Lost in the IM Shuffle?
- Thread starter commonwealth ki
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Very.
Good residency and performance in that residency, good scores, good LORs, good research.
Is it common for medical students to avoid IM for this very reason - and choose lets say Neurology, etc.
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I don't know if I'd say it's very common for residents to not be able to get their desired fellowship at all, if they are in a major academic hospital's IM program. If you look at the match rates into even GI and cards for US grads, the match rate for cards hovers around high 70% and for GI I don't know what it is, but I'm sure it's >>50%, like 60-something percent. However, what is common is for IM house staff to give up on even applying for things like cards or GI, because they give up. Why? For one thing, they realize that they might not get in (while getting into an easier-to-get fellowship like endo or renal is pretty much guaranteed if you apply) and want a guaranteed fellowship spot. Or maybe they don't want to break their backs chasing the LOR's and research they'll need (or even take an extra year or two to do research to strengthen their applications). Or they realize that if they apply for one of those easy to get fellowships, they can probably get into fellowship at one of their top 1-2 places, whereas if they try for cards or GI or allergy they might have to be willing to move anywhere that will take them. Also, sometimes people just burn out and decide they don't want to do a fellowship at all...they decide to be a hospitalist or do primary care.
I agree that people sometimes opt for a specialty like neuro or some others because they fear getting into IM and not being able to get their desired fellowship...doing IM is somewhat of a gamble if you don't realize that you need to get yourself into a major academic hospital IM program, and then bust your tail while you are there, if you want one of those picky/popular IM fellowships.
I agree that people sometimes opt for a specialty like neuro or some others because they fear getting into IM and not being able to get their desired fellowship...doing IM is somewhat of a gamble if you don't realize that you need to get yourself into a major academic hospital IM program, and then bust your tail while you are there, if you want one of those picky/popular IM fellowships.
Thanks for the info. Very helpful.
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interesting
it seems like competitiveness is based on perceived salary
any im subspecialties out there that still have high salary but are not in the competitive tier like cards, GI, allergy?
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Perceived salary is undoubtedly part of it, but for cards at least, I think a lot of people are also truly very interested in it. I mean, pretty much everyone knows multiple people affected by cardiovascular dz., and has seen some cool cardiology cases...it's just a field that tends to attract a lot of interest from med students and residents.
I'm not sure what the pay is for allergy/immuno, but it's probably actually the most competitive IM fellowship, based on the match rate. I'm not sure...I'd have to check and I'm too lazy.
Nephrology makes good money and it's not that competitive to get in...
Rheum and endo are not competitive...probably don't make that much either...I mean not much better than primary care or hospitalist.
Hem/onc is fairly competitive, makes probably on par with cards and GI.
I'm not sure what the pay is for allergy/immuno, but it's probably actually the most competitive IM fellowship, based on the match rate. I'm not sure...I'd have to check and I'm too lazy.
Nephrology makes good money and it's not that competitive to get in...
Rheum and endo are not competitive...probably don't make that much either...I mean not much better than primary care or hospitalist.
Hem/onc is fairly competitive, makes probably on par with cards and GI.
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Thanks
that's the 2nd time I've heard about nephrology now in terms of the ability to make significantly more than a hospitalist without absolutely banging your head against the wall trying to secure a cards/GI/allergy fellowship
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If heme/onc gets paid like noninterventional cardio or GI, why is it not quite as competitive? Are people turned off by very sick patients? Also, is pulm/CC becoming similar in competitiveness to heme/onc?
Also, I was under the impression that nephro was pretty much in the same range as rheum, endo, and ID in terms of competitiveness and pay. Is there hospitalist pay that can compete well with rheum, endo, ID, nephro?
Allergy/immuno sounds very derm-like. Something low risk that works when there are a lot of people with disposable income but not that great for a recessed/depressed economy.
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I actually don't know what rheum and allergy/immuno get paid, but I'm assuming allergy/immuno gets more because they do allergy testing, shots, etc. Anything with procedures gets paid more.
Endocrine and ID don't necessarily make any more $ than general IM or a hospitalist.
Hem/onc actually is pretty competitive (in response to the ? above). I think people like the idea of doing procedures, which may explain why more prefer GI and cards. I actually never understood why people like GI, but that's just me 🙂
Yes, I think some people are turned off by hem/onc due to the fact that it seems like you are just giving a lot of toxic drugs to patients who are likely to die. However, hem/onc is super important. My best friend had breast CA and it's obvious to anyone who has had friends or family members with CA that it's important to have excellent doctors doing hem/onc. I just think that it's not for everyone, emotionally speaking and in other ways. Personally, I find there isn't enough action and it's somewhat depressing, but that's probably why I'm doing cards.
Endocrine and ID don't necessarily make any more $ than general IM or a hospitalist.
Hem/onc actually is pretty competitive (in response to the ? above). I think people like the idea of doing procedures, which may explain why more prefer GI and cards. I actually never understood why people like GI, but that's just me 🙂
Yes, I think some people are turned off by hem/onc due to the fact that it seems like you are just giving a lot of toxic drugs to patients who are likely to die. However, hem/onc is super important. My best friend had breast CA and it's obvious to anyone who has had friends or family members with CA that it's important to have excellent doctors doing hem/onc. I just think that it's not for everyone, emotionally speaking and in other ways. Personally, I find there isn't enough action and it's somewhat depressing, but that's probably why I'm doing cards.
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I am kind of in the same boat (love Neurology, pondering Derm), although I love IM and certain subspecialties of it. The thing that turns me off about a fellowship is the thought of competing for several more years and applying all over again. I am particularly interested in ones like Endo, Rheum, and ID to a lesser degree which sound like they are relatively noncompetitive.
If I finish a well-respected (ie top 10 or 20 by reputation) IM program, having done a decent, hard-working job, am I pretty much a shoe-in for getting one of these or will I have to bust arse (meaning above and beyond everybody else's arse-busting as I am aware there is already large degree of arse-busting inherent in being a resident) like I did in medical school?
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I'm not sure I'd use the word shoe-in, but if you are/were competitive for derm, and you go to a good IM residency like that and don't screw up clinically or make the PD or cards or GI attendings mad or something, then yes, I think you would be very, very likely to get a cards or GI spot somewhere. This assumes average or better USMLE scores, and some research at some point along the way (not necessarily while a resident...could even be during med school, etc.). To get endo or ID or rheum would be super easy, and you could very, very likely just stay @the place you did your IM residency for that (or not, if you end up not wanting to). For cards or GI, often residents have to move somewhere else to do fellowship, because if you go to a good IM program there probably will be 7-10 people at least (more at the huge IM programs) applying for cards and GI, and the program will probably only keep 2-3 of its own residents. You can't necessarily control if YOU are going to be one of those people...you can increase the chances by getting to know as many attendings as you can in the department and trying to do research with one, but sometimes you just aren't that guy that they decide to keep, even if you wanted to be.
Keep in mind that the match rate for cards for US allopathic grads hovers around the high 70% range and for GI I think it's around 70% (not sure about the latter...would have to check). This is for all US allopathic grads who apply, so those are pretty good odds. You do have to keep in mind that it's a self selected group (people who don't think they are competitive often decide not to risk applying or are talked out of it by their PD or faculty, etc.), but that's still a pretty high match rate. To get cards or GI SOMEWHERE isn't ridiculously difficult in most cases. It just might not be at your favorite, ideal place.
