Questions about residency or res'y+fellowship options?

[TheNorthWaves]

Hey everyone - I searched for about an hour here, and gave up. I found info about fellowship salaries but that's about it. I'm an MS1 in a US MD school (that ranks well in primary care and not at all with research), and I am looking over my options.

1) I realize that all along the way, you have to stay on top of the pack (or at least not on the bottom). This was true in undergrad, was true for the MCAT and is true of ranking/quartile in my school... SO, If I choose IM and then want to do a subspecialty in say, endocrinology or cardiology, am I then facing stiff competition for a fellowship and is it possible to not match to the correct fellowship of choice?

2) Based on question #1, if that is true, will I need to gain entry into one of the better IM programs (let's make up a number here, the top 50%?) to even bother with an interesting subspecialty?

I realize fellows are underpaid compared to attendings, and it is occurring to me that I could do family or ER, get it all over with in 3 years of residency and be absolutely sure of what my career will be. Is IM a risky bet? FWIW I'm generally a B/A student, mainly Bs.

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[-Goose-]

Hey everyone - I searched for about an hour here, and gave up. I found info about fellowship salaries but that's about it. I'm an MS1 in a US MD school (that ranks well in primary care and not at all with research), and I am looking over my options.

1) I realize that all along the way, you have to stay on top of the pack (or at least not on the bottom). This was true in undergrad, was true for the MCAT and is true of ranking/quartile in my school... SO, If I choose IM and then want to do a subspecialty in say, endocrinology or cardiology, am I then facing stiff competition for a fellowship and is it possible to not match to the correct fellowship of choice?

2) Based on question #1, if that is true, will I need to gain entry into one of the better IM programs (let's make up a number here, the top 50%?) to even bother with an interesting subspecialty?

I realize fellows are underpaid compared to attendings, and it is occurring to me that I could do family or ER, get it all over with in 3 years of residency and be absolutely sure of what my career will be. Is IM a risky bet? FWIW I'm generally a B/A student, mainly Bs.

What?

 

[NewmansOwn]

What?

Dude, seriously.

OP, want to take a deep breath and give that another try?

 

[TheNorthWaves]

Sorry, I wrote that quickly without much thought about its structure. It's not THAT bad though

Simpler explanation - I am asking for career advice.
I am open to different options for a residency (my heart is not set on a particular one) and I'm openly trying to weigh the pros/cons of sticking with a dedicated residency program (family, EM) versus something like IM which you can then choose to subspecialize in (or I suppose generalize in, too). When I say a dedicated residency program, I mean it like "you're in an EM program, and you will be an ER Doc, period" - unlike IM which has what, 20 sub-specialties?

I am looking for opinions on how difficult it is to secure a particular type of fellowship following an IM residency. I would like to know how uncertain that process is. In other words, I might choose to take an EM path instead of going IM if it turns out that IM subspecialty choice is hard to obtain... etc

Could anyone elaborate on IM? I generally understand the 3yrs res + 3 yrs fellowship thing, but not much about how you obtain your subspecialty (ie: do some require tons of publications, A+ grades, you name it)?

 

[NewmansOwn]

Sorry, I wrote that quickly without much thought about its structure. It's not THAT bad though

Simpler explanation - I am asking for career advice.
I am open to different options for a residency (my heart is not set on a particular one) and I'm openly trying to weigh the pros/cons of sticking with a dedicated residency program (family, EM) versus something like IM which you can then choose to subspecialize in (or I suppose generalize in, too). When I say a dedicated residency program, I mean it like "you're in an EM program, and you will be an ER Doc, period" - unlike IM which has what, 20 sub-specialties?

I am looking for opinions on how difficult it is to secure a particular type of fellowship following an IM residency. I would like to know how uncertain that process is. In other words, I might choose to take an EM path instead of going IM if it turns out that IM subspecialty choice is hard to obtain... etc

Oh ok.

I wouldn't do IM unless you could be happy doing general IM, since that's a possibility if you don't position yourself well enough during your residency to secure a competitive fellowship. The subspecialties with good pay (ie Cards) or a nice lifestyle (ie Allergy/Immunology, GI) are extremely competitive and if you didn't do a very impressive IM residency, then you'll need to be the shining star of your own to have a comfortable shot.

