What happens if I don't get that fellowship?

[Handsome88]

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I'm in first year Med in Ireland. I'm planning to go into IM because it is a safe option for IMGs but it does not really help me out with my 250k+ debt. So I am relying on sub-specializing in Cardiology/GI, or going into Critical Care/Neurology after first year of residency for the higher pay.

So here are my questions:

1) What is the percentage of people that are able to clinch the top-tier fellowship of their choice?
2) What happens if I do not get that fellowship, can I re-apply again after practicing General IM for a couple of years? Or are we stuck with Gen IM forever?

I appreciate your help, thank you.

 

[Kiwi]

Hi there,

Are you a first year medical student in Ireland? Was not sure. Trust me, if you make up your mind and work hard you will definitely get into cards or GI on the first attempt.

Anyway, here are the rough statistics. Cards and GI are the most competitive specialities with approximately 30% match rate for IMGs. Check the web site www.nrmp.org for the exact numbers. Heme/Onc, Pulm Critical care, Rheu and Endocrine follow through. These specialities are started after a 3 year IM residency. Neurology can be started after 1 year of prelimnary or transitional year (that is one year of internship).

If you do not match, then you can work as a hospitalist or as an internist for a few years till you get your greencard and then re-apply for the fellowship of your choice. Even as a internist or as a hospitalist you make 180 to 220,000 USD annually.

Hope these answer your questions.

Cheers.

 

[Handsome88]

Hi there,

Are you a first year medical student in Ireland? Was not sure. Trust me, if you make up your mind and work hard you will definitely get into cards or GI on the first attempt.

Anyway, here are the rough statistics. Cards and GI are the most competitive specialities with approximately 30% match rate for IMGs. Check the web site www.nrmp.org for the exact numbers. Heme/Onc, Pulm Critical care, Rheu and Endocrine follow through. These specialities are started after a 3 year IM residency. Neurology can be started after 1 year of prelimnary or transitional year (that is one year of internship).

If you do not match, then you can work as a hospitalist or as an internist for a few years till you get your greencard and then re-apply for the fellowship of your choice. Even as a internist or as a hospitalist you make 180 to 220,000 USD annually.

Hope these answer your questions.

Cheers.

Thanks for the quick response.
Yes I'm a Canadian first year medical student in Ireland.
So are you telling me that I will have a lower chance of matching in Card/GI just because I'm an IMG, even though I will do my IM residency in the US? If so, then isn't it just easier to apply for something like EM or Anesth. in the first place...I bet they have higher than a 30% match rate for Irish grads.
I have read somewhere that I can go into Neurology and CC from IM after first year, or is that a different IM program (a transitional/prelim)?

 

[tsip]

Handsome88,

Neurology is it's own separate residency program that you match into straight out to medical school. You just do a prelim year in internal medicine, and then do 3 years in the neurology program. There are a significant number of IMGs who match into Neurology right after med school. However, neurologists generally make much less income than Cards or GI specialists.

Critical Care is its own fellowship that requires 3 years of internal medicine.

As far the whole IMG thing goes, it's not necessarily the fact that you are an IMG that will stop you from getting into Cards or GI, but the fact that as an IMG, you may not end up at a strong University program for Internal Medicine, which would then make it difficult to match into Cards/GI. You should focus on getting into the strongest IM program that you can, one that matches many fellows into competitive fellowships.

Are you at RCSI? I have a friend who went there and according to her, the debt load can easily go past 300k, so I can see why you would be worried about income.

 

[Handsome88]

Handsome88,

Neurology is it's own separate residency program that you match into straight out to medical school. You just do a prelim year in internal medicine, and then do 3 years in the neurology program. There are a significant number of IMGs who match into Neurology right after med school. However, neurologists generally make much less income than Cards or GI specialists.

Critical Care is its own fellowship that requires 3 years of internal medicine.

As far the whole IMG thing goes, it's not necessarily the fact that you are an IMG that will stop you from getting into Cards or GI, but the fact that as an IMG, you may not end up at a strong University program for Internal Medicine, which would then make it difficult to match into Cards/GI. You should focus on getting into the strongest IM program that you can, one that matches many fellows into competitive fellowships.

Are you at RCSI? I have a friend who went there and according to her, the debt load can easily go past 300k, so I can see why you would be worried about income.

Thanks tsip that was helpful.

I will look more into neurology, I thought it is more research oriented though and I have zero research.

Irish grads have one of the top match rates if not the top among IMGs (close to 100%). So I don't think matching into a strong IM program will be a problem, I just don't want the fact that I am an non-US citizen IMG cripple my chances at Cards/GI.

Looking at the website (http://www.nrmp.org/), it shows that Cards has a 60% match rate. Why would IMG's have a 30% (as kiwi indicated above) match rate? It all depends on whether they look at the medical school from which you graduated as much as they look at where you did your residency.

