internal medicine residency before derm

[erasable]

I had attended a meeting where the dermatologist giving the talk suggested an alternate path for students, who were not as competitive, to go to internal medicine first, then go into dermatology. How viable an option is this?

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[asmallchild]

I had attended a meeting where the dermatologist giving the talk suggested an alternate path for students, who were not as competitive, to go to internal medicine first, then go into dermatology. How viable an option is this?

Not at all.

Going into internal medicine first will severely limit the # of derm residencies you can apply to afterwards because you've already used up 3 of the 4 years of funding. Now certainly, there are programs who have taken applicants who have completed residencies in other fields but they are few and far in between.

For those students who may feel "weaker", taking some time off in the midst of medical school to pursue some form of research (whether that be a year of research or longer for a PhD) is probably a more fruitful approach.

Conversely, if you feel you could be very happy with a career in internal medicine, you could certainly complete an IM residency first, attempt to apply to derm, and if that doesn't work, revert to IM.

For those truly interested in both, there are an increasing # of IM-derm programs as well to select from. I would say this shouldn't be considered a "back door" entrance into dermatology as they are still highly competitive programs.

 

[erasable]

Not at all.

Going into internal medicine first will severely limit the # of derm residencies you can apply to afterwards because you've already used up 3 of the 4 years of funding. Now certainly, there are programs who have taken applicants who have completed residencies in other fields but they are few and far in between.

For those students who may feel "weaker", taking some time off in the midst of medical school to pursue some form of research (whether that be a year of research or longer for a PhD) is probably a more fruitful approach.

Conversely, if you feel you could be very happy with a career in internal medicine, you could certainly complete an IM residency first, attempt to apply to derm, and if that doesn't work, revert to IM.

For those truly interested in both, there are an increasing # of IM-derm programs as well to select from. I would say this shouldn't be considered a "back door" entrance into dermatology as they are still highly competitive programs.

I'm exploring the "complete an categorical IM residency first, then attempt to apply to derm". In practice that would entail applying to derm in August of PGY-2.

ie. a complete categorical residency followed by a complete dermatology residency.

1. Has it been done before? How often?
2. Would IM residency be an advantage (a categorical resident's fund of knowledge may be as strong if not stronger than an AOA medical student)? Or a disadvantage (for taking about 2-3 years longer to build a fund of knowledge on par with an AOA)?
3. How can a student make up for grades and step scores that are not quite up to derm-standards, aside from research?

 

[asmallchild]

I'm exploring the "complete an categorical IM residency first, then attempt to apply to derm". In practice that would entail applying to derm in August of PGY-2.

ie. a complete categorical residency followed by a complete dermatology residency.

1. Has it been done before? How often?
2. Would IM residency be an advantage (a categorical resident's fund of knowledge may be as strong if not stronger than an AOA medical student)? Or a disadvantage (for taking about 2-3 years longer to build a fund of knowledge on par with an AOA)?
3. How can a student make up for grades and step scores that are not quite up to derm-standards, aside from research?

1. I'm sure it's been done before. I haven't met any personally but I know people who have graduated from IM programs and then opted to pursue radiology. I've met people who've completed an otolaryngology residency and then opted to pursue dermatology. How often? That unfortunately I can't help you with.

2. It depends. There are programs that would welcome that kind of knowledge. I would certainly hope that knowledge bank is SIGNIFICANTLY larger than that of an AOA medical student's after a 3 year residency in internal medicine. At the same time, you could make the argument that while there is some overlap between medicine and dermatology, there's still a significant enough gap between the two fields that it won't give you a significant advantage to reapply as an IM resident. (Will anyone be deftly calculating FeNas and interpreting ABGs in derm clinic?)

3. It's typically research. You'll see very few people who have perfect grades, perfect step scores, and an outstanding research resume. Usually it's a combination of having as many good points as possible and minimizing your weaknesses. Coming across as an interesting, easy-going person during interviews is also helpful. Having a big name going to bat for you during the application process (again, typically done via research) is also helpful. In the end, this is a discussion best had with your dean or student advisor to see how competitive you are. My advice, ultimately, would be to pursue a categorical residency in IM only if you are truly interested in practicing IM. It's not going to be a pleasant 3 years if you are looking at that as purely a stepping stone to a derm residency position.

 

[N-Surge]

I had attended a meeting where the dermatologist giving the talk suggested an alternate path for students, who were not as competitive, to go to internal medicine first, then go into dermatology. How viable an option is this?

