mean that they will all end up being primary care physicians? I thought that internal medicine consists of many specialties such as cardiology, endocrinology, etc., but how come I’ve never really seen people match straight into these specialties right out of med school? Do you have to match into internal medicine first and then do a fellowship? Then what determine if you end up being a specialist or a primary care internal physician?

2) On match lists, I’ve seen the term medicine-primary and surgery-preliminary. What exactly does the “preliminary” term mean in these cases?

3) What is Medicine-Primary?

4) What is general surgery? How is it different form just surgery?

I know that my questions may seem very stupid, but I am a clueless prospective med student who is really feeling overwhelmed right. Now that I have gotten in, I just realized how much there is to learn about the medical field. What resources do you guys suggest in order to brush up on my knowledge of exactly what each specialty is and the training/type of residency involved? Also, what suggestions would you guys give in choosing a medical school? Do rankings really not matter at all? Thanks so much for your help and I look forward towards joining this thread soon!

 

[jennyboo]

Hmm. That's actually a really good question. It *is* worth looking at the quality of the match list, but as an entering medical student it's very difficult to tell what's "good." Some quick-and-dirty ways I could suggest to evaluate the match list:

Local vs National. Do most students remain in-state or do many go to other states? Look for major cities that are "hot" locations where many people may want to move after med school (Boston, New York, California, Seattle, etc). Personally, I think that if you see a decent number of students going to these highly desired locations, it's a good sign that the students are able to build competitive residency applications after going through this school. (And if you're completely interested in staying in-state, then it doesn't matter.)

"Top" residency programs. Unlike medical schools which are all one package and all have a US News ranking, residencies don't have this. Some departments at "top" hospitals are great while others suck. But, although it isn't very reliable, you can still "ballpark" estimate the number of residency programs with good reputations by using that very same US News ranking. The top 10 or 15 medical schools often have associated highly-desired residency programs. If a decent number of students match at these programs, it's a good sign that the school is able to make them competitive applicants.

Highly competitive specialties. Look at the number of people who matched in highly competitive specialties, and look at where they matched. Highly competitive probably includes dermatology, radiology, radiation oncology, ophthalmology, ENT, neurosurgery, plastic surgery, and orthopedic surgery. If there are few to no students who went into these specialties, I think that is a disadvantage should you choose to go these routes later. The main thing is to see whether ANYONE is going into these specialties. It shouldn't be more than the number of people going into internal medicine, but none at all is a red flag to me.

Internal medicine (cardiology, gastroenterology, medical oncology, etc are fellowships AFTER internal med) is going to be the most "popular" specialty among students based on straight numbers at any school. The question is whether many students go to nationally reputable residency programs, and whether many students are able to match (and, even better, match well) in highly competitive specialties and programs.

 

[Brainsucker]

If you already know what specialty you're interested in, you should just concentrate on that specialty specifically (going back a few years). My school has particularly impressive match lists in neurosurgery year after year, for example.

It also depends on what sort of career you want. If you're interested in primary care or working at a community hospital, you won't need the competitive academic residency that you would for academic medicine. Of course, just matching in the specialties the last poster listed is a challenge.

 

[Krazykritter]

1) A lot of people match into Int. Med b/c you often must do a combined (e.g. Cardiology requires 3 year IM and 3 year cardiology). There are relatively few (and highly competitive) spots for straight cards.

2) I believe that Medicine-Primary is an emphasis on Internal med that will be focuses on hospitalist type primary care training (not sure about this one though)

3) In regards to surgery...it is the same thing as general. Prelim surgery is a one year spot that people do for one of a couple reasons; it is often required for specialties like Ortho, ENT, and a few others or the person did not match into the Categorical (5 year) residency and will apply for either a PGY-2 spot the next year or re-do their intern year as a Categorical the next year.

I think that covers it...hope it helps

 

[DocKat]

1) A lot of people match into Int. Med b/c you often must do a combined (e.g. Cardiology requires 3 year IM and 3 year cardiology). There are relatively few (and highly competitive) spots for straight cards.

So most people who match into Internal medicine straight out of med school don't become primary care docs since an internal medicine residency is required for specialities such as pulmonary, nephrology, endocrinology and hematology? Thanks so much for your help 🙂

 

[jennyboo]

So most people who match into Internal medicine straight out of med school don't become primary care docs since an internal medicine residency is required for specialities such as pulmonary, nephrology, endocrinology and hematology? Thanks so much for your help 🙂

Internal med = 3 year residency

After the 3 year residency, you can stop and not specialize anymore. You are then a "general internist" which involves working either in an office (primary care) or in a hospital (hospitalist), or some people actually round on their own patients in the hospital and don't need with a hospitalist to manage their patients who go into the hospital. Office vs hospital depends on your preference.

But if you WANT to subspecialize, you do an additional fellowship.

So Internal Medicine includes people who both do and don't go into primary care.

 

[AJM]

1) A lot of people match into Int. Med b/c you often must do a combined (e.g. Cardiology requires 3 year IM and 3 year cardiology). There are relatively few (and highly competitive) spots for straight cards.

Actually, there are no spots for straight cards. In order to do cardiology, pulmonary, GI, or any of the other IM specialties you absolutely have to first do a residency in IM. That's why you don't see the IM subspecilties on residency match lists. And FYI, about 50% of IM residency graduates go on to do subspecialty fellowships.

2) I believe that Medicine-Primary is an emphasis on Internal med that will be focuses on hospitalist type primary care training (not sure about this one though)

Not really -- you're thinking of a different IM residency tract in your above explanation. Medicine-Primary refers to the primary care tract that many IM programs offer. This tract places emphasis on outpatient primary care, and the majority of people who go through a primary care IM residency will end up going into primary care in the outpatient setting. (although you can still choose to specialize in any of the IM specialties if you decide you don't want to do primary care). Some programs are starting to develop hospitalist tracts that focus on inpatient general internal medicine, although these tracts have not yet been formalized by the ABIM.

 

[size_tens]

I think choosing a med school based on what specialty you think you might want to go into is very dicey. Most med students change their minds numerous times on this issue.