Last edited:
IM Fellowships?
- Thread starter vkarp
- Start date
- Joined
- Oct 11, 2006
- Messages
- 10,418
- Reaction score
- 14,645
Your question is complicated to answer. In my experience, the simple answer is "No. competitive DO applicants with COMLEX only seem to do well in the fellowship match". However, low ComLEX scores are very likely going to impact your options for residency programs, and will also limit your options for fellowships. Both Cards and Pulm CC are competitive (with Cards>Pulm). You may have difficulty getting either of those spots, depending on where you do your residency -- some residencies are better at getting applicants into spots than others. Just taking USMLE won't solve your problem -- if you score low on the COMLEX, you may have the same problem with USMLE.
Nephrology, on the other hand, can't fill their spots. Anyone can get a spot. Whether you should get a nephrology spot is an open question, and there's a thread about some of the problems in nephrology in the IM Subspecialty forum you should read.
Nephrology, on the other hand, can't fill their spots. Anyone can get a spot. Whether you should get a nephrology spot is an open question, and there's a thread about some of the problems in nephrology in the IM Subspecialty forum you should read.
- Joined
- Nov 29, 2015
- Messages
- 816
- Reaction score
- 1,613
Our nephro program takes people who haven't done an IM residency
If you apply to nephro now as a med student, maybe you can get an early acceptance (kidding! sort of)
It could not be less competitive
If you apply to nephro now as a med student, maybe you can get an early acceptance (kidding! sort of)
It could not be less competitive
Last edited:
- Joined
- Oct 19, 2013
- Messages
- 5,560
- Reaction score
- 6,641
Pulse? Welcome to nephro
PCCM will be very hard to match
PCCM will be very hard to match
D
deleted1150906
Is there any advantage to doing a nephrology fellowship, salary wise compared to a hospitalist?
- Joined
- Feb 13, 2021
- Messages
- 159
- Reaction score
- 287
Nope, nephrology on average makes even less than general IM.
Why do people become nephrologists? Just for fun?
- Joined
- Nov 29, 2015
- Messages
- 816
- Reaction score
- 1,613
- escape from IM
- not competitive enough for cards, GI, PCCM, heme-onc
- they used to make a lot and people think things haven't changed
- IMGs use it to make themselves competitive for an IM residency
- some people might actually find it to be fun and have a passion for it regardless of the money. IMGs don't have loans and they can do this (vs US grads)
- escape from IM
D
deleted1150906
how doable is heme onc COMLEX only?
- Joined
- Jun 22, 2021
- Messages
- 4,533
- Reaction score
- 4,243
For cards,
Not really because need good residency
- Joined
- Oct 11, 2006
- Messages
- 10,418
- Reaction score
- 14,645
Short thread:
Why Nephrology Grads Cannot Expect To Earn The Same As Their Partners !
Years ago, I had a colleague who accepted a neph job out of fellowship and he was excited with the prospects. Although starting salaries were low(180K/year), within 3 years he will make partner, and according to what the partners told him, they average around 500K/year. Sounds great right? Fast...
forums.studentdoctor.net
Very long thread:
Nephrology is Dead - stay away
I did my fellowship with great interest in Nephrology - Acid base/electrolyte/Acute dialysis stuff. Joined a private practice - get around 170 K. my day starts at 6 and ends at 5. run around 4 hospitals and 3 dialysis units. Real life of nephrology - Oversupply - tremendous oversupply - so...
forums.studentdoctor.net
- Joined
- May 13, 2016
- Messages
- 159
- Reaction score
- 181
While having descent step scores can help. Having just comlex isn't the end of the world. Low scores on either isn't going to do you any favors. Bigger factors are where you do your residency and who your letters of recommendation are from. Obviously having better board scores, and in a lot of situations step scores, is going to get you into bigger programs that have more recognized names in the field of interest and more research opportunities.
- Joined
- Nov 10, 2009
- Messages
- 16,404
- Reaction score
- 7,617
Low board scores mean you'll likely get into a less name brand residency. And then at the very end a fellowship isn't really going to be keen to take you on because low board scores mean you're a higher liability to not pass your ABIM board and thus not be ABIM certified in their specialty and need to potentially defer to a weaker board certification through the ABOIM.
I wouldn't take Step if you did poorly on COMLEX. You're simply likely to either score poorly or fail.
I wouldn't take Step if you did poorly on COMLEX. You're simply likely to either score poorly or fail.
