Firstly, I think it's perfectly reasonable to have 1-2 safety programs if you've got a total of ten interviews planned. Just make sure one of them is a place you know that you really will have a spot (e.g. your home program). Stuff happens and great candidates do fall through. That being said, this is neurology folks, not interventional rads. Take a deep breath. With the exception of the tippy top programs, it really is a buyer's market still. It's no different than applying to college or med school. A few "dream" programs, a few reasonable matches, and 1-2 "CYA" programs.
Schedule each interview as you get them, but be making a pre-interview rank list somewhere so that you can cull out less-desirable programs as you start racking up more interviews. So go ahead and schedule with Po-dunk State. Once you've filled out your dance card with programs you're more interested in, you can always cancel. Every, and I mean EVERY program has cancellations and expects them. In fact, better to let them know early so they can offer the spot to someone who may be more interested that you are. A polite "I'm sorry but my circumstances have changed/ I'm unfortunately going to have to decline the interview but I really appreciate being considered and invited." will suffice. The program's just going to call the next person on the list... and there's ALWAYS a next person on the list.
If you've got a reasonable number of programs (let the NRMP match stats guide you), there's no reason to interview at Po-Dunk State if you know you'd rather not match than live in You-Can't-Get-There-From-Here, Nowhere.
Prelims get trickier. I was at a med school where we had all but guaranteed prelim years if we needed them and I mostly applied to categorical programs. I did the one prelim year interview and that was it! Clearly it's not that simple for most folks. Talk with the programs you're interviewing with. Many will work with the IM department to get you an interview while you're already in town, though it may be an abbreviated one without all the bells and whistles.
Most med school programs will work with you and expect you to be MIA as a fourth year. We've all been there. Try to cluster interviews when you can, say in the NYC or Boston areas. Don't be shy about calling the program to swap your dates around. Most all of them will work with you. No program expects that they're the only one that you're interviewing with and will at least try to work to accommodate you.
Other than that... Be nice. Be yourself. Enjoy the ride. 😀
