Backing up for Small Surgical Specialty

[smolcat]

Hi all,

I'm in the middle of my 3rd year right now and getting ready to pick electives. I have a rather strong interest in a small, moderately competitive surgical specialty and have a long-term project in this (unfortunately not yet published). I'm hoping to match to this specialty, and am looking for some advice on elective selection to maximize my chances of matching while also giving me a chance to back up into something else.

The new 8 week cap on electives of a given specialty goes into effect this year. I'll be doing those 8 weeks in this surgical subspec. For my remaining weeks, are there any thoughts on what strategy I should pursue? I could do a few IM electives (e.g. CTU, ICU, and a related IM specialty) and try to back up into IM, or do all of it in general surgery and try to back up into GSx. I realize general surgery doesn't typically like to be the back-up specialty and will likely rank me lower than other applicants, so perhaps the IM route is more preferable for matching purposes. On the other hand, maybe a few GSx electives can impart me some general proficiency that'll help me a bit more on my surgical subspec electives. What are your thoughts?

Thanks!!

[gangliocytoma]

3 hours ago, smolcat said:

Hi all,

I'm in the middle of my 3rd year right now and getting ready to pick electives. I have a rather strong interest in a small, moderately competitive surgical specialty and have a long-term project in this (unfortunately not yet published). I'm hoping to match to this specialty, and am looking for some advice on elective selection to maximize my chances of matching while also giving me a chance to back up into something else.

The new 8 week cap on electives of a given specialty goes into effect this year. I'll be doing those 8 weeks in this surgical subspec. For my remaining weeks, are there any thoughts on what strategy I should pursue? I could do a few IM electives (e.g. CTU, ICU, and a related IM specialty) and try to back up into IM, or do all of it in general surgery and try to back up into GSx. I realize general surgery doesn't typically like to be the back-up specialty and will likely rank me lower than other applicants, so perhaps the IM route is more preferable for matching purposes. On the other hand, maybe a few GSx electives can impart me some general proficiency that'll help me a bit more on my surgical subspec electives. What are your thoughts?

Thanks!!

Have your electives been assigned already? From the point of view from someone in the class of 2021, we had little control over what electives we did. It seems like you want to do surgery. Would you be happy doing medicine (i..e backing up with IM) if you matched to it? If not, then doing medicine is not the best idea, aside from gaining some general medicine proficiency. What specialty are you applying for? 

[bearded frog]

The only things that qualify for small and moderately compeditive are urology and vascular, which generally have an average of a third more applicants than spots, so with the extremely realistic chance of not matching you'd be well served to actually have a reasonable second choice and not just a "back-up" unless you'd consider doing the risky gambit of going unmatched and doing a research year or something.

So strongly consider what else you want to do, and do electives in that and make a real effort at applying to it with good reference letters and letters of intent, and just rank all your 1st choice specialty programs behind your second choice ones.

Otherwise you could do your electives in tangentially related specialities, ie plastics for ENT, gyne for urology, etc.

[smolcat]

4 hours ago, gangliocytoma said:

Have your electives been assigned already? From the point of view from someone in the class of 2021, we had little control over what electives we did. It seems like you want to do surgery. Would you be happy doing medicine (i..e backing up with IM) if you matched to it? If not, then doing medicine is not the best idea, aside from gaining some general medicine proficiency. What specialty are you applying for? 

applying to urology, which as @bearded frog stated is competitive enough to make me nervous about not matching lol. 

I'd prefer Uro > GSx > IM > ?FM > not matching, but with all the stories of GSx not liking to be a back-up specialty, would it be worth it to do my non-urology electives in GSx, even if I make a strong effort on GSx, try hard, get letters, etc? That's mostly my reasoning behind doing some complementary IM electives instead e.g. ICU/Nephro

[bearded frog]

If you did a few electives in gen surgery and expressed a legitimate interest while you're there: "I'm currently looking at gen surgery and urology and both interest me tell me about why I should do gen surgery" etc. and get strong reference letters then that's completely legit, and you can say in your personal statement you were interested in both urology and general surgery throughout medical school but eventually decided that [choice] was the right one for you because of X/Y/Z and just swap out the specialty as appropriate

[robclem21]

4 hours ago, bearded frog said:

If you did a few electives in gen surgery and expressed a legitimate interest while you're there: "I'm currently looking at gen surgery and urology and both interest me tell me about why I should do gen surgery" etc. and get strong reference letters then that's completely legit, and you can say in your personal statement you were interested in both urology and general surgery throughout medical school but eventually decided that [choice] was the right one for you because of X/Y/Z and just swap out the specialty as appropriate

With an elective cap, this becomes a very reasonable approach. To add as well, no specialty (including family medicine and IM) likes being a "back-up", so you will need to use this logic regardless of what your second choice specialty is. Every specialty is becoming challenging to back-up with (esp. in popular locations) so don't close doors by letting anybody know its a backup choice.

