IM as a back-up

[zizoupanda]

IM was pretty competitive this year. For those going into considering surgical specialties such as plastics,ophtho,...; is there any value in doing 1 pre-carms elective in IM or will the applicant not be taken seriously for IM in that case and is better off maximizing pre-CaRMS elective in the competitive specialty  (i.e. doing 5 out of 5)?

Second related questions how hard are Family, Path and RadOnc spots to get in the 2nd round if you no geographical restrictions but if you don't do electives beforehand or at best post-CaRMS electives?

Thanks for any insight!

[Snowmen]

My opinion is that you should go almost all out if you're targeting a competitive specialty but still a legitimate buy out for yourself if things don't work out. It seems that IM no longer is a reliable backup with how competitive it has gotten, even for IM gunners. A good way to back up would probably to go the FM or psych route in my opinion. One elective pre-CARMS and then perhaps your post-CARMS elective allows you to show some interest. The elective allows you to try and get a LOR. You can get another one during your core rotation which lets you have 2 specific letters. If those core rotations are after your electives like they are at my school, you could even pull the "I didn't get exposed to that specialty before choosing my electives and therefore didn't know I was interested" card.

I'm just finishing first year and therefore might not have the most accurate advice for CARMS, but that looks like a decent strategy to me.

[hamham]

I did not gun for surgery, so I won't be able to answer your 1st question.

As for your 2nd question, the availability of RadOnc and Path spots in the 2nd iteration depends on interest, which may vary from year to year. Most Path and RadOnc programs also wish to see evidence of interest in their programs (electives, shadowing, research etc), and would rather leave their spots unfilled than fill them with candidates whom they think are not worthy. 

There are definitely FM spots that go unfilled after round1, but most of them are from French programs. Don't expect FM spots to be available in popular programs like Toronto or UBC. FM spots in English programs become highly competitive in round2 b/c you now have to compete with IMGs and PGYs who are trying to transfer to FM (believe me, there are so many people trying to transfer to FM). Some of these people would kill just to get one of those FM spots in the English programs in less desirable locations.

So in short, try to match in round 1. If you don't match in round 1, some people prefer to wait a year before applying again because there is just so much competition for less desirable residency specialties in less desirable locations in round2.

[ralk]

It's still possible to back up into IM, though I wouldn't bank on a single elective to get you there. Some disciplines lend themselves nicely to having some IM electives without it looking like an obvious back-up - say, going for Gen Sx while doing a GI or Oncology elective - and in these cases a bit of a split in electives could lead to a reasonable chance at backing up into IM without affecting the chances at the intended discipline too much. However, when that elective synergy isn't readily available, splitting electives is generally a bad idea - never make anything more than a trivial sacrifice to your primary specialty application for the sake of a back-up.

With few exceptions, the 2nd round is not a safety net to be counted on. Too many people competing for too few spots - even good candidates who can show some interest in the field they're applying to in the 2nd round end up with nothing.

FM remains the main back-up specialty - an elective or two is all that's often necessary, especially if you can get some LORs in clerkship. Nowhere near a sure thing, especially if the rest of the application screams that you're gunning for something else, but if you're going for a competitive specialty and worried about going unmatched entirely, FM is still the safest bet.

Edit: Also, wanted to push back against the notion of Psych as a back-up specialty. Like IM, it's gotten more competitive recently and has minimal cross-over with the traditionally competitive specialties. Not really a great option.

[zizoupanda]

Thanks for the answers guys, I really appreciate it. So I am a bit confused. If I do go for a competitive specialty, is it a do or die situation? If backing up is near impossible (unless it is FM) and the 2nd round isn't assured, what then? Is a second attempt at the first round of CaRMS as a previously failed candidate not safe either? As much I would like to do a surgical subspeciality, I am not willing to take the risk if it entails not ever matching to anything and having no career with >150k debt.

Also another question, do programs have any idea what order you did your electives in (i.e. can they tell which ones you did pre and post-CaRMS)?

[ralk]

25 minutes ago, zizoupanda said:

Thanks for the answers guys, I really appreciate it. So I am a bit confused. If I do go for a competitive specialty, is it a do or die situation? If backing up is near impossible (unless it is FM) and the 2nd round isn't assured, what then? Is a second attempt at the first round of CaRMS as a previously failed candidate not safe either? As much I would like to do a surgical subspeciality, I am not willing to take the risk if it entails not ever matching to anything and having no career with >150k debt.

