Path going forward to fellowship

[Death and Taxes]

New intern at a university affiliated but community IM program, no inhouse fellowships. US MD below average steps, match gave me IM so it's the career path now. Besides working as hard as possible to be best resident I can be, what do I do to match into fellowships?

1) What kind of research to do for fellowship? Little to no ongoing research here in cards/hemeonc/pulmcc. Are case reports sufficient to match? I haven't done much research before and have never been published, who do you talk to in order to get started? What are tiers of research if there are no clinical trials to be a part of?
2) Away rotations are a thing in residency apparently, when do we do those?
3) Preparing for rotations on specialties to sound semi competent, recommended reading?

Thanks!

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[lulu09]

New intern at a university affiliated but community IM program, no inhouse fellowships. US MD below average steps, match gave me IM so it's the career path now. Besides working as hard as possible to be best resident I can be, what do I do to match into fellowships?

1) What kind of research to do for fellowship? Little to no ongoing research here in cards/hemeonc/pulmcc. Are case reports sufficient to match? I haven't done much research before and have never been published, who do you talk to in order to get started? What are tiers of research if there are no clinical trials to be a part of?

Case reports are better than nothing. It depends also on the exact fellowship you want to do. Basically, outside of the big 4 (cards, heme/onc, GI, pulm/CC and arguably rheum), you don't actually *have* to do research to match fellowship, as many of the less competitive fellowships have more spots than people, and especially "people" meaning AMGs, even if you have low board scores.

The best advice I have for new interns is to do a few electives early on in the fields you might be interested in and scope out attendings that way. Even if you're at a program with no in-house fellowship, you can ask the attendings if they know of other attendings (esp in the affiliated university) who you can do research with. Your PD/APD may be helpful too. Also ask the current third years who match in fellowship later this year what they did for research.

For now, I think you should focus on finding what you're interested in first though, and then go from there. I usually tell interns it's ideal to have this squared away and a potential mentor identified by New Years, but totally adequate if you can figure this out by the end of your intern year. But before then, just relax and focus on surviving intern year.

2) Away rotations are a thing in residency apparently, when do we do those?

Meh, I don't think they really help. Perhaps if you're low-average and aiming for a mid-range program to make an impression at. Top tier programs don't care if you do an away, and away rotations can hurt you as much as than they can help.

3) Preparing for rotations on specialties to sound semi competent, recommended reading?

I don't really think interns need to have dedicated reading, as you'll absorb a lot from just being on the floors and rounds, but if you have to read something I honestly would just Up To Date your patients' problems when you have time, and in a month or two you would have learned an immense amount. Read NEJM reviews on common topics like cirrhosis, CHF, COPD...etc.

 

[Crayola227]

wow is rheum really becoming that competitive these days?

 

[Crayola227]

Case reports are better than nothing. It depends also on the exact fellowship you want to do. Basically, outside of the big 4 (cards, heme/onc, GI, pulm/CC and arguably rheum), you don't actually *have* to do research to match fellowship, as many of the less competitive fellowships have more spots than people, and especially "people" meaning AMGs, even if you have low board scores.

The best advice I have for new interns is to do a few electives early on in the fields you might be interested in and scope out attendings that way. Even if you're at a program with no in-house fellowship, you can ask the attendings if they know of other attendings (esp in the affiliated university) who you can do research with. Your PD/APD may be helpful too. Also ask the current third years who match in fellowship later this year what they did for research.

For now, I think you should focus on finding what you're interested in first though, and then go from there. I usually tell interns it's ideal to have this squared away and a potential mentor identified by New Years, but totally adequate if you can figure this out by the end of your intern year. But before then, just relax and focus on surviving intern year.



Meh, I don't think they really help. Perhaps if you're low-average and aiming for a mid-range program to make an impression at. Top tier programs don't care if you do an away, and away rotations can hurt you as much as than they can help.



I don't really think interns need to have dedicated reading, as you'll absorb a lot from just being on the floors and rounds, but if you have to read something I honestly would just Up To Date your patients' problems when you have time, and in a month or two you would have learned an immense amount. Read NEJM reviews on common topics like cirrhosis, CHF, COPD...etc.

I disagree about doing aways, I know some in not well known, but solid, community programs that were able to match well-beyond what others might have expected by doing so, some by ending up at that program, others by the contacts they made at the away. I don't know how generalizable that is, so your point may stand. I agree that unless you are really strong, it can do a lot to hurt you.

