What are the "competitive" residencies?

[Saleemrodman1]

Can do heme/one fellowship after IM residency. Not sure about fellowship competitiveness.

Is a fellowship sort of like an extended residency? Is a fellowship a residency 2.0? Do you get paid like in a residency?

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[SpartanWolverine]

Is a fellowship sort of like an extended residency? Is a fellowship a residency 2.0? Do you get paid like in a residency?

Fellowship is essentially a specialization within a field that takes somewhere between 1-3 years after residency training. So yes, you could say it's like an extended residency. You are paid on a continuum with residents based on your number of years in graduate medical education. For example radiology will take me from pgy1 to pgy5 and then a fellowship would take me to pgy6 or pgy7.

Example pay scale: Office of Graduate Medical Education - Stipends - Vanderbilt Health Nashville, TN

 

[rg2o3]

Is a fellowship sort of like an extended residency? Is a fellowship a residency 2.0? Do you get paid like in a residency?

Fellowship is additional graduate medical education in a more specific specialty. Yes, you’re still a PGY-X. I’m sure some students or residents would have more detailed explanation than I.

 

[AnatomyGrey12]

What about Hematology? I know that it's a subspecialty of Oncology, but how does Hematology rank when it comes to competitiveness?

Google “NRMP fellowship outcomes 2018”

Fellowship is further subspecializaton beyond residency. Different fields have different fellowships. A few IM fellowships are the ones you most commonly hear about: cardiology, GI, heme/onc, pulm/cc and others.

 

[gensurghopeful]

Any sort of surgical fellowships after IM residency? Assuming no.

Also, why does median salary of an endocrinologist make less than an IM doc, when the endocrinologist had to do a fellowship and is a more specialized field? Isn't an endocrinologist first an IM doc and then becomes an endocrinologist, thus higher earning potential?

 

[gensurghopeful]

EM is my dream. I have a slight little interest in Anesthesia. I could live with IM but FM/Peds would be a huge life let down for me...

Best do well on your boards then bruv
I find it funny... "a huge life let down" haha come on

 

[AnatomyGrey12]

Any sort of surgical fellowships after IM residency? Assuming no.

Also, why does median salary of an endocrinologist make less than an IM doc, when the endocrinologist had to do a fellowship and is a more specialized field? Isn't an endocrinologist first an IM doc and then becomes an endocrinologist, thus higher earning potential?

Because pay isn’t based on specialization, you’re paid by how needed you are. The same drop in pay occurs for most peds fellowships, and other IM ones like nephro, rheum, etc.

No there aren’t any surgical fellowships post IM, however there are procedural fellowships such as GI, and interventional cards (super fellowship at a cardiology fellowship). Naturally these are very competitive.

 

[Blanky]

Best do well on your boards then bruv
I find it funny... "a huge life let down" haha come on

Lots of people are not interested in FM, bruv.
I find it funny that you had to come start a silly internet scuffle.

 

[Blanky]

I have huge respect for FM, it just isn’t for me.

 

[Blanky]

Best do well on your boards then bruv
I find it funny... "a huge life let down" haha come on

Apologies for the sarcasm... lack of sleep with the newborn

 

[gensurghopeful]

Apologies for the sarcasm... lack of sleep with the newborn

No worries - good luck in school!

 

[gensurghopeful]

Because pay isn’t based on specialization, you’re paid by how needed you are. The same drop in pay occurs for most peds fellowships, and other IM ones like nephro, rheum, etc.

No there aren’t any surgical fellowships post IM, however there are procedural fellowships such as GI, and interventional cards (super fellowship at a cardiology fellowship). Naturally these are very competitive.

So if you land an IM residency, complete that in 3 years, what determines what subspecialities you can do (gastro, endo, heme/onc, etc)?

 

[AnatomyGrey12]

So if you land an IM residency, complete that in 3 years, what determines what subspecialities you can do (gastro, endo, heme/onc, etc)?

IM fellowships are all about making connections, research, LORs, and prestige of your residency.

 

[ccrose]

This may seem ignorant but I've often seen Neurology included within IM, and sometimes it's not. Could anyone clarify this

 

[DrMcCoyDO]

This may seem ignorant but I've often seen Neurology included within IM, and sometimes it's not. Could anyone clarify this

Neurology has its own separate residencies that don’t involve the IM pathway, but from a clinical standpoint, it’s treated like an IM sub-specialty in the hospital.

 

[LukaDoncicLuk]

Sorry if this is a stupid question but what is going to happen to the AOA Derm/Ortho/ENT residencies after the merger? Will PD still preference DOs? Will MDs from good schools eat up all of these spots?

