Somewhat disappointed in the match, advice needed

[ChasingMaria]

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Hey everyone,

First off this is not a post meant to troll anyone. Congratulations to all those who matched! I am extremely grateful to have matched as well but I do have some reservations.

IM was not my first choice, I applied to a more competitive field and it was always an uphill battle as I am a foreign grad. I made the "mistake" for lack of a better word of not applying to a wide range of IM programs because it was a backup. Therefore, I didn't apply to some good IM programs that I was competetive for. Instead, I matched at my top choice in medicine in a mid/low tier university based IM program that does not have any of the fellowships I might have been interested in (GI, cards, heme/onc, pulm/CC). Now, I'm stuck with a feeling of confusion. I do not have any idea of what the landscape in IM is like, what the 'good' specialties are and what I'm competitive for. Therefore, my happiness with matching is slightly tainted with lingering questions: Did I choose a good field? Will I have a financially stable life? Will I still be able to get good fellowships even from the residency program I am at? I know there are many routes, in cardiology alone you can specialize three different ways, but I'm so out of touch with what is "popular" and up and coming right now.

Understand that I LIKE internal medicine, I enjoyed it as a med student and the intellectual aspect of it appealed to me that why I ranked it. Again, I'm very grateful because I know many people, even possibly US grads, may not have matched at all this year.

Comments, advice, general feel good pep talks are all welcome.

 

[235009]

I'd say the most up-and-coming thing in IM right now is hospitalist which is a lifestyle-friendly job with decent pay (much better if you're in a less desirable location). That you can easily get into with minimal effort from a low-tier university program.

 

[throw away]

Did I choose a good field? Will I have a financially stable life? Will I still be able to get good fellowships even from the residency program I am at? I know there are many routes, in cardiology alone you can specialize three different ways, but I'm so out of touch with what is "popular" and up and coming right now.

1. IM is the most popular area in the nation to apply for, so judging by popular opinion, it's definitely a good field if you personally enjoy it.

2. You will almost certainly be making at LEAST $150,000/yr with IM, likely closer to $200K. If you specialize, that jumps to almost certainly greater than $200,000. Almost all Americans would consider that financially stable. Obviously it all depends on your lifestyle choices, but you can live very reasonably (house, reliable car, vacations) on that salary.

3. Fellowships depend only partly on your home institution. Every year people get fellowships from community programs. You'll have to be involved in heavy research. You should go to as many conferences as possible in your area of choice to present and to network hard. Right now it is very popular for people to work as a hospitalist for a few years and then apply for a fellowship. This means that if you don't get a fellowship right away, you don't look bad if you try again in a year or two. It also means that the name of your home institution is getting less important, as many applicants are not coming directly from residency.

4. Right now hospital medicine is up-and-coming. There are lots of positions opening. It allows a nice lifestyle where you can spend time with your family or pursue other hobbies on the off weeks, but still make a good living (~200k). Many people like it because they don't enjoy outpatient medicine.

Tldr; it will work out fine.

 

[ChasingMaria]

I know medicine isn't about money but those numbers are much lower than what I expected.

I suppose my biggest fear is that I have no idea what my future is going to be like now (the other speciality I applied to was already specialized). The other thing is that again, i wonder what my chances for things like GI, Cards, and Pulm/CC are from a tiny uni program that isn't heavy on research at all.

 

[The kitchen sink]

I know medicine isn't about money but those numbers are much lower than what I expected.

I suppose my biggest fear is that I have no idea what my future is going to be like now (the other speciality I applied to was already specialized). The other thing is that again, i wonder what my chances for things like GI, Cards, and Pulm/CC are from a tiny uni program that isn't heavy on research at all.

I believe if you work a similar hospitalist gig in the Midwest you can make upwards of 300k with benefits, bonuses, etc but I will also just be starting residency so I'm not totally sure.

 

[ChasingMaria]

From the lack of responses but high view count I take it this means most people have relegated my fate to mediocrity and don't want say anything lol.

 

[throw away]

I believe if you work a similar hospitalist gig in the Midwest you can make upwards of 300k with benefits, bonuses, etc but I will also just be starting residency so I'm not totally sure.

