Internal Medicine Residency Thread

[NotAProgDirector]

For DO applicants to allopathic IM programs, would completing a one-year transitional year rotating internship prior to application give them any significant advantage?

Hard to give a clear yes or no to this question.

First, it depends on whether we are talking about a DO transitional internship, vs an allopathic TY. I would think that a DO internship would not make much of a difference in the allopathic match -- or, it is unlikely to overcome poor board scores, academic difficulty, or some other problem with your application. Allopathic PD's like myself have no idea what the content or quality of DO transitional years are -- this is NOT to say that they are bad, but that we simply don't have any metric by which to measure them. An allopathic TY could certainly be useful, but they are classically more competitive than IM categorical spots so I don;t think that applies (unless you are very competitive and are unsure of what field you want to go into).

Several other problems with this plan:
1. You will only have 3-4 months of your TY under your belt before applying in the match, which can make getting letters difficult.
2. You will need to arrange for sufficient flexibility in your TY to interview at 10+ programs, also difficult.
3. Medicare caps resident funding. Using 1 year of funding for a TY will leave you a year short for an IM categorical spot. Although many programs will overlook this, some will not. (There are entire threads dedicated to this issue, if you want more detail).

If you could arrange to do some allopathic rotations while doing your DO transitional year, that could be a big plus. I expect that would be very difficult to arrange.

If you plan to do a residency in a state that requires a DO internship for licensure, then you really have no choice.

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[NotAProgDirector]

Hi,

Thanks for taking the time to answer all these questions! My question is: are applicants considered on an absolute even playing field with other interviewees when they receive an interview or are candidates eventually still ranked based on stats, etc.?

Candidates are ranked based on their entire application. Honestly, your academic / clinical performance in medical school probably weighs more than your interview. In general, I expect that most programs assign applicants to a top 1/3 -- middle 1/3 --- bottom 1/3 type of classification based on their scores, etc. The interview probably moves you around in your group, but not necessarily between groups.

Each program is unique though, and you never know.

 

[NotAProgDirector]

Thank you for your wise advice ...

I started out with 3 Int Med letters, plus the Chairman's letter and MSPE. Then late in the game I received a letter from the attending I did clinical research with. I received mixed advice on whether or not to send it out, but some said it would appear strange if someone I did research with did not write me a letter. So instead of sending it out via snail mail I just de-selected one of the medicine letters and posted the research letter, to get around the 4-letter limit in ERAS. All the programs have downloaded all the letters, which is fine, I didn't deselect in an effort to hide anything.

Question: does deselecting a letter "look bad"? I didn't have any intent other than getting the researcher's letter out there for anyone who wanted to read it, and they have all the letters in hand (or whatever the electronic equivalent is). Is this something I should proactively explain, or just wait to see if anyone questions me about it?

Thanks!

This whole situation is best avoided to begin with, if possible. However, deselecting a single letter and sending a new one is not a huge deal. Do not bring any more attention to it. I doubt anyone will ask you about it. Leave it alone!

 

[NotAProgDirector]

How important is the so called "audition rotation" it seems difficult to do electives at all of your top choices. Will a good elective month at your program trump slightly above average board scores...

Thanks.

B-

IMHO, "Audition rotations" are probably not worth as much as people think they are worth. They are clearly not necessary -- you do NOT need to do electives at all of your top choices, and you should not try to do so. I would hope that an audition rotation helped YOU choose where you wanted to go, rather than the other way around.

In a few specific situations, an audition rotation can be very helpful:
1. A DO student rotating at an allopathic program
2. An IMG student rotating at a US hospital

In both these cases, a good rotation with an LOR can vbe very helpful, both at that program and generally. Neither is required -- many match without them.

 

[NotAProgDirector]

Hi aprogdirector,

I have a question about the etiquette for canceling interviews. I have an interview at a particular program that I scheduled at the beginning of the season when I wasn't sure how competitive my application would be. Now with several more interviews, and realizing from firsthand experience how expensive/draining the interview process is, I'm trying to save costs and energy by canceling some interviews.

After careful thought, I've admitted to myself that I'm unlikely to rank this program based on geographic factors, and in light of the other interviews I've received that are higher choices on my list. Thus, I'd like to cancel this interview. But my dilemma is that this interview is scheduled for next week. Is it poor form to give less than a week's notice to cancel an interview, or would it "blacklist" me in the eyes of the PDs? On the other hand, is it fair to travel to this program and take another applicant's spot?

Just want to do the right/proper thing, but am not sure how to approach the situation.

If you're sure you don;t want to go there, email them and cancel tomorrow. If this is the type of program that offers interviews to any candidate which meets their criteria, then there is no harm done. If they are competitive and have filled all their slots, someone on the waitlist will jump at an open interview spot. Interviewing at a program you're not interested in is a waste of their time and yours and the worst thing you can do.

 

[NotAProgDirector]

How important would say it is for a DO applicant to an allopathic IM program to write the USMLE in addition to the COMLEX. Is it just a small number of allo programs that accept the COMLEX? Do they even know how to interpret COMLEX scores?

It's a mixed bag. The most competitive programs demand the USMLE. Many good programs accept either. There is a paper published which compares USMLE to COMLEX scores, to help convert them.

If you decide to take the USMLE's, remember that whatever score you get on them will overshadow your COMLEX. If you get a 750 on the COMLEX and then get a 198 on the USMLE, you're poor USMLE score will be the one people "believe".

 

[NotAProgDirector]

Hi,

I read through the entire thread and you have clarified a lot of my doubts, thanks!

I am a medical student from India doing my final year MBBS. My ultimate aim is to finish MD Internal Medicine and subspecialize in Infectious Diseases.

I am doing pretty well in undergrad (studying in the second best institution in the country) and have just started serious preparations for USMLE all the steps of which I will be giving in the few months following my graduation. The graduation would be in November, and even if I finish all the steps and get ECFMG certification in about 3 months, I still would have to wait till November next year to send the applications right? Or should I start contacting individual universities by email before then?

You will most likely need to wait until the next application cycle (Nov 2008) to apply. You can try contacting programs looking for off cycle spots -- you have to contact each program directly, perhaps multiple times. There aren't many spots like this, and they can be hard to get. Best option is to plan for an application in Nov 2008.

Also, how many universities would consider a phone interview good enough? I can travel to US for a couple of weeks (and stay at an alumni's place) for the step2/cs examination, but staying there for a long time to attend many interviews may just not be the most economically feasible solution for me.

Not many. Some may require a phone interview first, but almost all will require a physical visit. How will you even know if its a program you want to go to without seeing it? Many programs will assume you are simply not serious about this if you don't come and interview.

This brings me to the most important question for me. Internationaldoc.com gives stats like 24% of IM residents are IMGs and cites Indians as the most common group. While I don't know how true that is, I would just like to know if coming from a 'developing' country would make a difference as far as residency/fellowship selections go? Does the feared 'stigma' still a reality? Especially with no LORs.

The biggest issue is lack of US experience. You will find it difficult to get a spot without US experience. Not impossible, but difficult.

Another burning question is how well would our marks in the indian university be useful in landing us a place? We are not graded on percentiles and gold medalists usually don't cross 80%. A good score here is 75%. Should I like mention it in my application or directors do not consider the university grades at all and choose solely based on USMLE scores?

USMLE scores are everything. We have no way of knowing what your transcript scores mean, and honestly you telling me that your scores are good really doesn't help. How do I know you are telling the truth?

I would not be able to afford the costs of observership. So, from a previous post of yours, I should probably be applying to only the community based / University affiliated programs? What exactly are the community based programs and why are they not valued as much as University based? I tried searching the net but could not come up with any plausible answer. I thought you would probably be the best person to ask. A university program would still need a hospital with community for teaching right? What are the benefits/disadvantages to an IMG? Assuming the program has a built-in ID fellowship. (Btw., how do i find this out? I have to email every program director I suppose?)

