Rheumatology and Endocrinology Competitiveness

[Premed12345]

How competitive are Rheum and Endo and is there a decently high chance of going unmatched despite doing Rheum/Endo research since medical school, getting strong letters, and applying broadly across the country? I have heard that Rheum has been getting more competitive over the years. 

[Psych]

13 hours ago, Premed12345 said:

How competitive are Rheum and Endo and is there a decently high chance of going unmatched despite doing Rheum/Endo research since medical school, getting strong letters, and applying broadly across the country? I have heard that Rheum has been getting more competitive over the years. 

I'm pretty sure that rheum and endo are fellowships after internal med so you don't "match" to them- you match to internal med which has the second-most seats of any specialty so it's not too competitive. I can't speak to how hard it is to get a fellowship after this, but worst case you work as a general IM doctor until you get accepted to one

[Haribo7173]

3 minutes ago, Psych said:

I'm pretty sure that rheum and endo are fellowships after internal med so you don't "match" to them- you match to internal med which has the second-most seats of any specialty so it's not too competitive. I can't speak to how hard it is to get a fellowship after this, but worst case you work as a general IM doctor until you get accepted to one

Yes you still “match” to them after 3 years of internal medicine.

[rmorelan]

40 minutes ago, Psych said:

I'm pretty sure that rheum and endo are fellowships after internal med so you don't "match" to them- you match to internal med which has the second-most seats of any specialty so it's not too competitive. I can't speak to how hard it is to get a fellowship after this, but worst case you work as a general IM doctor until you get accepted to one

you are completely correct and objectively it is relatively easy to get internal med (~90%+ chance often and you have wonder how many of the remaining group were restrictive in their application in some fashion - sometime fields that are easier to get into have people being more "causal" with their application. Doesn't always work out)

but that in a sense really just means you delayed the real CARMS -  you deferred the pain. They don't really want internal med in a sense - they specifically want rheum or endo. In fact you almost always want to get some sub field so you are stuck again with all the work informed in a carms process. The worst case as you put it is exactly the problem - some people don't want at all to do general internal medicine (just like there are say fields of radiology I am not at all interested in - being stuck doing that sort of work each day would neither interest me or play to my strengths and thus be suboptimal for the patients as well. It is fair to say I would rather not be a radiologists than to be that type of radiologist - it is similar for many in other fields  )

I have heard they are moderately competitive, and rheum has seen an increase in general over time year- of note there were still some open spots for adult rheum which was interesting!

as a side note I know a bunch of internal med people that didn't end up matching to ultimately what they wanted. Sometimes that can be a very bad outcome - working almost 7 years towards something and not getting it ( usually going for cardiology) in some ways it is worse than standard CARMS - you cannot easily apply again for instance (which is hard enough in regular carms). Plus you spend all this time prepping for carms part 1, and then as soon as you get into residency is like you are already immediately back on the treadmill for part two (you have a short time to get yet more contacts, more references, more research......). Gah......

Edited September 28, 2020 by rmorelan

[garlic]

https://www.carms.ca/data-reports/msm-data-reports/ may have some fun (or anxiety-invoking, depending on what you're looking at) stats for you.

I don't know any Endo people, but one of my best buddies matched to Rheum this year. He said it was quite doable, but as alluded to above, he absolutely hated the first 3 years of IM residency and said he'd actually quite medicine altogether if he had to do GIM. Not trying to scare anybody, but it is something to consider. Matching IM is really like deferring the carms process others went through, except the second time around it's arguably harder imo

[StudentInMedicine]

2 hours ago, garlic said:

Matching IM is really like deferring the carms process others went through, except the second time around it's arguably harder imo

Can you elaborate on why you think the IM subspecialty match is in your opinion harder than the carms match? Actually thinking about IM right now and this is something I want to know more about.

[JohnGrisham]

5 hours ago, garlic said:

https://www.carms.ca/data-reports/msm-data-reports/ may have some fun (or anxiety-invoking, depending on what you're looking at) stats for you.

