M4 just deciding to do IM- too late?

[redruby]

---

Members don't see this ad.

So, as the title states, I am an MS4 who pretty much had my heart set on radiology... until now. I just completed a medicine sub-i and enjoyed it far more than expected. Did 3rd year rotation at a community program with all FMGs. While I really liked those residents as people, they all seemed to really hate their lives and I was subsequently turned off to IM. Plus, I hated the interminable rounds and tried to avoid clinic like the plague.

However, I did the sub-i at my home institution- university based state hospital and liked it a lot more. The residents were hard-working and at times stretched, but they all seemed to enjoy what they were doing and loved teaching. As an M4, I knew more and had more responsibility, so it actually felt like I was doing something. Rounds can still be painful, especially post call with certain attendings, and we don't do clinic as sub-i's, but I'm just now beginning to feel that overall, IM might be a lot more fulfilling intellectually. Don't get me wrong, I think a lot of radiologists have more clinical knowledge than they get credit for, but at the end of the day, it may not be the kind of medicine I want to practice.

So I guess the question is, is it way too late to change things? I already have mult radiology rotations set up, which shouldn't be too hard to change, I'm actually more concerned about scheduling IM specialty rotations before ERAS submission, and overall, solidifying my application for IM residency.

Not sure if this is a red flag or not, but I only passed the medicine clerkship (bad shelf exam). Worked my ass off for this sub-i and should do much better. Will probably end up with Honors in Peds, Psych, OB/GYN, Surgery.
I also have a LOR from this sub-i, as well as one from surgery. The third letter should come from another medicine attending, right? Should all three letters come from medicine?

Step 1 is 245+, not planning on taking Step II until November, no research. I certainly don't have enough experience to judge broadly, but given my not so great experience in a community hospital for medicine, I'd like to match in a university program in a major city.

Is it too late? Am I crazy? Can this happen? Sorry for the long post!

Edit: Is my Pass in Medicine enough for some programs to completely eliminate me from consideration? Should I bring attention to it, explain it somewhere in my personal statement or ERAS?

 

[orientedtoself]

you should be fine. it is much easier to switch from rads to medicine than the other way around. medicine is a buyer's market. meet with a medicine advisor asap.

 

[gutonc]

Edit: Is my Pass in Medicine enough for some programs to completely eliminate me from consideration? Should I bring attention to it, explain it somewhere in my personal statement or ERAS?

Yes but the # of programs that will eliminate you based on this is probably in the single digits and are all big names. The places that I'm aware of that (in general) won't interview people w/o honors in IM and Sub-I are like the Brigham, Mayo, Duke, UCSF, Stanford, Hopkins and maybe 1 or 2 others. By my quick FREIDA search that leaves you with about 115 possible university IM residencies that probably won't rule you out based solely on your IM grade. You'll probably be OK and I wouldn't mention it in your PS, other than to briefly explain how you came to want to do IM when you were initially thinking Rads.

 

[paintballdoc]

If I were in your shoes, I would not back away from Radiology unless you cannot see yourself doing it for the next 20-30 years. It sounds as if you should be able to match (I have been out for awhile so I do not know the true competiveness of Rads). I would continue with your plans for Rads and do a R-1 prelim year in Medicine at a place you like. If you still like medicine after your prelim year, give up your Rads spot and I am sure the Medicine department will be happy to add you on as an R-2. Seen it happen at my home institutions. That being said, I would not change to medicine unless you have a specific aspect of medicine that you want to do. I hope this helps.

 

[jdh71]

No way. Too late. There is no way that you can possibly, in the middle of July, do a few more months of IM and get good letters before applications go out. There is just no way this is possible. I mean a month of IM in August and a month of IM in September and then sending your app in October?!?!??!?!?!!111!?!? 😱

fuggitaboutit

You should just settle on Rads . . . I means someone has to do it . . .