No US experience will make it more difficult to get a spot in the US. As the process gets more competitive, it may end up being a requirement. You are correct that you should only apply to community and Univ affiliated programs. We'll see how the match works out this year, but last year there were only 80 (out of 4700+) IM spots left in the scramble. This suggests that things are getting more competitive, and that IMG's with no US experience may find it much more difficult to get a spot in IM. FP is still much less competitive, but you cannot specialize in ID from an FP residency.

University program = Program at a univeristy, usually directly related to a medical school. Often called "Academic" programs.

Univeristy Affiliated = Program at a smaller community-type hopsital but one that has a relationship with a Univeristy program. These relationships can be very robust (i.e. multiple residents and students rotating at the hospital, staff at that hospital hold academic appointments at the university, etc) or weak (a few students rotate, or no one rotates but they have a business agreement so they are "affiliated).

Community = Not associated with a univeristy

Bottom line is this: In general, univeristy programs have sicker patients (Tertiary care), transplants, subspecialty services, more research opportunities. Fellowship programs are much easier to get from a univ program. Community programs still offer good training, but usually less research options and less fellowship opportunities.

You can look up the status of any program, and search if they have an ID fellowship, at FREIDA.

In case the community based program does not have the fellowship of my choice, would doing the residency in such a place affect my chances of selection when applying for a ID fellowship at a good University-based program three years later? You have mentioned ID is not at all competetive, but I just wanted to throw in Uni-based into the equation and see if it would balance out.

You will be more competitive for an ID spot from a Univeristy based program. Because ID is relatively non-competitive, you wll have a good chance of getting a spot regardless of where your residency is, but getting one at a "good univ-based" program will be more difficult.

Another big question I don't know if I am allowed to ask you, but anyway, for completion sake (for me): Would a IMG be considered for fellowship if he/she did not do his/her residency in US?

Usually not, except in very rare circumstances. In the past we matched an IMG into our medicine program whose spouse had completed a residency elsewhere and wanted a fellowship spot, and was able to get one, but this is generally an exception to the rule. IM fellowship programs must have 75% of their fellows over a 5 year period eligible to sit for the ABIM subspecialty boards, and you must have a US residency / ABIM board to do so, so spots are limited (this 25% would include all non-US trained residents, and DO students completing AOA residencies, US residents in FP or other non-IM fields, US students who decide not to take the boards, and anyone who fails the boards). Most importantly, you will NOT be able to practice in the US without a US residency first.

 

[NotAProgDirector]

Hi there,

I've been hearing a lot about 'hospitalists' recently, but I'm not sure what a hospitalist is, and what is it that they do which is different from a physician who isn't a hospitalist. Are there any advantages to working as a hospitalist in IM?

Somebody loves me, and asks a question. It's been two months!

Classic IM is mainly outpatient based. Some IM jobs include some amount of inpatient work -- usually rounding on your patients in the hospital. Most jobs like this are 90% outpatient, and 10% inpatient.

A relatively new development are Hospitalists. Instead of having an outpatient clinic, hospitalists do only inpatient care. Many people like this, because:

1. It's fun, inpatients are sick, you can do procedures, etc.
2. It's shift work, like the ED. Some jobs are 7 days on / 7 days off. There are many other structures.
3. There is no long term commitment. You can switch jobs basically anytime.
4. It's a great part time job.

Outpatient docs like it also. Many find that their inpatient skills deteriorate over time, and it's much more convenient to have hospitalists to take care of inpatients. Outpatient docs then don't need to round on inpatients on the weekend.

 

[NotAProgDirector]

I'll ask you some questions.

What are your feelings about combined residencies such as emergency medicine/internal medicine or psychiatry/internal medicine? Do physicians ever "gain" anything from going the combined route? Also, from your point of view as a PD, does the department lose out on not having an extra resident around when he's working with the other specialty?

My personal feeling is that these combined programs are usually not a good idea.

Many people go into these combined programs because they like both fields and want to "keep their options open". This is a very bad idea. Somewhere along the line, they figure out which of the two fields they like better, and discover that they're training is going to be longer than needed, and can become unhappy.

Specifically, Med/Psych is a tough road. Most insurance companies will not allow a doc to be listed both as an internist and as a psychiatrist, even if trained in both fields. Medical insurance and psych insurance are different, and you can't bill a visit to both systems at the same time. Thus, as a Med/Psych doc, you can't deal with the patient's schizophrenia and HTN during the same visit.

If you train in IM/ED or Med/Peds, it makes more sense but can still be difficult in the long run. If you train in Med/Peds, what practice are you going to join? Medicine practices won't be able to cover your peds patients, and vice versa. FP practices may want to hire FP only. Med/Peds works really well if you want to be a hospitalist -- now you can do so in IM or Peds, and that can be a plus.

IM/ED will work if you use your IM training to be a hospitalist and ED doc. If you want to do outpatient medicine, you'll need to find a very flexible office who will cover your patients while you're doing ED work.

Bottom line: This can work, if you do it for the right reasons and understand some of the challenges that can arise.

 

[NotAProgDirector]

Hi,

Thank you for all the useful information. I'm an international student who will be attending a mid-tier US medical school (MD) this fall. I was wondering whether my citizenship would be a issue when applying to IM residencies. If I have a US medical degree, does it matter whether I am international? Will US applicants be favored over me in the application process considering that our board scores, grades, dean letter, etc are very similar? (I understand that discrimination due to nationality may be illegal, but people do it all the time.)

Thank you!

In general, no. Your US training will be the overriding factor. You'll need a visa as a resident and there might be a few programs which won't want to be bothered with that, but the vast majority will be happy to get a visa for a good applicant.

By the way, you are likely on an F visa as an international student in a US school. You will be able to get an internship on an OPT visa, which is an extention of the F visa sponsored by your school. Many programs will accept you on this OPT visa, and then sponsor you for an H visa while you are an intern. Many programs that state they are "J only" will do this for an international grad from a US school. You should ask.

 

[NotAProgDirector]

As a follow up question, I was speaking to a general internal medicine attending who was complaining about how the rise of the hospitalist has affected his life. This surprised me because as you mention above, most primary care docs seem to like not rounding on hospital pts. But, this physician pointed out that rounding in the hospital represented a nice source of revenue for him and that is now gone. Also, he misses the continuity of managing his sick pts who are in the hospital.

What do you make of his comments to me? Thanks.

Well, given any change there will always be people who are unhappy.

Billing for inpatients is not usually a good revenue source. As a primary care doc, you're usually better off (financially) seeing 3-4 outpatients in an hour rather than driving to the hospital, seeing your inpatient, documenting, etc. In addition, if you have to go and see an inpatient a few times during the day (because they become more unstable) you usually only get to bill once. This is why many outpt docs prefer having a hospitalist.

You are always free to see your inpatients even if they are cared for by a hospitalist, although you then can't bill for it. Good hospitalists will contact the PCP every day and discuss the management of their patients.

 

[NotAProgDirector]

Hi there!

I will be graduating from a Canadian Medical school in 2009 and I am planning to apply for US IM programs.

As my decision to apply exclusively to US is a fairly recent one, influenced by personal circumstances, I am planning to write USMLE Step I in August. I have arranged several electives for the fall of this year at US schools to which I am applying for residency.

I would really appreciate advice and opinion about whether my timing for writing the USMLE Step I is late in consideration of application deadlines. I am also concerned about not having enough time to prepare for the exam, given that I will be in rotations up to 2 weeks prior to the USMLE. Would it perhaps be wiser to write all USMLE Steps upon graduation from medical school, and then apply for residency position starting in 2010. In case I decide to take the latter route, how will a one year pause between med school and residency be looked upon?

