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Family And Internal Med As A Back Up - Do You Need To Do Pre-Carms Electives?

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I am applying to a competitive specialty for CaRMS. I would like to back-up with either family med or internal med. Still undecided exactly on which one - I still have some time to decide but just have some questions about both.

 

Looking at this years IM interviews, it's becoming much more competitive. I really don't want to sacrifice a pre-CaRMS elective for my back-up as the primary specialty I'm going for is competitive enough that I need all the pre-CaRMS time I can get.

 

So - given the recently competitive nature of IM, how have people been doing who use it as a backup? In particular, those who didn't do any pre-CaRMS electives in IM? Is this just totally unreasonable? 

 

Similar question for family med - I know it's long considered a safe backup. However, with no pre-CaRMS electives in family, would I still be able to get interviews as long as I do some family med electives at some point in my 4th year? 

 

I know the challenge is letters. I luckily should be ok to accumulate enough for at least family, as I've done some stuff in my pre-clerkship. So letters withstanding - can you realistically backup in family/internal with NO pre-CaRMS electives in them, but still some in your 4th year?

 

Not so sure how this backing up business works!

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There is no clear formula, but common sense should go a long way here: you WILL have backup written all over you face.

 

Internal medicine and Family Med WILL know this. They are not that desperate, but you may get in off their bottom of their lists.

 

The likelihood of not going unmatched and ending up in an IM spot is comparatively low for someone who is a clear backup. It happens though. There are enough candidates who will have more demonstrated interest in IM and who will be better at it than you because they will have done several months of additional training in it. Thus, even 3-5 weeks pre-carms will more likely secure you even a viable backup.

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I definitely recognize that. However, my primary specialty isn't one where I could sacrifice 3-5 weeks pre-CaRMS for my back-up. I don't have a ton of pre-CaRMS time in my school, meaning I can't really give away very much of it. The most I could give up would be 2 weeks, although ideally I would try to find something within IM related to my primary specialty to spin it both ways. 

 

In that case, is it more realistic to back-up with family medicine, utilizing the same strategy? I fully recognize that it will appear as a back-up and that's a bridge I plan to cross when I come to it (i.e when I write my letters, at interviews). However would it be realistic to get at least a few interviews with only post-CaRMS electives for family? Or is it similar to IM in that I would need to commit at least 2 weeks of pre-CaRMS elective time to family? 

 

I realize there is no true formula - however, has anyone gotten interviews without doing pre-CaRMS elective time in family or IM? Or am I totally off base here?

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I definitely recognize that. However, my primary specialty isn't one where I could sacrifice 3-5 weeks pre-CaRMS for my back-up. I don't have a ton of pre-CaRMS time in my school, meaning I can't really give away very much of it. The most I could give up would be 2 weeks, although ideally I would try to find something within IM related to my primary specialty to spin it both ways. 

 

In that case, is it more realistic to back-up with family medicine, utilizing the same strategy? I fully recognize that it will appear as a back-up and that's a bridge I plan to cross when I come to it (i.e when I write my letters, at interviews). However would it be realistic to get at least a few interviews with only post-CaRMS electives for family? Or is it similar to IM in that I would need to commit at least 2 weeks of pre-CaRMS elective time to family? 

 

I realize there is no true formula - however, has anyone gotten interviews without doing pre-CaRMS elective time in family or IM? Or am I totally off base here?

 

No they have - I mean one obvious way around this is to actually really really work hard to get a LOR in the backup area during clerkship. 

 

and yeah they will know you are backing up. That can potentially turn off some people but a) there is nothing you can do about that and b ) many are smart enough to know that just because your top choice is X doesn't mean you won't be excellent at Y. Particularly if you get into family as a backup where it is less likely you can switch to another program even. 

 

So you may not get a top family location - but there are realistically many places where family medicine goes unfilled routinely. Those programs have a choice of interviewing you knowing there is a relatively high chance you will actually be going for their specialty ultimately and that you may be a strong candidate (going for something competitive so you are probably smart, hardworking.....).

 

I have had friend go into family when they didn't match in to plastics for instance going that way. 

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I think family at your home school is do-able without a pre-carms elective given that you ask your clerkship supervisor for a letter.

 

IM used to be able to a few years ago, i've heard of few who interviewed and matched without a pre-carms elective. But nowadays it will be difficult since IM is more popular.

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I can't speak to Family, but I did apply broadly for Internal.

 

I would suggest looking over the program descriptions on the CaRMS website, which will help you get a feel for how much emphasis programs place on you doing extensive Internal electives. I know that for certain programs not doing Internal electives is basically a non-starter, but for others you could still be invited to interview. At the end of the day a strong candidate is a strong candidate; it's not like someone who's gotten ace evals in Gen Surg and Family will be a shitty IM resident. 

 

In particular, consider applying to U of A's internal program. They really value diversity in electives and won't necessarily fault you for not doing Internal electives, so long as you had a strong core rotation and can reasonably demonstrate interest in the specialty. In fact several IM gunners I know did not get invites there despite the fact that it was their home school, whereas people who were using IM as a backup did get interviews.

 

Ultimately, applying costs you nothing but some time and $30, and you won't know until you try!

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This year was extremely tight for internal medicine. 498/502 spots were filled. Most applicants who were "all in" for internal medicine this year didn't get 2-3 interviews they were expecting to receive, let alone people who were backing up. Internal programs generally require 3 letters and you realistically need 2 letters from internists. A strong 3rd general letter from another specialty would generally be fine. I'm going to venture and say that it's extremely unlikely many people matched to internal this year who hadn't done at least one internal elective. 

 

That said, family this year was less competitive, with many spots left in desirable locations. 

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Definitely possible if you're a strong candidate overall. There were a few of my classmates who applied to competitive specialties and backed up with IM.

 

They were able to secure a few interviews at attractive places (Toronto, Mac, UBC, Calgary) despite having done only 2-4 weeks of IM. 

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Definitely possible if you're a strong candidate overall. There were a few of my classmates who applied to competitive specialties and backed up with IM.

 

They were able to secure a few interviews at attractive places (Toronto, Mac, UBC, Calgary) despite having done only 2-4 weeks of IM. 

 

That's somewhat re-assuring. But I know at least for Mac that it was very, very competitive this match. 

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