Worth duel applying to academic IM with missing key application pieces this late in the game?

[IrishWolverines894]

TLDR: OMS-4 previously dead-set on FM is now seriously considering duel applying FM/IM but is not sure if its wise to do so with no Step 1 or audition rotations and minimal research. Is seeking advice/answers to questions in post.

I apologize in advance for this being long, I know I am pretty late to the game regarding researching other specialties, but I am hoping to seek impartial advice from those who have gone through match for IM already or other OMS-4’s who are planning to apply this cycle and have been more “in tune” to applying IM. I doubt anyone is in a similar situation, but if so that would be awesome to get your insight as well

Background:
I go to a newish DO school and I have always been set on applying to FM. I like primary care a lot and its the most DO-friendly speciality. However, I finished a GI elective in august and I enjoyed it far more than I thought I would, in fact it is without a doubt my favorite rotation to date. I enjoyed it so much that I began to think about the idea of duel applying to IM. I contacted my school advisor and local community IM PDs for which I did 3rd year rotations with. All of which told me roughly the same things = get a chair IM letter from the school, a LOR from an IM PD, write a good PS surrounding why IM and dont sit for Step 1 with focus only on Step 2, since that’s what IM cares about with step 1 being p/f.

I didn’t even bother with Step exams at this point in my medical school career because I was only focused on FM and I knew that Comlex or Step was required, but not both. However, after studying and sitting for Step 2, I researched more information about applying to GI fellowships online and I am realizing (a bit too late) that I may have been given false information. It seems as though GI is super competitive, far more than anyone I was talking to up to this point was letting on, and you only have a good chance if you go to an academic or university affiliated IM program. I talked with a few colleagues at my school who I know are applying academic and they are under the impression that without a numerical scored Step 1, 4th year audition rotations and significant research under your belt, your pretty much DOA for academic IM and looking pretty bleak for university affiliated IM.

Honestly I keep going back and forth in my own head. On one hand, I would still be more than content with FM and I am frustrated with being fed what seems like misinformation about getting into a GI fellowship (prior to be digging in deeper myself). But on the other hand part of me feels like if I dont try, I might regret not doing so. However, if there really is no reason to apply IM because I am missing key components to my app and therefore its futile to even try, then maybe I should just forget IM altogether and stop stressing about this so close to application day.

Thank you for listening to the ramblings of a madman and for any advise anyone can offer!

Questions:
1) With no Step 1, minimal research and no IM audition rotations to date, is it worth even applying for IM?
2) Is IM a field you would even recommend a MS-4 to consider applying for if they are ONLY interested in GI as a subspecialty and only just thought about applying to IM within the last month or so?
3) If I should apply, Should I sit for Step 1 at this point even though its p/f and I wont get my score in time for when we have to submit apps on 9/28?

Current Stats:
- Step 1: N/A
- Step 2: 26x
- Level 1: 61x
- Level 2: 68x
- Clerkships: 6 honored, 1 HP (gen surg)
- Class rank: top quartile
- Research: 1 publication and 1 poster presentation but neither are GI related
- Volunteer/work experiences = 9/7 (not sure how much these actually matter for IM)

---

Members don't see this ad.

 

[Dr. Puffs]

1. Yes, you'll match somewhere.
2. No. the experience of IM vs FM residency is very, very different. If you didn't like rounding and inpatient rotations you will not like IM. And GI is one of the most competitive $ub$pecialtie$. As a DO, even if you go to a large University IM program you will have to put in a ton of work to get real research to get your application up to par and you will still be looked down upon.
3. No do not take step1. Your board scores are good enough to match somewhere and taking step 1 now is just dumb.

I'll tell you what I tell all DO students who want to do GI or another competitive sub-specialty. Your BEST chances of matching a competitive sub-specialty is to go to a previous AOA program (historic DO program) that has all of the AOA fellowships. These are smaller community hospitals that are very incestuous. Almost all of their fellows graduated from their residency programs, and there are a lot of these in Michigan.

However you need to seriously think about this. Last second applying to IM, a very different field than FM, because you want to do GI is asking to be very disappointed. I also thought I wanted to do a competitive fellowship until 3 months into intern year when I realized it was not for me. Plus, did you even like your IM rotations? You're about to spend many many months on 12 hour shifts inside a hospital working 72-80 hours a week whereas my friends in FM programs have a lot of weekends off, way, way way way more clinic, and only a few inpatient rotations total.

Also, not every program requires an IM chair letter. A lot of the smaller DO programs do not. I think you should apply to IM programs, see what happens. The only downside is you're going to spend a lot of money. But you'll have a few months to decide if you want to rank IM or FM programs first.

 

[NotAProgDirector]

1. It's impossible to say what IM programs will do with a P/F S1. Some programs consider DO's with just COMLEX - even univ or univ affiliated programs. And some don't. If you could go back in time, taking S1 would simplify issues. But you can't. No IM SubI is probably going to be the bigger issue.

2. I wouldn't recommend that anyone, MD or DO, train in IM with a GI-or-bust plan. GI is very competitive. Good people don't get spots. But in your case, you're looking at FM also -- so your plan B in IM can just be primary care.

3. I don't think S1 will add much. No program is going to interview you and then only rank you if you pass S1.

If you decide to do this, I would apply only to IM programs that have a GI fellowship in house. That will greatly enhance your ability to get research projects, and networks with GI docs who are in training programs. Unless you'd be happy with an adult-only IM primary care career, I would not consider community programs with no GI fellowship. Although it's possible to get a GI fellowship from a program like that, it's much more difficult.

