matching fellowship from community program

[deleted746658]

hi all - was very competitive residency applicant. switching into IM. staying at intern year program, which is a community program that does not have any in-house fellowship positions.

CV
- step 1/2/3 in 99th percentile
- solid research experiences, but none in IM-related fields
- thought of very positively in current program

not sure what i want do yet, tbh. likely hospitalist until i pay down loans/ save up

decided to stay at current program to avoid re-entering match, logistical headache, having to relocate, etc.... and i do really enjoy my program

my question is: did i severely limit my options if say i eventually want to match into competitive fellowship (GI, cards, etc)? how disadvantaged am i coming from community program?

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[rokshana]

hi all - was very competitive residency applicant. switching into IM. staying at intern year program, which is a community program that does not have any in-house fellowship positions.

CV
- step 1/2/3 in 99th percentile
- solid research experiences, but none in IM-related fields
- thought of very positively in current program

not sure what i want do yet, tbh. likely hospitalist until i pay down loans/ save up

decided to stay at current program to avoid re-entering match, logistical headache, having to relocate, etc.... and i do really enjoy my program

my question is: did i severely limit my options if say i eventually want to match into competitive fellowship (GI, cards, etc)? how disadvantaged am i coming from community program?

Amg? Img?fmg?
There probably is some compromise,especially if you want gi, but not impossible...you just have to work harder to make contacts, find research, do a chief year, etc...but not impossible

 

[shouldigomd]

If you are not AMG it will obviously be harder in any scenario. It is pretty difficult to answer your question because it hinges on the quality of your community program. I would look at prior graduates and how many entered the various fellowships to give you an idea of your odds.

 

[deleted746658]

AMG.

it is a lower quality program. previous residents do not match well, but i imagine that is more a reflection of the quality of the applicant than the program.

 

[Theavalachesflight22]

Do they have a cardiology fellowship attached to their institution? If so this might be a great avenue for you. Presuming you wouldn't mind staying in-house.

Otherwise If you get a few posters or potentially an abstract published at something like ACC that will also go a long way.

AMG, good stats, some publications will go a long way if you load the shotgun and fire it. I think the question for you is not IF you match cards, it will be WHERE you match.

 

[whoknows2012]

AMG.

it is a lower quality program. previous residents do not match well, but i imagine that is more a reflection of the quality of the applicant than the program.

While you might be correct, that is not necessarily an assumption that you should make. If this program is of lower quality and you have no personal connections it may be more difficult than you think to match into competitive specialties, despite your obvious excellent board scores (which is important but FAR less important for fellowship).

And while I also agree that getting some pubs and/or posters for national conferences would go a long way, actually completing these research ventures coming from a community program without in house fellowships is probably an uphill battle. Best bet would be to find a mentor at an Affiliated academic center (if there is one) to do research with.

That’s the long winded answer that yes you might be severely limiting yourself if you end up choosing a competitive specialty

 

[Osteoth]

Seems like for GI the match rate for AMGs is around 80% (361/447) and for cardiology is 88% (536/608), so it is likely, though I have known individuals from academic programs who do not match.

Need to find a research mentor, network, etc.

 

[Egghead34]

I did, but I’m a US-IMG. See here: My success story as a US-IMG applying for cardiology

 

[MyTachyBradyHeart]

hi all - was very competitive residency applicant. switching into IM. staying at intern year program, which is a community program that does not have any in-house fellowship positions.

CV
- step 1/2/3 in 99th percentile
- solid research experiences, but none in IM-related fields
- thought of very positively in current program

not sure what i want do yet, tbh. likely hospitalist until i pay down loans/ save up

decided to stay at current program to avoid re-entering match, logistical headache, having to relocate, etc.... and i do really enjoy my program

my question is: did i severely limit my options if say i eventually want to match into competitive fellowship (GI, cards, etc)? how disadvantaged am i coming from community program?

If you were that competitive, how did you end up at a community program? Assuming you tried to do an easy intern year at said program before your actual residency... too late now but your chances would've been far better if you re-entered the match to get into an academic IM program.

I echo what posters have said above. Research for you will be very important. Need to aim for multiple peer reviewed publications. In addition, you'll need to milk your contacts for all they've got. Step scores matter next to nothing for fellowships. Not impossible but you have more of an uphill battle than most.

Finally, I would think long and hard about taking a hospitalist gig for more than a year (2 at the max). Your chances of matching into a competitive specialty will decrease exponentially the further out you are.

 

[shouldigomd]

If you were that competitive, how did you end up at a community program? Assuming you tried to do an easy intern year at said program before your actual residency... too late now but your chances would've been far better if you re-entered the match to get into an academic IM program.

I echo what posters have said above. Research for you will be very important. Need to aim for multiple peer reviewed publications. In addition, you'll need to milk your contacts for all they've got. Step scores matter next to nothing for fellowships. Not impossible but you have more of an uphill battle than most.

Finally, I would think long and hard about taking a hospitalist gig for more than a year (2 at the max). Your chances of matching into a competitive specialty will decrease exponentially the further out you are.

Not sure about that. I think Step 1/2 are currently still extremely important for fellowship which is sad but true. Fortunately that will change with the pass/fail. If you think about it during residency there is very little that you can do to actually demonstrate your "intellect" or the "quality" of physician you are. Research / LORs are 75% sucking up and networking.

 

[MyTachyBradyHeart]

Not sure about that. I think Step 1/2 are currently still extremely important for fellowship which is sad but true. Fortunately that will change with the pass/fail. If you think about it during residency there is very little that you can do to actually demonstrate your "intellect" or the "quality" of physician you are. Research / LORs are 75% sucking up and networking.

