I'm going to apply to IM and GSurg residencies....Bad idea?

[Blitz2006]

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Ok, before I get bombed, let me explain.

I know most ppl on sdn will think its ludicrous that I have an interest in both IM and GSurg, but I honestly do.

I'll be very happy if in life I can same I am:

1) General Surgeon (with a fellowship in something like colo-rectal)
2) Medical Oncologist
3) Gastroenterologist

So therefore, IM and GSurg are the common residencies.

However, I'm seeing on the forums that if I apply to a hospital for IM AND GSurg, thats pretty much like committing suicide?

True?

Cheers,



**Sorry mods, I meant to post this on the ERAS/NRMP forum***

 

[ForbiddenComma]

I don't see how it's a problem. You don't have to necessarily broadcast what you are doing.

I mean, you obviously want a different set of letters and personal statements for each... but other than that, the chances of the two departments communicating with each other about their candidates is pretty low. I've personally never heard of it happening... but if you want to be extra careful, just don't apply to IM and surg at the same place.

I applied to both peds and IM. Some places, I was honest and told them I was into both adult and peds cards and that I applied to both. Other places, I kept my mouth shut. I matched into a program where I was honest.

 

[Smurfette]

The problem is, the two fields are so different that a PD may question your desire to do their specialty and it could affect you in the rank should they find out. Not all PDs, and not all programs will feel this way, but it may likely hurt your chances. You also will need completely separate LORs, as surgery letters should be from surgeons.

I realize this is said so often it's a cliche, but, if you can imagine yourself doing something other than surgery, do something else. I understand it can be hard to pick a specialty. Surgery residencies and medicine residencies are vastly different (surgery all is inpatient, ICU heavy, no patient # caps, quick decisions compared to outpatient months, patient caps and hours to formulate plans for medical patients, to name a few). If you can't decide, do a medicine sub-i and a surgery sub-i back to back. See which month you're happier and which one seems a better fit for you.
If you can see yourself being happy doing a medical specialty, do it.

Myself and many other surgical types I know would rather do almost anything than the hours of IM rounding and days (not to mention entire rotations *shudder*) of clinic...

 

[Gastrapathy]

I love GI. That said, IM subspecialties require another round of applications with considerable competition. If you get categorical GS, you are done. I don't think applying for both will keep you from getting IM but it might keep you from getting GS and from getting the more desirable (and therefore better fellowship odds) IM programs.

I'd recommend making a choice and going for it, particularly if you aren't a US grad.

 

[Blitz2006]

Thx guys,

Yeh, I'm doing electives in the States for 4 months, ranging from Oncology to GSurg to Transplant surgery to Gastro.

So I'm gunning for both GSurg and IM.

I understand that my applications will obviously have to be tailored to each speciality, but I'm hoping after 4 months in the U.S, I will have 3 IM LORs and 3 GSurg LORs (all American hopefully)

my hierarchy system is GSurg Categorical > IM Categorical >GSurg Prelim > IM Prelim

And yes, I'm IMG from the UK. But with a ton of observerships in the States, and next year electives at UMass + Mt. Sinai NYC. So I'm hoping something will workout, but am a bit nervous about screwing up my matching odds....

 

[SouthernSurgeon]

My only issue is that from reading these boards for a while, it has always seemed like you want to do surgery, but are using medicine as a back-up since you aren't sure about your chances of matching.

If that attitude comes through at all on the interview trail you could set yourself up for failure.

 

[braluk]

That you're also an IMG vying for Gsurg and IM, which already is going to leave a bad taste if PD's ask, and also doing your electives at very competitive hospitals (I am assuming that you are seriously considering matching to Umass or Mt. Sinai?) very, very tough. Are these electives strictly observerships, or can you scrub in or write notes in charts and so forth and essentially functioning similar to a medical student who is shadowing a physician, or will you be functioning in the capacity of a clerkship?

 

[Blitz2006]

Interesting,

I'll be honest with you guys straight up, I do love Med Onc, Gastro and GSurg all equally, will be pumped if I get any of the 3.

SouthernIM, I understand that on my previous posts it may appear that IM is a backup for me, which is true but in a different sense.

1) I put more emphasis on SDN threads on getting into GSurg because I know that GSurg categorical is much tougher to match into than IM Categorical, particularly for IMG.

2) Statistically, IM is a Backup, not because I have less interest in it, but only because from an odds point of view, I have a better chance of matching into it.

But honestly, if I get IM at a place like UMass, I would be ecstatic.

Yeh, these are proper electives, so I assume I will be simulating clerkship? Its the same electives that US meds guys will be doing.

UMass: 1 month Gastro
UMass: 1 month GSurg
UMass or Toronto: 3 weeks Med Onc
Mt. Sinai Manhattan: 1 month Transplant Surg


So I figure after 4 months at these places, I can bang out 3 LORs for each IM and GSurg. Will be tough I know, but I'm prepared to put in 100 hour weeks if need be.

