Is it too late to apply to Family Practice ?

[every1needsadoc]

Onto Plan F.
Any help/opinion/suggestions/insight would be appreciated.

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[elizabeth5863]

It's not too late depending on where you are applying, but you should apply as soon as possible. Most interview slots are already filled up at programs with popular locations, but at programs that don't interview many people each year, there's still a chance. Where are you thinking on going? I'd recommend Midwest family programs. They're excellent but don't get as many applicants as west coast programs, so they are more likely to grant you an interview. I'd recommend Iowa Lutheran, Cedar Rapids, Waterloo, Mason City - these are programs in Iowa. I also recommend Duluth in Minnesota. I've either interviewed or did rotations at most of these places except one. Good luck! and Hurry!

 

[sophiejane]

It's pretty late.

Why don't you just scramble? That way maybe you can still have a shot at plans A-E, and a shot at not being miserable because you resorted to plan F.

 

[elizabeth5863]

It's not too late depending on where you are applying, but you should apply as soon as possible. Most interview slots are already filled up at programs with popular locations, but at programs that don't interview many people each year, there's still a chance. Where are you thinking about going? I'd recommend Midwest family programs. They're excellent but don't get as many applicants as west coast programs, so they are more likely to grant you an interview. I'd recommend Iowa Lutheran, Cedar Rapids, Waterloo, Mason City - these are programs in Iowa. I also recommend Duluth in Minnesota. I've either interviewed or did rotations at most of these places except one. Good luck! and Hurry!

 

[Faebinder]

In all honesty.. it's too late...

Prepare to scramble and prepare well..

 

[RuralMedicine]

It's pretty late.

Why don't you just scramble? That way maybe you can still have a shot at plans A-E, and a shot at not being miserable because you resorted to plan F.

-I can't speak from experience fortunately but I have a friend who was in this situation and it wasn't pleasant for them.
-I'd agree it's late to be applying for any specialty however, some programs may still have available interview spots and I suppose if you have everything already uploaded electronically adding and reassinging will not be a problem.
-Do not apply to FM programs unless you can envision yourself doing that and being happy and fulfilled. (Not a knock on FM I'd say this about any specialty.)
-You can always rank programs in more than one specialty. It may look a little interesting if people ask you about it but then if you apply to only one program at an institution PDs may not even realize. Although I did not do this it is not uncommon for residents to sometimes rank combo residency programs at the top of their list and then categorical programs in one of the disciplines further down. I also have a colleague who ranked Med-Peds in the Northeast and the Midwest and FM on the West Coast (where Med-Peds doesn't have much of a foothold but where she had family). She ended up matching at one of her top Med-Peds programs but had decided that if she couldn't match she would do FM and that if she was doing FM she should do it near her family and where she intended to practice. So you could rank non-FM programs at the top of your list and FM programs below them.

 

[NDMD]

It's not too late at all. There is plenty of time to interview.

 

[iatrosB]

-I can't speak from experience fortunately but I have a friend who was in this situation and it wasn't pleasant for them.
-I'd agree it's late to be applying for any specialty however, some programs may still have available interview spots and I suppose if you have everything already uploaded electronically adding and reassinging will not be a problem.
-Do not apply to FM programs unless you can envision yourself doing that and being happy and fulfilled. (Not a knock on FM I'd say this about any specialty.)
-You can always rank programs in more than one specialty. It may look a little interesting if people ask you about it but then if you apply to only one program at an institution PDs may not even realize. Although I did not do this it is not uncommon for residents to sometimes rank combo residency programs at the top of their list and then categorical programs in one of the disciplines further down. I also have a colleague who ranked Med-Peds in the Northeast and the Midwest and FM on the West Coast (where Med-Peds doesn't have much of a foothold but where she had family). She ended up matching at one of her top Med-Peds programs but had decided that if she couldn't match she would do FM and that if she was doing FM she should do it near her family and where she intended to practice. So you could rank non-FM programs at the top of your list and FM programs below them.

