Pursuing IM for the sole purpose of getting to a cards fellowship?

[HappiSquirrel]

It seems the general consensus on SDN is to do an IM residency only if you are okay with practicing standalone internal medicine, just in case the fellowship route doesn't work out. If cardiology is the only thing I want to do, then would it be an okay idea to go into IM?

I kinda wish IM subspecialties can be their own things like the surgical subspecialties where the intern year will be general medicine and then you can go on to your speciality of choice.

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[sunshinefl]

It seems the general consensus on SDN is to do an IM residency only if you are okay with practicing standalone internal medicine, just in case the fellowship route doesn't work out. If cardiology is the only thing I want to do, then would it be an okay idea to go into IM?

I kinda wish IM subspecialties can be their own things like the surgical subspecialties where the intern year will be general medicine and then you can go on to your speciality of choice.

Not to be “funny”, but if it’s the only thing you want to do..... then what else would you do besides go to an IM residency in hopes of a cardiology fellowship?

 

[Anicetus]

Not to be “funny”, but if it’s the only thing you want to do..... then what else would you do besides go to an IM residency in hopes of a cardiology fellowship?

This.
Unless there is something else in medicine that you like that is more guaranteed. If you prefer vascular surgery/CT surgery then try to match those directly with IM as a backup. However if you hate everything about internal medicine whether it be PCP, hospitalist medicine, or administration medicine, I highly recommend you don’t do IM for the sole sake of doing cards. If one little thing blips along the way, ie you match somewhere in IM that isn’t great for fellowships, you mess up in IM residency, barring you from fellowship chances, or worst of all, you work insanely hard in IM only to not match cardiology, then you may be in a sticky situation. If you could see yourself being a hospitalist or a PCP at the very worst at the end of the day more than the other specialties out there then it’s worth going for it.

If you’re also from California like your profile says and you’re trying to go back and stay back, just keep in mind that applying to IM may pull you away from California if it means a better IM program outside of CA. There is also the higher possibility of not being in California for fellowship. Ultimately just prepare yourself mentally that you may be in 2 separate cities potentially for 6 years. I say this because a lot of people from California have chosen location over quality and ended up screwed applying to match fellowship in California when too many of their co-residents wanted in house spots.

 

[Gastrapathy]

Most allopathic grads in IM intend to subspecialize and get to do so.

 

[mszzeta]

It seems the general consensus on SDN is to do an IM residency only if you are okay with practicing standalone internal medicine, just in case the fellowship route doesn't work out. If cardiology is the only thing I want to do, then would it be an okay idea to go into IM?

I kinda wish IM subspecialties can be their own things like the surgical subspecialties where the intern year will be general medicine and then you can go on to your speciality of choice.

You just have to be a competent general internist in order to be a competent subspecialist.

 

[IMreshopeful]

It seems the general consensus on SDN is to do an IM residency only if you are okay with practicing standalone internal medicine, just in case the fellowship route doesn't work out. If cardiology is the only thing I want to do, then would it be an okay idea to go into IM?

I kinda wish IM subspecialties can be their own things like the surgical subspecialties where the intern year will be general medicine and then you can go on to your speciality of choice.

You cannot be a competent cardiologist without having a good foundation in IM. Doing intern year is not enough. You could potentially shorten it by a year but that’s all I would ever advocate for.

If you are a good allo grad going to at least an intermediate tier program, as long as you garner enough credentials (letters, research etc) you can typically match cardiology somewhere. If you’re an IMG, Caribbean, or DO grad it’s tougher.

That being said, if cardiology had not worked out for me I probably would have been fine being a hospitalist and doing well financially and lifestyle wise. So I personally believe you should go into IM with the plan that if something goes south, you can have IM alone as a backup.

 

[HappiSquirrel]

You cannot be a competent cardiologist without having a good foundation in IM. Doing intern year is not enough. You could potentially shorten it by a year but that’s all I would ever advocate for.

If you are a good allo grad going to at least an intermediate tier program, as long as you garner enough credentials (letters, research etc) you can typically match cardiology somewhere. If you’re an IMG, Caribbean, or DO grad it’s tougher.

That being said, if cardiology had not worked out for me I probably would have been fine being a hospitalist and doing well financially and lifestyle wise. So I personally believe you should go into IM with the plan that if something goes south, you can have IM alone as a backup.

Do step 1, AOA status carry over for fellowship application? Thanks for the answer btw, it does make sense.

 

[gutonc]

Do step 1, AOA status carry over for fellowship application? Thanks for the answer btw, it does make sense.