True. Salaries will be much higher at large academic centers and at hospitals or clinics with undesirable locations. I've heard Kaiser pays well for hospitalists, starting around $250k, but I heard this through a grapevine so take it with a grain of salt. Add in benefits, bonuses, etc. as you mentioned and the number climbs.

I am still a student and all this information has come from a few friends of mine that recently graduated from residency and found jobs. Therefore my sample number is small (N=3); perhaps someone has better info?

 

[235009]

True. Salaries will be much higher at large academic centers and at hospitals or clinics with undesirable locations. I've heard Kaiser pays well for hospitalists, starting around $250k, but I heard this through a grapevine so take it with a grain of salt. Add in benefits, bonuses, etc. as you mentioned and the number climbs.

I am still a student and all this information has come from a few friends of mine that recently graduated from residency and found jobs. Therefore my sample number is small (N=3); perhaps someone has better info?

large academic centers typically offer the worst compensation

 

[oncology2020]

Hey everyone,

First off this is not a post meant to troll anyone. Congratulations to all those who matched! I am extremely grateful to have matched as well but I do have some reservations.

IM was not my first choice, I applied to a more competitive field and it was always an uphill battle as I am a foreign grad. I made the "mistake" for lack of a better word of not applying to a wide range of IM programs because it was a backup. Therefore, I didn't apply to some good IM programs that I was competetive for. Instead, I matched at my top choice in medicine in a mid/low tier university based IM program that does not have any of the fellowships I might have been interested in (GI, cards, heme/onc, pulm/CC). Now, I'm stuck with a feeling of confusion. I do not have any idea of what the landscape in IM is like, what the 'good' specialties are and what I'm competitive for. Therefore, my happiness with matching is slightly tainted with lingering questions: Did I choose a good field? Will I have a financially stable life? Will I still be able to get good fellowships even from the residency program I am at? I know there are many routes, in cardiology alone you can specialize three different ways, but I'm so out of touch with what is "popular" and up and coming right now.

Understand that I LIKE internal medicine, I enjoyed it as a med student and the intellectual aspect of it appealed to me that why I ranked it. Again, I'm very grateful because I know many people, even possibly US grads, may not have matched at all this year.

Comments, advice, general feel good pep talks are all welcome.

congrats on matching, you should be really proud of your accomplishment because the reality is that you have in fact over-achieved..as an IMG you're very fortunate to have matched at a mid-tier university based program in IM, most IMGs dont even have that option

 

[chocoginger]

I know medicine isn't about money but those numbers are much lower than what I expected.

I suppose my biggest fear is that I have no idea what my future is going to be like now (the other speciality I applied to was already specialized). The other thing is that again, i wonder what my chances for things like GI, Cards, and Pulm/CC are from a tiny uni program that isn't heavy on research at all.

C'mon...you're disappointed with $150-$200K/year?

I know most medical students have issues with debt, but $150-$200K/year is a pretty comfortable lifestyle. I really don't understand needing to make more than that. American physicians are vastly overpaid, and overpaying specialists for procedures is one of things contributing to the unsustainable growth in health care.

 

[DermViser]

C'mon...you're disappointed with $150-$200K/year?

I know most medical students have issues with debt, but $150-$200K/year is a pretty comfortable lifestyle. I really don't understand needing to make more than that. American physicians are vastly overpaid, and overpaying specialists for procedures is one of things contributing to the unsustainable growth in health care.

Not based on the amount of medical school debt students owe.

 

[maygrl110]

Several comments on your original post:

1.) As an IMG, you are lucky to not have as much med school debt so the 200K salary will actually be earned income and is more than enough to live comfortably. For us, 200K loans 6% interest doesn't make that salary go as far!
2.) At a university based program, I'm sure you can find some amt of research to help you get into fellowship if you are persistent.
3.) As someone that switched into IM from another specialty, I can tell you that loving what you do is incredibly important. You are lucky to have matched into a field you actually like. Trust me, getting into another field for just the money can be miserable if you find no interest in that specialty.
Don't be disappointed-sounds like you will be happy with your match. You still have opportunities at specializing or hospitalist work. There are even people from community programs who get fellowships, so I don't think your chances are shot.

