3 Years Im And No Match?

[anesthete]

Hi all

Just wondering if anybody has any perspective on how the fellowship match after 3 years of IM works. Do people go all in for one specialty (eg cardio) or do people rank their subspecialties and back up with other fields? What happens if you don't match? I don't think you can just practice as an internist at that point...can you?

 

Thanks for any insight!!

[Flasses]

When people apply for their internal medicine subspecialty fellowship (technically it's still residency), most people apply to either 1 or 2 fields. It'd be very difficult to do enough electives / research in more than 2 fields to be competitive in any 1 field.

 

If you don't match (which seemed to happen a lot this past year) and you also don't match through the 2nd iteration, you generally move onto doing a "1-year GIM program", which is different than the official "2-year GIM program". You can practice as a general internist either way, but it seems that the 2-year program is far better when it comes to finding work.

[thatonekid]

People generally go for 1 specialty. It's hard to show genuine interest in 2+ when they're all quite different. The exception is if you apply for something and have the GIM fellowship as your second option/interest.

 

If you don't match, you continue on to finish your 4 year GIM program. You can practice as an internist, but jobs are harder to come by (from what I've heard. it's location dependant) You can also apply again.

[Arttomed]

Hey guys 

 

Can anyone shed some light on the competitiveness and job security of cardiology and GI? 

 

Thanks

[Maxime]

Can't comment for GI, but in cardiology the job market is tight. There are openings, but it's definitely not like it used to be. Also, subspecialty is also to be considered (very difficult in cath/EP right now). Everybody does get a job though, haven't seen anybody on welfare

[A-Stark]

Apparently rheumatology is really, really competitive this year. 

[rmorelan]

Apparently rheumatology is really, really competitive this year. 

 

wow that is interesting - they were fighting for people just a short time ago. so much variability with this stuff.

[Dermviser]

wow that is interesting - they were fighting for people just a short time ago. so much variability with this stuff.

 

yup very odd

[LittleDaisy]

EP= endocrinology???

 

Maxime, on 14 Oct 2015 - 9:50 PM, said:

 

Can't comment for GI, but in cardiology the job market is tight. There are openings, but it's definitely not like it used to be. Also, subspecialty is also to be considered (very difficult in cath/EP right now). Everybody does get a job though, haven't seen anybody on welfare

[rmorelan]

electrophysiology

[leviathan]

I've heard cardiology only had half the regular number of applicants this year nation-wide. 

[Edict]

So consensus is do what you love and don't do things based on numbers because it seems like things can change on a dime. 

[rmorelan]

So consensus is do what you love and don't do things based on numbers because it seems like things can change on a dime. 

 

pretty much - things really do change extremely rapidly when there are relatively so few spots. Doesn't take much for a field to go from completely matched to large non matched rank when you look at it. Lag effects seem to crop up all the time (if you try something because it looks like a "easy route" based on prior info then don't be surprised if a large number of others have the exact same idea for the exact same reason. The result is it won't be easy at all).

[keith_015]

pretty much - things really do change extremely rapidly when there are relatively so few spots. Doesn't take much for a field to go from completely matched to large non matched rank when you look at it. Lag effects seem to crop up all the time (if you try something because it looks like a "easy route" based on prior info then don't be surprised if a large number of others have the exact same idea for the exact same reason. The result is it won't be easy at all).

 

No. This is not true. Loving nephro will not get you a job any sooner than the many under employed nephrologists out there. No dialysis machines to be able to run patients on = no jobs. Same gig with cardio. Want to cath? Forget about it. There are very few facilities that have angiography across the country, and seldom do new people get added to those groups. I've seen as high as an aspiring PGY9 waiting their turn. You can however do cardio in a private setting outside the hospital relatively easily. 

 

Bottom line: be realistic like today's current IM residents. There is very poor outlook for resource requiring subspecialties. ie Critical Care, Nephro, Cardio, GI, and unless the money tree shakes wildly and more hospitals are built, don't expect that to improve. If you really love them and will go for them, accept that jobs will be in less desirable locations. Even working as a GIM with a different subspecialty will get harder and harder with the 5 yr GIM rolling out higher numbers now. IM residents are moving towards employable specialities, way less reliant on resources and there is also a movement for lifestyle. What is hot? Med Onc, Endo, Rheum, GIM.

