Honest opinion/feedback, preferably from PD if possible

[curious doc]

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I wanted to get some honest feedback & advice regarding my circumstance for Internal Medicine.

Briefly, I'm a US medical school graduate from a University of California medical school. I passed USMLE Step 1 on my first attempt (with a low score), didn't pass USMLE Step 2 on my initial attempt and subsequently also had to take Step 3 more than once before I passed.

Because of my poor USMLE performance, I didn't match into Anesthesiology and thus scrambled into a preliminary Internal Medicine position. Although that program offered me a categorical PGY2 position, I chose not to stay there as I wasn't happy there and it wasn't to the caliber that I was used to coming from the UC system. I was able to find a PGY2 position in Family Medicine and completed that but left the program as I learned that being boarded in FM actually limits your chances of working as a hospitalist. So fortunately, I'm currently licensed in one state, practicing medicine doing house calls for a company.

However, I'm interested in going back complete an Internal Medicine residency so that I may be BC and have the option of being a hospitalist.

In reviewing many residency requirements, many (if not all) completely screen me out because of my poor USMLE performance. My clinical performance has never been an issue ( and I have LoRs proving that from my previous PDs). I've tried to find a PGY2 position outside the match to no avail, so the way I see it I have no choice but to go through the match again & start at PGY1.

Anyone have any honest opinions about my circumstance? While beggars can't be choosers, I would appreciate any advice from any PDs out there.

I welcome questions.

thanks for your time

 

[Leukocyte]

....being boarded in FM actually limits your chances of working as a hospitalist.

Who is the idiot who gave you such garbage? Our 3rd years' recieve Hospitalist job offers in the butt load. 75% of my program's last FM graduating class DECIDED to work as hospitalists, and currently working as full time Hospitalists, two of them at a University Hospital teaching service. How is a Hospitalist work different from what we do as FM residents on a day-to-day basis, except that now you are the attending and getting paid 10x more?🙄

 

[curious doc]

this has been the consensus from people I ask - where they are recruiters, fellow physicians or what have you.
While I understand there are many FM physicians doing hospitalists work, its my understanding they are the minority.

 

[DarthNeurology]

I wanted to get some honest feedback & advice regarding my circumstance for Internal Medicine.

Briefly, I'm a US medical school graduate from a University of California medical school. I passed USMLE Step 1 on my first attempt (with a low score), didn't pass USMLE Step 2 on my initial attempt and subsequently also had to take Step 3 more than once before I passed.

Because of my poor USMLE performance, I didn't match into Anesthesiology and thus scrambled into a preliminary Internal Medicine position. Although that program offered me a categorical PGY2 position, I chose not to stay there as I wasn't happy there and it wasn't to the caliber that I was used to coming from the UC system. I was able to find a PGY2 position in Family Medicine and completed that but left the program as I learned that being boarded in FM actually limits your chances of working as a hospitalist. So fortunately, I'm currently licensed in one state, practicing medicine doing house calls for a company.

However, I'm interested in going back complete an Internal Medicine residency so that I may be BC and have the option of being a hospitalist.

In reviewing many residency requirements, many (if not all) completely screen me out because of my poor USMLE performance. My clinical performance has never been an issue ( and I have LoRs proving that from my previous PDs). I've tried to find a PGY2 position outside the match to no avail, so the way I see it I have no choice but to go through the match again & start at PGY1.

Anyone have any honest opinions about my circumstance? While beggars can't be choosers, I would appreciate any advice from any PDs out there.

I welcome questions.

thanks for your time

I take it from your post that you failed Step 2 at least once (maybe twice?) and failed Step 3 at least two times and passed Step 1 with a low score. You should know that multiple failures will limit your ability to obtain medical license in some states. What happened at the University of California? While you may be used to their "caliber" it seems maybe you didn't get the education you needed to pass the steps?

Family Practice doctors can do almost everything in certain hospitals, just depends what the local culture is. I have seen Family Practice doctors do intensivist care and also emergency medicine work, so it actually is a versatile residency.