 

[redruby]

If I were in your shoes, I would not back away from Radiology unless you cannot see yourself doing it for the next 20-30 years. It sounds as if you should be able to match (I have been out for awhile so I do not know the true competiveness of Rads). I would continue with your plans for Rads and do a R-1 prelim year in Medicine at a place you like. If you still like medicine after your prelim year, give up your Rads spot and I am sure the Medicine department will be happy to add you on as an R-2. Seen it happen at my home institutions. That being said, I would not change to medicine unless you have a specific aspect of medicine that you want to do. I hope this helps.

Thanks. I realize this will be a popular opinion among many many tired and overworked IM residents and attendings. Unfortunately, I have no idea if rads is something I could see myself doing for 20-30 years, I haven't even done a rotation yet! Although like most med students, spent plenty of time hanging out in reading rooms waiting for a wet read. To be honest, I have always had second thoughts about rads. It was always something my head pulled me towards- nice lifestyle and I am probably a fairly competitive applicant. My heart, on the other hand, has always wondered if I'd be able to stomach sitting in a dark room all day (I know there's more to it than that, but you can't argue that is a huge component of the daily grind).

I had an interest in IR, so I was thinking, maybe interventional cards or EP...

 

[paintballdoc]

Redruby,

I see. I was in your similar situation. I couldn't see myself sitting in a dark room also--I still wonder if I made the right decision but I believe I did. Now, if you are going to do Cards/EP, they have a sweet lifestyle, it's interesting stuff, and great pay, but my undersanding is that is changing. I have a friend that considered it, but decided against the extra 2 years. Interventional Cards can be tough and the compensation is decreasing.

It sounds like you want to change for the right reasons, so I say go for it. I would still consider Rads b/c there are many things that can are possible--Nuclear, IR, etc.

 

[radslooking]

No way. Too late. There is no way that you can possibly, in the middle of July, do a few more months of IM and get good letters before applications go out. There is just no way this is possible. I mean a month of IM in August and a month of IM in September and then sending your app in October?!?!??!?!?!!111!?!? 😱

fuggitaboutit

You should just settle on Rads . . . I means someone has to do it . . .

Are you serious? The poster has a 245+ Step 1 and just completed (and did a good job) on a medicine Sub-I. Not only would I say you have a chance...I'd say you have an exceedingly good chance of matching at even the best places.
And yes, you already have two letters of reference. One from a sub-I which is the most important, by far. Get one more somehow and you'll be fine. Even if you don't get another medicine letter, it probably won't matter. But I'd try.

Stop smoking the reefer jdh!

 

[jdh71]

Are you serious? The poster has a 245+ Step 1 and just completed (and did a good job) on a medicine Sub-I. Not only would I say you have a chance...I'd say you have an exceedingly good chance of matching at even the best places.
And yes, you already have two letters of reference. One from a sub-I which is the most important, by far. Get one more somehow and you'll be fine. Even if you don't get another medicine letter, it probably won't matter. But I'd try.

Stop smoking the reefer jdh!

Haha - I thought it would be easy to smell the sarcasm dripping off of my post . . .

(refer gets ya into trouble . . . no smokey smoke for me!)

 

[radslooking]

Haha - I thought it would be easy to smell the sarcasm dripping off of my post . . .

(refer gets ya into trouble . . . no smokey smoke for me!)

ah, holy schnikees, i usually am one of the last to not pick up on internet sarcasm, but I too have fallen prey this time. Something about the way you worded made me think you were genuine. Keep smokin' homie

 

[jdh71]

Ok, ok . . . so since my post made me look like an asshat as the sarcasm was not completely clear . . . there is PLENT-O time to apply to IM. You can easily do two more in-patient months and get your app out in October, which is NOT too late, and if I remember right, unless you are a complete superstar, all of the big name programs wait to offer interviews until after the Dean's Letters come out anyway at the beginning of Nov. So there is LOTS of time. I'd even pick a spot to do an externship and get it set up in the next two weeks, do it in September.

