Jun 24, 2020
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Hello Everyone,
I have been a passive reader of the forums here for some time, and occasionally benefited from the discussion. (Although, there has been the occasional dumpster fire which was entertaining to watch) I am writing today to solicit some advice. I feel trapped in my current residency program, and I'm not happy with the overall trajectory. I soaped into a community internal medicine program, which trains almost exclusively hospitalists. I'm not sure whether this hospitalist training is intended, or perhaps because of the low match rate for fellowships. (10-15%, including residents rejected from "easy fellowships" like ID and nephro) My main concern is that I don't feel like this will not help me achieve my long term career goals. All of the attendings are private practice and have no long-term interest in teaching residents. Most rotations are primarily note-mills, as many of the attendings have fired their former NP/PA, and clamor to have residents on service to maximize their billing. There is no research infrastructure, and research funding is abysmally low. However since coronavirus, there is no ($0.00) research funding available for residents. Of the >50 residents in the training program, only 2 attended a research conference last year. I feel that a lot of my Co residents have given up, or don't appreciate the gravity of the situation. About half of the residents are FMG, who are just grateful to have matched and did not rotate at academic hospitals. When we do have frank conversations about the difficulties of fellowship match and the training at our program, the end result is usually “yeah, but what can we do about it?”

There is no specialty advising, and PD is of little help. I am not sure if the PD is oblivious, or pretends to be oblivious and actually doesn’t care. Last year, for example, we had a resident not match to fellowship despite having “11 first author publications.” I later looked into this and found this individual had published 11 case reports… I am not sure whether the resident thought this was a good idea, or if the individual was advised to do so by someone who believed case reports would count as research.

I would really like to transfer to an academic IM program, but those prospects seem far and few between. Alternatively, it may be an option to try for a nonaccredited fellowship after residency, and apply to accredited programs afterwards. I have been doing what I can, working on retrospective chart reviews to try to publish what is within my means, learning as much as I can, studying nightly.

TLDR: I am grateful to have matched, but I am 1 year in and have serious concerns. Community program with poor fellowship prospects, low board pass rates, >75% of residents soaped, no research, no name recognition.
 

DrMetal

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which trains almost exclusively hospitalists.
In what sense? ACGME requires a certain % of both inpatient/outpatient rotations. I forget what the exact numbers are. Now being IM, of course you do more inpatient rotations than say FM. But still, you should be getting enough outpatient to decide whether or not you like it and want to do it.

of the low match rate for fellowships. (10-15%, including residents rejected from "easy fellowships" like ID and nephro)
No such thing as an 'easy' fellowship. It depends on when/where you're applying to, the rest of the applicant pool, etc etc. I'd be cautious in drawing general conclusions based on prior residents applications, you never know what exactly their applications hold (or how they stacked up to everybody else).

My main concern is that I don't feel like this will not help me achieve my long term career goals.
Which are?

Most rotations are primarily note-mills,
Yup, it's called being a trainee. Most programs are like this to some extent. We love to make our residents over document.

only 2 attended a research conference last year.
Ok, not every program can be a research Juggernaut. But most have some things going on, you just gotta carve out a niche.

or don't appreciate the gravity of the situation.
Gravity of what situation? To be honest, you're not describing such a terrible situation. Ok, maybe your program is a little weak, you haven't described anything all that malignant.

fellowship despite having “11 first author publications.” I later looked into this and found this individual had published 11 case reports… I am not sure whether the resident thought this was a good idea,
I don't get it. Something wrong with case reports? Or did the resident just publish a bunch of crap in predatory journals? Look, as far as research goes: you're not going to be spear-heading randomized clinical controlled trials and discovering the next Lipitor while you're in training. If you can join a project, contribute something, get your name on a paper or two, that's sufficient. A good case report (in a good journal) is also beneficial. Whether you have 2 publications or 12, I don't think it matters. Having 1 or 2 is enough to demonstrate aptitude in research.

I would really like to transfer to an academic IM program,
I dunno. Again, you're not describing anything too malignant here. It might look worse if you transfer. I'd stay put and make the best of it.
 
Jun 24, 2020
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To respond about the main concern, which is lack of research. In the last 5 years, there have been 0 research publications from this program. The PD last published in 2009, and most faculty have no publications. There are no active projects of any kind. I realize randomized clinical control trials are not likely to be found at small community programs and will never be a research powerhouse, but there are only 2 faculty members who have published anything in the last decade. (And those have been only case reports)
1) We have sufficient in/out patient rotations, but most end up as hospitalists or outpatient, not fellowships.
2) I realize there are no easy fellowships, yet matching only 4 of 25 is cause for concern. Looking at PD survey for fellowships, the reputation of program, comm vs academic, research, and letters from known faculty are all ranked highly and a weakness of the program.
3) Program is not at all malignant. Everyone is nice.
 
