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[deleted999322]

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[AnatomyGrey12]

You could probably match a university IM program if you applied broad enough, although it might not be super high on the prestige ladder. Unfortunately without a Step those mid-tier academic centers are likely off the table. I do think you can match university IM of some sort, but you will need a very broad app, and not be picky with location.

 

[nimbus]

Do yourself a favor and take USMLE. Even if you did average it would open a lot of doors and it’s more than likely you would do significantly better than average.

 

[Splenda88]

To be honest, the term 'prestigious' does not mean much when people are talking about FM residency. Most people in the medical community won't give a damn if you do your FM residency at the University of Pennsylvania (assuming they have an FM residency) since most of us know FM residency at most of these places is just an 'illegitimate child' (so to speak) compared to IM.

You have a great COMLEX and unfortunately, that COMLEX score might only get you into a low tier university IM program. Mid-tier programs will probably be a reach without step1 score because you will be competing with MD students who have 230-240 in step1. Both IM/FM will get you into a good palliative fellowship since palliative is not competitive.

My advice to you, go IM even if it's not at a 'prestigious' place...because if during residency, you change your mind and decide to pursue a different fellowship (let say Heme/Onc), IM at least will give you that opportunity.

I had a physician who told he was dead set in primary care while he was in med school. He started FM residency and for some reason could not stand primary care while he was in the thick of his FM residency. He had to go thru residency again (Internal Medicine ) after finishing FM so he could apply for a fellowship. Now he is an ID doc. What a waste of time and $$$!

 

[Ho0v-man]

For gods sake take step 1. A 700 is really great. You could probably hit 230’s on step by accident.

 

[DO2015CA]

I also highly recommend taking step 1. Set yourself up for the best program possible. You certainly have the smarts. Don’t short yourself because you want to save money.

 

[InternistDO]

Choosing IM vs FM mostly comes down to how strongly you want to be able to see pediatrics and to a lesser extent, obstetrics, and whether you’d be willing to give up the opportunity to sub specialize to make that happen. FM tends to have more outpatient procedural training as well.

I agree with everyone else that taking Step 1 will open up far more doors, even if you only score average.

 

[DO2015CA]

Choosing IM vs FM mostly comes down to how strongly you want to be able to see pediatrics and to a lesser extent, obstetrics, and whether you’d be willing to give up the opportunity to sub specialize to make that happen. FM tends to have more outpatient procedural training as well.

I agree with everyone else that taking Step 1 will open up far more doors, even if you only score average.

Well and looking into the future, big cities aren’t really wanting FM to be hospitalists. But if you don’t need to be in NYC/LA then FM hospitalists are definitely a thing

 

[Lexdiamondz]

Just take the USMLE dude.

A COMLEX in the 700s is impressive, but if you want to be working on a consult service in a tertiary academic centre you are shooting yourself in the foot by only taking the USMLE. Can you squeeze into a university IM programme? Sure - but you're diminishing your chances for fellowship greatly and will likely get stuck doing something community.


"Academic" and "COMLEX only" don't really go together tbh. Prep for the job you want.

 

[aafisahar]

you can match palliative care with a thready pulse (ironically) and they almost always need faculty at academic centers since it doesn't pay well.

FM vs IM probably doesn't matter much, but you'd be wasting a lot of time training in FM if you wanted to do adult palliative. FWIW, most palliative care departments are under the department of IM, not family, so IM might give you a leg up if location is an issue.

as others have said, take step 1, a 230 opens way more doors than a 700 because no one knows what a 700 is except historically DO friendly residencies and that can change with the PD leaving.

 

[AMEHigh]

you can match palliative care with a thready pulse (ironically) and they almost always need faculty at academic centers since it doesn't pay well.

FM vs IM probably doesn't matter much, but you'd be wasting a lot of time training in FM if you wanted to do adult palliative. FWIW, most palliative care departments are under the department of IM, not family, so IM might give you a leg up if location is an issue.

as others have said, take step 1, a 230 opens way more doors than a 700 because no one knows what a 700 is except historically DO friendly residencies and that can change with the PD leaving.

