Why apply integrated IR?

[harambe4ever]

I'm probably missing something obvious so please take it easy on my dumb self. Why apply integrated IR? You don't save any time in training if you do ESIR in DR residency, you can always pick IR fellowship later (or independent residency or whatever they're calling it), you lock yourself into one residency location for all 6 years, you have to do their desired internship, etc.

Why not just do DR and do the IR fellowship/independent-residency after? Thanks.

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[PL198]

ESIR spots might not be easy to get. If you have 3 people in your class that want to go into ESIR, but only 1 spot, then what do you do? People don't know how many independent residencies there will be.

 

[harambe4ever]

Fair point, but it seems like there are 3 applicants per 1 spot for the integrated IR programs right now too.

 

[Naijaba]

Hi harambe4ever, eventually the integrated program will be the only way.

As of right now, there are three reasons to pursue the integrated residency.

I. Maximizing your chances of matching. Many (most?) programs took spots from their DR programs and made them DR/IR. If you know you want to do IR, these spots are for you!
II. Maximizing your chances of eventually becoming an IR.
III. Avoid the headache of applying to fellowship.

For those who like conditional probabilities:
I. P(Matching | applied to both DR and IR/DR) > P(Matching | applied to DR-only)
II. P(Becoming IR | applied to both DR and IR/DR) > P(Becoming IR | applied to DR-only)

You can prove II via Bayes' Theorem:
a. P(Becoming IR | applied to both DR and IR/DR) = P(IR Fellowship | Matched DR) x P(Matched R) + P(Matching IR/DR)
b. P(Becoming IR | applied to DR-only) = P(IR Fellowship | Matched DR) x P(Matched R)
a > b <=> P(Matching IR/DR) > 0
Since P(Matching IR/DR) ~= 0.50 the statement is true.

 

[harambe4ever]

Hi harambe4ever, eventually the integrated program will be the only way.

As of right now, there are three reasons to pursue the integrated residency.

I. Maximizing your chances of matching. Many (most?) programs took spots from their DR programs and made them DR/IR. If you know you want to do IR, these spots are for you!
II. Maximizing your chances of eventually becoming an IR.
III. Avoid the headache of applying to fellowship.

For those who like conditional probabilities:
I. P(Matching | applied to both DR and IR/DR) > P(Matching | applied to DR-only)
II. P(Becoming IR | applied to both DR and IR/DR) > P(Becoming IR | applied to DR-only)

You can prove II via Bayes' Theorem:
a. P(Becoming IR | applied to both DR and IR/DR) = P(IR Fellowship | Matched DR) x P(Matched R) + P(Matching IR/DR)
b. P(Becoming IR | applied to DR-only) = P(IR Fellowship | Matched DR) x P(Matched R)
a > b <=> P(Matching IR/DR) > 0
Since P(Matching IR/DR) ~= 0.50 the statement is true.

I'm fairly sure they said there will also be the independent residency but I could be wrong. You bring up great points, thanks.

 

[Rads312]

I'm on my programs committee for ESIR/IR.

It's a false assumption that ESIR is going somewhere. For now, the SIR is maintaining three pathways moving forward:

1) integrated IR

2) ESIR -->entering IR fellowship as 2nd year fellow

3.) regular DR + 2 year IR fellowship.

Common misconception that ESIR is a 'bridge' or is getting phased out. That being said - some programs are limiting the number of residents they allow to pursue the pathway. We have done so at our program, but some programs don't - I know of a few smaller community programs that are offering 2-3 ESIR spots per year for 4-5 residents per class, etc.

The big benefit is really avoiding the headache of applying to fellowship ( potentially saving a year if you don't do ESIR ). Beyond that, I can't say. It's all too new.

 

[PL198]

I'm on my programs committee for ESIR/IR.

It's a false assumption that ESIR is going somewhere. For now, the SIR is maintaining three pathways moving forward:

1) integrated IR

2) ESIR -->entering IR fellowship as 2nd year fellow

3.) regular DR + 2 year IR fellowship.

Common misconception that ESIR is a 'bridge' or is getting phased out. That being said - some programs are limiting the number of residents they allow to pursue the pathway. We have done so at our program, but some programs don't - I know of a few smaller community programs that are offering 2-3 ESIR spots per year for 4-5 residents per class, etc.

The big benefit is really avoiding the headache of applying to fellowship ( potentially saving a year if you don't do ESIR ). Beyond that, I can't say. It's all too new.