If you want to go for Dermatology then go for Dermatology to begin with. I know, it is easier said than done. However, you may have a really hard time explaining why you did IM first, e.g. to refer patients to yourself? Perhaps it was to make up for deficiencies you think you had from med school.

Remember, you will be doing a year of something other than all Derm during your PGY1 year. If you want more IM training then apply for the catergorical Derm spots where you will be essentially doing the same rotations as other traditional IMs. Also, apply for some IM heavy prelim spots to go along with the advanced Derm programs you apply too.

 

[DermMatch]

Residencies who will take an IM person usually will fund the spot with grant money other than Medicare. Meaning, your doors to derm are MUCH fewer.

That said, it's been done before -- I know Utah specifically does like IM-trained people because they are a strong believer in derm as an IM-related specialty. I think they may also have their own inpatient service.

I also know people who trained in another field and despite all that, plus research, they couldn't get in because their scores sucked.

 

[Nellyakgo]

Going into internal medicine first will severely limit the # of derm residencies you can apply to afterwards because you've already used up 3 of the 4 years of funding.

Sorry for the stupid question: Can you please elaborate on the 4 years of funding and "using up" the years. I don't know what this is about. Thanks!

 

[DermViser]

Residencies who will take an IM person usually will fund the spot with grant money other than Medicare. Meaning, your doors to derm are MUCH fewer.

That said, it's been done before -- I know Utah specifically does like IM-trained people because they are a strong believer in derm as an IM-related specialty. I think they may also have their own inpatient service.

I also know people who trained in another field and despite all that, plus research, they couldn't get in because their scores sucked.

If an applicant has done several years of work in research in dermatology, why do their USMLE scores really matter at that point? Do you mean suck as in below 240 bad or below the national average? I've heard derm boards is really just pure rote memorization, unlike the USMLE which emphasizes more application rather than rote memory.

 

[asmallchild]

Sorry for the stupid question: Can you please elaborate on the 4 years of funding and "using up" the years. I don't know what this is about. Thanks!

I'm not entirely certain on the rules myself but when you sign up for a residency program, that's how much money Medicare "allots" for your education.

So if it's categorical internal medicine, that's 3 years of funding. Even if a spot opens up for derm and you manage to snag it, because derm is 4 years long (including a preliminary year), your funding will run short.

Perhaps someone with more knowledge can clarify the exact rules?

Either way, I've heard this from enough program directors to confidently say that if you want to do derm, going through internal medicine will NOT make you a more appealing candidate to most programs out there (there are of course exceptions as outlined above by other posters)

 

[erasable]

I'm not entirely certain on the rules myself but when you sign up for a residency program, that's how much money Medicare "allots" for your education.

So if it's categorical internal medicine, that's 3 years of funding. Even if a spot opens up for derm and you manage to snag it, because derm is 4 years long (including a preliminary year), your funding will run short.

Perhaps someone with more knowledge can clarify the exact rules?

Either way, I've heard this from enough program directors to confidently say that if you want to do derm, going through internal medicine will NOT make you a more appealing candidate to most programs out there (there are of course exceptions as outlined above by other posters)

I have heard that if you quit a residency half way and go to another residency, your funding will be limited to the # of years of your original residency.

If you complete one residency and then do another one (I've seen examples where ppl went from int med to radio), will medicare pay for the second residency?

 

[asmallchild]

I have heard that if you quit a residency half way and go to another residency, your funding will be limited to the # of years of your original residency.

If you complete one residency and then do another one (I've seen examples where ppl went from int med to radio), will medicare pay for the second residency?

My guess is no but it's just a guess.

 

[Nellyakgo]

Either way, I've heard this from enough program directors to confidently say that if you want to do derm, going through internal medicine will NOT make you a more appealing candidate to most programs out there (there are of course exceptions as outlined above by other posters)

Are there any particular programs that will make you a more appealing candidate to transfer into derm? And are there any programs even if not making you particularly appealing to transfer to derm, would - let's say - be Ok for a transfer?

 

[N-Surge]

Are there any particular programs that will make you a more appealing candidate to transfer into derm? And are there any programs even if not making you particularly appealing to transfer to derm, would - let's say - be Ok for a transfer?

I am not sure there are any Derm programs out there who are specifically looking for people who already have any IM credentials, other than having completed an IM prelim PGY1 year.

Then there are those programs specifically geared towards the applicant who wants both IM and Derm, the combined IM/Derm track. This is the closest I think you will come to a specific program having a built in desire for their residents to have added IM training.