I don't know any Endo people, but one of my best buddies matched to Rheum this year. He said it was quite doable, but as alluded to above, he absolutely hated the first 3 years of IM residency and said he'd actually quite medicine altogether if he had to do GIM. Not trying to scare anybody, but it is something to consider. Matching IM is really like deferring the carms process others went through, except the second time around it's arguably harder imo

Quiet over GIM? You could pretty much cater your practice as GIM and just do community referrals, and make a focus in rheum if you wanted to.

[rmorelan]

10 hours ago, JohnGrisham said:

Quiet over GIM? You could pretty much cater your practice as GIM and just do community referrals, and make a focus in rheum if you wanted to.

curious how much of that you could realistically do - I mean you need referrals of course, and getting that set up without the subspecialty sounds like a rougher road (but possible). If you are in too big a city you have other subspecialists around so competition. If you are in a smaller place is there enough work? How much tailoring is possible? There must be stuff at least initially you couldn't or at least shouldn't do (otherwise why have the subspecialty - those 2 years of focus serve a role). 

Ha I am full of questions today

 

[ACHQ]

15 hours ago, garlic said:

https://www.carms.ca/data-reports/msm-data-reports/ may have some fun (or anxiety-invoking, depending on what you're looking at) stats for you.

I don't know any Endo people, but one of my best buddies matched to Rheum this year. He said it was quite doable, but as alluded to above, he absolutely hated the first 3 years of IM residency and said he'd actually quite medicine altogether if he had to do GIM. Not trying to scare anybody, but it is something to consider. Matching IM is really like deferring the carms process others went through, except the second time around it's arguably harder imo

Yeah he's lucky than that he matched to Rheum. That being said it someone really hates GIM that much they should apply extremely broadly (across Canada) for their subspecialty and do all their electives (or as much that is allowable) in that subspecialty to max their chances of matching, if they do that they should find a spot *somewhere* (where it is tricky is when you are location and specialty limited... good luck). Unfortunately round 2 of CARMS for IM is one shot all, can't ever reapply (except for ICU, but even that only once I believe). The other option if someone is that against doing GIM is do apply to the U.S. (which you can apply to multiple times)

I usually tell medical students that unless you can bare doing a 3 year residency in IM, and then potentially not match and do GIM you have to be OK with that otherwise its a huge risk.

[cotecc]

16 hours ago, garlic said:

https://www.carms.ca/data-reports/msm-data-reports/ may have some fun (or anxiety-invoking, depending on what you're looking at) stats for you.

I don't know any Endo people, but one of my best buddies matched to Rheum this year. He said it was quite doable, but as alluded to above, he absolutely hated the first 3 years of IM residency and said he'd actually quite medicine altogether if he had to do GIM. Not trying to scare anybody, but it is something to consider. Matching IM is really like deferring the carms process others went through, except the second time around it's arguably harder imo

How is the lifestyle of a GIM in a city?

I kind of like the idea of GIM, but don't want to be overworked and abused hahaha

[ACHQ]

23 minutes ago, cotecc said:

How is the lifestyle of a GIM in a city?

I kind of like the idea of GIM, but don't want to be overworked and abused hahaha

GIM staff here at a large community hospital in the GTA

It really actually depends on how much you want to make. You will make money between 300-500k, but that is a huge range and depends on how many days/weeks you want to work. Some people don't need to make 500k and are happy with 300k and therefore work less and love their life. Others need the money to buy a home or whatever and therefore work much more to try to make 500k (and in some cases beyond).

I have been working fairly hard right now because I just started, but my actual commitment is about roughly 30-34 weeks a year (depending on how i stack my ER consult shifts). With that there is no doubt you can bill close to 300-350k/yr (not including the HOCC stipend you get) and so the total could be close to 350-400k. I've been picking up extra work so I can't be super accurate on those projections but they are estimates, and it also depends on how much volume you see too.

[cotecc]

2 hours ago, ACHQ said:

GIM staff here at a large community hospital in the GTA

It really actually depends on how much you want to make. You will make money between 300-500k, but that is a huge range and depends on how many days/weeks you want to work. Some people don't need to make 500k and are happy with 300k and therefore work less and love their life. Others need the money to buy a home or whatever and therefore work much more to try to make 500k (and in some cases beyond).