Yes, but their relevance/weight is much more variable. Some programs will still care about them (mostly for filtering reasons), others will glance and them and make sure they fit the overall story of your application.

 

[jdh71]

Cards is already basically the ortho of medicine. I can’t imagine it getting any worse unless of course you gave these folks an excuse to do and know even less internal medicine.

Acute and chronic medical conditions happen in the big big context of a whole patient.

 

[DolphInternist]

Difficult to say. As far as I know you are looking at 3 years residency + 3 years fellowship (+ 1 interventional?), with no guarantee of matching into fellowship.
But yes, as of right now it's the only way.
It's a mugs game. Has been forever. Do I think the whole thing can be shortened to 4 years? Yes, I do.
But yes, go for it if you want. General internal medicine is worse than all subspecialties (with perhaps the exception of oncology), and in turn, all internal medicine and subspecialties are worse than almost any other field you can name, with perhaps the exceptions of general surgery and emergency medicine.

 

[Anicetus]

Cards is already basically the ortho of medicine. I can’t imagine it getting any worse unless of course you gave these folks an excuse to do and know even less internal medicine.

Acute and chronic medical conditions happen in the big big context of a whole patient.

From IM residency in terms of competitiveness:
Cards is the ortho.
GI is the plastics

Rheumatology is anesthesiology.
Pulm crit is the EM
Heme onc is the obgyn/IM

Neprho/endocrine are the family medicine/peds

Allergy is the hidden gem on the side: Radiology

 

[Frogger27]

From IM residency in terms of competitiveness:
Cards is the ortho.
GI is the plastics

Rheumatology is anesthesiology.
Pulm crit is the EM
Heme onc is the obgyn/IM

Neprho/endocrine are the family medicine/peds

Allergy is the hidden gem on the side: Radiology

But is GI/Cards as difficult to match for fellowship as Ortho/Plastics is for residency? My understanding was that as long as you go to a mid tier IM residency and are a hardworking, good resident you should be able to match GI/cardio

 

[Dwan]

But is GI/Cards as difficult to match for fellowship as Ortho/Plastics is for residency? My understanding was that as long as you go to a mid tier IM residency and are a hardworking, good resident you should be able to match GI/cardio

No, but that's what some people in those fields like to believe due to massive ego. Nearly everyone from a decent IM program who wants it will get in, if they check the boxes. You don't need crazy step scores/AOA/top tier IM, unless you're aiming for the top academic programs.

 

[Anicetus]

But is GI/Cards as difficult to match for fellowship as Ortho/Plastics is for residency? My understanding was that as long as you go to a mid tier IM residency and are a hardworking, good resident you should be able to match GI/cardio

Almost all residents will look “good and hardworking” it’s the research, residency prestige, LORs from big time names in the field famous in the region, and step scores that get you in. No PD letter doesn’t look great similarly to medical school dean letters unless you deliberately screw up.

 

[deleted980918]

I had the same exact dilemma when i was a MS4. ultimately decided to go for the IM route, matched mid tier and will be applying for fellowship this year. i think for the most part, like others have said, if you are an AMG with a decent application you will likely match somewhere but the top places are incredibly competitive (probably more so than matching ortho/plastic in med school but competitive for different reasons).

 

[Gastrapathy]

The biggest downside to IM subs is the requirement for another app cycle to really reach your specialty of choice. That said, it’s not as competitive for AMDs as people sometimes make it sound. Charting Outcomes for the fellowship match was published last year.

 

[IMreshopeful]

No, but that's what some people in those fields like to believe due to massive ego. Nearly everyone from a decent IM program who wants it will get in, if they check the boxes. You don't need crazy step scores/AOA/top tier IM, unless you're aiming for the top academic programs.

Who likes to believe that?

You can match those fields just fine if you have the scores/letters/residency pedigree

 

[IMreshopeful]

Do step 1, AOA status carry over for fellowship application? Thanks for the answer btw, it does make sense.

To some degree. I know a couple of places which placed some emphasis on it because they saw it as an objective measure. But it varies hugely

 

[Milotic]

Do step 1, AOA status carry over for fellowship application? Thanks for the answer btw, it does make sense.

From the last cycle it seemed most of the California GI programs had a cutoff of like 230 Step 1 to cut out people when choosing applicants to interview.

 

[HappiSquirrel]

General internal medicine is worse than all subspecialties (with perhaps the exception of oncology), and in turn, all internal medicine and subspecialties are worse than almost any other field you can name, with perhaps the exceptions of general surgery and emergency medicine.

Wow, that sentence alone made me question my choice in medicine briefly. May I ask why that is?

 

[Anicetus]

Wow, that sentence alone made me question my choice in medicine briefly. May I ask why that is?