Thank you very much!

Your timing is fine. If you take Step 1 in August, you'll have your results by October. Although applications are released from ERAS to programs in mid Sept, you'll still have plenty of time to meet the Nov 1st ideal deadline of having your application together. There is no reason to wait until next year, you'll have everything you'll need.

Doing well on the USMLE is very important, depending on the field and programs you are looking at. Only you can decide how much preparation you will need, and whether this plan is adequate. If you decide to take a year off, you'd probably be best to find something medical to do -- research, volunteer/international work, etc.

 

[NotAProgDirector]

I am an FMG who graduated in 2003 but have no visa problems. I accepted prelim IM position in post match scramble 2008.(PS : I had not applied for the regular match in 2008 season)
My categorical residency choice may be IM.When I apply for 2009 match will I be in a postion to request LORs from the attendings such that they are available in ERAS on Sept 1st 2008? Or is at a better idea to request for letters in Sept end and have them available by November, meanwhile I will send the LORs from home country and LORs from the physician in US whose outpatient practice I have been observing for past 2 months. I ask all these questions because I will have to search for PGY1 or PGY 2 position in some place other than where i will do IM prelim because of family reasons. Please advise me on the course that I should follow. I read your earlier post on transfer from PGY1 to PGY2. I understand that some places might have funding problems when i request to re- do the intern year but it is not true of all residency programs. I want to confirm if I understood correctly.

First, congrats on getting a prelim year in the scramble. This is a big step forward.

As you mention, you'll need to either: 1) get your current program to offer you a categorical spot, 2) apply for a PGY-1 categorical spot in the match next year, or 3) get a PGY-2 spot outside the match for 2009. You are correct that there are funding problems with doing a second PGY-1, although some programs may not care.

You should:
1. Submit ONLY US letters if you apply to the match next year, and ONLY letters from your prelim program. By september you should be able to get a letter from 1) your PD, and 2+3) two faculty from your first three blocks. These are the only letters PD's will care about.

2. Try to organize your schedule so you have interview time in Dec/Jan. This can be very tricky. Tell your PD now, so that the schedule can include this.

3. Try hard to get a PGY-2 spot outside the match. Many open up. There is no simple way to find them, keep in touch with PD's in your preferred geopgraphic location.

 

[NotAProgDirector]

I am currently a fourth year medical student who was going for dermatology, did research, got 10+ derm interviews, but still felt my chances were low due to no AOA so applied to my home IM program. Found out yesterday that I matched at my home IM program and now I'm finding it to be a "curse and a blessing." By this I mean that I truly enjoyed derm, but felt that I never quite fit in. However, I loved my medicine attendings and peers. My mentor says I should try for derm again (and do a research fellowship), but I am not sure if I can put off my career anymore.

My question for you is what are my choices at this point (post-match)? Can I ask to be changed to a preliminary intern and re-apply? I imagine it would be a big deal to try and find another categorical resident to fill my place. And if I stay in medicine, will I have enough time to try to figure out if one of the subspecialties are for me?

Thank you for anwering all of our questions!

You can ask to be switched to a prelim, but you matched into categorical and your program will likely keep you that way. Your match is binding. Remember that if you switch to prelim, your program no longer holds a PGY-2 spot for you -- if you get nothing in derm the second time around, you might need to work to find a new PGY-2. Also, if prelim you will have no clinic.

If you start as a categorical IM, your funding is fixed at 3 years. Should you find a derm spot, they will have only partial funding for some of your residency (and this might limit your competitiveness).

Although many IM residents apply for fellowship in the PGY-2 year, there is an increasing number who apply as a PGY-3. This gives you more time to explore options. Most fill in the year between grad from residency and fellowship as a hospitalist -- helps with a nice infusion of cash.

 

[NotAProgDirector]

(Least valuable)

1. Volunteer in a physician's office who is a family member/friend
2. Volunteer in a private physician's office.
3. Volunteer at a community hospital (seeing inpatients)
4. Work in a physician's office for 6+ months as a patient care tech / EKG tech / lab tech (i.e. something with direct pt contact)
5. Work as a research fellow at a Univeristy hospital (and get something done)
6. Work as a research fellow at a Univ hospital doing direct patient research (i.e. interacting directly with patients), and getting something done.
7. Volunteer at a Univ hospital on an outpatient / consult service.
8. Volunteer at a Univ hospital on an inpatient service
9. Outpatient/Consult rotation at the level of a fourth year medical student (direct patient contact)
10. Inpatient rotation at the level of a fourth year medical student

(Most valuable)

Which # will you put a 'medical assistant' at a physician office?

That's equivalent to #4 on my list.

 

[NotAProgDirector]

You mentioned DME and IME funds in one of the forums while elaborating on funding issues. Can you please explain what are these two funds. Can you give a rough idea as to when do PGY 2 spots open up so that I can keep in touch with PDs in the geographic area of my interest. My logic says it should happen after the 2009 match results are declared, i.e around this time next year..............which I assume will be a very busy time for PDs...............and they might not have time to look at my e-mails. Your advice is appreciated.

DME and IME are two different sources of funding. It's explained here.

PGY-2 spots tend to open up in Dec-Jan, when contracts for the next year are sent out.

 

[NotAProgDirector]

Thank you. You are very helpful on this forum!

Why is research experience better than MA? I thought patient exposure is more important.

It's my own personal bias showing. I'm based at a Univeristy program, and in general some research success would be more valuable than an MA position. For a community program, it might be the other way around.

 

[NotAProgDirector]

One more question. What do you see experience as
research coordinator at clinical site or
research associate at CRO/Pharma?

Do you truly see only research fellow at Uni hospital is valuable?

I think these would be equivalent to working at a Univ, except for the (potential) lack of connections. The best reason to do research at a Univ site is you can probably get some clinical experience out of it -- shadow a clinician/researcher, get an elective, etc.

If you do research, you'll likely be evaluated on what you get done, not where you did it.

research may not help at all at a community program.

 

[NotAProgDirector]

Hi. I have just gone through alot of your work here and wish I had known about you earlier! I had a question that u have answered briefly earlier to someone,but I'd love some clarifications.
Question: If I do a primary care IM residency in a good University program which has all the fellowships available, can I still pursue a cards fellowship? MY university tends to take more categoricals internally for cards though. But would you say I stand a chance as I will be in a university program to cards? They get most fellowships in everythin other than cards/gi is wat the residents there told me on my interview day.

I have been told that Primary Care IM residents are just as competitive for fellowships as are Categorical residents. Like you, I worry that may not be true for the most competitive fellowships. Also, a Primary Care track will have more outpatient / primary care time, and less time to work on research. In addition, your research project might have to be primary care based.

If you know you want to do cardiology, you probably shouldn't be looking at primary care residencies.

 

[NotAProgDirector]

I may be asking a lot here, so please feel free to focus the question more if needed.

Background:
I'm graduating this year from a US school, matched in IM. I have a PhD in epidemiology and want to continue clinical / epidemiologic / prev med research and see patients. Originally, I was very interested in continuity of care and thought I'd like primary care. However, I realize that's probably not a reasonable option in academics. I haven't done rotations in ID or rheum yet, but I personally think that the patients and disease processes are interesting. I like the diagnostic challenges and I think that will be plenty of research opportunities in either field. I also like the prospect of possibility having a specialty clinic, following chronic patients (HIV or rheum seems logical, somewhat filling in for my interest in continuity).

On the other hand, my favorite rotation so far was the MICU. I originally wasn't as interested in taking care of hospitalized patients, but I found that I liked the complexity. My own dislike so far in hospitalized care is that I don't like the lack of follow-up I've witnessed so far (although I expect that this will change next year when I actually have clinic). I'm not sure I like the pace in outpatient primary care clinics, but again - I haven't had as much exposure.