I also I think that interns absolutely should start to think about a reading/study schedule, but certainly not early in the year. I agree, read for survival (ie frantically U2D as needed to treat your patients en progreso), that will be part of you gaining efficiency, once you gain efficiency and start to have free time, use that to screw your head back on for self care, and then when you think you might have that hour or so in an evening, start to read

This is usually something that doesn't gel until early spring

 

[Crayola227]

I think given what you've shared with us, that just saying to yourself "I've gotta get out of IM, give me anything in the top 3", the whole thing isn't really a picture of landing a competitive fellowship.

You might need to do the following:
Set your sights lower
Pick something on that tier, and then work your tail off focusing on that.

 

[Death and Taxes]

I think given what you've shared with us, that just saying to yourself "I've gotta get out of IM, give me anything in the top 3", the whole thing isn't really a picture of landing a competitive fellowship.

You might need to do the following:
Set your sights lower
Pick something on that tier, and then work your tail off focusing on that.

I dont think that's a fair assessment of my situation or what I'm asking. The match dealt IM so here I am asking SDN for advice. If 220/240 and a smaller community program is that much a barrier to cards, pulmcc or hemeonc, thank you for said advice. I'm not looking for "big bucks" or a derm lifestyle. I simply haven't had exposure to above fields and I certainly have no idea how competitive these fields are. People set on certain fields talked about research from day 1 and since I'm late to the party, I should probably get started.

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[IMreshopeful]

I dont think that's a fair assessment of my situation or what I'm asking. The match dealt IM so here I am asking SDN for advice. If 220/240 and a smaller community program is that much a barrier to cards, pulmcc or hemeonc, thank you for said advice. I'm not looking for "big bucks" or a derm lifestyle. I simply haven't had exposure to above fields and I certainly have no idea how competitive these fields are. People set on certain fields talked about research from day 1 and since I'm late to the party, I should probably get started.

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Rotate with those fields if possible to get exposure and see what they are like

At my big university program we periodically get residents from local community ones rotating here to get experience and letters of rec etc. generally unless they’re a stellar resident to begin with, this doesn’t help a lot although it may help them connect with a faculty member for research or something. In all truthfulness, I’ve seen about 10 of these guys rotate through here - about half didn’t match and half did not match here but did elsewhere. Those that did were generally strong step scores, research involved, and had excellent clinical skills - which not everyone has.

Your best bet is to talk to attendings in the dept in your field of interest and see what they have as far as advice to give

 

[NewYorkDoctors]

You are always welcome to do nephro .
See nephro threads . No research required to do nephro even in some above average academic centers .

If fact you can backup nephro and even scramble into a not half bad program in nephro on match day if your primary fellowship desire was not successful and you cAnnot do a hospitalist or PMD gap year

 

[Jinxapotato]

You are always welcome to do nephro .
See nephro threads . No research required to do nephro even in some above average academic centers .

If fact you can backup nephro and even scramble into a not half bad program in nephro on match day if your primary fellowship desire was not successful and you cAnnot do a hospitalist or PMD gap year

so is nephro really that undesireable nowadays? From what I read on SDN it's as if they'll take anyone with a pulse, yet in real life, the nephrologist I know in Midwest is doing pretty dam well for himself.

 

[IMreshopeful]

so is nephro really that undesireable nowadays? From what I read on SDN it's as if they'll take anyone with a pulse, yet in real life, the nephrologist I know in Midwest is doing pretty dam well for himself.

Yeah, pretty much so. Look at the threads from the “other subspecialties” subforum. Comes down to
- Bad reimbursement (mostly Medicare)
- Bad lifestyle (emergent HD evals at midnight)
- Difficult patient population, complex and sick without a good endpoint for many
- Tough breaking into the market - groups which have been around for a while are extremely self protective and don’t take kindly to a lot of the new young’uns coming in

 

[NewYorkDoctors]

Yeah, pretty much so. Look at the threads from the “other subspecialties” subforum. Comes down to
- Bad reimbursement (mostly Medicare)
- Bad lifestyle (emergent HD evals at midnight)
- Difficult patient population, complex and sick without a good endpoint for many
- Tough breaking into the market - groups which have been around for a while are extremely self protective and don’t take kindly to a lot of the new young’uns coming in

What he said .

If you go rural you can make a niche for yourself and probbaly get a 99214 mill of renal and PMD. But even then you need an HD corporation to be around and they tend to fill with their own hires (so they control your revenue and limit your profits )