This doesn't really seem logical. If the community places are offering 2-3 ESIR spots a year, how many do you think the big academic places are? A) I don't think there are that many people who want to go into IR B) If there were, this would be a huge increase in supply of new trainees

 

[Fab5Hill33]

Every program could offer ESIR to every one of their residents. Doesn't mean there's going to be enough independent programs to accommodate all those ESIR DR residents. That's the limiting factor. And that's why integrated offers a much better shot at IR - even if the ratio is 3 applicants per 1 spot.

 

[Rads312]

This doesn't really seem logical. If the community places are offering 2-3 ESIR spots a year, how many do you think the big academic places are? A) I don't think there are that many people who want to go into IR B) If there were, this would be a huge increase in supply of new trainees

ESIR isn't that hard to implement - essentially the extra IR time replaces mini fellowships and electives. A smaller program could technically let every resident do ESIR - but I don't know how all of them would get fellowship after. Honestly, I think self selection will play a role, out of my programs R1 class of 4, only 1 guy ( maybe ) is interested in ESIR.

 

[harambe4ever]

ESIR isn't that hard to implement - essentially the extra IR time replaces mini fellowships and electives. A smaller program could technically let every resident do ESIR - but I don't know how all of them would get fellowship after. Honestly, I think self selection will play a role, out of my programs R1 class of 4, only 1 guy ( maybe ) is interested in ESIR.

Yea I guess I just don't understand the point of the new integrated residency. They could have just implemented a 2 year fellowship with the option to reduce that fellowship to one year with ESIR. My guess is that it was to increase the prestige of the specialty and so forth.

Does anybody have any objective data on how competitive these new residencies are? All I see are subjective comments.

 

[PL198]

Yea I guess I just don't understand the point of the new integrated residency. They could have just implemented a 2 year fellowship with the option to reduce that fellowship to one year with ESIR. My guess is that it was to increase the prestige of the specialty and so forth.

Does anybody have any objective data on how competitive these new residencies are? All I see are subjective comments.

The data isn't out yet because they are new. They will be extremely competitive

 

[IRorBustguy]

I mean the guiding principle was that IR is very clinical and you can't expect to be a good clinician if you don't deal with patients for 4 years and then do an IR fellowship. Ideally, integrated IR should have more IR throughout the 5 years and DR could be more spread out instead of frontloaded. But it's coo

 

[PL198]

I mean the guiding principle was that IR is very clinical and you can't expect to be a good clinician if you don't deal with patients for 4 years and then do an IR fellowship. Ideally, integrated IR should have more IR throughout the 5 years and DR could be more spread out instead of frontloaded. But it's coo

In reality it basically changed nothing

 

[Naijaba]

Mini-rant time.

If you've ever done an IR rotation you'll know that there's a lot of scutwork for the fellows. They take consults, see patients in clinic, write H&Ps, do discharge notes, manage patients on the floor (pull lines, etc.) This is the stuff that interns typically do in the surgical specialties.

I think integrated IR should've been structured like integrated vascular/integrated plastics/integrated cardiothoracic, etc:

PGY-1: 50% General Surgery / 50% IR
PGY 2: 100% Rads
PGY 3: 100% Rads
PGY 4: 50% Rads / 50% IR (IR replaces all non-required rads electives)
PGY 5: IR

You still get 2.5 years of dedicated DR training and 2.5 years of dedicated IR, but you shave an entire year off of the program by eliminating 6 months of general surgery and 6 months of non-IR radiology electives.

 

[harambe4ever]

So what does a med student right now do if they are semi-sure they want to do IR but not 100% sure? I mean, if they apply now, they are going to probably match at a lower-tier program compared to where they would match for DR if they even match at all. But don't go for IR now and maybe you will never be an IR if there are no fellowships later.

The SIR screwed this all up IMO.

 

[IRorBustguy]

So what does a med student right now do if they are semi-sure they want to do IR but not 100% sure? I mean, if they apply now, they are going to probably match at a lower-tier program compared to where they would match for DR if they even match at all. But don't go for IR now and maybe you will never be an IR if there are no fellowships later.

The SIR screwed this all up IMO.

go to the strongest ESIR program with the best DR rep

 

[RadsFTW123]

The real question will be what will happen to all those ESIR people who can't find fellowships. Will they just do a DR fellowship? Will IR programs be able to resist the IR cheap labor and not pump out 400 new IR trainees per year?