 

[mercaptovizadeh]

The OP is an IMG and thus likely doesn't have much med school debt. So his rants about $200K fall flat.

Love the whole "I want to do cards/GI/heme-onc/pulm-CCM" - specialties that have nothing to do with each other - other than the fact that they bill a lot more than their ID/rheum/nephro/endo counterparts.

 

[rokshana]

well if they are from a caribbean school or ireland, then their loans are in the 300k range.

 

[ChasingMaria]

I didn't make a rant about 200k, that was someone else. As for the school, I am still in debt. Carbbean schools are just as costly as US ones.

Finally to the guy looking down on me for wanting to go into a field that make money....I'm sorry but medicine isn't JUST about 'helping others' its also about making money. If you need proof of that, tell all doctors that the income limit will be set at 150k across the board and see how many doctors are left, so don't give me that holier than thou attitude. If you love medicine enough to do it for little or no pay then good for you but do not put that burden on me.

 

[chocoginger]

I didn't make a rant about 200k, that was someone else. As for the school, I am still in debt. Carbbean schools are just as costly as US ones.

Finally to the guy looking down on me for wanting to go into a field that make money....I'm sorry but medicine isn't JUST about 'helping others' its also about making money. If you need proof of that, tell all doctors that the income limit will be set at 150k across the board and see how many doctors are left, so don't give me that holier than thou attitude. If you love medicine enough to do it for little or no pay then good for you but do not put that burden on me.

It's not like you would put that in a personal statement though. You would talk about how passionate you are about cards/GI/heme-onc/pulm-CCM.

 

[rokshana]

I didn't make a rant about 200k, that was someone else. As for the school, I am still in debt. Carbbean schools are just as costly as US ones.

Finally to the guy looking down on me for wanting to go into a field that make money....I'm sorry but medicine isn't JUST about 'helping others' its also about making money. If you need proof of that, tell all doctors that the income limit will be set at 150k across the board and see how many doctors are left, so don't give me that holier than thou attitude. If you love medicine enough to do it for little or no pay then good for you but do not put that burden on me.

well yes and no…you really need to do something that you have a true interest and get enjoyment from….medicine can grind you down…you don't at least like what you're doing, you won't do it for long…

the medicine subspecialties that you named are very different…just because they make money isn't a reason to go into them….and you never know when things can shift and change…a specialty that makes money now may not necessarily do so for the length of your career (just ask the nephrologist out there) and then you are stuck doing something you don't like.

and as an IMG coming from the caribbean your ability to get those competitive subspecialty spots is not that high…you need to be at terms that you may not get into one and remain in IM.

 

[visari]

It's kind of puzzling to me that a "mid/low tier university based IM program that does not have any of the fellowships I might have been interested in (GI, cards, heme/onc, pulm/CC)".
Dude! a program that doesn't have any of those fellowships is definitely not a mid-tier place and hardly a low-tier one.

Anyway, I agree that you can't be passionate about cards, GI, hem/onc and pulm/cc all together. If that's the case, it's making money that you're passionate about which is fine in my opinion. As long as you realize that making enough money is your #1 priority, there's not much problem there because you realize that if you go for GI for the money and in 10-15 years it becomes today's nephrology for some reason you will have to live with your decision without jumping off a bridge.

I think what bothers most people is not how much money they make, it's actually finding the job. If you ask enough people you'll see that most of them are OK with making 180-220K as specialists after paying off their loans (except for the real money seekers) as long as they're able to find a decent job in an acceptable location. Graduating nephrologists are not able to find a job except for those low-paying spots in the middle of nowhere. Now that is scary!

 

[ChasingMaria]

There's no doubt that it makes a lot more sense to choose something I like than just go after money. I'm not arguing that point. Just a little amazed at the reaction I got for listing off a few specialties that all happen to make money. Yes I eliminated endo, nephro, rheum etc because they are not going to make me happy financially long term. Of the remaining specialties I'm going to work towards one that interests me most...without worrying about the financial side of it.