There are more PGY-2 outside the match than PGY-1 IM categorical positions, so if you wanted something fast you could apply to everything on websites that list the PGY-2 positions. Realize what states were you couldn't be licensed due to failure of licensing examinations. You may have to go through the match and realize you may or may not find something equal to the caliber of your glory days at UC as many IM programs will filter you out or be hesitant to take on a resident who not only failed the steps multiple times but didn't take an IM position and left a family practice position.

 

[Leukocyte]

While I understand there are many FM physicians doing hospitalists work, its my understanding they are the minority.

Yes, that is what "people" blabber about. I almost believed it too, until I saw it with my own eyes. So who do I believe, the "people", some of whom have never been in a FM program, or my own eyes? I can hardly call 7 out of 11 graduating residents in the real flesh currently working as hospitalists a minority. Have you looked in the Classified ads section in the American Family Physician lately? Hospitalist jobs there often list BC/BE in IM or FM.

 

[Winged Scapula]

I think you are a victim of the UC/university hospital mentality.

There is no doubt that the caliber of the medical schools in California is great. Unfortunately, with your USMLE performance you now have to ACCEPT that you will likely not be able to train at a program of such caliber. Regardless of how good you are clinically, this is the truth: programs will filter by USMLE score and number of attempts and you are ineligible for a medical license in several states due to the multiple attempts. The sooner you realize that your UC halcyon days *may* be in the past, the sooner you can move on.

Secondly, what leukocyte and Darth tell you is true. FM physicians work in all arenas. It is true that at many university hospitals you do not see them working as hospitalists, but I have worked at many excellent community hospitals staffed by FM docs. And believe me, if I, as a surgeon, am aware of this and the job opportunities available to FM, surely there are tons of resources out there that I cannot begin to know how to access.

Lastly, do not believe anything a recruiter tells you. They know only what they want to know ad will hide whatever they can from you. If they have not ever recruited an FM as a hospitalist, they will tell you its impossible; same for fellow physicians. Do your own work, look at the ads, talk to some FM people. I think your information comes from people with limited viewpoint and experience.

At any rate, getting back into medicine will be hard, but choose the route which suits you best and you will have the most success, whether it be IM or FM.

 

[NotAProgDirector]

Well, you asked for a PD's opinion. So, here it is:

First, your story is an important one for people to hear. What people forget about the standardized testing that medical training entails is that it is inherently pyramidal. Here's what I mean: Of all of the people who are in college, some get into medical school. Of those, probably 95% graduate -- 5% don't, weeded out by the USMLE, coursework, etc. Of those that graduate, most get a residency but some do not -- they pass everything but have enough problems that no one is willing to take a risk on them. And then, of those that get into residency, not all graduate -- either due to getting terminated, or failing the boards, etc.

Medical school is still a better "deal" than law school or business school -- meaning that the chances of coming through it and having a good job making a good living is very much in your favor. But there are no guarantees.

Second: You've made some bad decisions. You had an IM spot, not perfect per your standards, and gave it up. Switched to FM, and now gave that up also, probably on bad advice. Now you're looking for a third chance. There are many on this site that would kill for these opportunities.

What to do now:

Getting another spot is going to be difficult. Many IM programs won't take a risk on you, given your poor board scores, and now a history of switching programs every year. In addition, you'll have a funding problem in internal medicine for your last year, as you'll get no credit for your PGY2 in FM. The ABFP requires that the last 2 years of residency occur at the same program, so changing programs will extend your training by another year.

So, my suggestions are this:

1. Try to get back into your FM program. You can certainly be a hospialist as FM trained. If hospitalist medicine becomes it's own board, something that is nowhere near happening, there will be a way to be grandfathered in regardless of your prior training. You were foolish to leave your FM program in the first place. Ask for your spot back. Failing that, beg for your spot back.

2. Try to see if your prior IM program will take you back as a PGY-2.

3. Failing #1 and #2, you're going to have an uphill battle. I doubt anyone will take you as a PGY-1 again, given that you've completed a PGY-1 and a PGY-2. You're going to need to look for a PGY-2 spot in either IM or FM (again, as I believe the ABFP requires that the final two years be completed at the same program. If they are flexible about that, then I guess you could look for a PGY-3. However, I doubt they'll be flexible when you're asking to complete your PGY-1, 2, and 3 at three different programs)

 

[DarthNeurology]

There is no doubt that the caliber of the medical schools in California is great. Unfortunately, with your USMLE performance you now have to ACCEPT that you will likely not be able to train at a program of such caliber.

