How unpleasant is fellowship application process?

[clownbabyMD]

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MS3 here, thinking specialty selection for the rapidly approaching future. Have narrowed it to subspecialty in medicine vs radiology. I'm curious how all you folks have found the fellowship app process. One of the big things holding me back from doing IM is the idea that I'd have to go through another match process, i.e. Worrying about competitiveness, needing to prove yourself day in day out (beyond just working hard), worrying about getting research pumped out on your "day off", and going through another round of not knowing where I'll be geographically for another two to three years. Anyway, maybe some of those that have gone or are going through the process could weigh in. Many thanks!

 

[IM2GI]

Want to do ID, Renal, Rheum, Endo? It is a cakewalk and you will treated like royalty if you are a US MD.

Want to do Cards or GI, and to a lesser extent but certainly still competitive, Pulm or heme/onc? It requires hard work, with a strong residency performance and research.

The practice of a medicine subspecialty is very different from radiology, so you need to fundamentally figure out whether you want to take care of patients, or interpret pictures all day. There are certainly pluses and minuses to each.

 

[bashwell]

Good question, OP! I'd be interested to know too.

Also:

going through another round of not knowing where I'll be geographically for another two to three years.

For most subspecialties (excepting the competitive ones -- GI, cards, heme/onc, pulm/cc), don't people end up staying at their IM program?

 

[bashwell]

By the way I've heard it's generally harder to switch from IM to rads than rads to IM.

Plus in rads you do a prelim year. If you can, why not do a prelim year in medicine in an academic place with a good IM program? If you end up loving medicine, then you can make the switch. (Although not sure if this is ethical? If it isn't, then obviously bad idea!)

Last thing, here is one person's perspective on radiology.

 

[Reubens]

Yeah I am kind of thinking like you. I read a lot about wanting to be a good general internist to go the IM route on here. However, let's be real and admit that some of the subspecialties are incredibly different, especially the procedurally ones. I am concerned about having very little knowledge of what specialty I will have after I graduate. I loved GI a lot before I knew about the current lifestyle, salary and thus competitiveness, but now I feel like I want more of a sure thing.

I have posted it on here about it before, but I do think 85% of US MDs matched GI in one of the recent NRMP stat sheets, but obviously there are multiple variables to consider with this.

 

[Beacopp665]

The answer to this question really rests on what you want out of your career and what you want to put into it. GI (a lot of procedures) and rads (none) are very different fields. Aside from the compensation for both being generous you need to think about what u really want to do day in and day out

P.S. Also I know a lot of people go into IM for the sole purpose of specializing, but on some level I would say you should have a basic liking for medicine too. You will be dealing with it even if u specialize so I would think about that

 

[DrBowtie]

The answer to this question really rests on what you want out of your career and what you want to put into it. GI (a lot of procedures) and rads (none) are very different fields. Aside from the compensation for both being generous you need to think about what u really want to do day in and day out

P.S. Also I know a lot of people go into IM for the sole purpose of specializing, but on some level I would say you should have a basic liking for medicine too. You will be dealing with it even if u specialize so I would think about that

The fact that you say radiology has no procedures leads me to believe you know little about the field of radiology.

 

[Beacopp665]

The fact that you say radiology has no procedures leads me to believe you know little about the field of radiology.

Since the OP is talking about GI and the uncertainty of matching into fellowship I assumed he/she was talking about diagnostic radiology as opposed to interventional. i could have more accurately said relatively more procedures instead of "a lot" and "none".

My point is still the same though. They are very different fields with different levels of pt interaction and the OP needs to soul search and think on what they really want to do

 

[FranzLO]

Just to be clear, even in DR you will be doing many procedures.

 

[rd31]

Since the OP is talking about GI and the uncertainty of matching into fellowship I assumed he/she was talking about diagnostic radiology as opposed to interventional. i could have more accurately said relatively more procedures instead of "a lot" and "none".

My point is still the same though. They are very different fields with different levels of pt interaction and the OP needs to soul search and think on what they really want to do

FYI in diagnostic radiology you regularly do CT guided biopsies, ultrasound guided biopsies/FNAs, paracentesis, even IVC filter placement among many many other procedures. Diagnostic radiology is a procedure heavy field, and most people (esp those who never did a DR rotation) don't seem to understand this.

Interventional radiology is a different beast on its own.

 

[DrBowtie]

Since the OP is talking about GI and the uncertainty of matching into fellowship I assumed he/she was talking about diagnostic radiology as opposed to interventional. i could have more accurately said relatively more procedures instead of "a lot" and "none".

My point is still the same though. They are very different fields with different levels of pt interaction and the OP needs to soul search and think on what they really want to do

As others above me have stated, all radiology procedures do not fall under the umbrella of interventional radiology. This is a very common misconception.

 

[Beacopp665]

FYI in diagnostic radiology you regularly do CT guided biopsies, ultrasound guided biopsies/FNAs, paracentesis, even IVC filter placement among many many other procedures. Diagnostic radiology is a procedure heavy field, and most people (esp those who never did a DR rotation) don't seem to understand this.

Interventional radiology is a different beast on its own.

So I actually did a DR rotation at my home institution and their scope of practice is not so expansive. So procedure intensiveness of DR duly noted.

I still maintain that a medical subspecialty and radiology are very different fields and you need to take all those factors into consideration especially things like clinic, being on the wards, and what kind of patient interaction you want

 

[Raryn]

FYI in diagnostic radiology you regularly do CT guided biopsies, ultrasound guided biopsies/FNAs, paracentesis, even IVC filter placement among many many other procedures. Diagnostic radiology is a procedure heavy field, and most people (esp those who never did a DR rotation) don't seem to understand this.

Interventional radiology is a different beast on its own.

As others above me have stated, all radiology procedures do not fall under the umbrella of interventional radiology. This is a very common misconception.

While most DR may be trained to do these procedures, what proportion of them actually do anything like that when they're out in practice? The attendings I've seen (in a variety of contexts, including a community hospital, VA, academic center) seem to cordon off all the procedural work to the procedural guy, with the rest sitting reading their studies of interest.

 

[rd31]

While most DR may be trained to do these procedures, what proportion of them actually do anything like that when they're out in practice? The attendings I've seen (in a variety of contexts, including a community hospital, VA, academic center) seem to cordon off all the procedural work to the procedural guy, with the rest sitting reading their studies of interest.

These were all done by attendings at a community hospital associated with an academic medical center. On a separate rotation at the major academic hospital associated with my med school, the residents did these procedures. There was no "procedural guy" in either setting.

 

[DrBowtie]

While most DR may be trained to do these procedures, what proportion of them actually do anything like that when they're out in practice? The attendings I've seen (in a variety of contexts, including a community hospital, VA, academic center) seem to cordon off all the procedural work to the procedural guy, with the rest sitting reading their studies of interest.

So obviously each setting will have its nuances in scheduling duties.

My point is that even if they have a designated rotating procedural person, they are not necessarily an interventional radiologist.

The scope of breast bx, thora/para, CT guided procedures, LPs, joint injections/aspirations, Thyroid, Lung, Liver, Renal biopsies, non tunneled central lines are all mastered during residency.

Some people continue into non IR fellowships and learn further advanced procedures such as vertebroplasty, radio frequency ablation, biliary interventions etc.

The only thing that is reliably IR is vascular angiography and related interventions.

 

[throwaway1988]

If you're asking that question. Go to Radiology. The process is not easy at all unless you want to do Endo, ID, Nephro, Rheum. All the negative things you've listed above about the fellowship match is true. Go to radiology while you can!