Prelim IM spot at top medicine places tough?

[GuP]

Is it just as difficult to obtain a prelim medicine spot at top IM places (mgh, penn, etc) as it is a categorical spot? Or is it easier? Would like to hear some input. Thanks.

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[gutonc]

It's tougher. You're competing against the Rads/Anesthesia/Rad Onc/Ophtho/Derm folks for those spots. Prelim Surg OTOH is a (relative) cake walk compared to Cat Surg.

 

[chicamedica]

Is it just as difficult to obtain a prelim medicine spot at top IM places (mgh, penn, etc) as it is a categorical spot? Or is it easier? Would like to hear some input. Thanks.

Also i've noticed those spots tend to go to an excellent candidate or three from the home program's own med school. (this goes mostly for the "huge name" ivy med schools).

 

[VCMM414]

I say easier. One would be naive to assume that derm/rad/ophthal/etc. applicants are automatically more competitive than IM applicants who are capable of matching at top programs. In addition, top IM programs tend to be very work-intensive, and may not necessarily be desirable for applicants going into non-IM fields. Doing prelim intern year at Penn or Hopkins vs lowly ranked IM programs makes little difference for someone who've matched into derm. There's a reason that many prelim applicants actually favor transitional years (viewed as more "cush"), as well as laid-back community prelim programs like Santa Barbara Cottage (again, more "cush"). In fact, transitional spots tend to be more competitive than prelim spots.

 

[GuP]

I doubt there is much competing for these spots from the derm/rads/ophtho folk. Most of these candidates opt for TY years or they look for something more geographically appealing. Does anyone have further input into how easy/hard these might be?

 

[randyo]

Many competitive applicants requiring an intern year (derm, gas, rads, ophtho, rad onc, etc) often try to choose the "cushest" transitional year/prelim year spots. At my school, the prelim year offered by the academic center in town went unfilled, while the community hospital TY/PY with 5-6 months of "elective" time were the most difficult to match into.
People want different things out of their intern years.

 

[iwmirott]

I would say that these spots are difficult to get. Coming from the applicant pool of Rad Onc/Optho/Rad (Rad Onc myself), I can tell you the order of preference for most applicants was TY over prelim, but the next factor was usually location and in some instances there are only a limited number of first year spots in any location, making the application process very competitive. As far as VCMM comment, the excellent IM applicants that can fill these spots are trying for them. They are trying for categorical spots. Out of all my interviews I say probably 80% from Rad/Optho/etc and the other 20% from atypical pathways (took time off after med school, FMG, waiting for spouse to finsih school/residency then reapply). Having matched at a top tier IM program (wasn't my first choice, first choice was a TY spot) I can tell you the group of prelim medicine residents are very impressive. All from top notch schools, with excellent grades/board scores, and all have multiple publications. With friends from the interview trail in similar situations, I think this is pretty much the norm. I would say that it would be difficult for anyone who wasn't competitive for the catergorical positon to secure a prelim spot unless they have something else going for them.

 

[GuP]

I would say that these spots are difficult to get. Coming from the applicant pool of Rad Onc/Optho/Rad (Rad Onc myself), I can tell you the order of preference for most applicants was TY over prelim, but the next factor was usually location and in some instances there are only a limited number of first year spots in any location, making the application process very competitive. As far as VCMM comment, the excellent IM applicants that can fill these spots are trying for them. They are trying for categorical spots. Out of all my interviews I say probably 80% from Rad/Optho/etc and the other 20% from atypical pathways (took time off after med school, FMG, waiting for spouse to finsih school/residency then reapply). Having matched at a top tier IM program (wasn't my first choice, first choice was a TY spot) I can tell you the group of prelim medicine residents are very impressive. All from top notch schools, with excellent grades/board scores, and all have multiple publications. With friends from the interview trail in similar situations, I think this is pretty much the norm. I would say that it would be difficult for anyone who wasn't competitive for the catergorical positon to secure a prelim spot unless they have something else going for them.

There is no way in hell that prelim spots are as competitive as the cat spots.

 

[E Yorrick Davis]

prelim spots at top medicine programs are not even remotely close to being as competitive as categoricals.

that being said, they are not a walk in the park to get either.

generally the cushest programs are the hardest to match into, followed by the prestigious spots (from the small remainder of applicants saying "i want to go somewhere with a name so i can learn") followed by the huge mass of programs that are either malignant and mid-tier or just poorly recognized

although i'm not saying it's an accurate measure, one way to look at how competitive programs are is to see where their graduates come from. take this with a grain of salt, however, as there are FMGs at the top programs but they are essentially attendings in disguise.

i have never seen a caribbean graduate listed as a resident either preliminary or categorical at any of the the top 25 medicine programs. i haven't really gone out of my way to comb through their websites though..

 

[werewethere]

Both preliminary and categorical spots at top places are quite competitive. However, there are a number of factors that are difficult to influence as a preliminary candidate. First is the fact that the number of preliminary positions is far smaller than the number of categorical positions, usually on the order of 4:1 to 5:1. Second, in this era of funding cutbacks, the first set of slots that gets cutback is usually prelim. Third, given the relative paucity of remaining prelim medicine spots compared to categorical spots in general, it would be easier for a program to find a qualified candidate for a prelim spot than a categorical. This makes the prelim spot more desirable, so it is less likely to be filled by a suboptimal candidate. Fourth, many programs will create rank lists for prelims based on their connections with other programs within and outside the hospital. This means that one to several of the prelim spots will go to either derm/rad onc/rads/gas/etc candidate accepted at the same hospital, or it will be kept as a negotiating tool during scramble, when program directors from well connected medical schools will try to place their remaining unmatched candidates (yes, there are a number of very qualified candidates who each year fail to secure a prelim/TY spot, because the competition is really stiff and getting stiffer).
So, even though you need to do more to get into a great categorical program, because, after all, IM is going to be your career, prelim medicine at the same spot may be equally to more competitive. Doesn't take away the fact that you have to have great credentials, contacts, and luck to match a top notch categorical spot.