I'm doing these electives more for LORs and CV. I already know I won't match into GSurg for Mt. Sinai, unless I publish 5 papers and drop a 250 on Step 1, which isn't happening. But I also know Surgeons love "big names", so thats why I decided to do 1 month at Mt. Sinai.

UMass again is competitive, but I think I have a half decent chance at UMass IM (I looked at their residency website, and they have a few IMGs). GSurg looks a bit tougher. But maybe I'm wrong?

For GSurg, I'll be ecstatic to get categorical in a community hospital, a place like Bronx-Lebanon or Cook County. I'm not expecting fireworks for GSurg as IMG.

For IM, I hopefully can get into a semi-decent place because I know the competition is fierce for fellowships, particularly Gastro. So a place like UConn. SUNY Downstate, Jefferson, Drexel, Albert Einstein Yeshiva etc. would be my 'goal'. But again, beggars can't be choosers...

I know its rare, but I'd be super happy with a match in either IM or GSurg. But I also know life is unfair, which is why I want to play the game properly....

 

[braluk]

What would your answer to this question be, which is commonly asked on interview trails.

1) What else are you applying for? and if they don't ask that, they'll ask
2) What was your favorite rotation outside of surgery? Why not apply to that? (People tend to answer this question if they are applying for a second specialty)

with a followup
3) What would you do if you do not match surgery?

Just keep in mind, saying that you have a backup in internal medicine if you do not match surgery will mean a fair chance of not being ranked there. Surgery has a higher attrition than many other specialties, and the only applicants they want are the ones who breathe surgery, and nothing else. This is a field that demands your loyalty to it before you have even finished the interview, so answering a question about all those different fields you are interested in can hurt you. Remember, surgeons do not like a wishy washy answer, they want discrete answers made with a firm decision, and nothing else.

As for the other things you mentioned. Working tough is essential, and getting recognized by a committee member is even better if they are your attending, and you will get a courtesy interview out of it. However, your step I is huge, particularly for IMG, so I don't know when you plan on taking it, but most people have done it before clerkships have even begun. Your letter writer may ask you what your score was, and a face to face meeting with the PD at the end of the rotation on possibly matching there will require a Step 1 score for it to useful. So just a consideration.

Surgeons also do not love "big names", when it comes to recs. As far as recs go from foreign institutions, they are helpful to assess you outside of your own home school's recs in that more than one institution can now vouch for your abilities, and helpful for applying to that hospital, and perhaps some affiliated ones, but carries so far. Also remember that many IMGs tend to also be those who have worked for many years as a physician back at home, and so many tend to be older, have experience on their belt. I'm understanding that you're a freshly minted IMG. So good luck and fight the good fight but pick your battles wisely.

 

[dragonfly99]

My advice is that you do NOT under any circumstances tell any surgeons that you are applying to IM. Surgeons in the US don't like medical students who are interested in IM, and will perceive it as a sign of weakness, lack of focus, or that you must be clumsy and not good with your hands, or that you don't want to work hard. It's not necessarily true, but it's just how they feel. So don't tell the truth on this one. Just don't do it. And at small community hospitals at least, you may want to avoid cross applying to both specialties. There are a ton of hospitals around so you can apply IM at some, surgery at others, etc. At larger hospitals there may not be much communication between the departments, but it's still a risk to apply to both.

I would also not advise that you tell IM clerkship directors (unless perhaps you tell them that you also crossapplied to IM prelim and then surg prelim as a last resort just to make sure you get something). Many of them also harbor stereotypes about surgeons and about medical students who are interested in surgery. I agree it is unfair...I also like procedures, like some "action" and I enjoyed some of my surgery clerkships. In reality there is some overlap between IM and surgery because some IM docs do procedures (critical care/pulm and cards do quite a few invasive procedures). An interventional cardiologist is fairly similar to some of the surgically-related specialties...the stuff they do is as invasive as a lot of the stuff a urologist or ophthalmologist does. But you cannot reason/argue with the people who have the power. Don't take unnecessary chances.

As an IMG, you can probably still get categorical IM, prelim IM and prelim surgery if you have a decent step I score. Getting into GI as a FMG/IMG type will be very hard because there are very few spots and a lot of the selection is based on where you did residency. You probably should check the stats and see what %age of FMG's match into GI if they try...for cards it is around 40 something percent, I would guess it's the same or worse for GI. Hem/onc is easier but still not easy to get a spot at a decent place.

