Cali IM Residency Quality vs Non-Cali

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Jaspreed24

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I am currently an M3 honing in on IM (vs EM) for residency, with the goal of further sub-specializing in GI vs CCM. I'm a Cali native at a reputable Midwest medical school, and would really like to be back near family. However, based on other SDN forums, I'm a bit concerned that outside of the uber competitive places (UCSF, Stanford, UCLA), the rest of the Cali programs are middle-low tier and have relatively limited fellowship options compared to programs in the Midwest (granted, many of these threads are older and times change).
With my app (Step 1: 251, honors in Neuro, letters Psych, only passed IM, 1st author paper, random/nonimportant extracurrics), and my school's match history, I could probably match at a decent place in California, though the top 3 Calis would be a definite reach.

Has anyone else felt like they had to choose between geographics, and residency quality? Did choosing a mid-to-low-tier Cali programs actually affect your fellowship plans and easy access to good research? It seems like most people here see Cali as the ultimate goal despite residency quality, and while being near family/friends again is extremely important to me (I'm tired of the Midwest), setting myself up for fellowship also matters. My main fear is going back to Cali and then having difficulty securing a good fellowship later.

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I am currently an M3 honing in on IM (vs EM) for residency, with the goal of further sub-specializing in GI vs CCM. I'm a Cali native at a reputable Midwest medical school, and would really like to be back near family. However, based on other SDN forums, I'm a bit concerned that outside of the uber competitive places (UCSF, Stanford, UCLA), the rest of the Cali programs are middle-low tier and have relatively limited fellowship options compared to programs in the Midwest (granted, many of these threads are older and times change).
With my app (Step 1: 251, honors in Neuro, letters Psych, only passed IM, 1st author paper, random/nonimportant extracurrics), and my school's match history, I could probably match at a decent place in California, though the top 3 Calis would be a definite reach.

Has anyone else felt like they had to choose between geographics, and residency quality? Did choosing a mid-to-low-tier Cali programs actually affect your fellowship plans and easy access to good research? It seems like most people here see Cali as the ultimate goal despite residency quality, and while being near family/friends again is extremely important to me (I'm tired of the Midwest), setting myself up for fellowship also matters. My main fear is going back to Cali and then having difficulty securing a good fellowship later.

This question is asked a ton and the answer is always the same: do what you prioritize. Looking at your app based on what you posted, all you having going for you is a good step 1 score. You only passed your IM rotation which is a problem. Top 20 programs are essentially out. You may get a bite and get interviews (if you end up applying IM that is) at a few if you kill step 2 and your Sub-I. Other than that I suspect with your current app you could potentially get interviews at a few upper tier programs if you apply very broadly (in regards to the west coast this means OHSU/UCSD/Colorado where you'd be an average applicant; UCSF/Stanford/UW/UCLA are unlikely at this point regardless; look at solid state programs too like USC/Davis/Utah/Etc.. If your priority is to get a competitive fellowship within medicine, the simple answer is go to the best program you can. If you prioritize going to california, sure you may very well end up at a middle-tier/popular community program. Does it hurt your chances of getting a competitive fellowship? Absolutely. Is it possible to get a fellowship: of course if you do well, work hard, and get your name out there.

Also to be honest, keep in mind the fellowship process is even more regional than in residency; and yes if you are not in Cali for residency sadly its gonna be a battle uphill to get there for fellowship. Keep in mind if you decide to subspecialize how you might see your future; academia/research or community, or do you just wanna make sure you get in somewhere? At this point in the game, the so called "prestige" of your fellowship program matters too undoubtedly. If you don't know yet (which is expected) then your goal should also be do go the the best fellowship program possible (including whats best for you). Is it gonna be hard to go to an big name fellowship program from a mid tier/community residency program? Yes......even more so than medical school to residency.

Critical care is getting more and more competitive, this is absolutely true. But it is not as competitive as GI and has more spots. You will most likely match to some Pulm/CCM program regardless where you go if you are a great resident as an AMG MD. Don't simply buy into match rates when you look at NRMP data, there is a ton of self-selection/program-pressure into where people end up applying.

As someone at a "top whatever" upper tier program, it is was much easier to secure a competitive fellowship in GI at a fantastic program. Academic prestige matters at this point in the game.

If you want to do IM. You should put as much effort into the rest of your app with the time you have remaining. Apply broadly to programs (including in Cali) and see where you get interviews. As people have mentioned there are literally dozens of fantastic academic university programs which will give you a great shot at fellowship. See where you get interviews, check out academic programs and a few community places if you want (in cali too if you get any interviews), and see if any place catches your eye.
 
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I am currently an M3 honing in on IM (vs EM) for residency, with the goal of further sub-specializing in GI vs CCM. I'm a Cali native at a reputable Midwest medical school, and would really like to be back near family. However, based on other SDN forums, I'm a bit concerned that outside of the uber competitive places (UCSF, Stanford, UCLA), the rest of the Cali programs are middle-low tier and have relatively limited fellowship options compared to programs in the Midwest (granted, many of these threads are older and times change).
With my app (Step 1: 251, honors in Neuro, letters Psych, only passed IM, 1st author paper, random/nonimportant extracurrics), and my school's match history, I could probably match at a decent place in California, though the top 3 Calis would be a definite reach.