Secondly, what leukocyte and Darth tell you is true. FM physicians work in all arenas. It is true that at many university hospitals you do not see them working as hospitalists, but I have worked at many excellent community hospitals staffed by FM docs. And believe me, if I, as a surgeon, am aware of this and the job opportunities available to FM, surely there are tons of resources out there that I cannot begin to know how to access.

Wow, red letter day for me as Winged is agreeing with me! Heh heh. Anyway, I think if more U.S. medical students knew what family practicioners could do they would choose it. Many U.S. medical schools, perhaps UC, often produce few Family Practicioners as U.S. medical students don't want to be "restricted" to just doing Family Practice and the OP maybe needs to realize that he/she may have a better shot at Family Practice programs.

I do think the OP has a somewhat of a good shot at landing a Family Practice residency, although APD obviously indicates an uphill battle to one degree or another. I am 75% confident that if the OP applied for PGY-1 in Family Practice that he/she would land a position somewhere, after all aren't there more than a dozen residents who decide to switch fields i.e. from FP to anesthesiology or other career switches? Some who switch into surgery after say having done internal medicine would have to do a surgical internship. So I think that while funding is an issue, hospitals can afford to hire residents and pay them with their own funds, i.e. hire one less gift shop worker or something. Realistically IF after failing to get back in with the OP's old programs (which I doubt would happen as residency application is more competitive now), I would say plan to go through the match at some point. The good thing is that doing home visits for a company sounds like good clinical experience at least.

I would try to contact your medical school, U of C, and ask them if you could do an observership or something and start kissing booty there so maybe they will take you back for residency since you got your foot in the door there once. Worth a try!

 

[Winged Scapula]

Don't get used to it, Darth!




😉

 

[elwademd]

lots of good advice.

just to add, i'm a hospitalist, im trained. i asked our recruiters point blank if our group accepts fm trained physicians as hospitalists, and i was told yes without a doubt. i also asked kaiser during my job search last year, and they do as well.

while it may not be the norm within a university system, as winged pointed out, it definitely is the norm in the private practice/community setting. while the university system can be great, it is not the end all, be all. for those of you reading this thread, make sure to read journals, read websites, and get info for what's happening in and around the medical field outside of what the people in your program tell you. you may find what they tell you to be true, or you may find that there are plenty of other things out there of which you had no idea.

for those wanting to be hospitalists, i would suggest society of hospital medicine, today's hospitalist, and medical economics at a minimum (all 3 are journals as well as websites).

bottomline, its up to you to stay informed.

 

[dragonfly99]

agree with
aprogramdirector
You are not really in the driver's seat, because of having switched programs multiple times and done poorly on your boards. However, if as you say you have some solid letters of recommendation, and did OK at your old programs, then you should just try to go back to one of them. It's the path of least resistance, and long term for your career you need to have completed some sort of residency (for hospitalist, fp vs. IM shouldn't matter much, though IM may be slightly preferred for some hospitalist jobs...). Your career is going to suffer in the long term if you don't finish some sort of residency. You also pretty much need to be able to pass your board certification exam...and the ABIM (internal med board certification exam) isn't entiredly a cakewalk, so whichever field you choose, I'd start studying up for that exam since it will help you look smart during morning report, etc. as well as getting you ready for your board certification exam.

I think you got some bad advice and you should just realize that, and that you might have to go back to one of your old programs and grovel to get your spot back. It's totally worth it in the long term. Just admit to them that you made a mistake, and assuage any fears they may have that you aren't committed and might leave again.

 

[Joe Richards]

this has been the consensus from people I ask - where they are recruiters, fellow physicians or what have you.
While I understand there are many FM physicians doing hospitalists work, its my understanding they are the minority.

I have to tell you that hospitalist jobs are wide open to FM docs. There are even hospitalist fellowships in FM.

Anyway, even if there were less chances of becoming a hospitalist by finishing your FM residency, you would still have had a chance.

but now you have to go back and do it all over again.