I have been working fairly hard right now because I just started, but my actual commitment is about roughly 30-34 weeks a year (depending on how i stack my ER consult shifts). With that there is no doubt you can bill close to 300-350k/yr (not including the HOCC stipend you get) and so the total could be close to 350-400k. I've been picking up extra work so I can't be super accurate on those projections but they are estimates, and it also depends on how much volume you see too.

To make 400-500k, you have to work how many hours a week?

And are those numbers after overhead and all?

[Recollections]

20 hours ago, StudentInMedicine said:

Can you elaborate on why you think the IM subspecialty match is in your opinion harder than the carms match? Actually thinking about IM right now and this is something I want to know more about.

As a current IM R3 going through the medicine subspecialty CaRMS match, I wouldn't necessarily say it's harder than the R1 CaRMS match but it does have its own unique challenges and arguably higher stakes. The biggest difference is that MSM CaRMS is on an accelerated timeline which gives you less room for error.

MSM CaRMS happens near the beginning of the R3 year, which really only gives you 2 years of core IM residency to explore different subspecialties and settle on one, do research, try to pump out a publication or two, and do electives in said specialty. Most IM programs only have three 4-week elective blocks in total occurring in PGY-2/3, which leaves little room for "experimentation" when you need all the elective time you can get for exposure and reference letters. In most cases, you'll need to have decided on a specialty by late R1/early R2 when you need to be booking away electives as they tend to fill up quickly. MSM CaRMS itself is also accelerated with there being only 3 months between applications opening to match day, versus ~5 months for the R1 match. 

As stated earlier in this thread, the most important thing is that you only have 1 shot at MSM CaRMS as an R3. There is a 1st and 2nd round just like in the R1 match, but if you go unmatched after the 2nd round you will default to doing a 4th year of GIM training and then entering independent practice as a general internist. You're considered ineligible for the subspecialty match if you've ever participated in the past, which disqualifies you from taking a "research year" and re-entering CaRMS the next year like what some people do with the R1 match. Obviously this can be devastating if you've dreamt of being an interventional cardiologist your whole life, because at that point you've already invested 9+ years of training between undergrad, medical school, and IM residency. Some people who go unmatched do find ways to secure fellowship positions outside of CaRMS, but this is uncommon and not something to bank on.

I will say that MSM CaRMS has been a less painful and more intimate process compared to the R1 match, because you're competing against a smaller pool of applicants and being interviewed by many people you've likely worked with or met at conferences before. The CaRMS numbers game isn't quite as punishing as with the R1 match as well. Generally, most applicants with an average-above average profile who are willing to apply broadly will match to their desired specialty somewhere, as long as they're not going for something ultra-competitive.

Based on the match numbers in Canada, I would rank the competitiveness of subspecialties in the average year as follows:

1. Need to gun hard: Cardiology, GI, Respirology, ICU (not solely a medicine subspecialty)

2. Moderately competitive: Endocrinology, Rheumatology

3. If you're a good applicant, you'll match: GIM, Hematology, Nephro, ID, Med Onc

4. Basically a guaranteed match: Geriatrics, Palliative Care, Pain Medicine

Certain specialties in certain years will be abnormally competitive, but this has been the general trend over the last few years.

[ijustwantanmd]

11 hours ago, ACHQ said:

GIM staff here at a large community hospital in the GTA

It really actually depends on how much you want to make. You will make money between 300-500k, but that is a huge range and depends on how many days/weeks you want to work. Some people don't need to make 500k and are happy with 300k and therefore work less and love their life. Others need the money to buy a home or whatever and therefore work much more to try to make 500k (and in some cases beyond).

I have been working fairly hard right now because I just started, but my actual commitment is about roughly 30-34 weeks a year (depending on how i stack my ER consult shifts). With that there is no doubt you can bill close to 300-350k/yr (not including the HOCC stipend you get) and so the total could be close to 350-400k. I've been picking up extra work so I can't be super accurate on those projections but they are estimates, and it also depends on how much volume you see too.

