what does "intership" mean when looking at residency matches

[Eagleye2]

hi guys oddly enough I cant seem to find this on google. Im looking at residency rates for schools im interested in and some of them match a lot of people into "internship" rather than pediatrics, OB/GYN, etc. can someone explain to me what this means?

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[DoctorPlzzz]

hi guys oddly enough I cant seem to find this on google. Im looking at residency rates for schools im interested in and some of them match a lot of people into "internship" rather than pediatrics, OB/GYN, etc. can someone explain to me what this means?

The first year (PGY-1) is generally regarded as an intern. This is important to distinguish in specialties that are considered "advanced" positions like anesthesiology, radiology. ophtho...etc where some programs do not offer PGY-1 training as part of the program and thus the applicant must find a separate intern year to match into before starting in thier desired specialty. There are programs out there called categorical, which means intern year is part of the specialty training. You are still called an intern though.

in short, intern = PGY-1 (first year of residency)

 

[getdown]

And to add to the confusion. Some people who don't match scramble into a one year surgical/medical intern year in order to reapply again for their specialty (usually the surgical subspecialties). Also true for people who are applying to advanced positions, don't match into an advanced position but did match into a one year prelim/transitional year program.

 

[getdown]

Just to clarify, "scramble" is how post-match placement was done. It is now under a more formalized process call SOAP (Supplemental Offer and Acceptance Program)

That is correct ... although I feel "scramble" more adequately captures the frantic and hectic nature of that process for the unlucky few.

 

[Jay Dave]

Can someone please answer my query over the shift between prelim year and PGY2 in advanced specialities.
Do we go through the match process all over again ? And wouldn't the gap between prelim year and again matching into the advanced speciality mean that your 1 year will be wasted ? International med student here.
Hoping for a reply.
TIA .

 

[CougarMD]

Can someone please answer my query over the shift between prelim year and PGY2 in advanced specialities.
Do we go through the match process all over again ? And wouldn't the gap between prelim year and again matching into the advanced speciality mean that your 1 year will be wasted ? International med student here.
Hoping for a reply.
TIA .

When you apply to residency, if you are applying to a program with advanced (PGY-2) positions, you ALSO apply for prelim positions at the same time.
On the Monday before match, you could then get several different types of emails:
1 - Congratulations, you have completely matched! This means you matched into an intern/prelim/PGY-1 spot AND an advanced position.

2 - Congratulations, you have matched into an advanced position. This means that next year, you have a guaranteed spot in an advanced program but you didn’t match into an intern/prelim/PGY 1 spot. You would then need to scramble into one of these.

3 - Cogratulations, you have matched into a first year position. (I believe this is what your question is really about).

This means you did NOT match into an advanced program. You have several options including applying again the next year and having a year gap between your PGY1 year and your advanced position, getting an advanced position that starts “on time” for you because someone dropped out, continuing in the specialty your prelim year is in (for example, the internal Med program says they would keep you for a full internal Med residency), quitting medicine, etc. All of these options have different rules and different timelines depending on the situation and institution.

4 - You have not matched. Self explanatory.

 

[Jay Dave]

Thanks a lot man.
And how does " scramble " work ?
And your answers (1) and (2) are applicable when we apply for both prelim and advanced at the same institute right ?

Also is it the educated norm to apply at the same institute for both Prelim And Advanced speciality and hope for matching into both and also at the same time apply to prelim programs SEPARATELY at different institutes to be on a safer side and if so how would match system work if one gets accepted at Advanced program at one institute and for prelim at other institute ?

When you apply to residency, if you are applying to a program with advanced (PGY-2) positions, you ALSO apply for prelim positions at the same time.
On the Monday before match, you could then get several different types of emails:
1 - Congratulations, you have completely matched! This means you matched into an intern/prelim/PGY-1 spot AND an advanced position.

2 - Congratulations, you have matched into an advanced position. This means that next year, you have a guaranteed spot in an advanced program but you didn’t match into an intern/prelim/PGY 1 spot. You would then need to scramble into one of these.

3 - Cogratulations, you have matched into a first year position. (I believe this is what your question is really about).

This means you did NOT match into an advanced program. You have several options including applying again the next year and having a year gap between your PGY1 year and your advanced position, getting an advanced position that starts “on time” for you because someone dropped out, continuing in the specialty your prelim year is in (for example, the internal Med program says they would keep you for a full internal Med residency), quitting medicine, etc. All of these options have different rules and different timelines depending on the situation and institution.

4 - You have not matched. Self explanatory.

 

[Lucca]

Thanks a lot man.
And how does " scramble " work ?
And your answers (1) and (2) are applicable when we apply for both prelim and advanced at the same institute right ?