What do you think about applying for FM and Med/Peds at the same institution? Would that be a red flag for either program?

 

[rice]

What do you think about applying for FM and Med/Peds at the same institution? Would that be a red flag for either program?

Normally, I wouldn't do it if it's your home institution, since home-field advantage is too much to lose both programs imho. I think there's a slim chance that either program would find out, as they are so busy processing applications that they won't be cross-checking every application with all the other departments...unless you might be neurotic enough to think that the hospital has a central database that cross-checks for these kind of things. But...you never know what might be inadvertently heard in a hallway or an elevator about your name. If it's another institution far away, you might get away with dual applications. The worst that can happen is that both programs would drop you. (well, I guess they can blacklist you too...) It's all a calculated risk.

 

[Faebinder]

What do you think about applying for FM and Med/Peds at the same institution? Would that be a red flag for either program?

I'd do it... Red Flag or no.

Your argument to them is... "Sir, I would much rather match in your Med-Ped program here but if I can't then I would rather match in FM here than Med-Ped elsewhere."

Trust me.. you are very unlikely to be asked... they don't communicate.

 

[every1needsadoc]

Wow, you guys are quick, appreciate it !
Well SophieJane & Faebinder, I have thought long & hard about the scramb......Have researched it a little & it just sounds like such a gamble ???(even though I haven't heard of a bad scramb.....experience, yet).

Just don't want to come up empty handed........... have already been out one year, got a masters in health service administration, taught medicine at a couple colleges, did every form of tech work you could imagine, dabbled with pharmaceutical research, would like to start some form of graduate medical training......

 

[sophiejane]

Wow, you guys are quick, appreciate it !
Well SophieJane & Faebinder, I have thought long & hard about the scramb......Have researched it a little & it just sounds like such a gamble ???(even though I haven't heard of a bad scramb.....experience, yet).

So then apply to some programs, see what turns up, if you don't match, then scramble.

You are going to have to decide at some point if you will be happy as a family doctor. If you are settling for it because you couldn't get into something else, you may be better off scrambling and taking your chances.

Do you mind sharing what you think is keeping you from getting interviews in your chosen field?

 

[RuralMedicine]

What do you think about applying for FM and Med/Peds at the same institution? Would that be a red flag for either program?

I think it may depend on where you are applying and the strength of the FM program at the institution. For example, the institution I trained at did have an FM program, however it was very weak perhaps largely because of being opposed by not just IM, Peds, EM, OB, Surg etc but Med-Peds as well. I think if our PD came across an applicant who was applying to both they would have presumed they weren't confident that they would match Med-Peds at our institution and needed desperately to be at our institution so would take FM if needed. However, if you are geographically limited and would be happy with FM then I'm not sure that is such a bad thing. Our PD might have tried to tactfully suggest to you to look very critically at the FM program before considering ranking.

I'm not sure how the FM PD at my former institution would react as they had a tendency to scream at other PDs at the institution on a regular basis when they disagreed with patient management. FM lost all ICU privileges or ability to write orders on any patient requiring above telemetry level of care midway through my intern year so things got even worse after that. Especially since some of the FM residents and attendings would continue to write occasional inappropriate orders and then IM or Surgery or Pulm or whoever would have to try not to get frustrated that the nurse carried them out (because it was not the nurses fault). At one point all the unit clerks/nurses had lists of every FM resident/attending at the institution and were supposed to cross check against the list before entering orders. I'm sure that got tedious. The interns did a month of ICU but took ?FM call (or maybe no call) so they weren't always taken very seriously. Also since they were never going to be managing ICU patients as upper levels I think the focus was not on preparing them for that. Things did get a little better when apparently there was strong consideration to eliminating the FM program all together and basically the FM attendings promised to "play nicer".