What I'd like your opinion on:

Where do you think a career in these fields will be like over the next 20 years (specifically at academic centers and in the realms of clinical physician-scientists)?

ID vs. Rheum vs. Critical Care vs. General outpatient internist

I have trouble predicting the next 5 years, let alone the next 20. Academic medicine is vastly different today than it was 20 years. Rather than worry about what it will look like 20 years from now, I'd look to see what it has to offer today. If you like that, and you're reasonably flexible, then you'll probably do OK.

I disagree with one statement you made above: Academic GIM is alive and well. You don't see many in academic GIM with their own lab (like ID and Rheum), the research being done in academic GIM is more about outcomes, education, etc. There are grants available for geriatrics, for example. I guess it depends if you see your research in the "softer" side (epidemiology like) or the "harder" side (lab based). You can of course do the "softer" side in ID/Rheum also. Choose what you like.

As far as the pace of outpatient medicine, this is where academic medicine is fun. It's much more fun doing medicine when you have 50-70% of your salary funded by research/admin/education. You have some busy days, but many days where the pace is much more reasonable. You can spread your patient visits out a bit more.

Anyway, my 2 cents, whatever it's worth.

 

[NotAProgDirector]

Hi

I just wonder if it is wise to reapply this year (for 2009 residency)
1) to programs that I went for interviews, but didn't match
2) to program that I applied, but didn't get IVs.

I know for sure, I should reapply to the second, but have doubt in the first one (unless new PD?, new coordinator?). Should I write totally new PS in both scenarios?

Do they know if I applied before in their eras software?

xxxxxxxxxxxxxxxxxxxxxxxxxxx

Do programs (which ranked me, but not high enough) know whether I did not match.

xxxxxxxxxxxxxxxxxxxxxxxxxxx

How do I answer if programs ask whether it is 1st match or 2nd match? Should I answer truthfully or just say 1st match?

Thanks for your response in advance.

Reapplying to programs where you interviewed but didn't match makes some sense. They liked you enough to interview you. Perhaps you were close to matching.

Reapplying to programs that didn't interview you doesn't make much sense unless you've done something to improve your application. If they didn't interview you this year, why would they interview you this year?

ERAS doesn't tell us if you applied last year, but I often recognize names from the past, and we often keep the last year's ERAS to look at.

We know the match result of everyone we ranked. If you were ranked, they know you did not match.

I'd highly recommend telling the truth. Lying on your application / interview is reason to terminate you at any time.

 

[NotAProgDirector]

Hi,
I am an IMG and will be applying for match 2009.
I have done my MD in Internal Medicine and currently doing my Senior Residency in Endocrinology.
I wish to pursue a fellowship program in Endocrinology and metabolism after my MD in IM there in the US.
My query is whether my MD and SR experience in India going to have any positive impact on the PD....can I expect them to include it as a criterion in their selection process.
I have got 99 in step 1 and will be sitting for my Step 2 this month.
USCE seems difficult as of now and if at all there it will be from Private Practitioners.
Please enlighten me on this.

That is one seriously narrow font

It's a mixed bag. Some programs look at non-US experience as helpful. Some find it difficult to evaluate, and hence do not. The real question you need to try to answer is whether your experience will help you in your internship -- i.e. non-US training and medical systems are often very different and you should try to explain in your PS what your training consisted of -- the more similar to US training the better.

Your scores sound quite good. Some US experience, even in a private office, might be of help.

 

[NotAProgDirector]

Hi, first, i want to thank you for your replies. its really helpful to us.i have few queries for you. if you could answer them then i would appreciate it.
1- i got matched in im in uni. affiliated program. i will be starting my residency in june. i have scores in mid 80s first attempt. permanent resident, fresh grad.
they say its nearly impossible to get gi from uni. affiliated pro. with scores in 80's ?????
2- research, good lor from pd in residency is what i am looking forward to now. is it enough for gi fellowship application???
3- i will be taking my step 3 in second year. how important is it???
4- i am very much interested in it but people are saying that my goal is unrealistic as i am an img with average scores and average program.would you mind telling me how to approach my fellowship application.
thanks in advance.

1. It is very difficult. GI has become increasingly competitive. If your home program has a GI fellowship, that's your best option.
2. Good clinical rotations, research leading to a NATIONAL presentation (poster or abstract is fine). You could also consider an away rotation at an institution with a GI program in your PGY-2 year.
3. If you do well, it can't hurt.
4. Never say never, but you need a plan B. You may not get a GI fellowship. In that case, what would you like to do? Think about it, and plan. If it's GIM (either hospitalist or outpatient) then you simply finish your program. If you would want to be another type of specialist, you should plan on applying as a PGY-3 to both GI and another field if you don't get a spot as a PGY-2

 

[NotAProgDirector]

(Regarding) Gi fellowship. thanks a lot for your valuable advice. as you said its very difficult from community program. i just have this plan that if i dont match in Gi then i would work as hospitalist for a year and also try to do some research in same hospital and then apply for Gi. is it a good idea???? if the program doesnt allow outside rotation then can i still request pd for it???
my program gives electives from second year so is it too late for fellowship???
i will really appreciate your reply. thanks

Working for a year as a hospitalist is becoming a frequent occurrence. As you mention, the major issue is doing something during your hospitalist year that makes you stand out.

Being a hospitalist at a program with a GI fellowship is also a good idea. Perhaps you can impress them and they will take you.

If your program does not allow away electives, I doubt asking your PD for one will be effective but you can try. No elective is too late -- you might need to plan on applying as a PGY3 (and then completing a hospitalist year).

 

[NotAProgDirector]

Hi

I am just in the process of writing up my Personal statement for the next match. Just wondering what you would look for?, also is it better to have a flowing text and prose, going from one paragraph to another or is it better to have subtitles/headings to direct the readers attention?

Thanks for your advice, much appreciated.

Write about something personal. Something NOT in your application. You can write about anything, it might have nothing to do with medicine at all.

There are 4 standard personal statements:

1. Why I want to be an internist -- usually "I like solving puzzles" or something on that theme.
2. Rehashing your CV in prose form.
3. Recounting a clinical encounter -- i.e. "I first saw Mrs. P in the Emergency room; she stood out because she was bright yellow."
4. Starting with a quote, and then trying to tie it into your PS (usually #1-#3 above).

My advice is to avoid all of these. It's not that they are bad, it's just that they are boring.

Choose one thing to write about. One of your EC's. Something you like to do outside of medicine. Something non-medical that you read an enjoyed.

If you make your personal statement enjoyable to read, it will drive your interview -- people will probably want to talk to you about your PS, and that only makes your interview that much easier.

 

[NotAProgDirector]

Hi,

1) I am an american IMG at a school in Israel with an American university affiliation. I have honored IM of all my clerkships this year, but only passed the others. When medicine programs look at my file in Sept. will it be a big deal that I have not honored other clerkships? Or will they mainly look at my Step 1 when granting an interview? I have a very good step 1 score (99), but sit about in the middle of my class as far as rank goes.

2) I am also wondering your opinion on contacting PDs (ie, setting up meetings, making phone calls, sending emails, etc.) about my program. Being an FMG, I want to make sure that they do not overlook my ERAS app. when I apply. As I of course, want to try to get the most amount of interviews possible at competitive programs.

Thanks so much for any advice.

Programs will review your entire file. Not honoring other clerkships is a mixed bag. Of course it's better if you honor more, but simply passing clerkships is fine too. Much of it depends on your school's grading system -- at some schools, 90% of students get honors and 10% get pass. At others, 10% get honors. Your MSPE will spell this out.