So this is with the 4 years of GIM residency? (Sorry I'm new so not sure how it all works :/)

[ACHQ]

21 hours ago, cotecc said:

To make 400-500k, you have to work how many hours a week?

And are those numbers after overhead and all?

It doesn't work out so cleanly in terms of hours a week, heck its even hard to say how *many* weeks a year do you need to work to earn that much, because evening/nights pay way more, weekends pay more. Generally speaking if you pick up alot of that work you will make more. I wish I had a more solid answer but it isn't so black and white. It also depends on volumes (if you are at a very busy centre with lots of volume you will make more). *Generally* (not exact) but 1 week of work (~5ish days) is about 10k. So to *bill* 400k you need to work close to 40 weeks. That doesn't include the stipend/HOCC you get which in total for a year can range between 20-50k additional cash.

GIM in hospital based practice pays 0 overhead. 0!

 

11 hours ago, ijustwantanmd said:

So this is with the 4 years of GIM residency? (Sorry I'm new so not sure how it all works :/)

Yes, or the 5 year GIM program, or you can technically do it as a subspecialist who can't find work/wants to make extra money/likes GIM doing GIM work.

 

16 hours ago, Recollections said:

Based on the match numbers in Canada, I would rank the competitiveness of subspecialties in the average year as follows:

1. Need to gun hard: Cardiology, GI, Respirology, ICU (not solely a medicine subspecialty)

2. Moderately competitive: Endocrinology, Rheumatology

3. If you're a good applicant, you'll match: GIM, Hematology, Nephro, ID, Med Onc

4. Basically a guaranteed match: Geriatrics, Palliative Care, Pain Medicine

Certain specialties in certain years will be abnormally competitive, but this has been the general trend over the last few years.

I agree with #4 and somewhat with #1. I just finished residency and the last few years consistently that I remember Heme was competitive as was ID (more than endo and rheum). As you mentioned certain years were worse than others

[StudentInMedicine]

21 hours ago, Recollections said:

As stated earlier in this thread, the most important thing is that you only have 1 shot at MSM CaRMS as an R3. There is a 1st and 2nd round just like in the R1 match, but if you go unmatched after the 2nd round you will default to doing a 4th year of GIM training and then entering independent practice as a general internist. You're considered ineligible for the subspecialty match if you've ever participated in the past, which disqualifies you from taking a "research year" and re-entering CaRMS the next year like what some people do with the R1 match. Obviously this can be devastating if you've dreamt of being an interventional cardiologist your whole life, because at that point you've already invested 9+ years of training between undergrad, medical school, and IM residency. Some people who go unmatched do find ways to secure fellowship positions outside of CaRMS, but this is uncommon and not something to bank on.

Yikes that sounds pretty scary. I took a look at stats on the CaRMS website and it seems like, for the most part, there's a good 10-20% of people who don't manage to get their desired subspecialty. It's a minority for sure, but still a lot given the high stakes. What do these people end up doing? Do most of them manage to grab a spot in 2nd round? Or do they mostly end up doing the 4th year GIM training?

For 2nd round matching, how does it work? What kind of options are typically available? For the R1 match, a lot of gunners who don't get what they want end up in FM; what's the FM counterpart for R3 2nd round match?

As for the 4-year GIM training, is the job market kind to them? I imagine urban centers would favor those who trained in the 5-year GIM program, so is the 4-year counterpart a career-ruiner?

Last question: how feasible is it to parallel plan during R1 and R2 for the MSM match? Could I gun for something competitive like GI while still reliably backing up with another less competitive subspecialty like endo or GIM (the 5-year program)?

Thank you!

[James Nystead]

On 9/28/2020 at 7:04 PM, garlic said:

Matching IM is really like deferring the carms process others went through, except the second time around it's arguably harder imo

Is matching cardio harder than Derm or Plastics or Ophtho?

[StudentInMedicine]

9 minutes ago, James Nystead said:

Is matching cardio harder than Derm or Plastics or Ophtho?