 

[-Goose-]

Sorry, I wrote that quickly without much thought about its structure. It's not THAT bad though

Simpler explanation - I am asking for career advice.
I am open to different options for a residency (my heart is not set on a particular one) and I'm openly trying to weigh the pros/cons of sticking with a dedicated residency program (family, EM) versus something like IM which you can then choose to subspecialize in (or I suppose generalize in, too). When I say a dedicated residency program, I mean it like "you're in an EM program, and you will be an ER Doc, period" - unlike IM which has what, 20 sub-specialties?

I am looking for opinions on how difficult it is to secure a particular type of fellowship following an IM residency. I would like to know how uncertain that process is. In other words, I might choose to take an EM path instead of going IM if it turns out that IM subspecialty choice is hard to obtain... etc

Could anyone elaborate on IM? I generally understand the 3yrs res + 3 yrs fellowship thing, but not much about how you obtain your subspecialty (ie: do some require tons of publications, A+ grades, you name it)?

IM is not that competitive overall. The top IM programs are very competitive, but overall, as a US grad, you will most likely match.

As far as subspecialties, there are some great threads in the IM & subspecialty forums, but here's my take. Remember, these are all relative.

Super Competitive
- Cardiology, GI, A&I

Competitive
- Pulmonolgy & Critical Care, Heme-Onc, Renal, Endocrine

The rest...

http://forums.studentdoctor.net/showthread.php?t=199551

 

[Pinkertinkle]

Cardiology and GI are the more competitive fellowships for IM and are not easy to match. You can't really compare fellowships with residencies but I'd say getting into cardio is about as hard as ortho or ophtho and GI a little bit less so. You should really worry about this after Step 1 or so.

 

[TheNorthWaves]

You should really worry about this after Step 1 or so.

True. But then again, if I want to be involved in something competitive after med school, I figure it would be best to start tailoring my earlier med student years (read: volunteer work, clubs) toward the residencies I'm most interested in.

Thanks for the help everybody. Does anyone know some valid/good websites (aside from the very good link posted above) out there that could help me see a clearer picture of IM subspecialties? It's amazing how little they have talked about it at my school (they want to make a bunch of family docs out of us).

 

[Law2Doc]

(read: volunteer work, clubs) toward the residencies I'm most interested in.

These don't really carry the kind of weight they perhaps did in undergrad. If you enjoy them, do them, but I wouldn't bother with them in hopes that it would look good to a residency director. If you use these to network with folks in the department and perhaps find a mentor, I suppose that could be helpful, but you don't really need to join a club to do this. Things like research carry far far more weight in the residency process. See if you can find an endocrinologist to do a research project with.

 

[TheNorthWaves]

That's good to hear - I've got some research lining up pretty well for next summer. Getting published is ideal, but if I can explain my work/contributions, is publication essential? It won't be with an endocrinologist - this school is limited in research as it is, so a good project with a good professor is good enough for me, haha.

Thanks again.

 

[TheNorthWaves]

That's good to hear - I've got some research lining up pretty well for next summer. Getting published is ideal, but if I can explain my work/contributions on paper and in an interview, is publication still essential? It won't be with an endocrinologist - this school is limited in research as it is, so a good project with a good professor is good enough for me, haha.

Thanks again.

 

[Law2Doc]

That's good to hear - I've got some research lining up pretty well for next summer. Getting published is ideal, but if I can explain my work/contributions, is publication essential? It won't be with an endocrinologist - this school is limited in research as it is

Publications look good, but aren't always possible if we are just talking about a summer of research. If your school is extremely limited in research and you think you need it, look into taking a year off to research after second year (some people research at the NIH or the like) so that you can improve your CV.

 

[TheNorthWaves]

that sounds like an excellent recommendation.

The problem is that I don't realistically know if I need "serious" research, or if a summer of unpublished stuff at my med school will fly. The opportunity cost of one more year that I'm not working as an MD, versus boosting my c.v. some more...

I would do it, if it seemed like a logical step. I don't know how to judge that, though.

 

[Law2Doc]

that sounds like an excellent recommendation.

The problem is that I don't realistically know if I need "serious" research, or if a summer of unpublished stuff at my med school will fly. The opportunity cost of one more year that I'm not working as an MD, versus boosting my c.v. some more...

I would do it, if it seemed like a logical step. I don't know how to judge that, though.

Is your school affiliated with a hospital that has endocrinologists or cardiologists or other IM specialties? Sounds like you need to find yourself a mentor or somebody you can bounce this sort of stuff off of.

 

[TheNorthWaves]

Fair point. Will do. Thank you all.