Hell I knew a guy, who didn't match Ophtho, called around in mid January, and still found a few places to interview him, and he matched into IM - these were all community programs, but the point I am making is that getting into IM is not ridiculous. I'm sure since you were interested in Rads before some of the FEVER rubbed off onto you and you've brought it with you to this process and it's just not the same.

EDIT: Not directed at the OP . . . Is it just me or do people claim honors all over the place? I really wonder how much anyone pays much attention to this? At my home institution getting honors was like pulling teeth. Do some places just pass them out, because you'd figure somewhere in the neighborhood of 10-15% of people would be getting honors, yet I see it all the time on SDN. Now I admit to not doing any sort of rigorous statistical analysis, because I am lazy, but intuitively it seems like people claiming honors is way out of proportion . . . >230 step scores too . . . I don't know. Everyone on SDN is a superstar.

 

[dragonfly99]

hi there

the answer is no, you will not have trouble matching into medicine at a good university program, as long as you have a good letter of rec. from your IM sub-I, and your Dean's letter doesn't say you are evil or something. 245 is quite a high Step I score for most IM programs. It would serve you well for radiology also. You really only need 2 letters total from internal medicine attendings - might even get away with one but I would get 2. The 3rd letter is your Dean's letter. You can easily get a 2nd letter by rotating on some medicine consult service, or through some attending's clinic, for 2 weeks to a month.

I am a medicine doc (done w/residency). I agree that IM offers lots of variety and intellectual rigor. However, the working conditions currently are not so hot, and the money is not as good as radiology either, and I don't expect those two things to change. The medicine residency is, in general, worse hours also, plus you will have to deal with more difficult patients and families (people who swear and yell at you, don't bathe, etc.). If you go in to private practice after that, you will have to deal with these same people, some who won't pay their bills, plus dealing with crap from the government and insurance companies who want to tell you how to practice medicine but don't want to pay you. And you will be stuck in a clinic room with these patients, unless you become a "hospitalist" who just sees hospital patients. If you do academic medicine that is a somewhat different animal, but I still think general IM is a perilous career choice just now. Hope I don't get pilloried for saying that. I am doing a medicine specialty so I am getting out of primary care, but remember that if you do medicine and then decide to further specialize, that is an additional 2-5 years after your IM residency. It would be 5 (4 at the very least) additional years if you do interventional cards or EP.

At this point in my 4th year I was still deciding between surgery and medicine, and I don't think I did my medicine sub-I until August or September, so you are FINE. I don't think you have enough radiology experience to decide whether you want to do radiology yet. I strongly feel you should go ahead and do your radiology month - 2 would be better. Then after that if you are sure you don't like radiology you can drop the idea of applying to radiology. The radiology attendings won't be mad - this (students changing their minds) happens all the time.

Agree with the poster above that medicine programs don't usually start sending out invitations to interview until after they get your dean's letter in November.

You should give thought to doing what someone suggested above...matching into radiology but doing your prelim year in medicine at somewhere with a good medicine residency. That way, if you liked medicine you could just stay on there as a medicine resident, and drop out of radiology. I know the "Match" says it's binding and all, but the radiology program would NOT have trouble finding someone to fill its open spot if you decided to drop out, say, 6-8 months into your medicine intern year. If you start in medicine and don't like it, switching into radiology would be MUCH more difficult.

 

[duncan11]

Plenty of time.

I am now an R2 medicine resident. I planned on doing radiology, and even started the application process in radiology. I did 2 months of radiology in August and September, applied as soon as applications could go in, and then changed my mind 1 week later. I started getting nervous at the end of August that radiology wasn't for me, but thought I was just having some buyer's remorse. Then by my 2nd month, I knew that radiology was not for me and pulled the plug.

I had to redo my application, get completely new letters, contact programs that I had applied to as a prelim to switch to categorical, and cancel all the radiology interviews.

I had no problem. I received interviews at pretty much all the top programs and it never came up during the interview process. I didn't do any medicine subspecialty months until November and starting interviewing in December.