- Joined
- Oct 19, 2013
- Messages
- 5,560
- Reaction score
- 6,641
When you factor in the hours, the answer is no. You can make more money working extra shifts as a hospitalist
- Joined
- Oct 19, 2013
- Messages
- 5,560
- Reaction score
- 6,641
Pretty much the fellowships open to you are (in no particular order): Infectious diseases, nephrology, endocrinology, geriatrics, hospice/palliative medicine, sleep medicine, allergy/immunology (harder), and rheumatology (harder). If you're looking for money, you can do some of these fellowships but will have to go live in undesirable areas. Otherwise, you pretty much do it for the intellectual pursuit, work-life balance, or because you hate the hospitalist/PCP role
D
deleted1150906
id rather just do GP than those fellowships as I don't see a financial benefit
- Joined
- Nov 10, 2009
- Messages
- 16,404
- Reaction score
- 7,617
You have to decide what your priorities are. Do you want to see a specific population or disease? Do you want to make money? Do you want good lifestyle and ease of choosing a job?
Some specialties will buy you lifestyle, ease of employment, and specific diseases, and immunity from working up crap that you don't like ex. pain medicine, random back pain. Others will give you a great pay but in exchange you're going to be working a lot more and doing a lot of things you don't want to.
D
deleted1150906
Not to hijack this thread but I would like to earn at least 500k. Which is doable as a hospitalist as long as I am working a ton
- Joined
- Nov 10, 2009
- Messages
- 16,404
- Reaction score
- 7,617
If you're working in a rural area and doing a lot of admitting shifts and do like 20 shifts a month sure.
- Joined
- Jun 22, 2021
- Messages
- 4,533
- Reaction score
- 4,243
No it’s not. Would be an extreme outlier working locuns gigs in the middle of nowhere
D
deleted1150906
nowadays finding a 7 on 7 off for 350k isn't hard. If I can work on my off weeks, hitting another 100-200k won't be hard
- Joined
- Apr 2, 2021
- Messages
- 888
- Reaction score
- 2,774
500k as a hospitalist will be hard...
- Joined
- Apr 21, 2014
- Messages
- 3,340
- Reaction score
- 5,799
Sounds like killing yourself to reach that price point though. There is a reason it is 7 on 7 off.
- Joined
- Oct 19, 2013
- Messages
- 5,560
- Reaction score
- 6,641
The easiest way would be doing night doctor. You get about 300k for 12 shifts. Work 24 shifts and you still get 6 days off
D
deleted1150906
no kids, not married. Got all the time in the world to be working and making money. I am not a competitive applicant so I probably wouldn't get those high paying specialties
- Joined
- May 17, 2019
- Messages
- 76
- Reaction score
- 61
should really look at data before throwing out high number because they sound good. if you want to live in the midwest or south it might be possible and even then youd have to be in the top 75 percentile of hospitalists. and thats total comp, not salary.
- Joined
- Nov 10, 2009
- Messages
- 16,404
- Reaction score
- 7,617
Truthfully your productivity and ability to keep up will degrade with that intense a schedule. Furthermore you're graded by your employer and group. Like If you're known as the guy who does shoddy admissions, leaves patients feeling dissatisfied, consultants with stupid consults/ unreasonable pages which boil down to please do this for me, you're going to get your pay docked, RVUs reduced, or just fired.
Like even during residency I saw doctors disappear off to lower RVU sites or places where they didn't have to interact with the physicians at the more cush hospital.
In the end it is in your interest to be effective, productive, and likeable.
Now regarding personal competitiveness. There are back doors into competitive fields. You just have to look for them. There are DO programs who have in house cardio, GI, pulm cc, onc, etc. You need to look for them and choose them.
- Joined
- Mar 19, 2021
- Messages
- 41
- Reaction score
- 40
lots of the ICU docs I used to work with said they were "grandfathered in", meaning they didn't have to do a fellowship. I am sure this isn't the case anymore, right?
- Joined
- Aug 24, 2007
- Messages
- 2,199
- Reaction score
- 2,251
Dude/dudette,
Why?
Unless you owe the Mafia or some drug dealers a poop ton of $, whats the need to be so aggressive.
If just out of Residency, you’ll need some time to get settled.