Just a student but I don't think so. Looking at the latest MSM match, there were 57 spots in cardio offered and 63 residents who ranked cardio as their first choice discipline. Maybe there's more to it than that and maybe this was a good year, but that's nowhere near plastics or ophtho level.

Edit: here's the report I was looking at: https://www.carms.ca/wp-content/uploads/2020/01/msm3e_2020.pdf

[cotecc]

5 hours ago, ACHQ said:

It doesn't work out so cleanly in terms of hours a week, heck its even hard to say how *many* weeks a year do you need to work to earn that much, because evening/nights pay way more, weekends pay more. Generally speaking if you pick up alot of that work you will make more. I wish I had a more solid answer but it isn't so black and white. It also depends on volumes (if you are at a very busy centre with lots of volume you will make more). *Generally* (not exact) but 1 week of work (~5ish days) is about 10k. So to *bill* 400k you need to work close to 40 weeks. That doesn't include the stipend/HOCC you get which in total for a year can range between 20-50k additional cash.

GIM in hospital based practice pays 0 overhead. 0!

 

Yes, or the 5 year GIM program, or you can technically do it as a subspecialist who can't find work/wants to make extra money/likes GIM doing GIM work.

 

I agree with #4 and somewhat with #1. I just finished residency and the last few years consistently that I remember Heme was competitive as was ID (more than endo and rheum). As you mentioned certain years were worse than others

thanks for the reply

Would you say GIM has a okay lifestyle? Is your schedule tied to whatever the hospital needs or you have a certain autonomy to decide how much you wanna work and how many vacation weeks.

[Recollections]

7 hours ago, ACHQ said:

I agree with #4 and somewhat with #1. I just finished residency and the last few years consistently that I remember Heme was competitive as was ID (more than endo and rheum). As you mentioned certain years were worse than others

Fair enough! I may be a little biased as I personally know 4 people in the last few years who were gunning for Endo or Rheum and failed to match to those specialties. Definitely depends on the year.

 

2 hours ago, StudentInMedicine said:

Yikes that sounds pretty scary. I took a look at stats on the CaRMS website and it seems like, for the most part, there's a good 10-20% of people who don't manage to get their desired subspecialty. It's a minority for sure, but still a lot given the high stakes. What do these people end up doing? Do most of them manage to grab a spot in 2nd round? Or do they mostly end up doing the 4th year GIM training?

For 2nd round matching, how does it work? What kind of options are typically available? For the R1 match, a lot of gunners who don't get what they want end up in FM; what's the FM counterpart for R3 2nd round match?

As for the 4-year GIM training, is the job market kind to them? I imagine urban centers would favor those who trained in the 5-year GIM program, so is the 4-year counterpart a career-ruiner?

Last question: how feasible is it to parallel plan during R1 and R2 for the MSM match? Could I gun for something competitive like GI while still reliably backing up with another less competitive subspecialty like endo or GIM (the 5-year program)?

Thank you!

Aside from the fact that the most popular specialties (Cardio, GI, etc.) almost always fill their spots in the 1st round, I don't think there are any guarantees as to which specialties will have spots left in the 2nd round. Luck of the draw at that point. Some competitive applicants who were victims of the numbers game will match to a different specialty as long as they're willing and have no red flags. From what I've seen though, unmatched applicants usually end up doing the 4th year in GIM to get into independent practice sooner rather than doing a 2-year fellowship in a subspecialty they don't enjoy.

From what I hear, 4-year GIM grads have little problem getting jobs at most community hospitals so it's not at all a career-ender. Getting a position at a major academic centre would be much more difficult though.

Parallel planning is usually not feasible in IM where you only have three 4-week electives to show your stuff and get reference letters. You may be able to split them into 2-week electives and do more electives in different specialties, but you're going to have trouble getting stellar references with only 2 weeks at a time. Some people apply to two closely related specialties and are able to spin it both ways in their letters/interviews, but going for something like GI/Endo would raise a lot of eyebrows. Even backing up with GIM isn't a great choice as 5-year GIM subspecialty programs don't like being seen as a backup, but it's doable. Most people go all-in on one specialty.