Obviously none of that goes into a personal statement but really no one is fooling anyone with those personal statements, its all a facade. We are here to do something we love to do while also making money off of it and there is nothing wrong with that and I am not any less noble than the ID specialist who spent 3 years extra doing a fellowship only to wind up making less as a specialist than he would have as an internist.

 

[rokshana]

There's no doubt that it makes a lot more sense to choose something I like than just go after money. I'm not arguing that point. Just a little amazed at the reaction I got for listing off a few specialties that all happen to make money. Yes I eliminated endo, nephro, rheum etc because they are not going to make me happy financially long term. Of the remaining specialties I'm going to work towards one that interests me most...without worrying about the financial side of it.

Obviously none of that goes into a personal statement but really no one is fooling anyone with those personal statements, its all a facade. We are here to do something we love to do while also making money off of it and there is nothing wrong with that and I am not any less noble than the ID specialist who spent 3 years extra doing a fellowship only to wind up making less as a specialist than he would have as an internist.

haha…i love that you eliminate endo, rheum (esp rheum), and nephro because of money….funny cuz i've been getting offers for endo for 250K as a base…now of course they are in the middle of nowhere (or an hour from sunny somewhere!) but 200k is not an unreachable goal…and heck! as a hospitalist 250K is pretty easily had even in a decent location. Sure GI will (at the moment anyway) easily make twice that, but really? you can't live and provide for your family on 250?

its the fact that you listed disparate specialties which it would be unusual for someone to have a such a strong interest in each one of them enough to do enough research and make connections in all of those.

and many people are distinct feelings toward those fields…of course that comes with exposure to them as an intern, so your tune may change after your intern year….for me personally you couldn't pay me enough money to do cardiology, but liked the medicine of CC but hated procedures

and as for the PS…don't be to quick to think thats all a facade, esp at the fellowship level…PDs and faculty who remain in academia (esp for those high paying subspecialties) are PASSIONATE about their field…and they have been reading applications forever…they can sniff out the poseur like a pig sniffs out a truffle!

 

[ChasingMaria]

Fair enough Rok. But how do you justify an Endo getting 250k base offer in middle of nowhere where the hospitalist at the same hospital would make at least 300k+ and with 3 years less training....Its not a knock against the field (although endo doesn't interest me personally) its a knock on the system I guess.

 

[chocoginger]

as for the PS…don't be to quick to think thats all a facade, esp at the fellowship level…PDs and faculty who remain in academia (esp for those high paying subspecialties) are PASSIONATE about their field…and they have been reading applications forever…they can sniff out the poseur like a pig sniffs out a truffle!

Agree with this---I'm sure the PD for other "lifestyle specialties" are the same, like dermatology. Med students are attracted to it because it's a well compensated field, but the program directors of the residencies are actually passionate about what they do...and they want like-minded people in their program.

 

[rokshana]

Fair enough Rok. But how do you justify an Endo getting 250k base offer in middle of nowhere where the hospitalist at the same hospital would make at least 300k+ and with 3 years less training....Its not a knock against the field (although endo doesn't interest me personally) its a knock on the system I guess.

supply and demand…right now hospitals are switching to having hospitalist groups managing inpt instead of their PCP admitting their own pts…and right now there are few career hospitalists…many are doing it as a temporary thing (between residency and fellowship, before settling down, etc) and the need is increasing….as IM residents start to look at hospital medicine as a career, they may actually command less…but that may take awhile.

Endo is actually on the upswing..there just aren't that many clinical endocrinologists, many go into research, and as the population is aging the demand is increasing….i had a job offer from the endocrinologist in my hometown even before i got a fellowship because he wants to retire in 10-15 years from now and he is the ONLY endocrinologist in your city (of 100, 000+ population so its not in BFE)…and you hear from pts everywhere how difficult it is to get an appt with an endocrinologist…easily booking 2-6 months out…so with demand up and supply low and really not a huge fear for reimbursements coming hugely down since its not procedure based…the money is there to be had…its not GI or Hem/Onc money, but i'm good with 200-250…

and you're right, I could have easily continued as a hospitalist (and as one for 2 years, heck I'm an experienced hospitalist), but the idea of doing gen IM for the rest of my life….I'd rather stick a hot poker in my eye...