Yes, unfortunately my debt will be that high. That's why I'm looking for something that would give me at least 230k+ yearly income in order to be able to pay it off before I die.

 

[staup]

Thanks tsip that was helpful.

I will look more into neurology, I thought it is more research oriented though and I have zero research.

Irish grads have one of the top match rates if not the top among IMGs (close to 100%). So I don't think matching into a strong IM program will be a problem, I just don't want the fact that I am an non-US citizen IMG cripple my chances at Cards/GI.

Looking at the website (http://www.nrmp.org/), it shows that Cards has a 60% match rate. Why would IMG's have a 30% (as kiwi indicated above) match rate? It all depends on whether they look at the medical school from which you graduated as much as they look at where you did your residency.

Yes, unfortunately my debt will be that high. That's why I'm looking for something that would give me at least 230k+ yearly income in order to be able to pay it off before I die.

Handsome,

You will have a more difficult time getting a fellowship unless you do your residency at a top 10 IM program. It's unfortunate, and often times not warranted, but that is the way of medicine residencies and fellowships these days. Unless you do something incredible in another country, applying as an IMG, even after doing a US residency, will hurt you.

That being said, if you work hard and are willing to go anywhere, I agree with everyone above and think you will a fellowship of your liking. Sometimes IMG's even get difficult fellowships at elite places under the right circumstances.

 

[ResidentMD]

Handsome88,

Neurology is it's own separate residency program that you match into straight out to medical school. You just do a prelim year in internal medicine, and then do 3 years in the neurology program. There are a significant number of IMGs who match into Neurology right after med school. However, neurologists generally make much less income than Cards or GI specialists.

Critical Care is its own fellowship that requires 3 years of internal medicine.

As far the whole IMG thing goes, it's not necessarily the fact that you are an IMG that will stop you from getting into Cards or GI, but the fact that as an IMG, you may not end up at a strong University program for Internal Medicine, which would then make it difficult to match into Cards/GI. You should focus on getting into the strongest IM program that you can, one that matches many fellows into competitive fellowships.

Are you at RCSI? I have a friend who went there and according to her, the debt load can easily go past 300k, so I can see why you would be worried about income.

A Pulmonary-Critical Care fellowship is 3 years. A critical care only fellowship is 2 years at most places. Also critical care only fellowships are not as competitive as Pulm Crit Care fellowships, even at the top places.

 

[Handsome88]

Handsome,

You will have a more difficult time getting a fellowship unless you do your residency at a top 10 IM program. It's unfortunate, and often times not warranted, but that is the way of medicine residencies and fellowships these days. Unless you do something incredible in another country, applying as an IMG, even after doing a US residency, will hurt you.

That being said, if you work hard and are willing to go anywhere, I agree with everyone above and think you will a fellowship of your liking. Sometimes IMG's even get difficult fellowships at elite places under the right circumstances.

What are the top 10 IM programs? Is there a thread that lists them? If so please refer me to it.

Also, is this the case with other IM subspecialities such as Hem/Onc and Nephrology? I have looked at stats which shows that most nephrology spots (>50% of them) go to IMGs. And the pay is not bad, about ~220k?

I am also wondering about the future of Gen IM. Due to the strong increase in demand for IM doctors and health reforms in favor of primary care, do you think that the average salaries will increase significantly (by significantly I mean 10-15,000) in the next 5-10 years?

Thank you for the help.

 

[docscience]

What are the top 10 IM programs? Is there a thread that lists them? If so please refer me to it.

Also, is this the case with other IM subspecialities such as Hem/Onc and Nephrology? I have looked at stats which shows that most nephrology spots (>50% of them) go to IMGs. And the pay is not bad, about ~220k?

I am also wondering about the future of Gen IM. Due to the strong increase in demand for IM doctors and health reforms in favor of primary care, do you think that the average salaries will increase significantly (by significantly I mean 10-15,000) in the next 5-10 years?

Thank you for the help.

You sound like me...panicky...haha. 😀

But let me shed my perspective (or what I think I have learned):
Why are you worried about average IM salaries going up 10-15K? What do you plan to do with that extra $1000 a month? You will definitely get paid 10-15 K more than the average if you practice in a smaller community. Are you willing to do that?

As far as top 10 IM programs you can search this forum and there are plenty of discussions and the same programs usually come up:
http://forums.studentdoctor.net/showthread.php?t=705041&highlight=top+tier Top 30 programs.

Not sure about your chances as a foreign grad even as an US IM resident. Perhaps it has to do with visa status and such? Perhaps someone else on the board can shed some light on this issue.

And why do you want to do nephrology when it pays about the same as a hospitalist? Why the interest in fellowships? Do you think they have a better lifestyle?