I unfortunately predict the number of trainees will go up. If so, job prospects tank and IR will become uncompetitive after all. I hope the leaders are thinking about this but I just don't have faith that radiology will get this right, other specialties care so much more about their trainees future, at least in the past...

 

[Fab5Hill33]

If you're semi-sure about IR. Don't apply to IR/DR. End of discussion.

Apply to DR and if you like IR, then do ESIR and an IR independent residency (aka fellowship). There is a chance you don't get into IR. And if you don't get in, that's just life. You move on and do DR. You can't have a safety net for every decision you make in life. Sorry to be the one giving the tough love, but you're complaining that you can't have your cake and eat it too.

Even in the current fellowship system, there's always a chance that you don't match into IR, or that you can't get a spot in a locale amenable to your significant other, etc.

So what does a med student right now do if they are semi-sure they want to do IR but not 100% sure? I mean, if they apply now, they are going to probably match at a lower-tier program compared to where they would match for DR if they even match at all. But don't go for IR now and maybe you will never be an IR if there are no fellowships later.

The SIR screwed this all up IMO.

 

[Fab5Hill33]

As it stands, the number of IR graduates per year is going down with the new residency. So job prospects are going to get better by numbers alone - let alone the advances that will continue to drive the field forward. Even if they do add spots later on, job demand will only return to the status quo which is pretty decent.

Also by your logic the number of ortho or ENT trainees should have increased significantly to get cheap labor and the job markets should have tanked. That didn't happen. No more reason to fear it will happen with IR.

I do think that happened to some degree with diagnostic radiology, but that has to do more with the culture of DR than anything else. The vast majority of DR's don't want to stay in house and take diagnostic call. They'd rather hire a resident. IR's don't think that way. They've accepted the fact that they have to come in for emergencies. Secondly, an attending always has to come into to scrub into a case. No IR housestaff is going to do trauma embolizations solo, just as no ortho resident is going to do trauma surgery alone. Adding IR housestaff doesn't make life any easier as adding DR housestaff does. So there is less of an incentive to expand positions.

The real question will be what will happen to all those ESIR people who can't find fellowships. Will they just do a DR fellowship? Will IR programs be able to resist the IR cheap labor and not pump out 400 new IR trainees per year?

I unfortunately predict the number of trainees will go up. If so, job prospects tank and IR will become uncompetitive after all. I hope the leaders are thinking about this but I just don't have faith that radiology will get this right, other specialties care so much more about their trainees future, at least in the past...

 

[PL198]

So what does a med student right now do if they are semi-sure they want to do IR but not 100% sure? I mean, if they apply now, they are going to probably match at a lower-tier program compared to where they would match for DR if they even match at all. But don't go for IR now and maybe you will never be an IR if there are no fellowships later.

The SIR screwed this all up IMO.

getting into a "lower-tier" IR program isn't going to be easy. Nothing like getting into a lower tier DR program in competitiveness.

 

[harambe4ever]

If you're semi-sure about IR. Don't apply to IR/DR. End of discussion.

Apply to DR and if you like IR, then do ESIR and an IR independent residency (aka fellowship). There is a chance you don't get into IR. And if you don't get in, that's just life. You move on and do DR. You can't have a safety net for every decision you make in life. Sorry to be the one giving the tough love, but you're complaining that you can't have your cake and eat it too.

Even in the current fellowship system, there's always a chance that you don't match into IR, or that you can't get a spot in a locale amenable to your significant other, etc.

Except one could have their cake and eat it too by applying IR/DR. I'm not going to do this but hear me out. If they match to IR/DR residency, they have guaranteed DR and IR training. If they hate IR, then just do DR. But if you apply DR from med school, there is a decent chance you will never be an IR.

I realize this is selfish and not in the best interest of the field, but by getting into IR now one would have the guarantee of IR and DR training, whereas applying DR only has the guarantee of DR only training.

I'm just pointing out why I think this new IR residency really has very few pros. At least with other integrated residencies like plastics and vascular you save time in training. You also don't end up being board eligible in both GS + plastics/vascular if you do one of those integrated programs.

 

[harambe4ever]

getting into a "lower-tier" IR program isn't going to be easy. Nothing like getting into a lower tier DR program in competitiveness.

My question was low-tier IR vs. top-tier DR. Top-tier DRs are as competitive as any specialty so I would imagine an applicant who could go to a top-tier DR residency would probably match somewhere in IR. Of course no guarantees.