I am really happy that I chose medicine. I wanted more patient contact. VIR is a different kind of contact and not what I wanted. I enjoy the broad nature of medicine. Don't let everyone tell you that radiology is paradise. It is not for everyone.

Doing a medicine prelim year/radiology and switching to medicine if you like it is not as easy as it sounds. I talked several people about this, because it sounded like the optimal solution. It is not as easy as it seems. The program that you do your prelim year at will need to have additional categorical spots or you cannot just stay. Otherwise you will be delayed by a year and have to reapply.

 

[WorkaholicsAnon]

Yes but the # of programs that will eliminate you based on this is probably in the single digits and are all big names. The places that I'm aware of that (in general) won't interview people w/o honors in IM and Sub-I are like the Brigham, Mayo, Duke, UCSF, Stanford, Hopkins and maybe 1 or 2 others. By my quick FREIDA search that leaves you with about 115 possible university IM residencies that probably won't rule you out based solely on your IM grade. You'll probably be OK and I wouldn't mention it in your PS, other than to briefly explain how you came to want to do IM when you were initially thinking Rads.

I dont think Mayo eliminates people without honors in medicine. A few of my friends were invited to interview and they did not have an honors grade in medicine. One of them matched there. This was like 3 years ago ago so i dont know, things may have changed by now.

 

[redruby]

Bumping the thread to ask about the whole "Pass" in medicine again.

So I met with the dean of student affairs today who insisted that I MUST do an away rotation to have a chance of matching at a top program. Her reasoning was that 1) the grade is a definite "blip" on my record so I should get my face out there, let people see how great I am themselves, and make connections to beef up my chances 2) if programs from across the country see that I did all my rotations at my home institution, they will assume I am not interested in moving somewhere else and 3) it will give me a chance to shine and throw off the dark shadow of the "P".

Here's the thing. I am not against doing aways, but at this point in late July, I have serious doubts about how easy it will be to secure an away in September or October. Also, I go to a mid-tier state school. Students are pretty laid-back. I do not want to go to a top-ranked school and get eaten alive by gunner students.

And finally, the thing that really has me freaking out is that she has suggested that because of my grade in IM, I am kind of screwed. I am getting an LOR from the clerkship director of where I did my IM rotation and she suggested that I get him to specifically explain the lackluster grade- is this really necessary? If I interview and it comes up, can't I just talk about it then?

I just found out that I did in factor honor the sub-I. I am at least in the top 1/3 of my class- is this, with a pretty good step I score enough to counter that crappy grade or am I going to be paying for it come match time?

 

[jdh71]

Bumping the thread to ask about the whole "Pass" in medicine again.

So I met with the dean of student affairs today who insisted that I MUST do an away rotation to have a chance of matching at a top program. Her reasoning was that 1) the grade is a definite "blip" on my record so I should get my face out there, let people see how great I am themselves, and make connections to beef up my chances 2) if programs from across the country see that I did all my rotations at my home institution, they will assume I am not interested in moving somewhere else and 3) it will give me a chance to shine and throw off the dark shadow of the "P".

Here's the thing. I am not against doing aways, but at this point in late July, I have serious doubts about how easy it will be to secure an away in September or October. Also, I go to a mid-tier state school. Students are pretty laid-back. I do not want to go to a top-ranked school and get eaten alive by gunner students.

And finally, the thing that really has me freaking out is that she has suggested that because of my grade in IM, I am kind of screwed. I am getting an LOR from the clerkship director of where I did my IM rotation and she suggested that I get him to specifically explain the lackluster grade- is this really necessary? If I interview and it comes up, can't I just talk about it then?

I just found out that I did in factor honor the sub-I. I am at least in the top 1/3 of my class- is this, with a pretty good step I score enough to counter that crappy grade or am I going to be paying for it come match time?

I'm sorry, but when did a passing grade turn into a "blip", a "dark shadow", a "lackluster grade" . . . you were either hearing her wrong (writing your own context onto her neutral constructive advice), or she's kind of an idiot.

