Well, I can't answer yes to all of those questions, since I am a US-IMG. Are the prelim IM programs in Cali really tough to secure? Should I look elsewhere?
Here the situation: I will be applying for a lot of advanced positions throughout the country. Should I focus my prelim. IM applications just to one or two regions, or just apply to a few at each place my advance programs are at? Thanks a lot!
Anecdotally I think California is a tough nut to crack unless you've got ties to the region or a stellar resume.
My advice would be to focus on programs that are geographically close to your advanced program prospects. You said you're planning to apply to "a lot" of advanced positions, so you should have more than enough options to consider when accepting interview offers. Do your best to schedule interviews the same or similar days to cut down on travel expense. Keep a written record of the different program pros and cons. (I was told to do this, didn't do it, and regretted it, even though I only did 7 internship intervews. By the time you are putting together your rank lists you'll forget which ones had the crappy call formats or great benefits.)
Try to read between the lines to find out what's really going on. Talk to current and former preliminary interns to get a, hopefully, unbiased and unvarnished appraisal. Consider throwing in applications to some transitional programs. Traditionally they're considered to be cushier than prelim medicine programs, but this isn't always the case. They are also generally more competitive than preliminary medicine or surgery.
There are, obviously, no hard fast rules on how many are necessary. My gut feeling is that even if you're an average to slightly below average applicant, I wouldn't go to more than 4 or 5 preliminary medicine interviews, but there's no way to know how many you'll need until Match Day. As I said, I did 7 internship interviews - 3 prelim-medicine and 4 transitionals - and I ended up matching at my #1 even though I'd say I'm a very average applicant, especially if you consider transitional program applicants.
Err on the side of caution. Apply broadly, decide beforehand how much you can budget for travel, accept interviews as they come in, cancel any that rank low on your list (be considerate to your fellow applicants and to the programs and cancel early, if possible), keep a record of pros, cons, likes, and dislikes, rank them honestly and how you truly feel (not how you think they'll rank you - I never in my wildest dreams thought I'd match at UPMC Mercy, but I put them #1 and here I am.), and then buy some Rolaids while you wait for Match Day.
Good luck!