 

[PL198]

My question was low-tier IR vs. top-tier DR. Top-tier DRs are as competitive as any specialty so I would imagine an applicant who could go to a top-tier DR residency would probably match somewhere in IR. Of course no guarantees.

ya thats reasonable

 

[Fab5Hill33]

I think you're oversimplying it.

If you match into IR/DR, you can practice both when you graduate. But if you hate IR, you will be miserable for 2 years doing IR during your training. I mean really miserable -- ask any diagnostic radiologist how much they'd enjoy spending 2 years doing IR and taking IR call. Moreover if you genuinely enjoy DR more than IR, you'll never be as good at DR going through an IR/DR pathway.

Also -- just in case you weren't aware -- note that if you match IR/DR, you can't just back out of the IR part of the training. You basically would have to find a DR residency with an open residency spot to take you. In order to get the IR/DR certificate you have to do all 6 years (including internship). You can't just do the first 4 years and quit and get a DR certificate. In fact, if you do quit after 4 years and you don't find a DR residency to take you, you'll never practice radiology.

You are saving time in training with the IR/DR because the independent pathway technically requires 7 years. Yes, you can potentially go the ESIR route and save the year, but do you want to gamble that it works out for you? If I was set on IR, I wouldn't.

Except one could have their cake and eat it too by applying IR/DR. I'm not going to do this but hear me out. If they match to IR/DR residency, they have guaranteed DR and IR training. If they hate IR, then just do DR. But if you apply DR from med school, there is a decent chance you will never be an IR.

I realize this is selfish and not in the best interest of the field, but by getting into IR now one would have the guarantee of IR and DR training, whereas applying DR only has the guarantee of DR only training.

I'm just pointing out why I think this new IR residency really has very few pros. At least with other integrated residencies like plastics and vascular you save time in training. You also don't end up being board eligible in both GS + plastics/vascular if you do one of those integrated programs.

 

[IR4thewin]

The growing pains for the new IR residency are very real. You've got to figure out who you take advice from, a lot of people say different things. Here's how I think about it.

1) Don't pay much attention to individuals still using the term 'fellowship' to describe IR training in the future. Yes, the training will look similar to the current fellowship model, but this is not the correct terminology and reveals that individual to be either behind the times or sloppy with their vocabulary, neither of which is ideal when receiving advice.

2) View the specialty of IR like the Republican party several years ago. There were the mainstream, and then there was the tea party. Both under the name of Republicans. (I won't even try to figure out how Trumpistas fit in now). You need to realize that there are two very different sub-currents in the realm of IR right now. 1) is what you will see in many community hospitals, that is an IR service that is closely tied to the DR group, really inseparable. These docs may read up to 50% diagnostic in their practice, and tend to do the bread and butter of IR. They tend to work as procedure monkeys, receiving whatever is referred to them in the hospital. If they havea clinic, it is not robust. These docs still highly value their 14-18 weeks of vacation a year. 2) in my short-lived experience, the second model involves a totally different type of person, cut from the surgery cloth more than radiology . The second sub-current is a clinically-aggressive model, wanting to compete with vascular surgery and interventional cardiology for high-end vascular cases. They prefer to practice 100% IR, and may have broken off from a diagnostic group to do just so. They sacrifice a good amount of that 18 weeks of vacation to be available to their referral sources. They seek to have a robust IR clinic, in which they have their own patients to follow over time. They operate much more like a surgery practice.

Just take a look at the general forum on SIR and you will see these two types quite easily. There was quite a bit of chatter a while back about some IR wanting to break off from DR. I have no doubt that the specialty is headed in that direction, I just don't think it will happen soon. With all that said, if you see yourself in the latter group that I described, I would try to find a strong clinical IR integrated program. I agree that if you are on the fence, you should just go for DR and try to go through and Independent Residency later on. I do think getting an Independent Residency will be about as difficult as getting an IR fellowship currently. Many may disagree with me but I think the numbers will work themselves out, and SIRPAC has increased funding for IR residencies as one of their top 5 aims on the agenda. (whether or not this is good for the job market is a different question).

I was lucky to interview at a few good clinical IR programs, but also quite a few that were operating with that older mindset and were not clinically aggressive. I am ranking a lot of strong DR places ahead of these weaker IR places in hopes of then being able to go to a Michigan/UVA/BCVI etc for an independent residency. (Remember that BCVI doesn't/may never have an integrated residency, so the only way you could get there is through the independent residency).

