Pathology vs IM - Backup

[by_protocol]

Applying for moderate-competitiveness first choice specialty and thinking about a backup. So far 2 options - path and IM; both are equally reasonable choices I would be happy with. Not interested in fam med. 
Currently, I am considering whether I should just pick one backup or have both of them and apply to 3 specialties in total.
Internal - advantages: have some past elective experiences (but still would have to do more), and a bit of research; disadvantages: more competitive, not that related to 1st choice specialty.
Pathology - essentially the opposite - advantages: less competitive, more related to my 1st choice specialty; disadvantages: no path research (although 1st choice specialty research overlaps somewhat with path), no electives beyond observerships.
In case covid doesn't ruin all elective plans before Feb 7, 2021, I might get some time to do 8 weeks in backup specialty electives. Any advice if I should just do internal only, pathology only or a mixture of both?
Thank you. 

[MD_scientist]

You may also want to consider whether or not you can handle a busy schedule during an IM residency vs a more relaxed schedule in pathology. Just something for you to consider when you are making your choice of a backup specialty .....

[procrastinating]

Just wondering, how important is it to do path electives vs IM electives to secure an interview? 

[Maruo]

A couple points. Source: was IM first choice, path second a few years ago.

1. Be cautious if you're backing up with internal. You really need to at least tolerate the life of an internal medicine resident (ideally, thrive and not just survive though). In my experience, it is very different from being a student rotating on medicine. I've heard of a number of people who ended up in IM as their 2nd choice and were very unhappy.

2. Path is significantly less competitive than IM, especially for some of the smaller path CaRMS entries like neuropath or general path. I'm assuming when you say path, you're referring to Anatomical Pathology, but these other specialties are also ones to have on your radar.

3. All this being said, I think it is reasonable to backup with the two. If you are set on doing this, I think your challenge will be accruing appropriate reference letters. In terms of experience/face time, you likely don't need much Pathology elective time. I would recommend 2-4 weeks of path electives and ensure you get to work with a few staff (don't get stuck with one for the entire duration because it will limit the number of letters you can get). However, most path electives are pretty good at moving you between different staff.

4. Probably goes without saying, but make sure you talk to residents in all the programs you're considering. Get a sense of what its like and if you could see yourself doing it.

42 minutes ago, procrastinating said:

Just wondering, how important is it to do path electives vs IM electives to secure an interview? 

My understanding is that IM committees and reviewers can spot people backing up pretty easily based on electives. That doesn't mean you can't get in, however. Be ready to answer why you have most of your electives in another specialty when it comes time for interview. Path is way more lenient on who they give interviews to because they have significantly fewer applicants (and many unfilled spots historically).

[by_protocol]

Excellent points, thanks so much for advice!

[shikimate]

2 weeks in pathology should get you interview at many programs (but might not at places like UBC, Toronto). Also the workload of a medical student on pathology is a fraction of the real workload of a resident so don't get fooled. 

In general I do not recommend 2 backups in first round. There are always pathology spots in the second round but not many IM spots in the second round.