Pitfalls of having a back-up specialty?

[IronyDeficient]

Hi all,

I'm a newly minted MS4 planning to apply to general surgery and FM as a back-up. I'm realistic about my competitiveness for surgery, but loved the OR and procedural/technical aspect, and want to shoot my shot. I did enjoy my FM rotation, and if that's where I ended up I would absolutely be a hard-worker and make the most of it. Besides the obvious (don't apply for both programs within the same health system) what are some pitfalls when applying to more than one specialty, especially when they're seemingly so opposite like surgery and FM? Any advice to approach asking for LORs from the FM physicians I worked with? Should I just be up-front that it's my back up plan? Do FM attendings tend to be understanding about this?

USMD
STEP 1: 22X
Step 2CK: Haven't taken yet; planned for ~4 weeks away
Pre-clinical: Low to average; had to remediate the first lab practical of M1 year because I studied incorrectly (for identification rather than second/third order questions); passed this on remediation and didn't have any other failures as an MS1 or MS2
Clinical: All High Passes and Honors; the usual constructive criticism was to "read more" but mostly positive comments on my evals; surgery was a High Pass & FM was an Honors
Research: Some from undergrad and 1-2 things from medical school (still pending); but nothing high-impact

I plan to apply broadly to community surgery programs without regard to geography, but be a bit more targeted in where I apply for FM (maybe a mix of academic and community programs in the NE). I'm assuming the FM programs will realize they're a back-up based on my MS4 schedule (surgery Sub-I; surgery away rotation; surgery & anesthesia electives). Is this necessarily a deal-breaker for FM interview invites? Should I add an FM elective to my MS4 schedule?

My assumptions (correct these if they're wrong):
-Write two personal statements, one for surg and one for FM
-Have completely separate LORs for FM and surgery
-Don't apply to both programs in the same health system
-Be prepared to explain "why FM" and "why surgery" in interviews and explain why my 4th year is mostly surgery to the FM programs

Appreciate any advice--is dual applying was more common than SDN makes it appear? (Search function didn't yield much for me...) I'd like to save SOAP as an absolute last resort, and the surgery advisor at my school recommended against surgical pre-lim programs as only ~50% of those lead to a PGY-2 position.

Thanks! Best of luck to all the other MS4s worrying about their futures

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[NotAProgDirector]

You've basically laid it out well. You'll have only one application itself, and one transcript. The FM programs will see all those GS rotations and guess you're probably dual applying. Some may decline to invite you -- why bother inviting someone who already is going to rank them low (presumably under all your GS options)? Other programs might not notice/check. Yet other programs might decide you're unlikely to get a GS position, and hence offer you an FM interview and hope you fail to match to GS.

-Write two personal statements, one for surg and one for FM

Absolutely

-Have completely separate LORs for FM and surgery

Absolutely. You could ask people to write generic letters, but that's probably not as good an idea as separate letters. And if you ask a surgeon to write a generic letter, they may either question your interest in GS or forget and put it in your letter anyway -- both bad.

-Don't apply to both programs in the same health system

Probably not. My guess is that GS programs are unlikely to check or care, but FM programs may. If there's one specific location that you really want to be, applying to both is probably OK but in general I would not.

-Be prepared to explain "why FM" and "why surgery" in interviews and explain why my 4th year is mostly surgery to the FM programs

Yep. Hopefully you can spin the "I was initially interested in GS but then 'saw the light' and realize FM is what I want" Good luck!