 

[SpartanWolverine]

Sorry if this is a stupid question but what is going to happen to the AOA Derm/Ortho/ENT residencies after the merger? Will PD still preference DOs? Will MDs from good schools eat up all of these spots?

In general a DO PD will still give preference, or at least level ground, to DOs. Some spots will inevitably go to well-qualified MD applicants, of course. A difficult question to generalize, though.

 

[AlbinoHawk DO]

To answer the fellowship questions:

1. Fellowship is basically Residency 2.0 in a subspecialty of the field you want to go to.
2. Yes, you get paid more in fellowship, but it's not because you are a fellow. You get paid more because now you're a PGY-4 (in the case of IM subspecialties)
3. What matters to get into fellowship is the quality of your residency. It is nothing to do with your degree.

 

[Garurumon]

What about pediatric surgery? I'm aware that you do residency in general surgery, then additional training in pediatric surgery, so I'm just wondering if that's a surgical subspecialty considered out of reach for DO.

 

[AlbinoHawk DO]

What about pediatric surgery? I'm aware that you do residency in general surgery, then additional training in pediatric surgery, so I'm just wondering if that's a surgical subspecialty considered out of reach for DO.

There is no such thing as surgical subspecialties that are out of reach. Again, fellowships are a combination of where you did your residency and your performance in said residency.

 

[Garurumon]

There is no such thing as surgical subspecialties that are out of reach. Again, fellowships are a combination of where you did your residency and your performance in said residency.

Gotcha, thanks for the clarification. Fellowship's too far down the line from where I'm at now, but I couldn't help wondering.

 

[AnatomyGrey12]

What about pediatric surgery? I'm aware that you do residency in general surgery, then additional training in pediatric surgery, so I'm just wondering if that's a surgical subspecialty considered out of reach for DO.

Depends. A peds fellowship post ENT, Ortho, etc. isn't hard, the hard part is getting the residency. A peds fellowship post GS is likely more out of reach for a DO student than almost any other field. You have to have research and connections. Bare minimum you need at least a mid-tier academic GS residency that is 7 years in length and has 2 enfolded research years, and even better if that program has an in house fellowship for connection building. Basically the kind of program few DOs get into. It's been a good minute (read: multiple years) since a DO has landed a peds surgery fellowship.

 

[WedgeDawg]

What about pediatric surgery? I'm aware that you do residency in general surgery, then additional training in pediatric surgery, so I'm just wondering if that's a surgical subspecialty considered out of reach for DO.

Pediatric surgery is the most difficult fellowship to get out of general surgery. Successful applicants into peds surgery usually come from top or at least strong academic general surgery residencies and will often do 1-2 years of research before applying. The match rate into this fellowship even so is about 60%. The barrier to entry here would be that most of these gen surg residencies are likely the same ones that would not be taking DOs, thus it would be hard to be a competitive peds surgery applicant. I would not count on peds surgery as a viable career option coming from a DO schools.

 

[WedgeDawg]

I greatly agree with this. Every med student should enter med school being okay with ending up in primary care, most do, MD or DO.

Most people think they’re the exception and won’t end up in primary care.

I don't think this is necessarily true. Most medical students have every specialty available to them outside of derm and the surgical subspecialties. If you don't want to do primary care and you're a below average student, you still have the following options easily accessible:

1. neurology (you're a specialist, can become a subspecialist including an interventionalist, intensivist, oncologist, whatever)
2. non-primary care internal medicine (hospitalist, rheumatologist, nephrologist, infectious disease, intensivist, endocrinologist)
3. anesthesia (easy to match, not at all primary care, can be an intensivist, pain specialist, or mostly do OR work)
4. radiology
5. pathology
6. PM&R
7. OBGYN (can be primary care, but doesn't have to be)
8. Emergency medicine
9. pediatrics (see internal medicine)
10. psychiatry (though this may no longer be the case in a few years, who knows)

Thats a TON of options even if you're in the bottom quartile of your class, MD or DO. 95% of students will not be forced into primary care if that's not what they want to do.

 

[Angus Avagadro]

Look at NRMP website and see match rates for 4th yr D.O. students. Only 5 out of 18 specialties have lower than 60 % match rates, most in high 80 's and 90's. It's all about what kind of applicant you make yourself.

 

[adrenocorticotropicana]

What about transgender medicine (management of HRT) and reassignment surgery? (Urology I think would be a relevant field here.) Would being a trans candidate like make any difference?