That has not been my experience on the IV trail and from talking to multiple PDs. It is well known that USMLE scores mean next to nothing. What is sad but true is the fact that a strong LOR from a nationally recognized faculty (who may have never worked with you on-service) despite an applicant being a crappy clinician will secure you IVs. Programs rely on LORs and PD letter precisely because they have no idea how an applicant is clinically.

All of this is assuming your USMLE scores are respectable. Some programs continue to use them as a screening tool but the cutoff is pretty much median to slightly above average scores (230-240 at top-'insert number' institutions).

 

[shouldigomd]

That has not been my experience on the IV trail and from talking to multiple PDs. It is well known that USMLE scores mean next to nothing. What is sad but true is the fact that a strong LOR from a nationally recognized faculty (who may have never worked with you on-service) despite an applicant being a crappy clinician will secure you IVs. Programs rely on LORs and PD letter precisely because they have no idea how an applicant is clinically.

All of this is assuming your USMLE scores are respectable. Some programs continue to use them as a screening tool but the cutoff is pretty much median to slightly above average scores (230-240 at top-'insert number' institutions).

I agree with you that the prestige of your program and the names on your LORs are very important. PD letters are not as important imo. What PD would not write a decent LOR for an applicant unless the program was malignant as all heck or the resident was truly the worst of all time. They want their programs to match as well as possible.

I disagree. I matched cardiology and from my experience there is a reason why the step scores are at the top of your "file" next to your picture. Precisely for reasons you mentioned (no way to determine clinical / academic acumen).

LORs are extremely generic for the vast majority and there are many respected attendings at most university academic programs. There is so little to really triage resident applicants and for that reason I think step 1/2 and even med school transcripts have more importance than "next to nothing." I am a resident at a mid tier university program so my step score probably matters more than a resident from harvard.

Step 3 now .... we can all agree means next to nothing.

 

[GastriqueGraffin]

Once they do away with step 1 score and eventually step 2, I think it’ll be on ABIM to release and create weight for IM ITEs for fellowship program directors. If your goal is to be a great community clinician, you shouldn’t have to fake an interest in research or be forced to go to an academic powerhouse residency to match into fellowship. The amount of weight we give research papers and LORs (more so, the name of the letter writer) is not right. This would be an ideal world.

 

[MyTachyBradyHeart]

I agree with you that the prestige of your program and the names on your LORs are very important. PD letters are not as important imo. What PD would not write a decent LOR for an applicant unless the program was malignant as all heck or the resident was truly the worst of all time. They want their programs to match as well as possible.

I disagree. I matched cardiology and from my experience there is a reason why the step scores are at the top of your "file" next to your picture. Precisely for reasons you mentioned (no way to determine clinical / academic acumen).

LORs are extremely generic for the vast majority and there are many respected attendings at most university academic programs. There is so little to really triage resident applicants and for that reason I think step 1/2 and even med school transcripts have more importance than "next to nothing." I am a resident at a mid tier university program so my step score probably matters more than a resident from harvard.

Step 3 now .... we can all agree means next to nothing.

I am also a cardiology fellow at an upper tier program. I can tell you at least at my institution USMLE scores don't even come up during the committee meeting. Granted I've only been doing this for 1 year and I suppose faculty could be "secretly" looking at USMLE scores.

I maintain that USMLE scores are used as an initial screening tool. However, I do acknowledge that upper tier programs tend to take fellows from top IM residencies and perhaps in this smaller pool of applicants, objective scores may not matter since the faculty can just call each other (there was definitely post-IV communication that occurred during my interview process). In lower tier programs, USMLE scores are likely more important to differentiate candidates.

 

[shouldigomd]

I am also a cardiology fellow at an upper tier program. I can tell you at least at my institution USMLE scores don't even come up during the committee meeting. Granted I've only been doing this for 1 year and I suppose faculty could be "secretly" looking at USMLE scores.

I maintain that USMLE scores are used as an initial screening tool. However, I do acknowledge that upper tier programs tend to take fellows from top IM residencies and perhaps in this smaller pool of applicants, objective scores may not matter since the faculty can just call each other (there was definitely post-IV communication that occurred during my interview process). In lower tier programs, USMLE scores are likely more important to differentiate candidates.

I think we are beating a dead horse. Step scores are objective and are what they are. Committee meetings are to discuss the more subjective things. Regardless to get into a top IM program you need a solid STEP score so directly or indirectly they are meaningful.

I think they mattered for me. I went to a mid tier IM program with a top tier STEP score and I think it helped me but who knows...

 

[Mdpowerb]

little confusion on my side maybe, but I'll be going to large non-unniversity academic program with inhouse fellowships and famous faculty. Does that still count as a community program in the eye of fellowships (such as cardio) later on?

 

[Gastrapathy]

Depends...

 

[GastriqueGraffin]

little confusion on my side maybe, but I'll be going to large non-unniversity academic program with inhouse fellowships and famous faculty. Does that still count as a community program in the eye of fellowships (such as cardio) later on?

Obviously people aren’t referring to places like Mayo, Cleveland Clinic, Cedar Sinai, etc when they are talking about “community programs”.

 

[NotAProgDirector]

little confusion on my side maybe, but I'll be going to large non-unniversity academic program with inhouse fellowships and famous faculty. Does that still count as a community program in the eye of fellowships (such as cardio) later on?

At this point, your best measure is how other residents from that program have done in the fellowship match.

 

[CluvK]

At the beginning of my intern year, half of my class wanted to do cardiology and the other half wanted to do GI except me who was content being a hospitalist .... I am pretty sure some of us will change minds.