Working so much will only lead to shoddy work
- Joined
- Oct 19, 2013
- Messages
- 5,560
- Reaction score
- 6,641
Not anymore. Before you could just do the 2-year pulmonology and be grandfathered in. I think this was before 1990
- Joined
- Oct 19, 2013
- Messages
- 5,560
- Reaction score
- 6,641
Yes, they go by name college of (osteopathic) medicine. They are affiliated with this global cartel called US government
- Joined
- Dec 1, 2016
- Messages
- 159
- Reaction score
- 190
Don't tell that to the transplant surgeons at your hospital.
- Joined
- Jul 17, 2014
- Messages
- 556
- Reaction score
- 1,106
They made me an offer I couldn't refuse
It was my only acceptance, I couldn't refuse it.
- Joined
- Aug 24, 2007
- Messages
- 2,199
- Reaction score
- 2,251
True…. But step one is always to have a good foundation.
We hired a new grad for admission shift.
Would do crappy H&Ps, even crappier orders, then study for his real estate license with the time he “saved”, all while also doing remote work for a rehab on his week off…. Lasted 8 months.
Loans will die with you…. Enjoy a bit, get settled a bit, then go hard on them if you wish.
Had barely passing COMLEX scores (sub 500) and no USMLE. Matched into pulm/crit this year. I made lots of connections and worked hard on wards/ICU and specialty services. Physicians talk to each other. Building a reputation of being a hard worker that people can trust is worth more than your scores. PDs were more interested in research, QI projects, and all of them commented on my letters of rec.
Thanks for your response! How much do you think board scores factor into fellowship apps? And did you do IM residency programs where they have PCCM fellowships??
- Joined
- May 13, 2016
- Messages
- 159
- Reaction score
- 181
Board scores matter but to a lesser degree than applying to residency. Things like LOR (especially from people known in the field), residency program reputation, and research are more important for many.
For me personally and others that I talked to, it didn't factor much. I did IM at a community program, matched into one of those community programs with a university affiliate. All the stuff I stated before plays a bigger role and being chief makes a difference. When you apply for fellowship, there's a check box specifically for chief residents so that everyone knows you were chief when you apply lol.
- Joined
- Nov 10, 2009
- Messages
- 16,404
- Reaction score
- 7,617
EM/CC is competitive. That being said I personally think it does not provide ideal training for MICU. Likewise it does not offer the pay benefit of having off pulmonology consultations and the escape of pulmonology clinic. EM/CC you're stuck in the hospital while also in my opinion not having as good background in Lung while being in essentially in the intubation/trach unit.
I mean I only like ICU. I hate outpatient clinic. I love being in the hospital. So I don’t think that pulm clinic matters to me. I’m debating between IM vs. EM to get into ICU fellowship at this time. So I don’t know if it’s easier to get into ICU fellowship after EM compared to IM??? I love working fast paced and getting busy (I get bored very easily when doing nothing), that’s why I think of EM. But I’m scared of EM job market in cases I cannot get into ICU fellowship later on…
- Joined
- Apr 21, 2014
- Messages
- 3,340
- Reaction score
- 5,799
Once you get further along, you’ll realize Clinic is anything, but “doing nothing”. You will be chasing your tail the entire day most times. And as you get older, you get tired of the unpredictable schedule and nights/weekends at the hospital. It all becomes mundane anyways so it really doesn’t matter what you’re doing. I’m not pulm/cc but I’m also not hearing folks, moving more and more towards the ICU as they age. They tend to move towards the clinic.
- Joined
- Sep 15, 2013
- Messages
- 248
- Reaction score
- 247
I agree with @DO2015CA. This is a very short sighted take
- Joined
- Nov 10, 2009
- Messages
- 16,404
- Reaction score
- 7,617
If all you're interested in is critical care then you shouldn't do an IM residency. You're going to be bored trying to understand disease processes and rounding 5 hours a day on inpatient and you're going to be bored managing patients who aren't acutely dying and just need baby-sitting until the fluids/antibiotics/ anti-whatevers kick in and they're stable enough for you to start a process of finding them a SNF.
You need to look at your residency as less of a ladder and more of a what happens if I don't get in or a what happens if I find out I want to do something else. I knew that if I didn't get into Endo I could at least do Primary care or potentially something else in a few years. Doing IM just to say I can't go anywhere with this if you fail to get an CC fellowship is going to be a bad look.