 

[staup]

Let me just make something clear, from my perspective, I think coming from Uk/Ireland, it may be a little more difficult for you, but if you tried hard enough you could probably get almost any specialty fellowship. Unfortunately, people just see a foreign medical school from anywhere, and they discriminate against it, that's just the way it is. However, the UK definitely looks better because language and culture is less of an issue, and coming from a good residency, making the right connections, you could get anything. Fellowship is more about letters of recommendations and connections more than anything else.

I wouldn't worry about it right now, just try to get the best residency you can.

Money wise, as long as you don't need to live in a million dollar house, you will be well off in any job or specialty, seriously. It's just a matter of whether you want to live upper middle class (like primary care) or high high upper middle class while simultaneously putting away for your children and grandchildren's education with some very high paying specialties. Especially if you don't have the 100 to 300k (for med school alone) in debt like many US grads.

 

[staup]

By the way, in the US and at a doctor's tax bracket, you only take home about half of what you earn, so that 10-15 K extra you want turns out to only be 5-8k. My naive advice is to not fret about that little extra money, but rather find something that will actually make you happy and prevent burnout.

 

[Handsome88]

Let me just make something clear, from my perspective, I think coming from Uk/Ireland, it may be a little more difficult for you, but if you tried hard enough you could probably get almost any specialty fellowship. Unfortunately, people just see a foreign medical school from anywhere, and they discriminate against it, that's just the way it is. However, the UK definitely looks better because language and culture is less of an issue, and coming from a good residency, making the right connections, you could get anything. Fellowship is more about letters of recommendations and connections more than anything else.

I wouldn't worry about it right now, just try to get the best residency you can.

Money wise, as long as you don't need to live in a million dollar house, you will be well off in any job or specialty, seriously. It's just a matter of whether you want to live upper middle class (like primary care) or high high upper middle class while simultaneously putting away for your children and grandchildren's education with some very high paying specialties. Especially if you don't have the 100 to 300k (for med school alone) in debt like many US grads.

Income is important for me because I do have a 300k+ debt (federal/provincial loans, bank loans...etc). But what was mentioned above about the tax bracket is true... when you take that into consideration, sub-specialization doesn't really give you that much extra.

What I have heard from many residents on this forum that once you match as an R1, people no longer care where you went to med school. When applying for fellowship, you will be a resident trained at X US university. I don't know how true that is.

 

[ResidentMD]

What I have heard from many residents on this forum that once you match as an R1, people no longer care where you went to med school. When applying for fellowship, you will be a resident trained at X US university. I don't know how true that is.

That's partially true. However, that's when your citizenship status becomes an issue. Hence, you have to be over and above most other candidates to be considered for a competitive fellowship at the top programs.

 

[C5toC9]

Have wondered about this for a while, but what percent of IM residents do a subspecialty fellowship? Any specific %s on which fellowship and how many become internists/hospitalists?

 

[Handsome88]

Have wondered about this for a while, but what percent of IM residents do a subspecialty fellowship? Any specific %s on which fellowship and how many become internists/hospitalists?

I've heard 60% sub-specialize. Not quite sure. But more are staying with general IM as the salaries are starting to average out to be the same really, with hospitalist/internist salaries increasing (exception with Cardio and GI, even though Cardio salary is expected to drop significantly too). There is talk about hospitalist becoming a 1 year fellowship too.

 

[C5toC9]

I would have guessed it'd be higher than 60%. What is the difference between an IM-primary care program vs doing an IM program but not pursuing a fellowship? Is it simply primary care practice vs hospitalist/GIM?

 

[Lucylu123]

That's partially true. However, that's when your citizenship status becomes an issue. Hence, you have to be over and above most other candidates to be considered for a competitive fellowship at the top programs.

Does this same issue tend to apply to DOs also? I know IM itself is not too competitive, but even if you train at a decent program, will there still be an extra hoop to jump through when applying to a fellowship if you are a DO?

Thanks!

 

[PistolPete]

I'm also interested in what people think about DO's at ACGME residencies going for fellowships... is the DO status still a big disadvantage at that point, even for cards or GI?

 

[DrWBD]

Does this same issue tend to apply to DOs also? I know IM itself is not too competitive, but even if you train at a decent program, will there still be an extra hoop to jump through when applying to a fellowship if you are a DO?

Thanks!

I'm also interested in what people think about DO's at ACGME residencies going for fellowships... is the DO status still a big disadvantage at that point, even for cards or GI?

In general fellowship directors favor American MD applicants for their fellowships. Many DOs do obtain medicine fellowship training in ACGME programs but being a DO or FMG does put you at a disadvantage if there are a lot of American MDs applying and the specialty competitive enough (think cardiology).