What Exactly is a Tier? and IM subspecialty?

[Dr Meow]

Hi, I'm OMS1 going into OMS2.
I'm considering something doing an IM fellowship but I go to a new DO school.
I have 7 publications before med school. And I might get 1 publication during med school. Total 8 pubs.

But I hear, you really need to go to a high tier IM residency (which means academic?. why? Why academic = high tier?) to get these IM fellowships (For Cards, GI, etc).

But what is a tier? I can't seem to find a real list anywhere. Where are these lists?
Like for med school, we applied via AACOMAS/AMCAS. And for residency, we have ERAS.
But how do I find these application portals and Tiers list for IM?

Also, if I go to a midtier academic residency (whatever midtier means...?) can I get a fellowship easily? What are my chances? How much does my 8 pubs help?

My end goal is to work community. I'm not planning on doing academic but I assume you need to get into an academic residency to get ANY(?) fellowship so that I can work community. (???). ...isn't that weird? Can community IM not get community fellowship?

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[Kaustikos]

Hi, I'm OMS1 going into OMS2.
I'm considering something doing an IM fellowship but I go to a new DO school.
I have 7 publications before med school. And I might get 1 publication during med school. Total 8 pubs.

But I hear, you really need to go to a high tier IM residency (which means academic?. why? Why academic = high tier?) to get these IM fellowships (For Cards, GI, etc).

But what is a tier? I can't seem to find a real list anywhere. Where are these lists?
Like for med school, we applies AACOMAS/AMCAS. And I expect for residency, we have ERAS.
But how do I find Tiers for IM?

Also, if I go to a midtier academic residency (whatever midtier means...?) can I get a fellowship easily? What are my chances? How much does my 8 pubs help?

My end goal is to work community. I'm not planning on doing academic but I assume you need to get into an academic residency to get ANY(?) fellowship so that I can work community. (???)

Not necessarily. You can apply for a fellowship from a community program. Though, personally and anecdotally from other colleagues it's dependent on whether you can get a good experience in the specialty you want and the quality letters that you can get. Also, it may be about applying extensively to multiple programs and taking what interviews you can get.

 

[Dr Meow]

Not necessarily. You can apply for a fellowship from a community program. Though, personally and anecdotally from other colleagues it's dependent on whether you can get a good experience in the specialty you want and the quality letters that you can get. Also, it may be about applying extensively to multiple programs and taking what interviews you can get.

Thanks for responding!
What does a good experience in the specialty mean? Like if I'm doing IM residency, how do I get good experience in the subspecialty? Is IM like 3rd/4th year med school where we rotate between all the specialties?

So IM residency is like 3rd/4rd year med school on steroids?

 

[Lord Osis]

Thanks for responding!
What does a good experience in the specialty mean? Like if I'm doing IM residency, how do I get good experience in the subspecialty? Is IM like 3rd/4th year med school where we rotate between all the specialties?

You are building your career path. You want your CV to reflect that. Doesn't matter if you go to an elite institution or a community program - you want your CV to tell a coherent story of your professional goal. Maybe do some summer research before M3. Show your interest in certain fields during M3 rotation - chances are your residents will assign more pertinent cases to you. Maybe start by doing away rotation during 4th year med school. More importantly, you will want to have lots of interaction with your subspecialty of choice when you go into residency. You will be given the chance to have elective rotation of your subspecialty of choice, maybe multiple times. You will interact with your subspecialty fellows and attendings. Maybe some a??-sucking is involved during the process. You will leave impression and likely accumulate a tad bit more knowledge in the subspecialty compared to your peers in the class.

So IM residency is like 3rd/4rd year med school on steroids?

4th year med school is basically coma. I'd say IM residency is like 3rd year MS on triple pressor. Oh, if you add steroids on that, it's called fellowship.

 

[Deecee2DO]

Hi, I'm OMS1 going into OMS2.
I'm considering something doing an IM fellowship but I go to a new DO school.
I have 7 publications before med school. And I might get 1 publication during med school. Total 8 pubs.

But I hear, you really need to go to a high tier IM residency (which means academic?. why? Why academic = high tier?) to get these IM fellowships (For Cards, GI, etc).