 

[elizabeth5863]

I have a friend who didn't match into optho last year; there were slots to scramble in but they weren't in the location that he wanted. He showed me a list of fields/places that you can scramble into and there was an opening in radiology. So, there might be an opening in the field that you're interested in, but the location might not be the one you want. If you're trying to get into a field that has an early match (i.e. urology, optho, etc), I'd still apply to some fp programs as backup. The early match is in January (I think), but for the regular match (which is in March), you won't have to submit your rank list until February. If you see openings in the field you're interested in in the early match, then I'd go ahead and scramble. If not, then you still have fp as a backup. (You can apply to fp and do some fp interviews, but you can decide not to rank any of the fp programs if you want. Many of the Midwest fp programs pay for travel and/or hotel expenses). Another thing you can do is a transitional year if you don't get into the field you want. Then reapply next year for the match during your transitional year. Hope that helps.

 

[sophiejane]

I'm not sure how the FM PD at my former institution would react as they had a tendency to scream at other PDs at the institution on a regular basis when they disagreed with patient management. FM lost all ICU privileges or ability to write orders on any patient requiring above telemetry level of care midway through my intern year so things got even worse after that. Especially since some of the FM residents and attendings would continue to write occasional inappropriate orders and then IM or Surgery or Pulm or whoever would have to try not to get frustrated that the nurse carried them out (because it was not the nurses fault). At one point all the unit clerks/nurses had lists of every FM resident/attending at the institution and were supposed to cross check against the list before entering orders. I'm sure that got tedious. The interns did a month of ICU but took ?FM call (or maybe no call) so they weren't always taken very seriously. Also since they were never going to be managing ICU patients as upper levels I think the focus was not on preparing them for that. Things did get a little better when apparently there was strong consideration to eliminating the FM program all together and basically the FM attendings promised to "play nicer".

That sounds awful, but what is the point of relating this little gem? Exactly what does the abysmal nature of the FM program at YOUR former residency program have to do with answering Iatros' question? I'm really struggling to see what your point is here.

Your program's FM department is not at all the norm. Please try to remember that you are among people who either practice Family Medicine or plan to in the future, and keep your criticism in the constructive lane.

 

[Faebinder]

I think it may depend on where you are applying and the strength of the FM program at the institution. For example, the institution I trained at did have an FM program, however it was very weak perhaps largely because of being opposed by not just IM, Peds, EM, OB, Surg etc but Med-Peds as well. I think if our PD came across an applicant who was applying to both they would have presumed they weren't confident that they would match Med-Peds at our institution and needed desperately to be at our institution so would take FM if needed. However, if you are geographically limited and would be happy with FM then I'm not sure that is such a bad thing. Our PD might have tried to tactfully suggest to you to look very critically at the FM program before considering ranking.

I'm not sure how the FM PD at my former institution would react as they had a tendency to scream at other PDs at the institution on a regular basis when they disagreed with patient management. FM lost all ICU privileges or ability to write orders on any patient requiring above telemetry level of care midway through my intern year so things got even worse after that. Especially since some of the FM residents and attendings would continue to write occasional inappropriate orders and then IM or Surgery or Pulm or whoever would have to try not to get frustrated that the nurse carried them out (because it was not the nurses fault). At one point all the unit clerks/nurses had lists of every FM resident/attending at the institution and were supposed to cross check against the list before entering orders. I'm sure that got tedious. The interns did a month of ICU but took ?FM call (or maybe no call) so they weren't always taken very seriously. Also since they were never going to be managing ICU patients as upper levels I think the focus was not on preparing them for that. Things did get a little better when apparently there was strong consideration to eliminating the FM program all together and basically the FM attendings promised to "play nicer".

Feel free to tell us where this program is so people dont apply there and it get closed... but as Sophie said..... What does this have to do with the OP's issues? Or is this a claim that other specialties don't have any bad ones amongst them?

OP: Scramble is totally different for US grads vs FMGs/IMGs. For US grads it's a breeze.. the dean's department will call places for you and within the end of the first day you will end up somewhere. For IMGs/FMGs, your ass is on your own and for every one openinng there are 10 applicants... you better have some very good scores... Even FM becomes a struggle. This has become worse in the last few years. Take a look at nrmp characteristics. Last year there were 6643 unmatched applicants and 620 PGY-1 position unfilled. Yup a little over 10:1 and a thousand of those applicants are US MDs. I am not the kind of person to feed you garbage and tell you everything is alright.. But if you are IMG/FMG and it sounds like it since you wouldn't be worried about scrambling..... Get a good plan. If you are a US MD then go talk to the Dean's office.. I am sure they will set you up.