Also another question, do programs have any idea what order you did your electives in (i.e. can they tell which ones you did pre and post-CaRMS)?

It can seem like do-or-die, but that's probably a bit simplistic. Many people still manage to back up from competitive specialties, but that's easier in some specialties than others - for example, Derm and Emergency Medicine are both very competitive, but have high back-up rates, in comparison to specialties like Ophtho where most applicants either get it or get nothing first round. A good number match in the 2nd round, but there are no guarantees and there's so much that's simply out of your hands at that stage. The remainder go through CaRMS again next year, some aiming for the original, competitive specialty they wanted the year before, others going for less competitive options. It's not a safe option either, but still has a decent success rate for candidates who get to that stage.

Overall, even among candidates who do not match in the 1st round of their graduating year, a strong majority of people eventually match. The best shot is always during the 1st round of the graduating year, and none of the routes to residency after that point are particularly appealing, but all those routes combine together to produce very good chance of matching at some stage.

If you're looking at a surgical specialty, the best advice I have from the experience of classmates and looking at match stats is to gun hard for it in the 1st round. If you want to guard yourself against a worst-case scenario, do an FM elective or two, even if it's post-CaRMS, and apply to FM programs in less desirable geographic locations as a 1st round back-up. If you can't see yourself in FM ever, then try for IM instead - it's still likely the second-best back-up option - but understand that the chances of backing-up into IM are much lower than FM.

Programs do see what order you did electives in, as they have to be entered in the CaRMS portal (and should probably be listed on your CV as well).

[indefatigable]

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[gsmith]

On 6/12/2017 at 7:56 PM, zizoupanda said:

Also another question, do programs have any idea what order you did your electives in (i.e. can they tell which ones you did pre and post-CaRMS)?

CaRMS does not see your post-CaRMS electives. You can put it on your CV but they won't believe it. At least this has been my experience. I got asked specifically about why I did X electives in the specialty I was applying for, and they did not count my post-CaRMS one.

[Caliver]

I think this depends on your institution. For example, at U of T, I'd say it was almost impossible to back up with IM if you were going for a competitive specialty, because the IM program at U of T is very competitive and will not consider you unless you are "serious" about IM. Essentially, your "home" program does not render you any advantage if you "back up" with them. 

If you are from a smaller school, I'd imagine the situation is a little different and you may be able to back up with IM. 

[psychiatry2017]

I know a few people who backed up with IM who got UofT IM interviews. The key is that they are excellent medical students, and did 1-2 electives in IM (pretty split up their electives). 

For now, I think that IM selection committees put more emphasis on the quality of your application, than your motivation or how many electives you did. IM is the second biggest specialty with the most spots, I think that the selection committee is used to see back-up ''applications''.

What sucks is that those true IM gunners won`t have more advantages for interviews over those gunning for more competitive specialties, with a better academic dossier. 

[Caliver]

1 hour ago, psychiatry2017 said:

I know a few people who backed up with IM who got UofT IM interviews. The key is that they are excellent medical students, and did 1-2 electives in IM (pretty split up their electives). 

For now, I think that IM selection committees put more emphasis on the quality of your application, than your motivation or how many electives you did. IM is the second biggest specialty with the most spots, I think that the selection committee is used to see back-up ''applications''.

What sucks is that those true IM gunners won`t have more advantages for interviews over those gunning for more competitive specialties, with a better academic dossier. 

I spoke to some IM staff about this. You can get IM interviews but you likely won't be ranked highly at the end. Some staff told me to do at least 1-2 CTU electives (3 weeks each). Take this with a grain of salt, as it is "unofficial" and it is an online forum. Similar deal with Toronto FM. Personally, I did not apply to IM as a backup, so I don't have a first-hand experience, but I did observe what happened to some of my classmates. 

They do take your motivation into account (at least what I was told.. as above). If your electives consist of 5 urology electives + 1 IM elective, it seems clear to them that you want urology. They don't like being considered as "back up." At least this is the case at U of T. 

If your other choices are family medicine, psychiatry, etc. etc, mixed with a handful IM electives, then you likely have a higher chance of getting that IM interview. 

Obviously, life is about making choices. OP will need to make a decision on what to do and take risks accordingly. 

[ameltingbanana]

Beyond the statistics for IM (which paint it as a competitive year), anecdotally, I know several individuals at various schools (who I felt were strong and capable applicants for IM) this year who didn't get nearly as many interviews as they were hoping. I would do at least 2 CTU or IM-oriented electives (e.g. a month total) that you knock out of the park to demonstrate interest and snag stellar reference letters. 