Contacting PD's and trying to tell them about your school is IMHO a waste of time. Either they'll interview you or not. Some programs don't look at IMG's, and you're unlikely to change that. If you're rotating at a specific program, then of course you want to meet with the PD when you are there -- perhaps twice, once at the beginning and once at the end.

Your excellent Step 1 score will help. An equally good Step 2 score early in the season will help also.

 

[NotAProgDirector]

Hello

Hope you had a nice vacation. I posted three questions (I think April 9) regarding PS, asking programs to give feedback on last year's application etc.; but I don't see your responses. Just wonder if they are not to standard to response or you didn't receive them.

Thanks

Because your questions were very specific to your own situation, I PM'ed you answers. If you didn;t receive them, let me know (via PM) and I'll send them again.

 

[NotAProgDirector]

I am an IMG who came to US for a PhD in Molecular Biology and wanted to do residency in Pathology after that. Since there is no separate thread for Path in this forum and I am in dire need of help now, I am posting my question here. Hope I am not annoying you.

After struggling with challenging research for about 6 years, I ended up not having a first author publication. Suddenly, due to unforeseen circumstances, I might have to end my training with a Masters and not PhD. I haven't given the USMLE steps yet. Can you please guide me?

1. How competitive is Pathology residency?
2. I have 3 co-author publications, and I am working hard to finish my experiments before a deadline to have a first author publication. How much value does research experience hold for a Path applicant?
3. Will this 6 year gap affect my application?
4. Are there any equivalents of USCE in Pathology?
5. Any other suggestions you might have that can help me will be greatly appreciated. Thank you.

This is a bit out of my area. Most of your questions are answered in the NRMP's "Charting Outcomes in the Match" and the 2007 and/or 2008 match results. Specifically, in the Charting Outcomes you can look up the statistics of those that matched and didn't in pathology, including number of publications, USMLE scores, etc. The match results will show you which programs filled and which didn't, and which take IMG's, all of which should help you plan. Regardless, the next step is the USMLE's if you are interested in pursuing clinical training.

 

[NotAProgDirector]

Hi, I would appreciate any advice at all. I graduated from medical school in 1997 and did a transitional year at NYU/ Bellevue 1n 1998-1999. I started PM&R there and left on maternity leave in the late fall. Then, I was unable to return due to caring for a seriously ill child with multiple disabilities. I now want to reenter medicine and would like to get an FP position.

My undergraduate and medical schools are top notch, but I am well aware I am in no position to be fussy. What can I do to get a residency?

So far, what I have done is to contact all east coast programs that have had unfilled slots in recent memory and explain my situation. I found three programs this way that need PGY-2s. i have sent them all materials requested, and have already heard from one that they can't use me. Any better ideas? I am willing to fill a PGY-1 or PGY-2 position or anything in between.

Thanks

Trying to get a PGY-2 position is a disaster waiting to happen. Medicine has changed dramatically since 1998, and I expect your skills are rusty. No matter how smart you are, you run the risk of performing badly for your first months, and overseeing interns might be very uncomfortable for you, especially in a new program where you don't know the system.

You want to find a PGY-1 spot, at least for 6 months. You'll probably have to repeat your entire PGY-1. If you don't, you'll want to make sure that the ABFP will give you credit for your TY -- they may not, or may only give you partial credit, and then you'll need the additional training anyway.

Your best options are:

1. Contact programs that you might be geographically interested in, to see if there are open spots. Some PGY-1's might not show up.
2. Plan to enter the match this year, You'll be applying in November, which is not that far away.
3. You'll need to apply broadly. As a US grad with (hopefully) good USMLE scores but a distant grad date you will likely get some nibbles. Stress in your PS that you're ready to start over again given your hiatus from clinical medicine.
4. As programs interview, they might have an open off cycle spot -- someone drops out, someone gets pregnant, etc. You might get a prematch offer to start off cycle.
5. As a US grad with 1 year of training and passing Step 3, you can get a license in most states. Although no one will likely hire you with those stats alone, a license might allow you to get some clinical experience somewhere. Perhaps your original training program, or your medical school will help you out. 1-2 months of clinical experience with a letter will make a TON of difference.
6. Did you not take Step 3? That would be very unfortunate. If not, then you will need to take all three steps again to get licensed in most states. Perhaps taking them again (and doing well) would convince a program to take you. I would only do this if all of the above fail.

I will point out that you would want to make sure that your personal issues are in order. Residency is a very big commitment. It's not a 9-to-5 job. You should assume it's 7-to-7 at best, with uncontrollable late days which can be unpredictable. You can't not come to work because your child is ill, care provider didn't come, etc. There are some more benign programs, some with no overnight call, etc -- and you might want to focus on those if these are still issues.

Good luck!

 

[NotAProgDirector]

Hi, first of all i want to thank you for taking the time out to answer all of our questions, ive really learned a great deal from you. im beginning to research programs for my 2009 match and i had a question about committing to programs. lets just say i match at a program lower on my list, and then later on i have an opportunity to switch to one i had ranked higher. whats the policy on switching programs if youve already signed a contract with one? thanks for your help i really appreciate it!

If you MATCH to a program, then you cannot back out of the match. The match is binding on both program and applicant -- they must offer you a spot, and you must take it. If you try to swap as discussed above, both you and the other program can be considered match violators and you can be barred from further matches. Although individuals may be willing to do so (esp if you are not interested in a specialty), most programs will not as it could prevent them from matching anyone in future years.

If you PRE-MATCH to a program, then backing out for another contract can be done but some consider it either illegal, unprofessional, or some combination. Although it MIGHT be illegal, there really is nothing programs can do about it, as suing interns is not a valid strategy for success. Whether or not it is unprofessional is in the eyes of the beholder.

 

[NotAProgDirector]

Thank you for taking the time to answer questions in this forum!

My question relates to fellowship application. Hopefully it is not too specific.

I am an IM resident about to start applying for fellowship. Between medical school and residency, I took a year off and did basic science research in my field of interest, resulting in publications.

The circumstances were as follows. I matched at a well respected IM program in my 4th year of med school. For personal reasons, I withdrew from the spot (with the approval of the program director and the match - so no match violation involved), found the research position, and entered as a PGY-1 at my home institution (also a well respected program) the following year. I have performed well in residency, been involved in research and been offered leadership positions.

Although my fellowship of interest is not generally too competitive, I am interested in some of the more "high ranked" programs.

How do you think the programs will interpret my year off, and how can I best present it so-as not to appear like a flake? I really appreciate your insight. Thanks!

I doubt many programs will care at this point. Presumably, you had a reasonable reason to withdraw from the match in the first place, since the NRMP "blessed" your withdrawal.

At this point, I would just stress your research year and your residency. If you have done well, I doubt anyone will care about something that happened 4 yrs ago -- you have since proven that it's in the past.

 

[NotAProgDirector]

1. Which is better if I have to choose one: detail content from a regular private practitioner who knows me well or mediocre leter from a Uni Hosp doctor who just knows me?

2. Max LoR requested in ERAS is four. Do you think the more the better? (In the last episode of Grey Anatomy, one resident have 8 LoR!)

Thanks.

If you are applying for univeristy programs, then the Univ letter is probably better. If applying for community programs, then the private doc letter may be better. Much depends on what you did with these people. If the Univ doc "knows" you personally but hasn't worked with you clinically, then I personally find those letters useless and would favor the private letter.

More is NOT better. More makes you look foolish, wastes my time, and demonstrates that you cannot follow directions. Submit 4 letters, no more. If you think you might have a letter later in the application process, submit 3 at application and save one for later.

 

[NotAProgDirector]

Many DO schools do not have what would be considered a traditional allopathic sub-I. What is a SubI?

A Clerkship is a third year rotation. Usually, you work on a team with an intern, managing 1-3 patients. Most clerkships involve multiple "rounds" with senior physicians, presenting your cases, and usually a shelf exam at the end.

