Last Minute Change in Specialties

[bread]

Hi all! I’m currently just starting my fourth year, and have been planning to apply to family med and a 5-year surgical specialty. However, my last core rotation was in internal med (CTU). It was honestly the only rotation I hadn’t been looking forward to, and I didn’t expect to like it at all. But, I ended up loving it. I received fantastic evals from my preceptors, who all told me I should strongly consider/would be an excellent candidate for internal med. I also asked one preceptor for a reference letter at the end of the rotation, to which she agreed. Another said to reach out to him should I change my mind and decide to apply to internal. 
 

I’m now at a bit of a crossroads because it was only 4 weeks, and I’m unsure of how to proceed. I never expected to like internal, and am not sure that I would continue to love it (I did rheum and GI observerships in pre-clerkship and wasn’t a huge fan; I also don’t enjoy doing research). Also unsure of whether I’d miss the other speciality I was planning to apply to. I don’t have any fourth year electives in internal currently, and from what I’ve heard from classmates, they’re full at my school (many classmates received far fewer internal med electives than they had requested). Carms is so soon, and I didn’t expect my plan to change this close to it. Should I be considering ranking family med first now, given it provides the opportunity to do both hospitalist and some aspects of the other specialty (ex. Surgical assist, niche clinics)?  I guess I’d just really appreciate some insight/advice with regards to things to think about, and where to go from here.  

[QuestionsAbound]

Hospitalist medicine can have varying acuity depending on the hospital you are working in. 

You have the advantage of using COVID as an excuse. Consider using it.

Take some time to reflect, speak with residents in those specialties, and decide what is most important to you. Where do you want to work, what level of acuity, generalist or specialist, etc). Ultimately this decision falls entirely on what you want with your life.

[a7x]

While electives are important with COVID it is easier to argue your interest with less elective time than it normally would. At the end of the day strong letters (esp from CTU) for IM are the most important and it sounds like you already have 2 of them so I would definitely apply.

[ACHQ]

10 hours ago, bread said:

Hi all! I’m currently just starting my fourth year, and have been planning to apply to family med and a 5-year surgical specialty. However, my last core rotation was in internal med (CTU). It was honestly the only rotation I hadn’t been looking forward to, and I didn’t expect to like it at all. But, I ended up loving it. I received fantastic evals from my preceptors, who all told me I should strongly consider/would be an excellent candidate for internal med. I also asked one preceptor for a reference letter at the end of the rotation, to which she agreed. Another said to reach out to him should I change my mind and decide to apply to internal. 
 

I’m now at a bit of a crossroads because it was only 4 weeks, and I’m unsure of how to proceed. I never expected to like internal, and am not sure that I would continue to love it (I did rheum and GI observerships in pre-clerkship and wasn’t a huge fan; I also don’t enjoy doing research). Also unsure of whether I’d miss the other speciality I was planning to apply to. I don’t have any fourth year electives in internal currently, and from what I’ve heard from classmates, they’re full at my school (many classmates received far fewer internal med electives than they had requested). Carms is so soon, and I didn’t expect my plan to change this close to it. Should I be considering ranking family med first now, given it provides the opportunity to do both hospitalist and some aspects of the other specialty (ex. Surgical assist, niche clinics)?  I guess I’d just really appreciate some insight/advice with regards to things to think about, and where to go from here.  

Recent staff GIM grad here and staff at a community hospital.

if you don't mind me asking what was the 5 year surgical specialty? Is this something you still want to pursue and did you love it as much as CTU (or more?). Do you like family medicine as much as either of those?

What did you love about CTU most? was it the inpatient/ward work? was it the new consultations from the ER (or other areas)? was it the resuscitation's? was it clinics? was it all the above? if you exclusively only enjoyed inpatient ward work then family medicine with extra training in hospitalist medicine is not a bad idea, but doesn't offer the range of work possibilities GIM does (ER consults, urgent GIM clinics, inpatient consults to non-IM services).

Given the COVID-19 pandemic (and the fact that we are definitely in the beginning of a 2nd wave) it may be tough to organize, but try to and see if you can get *any* Internal medicine related electives (GIM or sub-specialties). If your heart is truly set on it then at least give it a shot. Even if you can't get an elective you can at least apply and see what happens and delay making a decision right now (or at least have a decision made for you via carms interviews received or not received). I have seen people get interviews with minimal electives (they were using it as a backup), and given the pandemic you can definitely use that to help out your case.

