Can someone explain the path to specializing?

[Petyr.Baelish]

this is definitely a naive question, but I truly do not understand the difference between fellowship and matching into a specialty on upon graduation. If someone wanted to be a cardiologist, nephrologist, etc, would they just do a fellowship after IM or do they match straight into it? if both are true, is there a difference in the extent to which the one with fellowship can practice within that speciality compared to someone who matched straight into that residency? if the answer is no, do board scores even matter then, if someone can simply go the IM route then apply for fellowship at one point after? how competitive is it land a fellowship in cardio? are they long years? can a doc with a fellowship in cardio see cardio patients only? is compensation the same as an actual cardiologist who did cardio residency? clearly I don't know much about this and would appreciate if someone can shed some knowledge.

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[FutureDoctor5000]

Ohhh boy.... theres a lot of information to explain in that loaded question...... firstly in order to match a specialty that is a fellowship of IM you have to match into an IM residency, some fellowships are easier/less competitive than others. Cards is one of the more competitive ones, prbly after GI. You can match cards after any IM residency but your chances increase if your at a University program with an in house cardiology fellowship where you can do some research and get a good letter... it is a 3 year fellowship and yes, as a cardiologist you will see cardiology patients.... and theres no such thing as a cardio residency and the only way you can become a cardiologist is doing an IM residency plus 3 years of fellowship.... dear god, I am surprised as to how clueless some folks are on this...

 

[hungrydoc710]

IM residency (3 years) >> apply for cardio fellow (3 years)

In terms of compeitiveness...
Cardio > GI >> Heme/Onc > Pulm/CC > the rest...

Go to academic residency for IM, research in the field, and shakes some hands to max chance of landing a fellowship
Also crush Step 2

 

[FutureDoctor5000]

IM residency (3 years) >> apply for cardio fellow (3 years)

In terms of compeitiveness...
Cardio > GI >> Heme/Onc > Pulm/CC > the rest...

Go to academic residency for IM, research in the field, and shakes some hands to max chance of landing a fellowship
Also crush Step 2

I always thought GI> Cards, this is the first time I’ve heard it be the other way

 

[AnatomyGrey12]

I always thought GI> Cards, this is the first time I’ve heard it be the other way

It is GI>Cards

 

[FrkyBgStok]

To add on others, if you want to be a pediatric GI doc, you have to go through peds to specialize. If you want to be a plastic surgeon, you have to go through general surgery. Every specialty (EM, IM, peds, general surgery, ortho, anesthesia, neurosurgery, pathology, seem, etc.) has a chunk of fellowships after it. Some have cross over. You can do critical care from IM, anesthesia, or EM. You can do pediatric EM from peds or EM. You can do sports medicine from family med or peds and you can do sports med from ortho but that is different.

The purpose of specializing is exactly that. To specialize into a specific focus. Fellowships range from 1-3+ years and competitiveness is highly variable. And the only way to be a cardiologist is to do an IM residency and then a cardiology fellowship. If someone didn’t take that path, they probably trained outside of america.

 

[AlteredScale]

this is definitely a naive question, but I truly do not understand the difference between fellowship and matching into a specialty on upon graduation. If someone wanted to be a cardiologist, nephrologist, etc, would they just do a fellowship after IM or do they match straight into it? if both are true, is there a difference in the extent to which the one with fellowship can practice within that speciality compared to someone who matched straight into that residency? if the answer is no, do board scores even matter then, if someone can simply go the IM route then apply for fellowship at one point after? how competitive is it land a fellowship in cardio? are they long years? can a doc with a fellowship in cardio see cardio patients only? is compensation the same as an actual cardiologist who did cardio residency? clearly I don't know much about this and would appreciate if someone can shed some knowledge.

IM subspecialty (focused on an organ system) is usually a secondary application process after matching into IM residency from medical school.

99.9% repeat the process of applying. At the level of fellowship, certain aspects become more important to programs including dedication to the specialty via research or visiting rotations and perception of dedication through letters in that field. Board scores matter variably across programs. Fellowship programs that offer T32 research tracks will prefer those who want to stay in academics and have a research focused career. Fellowship programs in the community will want probably want someone who is teachable and dependable and be cautious taking someone who wants an academic career.