A SubI is a fourth year rotation. During a SubI, you usually work directly with a resident. There is no intern for your patients -- you are the intern, hence the name SubI = Sub-intern. SubI's are given as many patients as they can handle -- a good subI can handle around 5 patients at a time, sometimes more and sometimes less depending on complexity. You do what an intern does, and are treated just like an intern. It's a call block -- you're admitting and evaluating patients. Most consult / elective rotations are not considered SubI's, but an ICU certainly can be. So would be a subspecialty admitting service -- i.e. a Cardiology service or Heme/Onc service. Some programs offer outpatient Sub-I's -- again you would be given patients that you would be expected to interview, examine, manage, and document yourself with assistance from a faculty member or resident.

Is a SubI necessary? Not exactly, but it's nice to have a rotation where you were treated like an intern, and have an LOR from the rotation stating how your performance was.

As for your LOR's, if you plan to apply to Univeristy based programs, you'll be much better off with LOR's from univeristy programs.

Very few DO's get IM Department letters. There is nothing you can do about this, so that's why the rest of your letters are more important.

First off, thanks for providing us with this forum! I'm finishing up my 3rd year at an osteopathic medical school and want to go into IM - your advice has been wonderful! I don't have an IM advisor (all of our clinicals are at other sites, so we don't have a medicine department at my school) so I've really been struggling with finding answers to the following questions:

Is a sub-I necessary for an IM residency? (And how exactly is a sub-I defined? My school counts any month in an IM specialty, like GI or cardio consults, a sub-I; but I was under the impression a true sub-I must be in general IM with direct patient management responsibilities?)

Here's my problem: I'm from Chicago but went to medical school at a small osteopathic school in New England, which has been wonderful, but want to return to Chicago for residency. We arrange all of our MS4 rotations on our own, so I'm trying to set mine up back in Chicago. Our 4th year doesn't begin until August. I'm struggling to find a site in Chicago that will take me in August or Sept for a sub-I or even ICU (so that it's not too late to get a LOR from the rotation), as they give precedence to their own students. I can probably set up specialty rotations, though, but not at sites where there are residency programs. If I do need a general IM sub-I, would it count toward residency requirements if I set it up with a general internist in private practice or at a non-residency hospital? Or can a month in oncology or pulmonology fulfill residency requirements for a sub-I?

Finally, how important is it to obtain LORs from reputable institutions or physicians? I will have one from my MS3 IM core, at a hospital no one in Chicago will have heard of, and a departmental EM letter from well-recognized NY hospital. Should I arrange my August and Sept clerkships around getting LORs at reputable Chicago institutions, or will a good letter from a specialist at a small perhaps little-known community hospital be sufficient?

Last question - is a departmental LOR in IM necessary? (As mentioned above, my school doesn't have a department of medicine...)

Thank you, and my sincere apologies for the length of this message!

 

[NotAProgDirector]

Would it be accurate to say that the overhead costs of running your own practice in IM (malpractice insurance included) would be lesser than specialties like, surgery?

As a university based, salaried physician I'm not sure I'm really qualified to answer, but I think the answer is yes. For certain, the med mal insurance rates for IM are much lower than for surgery. So is the reimbursement for your clinical time, though. So overhead is lower, but so is gross income.

 

[NotAProgDirector]

Thank you for the clarification. I have a follow-up question - how does a program director know from the transcript whether the rotation was a true sub-I or not? (Presumably in a LOR this would be stated?)

I also have an unrelated question. I come from a long line of physicians in my family, so when I graduated college (almost a decade ago), I spent some time trying to get as far away from medicine as possible - I didn't want to default into it. I spent 2-3 years working several different jobs before I began graduate school. During this period, many jobs were 1-3 month 'temp' or seasonal positions, I jumped around through many professions, and I've lost record of whom my supervisors were (though apparently ERAS requires it).

Looking over the ERAS, it seems including my additional 5-10 seasonal jobs would bog down my application with irrelevant details, and would also make it more difficult for a program director to filter through to my later relevant long-term medical employment. I don't wish to be dishonest, as ERAS states I must list every job since high school. Is there any way I can simplify it? From the perspective of a program director, will listing all the temporary and seasonal employment make my application more difficult to look at?

For Allopathic schools, it will clearly say SubI on the transcript. For Osteopathic schools, it's mixed. In either case, it's the LOR that clearly defines what the rotation was like, and what your performance was.

Don't lose any sleep over your second question. PD's are much more interested in what you did in medical school than what you did beforehand. Presumably, your most recent jobs were the most relevant and will be listed first anyway. If ERAS tells you to list all jobs since High School, that's what you do. You can be brief about jobs in the distant past which are less relevant to your current career goals.

 

[NotAProgDirector]

Hello,
My current position is that I am starting prelim IM prog from July( accepted in scramble). I shall apply for Cat IM this year and be on look out for open PGY2 IM positions. I had requested for vacation of 1 week in Dec and 2 weeks in Jan and have been granted the same to cater for interviews. My prog ends on June 30 2009. I foresee that in future when I will start a new PGY1 or PGY2 position I will have to ask to be excused from orientation and may have to request permnisssion to join one or two days late. How do the PDs view such requests? Is it possible to be excused from orientation? Thanks

Sounds good so far. You are correct that you should be applying both in the match (for a PGY-1 Cat spot, if need be) and a PGY-2 opening. One of the best ways to find a PGY-2 opening is to apply as a PGY-1 -- programs with an open PGY-2 might offer it to you after interviewing.

I assume your current program only offers 3 weeks of vacation. This is unlikely to be a problem -- you should be up front about it but I expect most PD's will recognize the problem. It won't be much of a problem because a program can always put you into a non-overnight call block first -- outpatient, or ED, etc. You will need to do some sort of orientation (all hospitals require it), you'll be able to do that in the first week in July and then get started. I doubt you will have much problem with that -- esp with a PGY-2 spot, which rarely ever start on July 1 due to this issue, moving times, etc.

 

[NotAProgDirector]

I had to retake step 1 and got 99/242. I also got 99 on step 2 (1st attempt). Should I apply to those programs which ask for a score > 80/85 on first attempt ? Can the software also filter out multiple attempts? I am a recently graduated IMG with a solid US clinical experience. The multiple attempt is the only red flag.

I don't have a simple answer for you. There is no way in ERAS for PD's to filter out multiple USMLE attempts. They will of course see it when they review your USMLE transcript. Whether they throw it in their trash pile or not depends on the rest of your application. IMHO, most people who take multiple attempts do not score as well as you, so I expect that many PD's will review the rest of your application, but that's a guess. It's a gamble probably worth taking.

 

[NotAProgDirector]

After getting board certified in Family medicine if one wishes to pursue Internal medicine, then how much credit will he get for the rotations he did as a part of FM residency?

From the ABIM website:

For trainees who have satisfactorily completed some U.S. or Canadian accredited training in another specialty, the Board may grant:

1. Month-for-month credit for the internal medicine rotations that meet the criteria listed under (1) above PLUS
2. Maximum of six months credit for the training in a family medicine or a pediatrics program or
3. Maximum of three months credit for training in a non-internal medicine specialty program.

Up to 12 months credit may be granted for at least three years of U.S. or Canadian accredited training in another clinical specialty, and Certification by an ABMS member Board in that specialty.*

So, if you complete your FM training and pass the boards, you can get 12 months credit. But, it's not so simple. Only a PD or Chairperson can petition the board, and it's not guaranteed. The process is described here.

You can get 6 months credit relatively easily.

Either way, you can only get the credit from an IM PD.