Edit: and as mentioned before, depends heavily on the site/program for IM

[Edict]

On 6/12/2017 at 5:06 PM, zizoupanda said:

IM was pretty competitive this year. For those going into considering surgical specialties such as plastics,ophtho,...; is there any value in doing 1 pre-carms elective in IM or will the applicant not be taken seriously for IM in that case and is better off maximizing pre-CaRMS elective in the competitive specialty  (i.e. doing 5 out of 5)?

Second related questions how hard are Family, Path and RadOnc spots to get in the 2nd round if you no geographical restrictions but if you don't do electives beforehand or at best post-CaRMS electives?

Thanks for any insight!

I'm pretty cautious about backing up with IM especially if you have only one pre-CaRMS elective in it. I would back up with family or psych or peds instead. If you can make a reasonable argument for IM and have at least 2 electives in IM or IM sub-specs its more reasonable to apply as a backup. 

[ArchEnemy]

On 6/12/2017 at 5:06 PM, zizoupanda said:

IM was pretty competitive this year. For those going into considering surgical specialties such as plastics,ophtho,...; is there any value in doing 1 pre-carms elective in IM or will the applicant not be taken seriously for IM in that case and is better off maximizing pre-CaRMS elective in the competitive specialty  (i.e. doing 5 out of 5)?

Second related questions how hard are Family, Path and RadOnc spots to get in the 2nd round if you no geographical restrictions but if you don't do electives beforehand or at best post-CaRMS electives?

Thanks for any insight!

I knew a stellar candidate applying for a highly competitive specialty who backed up with IM and did 3 electives (2 pre-CaRMS) in IM. This candidate received multiple interview invites for the highly competitive specialty, yet did not receive any IM interviews at UofT, Mac, Calgary, UBC or UofO. 

IM is getting more competitive and may not be a viable backup option for many anymore.

[bearded frog]

4 hours ago, Edict said:

I would back up with family or psych or peds instead.

Note that pediatrics was more competitive than internal medicine this year, based on the ratio of number of spots to first-choice applicants (0.77 vs 0.97), so would be a poor back-up choice without demonstrated interest. Although there were probably more second choice internal applicants than pediatrics.

Edit: for reference, psychiatry was 1.01 and family 1.38. Found here.

[ralk]

1 minute ago, bearded frog said:

Note that pediatrics was more competitive than internal medicine this year, based on the ratio of number of spots to first-choice applicants (0.77 vs 0.97), so would be a poor back-up choice without demonstrated interest. Although there were probably more second choice internal applicants than pediatrics.

Agreed, I wouldn't consider Peds a back-up specialty (or Psych for that matter). I know some people set themselves up for Peds or Psych while intending to apply for FM, and in that sense they could become a back-up (I very nearly applied to a Peds program or two as a "back-up" to FM), but they're not really safe back-up options when going for anything competitive.

[codebar]

I did back up a very competitive surgical specialty with a even more competitive surgical speciality, doing only one 3-weeks elective and I matched in it. 

It is only my personal experience but if I hadn't backed up, I would be unmatched at the moment. I'm glad I decided not to follow the do or die recommandations of this forum. 

[Lactic Folly]

Could it be that this worked because your backup was the unusual case of being a *more* competitive specialty - so that program would not have expected that you were using them as a backup? Even knowing that candidates need realistic options, no program likes to be considered a backup - it's just psychological.

[GrouchoMarx]

Path's always a viable backup. Nobody really wants to do it so there are tons of free spots.

[codebar]

@Lactic Folly

No. They told me afterwards that they didn't care and that their prime goal was to find colleagues that would best fit the team. 

[Bambi]

On ‎2017‎-‎06‎-‎22 at 9:40 AM, codebar said:

I did back up a very competitive surgical specialty with a even more competitive surgical speciality, doing only one 3-weeks elective and I matched in it. 

It is only my personal experience but if I hadn't backed up, I would be unmatched at the moment. I'm glad I decided not to follow the do or die recommandations of this forum. 

I too matched to a competitive surgical specialty doing only one 2 week elective. It is impossible to predict where lightning will strike, and I applied to 3 fields where I felt I would be a good fit. With 1 pre-carms elective, I certainly was not a gunner, I had a good LOR from the attending, my resident was on the Panel of 6 Interviewers, and they too thought I would make a good fit to their team. And this was not my first choice where I was a gunner.