 

[qxrt]

1) Don't pay much attention to individuals still using the term 'fellowship' to describe IR training in the future. Yes, the training will look similar to the current fellowship model, but this is not the correct terminology and reveals that individual to be either behind the times or sloppy with their vocabulary, neither of which is ideal when receiving advice.

Eh...I wouldn't put too much stock into who uses this so-called appropriate terminology. The so-called two-year IR "residency" is for all practical purposes just a two year fellowship that comes after a standard DR residency. No other specialty has a "residency" that requires another residency as a pre-requisite. This new method of calling what is practically a fellowship a "residency" just introduces a whole new layer of confusion where there doesn't need to be any.

 

[IR4thewin]

I was just saying that in my experience on the interview trail, people still using the word 'fellowship' knew much less about the new pathways than those actually using the correct terminology. When we are all conjecturing about how things will be in the future, I am more inclined to listen to someone who has actually paid enough attention to get the terms correct.

 

[PL198]

I was just saying that in my experience on the interview trail, people still using the word 'fellowship' knew much less about the new pathways than those actually using the correct terminology. When we are all conjecturing about how things will be in the future, I am more inclined to listen to someone who has actually paid enough attention to get the terms correct.

it's a fellowship. I don't care if you call it a residency, a zebra or a summer camp. it's a fellowship


I really don't think there are that many people that do 100 % IR

 

[IR_2016]

it's a fellowship. I don't care if you call it a residency, a zebra or a summer camp. it's a fellowship


I really don't think there are that many people that do 100 % IR

Correct me if I'm wrong, but you are not acknowledged as an FSIR following the Integrated IR residency or the ESIR/Independent pathway, so I don't think Fellowship is really a good term to use anymore.

 

[IR4thewin]

You all realize I'm an M4 and have nothing to do with the terms? I'm just saying there's some people who know what they're talking about, and there's a lot of people who are ill informed. Be careful out there


Sent from my iPhone using SDN mobile

 

[IR_2016]

You all realize I'm an M4 and have nothing to do with the terms? I'm just saying there's some people who know what they're talking about, and there's a lot of people who are ill informed. Be careful out there


Sent from my iPhone using SDN mobile

I agree with what you said above.

 

[Fab5Hill33]

FSIR has nothing to do with completing a "fellowship" in IR. Becoming a fellow of the society of interventional radiology is an honor bestowed upon roughly 10% of all interventional radiologists. It was easier to attain 10-15 years ago. But now it's pretty select company that gets it.

Correct me if I'm wrong, but you are not acknowledged as an FSIR following the Integrated IR residency or the ESIR/Independent pathway, so I don't think Fellowship is really a good term to use anymore.

 

[IR_2016]

FSIR has nothing to do with completing a "fellowship" in IR. Becoming a fellow of the society of interventional radiology is an honor bestowed upon roughly 10% of all interventional radiologists. It was easier to attain 10-15 years ago. But now it's pretty select company that gets it.

Interesting. So what determines who receives it?

 

[Fab5Hill33]

Interesting. So what determines who receives it?

https://www.sirweb.org/member-central/join-now/sir-fellowship-a/
https://www.sirweb.org/member-central/join-now/sir-fellowship-a/fellowship-criteria-policy/

Fellowship is one of the most prestigious honors granted to SIR's Active and Corresponding members, and is the ultimate recognition of professional achievement.

Policy on Criteria for Fellowship
The candidate shall have made significant contributions to interventional radiology and shall have actively participated in the Society of Interventional Radiology. As a criterion for fellowship candidacy, the candidate shall have demonstrated some level of activity contributing to the work and mission of the Society. The level of SIR activity will be reviewed in conjunction with the candidate’s overall contributions to the field of IR. The following areas of activity and achievement will be considered in review of the candidate’s record.