 

[mercaptovizadeh]

and you're right, I could have easily continued as a hospitalist (and as one for 2 years, heck I'm an experienced hospitalist), but the idea of doing gen IM for the rest of my life….I'd rather stick a hot poker in my eye...

Why is gen IM so horrible? Just wondering, not arguing. I would think you could do all diagnostic stuff that any IM-based subspecialty does, just not special meds (chemo, antiarrhythmics) or procedures (caths, scopes, etc.). I can't see why a general internist wouldn't be qualified to do a renal or thyroid biopsy, to order a dexamethasone suppression test or amp/gent for enterococcal endocarditis.

 

[mercaptovizadeh]

I didn't make a rant about 200k, that was someone else. As for the school, I am still in debt. Carbbean schools are just as costly as US ones.

Finally to the guy looking down on me for wanting to go into a field that make money....I'm sorry but medicine isn't JUST about 'helping others' its also about making money. If you need proof of that, tell all doctors that the income limit will be set at 150k across the board and see how many doctors are left, so don't give me that holier than thou attitude. If you love medicine enough to do it for little or no pay then good for you but do not put that burden on me.

It's not holier than thou. It's just that you're transparently obsessed with the financial aspect of things. You obviously applied to IM as a backup and the real thing you wanted was derm or rad-onc (which have SO much in common, am I right?) or something in that vein, and now you want cards or GI or CCM or H/O. Cards is about caths and perfusion imaging and stress tests and EKGs (and BP management, and CHF, etc.), all focused on one organ, the heart. GI couldn't be more different. Scopes and ERCPs and biopsies on a whole plethora of abdominal organs from stomach and colon to pancreas and liver. CCM is all the systems at once, the only connection between them being the critical nature of the illness, with most procedures centered on bronchs, lines, taps, etc. H/O has BMT but is minimally procedural and is focused on diagnosis, chemo, and coordination with rad onc and surg onc.

Personally, I would argue that pulm alone is closer to cards/GI in mentality of the specialty with focuses on particular macro-scale organs/organ systems and diagnostic and therapeutic procedures, while CCM (if we can disentangle the pulm/bronch aspect) and heme-onc are much closer in mentality to the more multi-organ system, micro/molecular-scale specialties of ID, endocrine, rheum, allergy-immuno, and renal. These latter specialties are paid much less so than heme-onc only because chemo is practically treated as a procedure rather than as a medication as an antibiotic or a hormone would be. That could easily change and heme-onc salaries would crash. Here's news also: GI could suddenly see screening colonoscopies performed by CRNPs or PAs (with GI on hand in case something weird shows up, much like anesthesia runs a bunch of CRNAs). Is your life suddenly going to go haywire if GI is suddenly paid $250K instead of the $500K you obviously expect?

So what is the connection - in your mind - between these specialties? Because you're going to have to pick one of them and tailor your application to it. Especially as an IMG. Doing clinical research on cardiac perfusion studies while studying IBD in mice in the lab and stacking your elective schedule with a bunch of oncology rotations isn't going to cut it.

 

[rokshana]

Why is gen IM so horrible? Just wondering, not arguing. I would think you could do all diagnostic stuff that any IM-based subspecialty does, just not special meds (chemo, antiarrhythmics) or procedures (caths, scopes, etc.). I can't see why a general internist wouldn't be qualified to do a renal or thyroid biopsy, to order a dexamethasone suppression test or amp/gent for enterococcal endocarditis.

it was more me that it is the field in general…but inpt…the social work maze is a nightmare (a good social worker/case manager is worth his or hers weight in gold) and the CP r/o MI (after cocaine, or some other drug), the IV drug user admitted for the gazillionth time for skin abscesses, the dump after dump from other services (admit to medicine because they are 70 yo and we will consult) drove me crazy…on the output side…the need to see 50 pts a day and able to manage to discuss their 6 co-morbidities, review their 35 medications AND make sure you cover all the health maintenance issues in the 10 minutes you have allocated for them….some people have no issues…the CP r/o, the IV drug user…easy peasy done in 20 minutes…but they bugged me.

and trust me NO ONE is gonna let a PCP do a renal biopsy…its not as simple as just shooting a needle into a kidney…same goes with a thyroid…its not as easy as you may think…and i seriously doubt insurance will reimburse an IM doc doing such procedures.