Check out the other thread in IM residency on what hospitalists can do. Basically most hospitalists don’t enjoy it (I think only 20% of IM docs would choose IM again) and if they had the opportunity to do a subspecialty again without the life barriers they would take it in a heartbeat.

 

[jdh71]

From IM residency in terms of competitiveness:
Cards is the ortho.
GI is the plastics

Rheumatology is anesthesiology.
Pulm crit is the EM
Heme onc is the obgyn/IM

Neprho/endocrine are the family medicine/peds

Allergy is the hidden gem on the side: Radiology

Wasn't exactly the point I'm making

Depending on the call schedule, often the lowest form of life intermittently in the hospital is the cards consultant

"But I can't Cath that" "That doesn't need a catheterization" "The patient is too sick to CATH"

 

[Merely]

From IM residency in terms of competitiveness:
Cards is the ortho.
GI is the plastics

Rheumatology is anesthesiology.
Pulm crit is the EM
Heme onc is the obgyn/IM

Neprho/endocrine are the family medicine/peds

Allergy is the hidden gem on the side: Radiology

I don’t think that’s what he meant. He meant that cards know no medicine similar to how ortho knows no medicine.

 

[IMreshopeful]

I don’t think that’s what he meant. He meant that cards know no medicine similar to how ortho knows no medicine.

Yeah, not true. We deal with noncardiac issues all the time. But a little snark is fine lol

I’ve met heme/onc attendings who don’t know how to read ECGs - if anything is hyperspecialized ridiculously hard it’s that

 

[Stagg737]

From IM residency in terms of competitiveness:
Cards is the ortho.
GI is the plastics

Rheumatology is anesthesiology.
Pulm crit is the EM
Heme onc is the obgyn/IM

Neprho/endocrine are the family medicine/peds

Allergy is the hidden gem on the side: Radiology

You forgot palliative care, which is like the PM&R of IM.

 

[InvestingDoc]

Half my residency "class" if not more than half were dead set on specializing. Almost all were very vocal that they would quit medicine once loans were paid off if they had to do general internal medicine.

You wont be alone OP if you feel this way.

 

[Milotic]

Half my residency "class" if not more than half were dead set on specializing. Almost all were very vocal that they would quit medicine once loans were paid off if they had to do general internal medicine.

You wont be alone OP if you feel this way.

Did they all end up specializing?

 

[Anicetus]

Did they all end up specializing?

My med school’s graduating IM class: started 50/50 GI/cards. —-> life expectations and reality bombs hit —-> 50% hospitalists, 10% cards, 2 GI apps didn’t match, the rest pulm, heme, rheum, nephro, endo.

 

[InvestingDoc]

Did they all end up specializing?

Yes, everyone who wanted to get into fellowship got into fellowship. They may not have gotten into the program they wanted, but everyone matched.

 

[rokshana]

My med school’s graduating IM class: started 50/50 GI/cards. —-> life expectations and reality bombs hit —-> 50% hospitalists, 10% cards, 2 GI apps didn’t match, the rest pulm, heme, rheum, nephro, endo.

Sounds about right.

 

[Gastrapathy]

Except the GI match rates for AMGs aren’t that bad

 

[Instatewaiter]

Difficult to say. As far as I know you are looking at 3 years residency + 3 years fellowship (+ 1 interventional?), with no guarantee of matching into fellowship.
But yes, as of right now it's the only way.
It's a mugs game. Has been forever. Do I think the whole thing can be shortened to 4 years? Yes, I do.
But yes, go for it if you want. General internal medicine is worse than all subspecialties (with perhaps the exception of oncology), and in turn, all internal medicine and subspecialties are worse than almost any other field you can name, with perhaps the exceptions of general surgery and emergency medicine.

Yeah so I'll have to politely disagree and tell you there basically is no better field than cardiology...

Change my mind

Also there is nothing I can't cath

 

[Milotic]

Yeah so I'll have to politely disagree and tell you there basically is no better field than cardiology...

Change my mind

Also there is nothing I can't cath

Requesting consult for chest pain. Outside records? Nope. Yeah, my attending wants this consult, Bye.

 

[IMreshopeful]

Requesting consult for chest pain. Outside records? Nope. Yeah, my attending wants this consult, Bye.

That’s okay we can still cath em

 

[jdh71]

That’s okay we can still cath em

But not until after 9am!!

 

[IMreshopeful]

But not until after 9am!!