A small subset of folks will “fast track” into a subspecialty by way of a research track (ABIM physician scientist pathway). They do not formally apply for fellowship again. Few institutions have this. It is usually saved for MD PhDs or clinicians who truly want the majority of their career to be a research career.

Cardiology is at the same tier of competitiveness as GI meaning you need to work your butt off to match and not be surprised if you don’t despite your best efforts.

You can train as a cardiologist via fellowship and choose to still be a hospitalist where you still see all sorts of patients. You can also choose to do cardiology consults where you also see a variety of pts with new onset or worsening cardiac conditions. You make more money as a cardiologist than as a internist/hospitalist (some exceptions apply to this).

 

[CocoMelon0531]

I always thought GI> Cards, this is the first time I’ve heard it be the other way

Competitiveness switches three years ago, due to better lifestyle as a GI doc.

 

[ciestar]

To add on others, if you want to be a pediatric GI doc, you have to go through peds to specialize. If you want to be a plastic surgeon, you have to go through general surgery. Every specialty (EM, IM, peds, general surgery, ortho, anesthesia, neurosurgery, pathology, seem, etc.) has a chunk of fellowships after it. Some have cross over. You can do critical care from IM, anesthesia, or EM. You can do pediatric EM from peds or EM. You can do sports medicine from family med or peds and you can do sports med from ortho but that is different.

The purpose of specializing is exactly that. To specialize into a specific focus. Fellowships range from 1-3+ years and competitiveness is highly variable. And the only way to be a cardiologist is to do an IM residency and then a cardiology fellowship. If someone didn’t take that path, they probably trained outside of america.

There are also plastic surgery residencies!

 

[FrkyBgStok]

There are also plastic surgery residencies!

Thank you for semantics.

OP there are also integrated plastics and integrated plastics residencies but they are incredibly rare and incredibly competitive that I didn’t initially bring them up.

 

[ciestar]

Thank you for semantics.

OP there are also integrated plastics and integrated plastics residencies but they are incredibly rare and incredibly competitive that I didn’t initially bring them up.

Completeness. They exist although very competitive, yes.

 

[Petyr.Baelish]

Thank you all for your responses, definitely closed big gaps in my understanding. Another question though, what goes into consideration when applying for fellowship - aside from post graduation metrics? I guess I am asking does preclerkship performance still matter as much? such as class ranking or remediation attempts?

 

[CocoMelon0531]

Thank you all for your responses, definitely closed big gaps in my understanding. Another question though, what goes into consideration when applying for fellowship - aside from post graduation metrics? I guess I am asking does preclerkship performance still matter as much? such as class ranking or remediation attempts?

LORs, research production, and interview performance in that order.

Your performance in medical school doesn't matter a lot, but your performance leads to the type of residency that you will be in. If you don't come from an university program, your LORs and research production will be weaker than your peers bc your competition from these places will have glowing LORs from leaders in the field and research mentorship from Day 1 if they're seeking those opportunities out.

LORs and research production determine the # of IIs and the quality of programs.

Interview performance determines if you match or not.

 

[AnatomyGrey12]

Thank you all for your responses, definitely closed big gaps in my understanding. Another question though, what goes into consideration when applying for fellowship - aside from post graduation metrics? I guess I am asking does preclerkship performance still matter as much? such as class ranking or remediation attempts?

Fellowship is mainly about who is going to bat for you (I.e. what residency you are coming from) and your performance in residency. Board scores can still matter depending on the fellowship.

 

[AlteredScale]

Thank you all for your responses, definitely closed big gaps in my understanding. Another question though, what goes into consideration when applying for fellowship - aside from post graduation metrics? I guess I am asking does preclerkship performance still matter as much? such as class ranking or remediation attempts?

I highly doubt fellowship PDs are digging into preclinical grades because they correlate with nothing that is important at that stage of your career.