Also is it the educated norm to apply at the same institute for both Prelim And Advanced speciality and hope for matching into both and also at the same time apply to prelim programs SEPARATELY at different institutes to be on a safer side and if so how would match system work if one gets accepted at Advanced program at one institute and for prelim at other institute ?

How the Matching Algorithm Works - The Match, National Resident Matching Program

Medical Schools and the Match Process - The Match, National Resident Matching Program

^ here's some basic info.

If you look at match lists you will find it's quite common to do prelim somewhere and advanced placement somewhere else, maybe even across the country.

Mayo's list is pretty detailed so take a look to see for yourself:

Mayo Clinic Residency Match 2018

 

[Jay Dave]

Thanks a lot !
So it is possible to match into prelim somewhere else and do advanced speciality somewhere else.

And scramble is the process of matching into those institutes that have gone unmatched after the initial rounds. And all this is possible in the week prior to match day. Am I right ?

Also, the Mayo program shows so many which have been in transitional year and later went to radio.
Considering transitional > prelim but it is still possible to match into radio after prelim year right ?

 

[DoctorPlzzz]

Thanks a lot !
So it is possible to match into prelim somewhere else and do advanced speciality somewhere else.

And scramble is the process of matching into those institutes that have gone unmatched after the initial rounds. And all this is possible in the week prior to match day. Am I right ?

Also, the Mayo program shows so many which have been in transitional year and later went to radio.
Considering transitional > prelim but it is still possible to match into radio after prelim year right ?

Just to add to what's already been said:

1. It may or may not help to apply to the same institution for PGY-1 and advanced position because they are considered separate programs and the PD is different as well as everyone else who works in the program. But for most people it is ideal since it means one less year of moving. Look at categorical too to avoid all this.

2. In the event that you do match into your advanced position, but not PGY-1 year AND fail to scramble into a PGY-1 you will have to forfeit your advanced position as well. Keep this in mind so as not to be picky in this situation.

3. There are also FEW R-spots (physician only) that you can apply to during PGY-1 to avoid a gap year.

Good Luck!

 

[Jay Dave]

Thanks a lot !
This was helpful.
But if we apply to categorical we cannot change speciality after PGY1 right ?
And also can you elaborate the PHYSICIAN (R) programs ? What are those and how are they different from other normal residents and how it helps avoid a year gap ?

Sincere thanks.

Just to add to what's already been said:

1. It may or may not help to apply to the same institution for PGY-1 and advanced position because they are considered separate programs and the PD is different as well as everyone else who works in the program. But for most people it is ideal since it means one less year of moving. Look at categorical too to avoid all this.

2. In the event that you do match into your advanced position, but not PGY-1 year AND fail to scramble into a PGY-1 you will have to forfeit your advanced position as well. Keep this in mind so as not to be picky in this situation.

3. There are also FEW R-spots (physician only) that you can apply to during PGY-1 to avoid a gap year.

Good Luck!

 

[DoctorPlzzz]

Thanks a lot !
This was helpful.
But if we apply to categorical we cannot change speciality after PGY1 right ?
And also can you elaborate the PHYSICIAN (R) programs ? What are those and how are they different from other normal residents and how it helps avoid a year gap ?

Sincere thanks.

You can always change specialties, but it is very difficult. It used to be easier in older generations when there was less competition, but I know of current residents who switched from surgery to anesthesiology (for unforeseen physical problems that arose during training), EM to IM (didn't like shift-work of EM). These were people who switched programs at the same institution so I am not sure if they did through less "official" methods. You will often have to start at a lower PGY year, if not PGY-1 when switching.

The physician spots are mean for people who already have their degrees. I unfortunately do not know much about these except they are VERY far and few. I would not bank on these spots if starting PGY-1.

Advanced positions are filled for the PGY-2 year so a gap occurs for those who are in PGY-1 (since they don't do PGY-1 again). R positions are for current physicians and they start the same year as the match. I'm sure there was some historical purpose for these positions (perhaps for IMGs that have clinical experience already).

 

[Jay Dave]

Thank you. This stuff was extremely helpful.

Does IMG status again come into effect when applying for fellowship after IM residency ?

And is IM worth the attempt in terms of " Future in IM + maintaining work-life balance " ( I know it depends on interest and dedication but realistically is it a leap worth taking considering the fact that advanced speacilities are difficult to reach and one doesnt have many choices

You can always change specialties, but it is very difficult. It used to be easier in older generations when there was less competition, but I know of current residents who switched from surgery to anesthesiology (for unforeseen physical problems that arose during training), EM to IM (didn't like shift-work of EM). These were people who switched programs at the same institution so I am not sure if they did through less "official" methods. You will often have to start at a lower PGY year, if not PGY-1 when switching.