 

[NotAProgDirector]

I am currently writing my personal statement for ERAS and having an incredibly difficult time! The reason I'm applying to internal medicine is because I want to be an endocrinologist. However, my gut tells me that writing about my passion for a particular subspecialty is not exactly what internal medicine program directors are looking for. How do I reconcile this? I realize that there is a need for internists everywhere - will my desire to pursue a fellowship rank me lower than those wanting to do pure internal medicine? I know what comprises the field and like it very much. Honestly I could write a personal statement for an endocrine fellowship in about an hour. I've been working on this for a month and am getting nowhere!

Thank you so much.

I personally have no problem with a PS talking about endocrine. Write your PS about what you like -- either inside or even better outside of medicine. As a PD, I really don't care if you're interested in plain IM or a fellowship -- I'm totally fine with either.

 

[NotAProgDirector]

Hello,

Thanks for volunteering in this forum and helping us... i hav few questions..

1) Im a IMG trying for 2010 match.. I ve graduated from my med school 2 months ago and im givin my step 1 next month.. my problem is i ve done 3-4 small clinical research works during my med school.. very simple studies.. i presented 3 papers in conferences in my country with one paper in a asian-pacific conference.. however i ve not published any of them in journals as i didnt realise their value then. now im preparin for my steps.. my question is do i have to try to write them up n try to get them published?? they r mostly simple statistical studies as my medical school has no research funding and does not show any interest towards reseach activities. if i write the papers now compromising my study time will it be of any use?

2) through some contacts, i managed to secure a observership in cardiology in a reputed university. how useful is a observership for an IMG like me?? also how useful is it for IM residency, if i do an observership in cardiology.. also does more observerships strenthen ur CV?? i can get another observership in IM in another univ affiliated community hospital if i try but i think it may compromise my preparation for the steps. also the misc costs occuring during the observership is also a factor..

3) wat do we actually do in a observership?? wat does a typical day include??

4) also as a progdirector, wat do u expect from a IMG ??

Any advise is highly appreciated.. im confused.. Thanks a lot!!!

1. Your USMLE scores are critical. Do not spend time writing up a small research project that may or may not get published here in the US. If you have a mentor here in the US who reviews your data and says they can help you get it published somewhere, then that's fine.

2. The value of observerships is debated. Most university programs are not impressed, because as an observer you can't actually do anything, so it's hard to know what your skills are. Still, it's probably better than no US experience.

3. You cannot touch or examine patients, write orders, or otherwise actually do anything. You observe. Perhaps you get asked questions. Honestly, I don't know.

4. The same things I expect from AMG's.

 

[NotAProgDirector]

What is the IM "in training exam" in residency? Is it very important?

There is a sticky FAQ about the IM ITE here.

In summary, the ITE is a "low stakes" multiple choice question exam given to most IM residents in October. It is theoretically for your use, in assessing your knowledge. It should not be used for fellowship applications, and should not be used for promotion decisions. Of course, in some programs, I expect they are used for these purposes -- there was a poster once who mentioned that the prelim who got the highest ITE score was given a categorical spot -- whether this is true or not is anyone's guess.

 

[NotAProgDirector]

Are conference presentations considered equal to publishing in a journal??

Also if i do get it pubished in a indexed journal in my country will it be counted or they expect only american journal publication??

Also do community programs n Univ. affliated community programs expect research credentials??

Regarding the visa issue, during my interview can i ask the program for a H1b visa?? if im goin thro the match how can i indicate the preference for a H1b visa?? also i heard that most univ. programs dont offer H1b.. is it true??

In general, a journal publication is more "prestigious" than a conference presentation. However, it depends on the journal and the conference.

Publication in a journal is more impressive as the stature of the journal rises. In general, in the US the US / Canadian / European journals are the highest regarded. This is not to suggest that journals in other countries are not of any value -- it's just that the person reviewing your application needs to be familiar with the journal to have some sense of it's worth.

I don't know if Community or Univ Affiliated programs require research. I expect they review your entire application, and that an IMG from a known school, with good USMLE's, and some US experience but with no research would get a good number of interviews.

I've answered many visa issues in this thread. Take a look there and see if that answers your visa questions. Many programs advertise the types of visas they offer on their websites, or you can call the program administrator.

 

[NotAProgDirector]

I will apply to urology, and internal medicine as a back up. Howver, urology needs the AUA ID # on CAF. Do I need to put this AUA number in the CAF before early urology match result? If this number shown in CAF, can the PDs see this number and affects the internal medicine match?

Many thanks

A great question. I am "between ERAS's" -- i've uninstalled ERAS 08 and installed ERAS 09, but I don't have any data yet for 09.

I looked at an old application for ERAS 08, and nowhere was there a spot for AUA number.

In ERAS 09, I can't filter by AUA number (i.e. I can't ask it to show me all the people who have one or don't). So, it looks like AUA numbers are not visible to IM PD's. I'll be able to update this next week, once I have some real data to look at.

 

[NotAProgDirector]

I have 1 publication in an academic journal and 1 more paper from my research currently being reviewed for publication. I completed the work before I came to medical school but my last paper will be published while I am in medical school. Will this help me when I apply to residency programs? Do programs want to see research done while in medical school? I would like to go to a decent program in the Southeast and want to specialize after completing my IM residency.

Yes, it will. List it on your application proudly.

 

[NotAProgDirector]

I am an FMG doing prelim IM and do not have another destination program. I want to do categorical IM prog. I have asked you several questions on this forum earlier this year and appreciate your response. I have 3 LORS from the 3 cardiology attendings in My first block of CV consults. I am applying for both PGY-1 and any PGY2 openings in the current season. I will now ask for LOR from my PD. Should I assign the 3 LORS from cardiology to all my applications and apply on Sept 1st or wait till I have the PDs letter and then submit my applications?
I do not like the idea of all 3 LORs from 1 block. I have a few LORs from the my college in India and work experience in India. Should I use these LORs from India for now? When I get a LOR from my PD or a block 2 attending can I change the LORs assigned to my application? Or is it a good idea to submit my application after I have the PDs LOR. I hope I have been able to convey my dilemma. Appreciate your help.

Several thoughts:
1. All of your LOR's should be from your internship.
2. A PD LOR will be very helpful.
3. I agree that three letters from a single block is less than ideal.

Your second block should be finising soon. Chances are there is someone you could already ask for a letter. Do so now.

Apply now, submit 2 cardiology letters. Add the PD letter and the block 2 letter ASAP. Alternatively, if you have something Block 3 that you think would generate a nice letter, submit 1 cards letter and then add the block 2 letter, block 3 letter, and the PD letter. Should a block 3 letter not come through, then you can always add another cards letter.

The PD letter is the key one here.

I am assuming your home program doesn't have a spot for you -- that would of course be the easiest course of action.

 

[NotAProgDirector]

How important is it to submit our ERAS early? Will I have better chances if I submit now versus later in September? (I'm still waiting on LORs)

It somewhat depends on whether you're an allopathic, osteopathic, or IMG applicant. If you're allopathic, then it doesn't matter much. Hypercompetitive programs will be waiting for MSPE's. Less competitive programs will offer interviews on a rolling basis, but will likely make room for you. Regardless, anytime before Nov 1st is fine.

If you're a DO or an IMG, the process is more complicated. You might apply to programs that take people outside the match. If so, earlier interviews are better than later interviews, so it's best to apply early. Still, later in Sept is likely not too late.

Sorry, another question - regarding the LORs, I have a strong one from my IM core 'discipline chief' (my school has no dept of medicine, so that's the closest I can get). I'm waiting on one from my EM elective, and was told it would not be written until mid-September. I'm also waiting on one from my MICU rotation, which was supposed to have been finished last week but I haven't heard from the writer.

I have not done any other electives in medicine or my sub-I yet, so I'm in a pinch for back-ups. If either or both of those two falls through, I will only have one IM letter. Would a letter from a family medicine attending be an acceptable alternative? How many of the 3 requisite LORs should be IM, and if I can get a good third one in October from my sub-I, should I wait until then to submit my ERAS, or should I submit now with only one IM and perhaps an FP and an EM (or hopefully ICU) LOR?

