Rheum rotations

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

Balo

Full Member
10+ Year Member
Joined
Apr 21, 2013
Messages
86
Reaction score
46
Hi, wanted to know what people's opinions were. I have a particular geographical location I prefer that is far from my current location and am considering doing an away there, but a lot of those programs would probably be deemed "reach" or highly desirable due to university name brand and thus highly competitive. I likely will have 4 weeks each for 2 away rotations. Would it be better to rotate at a seemingly less prestigious program even though the location is not my preference or would it be better to rotate at my desired location even though the competition is likely stiffer? I will probably do one rotation at one of those nearby fellowships but then I have an open slot for either a competitive away in a place I would like to live long-term or a more community kind of program in a place I wouldn't normally consider (will apply broadly).

I'm not a very competitive applicant at this time but would like to shoot my shot. Am working on a case report that isn't published yet. Also planning on going to a conference. I have a benchwork paper from med school in a different field. Have a QI project in a different field as well although it is clinic-based. Volunteered in sports med as well. I will likely be able to get 1-2 rheum letters and a letter from PD; I may also ask PCP for a letter if that helps speak towards my clinical ability out-patient. Passed all levels, no STEP.

Members don't see this ad.
 
Hello. if you have a good app I think your chances of matching at your desired locale is high. Also if you can get a letter from those high reach places it will boost your app more. However, if you think your app is not strong, I would rotate at the less competitive places since that will expose your face more to those faculties and you will have high chance of getting interviews/ matching there. I would split up your 4 weeks as 2 weeks at high reach place and try to get a letter and 2 weeks at the less known place so they get to know you and you can try to get a letter there as well.
Aside from that, just wondering what made you choose rheumatology over other specialties? I'm a pgy-1 trying to figure out between allergy vs. Rheumatology vs. Endo (was thinking heme onc before but gave up on that cause I'm tired of the rat race of matching a competitive fellowship)
 
  • Like
Reactions: 1 user
Rheumatologist here.

Not sure it really matters that much. It’s hard to excel on this type of rotation if you’re not affiliated with the institution and don’t know the ropes of how the hospital works, the EMR, etc.

I was a fellow at one of those “name brand” institutions and we had a number of these away rotators come through during my fellowship. The faculty generally said they weren’t all that impressed with these rotators, although I’m not sure that was because of any specific deficiency in them - more that it’s just hard to look good in a 4 week period at an institution you’ve never been to before.

Rheum is more competitive than it used to be, although not extremely so. When I applied I had only done a rheum rotation two months before the app deadline - just then, I decided I liked it. I had no rheum research but I had a couple of good letters. I was a DO, came out of a mid tier academic IM residency and did pretty well as a resident. I went to a very good rheum program in my desired locale. So it worked out.
 
Last edited:
  • Like
Reactions: 2 users
Members don't see this ad :)
Hello. if you have a good app I think your chances of matching at your desired locale is high. Also if you can get a letter from those high reach places it will boost your app more. However, if you think your app is not strong, I would rotate at the less competitive places since that will expose your face more to those faculties and you will have high chance of getting interviews/ matching there. I would split up your 4 weeks as 2 weeks at high reach place and try to get a letter and 2 weeks at the less known place so they get to know you and you can try to get a letter there as well.
Aside from that, just wondering what made you choose rheumatology over other specialties? I'm a pgy-1 trying to figure out between allergy vs. Rheumatology vs. Endo (was thinking heme onc before but gave up on that cause I'm tired of the rat race of matching a competitive fellowship)
If you want to get out of the rat race (get a fellowship with little to no work) consider endo, sleep, or just do general IM.

Allergy was the third most competitive speciality for IM last year based on NRMP match data (match rate 72%), right behind GI/Cards. Heme/Onc had a 77.5% match rate. All four had >99% fill rate. To highlight doz’s point, Rheum had a 77.9% match rate, the same as Heme/Onc. Allergy seems to be getting more competitive, last year was particularly tough, though it’s unclear if this trend will persist or not where in the past, heme/onc has been more competitive.