[dooogs]

2 hours ago, robclem21 said:

With an elective cap, this becomes a very reasonable approach. To add as well, no specialty (including family medicine and IM) likes being a "back-up", so you will need to use this logic regardless of what your second choice specialty is. Every specialty is becoming challenging to back-up with (esp. in popular locations) so don't close doors by letting anybody know its a backup choice.

Im curious what you can say a at a family medicine interview if you only have 1 elective in it. 

[bearded frog]

5 hours ago, dooogs said:

Im curious what you can say a at a family medicine interview if you only have 1 elective in it. 

You could make up something like "Ever since I was a little girl I have always wanted to be a family doctor and even from day 1 of medical school have been 100% invested in family and I knew I wanted to be the best family doctor ever and really be able to help my patients and work with the other aspects of medicine so since I was so familiar and set on doing family I decided to use my elective time (since we could not do visiting electives) to fully experience other aspects of medicine so I am able to better help my patients in residency and also make more effective referrals and I feel my diverse elective experience will be a strong asset to your program as a resident"

Dunno how far that would get you though lol. Also less effective if all your other electives are clearly derm :p

[dooogs]

2 minutes ago, bearded frog said:

You could make up something like "Ever since I was a little girl I have always wanted to be a family doctor and even from day 1 of medical school have been 100% invested in family and I knew I wanted to be the best family doctor ever and really be able to help my patients and work with the other aspects of medicine so since I was so familiar and set on doing family I decided to use my elective time (since we could not do visiting electives) to fully experience other aspects of medicine so I am able to better help my patients in residency and also make more effective referrals and I feel my diverse elective experience will be a strong asset to your program as a resident"

Dunno how far that would get you though lol. Also less effective if all your other electives are clearly derm :p

I feel like you are good at this... lucky for me I have no interest in derm. But say I am interested in rads... that would be hard to spin into family..... 

[bearded frog]

1 minute ago, dooogs said:

I feel like you are good at this... lucky for me I have no interest in derm. But say I am interested in rads... that would be hard to spin into family..... 

"Although I am not yet decided on what kind of practice I would have as a family physician I am strongly interested in rural care and I am aware that unfortunately a lot of rural areas are underserved in terms of diagnostic procedures available. I foresee that I will have patients who will be able to get x-rays and other imaging fairly urgently but not have it formally interpreted for a day or more. As you know, radiology is a field that is woefully under-taught in medical school and a special interest of mine so I took it upon myself to do a number of electives so that I may be able to better make a preliminary interpretation of their imaging, as well as to potentially offer point of care ultrasound during their visit and saving them from having to wait for an ultrasound appointment or travel to a separate site to rule out simple pathology. The additional foundation I have in this domain would be a valuable asset to your program"

[rmorelan]

you can also has that because again you may be more rural based and may have multiple roles you are considering possibly an emerg component -

emerg in most places in Canada have to read x rays when rads is not around which in some cases literally most of the time (evenings, overnight, weekends and holidays.....). It becomes a required job skill (at least until we as a field force ourselves to do it - which we are working on ha. ER radiology!)

Edited January 18, 2021 by rmorelan

[robclem21]

21 hours ago, dooogs said:

Im curious what you can say a at a family medicine interview if you only have 1 elective in it. 

This is why interview prep with trusted friends and people who give you honest feedback is imperative before going into an interview and trying to "wing it". See above for excellent examples. Sadly I don't think @bearded frog wants to go through another CaRMS match so you may have to do some independent thinking on this one. I heard residency programs favour that skill.

[dooogs]

4 hours ago, robclem21 said:

This is why interview prep with trusted friends and people who give you honest feedback is imperative before going into an interview and trying to "wing it". See above for excellent examples. Sadly I don't think @bearded frog wants to go through another CaRMS match so you may have to do some independent thinking on this one. I heard residency programs favour that skill.

Yes for sure! I was just curious because I am just learning about CARMS. I'm still in first year med so lots of time to think about interview questions

[robclem21]

4 hours ago, dooogs said:

Yes for sure! I was just curious because I am just learning about CARMS. I'm still in first year med so lots of time to think about interview questions

Then you should be enjoying life and not worrying about CaRMS for another 3 years

[dooogs]

18 hours ago, robclem21 said:

Then you should be enjoying life and not worrying about CaRMS for another 3 years

I'm trying to but we keep having "scary" CARMS talks by the school! But advice taken. Thanks for everybody's input. Always great to hear from others

[shikimate]

I think in retrospect Carms is scary and it is not scary. It is scary because for 99% of grads it is their only way out, otherwise their 4yr MD degree more or less go down the drain. For people whose minds are fixated on 1 specialty of course super stressful.

