Should I match according to fellowship competitevness

[tick_bite]

Resident Career Counseling

I am a 4th year medical student about to list my rank order for the match. I have a very important question concerning applying for an internal medicine reidency with intent to apply for a fellowship position in the future.

I would like to attend the same school for both residency and fellowship. I am stuck between ranking schools with great medicine programs vs. schools with great fellowship programs. Most schools with great internal medicine programs have very competitive fellowship spots. Some schools with lower ranked/quality medicine programs have less competetive yet highly ranked fellowship positions. Should I be concerned with fellowship competetiveness at this time? Should I sacrafice a great medicine opportunity for my future goal? Can I afford to miss out on my career goals in place of a good medicine education? (... of course not!)

As it turns out, most great medicine programs with competitive fellowships are in great cities. Less competetive fellowship positions are available in less than perfect cities.

Everybody I ask cannot answer my question. Time is ticking and I need help. Please respond.

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[titan]

What fellowship(s) are you interested in? I plan on doing my residency into internal medicine and then going on to an oncology fellowship. I am interested to see the responses to your inquiry!

titan

 

[tick_bite]

I want to go into GI.

The program I love the most offers 2 GI positions. 1 position is given to a resident at the school while the other is usually granted to students from other programs. (This is somewhat typical for GI fellowships.)

Last year 5 students from the school applied for GI (the 1 garanteed inhouse position). The school recieved over 300 applications for the other position.

At other less competetive medicine programs, they have the same acceptance criterea except only 1 or no students applyed for the GI position at their program.

The secretary gave me the inside scoop at what they look for also. Many students had STEP scores in the 90's. I couuldnt believe that they actually use STEP scores as a determinating factor! What good does knowing OB and Psych do for a GI? Wish I knew that these scores would affect my future before hand.

Anyway... I hope this gives u an idea of how competitive some fellowships can be. I hear that cardiology is just as or even more competetive than GI.

 

[task]

Hands down, go to the better IM program.

GI and Cards are by far the most competitive medicine subspecialties. Their attraction comes from the balance between the cognitive skills that herald a good internist with the desire to do procedures and intervene. It doesn't hurt that procedural fields tend to pay more either :wink:

GI was not like this even 5 years ago. So the story goes, a prominent GI academic wrote in the Red Journal (Journal of the AGA, I think) that there was an oversupply of GI docs, that the demand was far surpassed by supply and that there would be plenty uncmployed GIs. So Medicine people applying to fellowship went toward Cards or Heme-Onc. No on did GI. Programs went completely unfilled and they took IMGs. Now those same programs are sitting pretty, taking their pick. If they're smart they'll keep the # of spots small (275-320) and ensure that they will always attract high caliber folks, like ENT or GU do. What happened? -- the application and scope (no pun intended) of GI endoscopy has expanded exponentially and so has the amount for reimbursement for GI procedures. Combine that with a fairly decent lifestyle for a procedural field, and people come running.

Cards is probably only slightly more competitive for the meantime. Eventually the sheer number of Cards spots (more opening soon) will make GI the most competitive IM subspecialty.

I train at a top 5 IM program. Our folks interview everywhere. This year, I know of one guy who did not match -- 2nd year applying. But from what I understand he either pissed off the wrong people or didn't line ducks up. Not sure. What's more important is that everyone else did match. Probably an anomaly, but hands down your chances of matching into GI will be optimal if you get the right letters from the right people. Going to a mediocre IM program in the hopes of getting a fellowship spot there is a bigger gamble. I grew up with a guy who was top of his med school class, wanted to be a Cardiologist. Went to the Cleveland Clinic for IM in the hopes of staying there for Cards. Didn't work out -- he's at Michigan from what I understand. Not exactly shabby, mind you, but not what he planned.

Go to a top IM program and you will rotate with, get letters from and have the opportunity to do research with the people who are THE PEOPLE in the field. They trained with and play golf with the other PEOPLE in the field, and when it comes letter/phone call time, these guys are ALL pals and will make the right phone call or email at the opportune time. That is what gets you into fellowship.

GI is more susceptible to more out of match filling of spots than Cards, for whatever reason. For that reason, it's all the more important to have the right people knowing you and supporting your candidacy.

Think about it this way. Every year GI keeps getting more and more competitive and more and more people want to do it. Eventually, even the average program where you'll be will attract top candidates to its GI fellowship because all these people want to do GI. Then where are you? Your GI folks at your program will want to enhance the reputation of their program by taking IM residents from top programs, and could leave you in the cold. But, if you go to a top IM program -- you can be competitive/match into any level of program on the map, whereas an avg. IM program will limit the range of GI programs that will consider you.

And something you touched on -- do not underestimate the value of being a good Medicine doc first. That will make you an excellent medicine subspecialist later. Keep that in mind.

If what's important is getting the fellowship you want, go to the best medicine program you can to have the most options at your disposal.

 

[navs]

Hi Task,

That was VERY WELL put!!

Thanks for the advice.

Good luck.

 

[titan]

Thanks task! Excellent post.

titan

 

[tick_bite]

To add a twist on the subject...

What if a lesser ranked IM program could garantee me a GI fellowship at there institution? Although nothing is 100%, one program in particular told me that I am in their GI program as long I dont screw up in the IM program. They were very impressed with my med school research and are looking for more research in their program in the future.

Does it really matter how nice the IM program really is? Many people at many different institutes tell me that wherever you are you WILL learn medicine.

And another...

It is very important that I attend my fellowship in the same city as my IM program. My wife is a third year med student and she will be following me wherever I go.

As you can see my situation is a very sticky one.

Your help is greatly appreciated.