Yah just push tenecteplase they’ll be fine bro

 

[Raryn]

Yeah, not true. We deal with noncardiac issues all the time. But a little snark is fine lol

I’ve met heme/onc attendings who don’t know how to read ECGs - if anything is hyperspecialized ridiculously hard it’s that

Meh. My cards attendings in residency would quite literally put in general medicine consults to manage insulin if they happened to have a diabetic that ended up admitted to their service (say, s/p intervention for STEMI).

 

[afib123]

Meh. My cards attendings in residency would quite literally put in general medicine consults to manage insulin if they happened to have a diabetic that ended up admitted to their service (say, s/p intervention for STEMI).

I get what you are saying but it seems that is pretty common across lot of subspecialties. Don't think many GIs or nephrologists will do much workup for chest pain on their service. Will probably call cards after ordering an ekg and troponins. Internists can manage non-emergent chest pain.

 

[gutonc]

I get what you are saying but it seems that is pretty common across lot of subspecialties. Don't think many GIs or nephrologists will do much workup for chest pain on their service. Will probably call cards after ordering an ekg and troponins. Internists can manage non-emergent chest pain.

Raryn is basically talking about getting a gen med consult to continue home meds.

I had an attending in (onc) fellowship who would call cards if a patient was on more than 1 anti-hypertensive (regardless of stability), endo for any diabetic on insulin, etc, etc. And when I say that "he" called, of course what I mean is that he made the fellows call. It got to the point with endo that they fellows would immediately know who was the attending on service when they got those calls and apologized to us for having to make the call.

 

[IMreshopeful]

Meh. My cards attendings in residency would quite literally put in general medicine consults to manage insulin if they happened to have a diabetic that ended up admitted to their service (say, s/p intervention for STEMI).

That may have been your experience. I don’t think I have ever called endocrine for post STEMI diabetes management unless the patient is on an insulin pump. We also can’t call general medicine consults because our patients are on a medicine team being managed by medical residents and fellows. That seems out of the norm for most cardiology practices I have experienced.

Our cardiology attendings are generally reasonable in terms of who to call when. We do have a little lower threshold to call if the patient is a VAD or transplant and some of the transplant attendings are super consult happy. However in all fairness those patients aren’t much more fragile and complex.

Bottom line, don’t kid yourselves that any specialty is somehow “better” at being less frivolous with consults. I’ve seen examples of pan consulting in pretty much every subspecialty. And I stand by my earlier opinion that we have to have the background to manage noncardiac issues even if we aren’t actively managing them day to day

 

[Doctor_Strange]

Can someone explain the challenges of matching into a fellowship from a community-based IM program? Based off my board scores, that's likely what I'll end up doing!

 

[nlax30]

Can someone explain the challenges of matching into a fellowship from a community-based IM program? Based off my board scores, that's likely what I'll end up doing!

Likely less connections with other fellowships from a lesser known community program, less established research opportunities. I did residency and first fellowship at a community shop and then my final fellowship at a large ACGME tertiary care center. It will certainly depending on what fellowship you want and where. If you do end up at a community place work make sure you make the most of it by working hard, being known as a "solid resident" and hope that some of your attendings/mentors have connections to bigger academic programs for fellowships where they can make a call on your behalf.

My case was a little different as I'm in a fairly small field, stayed local and had several mentors call on my behalf and proved myself. I certainly though was not going to be able to get into a "brand name" fellowship coming from my community IM program though.

 

[jdh71]

Bottom line, don’t kid yourselves that any specialty is somehow “better” at being less frivolous with consults. I’ve seen examples of pan consulting in pretty much every subspecialty. And I stand by my earlier opinion that we have to have the background to manage noncardiac issues even if we aren’t actively managing them day to day

Literally, I KNOW. And most of ya'll were the smartest guys in your residency class, and this is why many of us get annoyed AF when we get consulted to do this stuff in the "real world". Don't be that guy when you're done. I hope you're never "that guy".

I have to deal with one joker, cards fellowship AT MAYO, so . . . you know . . . no way he was an idiot going in right? Pretends he can't do anything (except cath and perc aortic valves). It's actually cringeworthy.

 

[nlax30]

Literally, I KNOW. And most of ya'll were the smartest guys in your residency class, and this is why many of us get annoyed AF when we get consulted to do this stuff in the "real world". Don't be that guy when you're done. I hope you're never "that guy".

I have to deal with one joker, cards fellowship AT MAYO, so . . . you know . . . no way he was an idiot going in right? Pretends he can't do anything (except cath and perc aortic valves). It's actually cringeworthy.

To play devil’s advocate.... I know some of those types who did Cardio some cards sub-specialty at top name places. And I actually would not want them managing insulin or other routine issues.