But what is a tier? I can't seem to find a real list anywhere. Where are these lists?
Like for med school, we applied via AACOMAS/AMCAS. And for residency, we have ERAS.
But how do I find these application portals and Tiers list for IM?

Also, if I go to a midtier academic residency (whatever midtier means...?) can I get a fellowship easily? What are my chances? How much does my 8 pubs help?

My end goal is to work community. I'm not planning on doing academic but I assume you need to get into an academic residency to get ANY(?) fellowship so that I can work community. (???). ...isn't that weird? Can community IM not get community fellowship?

Academic IM programs will open more doors for the more competitive fellowships (Cards GI H/O PCC) thats why DO students tend to want to enhance their candidacy for these types of programs so they have more options and can be more confident in their ability to do the fellowship they want. Coming from a no name community program with limited resources and minimal inhouse fellowships is going to be A LOT harder to match cards/GI than coming from an academic program with inhouse fellowships. Landing an academic IM residency can pay dividends for fellowship match especially if you end up matching mid tier academic or higher-which can essentially bolster your fellowship application to have more of a choice of where you want to go. This is because you have more resources, more docs available to connect with/get letters phonce calls that know names in the field and can vouch for you. Many times you can erase most of the DO stigma that comes with DO school once youve matched to an academic residency especially a namebrand one. If youre coming from a place like BU or UNC as a DO, fellowship PDs see you as more even playing field to the other USMDs than if you are coming from some no name community program. Its just the way it is. DOs typically cap out around upper mid-tier in the match unfortunately because of the DO stigma. Any DO that is at an upper mid tier academic IM residency or higher essentially has an almost perfect application where as if you are coming from a top tier USMD program you really only need an avg application. Where you went to med school does actually matter in residency match to an academic center where being at a DO school can hinder you (requiring a stronger app) and being at a top tier USMD school (only needing an avg app) can seriously help you

 

[Kaustikos]

Thanks for responding!
What does a good experience in the specialty mean? Like if I'm doing IM residency, how do I get good experience in the subspecialty? Is IM like 3rd/4th year med school where we rotate between all the specialties?

So IM residency is like 3rd/4rd year med school on steroids?

You are building your career path. You want your CV to reflect that. Doesn't matter if you go to an elite institution or a community program - you want your CV to tell a coherent story of your professional goal. Maybe do some summer research before M3. Show your interest in certain fields during M3 rotation - chances are your residents will assign more pertinent cases to you. Maybe start by doing away rotation during 4th year med school. More importantly, you will want to have lots of interaction with your subspecialty of choice when you go into residency. You will be given the chance to have elective rotation of your subspecialty of choice, maybe multiple times. You will interact with your subspecialty fellows and attendings. Maybe some a??-sucking is involved during the process. You will leave impression and likely accumulate a tad bit more knowledge in the subspecialty compared to your peers in the class.


4th year med school is basically coma. I'd say IM residency is like 3rd year MS on triple pressor. Oh, if you add steroids on that, it's called fellowship.

Pretty much this.

 

[mszzeta]

Hi, I'm OMS1 going into OMS2.
I'm considering something doing an IM fellowship but I go to a new DO school.
I have 7 publications before med school. And I might get 1 publication during med school. Total 8 pubs.

But I hear, you really need to go to a high tier IM residency (which means academic?. why? Why academic = high tier?) to get these IM fellowships (For Cards, GI, etc).

But what is a tier? I can't seem to find a real list anywhere. Where are these lists?
Like for med school, we applied via AACOMAS/AMCAS. And for residency, we have ERAS.
But how do I find these application portals and Tiers list for IM?

Also, if I go to a midtier academic residency (whatever midtier means...?) can I get a fellowship easily? What are my chances? How much does my 8 pubs help?

My end goal is to work community. I'm not planning on doing academic but I assume you need to get into an academic residency to get ANY(?) fellowship so that I can work community. (???). ...isn't that weird? Can community IM not get community fellowship?

1. A good way to see fellowship chances is to see their previous graduate's fellowship placement result.

2. mid-tier academic residency (the main university program, not an affiliated community hospital) should still have a high chance of matching into a competitive fellowship.

 

[aafisahar]

the reason we talk about tiers in IM because IM programs range from they'll take anyone with a thready pulse to programs where matching is as hard or harder than dermatology. the better program you go to the better chances you'll match in a competitive fellowship.