An FM letter would be fine. IN the end, it would be better if you had at least 2 IM letters. That could easily include your medicine SubI. So, I agree with your plan. Send three letters now -- IM, MICU, and EM if available. If one of the latter falls through, replace with an FM letter. Send the SubI letter later when available as a 4th letter.

A couple more questions...

How unwise is it to limit myself to a single city for residency applications (a city that has over a dozen programs, but only a handful university based...yes, I am thinking fellowship)? And if I do limit myself geographically, would it make sense to apply for both categorical and prelim positions to increase my chances for a university-based program?

Also, if I have a first-authored article that's currently in press, which I also presented at a couple of conferences prior to its acceptance, should I list the conferences as well (same title) or just limit it to the in-press pub?

Whether this plan is wise or unwise depends on how badly you want to be in that city. If that's where you need to be to be happy, then that's what you do. If you're doing this on a whim, then yes it's a silly idea. I assume you have a family issue that limits your options. There are many threads about people being miserable in their residency because they left their family behind.

Applying to both Cat and prelim is a double edged sword. Perhaps you get "two chances" to get in, but it also could hurt you as some programs might get confused about what you are looking for, or perhaps you're applying to advanced programs and just using IM as a backup, or it suggests that you don't think you deserve to get in. So, what I'd do is apply to categorical programs. if you don't get an interview, then consider contacting the program and seeing if you could apply to the prelim program instead. Or, if you do get an interview, you might ask to be listed on their prelim list also (but this risks the questions above). But I'd avoid applying to both tracks.

As far as the article is concerned, I think you could list the publication, and then in the "research experience" section state that it led to a poster presentation (at wherever) and a publication. You could list both the poster and the publication also. Honestly, I don't think it matters much which way you do it.

 

[NotAProgDirector]

I will be doing an epidemiology elective with the CDC this winter, and have already been assigned a mentor. Is there some way to list this on ERAS, even though it is a future endeavor? I'm not certain either whether it would be considered research, work, or volunteer...

If it's an elective that you'll be getting credit for as part of your degree, then it's not really any of the above. If you want to list it, then I'd choose research since that fits best. Be VERY clear that this is a future rotation that you have not yet done.

 

[NotAProgDirector]

Hi AProgDirector ,

Will there be a problem after one year of Prelim Surgery PGY1 to move to IM PGY1? I have heard that IM PDs do not like Prelim Sx PGY1 coming to IM PGY1. Is it true? One year prelim Sx pgy1 experience is counted as US clinical exp? I thought something is better than nothing. I see a lot of unmatched prelim sx positions every year.

Thanks

There are many unfilled prelim surgery spots. That should be a warning of a problem.

The good news:

1. Prelim surgery is definitely "US Clinical Experience". You'll get a chance to examine patients, write orders, etc.
2. It's a job, you get paid.
3. I can't really think of any more good news.

The Bad news:

1. If you don't love surgery, many find prelim surgery is a miserable year. Usually, the prelims get locked out of the OR (as the categorical interns get first dibs on cases) and stuck manning the floors. There might not be much teaching. The hours can be brutal.
2. Prelim surgery promises no further training. Remember that all of the prelim surgery interns are trying to outdo one another in the hopes that if a categorical spot opens, they'll get it. It can be a very competitive environment, with all the backstabbing of a soap opera.
3. Are you planning on interviewing while you're a prelim surgical intern? Exactly how do you expect to do that? You'll need to use your vacation time (which makes the prelim year that much harder) and there's no guarantee that you'll be on a block where you can take vacation in Dec or Jan.
4. You will get no credit (or a max of 3 months, which is essentially nothing) in IM for any surgical training.
5. It will use one year of funding, so you will be one year short of funding. This can be a problem for some programs.
6. If you burn out / fail out / quit early, you will make it much harder to get a spot in the future.

I think your question can be reduced to this scenario: I applied last year and got nothing in the match or the scramble. I'm going to try again this year. Is a prelim surgery spot better than nothing?

It's a hard question to answer. If you do well, with some luck you might be able to get a spot in another program, having proven yourself in the US healthcare system. Logistically it's difficult to get from a prelim surgery year to something else, but it can happen. The larger the institution you are in, the more likely there will be an opening somewhere. It will be easier to transition within the same institution than transferring somewhere else. If you don't like surgery, this can be a nightmare. Approach with caution.

 

[NotAProgDirector]

Hi

I have heard each program receives extremely high vol: of applicants this year. One program has received about 500 applications for 4 postions. So what are unique ways to screen to get a good applicant? More or less, a buch of them are similar in qualifications, I guess. So does the program choose based on PD's gut feeling as applicants do nowadays as we don't know what a program exactly looks for (even though we know some per program's website). So applicants are seeking for luck (applying more programs like playing lottery; more application, more chance). Or they find a good contact in the program and get in? Possibly there might be a bribery in future? Is there any solution for this sort of crisis (like financial) for programs in near future? I mean any cooperative movements among programs? Do you think ERAS should limit the number of applications per applicant? This way, applicants can save money; similarly programs can save time and energy. ERAS of course will earn less money.

Even AMGs need to apply for more programs!

Another thing is whether you think ERAS/NRMP should have a rule that all programs must go 'matching' (no prematch) to have a fair and square for all and to avoid playing game by some applicants.

Thanks for your opinion and comment.

In some fields, the competition is fierce. There's no magic here -- PD's use the usual things to help narrow down their interview offers: Perceived quality of medical school, grades, USMLE scores, letters from someone known to the PD or known in the field, and research. How much each of these is weighed is dependent on the program. Also included is how likely you are perceived to actually come to that program -- i.e. if all of your prior training / living is in Texas, perhaps some NE programs will choose to interview people that seem comfortable with cold winters.

Will there be bribery? I doubt it. As competition increases, the "who you know" component to applications will clearly increase. This isn't a crisis for programs, other than the work of reviewing 400 applications. But honestly, it can be done in a relatively short period of time.

Should ERAS limit applications? I think this would be a complete disaster and not supported by programs or students. Almost certainly students would start sending applications via email once they reached their "limit", and programs would want to review those applications.

What else could be done? if programs are truely unhappy with their large number of applications and want a smaller number of "more serious" applicants, they only have to create a secondary application with an application fee. I am surprised that some of the competitive programs have not done this yet.

On a completely separate note, there has been much talk of an NRMP "all in" rule. The theory is that if you forced programs to be "all in" (i.e. all spots assigned in the match or all prematched), programs would tend to stay in the match, and this would force DO and IMG applicants into the match. Theoretically, if everyone's in the match, the whole process is fairer (if you agree that the match is fair). The process was stopped by PD's, mainly because many felt that prematches were necessary due to visa processing times. At the current time, there is no forward momentum on this issue of which I am aware.

 

[NotAProgDirector]

Hi,

A couple quick questions:

Should I "withdraw" from programs on ERAS that I'm no longer interested in? There are some I've received interviews from that I haven't responded to, and others I haven't heard from. In either case, what is etiquette?

I know opinions vary on post-interview thank yous...what is yours? Yes/no, handwritten card vs typed letter, interviewers vs PD vs chairman vs all?

Thanks! (And Happy Thanksgiving!)

Yes, I would withdraw from programs that you are no longer interested in. Don't waste your time or their's. You should also contact the program directly (email is fine), if you have been offered or scheduled an interview. If scheduled, you want to be 100% sure they know you will not be coming.

As far as post-interview notes, there are many threads about this. Some people feel it is the right thing to do to be polite. It's unlikely to alter your ranking. The rest of your questions are otherwise moot -- do what you want.