Obviously this sort of thing will vary based on local culture or how the services are structured. I’m in a cards sub-specialty and we just aren’t set up or staffed to be primary on all our patients so if they are going to be admitted for more than an overnight outpatient procedure they usually get admitted to medicine where they have a separate Hospitalist service (separate from the resident/student teaching services) where they have plenty of docs and actually want to take these easy patients.

 

[jdh71]

To play devil’s advocate.... I know some of those types who did Cardio some cards sub-specialty at top name places. And I actually would not want them managing insulin or other routine issues.

Obviously this sort of thing will vary based on local culture or how the services are structured. I’m in a cards sub-specialty and we just aren’t set up or staffed to be primary on all our patients so if they are going to be admitted for more than an overnight outpatient procedure they usually get admitted to medicine where they have a separate Hospitalist service (separate from the resident/student teaching services) where they have plenty of docs and actually want to take these easy patients.

Every cardiologist where I work has TWO NP's. You heard me right, TWO. Plus an overnight Cath guy in house who holds the small list.

 

[IM2GI]

Literally, I KNOW. And most of ya'll were the smartest guys in your residency class, and this is why many of us get annoyed AF when we get consulted to do this stuff in the "real world". Don't be that guy when you're done. I hope you're never "that guy".

I have to deal with one joker, cards fellowship AT MAYO, so . . . you know . . . no way he was an idiot going in right? Pretends he can't do anything (except cath and perc aortic valves). It's actually cringeworthy.

Are we just going to pretend that there are not plenty of terrible hospitalists who consult everyone as well? If you really wanted to you could call a GI consult on half of the patients admitted to the hospital, and some hospitalists will do just that.

This is not a matter of general IM good/specialist bad, but lazy vs. trying.

 

[jdh71]

Are we just going to pretend that there are not plenty of terrible hospitalists who consult everyone as well? If you really wanted to you could call a GI consult on half of the patients admitted to the hospital, and some hospitalists will do just that.

This is not a matter of general IM good/specialist bad, but lazy vs. trying.

I do think the context of the thread was cardiology though.

If we want to talk about other specialties I don't think I've ever had a helpful consult from GI that wasn't for a scope. Not sure if lazy. But definitely not trying to help.

 

[IMreshopeful]

Literally, I KNOW. And most of ya'll were the smartest guys in your residency class, and this is why many of us get annoyed AF when we get consulted to do this stuff in the "real world". Don't be that guy when you're done. I hope you're never "that guy".

I have to deal with one joker, cards fellowship AT MAYO, so . . . you know . . . no way he was an idiot going in right? Pretends he can't do anything (except cath and perc aortic valves). It's actually cringeworthy.

Eh being trained at Mayo means nothing to me. It doesn’t mean anything to me regarding their clinical training. All it tells me is that they read their echos backwards.

I think we’ve beaten this to death but cardiology is no different in terms of bad consults than any other specialty - do you know how many garbage MICU consults I’ve seen? And you have to be pretty damn smart for pulm/CC as well bro. Anyway I’m rarely going to be primary on any patient so this is sort of moot - but yes I do endeavor to be judicious with my consults.

 

[jdh71]

Eh being trained at Mayo means nothing to me. It doesn’t mean anything to me regarding their clinical training. All it tells me is that they read their echos backwards.

I think we’ve beaten this to death but cardiology is no different in terms of bad consults than any other specialty - do you know how many garbage MICU consults I’ve seen? And you have to be pretty damn smart for pulm/CC as well bro. Anyway I’m rarely going to be primary on any patient so this is sort of moot - but yes I do endeavor to be judicious with my consults.

The point wasn’t about being trained at Mayo. It’s not the training. It’s the selection by Mayo. They get to pick the cream of the crop. The smartest guys in my residency we’re almost all uniformly cards gunners. So. To try to bring the point home, none of you are stupid. And IF not stupid then should be handling most of the medical problems on your patients in the hospital. And the only reason you do not is a stupid sense of elitism. Don’t ever be that guy. Or. You can be that guy but the rest of us wont respect you. Maybe you won’t care.

 

[ILikeMilk]

IM gets a bad rep, its really not that bad. The hospitalist schedule is pretty awesome, 7 on 7 off. You may have a 12 hour "shift" but you come in and leave at whatever time you like. The private hospitalists at my residency would basically start at around 8 and leave at variable times in the afternoon, anywhere from 3 to 5, rarely 7. You can stack weeks together and take multiple weeks off. You can work extra weeks and get paid extra. I find that better than clinic work where you work mon-fri 8-5, but you're doing work related stuff an hour before and an hour or 2 after work too, on weekend calls, on overnight calls for procedures.