Either way, if you want a desirable specialty in IM, you’re gonna have to do some amount of work/grind for it. ID, Nephro, Sleep, Geri/Pali (>90% match rate) are the specialties you can walk in to, but for obvious reasons.
 
  • Like
Reactions: 1 user
Second @dozitgetchahi, it is hard to show your stuff in 2-4 weeks, especially if you don't have access to their EMR.

Rheumatology is getting very competitive. I'm finishing from a "name brand" institute. I applied after working 4+ years as a PCP. I had strong Rheum LORs because I schmoozed with the Rheum department at my PCP job and got to work on a book chapter and meta-analysis that later became an ACR abstract after I matched. Also did various volunteer stuff for my local and national ACP. I will say the 2 classes that came after me had much more impressive stats and publications, and most were in-house MD-PHD residents. This is your competition for "name-brand" programs. I was the only non-in-house applicant accepted in my year.

Does your current program have affiliated outpatient rheum attending you can work with? If so I say try to secure a 4-week rotation at the "name brand" institute, impress a couple of attendees, make sure they know you are applying, and pray they write you a LOR. 1-2 strong LORs from the name brand will help.

Try to present a poster, research, or thieves market at ACR or even CCR (Clinical Congress of Rheumatology). It's a good experience and a lot of PD are there and may remember you. I went to CCR last year and the current president of EULAR and queen of Lupus were both there. Great place to "schmoozed".

Shoot your shot!
 
  • Like
Reactions: 1 user
sleep is a decent backdoor for PCCM . just saying dark horse pathway.
 
  • Like
Reactions: 1 user
Rheumatologist here.

Not sure it really matters that much. It’s hard to excel on this type of rotation if you’re not affiliated with the institution and don’t know the ropes of how the hospital works, the EMR, etc.

I was a fellow at one of those “name brand” institutions and we had a number of these away rotators come through during my fellowship. The faculty generally said they weren’t all that impressed with these rotators, although I’m not sure that was because of any specific deficiency in them - more that it’s just hard to look good in a 4 week period at an institution you’ve never been to before.

Rheum is more competitive than it used to be, although not extremely so. When I applied I had only done a rheum rotation two months before the app deadline - just then, I decided I liked it. I had no rheum research but I had a couple of good letters. I was a DO, came out of a mid tier academic IM residency and did pretty well as a resident. I went to a very good rheum program in my desired locale. So it worked out.
Thanks for your two cents, update to my situation is that I ended up asking numerous programs at varying degrees of prestige and locations for the opportunity to rotate and I finally got a handful of opportunities out of a lot of rejections. I chose rotations based on the availability of time slots and even had to decline some. Some are 4 weeks and some are 2 weeks, and most are more community although one is academic; it's better than nothing to get my face and name shown and I got what I assume to be a courtesy interview invite already although I was able to meet some of the fellows and program attendings at a conference. I didn't present at the conference but networked and learned a bit more about the specialty and then presented the case I mentioned elsewhere. I have some other interesting cases bubbling, some of which are rheum-centric and some of which aren't; the question is where and how to publish or present them as well as obtaining consent.

Luckily it seems most EMR's are EPIC so it probably won't take too long to get acquainted.

Still waiting for all my letters to upload. Hopefully they can get in by the end of the month.
 
Hello. if you have a good app I think your chances of matching at your desired locale is high. Also if you can get a letter from those high reach places it will boost your app more. However, if you think your app is not strong, I would rotate at the less competitive places since that will expose your face more to those faculties and you will have high chance of getting interviews/ matching there. I would split up your 4 weeks as 2 weeks at high reach place and try to get a letter and 2 weeks at the less known place so they get to know you and you can try to get a letter there as well.
Aside from that, just wondering what made you choose rheumatology over other specialties? I'm a pgy-1 trying to figure out between allergy vs. Rheumatology vs. Endo (was thinking heme onc before but gave up on that cause I'm tired of the rat race of matching a competitive fellowship)
I would say unless you have a lot of opportunities to do electives at your institution, you might have to delve back on what experiences you had in med school in terms of what piques your interest, choose electives based on those, and then figure out what to apply to based on your electives and overall impression of the specialty as well as your own profile. I only got the opportunity during residency to do a couple of electives in addition to 2-4 weeks of some subspecialties and unfortunately will not get the chance to rotate in some other subspecialties before I graduate unless I am lucky or rearrange my schedule.