 

[ChasingMaria]

It's not holier than thou. It's just that you're transparently obsessed with the financial aspect of things. You obviously applied to IM as a backup and the real thing you wanted was derm or rad-onc (which have SO much in common, am I right?) or something in that vein, and now you want cards or GI or CCM or H/O. Cards is about caths and perfusion imaging and stress tests and EKGs (and BP management, and CHF, etc.), all focused on one organ, the heart. GI couldn't be more different. Scopes and ERCPs and biopsies on a whole plethora of abdominal organs from stomach and colon to pancreas and liver. CCM is all the systems at once, the only connection between them being the critical nature of the illness, with most procedures centered on bronchs, lines, taps, etc. H/O has BMT but is minimally procedural and is focused on diagnosis, chemo, and coordination with rad onc and surg onc.

Personally, I would argue that pulm alone is closer to cards/GI in mentality of the specialty with focuses on particular macro-scale organs/organ systems and diagnostic and therapeutic procedures, while CCM (if we can disentangle the pulm/bronch aspect) and heme-onc are much closer in mentality to the more multi-organ system, micro/molecular-scale specialties of ID, endocrine, rheum, allergy-immuno, and renal. These latter specialties are paid much less so than heme-onc only because chemo is practically treated as a procedure rather than as a medication as an antibiotic or a hormone would be. That could easily change and heme-onc salaries would crash. Here's news also: GI could suddenly see screening colonoscopies performed by CRNPs or PAs (with GI on hand in case something weird shows up, much like anesthesia runs a bunch of CRNAs). Is your life suddenly going to go haywire if GI is suddenly paid $250K instead of the $500K you obviously expect?

So what is the connection - in your mind - between these specialties? Because you're going to have to pick one of them and tailor your application to it. Especially as an IMG. Doing clinical research on cardiac perfusion studies while studying IBD in mice in the lab and stacking your elective schedule with a bunch of oncology rotations isn't going to cut it.

I think you're missing my point. IM is my backup but believe me it was a well chosen backup. I enjoy medicine. That being said I am VERY open to different options in terms of branching out hence my very wide range of potential fellowship interests. At this point in my life, having not done any of those rotations as a resident the only differentiating factor is money and I have eliminated the bottom half. The next stage is to go for the one I enjoy the most be it heme/onc, PCCM, or cards. It's really beyond me that you would even begin to criticize someone who uses the word "or" when discussing options. Yeah man, I like my options or or or or or or all the way why limit myself right now if there isn't something I'm truely passionate about yet. I just want to know how many of the current GI fellows were TRUELY passionate about GI.....let's be real about this, most of them are brilliant people who didn't have nearly as much fun as I did in college, got to a good MD school and rocked it, killed the boards and now get to pick which specialty they want probably applied for derm or rad onc and didn't get it, went to IM at a top 25 residency and then chose GI. If you don't think thats true most of the time then you're living in a dream world. The majority of the people in GI who got into the field in the last 10 years did it with a HUGE financial incentive weighing in their mind. If you wish to debate this, lets discuss why cards is no longer as competitive as it was 5 years ago.

Don't make me out to be some money loving monkey. But you better be sure I'm going to chose a specialty that satisfies me both intellectually AND financially. I won't make a career decision based solely on passion, ie no matter how much I think Family medicine is awesome and intellectual there was no chance in hell I was going to agree to going into that and I made that decision with $$ in mind and quite frankly I don't think anyone should think less of me for it.