The physician spots are mean for people who already have their degrees. I unfortunately do not know much about these except they are VERY far and few. I would not bank on these spots if starting PGY-1.

Advanced positions are filled for the PGY-2 year so a gap occurs for those who are in PGY-1 (since they don't do PGY-1 again). R positions are for current physicians and they start the same year as the match. I'm sure there was some historical purpose for these positions (perhaps for IMGs that have clinical experience already).

) from your personal experience if you are in IM or know anyone else or so.

And a silly question : Are there any EXAMS in residency ( taking IM into consideration only here ), like after PGY 1-2-OR at the end after PGY3 ?

You have been a tremendous help !
Sincere thanks.

 

[DoctorPlzzz]

Thank you. This stuff was extremely helpful.

Does IMG status again come into effect when applying for fellowship after IM residency ?

And is IM worth the attempt in terms of " Future in IM + maintaining work-life balance " ( I know it depends on interest and dedication but realistically is it a leap worth taking considering the fact that advanced speacilities are difficult to reach and one doesnt have many choices

) from your personal experience if you are in IM or know anyone else or so.

And a silly question : Are there any EXAMS in residency ( taking IM into consideration only here ), like after PGY 1-2-OR at the end after PGY3 ?

You have been a tremendous help !
Sincere thanks.

I am not sure about fellowship and IMG. I would assume it does not matter as much and instead your residency would have more weight.

I am not in IM, but it can provide decent work-life balance depending on what you do after residency (clinic, hospitalist, inpatient teams, academics...etc).

Yes, there are exams. There will be exams in every specialty you go into during residency and for fellowship should you choose that route.

 

[getdown]

Thank you. This stuff was extremely helpful.

Does IMG status again come into effect when applying for fellowship after IM residency ?

And is IM worth the attempt in terms of " Future in IM + maintaining work-life balance " ( I know it depends on interest and dedication but realistically is it a leap worth taking considering the fact that advanced speacilities are difficult to reach and one doesnt have many choices

) from your personal experience if you are in IM or know anyone else or so.

And a silly question : Are there any EXAMS in residency ( taking IM into consideration only here ), like after PGY 1-2-OR at the end after PGY3 ?

You have been a tremendous help !
Sincere thanks.

Every specialty has their in-training exams (ITE) every year. Every specialty will require you to take either a written or oral or both for your board certification. Some specialties will even have you take exams every 10 years or so to maintain your certification. So no you will never be done with exams.

IMG status may indirectly play a role in fellowships as the more competitive fellowships tend to take people from academic institutions. This is something an IMG lacks as they'll likely end up in a community program. As someone stated above, your fellowship chances depend more on where you did your training but where you do your training is impacted by your IMG status. But, it's not impossible.

 

[Jay Dave]

Thank a lot for your help.
This has been very insightful.

I am not sure about fellowship and IMG. I would assume it does not matter as much and instead your residency would have more weight.

I am not in IM, but it can provide decent work-life balance depending on what you do after residency (clinic, hospitalist, inpatient teams, academics...etc).

Yes, there are exams. There will be exams in every specialty you go into during residency and for fellowship should you choose that route.

 

[Jay Dave]

Thank you.
And for a GC holder planning IM in a reputed institute would you recommend ( apart from good scores, USCE and LOR ) research in IM also ? Does research have that of an impact when it comes to IM and good programs ? And if so, can you please provide some more info on the duration of research required ( 6 months, 1 yr etc ).
TIA.

Every specialty has their in-training exams (ITE) every year. Every specialty will require you to take either a written or oral or both for your board certification. Some specialties will even have you take exams every 10 years or so to maintain your certification. So no you will never be done with exams.

IMG status may indirectly play a role in fellowships as the more competitive fellowships tend to take people from academic institutions. This is something an IMG lacks as they'll likely end up in a community program. As someone stated above, your fellowship chances depend more on where you did your training but where you do your training is impacted by your IMG status. But, it's not impossible.

 

[getdown]

Thank you.
And for a GC holder planning IM in a reputed institute would you recommend ( apart from good scores, USCE and LOR ) research in IM also ? Does research have that of an impact when it comes to IM and good programs ? And if so, can you please provide some more info on the duration of research required ( 6 months, 1 yr etc ).
TIA.

I'm not in internal medicine so I can't for sure speak about what's needed to get into a reputed institution. In general, research is not necessarily a requirement for residency. It's very nice to have on the resume but it won't discount you from being considered as long as you have the necessary USMLE scores.

 

[Jay Dave]

Thank you so much.

I'm not in internal medicine so I can't for sure speak about what's needed to get into a reputed institution. In general, research is not necessarily a requirement for residency. It's very nice to have on the resume but it won't discount you from being considered as long as you have the necessary USMLE scores.