Has anyone else felt like they had to choose between geographics, and residency quality? Did choosing a mid-to-low-tier Cali programs actually affect your fellowship plans and easy access to good research? It seems like most people here see Cali as the ultimate goal despite residency quality, and while being near family/friends again is extremely important to me (I'm tired of the Midwest), setting myself up for fellowship also matters. My main fear is going back to Cali and then having difficulty securing a good fellowship later.

You sound very similarly to me from last year. California native at mid-tier midwest school. Steps high 240s, no AOA, HP medicine, same research/EC as you. My west coast rejections included: UW, UCSF, UCLA, UCSD, Stanford. My west coast invites: OHSU, USC, UC Irvine, UC Davis, Cedars. I had the same concerns as you coming into the match as I plan on cardiology but wanted to make sure I stay in California. Had the opportunity to interview at better tiered programs throughout the country compared to my west coast places, but ultimately chose to rank the west places highest. Ended up matching at one of the California mid-tier programs. Was this the correct decision? No one knows. For me being in Cali and setting up connections at my home program which will hopefully translate over to fellowship matching regionally outweighed the slight hit to national rep. My reasoning is that if California fellowship is the ultimate goal then I might as well be here than going to some good program elsewhere and trying to come back.

As for you, I think we need to know how good is your program (does reputable mean Michigan, Northwestern, WashU or does it mean (no offense) Wisconsin, Ohio St)? Based on what you posted, you got no shot at UCSF, Stanford, or UW. You will have a very good chance at the schools I interviewed at. The question for you becomes: what will it take to get a shot at UCLA or UCSD. I think the above poster is correct that you must honor you Sub-I and do well on StepII to get a crack at either place as it is probably too late to get quality research done. UCLA and UCSD are stellar programs (UCLA slightly more so) so you have a tough challenge ahead of you. If you're willing to not be in Cali and ok with being regional, then Colorado or OHSU should be places you look at, both of which I think you'll be competitive for. Last thing, people say that whereever you go you need to be happy. Just remember that. Made decisions a lot easier when trying to compare a place like Cleveland to Los Angeles (I'm sure others may feel the opposite).

I'm not sure if this applies to people at high tiered med schools, but my friends who interviewed at UCSF/Stanford/UW were all 245+, AOA, H medicine, solid research (no deficits). My friends who didn't interview at those places but got UCLA/UCSD were all 245+, medium to upper tier grades, solid/pretty good research. OHSU is kind of random because their class is smaller and get applicants from everywhere. Colorado is huge program so based on numbers you have better shot there.
 
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I am currently an M3 honing in on IM (vs EM) for residency, with the goal of further sub-specializing in GI vs CCM. I'm a Cali native at a reputable Midwest medical school, and would really like to be back near family. However, based on other SDN forums, I'm a bit concerned that outside of the uber competitive places (UCSF, Stanford, UCLA), the rest of the Cali programs are middle-low tier and have relatively limited fellowship options compared to programs in the Midwest (granted, many of these threads are older and times change).
With my app (Step 1: 251, honors in Neuro, letters Psych, only passed IM, 1st author paper, random/nonimportant extracurrics), and my school's match history, I could probably match at a decent place in California, though the top 3 Calis would be a definite reach.

Has anyone else felt like they had to choose between geographics, and residency quality? Did choosing a mid-to-low-tier Cali programs actually affect your fellowship plans and easy access to good research? It seems like most people here see Cali as the ultimate goal despite residency quality, and while being near family/friends again is extremely important to me (I'm tired of the Midwest), setting myself up for fellowship also matters. My main fear is going back to Cali and then having difficulty securing a good fellowship later.

I'm also very similar to you, are you my twin?!?!

Used to live in California, moved out East to attend college at some fancy big name school, then stayed nearby to attend a top 25 med school (not Ivy though). My med school performance was pretty average. Second quartile, pass in IM, but H in Neuro, Peds, ObGyn, and Surgery. 1st author paper, 2nd author paper, and multiple presentations. Step 1: low 250's and Step 2: low 270's.

I was struggling to get good Cali interviews-> rejected from UCLA UCSD UCI UCSF and Stanford, but IV from everywhere else.
I attended USC Cedars Olive View Harbor CPMC and UCD and really liked USC and Cedars actually.

I wanted to do GI but also really wanted to return to Cali as well. So I was struggling with the same thing since I do have much more reputable programs in the Midwest than USC and Cedars. My top 3 constantly changed up until literally 2/22/2017.

