How much should I let the competitiveness of fellowship matching dissuade me from going IM (or more broadly, from going into any prelim position)?

[NegativeMargin]

I'd love advice, or just other people's point of view, or how people in a position similar to this have handled it. If I would not be happy as an internist for the rest of my life, or in gen-surg, should that be a red flag to me that I should consider not going into those fields with the hopes of getting into a fellowship?

I've gotten into a good ranked MD school with excellent match statistics. I've made mentors and am now published (yay!) with a funded summer research project to boot. I'm volunteering at my favorite places, I'm shadowing, networking, going on trips to conferences.. I'm doing all that I can.

But these mentors I've made who have gone through the process of obtaining a fellowship after IM, and have mentored people who recently have gone through the process, are telling me seriously how competitive some of these spots are/are becoming.. and when you crunch the numbers, it really is telling.

There are decisions I will need to make in the next 2-3 years that will be more difficult than what I'm about to discuss, and I get that. But I am at a bit of a cross-road, or I will be in a year. I will have 3 cancer related research projects finished by this time next year, and that was my goal heading into clinicals. But I don't know what I should do after that. It's honestly been a bit brutal to balance starting school and doing research right from the get-go, and that coupled with the advice I had gotten about how you actually have more free-time in didactics than in clinics is what led me to do multiple research projects right away despite that hardship.

I wonder if doing more cancer research will paint me into a corner, though. If I get through med school and have 6 different research projects all focused on cancer, and I end up liking Urology, ENT, Radiology, or hell even Cardiology, I will have to explain that discrepancy between my residency selection and research experience in an interview.. and that is one less thing a person who has done 4 years of Urology, ENT, or Radiology research will have to do.

In any case, the idea of running this race, just to run another one, only to lose out.. and be "stuck" as an internist has me concerned. And despite wanting to go into hem/onc, loving the shadowing and research I'm doing, and making great relationships with mentors related to it.. because I'm not allowing myself to go all in on it mentally until I've actually done all the rotations, I can see some very logical reasons why it would make sense to leverage my competitiveness to match into something I might like slightly less than hem/onc, just to forgo the struggle of the fellowship process. And as it stands, maybe it's because I'm a non-trad, but I could really see myself doing a lot of these specialties and having a good time doing it. I even wonder about oncological surgery, but there are difficulties in matching into that as well. And also something like radiation oncology despite all the red flags, or an oncological orthopedic fellowship but that'd be even more competitive.

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[collegestud2013]

I'd love advice, or just other people's point of view, or how people in a position similar to this have handled it. If I would not be happy as an internist for the rest of my life, or in gen-surg, should that be a red flag to me that I should consider not going into those fields with the hopes of getting into a fellowship?

I've gotten into a good ranked MD school with excellent match statistics. I've made mentors and am now published (yay!) with a funded summer research project to boot. I'm volunteering at my favorite places, I'm shadowing, networking, going on trips to conferences.. I'm doing all that I can.

But these mentors I've made who have gone through the process of obtaining a fellowship after IM, and have mentored people who recently have gone through the process, are telling me seriously how competitive some of these spots are/are becoming.. and when you crunch the numbers, it really is telling.

There are decisions I will need to make in the next 2-3 years that will be more difficult than what I'm about to discuss, and I get that. But I am at a bit of a cross-road, or I will be in a year. I will have 3 cancer related research projects finished by this time next year, and that was my goal heading into clinicals. But I don't know what I should do after that. It's honestly been a bit brutal to balance starting school and doing research right from the get-go, and that coupled with the advice I had gotten about how you actually have more free-time in didactics than in clinics is what led me to do multiple research projects right away despite that hardship.

I wonder if doing more cancer research will paint me into a corner, though. If I get through med school and have 6 different research projects all focused on cancer, and I end up liking Urology, ENT, Radiology, or hell even Cardiology, I will have to explain that discrepancy between my residency selection and research experience in an interview.. and that is one less thing a person who has done 4 years of Urology, ENT, or Radiology research will have to do.

In any case, the idea of running this race, just to run another one, only to lose out.. and be "stuck" as an internist has me concerned. And despite wanting to go into hem/onc, loving the shadowing and research I'm doing, and making great relationships with mentors related to it.. because I'm not allowing myself to go all in on it mentally until I've actually done all the rotations, I can see some very logical reasons why it would make sense to leverage my competitiveness to match into something I might like slightly less than hem/onc, just to forgo the struggle of the fellowship process. And as it stands, maybe it's because I'm a non-trad, but I could really see myself doing a lot of these specialties and having a good time doing it. I even wonder about oncological surgery, but there are difficulties in matching into that as well. And also something like radiation oncology despite all the red flags, or an oncological orthopedic fellowship but that'd be even more competitive.

You need to decide whether you want to go into a procedure/surgical field or non-procedural first. That will narrow things down. Of the fields you're interested in, radiation oncology is probably the least competitive at the moment and does not require matching in a competitive fellowship afterwards, so if you want to play it safe that's your best bet. However, the job market is mediocre for new grads at the moment so more are doing a fellowship afterwards to become more competitive (though the job market could change for better or worse by the time you graduate from rad onc residency).