[rmorelan]

No. This is not true. Loving nephro will not get you a job any sooner than the many under employed nephrologists out there. No dialysis machines to be able to run patients on = no jobs. Same gig with cardio. Want to cath? Forget about it. There are very few facilities that have angiography across the country, and seldom do new people get added to those groups. I've seen as high as an aspiring PGY9 waiting their turn. You can however do cardio in a private setting outside the hospital relatively easily. 

 

Bottom line: be realistic like today's current IM residents. There is very poor outlook for resource requiring subspecialties. ie Critical Care, Nephro, Cardio, GI, and unless the money tree shakes wildly and more hospitals are built, don't expect that to improve. If you really love them and will go for them, accept that jobs will be in less desirable locations. Even working as a GIM with a different subspecialty will get harder and harder with the 5 yr GIM rolling out higher numbers now. IM residents are moving towards employable specialities, way less reliant on resources and there is also a movement for lifestyle. What is hot? Med Onc, Endo, Rheum, GIM.

 

I guess my point is BECAUSE Rheum, GIM, Med Onc and Endo are "hot" - that pretty soon you are just going to have the exact same problem - those specialties become hard to get into due to the upped competition and the market is then flooded with exactly those specialists (noting that some are more resistant of course to issues). How long would it take those fields to be saturated when many of those fields don't really require that many people comparatively? The life cycle of a newly entering medical student to completed subspeciality is relatively long (9 years say). Even starting to gun for those fields starting IM training is 5 years until graduating. Five years ago they were crying for Rheum people - now not so much. Where will be be 5-6 years from now? There are only so many slots and we are going to fill them up at some point. We haven't solved the problem - we have shifted it for just a bit of time.

 

We have exactly the same problem in rads right now - good luck getting specific subspecialist positions and there are people zipping around getting 2+ fellowships for somethings, or setting up shop is shall we say less than desirable areas. Everyone is holding their breath waiting for the government to generate the new norm. 

 

Not to say there is a perfect answer - there isn't when we are in a resource crunch from the government coupled with high medical student enrollment. VERY easy for me to say because of course I am in the middle of residency and thus I have past a big hurtle but you have to wonder when we should scale back medical school enrollment (we are pumping out people quickly on one end, and clawing back the income of people on the other). 

 

Personal choice in the end - I mean do you want to be an underemployed (for a time at least - and who knows how long) nephro if you really like that field, or a full time Rheum if you don't like that field (again how long before that field becomes saturated)? Arguments either way of course.

[NLengr]

I guess my point is BECAUSE Rheum, GIM, Med Onc and Endo are "hot" - that pretty soon you are just going to have the exact same problem - those specialties become hard to get into due to the upped competition and the market is then flooded with exactly those specialists (noting that some are more resistant of course to issues). How long would it take those fields to be saturated when many of those fields don't really require that many people comparatively? The life cycle of a newly entering medical student to completed subspeciality is relatively long (9 years say). Even starting to gun for those fields starting IM training is 5 years until graduating. Five years ago they were crying for Rheum people - now not so much. Where will be be 5-6 years from now? There are only so many slots and we are going to fill them up at some point. We haven't solved the problem - we have shifted it for just a bit of time.

 

We have exactly the same problem in rads right now - good luck getting specific subspecialist positions and there are people zipping around getting 2+ fellowships for somethings, or setting up shop is shall we say less than desirable areas. Everyone is holding their breath waiting for the government to generate the new norm. 

 

Not to say there is a perfect answer - there isn't when we are in a resource crunch from the government coupled with high medical student enrollment. VERY easy for me to say because of course I am in the middle of residency and thus I have past a big hurtle but you have to wonder when we should scale back medical school enrollment (we are pumping out people quickly on one end, and clawing back the income of people on the other). 

 

Personal choice in the end - I mean do you want to be an underemployed (for a time at least - and who knows how long) nephro if you really like that field, or a full time Rheum if you don't like that field (again how long before that field becomes saturated)? Arguments either way of course.

Unless the government plans to change the amount of money in the system or the way it is allocated, at the very least we need to start reducing some specialist residency spots and moving them into stuff that still has demand (family, psych etc). I think a med school seat cut is probably in order too.

[rmorelan]

Unless the government plans to change the amount of money in the system or the way it is allocated, at the very least we need to start reducing some specialist residency spots and moving them into stuff that still has demand (family, psych etc). I think a med school seat cut is probably in order too.

