IM Fellowship Question

[dgruntledmizzou]

Curious about the IM fellowship landscape. Like everyone else, I'm certainly basing my decision on "what I like". But I would be lying if I said lifestyle and salary weren't big factors as well. The only problem? I'm sick of competition.

I'm currently an intern at a prestigious preliminary medicine program (I'm going to be intentionally vague to protect my identity)

I applied for a very competitive field last year, failed to match, and am going through my preliminary year now. Despite re-applying this year to an even larger # of programs in that field, I find myself with even fewer interviews a year later.

I've spoken with my PD and have an option to continue as a categorical resident if I am unable to match again this year. Now I'm trying to find a fellowship to pursue. I realize cardiology and GI are usually the most popular choices (I assume more for salary than lifestyle) which is why I am very wary of pursuing them. Any advice?

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[howelljolly]

It is neither for salary or lifestyle. (in general)

Its also because these two fields have more procedures... caths, angiograms, stenting..... scopes, EGD, ERCP.

Also the pathologies are interesting.
Cardiology has fascinating, logically sound pathophysiology, interesting bedside diagnostics as well as technologically advanced diagnostics. Theres loads of new research going on in Cardiology. The field is so advanced and broad that there are boarded subspeciaties..... and a ton of other nice things. Its also a field where you can make a significant difference in patient outcomes.

Gastroenterology has a great mix of medicine, procedures, emergencies, consults, primary care. It deals with the hepatobiliary system which is fascinating and complex. GI has an nice mix of pathologies, including cancers, which are preventable and treatable... infections, autoimmune disorders, medical and surgical diseases etc etc. Research and super-fellowships in liver transplant. And again, its another field where you can really make a significant impact on patient outcomes.

Saving lives and making differences.

Maybe Ive been lucky, but except for the silly pipe dreams of med students... Ive never heard of anyone actually applying for fellowship based on salary and lifestyle. Every IM resident Ive met that's going for fellowship is passionate about that partiular branch of IM.

The most competitive fellowships are the above, plus Allergy/Immunology... which has interesting research, and a molecular and biochemical basis for disease if thats your bag. Its also got a great lifestyle, and a lousy salary.

Pulmonary is mine... you cant have that

Of the less competitive ones....

Nephro.... very close ties to basic sciences, with the most complicated of the MS-2 pathology topics, acid-base disorders, fluids and electrolytes... Saving lives and making differences.

ID... if you like sherlock holmes, you'll like ID. This is where finding out what sort of house-pets your patient has will pay off. You also have the chance to cure patients.

Heme-Onc... cancer nuff said

rheumatology... the black hole of medicine... disease processes that were poorly understood until recently, and physical exam skills that you dont see anywhere else. The details they notice in x-rays will make your head spin. Treatment? Aspirin and Cytoxan for everyone.

However, if you are in it for the money, dont bother... these things are cyclical. GI has skyrocketed because of colon CA screening is standard of care, and other screenings are not. Heme-onc will drop because reimbursements for chemo will go down. Rheumatology and AI may increase because of all the new immunomodulators that are being developed.

One never knows.

 

[dgruntledmizzou]

Wow, thanks for the detailed post!

I really wish I would have explored this pathway as a medical student instead of honing onto one supposed "dream field" and being left with nothing

Words of wisdom for younger students

 

[howelljolly]

Im wondering what that dream field is... derm? plastics? Because you can find the plus points in some IM fellowships....

Derm has a lot of bedside diagnosis... which you'll find in rheum.

plastics, no two cases being the same, and thinking on your feet.... who knows....

 

[elresidante]

If you failed to match into a highly competitive program, and are liking IM, then pursue that. GI and cards are super competitive and you will be busting your butt (literally) to get a spot in either. And most GI and cards docs I know work more than the average doc as well. I would ask yourself if this is really the path you want to go down. IM as hospitalist or outpatient can be very rewarding (and pay well too) - where I live in the 200's (low and high). Also think of all the time off hospitalists get! And there are many "other" specialty fields that are very rewarding and much less stressful. I myself am pursuing the ID match this year. And although we will all say we didn't go into medicine for the money, let's be honest with ourselves - we all would like more. But you are going to be doing this for the rest of your professional life and you better like it, right? From personal experience, I don't remember the last time I saw a lot of smiling cardiologists or GI's. Food for thought.

 

[adam6]

The most competitive fellowships are the above, plus Allergy/Immunology... Its also got a great lifestyle, and a lousy salary.

Did you mean "lousy" in a sarcastic sense? ^_^
Many allergists make tons o' money given the reimbursement for patch testing and desensitization. It is not rare for some in private practice to make 300-500K. While many truly enjoy A/I, the lifestyle and money factor make it the IM "equivalent" of derm -- and adds to the competition (especially given the fewer number of fellowship spots).

Also, you forgot to mention endocrine (as a fellow, I hafta toot that horn!) in your review

 

[howelljolly]

Did you mean "lousy" in a sarcastic sense? ^_^
Many allergists make tons o' money given the reimbursement for patch testing and desensitization. It is not rare for some in private practice to make 300-500K. While many truly enjoy A/I, the lifestyle and money factor make it the IM "equivalent" of derm -- and adds to the competition (especially given the fewer number of fellowship spots).

Also, you forgot to mention endocrine (as a fellow, I hafta toot that horn!) in your review

Oh... I really was under the impression that they didnt make too much money on average because, allergic rhinitis is treated by PCPs, and there really isnt a huge volume of patients that see an AI... that part of their cush lifestyle was due to a low patient load.

Sorry about Endocrine... I forgot... so heres my dos pesos on endocrine....
Its based heavily on physiology, and it's very logical. So, the mental exercises involved are pretty interesting. If you like to study with charts full of arrows going up, down, and around, like I do... you'll like Endo. And once you learn to "think like a pancreas" you'll be the best at managing DM.

 

[tenacious11]

Hey adam6 good to hear from you.Endo is definitely a choice if you are fascinated with Int Medicine.Its an amalgamation of all of medicine especially nephrology ,cardiology,GI,neuro.....

 

[Captopril]

I was always a cards fan, but now that i finally finished med school..I'm starting to realize there's other really cool options after IM. The fields which are multi-system (ID, Endo, etc) are particularly enticing. I think I'll let internship year rotations sort out what I do and don't want to do.

 

[howelljolly]

I was always a cards fan, but now that i finally finished med school..I'm starting to realize there's other really cool options after IM. The fields which are multi-system (ID, Endo, etc) are particularly enticing. I think I'll let internship year rotations sort out what I do and don't want to do.

Yeah same here, Ive always been a cardio nut, but as I progressed in med school, I really dug the mult-system specialties. So now Im debating between going into EM vs. IM-PCCM.

 

[drivesmecraazee]

Im a MSIII and I haven't choosed a speciality yet, Im not even sure if I want surgery (uro, ortho or ENT) or IM, but if I had to choose an IM fellowship it would definetly be ID or nephro, I think Im more inclined towards ID. Anyway, the rest of the IM fellowships don't seem interesting to me, neither the idea of not doing a fellowship at all.

 

[desertsand]

Does anybody knows, can you apply in 2 different subspeciality fellowship at the same time and if yes is there any drawback and can Fellowship director able to find that you also applied in different fellowship?