Matched into a small community program...now what?

[simba181800]

I'm absolutely devastated that I matched into a small, community Internal Medicine program, in the middle of nowhere. I was hoping for a large academic institution in a large city, but my Step 1 score was pretty terrible. So, I know I should be very happy that I matched at all...but I'm devastated that I didn't get into my top choices.

I'm trying to stay positive, and maybe these 3 years would actually turn out to be the best 3 years of my life, who knows right? But I'm really scared this residency program will severely limit my career opportunities. Could anyone comment on my questions below?


1. How difficult would it be to obtain a hospitalist job at an academic institution coming from a small, unknown community program residency?

2. Given my low step 1 score, and a community residency program with poor fellowship match rates, what fellowship programs are realistically still possible? (I'm a US MD graduate)

Thanks!

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[Drrrrrr. Celty]

I'm absolutely devastated that I matched into a small, community Internal Medicine program, in the middle of nowhere. I was hoping for a large academic institution in a large city, but my Step 1 score was pretty terrible. So, I know I should be very happy that I matched at all...but I'm devastated that I didn't get into my top choices.

I'm trying to stay positive, and maybe these 3 years would actually turn out to be the best 3 years of my life, who knows right? But I'm really scared this residency program will severely limit my career opportunities. Could anyone comment on my questions below?


1. How difficult would it be to obtain a hospitalist job at an academic institution coming from a small, unknown community program residency?

2. Given my low step 1 score, and a community residency program with poor fellowship match rates, what fellowship programs are realistically still possible? (I'm a US MD graduate)

Thanks!

1. Depends on what you make of it and how you market yourself. Most Academic hospitalist jobs aren't necessarily sought after.

2. I would say that the door is still open for everything. It's really about how hard you want to work for it or do fellowships to become competitive for it. It's not unheard of for folks to do Hepatology or Sleep medicine to improve their shots at GI or Pulm/CC.

 

[Redpancreas]

I'm absolutely devastated that I matched into a small, community Internal Medicine program, in the middle of nowhere. I was hoping for a large academic institution in a large city, but my Step 1 score was pretty terrible. So, I know I should be very happy that I matched at all...but I'm devastated that I didn't get into my top choices.

I'm trying to stay positive, and maybe these 3 years would actually turn out to be the best 3 years of my life, who knows right? But I'm really scared this residency program will severely limit my career opportunities. Could anyone comment on my questions below?


1. How difficult would it be to obtain a hospitalist job at an academic institution coming from a small, unknown community program residency?

2. Given my low step 1 score, and a community residency program with poor fellowship match rates, what fellowship programs are realistically still possible? (I'm a US MD graduate)

Thanks!

Academic programs make matching into competitive fellowship much easier. You're going to have to grind to get published +/- a chief year to match competitive fellowship (GI/Cards, possible A/I, PCCM, HO) from your community program. In terms of an academic hospitalist job, you can work your way up gradually and there are additional years you can apply to that are less competitive (hospital medicine fellowships) and other resume-builders involving national conferences that can make you more competitive for a position as an academic hospitalist.

In short, more years and academic pursuits can level the playing field if you're willing to invest more time in it.

 

[Planes2Doc]

They can do a great job preparing you for something like hospitalist work if you are good with that. You won't have to compete with fellows in most cases. After having our baby during PGY-2, my fellowship aspirations had changed.

 

[holaho]

The reason why small community programs have a terrible fellowship match rate is because they are filled with IMGs. A US MD should still be able to match GI/Cards with some hard work. Posters/QI projects can be done in any hospital setting. I would not discount your prospects just because you matched a community program. I have seen US MDs match into competitive specialties even when coming from small programs.

 

[Redpancreas]

The reason why small community programs have a terrible fellowship match rate is because they are filled with IMGs. A US MD should still be able to match GI/Cards with some hard work. Posters/QI projects can be done in any hospital setting. I would not discount your prospects just because you matched a community program. I have seen US MDs match into competitive specialties even when coming from small programs.

I think this poster makes a good point and reality’s somewhere in the middle of my point and his. An AMG at a community program is not the same as an IMG. Community programs unfairly get a double whammy because their match lists aren't great and their residents are IMGs without taking into consideration both factors are interrelated.

I think coming from a community program, you’ve got to put the work regardless. I’ve seen plenty of AMGs at midtier academics expecting to match fellowships with a few case reports/letters who weren’t successful. If you’re at a community program or even lesser known university program, you have to network and grind for scholarly activity and take what you can get. If you're willing to spend an extra year being a chief, that will make you generally more competitive. Get started once you feel comfortable with the intern year workflow because it’s only 20 months from the start before you have to start preparing your GI/Cards fellowship application. Good luck!

 

[Bobblehead]

I'm trying to stay positive, and maybe these 3 years would actually turn out to be the best 3 years of my life, who knows right? But I'm really scared this residency program will severely limit my career opportunities. Could anyone comment on my questions below?


1. How difficult would it be to obtain a hospitalist job at an academic institution coming from a small, unknown community program residency?

2. Given my low step 1 score, and a community residency program with poor fellowship match rates, what fellowship programs are realistically still possible? (I'm a US MD graduate)

Thanks!

I'd spend a bit of time reflecting on what else went wrong with your application. A low step score alone would not have eliminated you from every "large academic institution in a large city" unless you set your sights impossibly high in an impossibly narrow set of geographical choices. That suggests there's something else about your clinical performance that made programs shy away from you.

Step 1 scores aren't considered in a fellowship application. What you do during your residency will determine where you go next.

 

[collegestud2013]

I'd spend a bit of time reflecting on what else went wrong with your application. A low step score alone would not have eliminated you from every "large academic institution in a large city" unless you set your sights impossibly high in an impossibly narrow set of geographical choices. That suggests there's something else about your clinical performance that made programs shy away from you.

Step 1 scores aren't considered in a fellowship application. What you do during your residency will determine where you go next.

Step scores aren't as important for fellowship as residency, but as long as you have a score it will be used by most applications for screening. And usually they weigh Steps 1, 2, and 3 all roughly equally. Competitive fellowships get hundreds of applications per spot so they need a quick way to screen the applicant pool and just like in residency applications Step scores are an easy way to screen out some applicants. For the competitive fellowships, you should have at least >230 on all your steps to avoid being screened out by most programs. Scores in the 220s may get you screened out at some programs, and any Score < 220 can get you screened out quite a bit unless you have connections at that particular program. In contrast, most fellowship programs don't really care much about the difference between a 240 and 260.