 

[RuralMedicine]

That sounds awful, but what is the point of relating this little gem? Exactly what does the abysmal nature of the FM program at YOUR former residency program have to do with answering Iatros' question? I'm really struggling to see what your point is here.

Your program's FM department is not at all the norm. Please try to remember that you are among people who either practice Family Medicine or plan to in the future, and keep your criticism in the constructive lane.

I think I've frequently stated that the FM program at the institution I trained at is quite disparate from an unopposed program and definitely different than better academic university programs. My point was that if the two programs/ their respective program directors do not get along then applications to the other program may be viewed negatively by the PD of the weaker program. The stronger PD may question the applicants confidence but then I personally favor physicians with a confidence:competence ratio slightly below one.

I'm truly sorry if my response offended you.....

 

[RuralMedicine]

Feel free to tell us where this program is so people dont apply there and it get closed... but as Sophie said..... What does this have to do with the OP's issues? Or is this a claim that other specialties don't have any bad ones amongst them?

I don't think it would be appropriate to tell you where this program is. To discourage applicants from applying would be even more inappropriate. However, I believe from glancing at your list of interview invites a few weeks ago I can tell you that it is not included on your list.

My response was in reply to Iatros question of applying to Med-Peds and FM at the same institution not the OP's question about applying late to FM.

As far as other specialties not having any programs that could use improvement or perhaps are best improved by closing all together I would strongly disagree with that statement. Conversely I can think of strong FM programs that I would have ranked had I planned to do FM.

 

[sophiejane]

I think I've frequently stated that the FM program at the institution I trained at is quite disparate from an unopposed program and definitely different than better academic university programs. My point was that if the two programs/ their respective program directors do not get along then applications to the other program may be viewed negatively by the PD of the weaker program.

Then why go into so much detail about how the FM residents weren't respected or taken seriously, and about how they were monitored and apparently babysat because residents weren't trusted not to write "inappropriate" orders...?

You had one line about PDs not getting along, and 12 about how incompetent the FM residents and faculty were.

 

[Faebinder]

Then why go into so much detail about how the FM residents weren't respected or taken seriously, and about how they were monitored and apparently babysat because residents weren't trusted not to write "inappropriate" orders...?

You had one line about PDs not getting along, and 12 about how incompetent the FM residents and faculty were.

I'd ask you to marry me sophie but your avatar is scary and I am already married....

 

[sophiejane]

I'd ask you to marry me sophie but your avatar is scary and I am already married....

Scarier than the last one? Should I go back to the two drunken AbFab gals?

Well, I'm married too, darn it.

 

[RuralMedicine]

Then why go into so much detail about how the FM residents weren't respected or taken seriously, and about how they were monitored and apparently babysat because residents weren't trusted not to write "inappropriate" orders...?

You had one line about PDs not getting along, and 12 about how incompetent the FM residents and faculty were.

Again my sincere apologies if I offended you. I think saying anything further is just going to upset you more so I'll just excuse myself now. Best of luck with the match process and beyond.

 

[lowbudget]

I'm not sure how the FM PD at my former institution would react as they had a tendency to scream at other PDs at the institution on a regular basis when they disagreed with patient management. FM lost all ICU privileges or ability to write orders on any patient requiring above telemetry level of care midway through my intern year so things got even worse after that. Especially since some of the FM residents and attendings would continue to write occasional inappropriate orders and then IM or Surgery or Pulm or whoever would have to try not to get frustrated that the nurse carried them out (because it was not the nurses fault). At one point all the unit clerks/nurses had lists of every FM resident/attending at the institution and were supposed to cross check against the list before entering orders. I'm sure that got tedious. The interns did a month of ICU but took ?FM call (or maybe no call) so they weren't always taken very seriously. Also since they were never going to be managing ICU patients as upper levels I think the focus was not on preparing them for that. Things did get a little better when apparently there was strong consideration to eliminating the FM program all together and basically the FM attendings promised to "play nicer".