 

[voxveritatisetlucis]

Would be tough to get academic IM with these stats and as you know GI is the toughest fellowship. Best chance would be community or communiversity program that has an in house fellowship

 

[DrStephenStrange]

Would be tough to get academic IM with these stats and as you know GI is the toughest fellowship. Best chance would be community or communiversity program that has an in house fellowship

Besides not having Step 1, I think OP's stats are above average to match academic IM actually. Some university programs will consider DOs without Step 1.

 

[voxveritatisetlucis]

Besides not having Step 1, I think OP's stats are above average to match academic IM actually. Some university programs will consider DOs without Step 1.

Even still Isn’t it hard to get GI from low tier university. Was looking at Penn State IM fellowship match and only saw like one or two GI over the past few years

 

[DrStephenStrange]

Even still Isn’t it hard to get GI from low tier university. Was looking at Penn State IM fellowship match and only saw like one or two GI over the past few years

You're right about GI. Was just clarifying that OP can definitely match into a university program.

 

[IrishWolverines894]

1. Yes, you'll match somewhere.
2. No. the experience of IM vs FM residency is very, very different. If you didn't like rounding and inpatient rotations you will not like IM. And GI is one of the most competitive $ub$pecialtie$. As a DO, even if you go to a large University IM program you will have to put in a ton of work to get real research to get your application up to par and you will still be looked down upon.
3. No do not take step1. Your board scores are good enough to match somewhere and taking step 1 now is just dumb.

I'll tell you what I tell all DO students who want to do GI or another competitive sub-specialty. Your BEST chances of matching a competitive sub-specialty is to go to a previous AOA program (historic DO program) that has all of the AOA fellowships. These are smaller community hospitals that are very incestuous. Almost all of their fellows graduated from their residency programs, and there are a lot of these in Michigan.

However you need to seriously think about this. Last second applying to IM, a very different field than FM, because you want to do GI is asking to be very disappointed. I also thought I wanted to do a competitive fellowship until 3 months into intern year when I realized it was not for me. Plus, did you even like your IM rotations? You're about to spend many many months on 12 hour shifts inside a hospital working 72-80 hours a week whereas my friends in FM programs have a lot of weekends off, way, way way way more clinic, and only a few inpatient rotations total.

Also, not every program requires an IM chair letter. A lot of the smaller DO programs do not. I think you should apply to IM programs, see what happens. The only downside is you're going to spend a lot of money. But you'll have a few months to decide if you want to rank IM or FM programs first.

Thank you for your response I truly appreciate the insight!

I will take the next 2 days or so and truly think about this. I didn't mind my inpatient IM rotation, doing rounds and working on the floor with the inpatient team. But if I’m being honest, I think i would be disappointed being an internist rather than being an outpatient PCP... so while the ceiling of GI is appealing to me, I think the metaphorical floor of being an internist/hospitalist might not be worth it.

 

[IrishWolverines894]

1. It's impossible to say what IM programs will do with a P/F S1. Some programs consider DO's with just COMLEX - even univ or univ affiliated programs. And some don't. If you could go back in time, taking S1 would simplify issues. But you can't. No IM SubI is probably going to be the bigger issue.

2. I wouldn't recommend that anyone, MD or DO, train in IM with a GI-or-bust plan. GI is very competitive. Good people don't get spots. But in your case, you're looking at FM also -- so your plan B in IM can just be primary care.

3. I don't think S1 will add much. No program is going to interview you and then only rank you if you pass S1.

If you decide to do this, I would apply only to IM programs that have a GI fellowship in house. That will greatly enhance your ability to get research projects, and networks with GI docs who are in training programs. Unless you'd be happy with an adult-only IM primary care career, I would not consider community programs with no GI fellowship. Although it's possible to get a GI fellowship from a program like that, it's much more difficult.

Thank you very much for your insight!

I think because you are correct with the “GI-or-bust plan” train of thought that I am having, that perhaps I should just apply to IM with in-house GI only + FM like I was planning too and maybe just feel it out on the interview trail? While I didn’t mind doing inpatient work, and would certainly be open to doing it if the ends justified the means, I almost can guarantee I would be regretful of my path if I was stuck internist work my whole life With no Fellowship. I feel like at that point I would be happier as broad scope-trained outpatient FM doctor.

 

[NotAProgDirector]

The scope of outpatient work in IM is rather enormous. No kids and no OB. Otherwise, you can totally have an outpatient life in general IM. Just sayin'.

Still, if you think you'll be happier in Fm, go for that.

And I hate to be "that guy", but it's "dual applying". Duel is a swordfight.

 

[FutureDoctor5000]

A 260 step 2? Y’all are crazy… OP will get some solid university IM invites, including some top 30-40 ones, as long as he/he applies boradly(even as a DO), matching GI won’t be easy but will be easier from a university IM program that’s has in house fellowships. I know this from experience as I applied IM as a DO this past cycle with scores much lower than OP..

 

[FutureDoctor5000]

We have a very large IM program that matches <2% DO (top 30 program according to the Redit IM tracker). OP has the step 2 score for our IM program, but fellowship to the in-house GI program looks tough. I found one DO back in the 2000 timeframe in the in-house GI program.

I mean if your program is 2% DO’s it will obviously be hard to find DO’s that routinely match gi at your program so that’s not surprising