 

[rokshana]

guess you haven't met many fellows….in any subspecialty…most people who go into a IM subspecialty actually have a love for their chosen specialty…remember, people who go into an IM subspecialty are spending an extra 3-5 years beyond residency to do this…you really think the guy who is ultimately competitive wasn't competitive for radiology? or orthopedics? or some other high paying specialty that who take less time?

sure there are those who enter the specialty because of their interests, they pick the higher paying one…say love procedures? well then going towards GI or CCM seems to be a good fit…

and what happens if you fall in love with, say, ID? or Rheum? you're going to have some exposure to them in your residency….what then?

and realize that if you aim for the more competitive fellowships, you may not get them (just being an caribbean IMG sorely limits you for those spots).

 

[padastra]

let's be real about this, most of them are brilliant people who didn't have nearly as much fun as I did in college, got to a good MD school and rocked it, killed the boards and now get to pick which specialty they want probably applied for derm or rad onc and didn't get it, went to IM at a top 25 residency and then chose GI.

In my medical school class about 8 or 9 of us went into a consensus top 15 IM residency. I knew all of them and none had IM as a "backup". People who get into these residencies are also generally competitive for e.g. derm, ENT, opthamology, etc. (although perhaps not at the same "level" program) and the select few who get into MGH/UCSF/BWH/etc. would likely have been very competitive for any residency at any school.

I understand you have no experience in this given your colleagues, and I don't care if money drives your decisions (as long as it doesn't drive your medical decision making), but please do not make unsupported generalizations about the people who are going to IM at a top residency program. Never underestimate the tendency of true nerds to pursue their interests at the detriment of other things (e.g. academic salaries are often much lower than community hospital salaries).

 

[amine2086]

I think you're missing my point. IM is my backup but believe me it was a well chosen backup. I enjoy medicine. That being said I am VERY open to different options in terms of branching out hence my very wide range of potential fellowship interests. At this point in my life, having not done any of those rotations as a resident the only differentiating factor is money and I have eliminated the bottom half. The next stage is to go for the one I enjoy the most be it heme/onc, PCCM, or cards. It's really beyond me that you would even begin to criticize someone who uses the word "or" when discussing options. Yeah man, I like my options or or or or or or all the way why limit myself right now if there isn't something I'm truely passionate about yet. I just want to know how many of the current GI fellows were TRUELY passionate about GI.....let's be real about this, most of them are brilliant people who didn't have nearly as much fun as I did in college, got to a good MD school and rocked it, killed the boards and now get to pick which specialty they want probably applied for derm or rad onc and didn't get it, went to IM at a top 25 residency and then chose GI.

You are going to be miserable $hit regardless of what specialty you go into. Where did you find out people that match into top 25 IM programs match there because they failed to match derm/rad onc etc ? Some of us actually love IM and you could not pay me enough to do any of those specialties.

 

[ChasingMaria]

I apologize. I see now that my wording was terrible. The people who got into a top 25 IM residency probably wanted that more than anything else. I completely agree. I was trying to hammer in the point that money IS a driving factor for many people who go into the lucrative fields and therefore getting criticized for openly admitting my desire to be in one of those fields is a little much. Regardless my point is the same, there shouldn't be any lashing out for people who want GI or Derm or Rad-onc primarily because it makes money and secondarily because it interests them. If you are one of those people that i primarily interested in your field and then its financial reward then GREAT FOR YOU!

And finally, to answer the "What if you fall in love with ID?" Well my friend if I wind up liking my field so much that money stops mattering well then I've hit the jackpot. I just think that ship has sailed (the specialty i applied to originally was not a money making specialty).

Guy above me, I enjoy life too much to be miserable at any point in time, so grow up.

 

[amine2086]

Guy above me, I enjoy life too much to be miserable at any point in time, so grow up.

It seems like you are already very miserable and havens forgive if you don't get into one of those "money making" sub-specialties, you are probably going to start questioning your existence (if you already are not). You have to start realizing that there is more to life than money. Unlike you, many of us went into medicine because we actually like taking care of people, it offers us intellectual challenge and it also is not a bad way to make a living (offers career stability, flexibility in practice locations, etc). Also, unlike you, many of us actually meant what we said in our personal statements. You have to realize some of us switched into medicine from other successful careers (where we were making a lot more money than we will ever make in medicine) because medicine is a lot more than a career for your us. It's a passion and is a way of life.