Hmmm... this kind of crap happens all the time in the ICU, though, with every specialty. Cards disagrees with Pulm who disagrees with Renal. GI with Gen Surg. I think it comes with the territory when you manage complicated patients. If it were easy, you wouldn't need 6 doctors on the case. But from what I've seen, when attendings disagree or if management plans aren't unified, they typically page each other to talk about the case, resolve it over conversation (and not in the chart), and come up with something that makes sense. I mean, patient first, you know? I don't think it has to do FM's competence (obviously, especially if they are willing to outright disagree with a consultant)... sounds like it has more to do with personality and ability to "play nice" (i.e. play politics... and knowing which battles to fight)...

The other thing is if you have a consultant on board and you want to write orders that conflicts, at my hospital, it's consider poor form as a primary to not inform the consultant that you're writing those orders. BTW, I like "conflict" better. "Inappropriate" is someone's opinion. I mean, why would someone write an order that's "inappropriate"? Were they doing something that would harm the patient? Or was it something that didn't coincide with the consultant's organ system/agenda? Same thing goes for the consultant. If they're going to do something major, they'll usually communicate with the primary to let them know that that should be the plan. Sounds like there's a problem with communication and the residents (from all specialties) are getting involved in faculty soap opera. Again, poor form all around.

The other difference is that if a consultant and a primary can't "play together" nicely, you simply don't ask for that consultant if you can help it.

The other thing I can think of is, well, maybe there are too many people in the kitchen... I mean, is FM trying to manage HTN when Cards and/or Renal are doing it? I mean, isn't it true that if 2 doctors are working on the same problem, only 1 can get paid because payers don't give a damn how many doctors are on board (DRG or something... no, "concurrent care", correct me please...). If that's the case, don't consult in the first place.

I think there are cases where consultants are brought on when you call consultants. Some consultants will ask for your permission first, but others will go ahead and start pulling in other consultants. The bad news is that you lose control of that patient as a FM primary and you're stuck following along having to do the discharge summary and take nursing calls. The good news is that if you have a patient who you want to give it up, you just call on these consultants and they'll bring in all their friends. Sometimes, these guys will write it into the chart, so you're stuck and have to call these consults. Again, the ones with etiquette will call you to talk to you before going that far.

I dunno those're just my observations. I mean, RuralMed, what was the culture like at your training institution? How does it differ from the place where you admit now?

 

[goldengate]

I have thought long & hard about the scramb......Have researched it a little & it just sounds like such a gamble... Just don't want to come up empty handed........... have already been out one year

To rely on the Scramble does seem like a gamble. I am like you in that taking chances is not an option as I am already delayed TWO years. I did have some anxiety over applying so late to FM, but I thought better late than never. I called many of the programs to see if they were still taking apps so I wouldn't waste the $25. I ended up applying to 61 programs from mid to late Nov. and actually have 1 interview already. Hopefully more to come. I did get my share of rejections as well probably b/c I applied so late. But it's not too late. Did you apply yet?

Just curious, when you said Plan F, does F stand for Family, or does it mean it's your 6th choice?!

 

[elizabeth5863]

I called many of the programs to see if they were still taking apps so I wouldn't waste the $25. I ended up applying to 61 programs from mid to late Nov. and actually have 1 interview already. Hopefully more to come. I did get my share of rejections as well probably b/c I applied so late. But it's not too late.

I think that when you call programs to ask if they're still taking applications, you also need to ask if they have interview dates still available (many places are booked with interviews already). Even if they're still taking applications, if they don't have an interview opening available, there's no point in applying to those programs and wasting your money. However, with the bad weather in some places, there are people canceling interviews too. Good luck.