I actually met someone else who was like me who was interested in pulm crit vs rheumatology (an unusual but not unheard of pairing of interests). The other person told me after their crit care month and rheumatology rotation shortly before that they decided to do rheumatology because of lifestyle and doing something further than general IM. For me, these are seemingly different specialties in terms of practice styles and yet have similarities in being whole body specialties with deep considerations for broad differentials and empiric treatments and some procedure opportunities (of course you have more in pulm/crit than rheum). I was interested in crit first from med school and first year and then became interested in pulm after doing a rotation in it. However, I also remained interested in rheum from med school and saw some interesting immune-mediated cases, so I suspended my decision on which to pursue until late 2nd year since my rheum elective and another crit care rotation was timed late. I felt crit care relegated me to scutwork often, and I was frustrated by the lack of opportunities to participate in procedures even though I was technically more senior than others, whereas people in rheumatology actually seemed to want to attract new candidates. Add to that the competitiveness factor; I saw some people who were gunning solely for either crit care or pulm crit had not matched and had to come up with plan B's. I feel if I wanted pulm crit, I would have to do a gap year to build a more amenable profile. With rheum, it's more of a black box in terms of how people do due to the smaller specialty and is still medium competitive but feels more potentially attainable. I still have to keep in mind a plan B if this cycle ends without a match, but I feel more confident in applying to rheum right now than pulm crit. It's also nice to be a consultant in-patient as opposed to primary in-patient, and out-patient life has its perks of no call, no weekends, no nights. Also, I like zebras and am okay with learning about MSK and connective tissue diseases. I briefly considered nephro and ID too since they are less competitive, but rheum interests me the most out of those three right now and seems to provide the most procedure opportunities.
 
Last edited:
Second @dozitgetchahi, it is hard to show your stuff in 2-4 weeks, especially if you don't have access to their EMR.

Rheumatology is getting very competitive. I'm finishing from a "name brand" institute. I applied after working 4+ years as a PCP. I had strong Rheum LORs because I schmoozed with the Rheum department at my PCP job and got to work on a book chapter and meta-analysis that later became an ACR abstract after I matched. Also did various volunteer stuff for my local and national ACP. I will say the 2 classes that came after me had much more impressive stats and publications, and most were in-house MD-PHD residents. This is your competition for "name-brand" programs. I was the only non-in-house applicant accepted in my year.

Does your current program have affiliated outpatient rheum attending you can work with? If so I say try to secure a 4-week rotation at the "name brand" institute, impress a couple of attendees, make sure they know you are applying, and pray they write you a LOR. 1-2 strong LORs from the name brand will help.

Try to present a poster, research, or thieves market at ACR or even CCR (Clinical Congress of Rheumatology). It's a good experience and a lot of PD are there and may remember you. I went to CCR last year and the current president of EULAR and queen of Lupus were both there. Great place to "schmoozed".

Shoot your shot!
Ah, MD-PhD, good to know... I would be content with matching non-name brand, a.k.a. community, so I applied broadly. It just happens that a lot of the programs in the location I most desire are name brand academic, so I wondered if it would be worth it.

I did work with the out-patient rheum attending and requested a letter; unfortunately it is one of the letters I am waiting for and probably the most important part since you're right that it seems to be who you know moreso than what you know at some programs...

I likely won't have an opportunity to ask for any additional letters for this cycle since it seems a lot of programs are passing out interviews early between now to August and my first away rotation will be in late August. So I am just going to shoot my shot and continue working on getting cases. Thanks for the advice.
 
Top