So, if there is anyone that has growing up to do, it's you. Try to find out what you like rather than what will make you the most money. The fact that you had to settle for a caribbean school may not be because of your lack of intelligence but rather because of your poor insight about medicine and your lack of dedication to the field.

 

[rokshana]

The fact that you had to settle for a caribbean school may not be because of your lack of intelligence but rather because of your poor insight about medicine and your lack of dedication to the field.

i'll have to beg to differ here…there very well may have some poor judgement and/or insight at the UG level (raising hand here!), deciding later in life to go to med school, or other reasons which make the only option to become a doctor going to off shore ;however, lack of dedication is not something that you see from the person who decides to leave behind friends and family and incur a great deal of debt for the (increasingly difficult) chance to practice as a doctor.

and while i don't agree with the OP about the reasoning for entering a specialty, she is not that far off about many people gong into medicine for the money (i still feel they will be miserable if they chose a specialty only for the money) after all only 2% of US seniors go into PC…mostly because it doesn't pay well.

 

[ChasingMaria]

It seems like you are already very miserable

The title of this thread is "I am somewhat dissappointed" not "I am miserable" so I don't know where you got this from but okay.

The fact that you had to settle for a caribbean school may not be because of your lack of intelligence but rather because of your poor insight about medicine and your lack of dedication to the field.

This shows me how little you know of carribbean schools. The attrition rate at my school was close to 60%. Yes over half of my class never made it to the end. Believe me, no one is more dedicated than a foreign grad who jumped through countless hoops set by his/her own school only then to have to jump the hoops in the states to land a residency. No one at an off shore school gets their hand held if they fail or do poorly on an exam the way an american grad does.

So you are sorely wrong about my dedication. Bad judgment? Sure..I really couldn't be trusted with anything serious from 18-21 but I sure did make up for it afterwards.

 

[ladoctor]

Hey everyone,

First off this is not a post meant to troll anyone. Congratulations to all those who matched! I am extremely grateful to have matched as well but I do have some reservations.

IM was not my first choice, I applied to a more competitive field and it was always an uphill battle as I am a foreign grad. I made the "mistake" for lack of a better word of not applying to a wide range of IM programs because it was a backup. Therefore, I didn't apply to some good IM programs that I was competetive for. Instead, I matched at my top choice in medicine in a mid/low tier university based IM program that does not have any of the fellowships I might have been interested in (GI, cards, heme/onc, pulm/CC). Now, I'm stuck with a feeling of confusion. I do not have any idea of what the landscape in IM is like, what the 'good' specialties are and what I'm competitive for. Therefore, my happiness with matching is slightly tainted with lingering questions: Did I choose a good field? Will I have a financially stable life? Will I still be able to get good fellowships even from the residency program I am at? I know there are many routes, in cardiology alone you can specialize three different ways, but I'm so out of touch with what is "popular" and up and coming right now.

Understand that I LIKE internal medicine, I enjoyed it as a med student and the intellectual aspect of it appealed to me that why I ranked it. Again, I'm very grateful because I know many people, even possibly US grads, may not have matched at all this year.

Comments, advice, general feel good pep talks are all welcome.

Here's the truth. To match into a cards, GI or heme/onc fellowship as a foreign grad from a medicine program without any fellowships (I don't know what a 'university based' IM program is but it sounds like a community program with a loose univ. affiliation) you will need 1-2 years of research or some sort of other fellowship (for example an echo fellowship for cards, etc.) to get in. Not going to happen without some extra time

 

[rokshana]

Here's the truth. To match into a cards, GI or heme/onc fellowship as a foreign grad from a medicine program without any fellowships (I don't know what a 'university based' IM program is but it sounds like a community program with a loose univ. affiliation) you will need 1-2 years of research or some sort of other fellowship (for example an echo fellowship for cards, etc.) to get in. Not going to happen without some extra time

in FREIDA, usually university based means its an academic program…community program, university affiliated usually is the community program with a loose affiliation.