 

From a overall perspective it is hard to argue with that - again noting of course that of course that situation would be less than ideal if you have say zero interest in either psych or family med.

 

and perhaps a jab at the current Ontario situation - the government is making it pretty clear if fewer family doctors appeared it would exactly be crying over it. Restrictions on new grads? New policy at a vastly reduced quasi salary status? Clawbacks that are extra painful in overhead heavy situations? Doesn't exactly sound like happy joy joy times. What would be the point in training any new family doctors in that situation either? The advantage to grads in the ability to work anywhere and be free of the hospital politics and budget limitations. The issue is now there are just as bad direct limitations and as the markets are much more saturated saying you can work anywhere is a bit of stretch.

[A-Stark]

I guess my point is BECAUSE Rheum, GIM, Med Onc and Endo are "hot" - that pretty soon you are just going to have the exact same problem - those specialties become hard to get into due to the upped competition and the market is then flooded with exactly those specialists (noting that some are more resistant of course to issues). How long would it take those fields to be saturated when many of those fields don't really require that many people comparatively? 

 

I don't think there's any surplus of rheumatologists currently, but this year there were 40-something applicants for 18 R4 spots. I'm worried for my friends who applied and will find out where the chips fall tomorrow. 

[rmorelan]

I don't think there's any surplus of rheumatologists currently, but this year there were 40-something applicants for 18 R4 spots. I'm worried for my friends who applied and will find out where the chips fall tomorrow. 

 

ouch - that really is tight. Hope things work out.

[NLengr]

From a overall perspective it is hard to argue with that - again noting of course that of course that situation would be less than ideal if you have say zero interest in either psych or family med.

 

and perhaps a jab at the current Ontario situation - the government is making it pretty clear if fewer family doctors appeared it would exactly be crying over it. Restrictions on new grads? New policy at a vastly reduced quasi salary status? Clawbacks that are extra painful in overhead heavy situations? Doesn't exactly sound like happy joy joy times. What would be the point in training any new family doctors in that situation either? The advantage to grads in the ability to work anywhere and be free of the hospital politics and budget limitations. The issue is now there are just as bad direct limitations and as the markets are much more saturated saying you can work anywhere is a bit of stretch.

Ontario is such a disaster right now it's amazing. It's not just healthcare either, every department in the provincial government is a disaster. The current government has to be one of the worst in recent Canadian history.

[keith_015]

I guess my point is BECAUSE Rheum, GIM, Med Onc and Endo are "hot" - that pretty soon you are just going to have the exact same problem - those specialties become hard to get into due to the upped competition and the market is then flooded with exactly those specialists (noting that some are more resistant of course to issues). How long would it take those fields to be saturated when many of those fields don't really require that many people comparatively? The life cycle of a newly entering medical student to completed subspeciality is relatively long (9 years say). Even starting to gun for those fields starting IM training is 5 years until graduating. Five years ago they were crying for Rheum people - now not so much. Where will be be 5-6 years from now? There are only so many slots and we are going to fill them up at some point. We haven't solved the problem - we have shifted it for just a bit of time.

 

 

A rheumatologist told us just a few weeks ago at a career day that in Ontario, Rheum will continue to be under represented for the next 20 years. As it stands, it takes a long time to see a rheumatologist, especially if not urgent, with wait times well over 1 year now. For other outpatient IM specialties like endo and GIM, there will always be plenty of work to spread around. Med Onc has work too, but becomes less appealing if you aren't attached to a Cancer Centre and get salaried wages rather than fee for service.

[3change]

...

[JohnGrisham]

Infrastructure. Orthos are pretty much tied to OR time for most cases. Lack of OR time = unemployed orthos.

[bloh]

I don't think there's any surplus of rheumatologists currently, but this year there were 40-something applicants for 18 R4 spots. I'm worried for my friends who applied and will find out where the chips fall tomorrow. 

 

There likely is. The problem lies in that so many work part-time hours. You can't even get ahold of their reception unless you call during an exceptionally tight hour window.

[rmorelan]

Infrastructure. Orthos are pretty much tied to OR time for most cases. Lack of OR time = unemployed orthos.

 

exactly - it isn't a free market, and just like any system where supply and demand cannot equalize for whatever reason you end up with inefficiency (inefficiency is not always bad - I am just speaking in a pure economic sense of the word).