Matching into IM should usually be no problem as an USMD, but heme/onc is a lot more competitive than rad onc at the movement. While doing well at most academic IM residencies with an in-house heme/onc fellowship should lead to a high chance of matching into fellowship, it's still not guaranteed. So yes if you go into IM you need to be prepared for the possibility of being a general internist doing hospitalist or outpatient PCP or urgent care etc... if you don't match. Even in those cases you can still make your practice more oncology related; for example you could work as a hospitalist at a cancer hospital, or do palliative care with focus on oncology patients. And as a non-traditional student, it's not a bad thing to cut down your training either by foregoing fellowship.

 

[voxveritatisetlucis]

You can get GI or cardiology or heme onc or pccm as an md from any university internal medicine residency however the specific competitiveness of each of the above wax and wane so it’s impossible to tell which will be in reach or out of reach at the time of application

 

[GoSpursGo]

Frankly, with multiple pending publications already underway, it is difficult to imagine you not getting a strong academic IM program and subsequently a heme/onc fellowship if that’s what you want. For any other competitive IM fellowship like cards, you’ll need to get some research in that area, but the cancer projects will still be seen as a plus.

If you really think you might want a surgical subspecialty, however, then you really need to figure that out now. You’ll need specialty specific research for those fields and you’ll need it very soon.

 

[Splenda88]

Hospital medicine is not a bad gig if you don't get into any lucrative fellowship such as GI/hemonc (PCCM is excluded IMO).

 

[voxveritatisetlucis]

(PCCM is excluded IMO).

Why

 

[Splenda88]

Why

Because PCCM physicians are glorified hospitalists that make an extra 100k/yr w/o dealing w/ some social issues that hospitalists deal with. The extra 3 years of opportunity cost does not justify it IMO.

 

[ACSurgeon]

Because PCCM physicians are glorified hospitalists that make an extra 100k/yr w/o dealing w/ some social issues that hospitalists deal with. The extra 3 years of opportunity cost does not justify it IMO.

The difference in pay isn’t the only thing to look at. CC docs do a variety of procedures that makes the job more interesting.

Also the difference in pay is at least 100/hr which makes the annual pay difference significantly higher than 100k if all else is equal

 

[Splenda88]

The difference in pay isn’t the only thing to look at. CC docs do a variety of procedures that makes the job more interesting.

Also the difference in pay is at least 100/hr which makes the annual pay difference significantly higher than 100k if all else is equal

Based on the 2022 MGMA, it's ~$55/hr more. These numbers reflect the exact salary at two hospitals where I have privilege.

For instance, hospitalists salary at my main gig is 330k while the CCM docs make 450k.

Intubation, central/a lines, para/thora and occasional bronch make CCM interesting...really!

 

[ACSurgeon]

Based on the 2022 MGMA, it's ~$55/hr more. These numbers reflect the exact salary at two hospitals where I have privilege.

For instance, hospitalists salary at my main gig is 330k while the CCM docs make 450k.

Intubation, central/a lines, para/thora and occasional bronch make CCM interesting...really!

The context of the procedures makes them interesting. I’m a surgeon and still find my time in the ICU interesting. And it’s not the note writing or rounding that I enjoy… obviously not everyone thinks the ICU is an exciting place, so that’s fine.

seems like your place pays the Hospitalists a lot more than what our hospitalists have told me.

Finally, it’s not just the pay. You have to find the nature of the work interesting. Sometimes people do a fellowship for no additional pay, but maybe better life style or a job that’s more interesting to them.

 

[Splenda88]

The context of the procedures makes them interesting. I’m a surgeon and still find my time in the ICU interesting. And it’s not the note writing or rounding that I enjoy… obviously not everyone thinks the ICU is an exciting place, so that’s fine.

seems like your place pays the Hospitalists a lot more than what our hospitalists have told me.

Finally, it’s not just the pay. You have to find the nature of the work interesting. Sometimes people do a fellowship for no additional pay, but maybe better life style or a job that’s more interesting to them.

FM-hospitalist makes more (median ~330k) from that same MGMA survey. Not sure why.

 

[vomitcom]

Believe it or not some people just like the ICU and do not make all of their decisions with a monetary cost/benefit in mind because after a certain point each additional dollar of income becomes less important than one's happiness

 

[throwaway123342]

The context of the procedures makes them interesting. I’m a surgeon and still find my time in the ICU interesting. And it’s not the note writing or rounding that I enjoy… obviously not everyone thinks the ICU is an exciting place, so that’s fine.

seems like your place pays the Hospitalists a lot more than what our hospitalists have told me.

Finally, it’s not just the pay. You have to find the nature of the work interesting. Sometimes people do a fellowship for no additional pay, but maybe better life style or a job that’s more interesting to them.

Hospitalists can still do procedures. At my institution they are routinely doing thoras, paras, LPs, and central lines (if there is access problems). The procedures done by Crit care docs isn't not much beyond that.

 

[imidazzle92]

People change their minds frequently. If you publish from Oncology projects, it shows you've developed strong research skills and can take projects to the end. If you decide to apply into something else that is selective, as long as you do some research in that field that should be sufficient along with your track record of strong research output. In some cases, a research year may be necessary though.