The problem with a lot of our education is that lack of consistent continuity or an environment that actually has stable enough clinic patients that are enjoyable to be around. I get a lot of interesting patients, a lot of respect from my staff, and an environment that is moderately predictable and controllable. This is an enormous difference from the 430pm ED page that they want you to admit that 1-2 hour full plate admission on your 12 day in a row friday that as you're walking out starts to have a profuse GI bleed and needs tubed.
- Joined
- May 13, 2016
- Messages
- 159
- Reaction score
- 181
Most people who do EM or IM aren't big fans of clinic. At least not primary care clinic. I am one myself. I love when I don't have to go to my continuity clinic, but I typically enjoy the subspecialty clinics. Big difference between IM and EM though. I would figure that out first. I was in the same boat a few years ago and then quickly realized EM was not for me. I have a ton of respect for my EM colleagues though. If in the end you decide you still would rather just do CCM fellowship rather than PCCM, you can also do it from IM residency. My program had a fellow last year who did CCM after IM because they didn't want to do any clinic.
THIS is exactly me. For ex, I don't go to Gen Surg because I don't like to be in the OR, but I enjoyed GS clinics much more than my FM clinics. I don't like to see ppl just come back for hypertension/diabetes recheck and med refills. I had 2 FM outpatient clinic rotations and had like at least 5 patients like that everyday. All I did was look at the clock and count how many more hours left to leave. I'd love more if patients come in with specific new problems, and then just come back 1-2 times to see if problems resolved, but that's it. Plus, complexity of the problems is what attracts me to ICU.
So would applying to CCM fellowship alone be easier than PCCM combined?? How much easier do you think it would be?
- Joined
- Nov 10, 2009
- Messages
- 16,404
- Reaction score
- 7,617
I disliked my FM clinic as a med student. It actually was a rotation I absolutely hated. I thought the attending was miserable, the patients were extremely uninteresting, and we did a lot of things that had utterly no relevance i.e EKGS yearly, PFTs yearly, etc. Also because I didn't know anyone and the patients were private pts, they didn't want to talk to me and wanted to just get out and go do whatever the rest of their day had in store for them.
A year later I did an Endo clinic and I found that IM subspecialty medicine is not primary care. Its an entirely different paradigm and you find that the field you're doing is less just throwing **** at patients and more being scientifically backed up, knowing exactly why and what you're doing, and doing it in a way that avoids having to deal with a whole bunch of bs.
Also here's the thing. There are open ICUs. Nothing is stopping you from being a hospitalist and being certified to do lines, tubes, paras, chest tubes, etc. But again, it comes down to back up and goals.
IM -> PCCM / CCM. You risk not getting CCM. You end up hospitalist v.s other fellowship. If you're a hospitalist you might do a procedure twice a week. The rest of the week you're rounding on CHF pts and osteo patients while you wait for placement.
EM -> CCM. You risk not getting CCM. You end up doing emergency medicine and will probably actively be doing at least a few procedures a week even on a slow week. You'll run codes more frequently, you'll handle traumas, etc.
Personally I've run 20 codes and done >100 procedures. I'm good. I don't want to do it anymore. So for me doing a outpatient based subspecialty fit me. But if I didn't get it, I had a reasonable plan for back up.
- Joined
- Oct 19, 2013
- Messages
- 5,560
- Reaction score
- 6,641
CCM alone is harder as it's 2 years training and the majority of PCCM people do the extra year of pulm just to get to CCM
- Joined
- Mar 28, 2015
- Messages
- 3,599
- Reaction score
- 4,337
I wouldn't lump Allergy into the rest of those-i would say it counts as a good return on investment unlike the rest you listed. Allergy makes very good money its also more competitive than the rest as you mentioned (not as competitive as Cards, GI, H/O, PCCM of course). PP Allergists routinely make 400K+ (many partners make 500K+) its a lucrative subspecialty and you don't work all that much (think 30-40 hr weeks). Of course if you do academics Allergy makes crap but most academic positions in anything make far less anyways.
- Joined
- Mar 28, 2015
- Messages
- 3,599
- Reaction score
- 4,337
Allergy is a good return on investment it shouldn't be lumped in with those. Median Allergy salary is just short of 400K (MGMA) with avg being low 400K. If you are a partner in a pvt practice group its not uncommon to make 500K+ at all. Endo, ID, nephro, rheum, sleep, palliative are not worth it financially (median salary is under 300K with an extra 2 years in fellowship) unless you are doing a PP rheum infusion center and caking money but i heard insurance has made those gigs more difficult now