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rokshana

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So we need more information...what fellowship are you looking to get? GI... well that is going to be rather difficult...Nephrology...not as difficult.

Unfortunately, with covid, the usual methods of going to meetings to make some connections is going to be difficult.

Case reports are not terrible things...and frankly easy enough to get accepted to meetings and journals that do case reports...QI projects and chart review to do some studies are also relatively simple enough to do...does your program have any fellowships? Can you see if any one of the have any research you can help with?

Are you an AMG? Or I/FMG? If AMG, frank question...how did you end up at this program? Are you really competitive enough to transfer to a more academic program?

It’s going to be up to you to make the best out of this program to get yourself where you want to be...that may end up being a hospitalist at an academic center to buff your cv by being able to then get involved with research and make contact for fellowship.
 

DrMetal

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To respond about the main concern, which is lack of research. In the last 5 years, there have been 0 research publications from this program. The PD last published in 2009, and most faculty have no publications. There are no active projects of any kind. I realize randomized clinical control trials are not likely to be found at small community programs and will never be a research powerhouse, but there are only 2 faculty members who have published anything in the last decade. (And those have been only case reports)
1) We have sufficient in/out patient rotations, but most end up as hospitalists or outpatient, not fellowships.
2) I realize there are no easy fellowships, yet matching only 4 of 25 is cause for concern. Looking at PD survey for fellowships, the reputation of program, comm vs academic, research, and letters from known faculty are all ranked highly and a weakness of the program.
3) Program is not at all malignant. Everyone is nice.
Ok, your program is weak in research and notoriety. That's not grounds for transfer. And if you make that request, you may really piss off your program director and not get that sexy letter of recommendation for rheumatology. go with what you have, make the best of it. Medicine residency is very short anyways

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People are becoming more and more entitled each passing day.

OP said: "I soaped into a community internal medicine program".

You soaped to your current program.

You didn't match and you ended up soaping.

You're lucky that you found a program to accept you.

Be glad that you didn't stay unemployed and unmatched, work with your current situation, maximize your current resources to achieve your goals and grind.
 

rokshana

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People are becoming more and more entitled each passing day.

OP said: "I soaped into a community internal medicine program".

You soaped to your current program.

You didn't match and you ended up soaping.

You're lucky that you found a program to accept you.

Be glad that you didn't stay unemployed and unmatched, work with your current situation, maximize your current resources to achieve your goals and grind.
Oh I missed the soap part...and he’s talking down about the program being > 50% FMG that we’re grateful to just match...they match...a feat that the OP did not accomplish....jeez
 

DrMetal

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People are becoming more and more entitled each passing day.
The lack of maturity also is daunting. You'd think after 8 years of higher education (all the trials and tribulations that come with being a pre-med, then a medical student) people would wise up a little more. The minimum age for matriculation in medical school should be 30!

BTW: A good lesson here. If you're going to do a residency in IM, GS, Pediatrics, whatever have you, be prepared to be a generalist in that specialty. Fellowships are not guaranteed (you may not become a strong applicant, other life circumstances come into play, etc etc). If you're really not willing to be that generalist (internist, general surgeon), don't do the residency.
 

GoSpursGo

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I think people are being a little harsh, but the underlying point that is being made is valid. If you graduate from a US school, you basically are guaranteed to get a residency spot somewhere, but nobody is guaranteed a particular specialty or academic environment. So if you go to med school hoping to be a surgical subspecialist, or go into cards/GI/other competitive specialty, you need to be OK with the "fail case" of winding up in a specialty or program that wasn't your first choice.

OP, you feel stuck because you are stuck. You applied either to a specialty or to a set of programs that was above your level of competitiveness and failed to match. At that point, you either could have delayed graduation by a year to try and re-apply or SOAP into a bottom of the barrel program, and you chose the latter. These decisions have consequences, and now you need to find a way to be happy with the situation you are in rather than the situation that you wish you were in.

I say this probably half a dozen times a year--for future applicants, you need to really consider your "worst case scenario" of what to do if you're applying to a reach specialty or programs and ultimately fail to match. Most people SOAP and take what they can get just because it's what you're "supposed to do," but it really may not be in your best interest. As painful as it is, sometimes taking an extra year and re-applying is a better option in the long-run than SOAPing into specialty and program where you will be unhappy.
 
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