[Kitara]

On 9/29/2020 at 4:53 PM, Recollections said:

1. Need to gun hard: Cardiology, GI, Respirology, ICU (not solely a medicine subspecialty)

Hi, so what does gunning hard entail for such specialities? I am interested in cardiology and I am not afraid of hard work, but I don't think I can be the neurotic person who gets 4 hours of sleep a night and does all the extracurriculars

[ACHQ]

21 hours ago, StudentInMedicine said:

As for the 4-year GIM training, is the job market kind to them? I imagine urban centers would favor those who trained in the 5-year GIM program, so is the 4-year counterpart a career-ruiner?

outside of academic centers, no one cares if you do the 4 year or 5 year program. In the community you make substantially more vs academics so in fact there is a financial incentive to do the 4 year program so you can make money as soon as possible. At least in the GTA, there are *more* community hospitals than fully academic ones (No I don't count NYGH, TEGH or THP as academic...).

As someone who did the 4 year GIM program, I'm done and live in Toronto and work in a large community hospital. Life is good

 

20 hours ago, cotecc said:

thanks for the reply

Would you say GIM has a okay lifestyle? Is your schedule tied to whatever the hospital needs or you have a certain autonomy to decide how much you wanna work and how many vacation weeks.

Depends on how your contract is set up. Most acute care sites will make you sign up for a certain amount weeks/days. Mine is 9 weeks/yr of Hospitalist coverage (these are 7 day blocks), 3 weeks/yr of medical consults (also 7 day block), 4 weeks/yr of Urgent medicine clinic (only M-F), and 5 ER shifts a month (8 hour shifts: day- 8-4am, evening- 4pm-12am, night- 12am-8am)- with about 1-2 day shifts, 1-2 evening shifts, 1-2 night shifts. This IMO is pretty lifestyle friendly and gives me about 1-1.5 weeks off a months (the days aren't always stacked so nicely though).

That being said I have just started and have been picking up extra stuff whenever I get a chance, and I still think I have a pretty decent lifestyle, with almost 2-2.5/3 weekends off a month and random days off here and there (like today and tomorrow).

[Recollections]

23 hours ago, Kitara said:

Hi, so what does gunning hard entail for such specialities? I am interested in cardiology and I am not afraid of hard work, but I don't think I can be the neurotic person who gets 4 hours of sleep a night and does all the extracurriculars

Gunning for Cardio or GI isn't as cutthroat as it would be if you were going for Derm/Ophtho/Plastics. From a numbers standpoint, the majority of people who want Cardio will match somewhere as long as they apply broadly.

What's different is that the standard to be one of those successful Cardio applicants is higher across the board than it was for the R1 CaRMS match. (Almost) everyone who matches to IM is a good clinician and does some scholarly work or extracurricular activities. They wouldn't have matched to IM in the first place if they didn't already have the qualities to be a good resident. The people I know who matched to Cardiology were either exceptional clinicians functioning at a higher level than their co-residents, exceptional researchers with at least a few cardiology publications and presentations, or exceptional people who also offered some other unique quality that made them attractive to their program.

You don't want to be the only average candidate in a pool of superstars.

[James Nystead]

2 minutes ago, Recollections said:

What's different is that the standard to be one of those successful Cardio applicants is higher across the board than it was for the R1 CaRMS match. (Almost) everyone who matches to IM is a good clinician and does some scholarly work or extracurricular activities. They wouldn't have matched to IM in the first place if they didn't already have the qualities to be a good resident. The people I know who matched to Cardiology were either exceptional clinicians functioning at a higher level than their co-residents, exceptional researchers with at least a few cardiology publications and presentations, or exceptional people who also offered some other unique quality that made them attractive to their program.

You don't want to be the only average candidate in a pool of superstars.

So what is to be said for the premeds gunning for EP or IC I wonder, those odds must be horrendously low once youre in such a competent field of cardiologists 

[TheStern]

Once you're in your 3rd year of IM can you apply to a subspecialty anywhere in Canada? E.g. a UofT IM resident applying for rheumatology in Calgary?