A. Outstanding Contributions to the Specialty of Interventional Radiology:

1. The candidate shall have been the first or corresponding author of at least eight significant papers on interventional radiology subjects in major, peer-reviewed journals such as the JVIR, AND/OR
2. The candidate shall have a history of full-time supervision and training of medical students, residents and/or fellows in interventional radiology for a minimum of eight years, AND/OR

B. Outstanding Contributions to SIR/SIRF:

1. The candidate shall have a strong history of Society leadership and participation.

• Leadership roles within the SIR. For example, chairing committees or task forces, JVIR editorial position, CPT/RUC advisor for SIR
• Leadership in educational activities of SIR. For example, moderator, workshop or course coordinator, Annual Scientific Meeting committee, coordinator for SIR-affiliated webinars or other SIR-affiliated CME medical conference, APDIR.
• Exceptional leadership for SIR through service to IR in local, state, or national medical organizations (eg, AMA delegate for SIR, ACR delegate for SIR, SIR liaison for committees or workgroups with other societies)

 

[Fab5Hill33]

The number or percent of faculty at any given program that are FSIR is actually a reasonable reflection of how academically strong an IR department is. Of course, there are many really strong younger IRs who are less than 10 years out and may not have had time to achieve FSIR status. But might be something worth considering for you med students and residents out there trying to make up your mind about ranking programs.

 

[irwarrior]

Interesting points that IR4thewin brings up. The new integrated IR residency is really for those who know for certain they want to do IR and would ideally try to join or develop a 100 percent IR practice. If you are on the fence, it is probably best to join a program that has ESIR. The challenge is no one can tell you how many independent spots are available (1 or 2 year). If there are more ESIR graduates vs 1 year independent spots , I wonder if the ESIR will also apply to 2 year independent spots as well vs waiting another year and reapplying. If this was the case, it may limit the number of conventional DR graduates who could get a 2 year Independent spot.

There is a growing dichotomy in private arenas of what IR truly is. In the conventional DR practice an IR does any procedure with a needle including LPs, arthrograms, paracentesis, thoracentesis, abscess drains. The heavy DR practices do not want to promote IR due to the overhead of running a clinic and the staffing requirements. The reimbursements of the procedural and clinical aspects of IR are not as lucrative (in general) compared to what a DR physician can do in terms of throughput and efficiency. DR physicians are able to churn through imaging at break neck speeds.


This is forcing those who want to practice clinical IR to form separate groups, become hospital employees, set up an outpatient lab, or join multi-specialty surgery groups.

I think that the scope and breadth of IR has increased dramatically in the last 10 years and the complexity of the patient population has also increased. What we are able to offer patients with vascular conditions, acute strokes, aneurysmal disease, dvt,pe, varicose veins, compression fractures, fibroids, BPH, lung cancer, liver cancer, renal masses, etc is not something anyone could have predicted. This requires a high degree of cognitive clinical knowledge which in my opinion requires an integrated training process. I worry that there is inadequate clinical integration in the current model in the PGY2,3 and 4 year (1 month of IR each year is too little). UVA and U of Michigan have far more early integration (including ICU time) and IR call responsibilities which I think will enable them to potentially be clinically stronger.

I agree the basic technical component of IR can be learned by most in 1 to 2 years. The cognitive component of IR is the big hurdle which includes the clinical component (which historically has been poorly taught) and the imaging component.

I don't think that the current system of integrated residency is perfect and we will have some serious growing pains in the next decade as we learn from one another on how to optimize training efficiency. This is certainly not a lifestyle specialty as more and more data comes out for the emergency IR procedures such as acute stroke therapy, PE thrombolysis, GI bleeds, hemoptysis patients, trauma, acute limb ischemia , post partum hemorrhage etc.

These are very exciting times for IR and this specialty is great for the highly motivated individual with a great work ethic , a passion for minimally invasive therapy and innovation and a passion for patient care.

 

[Smoking Jay Cutler]

Dr. Sabri at UVA said 578 applicants for 120 spots (now a couple more with Miami).

There are a lot of applicants for a few spots.


In the last batch of fellowship match data (2016), there were 240 applicants (185 US grads) for 238 spots with 225 matches.
http://www.nrmp.org/wp-content/uploads/2016/03/Results-and-Data-SMS-2016_Final.pdf


So, there were previously 238 spots (2016) for these 578 applicants (2017). Some of these applicants are not as serious or committed to IR as the 240 fellowship applicants from before, and we don't have data on how many have ranked IR #1.
Nevertheless, I haven't heard that the new residencies were intended to create new spots. Maybe the # of positions shrinks a little compared to 2016, maybe it grows a bit, no one knows yet. The mix of IR integrated and independent residencies will definitely total more than 120 spots. Will it be more than 238? Who knows?


Also, the number of bonafide IR applicants- taking into account DR-matched people losing interest, people who ranked various specialties above IR, and people who don't match at all- will be lower than 578. Less than 240? Probably not.


I think knowing that 578 people are interested in less than 578 spots, makes it in your best interest to get accepted into the specialty when you can.