Now that Biden is in office I think visa restrictions hopefully will loosen, I still encourage people to do step 1. USA has so many spots if you are so worried about not matching you have insomnia apply to some FM/IM there and more or less you'll match no problem.

Also in retrospect those 4 years med school never told you zilch about finance and investing. med students have credit at their fingertips and the few who were smart probably made a fortune leveraging their LOC. Again I believe academics do this on purpose to keep med students poor so they are stuck trying to match to residency so they can collect some meager salary to stay out of homeless shelters lol.

[medhopefull1984]

@shikimateAs a first year student who was actually homeless as recently as a few years ago your conclusion left me speechless.

As an aside though, things are not looking any brighter than they have for the past few years in terms of matching at all, much less into competitive programs (for some of us anyways). I personally just want to match into something at all at this point. In the limited clinical exposure I did have (admittedly any conclusion based off of which is a hell of an extrapolation) matching to a large extent may come down to networking. This is particularly concerning for plebs like me who have had limited interaction with the crowd even remotely similar to the faculty and the pandemic has further contributed to lack of such exposure this year. It is sad but distinct possibility that some of us may be left fighting to match even to the less competitive specialities by the time CaRMSs comes around given the current trajectory in terms of the number of grads left unmatched.

[1D7]

27 minutes ago, medhopefull1984 said:

@shikimateAs a first year student who was actually homeless as recently as a few years ago your conclusion left me speechless.

As an aside though, things are not looking any brighter than they have for the past few years in terms of matching at all, much less into competitive programs (for some of us anyways). I personally just want to match into something at all at this point. In the limited clinical exposure I did have (admittedly any conclusion based off of which is a hell of an extrapolation) matching to a large extent may come down to networking. This is particularly concerning for plebs like me who have had limited interaction with the crowd even remotely similar to the faculty and the pandemic has further contributed to lack of such exposure this year. It is sad but distinct possibility that some of us may be left fighting to match even to the less competitive specialities by the time CaRMSs comes around given the current trajectory in terms of the number of grads left unmatched.

It's a numbers game and you're compared to your peers. The average medical student applying to a noncompetitive specialty has no trouble matching. Generally students applying to low-mid competitive specialties will match some effort and applying broadly.

[shikimate]

I make a number of valid points medhopeful1984. Sounds like you have honorary PhD from the university of hard knocks.

CaRMS to a large extent is just like looking for a job and even entrepreneurship, a lot of it rests on networking. Entrepreneurs who find the right mentor or angel investor could take off in no time, while those with great ideas but were at the wrong time in the wrong place are forgotten by history. In case you didn't know, read up on the story of UBC cardiac surgery match scandal in 2013. 

Covid does make networking very difficult for everyone. There are still chances such as summer research and whatnot, but you gotta up your game if you are at the "periphery". By med school stage I hope you are not afraid of sending out cold emails and rejections, because in the real world that's what it takes to find the opportunities. If you match to an in demand specialty, wonderful, you'll have your choice of jobs. But if you match to a specialty where job is scarce, well guess what, you gotta use your personal connections again and maybe even cold call, cold email and expect rejections. 

Academia is a mixed bunch. With some exceptions, they aren't the best at giving out financial or even life advices. Although some have good intentions, I find they view gets very narrow after they've been in academia for a while. For example when I ask about incorporation or how to balance work and life they rarely have anything useful to say. I see some of them work 996 but they are super inefficient at what they do, but they never think about improving efficiency. It's like Amazon deliver your packages with a fleet of camels when it's time to use remote operated drones. Others are just plain malicious. Maybe they've been trapped in academia for so long they just wanna drag whomever they can into the same life they have. Better to have 1 scapegoat than no scapegoat right?

[lovemedicinesomuch]

On 1/18/2021 at 6:38 AM, dooogs said:

Im curious what you can say a at a family medicine interview if you only have 1 elective in it. 

I only had 1 week of FM electives and got 10+ FM interviews.. most of them are closed and won't know that they were a back up lol...

 

[dooogs]

21 hours ago, lovemedicinesomuch said:

I only had 1 week of FM electives and got 10+ FM interviews.. most of them are closed and won't know that they were a back up lol...

 

Congratulations! That is pretty reassuring actually... do you ever have to put in what your electives were?

[RicardoKaká]

4 hours ago, dooogs said:

Congratulations! That is pretty reassuring actually... do you ever have to put in what your electives were?

Applicants have to put this on the CARMS application online and traditionally most include it on their CARMS CVs as well. However, if it is a closed interview they wont have access to these documents during the interview and thus wont know where/what you did electives in.

Have heard from many of my colleagues doing 1 elective in FM and getting a lot of interviews, so if you can see yourself backing up with FM and are willing to put the time/effort into that and additional interviews then it is a reasonable thing to do!