You have PLENTY of time to get an externship set up. Start work on it tomorrow. Where do you want to do one? Call the dean's office there, ask them to fax you an application (the secretaries in your deans office will more than likely be more than happy to field this fax for you if you let them know), and ALSO ask specifically what they need from you and your school. Ask the school where you want to rotate at who the student point of contact is in the IM department, probably one of the secretaries, ask her who you need to talk to or what needs to get signed, find out if they have room for you in either September or October. Fill out the forms, send them all in, and you'll be golden. For good measure I'd fire an email to the PD once you have it all ironed out letting him know about your presence. He may not care, but you never know . . . let him know your stoked about spending time and are very interested in the program. Then don't bug him anymore - he'll have his eye out.

Lots of people find places to stay on Craig's List. Also ask about any medical fraternity houses - a lot of times you can crash for pretty cheap for the month if they have one on or near campus. Go there and rock SO HARD, and then match.

This is easy. I should really charge for this stuff, but you're getting it for free

EDIT: Where are interested in going and where are you coming from? You can PM if you like.

 

[redruby]

I'm sorry, but when did a passing grade turn into a "blip", a "dark shadow", a "lackluster grade" . . . you were either hearing her wrong (writing your own context onto her neutral constructive advice), or she's kind of an idiot.

Well... the student affairs office at my school is kind of known for being uninformed and hysterical. For example, all students were urged to take Step II ASAP, regardless of Step I performance so we could compete with all the FMGs who have already taken Step II. So, yeah. It's really frustrating that most information we're getting for residency prep is coming from a bunch of people who have never been to medical school and have probably not even read a book about it. "Oh, so after Internal Medicine, you can choose to specialize further?"🙄

I guess it just seems like everybody had their stuff in months and months ago for aways. To clarify, I am looking to end up in a university program in a large city- possibly Northeast that will maximize my chances of getting a competitive fellowship (or at least keep that avenue open). Which brings up this question, if the university program is already filled, should I just take a spot at an affiliated community program, or look into another academic program in the same city?

 

[orientedtoself]

reality check. it is the end of july. you are fine. you can't even submit your application until september.

http://www.aamc.org/students/eras/timeline/start.htm




oh, i see- you're referring to an away sub-i. not necessary in my opinion.

 

[jdh71]

I guess it just seems like everybody had their stuff in months and months ago for aways. To clarify, I am looking to end up in a university program in a large city- possibly Northeast that will maximize my chances of getting a competitive fellowship (or at least keep that avenue open). Which brings up this question, if the university program is already filled, should I just take a spot at an affiliated community program, or look into another academic program in the same city?

I agree with orientatedtoself, it's not necessary, but I kid of like the externships, plus they are fun if nothing else.

So you want to o NE only for the possibility of fellowship opportunities or do you want to live there, be there too? Which competitive fellowships are you thinking, because right now Cards and GI are the two really competitive pretty much everywhere - some places you will pretty much have to do three things 1) cure cancer, 2) complete the unified theory, and 3) solve a rubik's cube in order to even be considered, with Pulm/CC and Heme/Onc being mildly/relatively competitive (meaning, trying to do one of thee specialties at a place like WashU, or Duke, or Hopkins will be a blood bath, but you have really good chances of finding a spot in one of these fellowships if you're coming from an university program and are applying to other university programs of equal or lesser "food-chain" status). Everything else you should be able to find yourself into a fellowship without too much hassle (again BIG places will require a better application even for these specialties).

Here the thing, you don't have to go the NE to make sure all this happens. So check your motives. And doing an externship out there will give you an idea if you like that kind fo environment.

 

[NotAProgDirector]

So I met with the dean of student affairs today who insisted that I MUST do an away rotation to have a chance of matching at a top program. Her reasoning was that 1) the grade is a definite "blip" on my record so I should get my face out there, let people see how great I am themselves, and make connections to beef up my chances 2) if programs from across the country see that I did all my rotations at my home institution, they will assume I am not interested in moving somewhere else and 3) it will give me a chance to shine and throw off the dark shadow of the "P".