Why do you say doing FM is a waste if you want to do adult palliative? I’m FM and have several colleagues who did palliative fellowship through FM.

 

[DO2015CA]

Why do you say doing FM is a waste if you want to do adult palliative? I’m FM and have several colleagues who did palliative fellowship through FM.

I believe they are referring to not using your ob or peds knowledge. Just your adult medicine. Not that you would be any less effective

 

[Limvostov]

Can't agree more with these posts. Take step 1 if you want academic MD residency. Otherwise do IM because you might decide you want to get paid for your time and do GI or cards which will be off the table if you go FM. Palliative care is not competitive at all.

 

[Drrrrrr. Celty]

If your goal is primarily inpatient care then going for IM is more advisable. You'll do simply far more inpatient, see more sick patients with more acute comorbidities and diseases. As people mentioned your interests may change and you'll be trained to process patients in a more academic perspective in IM.

That being said, I also think that we as a site unique endorse this absurdist notion that if we aren't constantly walking up the ladder of fellowships or specialties and choose something more grounded like primary care we must be degenerates who weren't effectively screened by their medical school interviewers.

So in the end apply both. Find a place where you'll be happy and you'll be able to make your niche. You may be able to have a job or a fellowship just by virtue of your program having one.

To be honest, the term 'prestigious' does not mean much when people are talking about FM residency. Most people in the medical community won't give a damn if you do your FM residency at the University of Pennsylvania (assuming they have an FM residency) since most of us know FM residency at most of these places is just an 'illegitimate child' (so to speak) compared to IM.

You have a great COMLEX and unfortunately, that COMLEX score might only get you into a low tier university IM program. Mid-tier programs will probably be a reach without step1 score because you will be competing with MD students who have 230-240 in step1. Both IM/FM will get you into a good palliative fellowship since palliative is not competitive.

My advice to you, go IM even if it's not at a 'prestigious' place...because if during residency, you change your mind and decide to pursue a different fellowship (let say Heme/Onc), IM at least will give you that opportunity.

I had a physician who told he was dead set in primary care while he was in med school. He started FM residency and for some reason could not stand primary care while he was in the thick of his FM residency. He had to go thru residency again (Internal Medicine ) after finishing FM so he could apply for a fellowship. Now he is an ID doc. What a waste of time and $$$!

Kind of like the above mentioned. I think calling FM an illegitimate child or IM lite plus ob/gyn and peds isn't a fair assessment. I think it's its own specialty and it attracts its own type of people. Not everyone should be funneled down the fellowship or academic hole nor will they be happy going down that path. I wish in truth we had better metrics that could help people figure out whether they would be happier in one or the other.

 

[Splenda88]

Kind of like the above mentioned. I think calling FM an illegitimate child or IM lite plus ob/gyn and peds isn't a fair assessment. I think it's its own specialty and it attracts its own type of people. Not everyone should be funneled down the fellowship or academic hole nor will they be happy going down that path. I wish in truth we had better metrics that could help people figure out whether they would be happier in one or the other.

When I called FM an 'illegitimate child', I was not trying to say FM is bad or compare to IM or it is "IM lite"... My issue is with FM residency at some of these big-name schools. I have noticed that at these big-name schools (even some mid-tiers) don't allocate nearly the amount of resources for FM as they do for IM (N= 4).

 

[Drrrrrr. Celty]

When I called FM an 'illegitimate child', I was not trying to say FM is bad or compare to IM or it is "IM lite"... My issue is with FM residency at some of these big-name schools. I have noticed that at these big-name schools (even some mid-tiers) don't allocate nearly the amount of resources for FM as they do for IM (N= 4).

Undoubtedly. But that probably stems from the fact that a nice outpatient facility is a lot cheaper than a new world class cancer center.

 

[comprepmed]

For gods sake take step 1. A 700 is really great. You could probably hit 230’s on step by accident.

This is the truth! Take STEP!

Mine was 704 and 256 for comparison... you should be fine taking STEP!