The one thing I would consider is if you are applying for  a 5 year specialty and get it it would be easier to transfer to Internal medicine (or family medicine) than the other way around (due to funding issues)

Good luck!

[bread]

11 hours ago, ACHQ said:

Recent staff GIM grad here and staff at a community hospital.

if you don't mind me asking what was the 5 year surgical specialty? Is this something you still want to pursue and did you love it as much as CTU (or more?). Do you like family medicine as much as either of those?

What did you love about CTU most? was it the inpatient/ward work? was it the new consultations from the ER (or other areas)? was it the resuscitation's? was it clinics? was it all the above? if you exclusively only enjoyed inpatient ward work then family medicine with extra training in hospitalist medicine is not a bad idea, but doesn't offer the range of work possibilities GIM does (ER consults, urgent GIM clinics, inpatient consults to non-IM services).

Given the COVID-19 pandemic (and the fact that we are definitely in the beginning of a 2nd wave) it may be tough to organize, but try to and see if you can get *any* Internal medicine related electives (GIM or sub-specialties). If your heart is truly set on it then at least give it a shot. Even if you can't get an elective you can at least apply and see what happens and delay making a decision right now (or at least have a decision made for you via carms interviews received or not received). I have seen people get interviews with minimal electives (they were using it as a backup), and given the pandemic you can definitely use that to help out your case.

The one thing I would consider is if you are applying for  a 5 year specialty and get it it would be easier to transfer to Internal medicine (or family medicine) than the other way around (due to funding issues)

Good luck!

Thank you guys all for your insight and feedback - I really appreciate it

The 5-year specialty is OBGYN.  I'm having a hard time determining whether I loved IM more or less than it - I love the mix of medicine and surgery in OBGYN, love the patient population, caring for expectant moms/women across their lifespan, and doing deliveries - very different reasons than IM.  What I like most about family is the flexibility to do a bit of everything; if I did FM, I'd love to do a bit of everything with it, including obstetrics and women's health, procedures, surgical assist, and/or maybe hospitalist.  I did not enjoy general FM clinic as much as OBGYN and IM.

I loved a lot of things about CTU - the consults, really thinking about the physiology when coming up with management plans/determining what was going on, following the same patients and getting to know them and their families (and communicating with families/navigating family dynamics), working as a team as well as consulting other services and learning from their management plans, and caring for/addressing more than just one medical problem.  I also loved the higher acuity patients, resuscitations, managing an acute change/deterioration.  I didn't do any clinics during my rotation, but so far I've generally enjoyed procedures/OR/emerge/inpatient work more than outpatient clinics.  

I totally realize that most people have it more "figured out" by now, and that these are 3 very different specialties, so I really appreciate all the helpful feedback and perspectives you all have shared!  

[ACHQ]

11 hours ago, bread said:

Thank you guys all for your insight and feedback - I really appreciate it

The 5-year specialty is OBGYN.  I'm having a hard time determining whether I loved IM more or less than it - I love the mix of medicine and surgery in OBGYN, love the patient population, caring for expectant moms/women across their lifespan, and doing deliveries - very different reasons than IM.  What I like most about family is the flexibility to do a bit of everything; if I did FM, I'd love to do a bit of everything with it, including obstetrics and women's health, procedures, surgical assist, and/or maybe hospitalist.  I did not enjoy general FM clinic as much as OBGYN and IM.

I loved a lot of things about CTU - the consults, really thinking about the physiology when coming up with management plans/determining what was going on, following the same patients and getting to know them and their families (and communicating with families/navigating family dynamics), working as a team as well as consulting other services and learning from their management plans, and caring for/addressing more than just one medical problem.  I also loved the higher acuity patients, resuscitations, managing an acute change/deterioration.  I didn't do any clinics during my rotation, but so far I've generally enjoyed procedures/OR/emerge/inpatient work more than outpatient clinics.  

I totally realize that most people have it more "figured out" by now, and that these are 3 very different specialties, so I really appreciate all the helpful feedback and perspectives you all have shared!  

Tbh get letters from your core CTU rotation and see if you can get at least 1 elective. If not no biggie just apply to all 3

[bread]

On 9/18/2020 at 10:08 AM, ACHQ said:

Tbh get letters from your core CTU rotation and see if you can get at least 1 elective. If not no biggie just apply to all 3

Thanks very much!!  Appreciate the help

[santosha123]

I had a similar situation happen, and would be happy to discuss. send me a PM