Before the rank list was due, I decided to talk to the PD at my home program. He told me that as competitive as GI is these days (with GI match rate hovering in the 50-60%), getting to a more reputable program would be much more advantageous in obtaining GI fellowship. No doubt about that. It doesn't mean it'll make it easier to get a fellowship in California, but definitely gives you a better chance of landing a fellowship anywhere in the country. I suppose the advise I get from a PD in the east coast will be different from the advice you get from a PD in the west coast, but I thought it made sense.

I eventually chose to rank my midwest more reputable programs higher than USC and Cedars and I ended up getting my top choice (yay) but I do know this means I won't be going back to California for 3 years or more. I mean I've been away for so long already, what's 3 more years gonna do? But on the bright side, this away from California thing is pretty temporary (3-6 years or w/e), but GI as a career is for the rest of my life. I think I'll be much happier doing GI fellowship at idk lets just use Cleveland again than hospitalist at USC.

TL;DR
If you choose a more reputable program in the Midwest: you'll be more likely to get into GI, but if you're lucky, you may get to go to Ca for fellowship.

If you choose a mid-lower tier program in Cali: you'll more likely get to stay in Ca, but if you're lucky, you may get into GI.

Just my 2 cents though, do what you value more!
 
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Hello everyone!

Thank you all for your insight and honesty! I am from Ohio St, so definitely not a top-tier program, though we match pretty well. It sounds like my Sub-I (w/ resulting LORs) and Step II are going to be most important to frame the rest of my app, though the top-tiers on the W coast are out regardless. I'm going to be applying broadly regardless, but it is nice to set some priorities and realistic expectations beforehand. I'm not certain which way I would specialize yet--Pulm/CCM is sounding more in line with my career goals than GI, but at this point I would just plan for the most competitive fellowship and see where things take me after.

Another question I have is for away rotations--how should a student decide if they should do one for IM? I've heard differing views on how important they are, how much they will affect the interview process, and how they can be a double-edged sword if you get a rough attending, etc.
 
@Jaspreed24

I agree with the advice posted above. But I just like to add a few things:
1. Your step 1 is stellar, unfortunately the P in medicine will hurt you. You need to honor that early sub-I and get a glowing LOR.
2. Take CK early and kill it. AOA helps.
3. If Ohio St has a track record of sending people to top-tier West coast programs, then you have a chance. You will need to highlight in your PS on why you want to go to California.
4. Call/email the programs if you haven't got an invite yet. There's just too many applicants.
5. Away rotations: Too many variables out of your control that may help or hurt you. Personally I'd lean towards getting an amazing Ohio st sub-I LOR and an amazing California elective LOR.
6. Look at the matchlist from the West coast programs (top, mid-tier, and reputable community) and decide for yourself. You said being close to family/friends is extremely important to you. You may end up performing better in residency and have a better chance for fellowship.
7. Don't stress out too much about fellowships right now. You may change your mind. If you have a passion for something you will most likely find a way. Everything works out in the end.

I hope you the best in the upcoming application cycle!
 
Hello! I am graduating this week, and remembered how terribly I perseverated over programs and career decisions. Since you all were kind enough to give me your honest advice, I thought it would be nice to share what ending up panning out for me (also because so many of these posts are stressed out med students without any closure)! In terms of Cali interviews, I received invites at USC, UCSD, UCI, Cedars, Harbor, Olive-View, UCSF-Fresno, along with some Midwest/East Coast programs. I also did an away rotation at USC in September and killed it. I really liked USC, and ultimately ranked it first and matched there, though a Chicago and DC program were very high on my list too. (Side note: I grappled with UCSD for a long time because it's arguably a "better" program, but it just wasn't the right fit for me and the thought of living in San Diego was a big turn-off). Along the way I also realized I don't really care about colonoscopies too much, so GI became less of an issue, but I was surprisingly interested in heme/onc--to the point that I could see myself doing that in the future, but we'll see. After being so stressed out a year ago, I feel like things ended up sliding into place very well, and I feel confident about the future, though I know intern year is going to be insane. Just wanted to share, since I feel like success stories aren't usually posted after these freak-out session posts! :soexcited:
 
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Thanks man...success stories are rarely posted here. It's aggravating AF for those of us who spend years (12+ for me at this point) giving advice for free to people who register just to post a single question here and then never come back.
 
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I attended UCSD for IM training and thought it was a great program that had the right infrastructure to set me up for cardiology fellowship. I'm finishing my last year at UCLA for cardiology now. Every fellowship is different, but it definitely helped to have some "regional" connections when it comes to matching for a competitive program.
 
I attended UCSD for IM training and thought it was a great program that had the right infrastructure to set me up for cardiology fellowship. I'm finishing my last year at UCLA for cardiology now. Every fellowship is different, but it definitely helped to have some "regional" connections when it comes to matching for a competitive program.

I agree ^_^ UCSD is a superb program, and I was very impressed by it :) I remember them saying they are especially good at Cards and Pulm/Crit exposure (though they do well across the board)! It really just came down to my own personal goals. And congratulations on nearly becoming a cardiology attending!! That's so exciting!
 
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