Be aware that prelim surgery internships in the US sometimes go to FMG and IMGs who the residencies know they can abuse. They will lure you in with the suggestion that if you do well that you have a decent chance to stay on as a categorical, and/or move on to a categorical spot somewhere else. There are IMG's from Caribbean and Israel, FMG's from India, etc. who get sucked in this way every year. The hospitals need cheap labor. The programs know they can get away with this. Some have little intentions of keeping many of you. They might have 5 or 6 prelims, and keep 1. If you take a surgery prelim spot, do not believe anything they tell you at the interview. I know multiple people who were good residents who got used and thrown away by surgical prelim places. There are places in NYC that are known for that.

 

[jakstat]

I dont understand why there is the opinion that one can only like either surgery OR IM. So if someone is good with their hands and also likes problem solving then it would make sense they will like both fields.

 

[Law2Doc]

I dont understand why there is the opinion that one can only like either surgery OR IM. So if someone is good with their hands and also likes problem solving then it would make sense they will like both fields.

It's really not that complicated. Most surgeons would rather blow their brains out than spend half the day rounding on the same handful of patients day after day, and most medicine docs would rather blow their brains out than be standing in the OR all day, elbow deep in some guys abdomen. In general the FIRST branch on the decision tree as to what field you want to go into tends to be surgical vs nonsurgical. That's an important first decision, because each path has numerous other branches based on your likes and dislikes once you get past that initial decision.

So it's simply not going to ring true to anyone that you like both surgery and IM equally. There's just something wrong with that picture. There are lots of opportunities to work with your hands or solve problems in each specialty, but just because you like to work with your hands does not suggest you want to be a surgeon, and just because you like problem solving doesn't mean you would enjoy medicine. Not only are there huge job function difference, but there are huge differences in lifestyle, in culture, in patient care approaches. So no, I'm not buying that the same person would be equally happy in medicine or surgery. That simply means you need to spend more time in each field before you apply. It's simply lazy to take an apple and a clove of garlic and say -- I like them equally and don't care which one I get. Everyone likes one over the other. Such is the case with drastically different fields of medicine too. In general, it benefits you to figure out what you want to go into and go whole hog in that direction, rather than try to walk a fence. Now, if you were to say, I want categorical surgery, but maybe I'll use medicine as a fallback since I am an IMG, I might buy that. But to try to make the straight faced argument that they are equally good to you, is not reasonable. They are very different fields, have very different lifestyles, very different cultures, very different approaches to disease, the people who gravitate to them are different as night and day, the daily job functions are very different, and so on.

 

[Dr.LeoSpaceman]

I do think it's possible to like endpoints from each path (IM vs. Surgery). For example, the only other thing I could have seen myself doing something like interventional cards. The problem is, there is absolutely no way I could have maintained my sanity through an IM residency and cards fellowship, all for the chance at an interventional fellowship.

The other thing to remember is that dreams of becoming an uber-specialized, niche practitioner may change. When you pick a residency, you should be able to tolerate the "basic" career path involved. Ten years from residency to the end of fellowship is a long time, and your life may change significantly. When it came down to it, I could see myself being a general surgeon, doing lumps/bumps, appys, and choles everyday. On the other hand, if I would have started down the road of interventional cards, and didn't make it, I would have been miserable.

 

[dragonfly99]

jakstat,
I agree with you.
I did IM residency and didn't hate it, but I still find the OR fascinating and I love the cath lab and EP lab, which are kind of like the OR in a lot of ways. It is true that in order to tolerate IM you have to be able to at least tolerate a lot of hospital rounding...and somewhat more clinic. However, I know a lot of IM residents and fellows (and attendings) who don't like clinic that much. You won't find most cardiologists clamoring to get more clinic time. So this whole stereotype of "surgical types are this way" and "IM people are that way" is just a big fat generalization...has some basis in fact, but far from being totally true. And I think this big lie that there are two basic pathways (surgical versus the peds/IM type) that one must pick one FIRST and then go from there is totally not right. I think it's a gross simplification of what is a very complex process. And there aren't two kind of docs in the world...there are a LOT of types, even sometimes within the same specialty.

 

[Buzz Me]

I dont understand why there is the opinion that one can only like either surgery OR IM. So if someone is good with their hands and also likes problem solving then it would make sense they will like both fields.

Though they may have some traits in common, there are vast differences between the two fields. For Medicine, people like to focus on long hours spent rounding; lack of procedures (at least before fellowship); many chronic, noncurable problems to deal with in clinic; etc. For Gen Surg, it's usually bad lifestyle; often aggressive, malignant personalities; long hours of standing in often painful OR cases.

I would argue that for the vast majority of us in surgery, what separates us from everyone else that enjoys being in the OR (many med students like being in the OR, using their hands, performing technically challenging tasks) is that we're willing to put up with the harsh lifestyle and constant beatdowns either because (1) we love General Surgery (and operating) that much, or (2) we're so driven to pursue a particular fellowship that we can put up with anything.