Here's the thing. I am not against doing aways, but at this point in late July, I have serious doubts about how easy it will be to secure an away in September or October. Also, I go to a mid-tier state school. Students are pretty laid-back. I do not want to go to a top-ranked school and get eaten alive by gunner students.

And finally, the thing that really has me freaking out is that she has suggested that because of my grade in IM, I am kind of screwed. I am getting an LOR from the clerkship director of where I did my IM rotation and she suggested that I get him to specifically explain the lackluster grade- is this really necessary? If I interview and it comes up, can't I just talk about it then?

I just found out that I did in factor honor the sub-I. I am at least in the top 1/3 of my class- is this, with a pretty good step I score enough to counter that crappy grade or am I going to be paying for it come match time?

I'll throw in my 2 cents.

1) the grade is a definite "blip" on my record so I should get my face out there, let people see how great I am themselves, and make connections to beef up my chances

A "pass" in medicine's signifcance depends on your schools grading policy. If 10-25% of the class gets H and the rest get pass, then it's no big deal. Heck, you could be in the top 26% and get a pass.

If 90% get H and 10% get P, well then that's a very different story now.

It also depends on your performance in other clearkships. If you have straight H's on everything else, people will not care.

2) if programs from across the country see that I did all my rotations at my home institution, they will assume I am not interested in moving somewhere else

This is pure baloney. Most medical students do not do away rotations.

3) it will give me a chance to shine and throw off the dark shadow of the "P".

Same as #1. Depends.

An away rotation is a mixed bag. It will be a new system for you, so you'll have some adjustment issues. You won't know the other students, and you will be away from your usual support structures. Prepare to work very hard. You may feel like you're under a lot of pressure to perform (self imposed).

 

[dragonfly99]

Your residency advising office are idiots. I would cease getting "advice" from them. They are idiots. Do not worry. You CAN get in a good IM program. I know what I am talking about. I did.

It's a bunch of crapola that you "have" to do an away rotation. You do not. Most students at my school never did one. People who wanted to do very competitive specialties but might be marginal candidates did do them, but the rest of us pretty much never did. If you have a specific picky place you want to go (i.e. Ivy League east coast place) you could go to do one there. You may shoot yourself in the foot if you don't do well, though. Still, it's not THAT high stakes b/c you would be shooting yourself in the foot ONLY at that one place.

I think it's kind of garbage that the 3rd year IM grade will hurt you that much. I DEFINITELY think you should NOT mention it in your applications. You already got an honors for your subI. Who gives a care about your 3rd year IM grade now. Unless there is something bad (i.e. evil narrative comments) on your dean's letter, I just don't see how it will hurt you much, if at all. It would be stupid to bring attention to something which really isn't a "black mark" anyway, in my opinion (it's just not a "selling point"). Aprogdirector does have a point about the grading system being important though - if some ridiculous number of people get honors and only 5-10% get a pass, then I guess it make you look a little bad. But even then, you could just say you were still in the learning process, or you had a difficult attending, etc. The IM programs will still see a student who has (for internal medicine) very high USMLE scores and who honored his/her subI. Stop obsessing about the one less-than-stellar grade you had.

You are saying you are in the top 1/2 of your med school class.

I had similar USMLE Score to you, honored my medicine subI, was NOT in the top 1/2 of my med school class (but did go to a very competitive/kinda cutthroat med school) and I matched at a well known university hospital for IM training.

I agree with other comments. Examine your motive for wanting to go to residency in the northeast. Will you enjoy living there? If not, consider other residencies. How about Mayo/Washington U/Emory/Vanderbilt/west coast schools? There are plenty of good IM residencies.

 

[DrJosephKim]

Get some robust letters from your medicine attendings. Make sure they get to know you personally so they can write really strong letters.