 

[Goro]

What about transgender medicine (management of HRT) and reassignment surgery? (Urology I think would be a relevant field here.) Would being a trans candidate like make any difference?

No

 

[MotherofDragonflies]

I’m not really set on MD or DO...a doctor is a doctor in my book. It’s what you put into it that will take you the farthest.

I’m older and doing a “reinvention” as many call it. I’m most interested in pathology, neurology and infectious/parasitic disease). I’m an entomologist and the latter is a sort of extension of that. But forensic path is my goal.

This thread has been quite enlightening and polite. Always wonderful.

 

[ChiDO]

Just remember that many of the most competitive specialities have AOA spots. It's true, going in MD ortho as a DO is very rare. But there are 100ish DO ortho spots per year... So you go to those programs.

 

[Mad Jack]

Plastic Surgery
ENT
Vascular
Optho
Interventional Radiology (sort of)
Ortho
CT
Neurosurgery
Urology

Pretty much everything, except for General Surgery, although fellowships may be attainable for DOs after General Surgery to get into some of these fields specifically.

DOs match surprisingly well in ortho and ophtho, but like, definitely not something to hang your hat on. Just not impossible. Probably like, 20% chance at best

 

[Mad Jack]

Just remember that many of the most competitive specialities have AOA spots. It's true, going in MD ortho as a DO is very rare. But there are 100ish DO ortho spots per year... So you go to those programs.

All AOA ortho programs have transitioned to ACGME in some capacity or closed due to the merger. By 2020, all MUST be ACGME

 

[mariposas905]

DOs match surprisingly well in ortho and ophtho, but like, definitely not something to hang your hat on. Just not impossible. Probably like, 20% chance at best

Does this depend on what school you do to?

 

[ChiDO]

All AOA ortho programs have transitioned to ACGME in some capacity or closed due to the merger. By 2020, all MUST be ACGME

Yes, my program was ACGME approved a couple years ago already, yet we still only took DOs, and I'd assume going forward most of the DO programs will take DOs still,but obviously it will be more competitive with influx of MD candidates..

However, DO programs predominantly are looking for a fit, rather then crazy board scores and research.

 

[ChiDO]

Does this depend on what school you do to?

I

No. Matchlists are individually based. Looking at them has no meaning or usefulness for future students. See my signature for more information

 

[Mad Jack]

Yes, my program was ACGME approved a couple years ago already, yet we still only took DOs, and I'd assume going forward most of the DO programs will take DOs still,but obviously it will be more competitive with influx of MD candidates..

However, DO programs predominantly are looking for a fit, rather then crazy board scores and research.

There's a big program on Michigan that only took MDs. Every slot lost represents diminished ability for DOs to match, and slots will be lost to MDs. Couple that with increasing DO graduate numbers and the ortho match numbers are looking increasingly grim

 

[AnatomyGrey12]

There's a big program on Michigan that only took MDs. Every slot lost represents diminished ability for DOs to match, and slots will be lost to MDs. Couple that with increasing DO graduate numbers and the ortho match numbers are looking increasingly grim

You’re forgetting that statistic is confounded by the fact that the program would have had to convince DOs to forego the AOA match to match there... only something like 8 DO did that, and 4 matched ACGME programs.

The NRMP statistics show a bunch of people with only one rank in ACGME and according to an ortho resident that number is from Nassau’s program having one spot on each match, and the people who interviewed there who didn’t match AOA all still could have that one rank in the ACGME match because they had interviewed there. So if you take them out of the number of ACGME Ortho applicants then there were truly only 8 DOs that truly tried to match in the ACGME match.

The point is that we still won’t be able to know what’s going to happen until everything is fully merged.

 

[Mad Jack]

You’re forgetting that statistic is confounded by the fact that the program would have had to convince DOs to forego the AOA match to match there... only something like 8 DO did that, and 4 matched ACGME programs.

The NRMP statistics show a bunch of people with only one rank in ACGME and according to an ortho resident that number is from Nassau’s program having one spot on each match, and the people who interviewed there who didn’t match AOA all still could have that one rank in the ACGME match because they had interviewed there. So if you take them out of the number of ACGME Ortho applicants then there were truly only 8 DOs that truly tried to match in the ACGME match.

The point is that we still won’t be able to know what’s going to happen until everything is fully merged.

My bet: nothing good

 

[AnatomyGrey12]

My bet: nothing good

I’m not saying you’re wrong, I’m just saying it’s still a little early to be jumping in the life boats. Personally I am watching closely some of the 3rd and 4th year’s ahead of me as there are a handful applying ortho. I’m curious to see what happens and talk to them directly about their experiences.