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what do FM and IM PDs look for


cotecc

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1 hour ago, cotecc said:

Considering IM and FM are often backups for more competitive specialties, what do PDs in IM and FM look for in candidates? For sure they must know lots of applicants use them as backups.

What type of commitment to the program they are looking for and students should demonstrate

people really need to watch what they say, the disrespect is real. Crazy thought to you but the vast majority (75-80%) of the hundreds of applicants to FM or IM have it as their 1st choice..

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16 minutes ago, offmychestplease said:

people really need to watch what they say, the disrespect is real. Crazy thought to you but the vast majority (75-80%) of the hundreds of applicants to FM or IM have it as their 1st choice..

Agreed, CARMS statistics are very clear that majority of IM and FM applicants have it as their first choice, and often their only choice specialty. 

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6 hours ago, cotecc said:

Considering IM and FM are often backups for more competitive specialties, what do PDs in IM and FM look for in candidates? For sure they must know lots of applicants use them as backups.

What type of commitment to the program they are looking for and students should demonstrate

probably also wise to google - always a good place to start. and agreed with the above - lots of people have it as first choice. 

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8 hours ago, offmychestplease said:

people really need to watch what they say, the disrespect is real. Crazy thought to you but the vast majority (75-80%) of the hundreds of applicants to FM or IM have it as their 1st choice..

 

8 hours ago, JohnGrisham said:

Agreed, CARMS statistics are very clear that majority of IM and FM applicants have it as their first choice, and often their only choice specialty. 

Or, you know, you could not make up statistics? CaRMS publishes this data plainly (tables 9 and 11).

For CMGs, in 2020 there were 953 first choice FM applicants and 2125 total, meaning that only 44.8% of total applicants to FM had it as their first choice, and the majority of FM applicants literally are applying it as a second or lower choice. The numbers for IM are 453 first choice applicants of 885 total spots, or 51.2% of all IM applicants ranked it as their first choice. So for IM, it's technically true that the majority have it as their first choice, but I wouldn't say its clear at all.

And when you say "It's often their only choice specialty" we can see that would only apply if you consider 30% (640) for FM and 17% (148) for IM often...

I'm not hating on FM or IM, its just how things are. Only 17 people only applied to peds last year (I was one of them in my year).

Frankly, it's not at all controversial that people often back up with IM and FM. To answer OP's question, they look to see if you would make a good family medicine/internal medicine resident and doctor, same as if someone was gunning it. You can't just apply and cross your fingers. You'll need to plan ahead and get FM/IM specific letters of reference, write personal letters about why you want to do FM/IM at X program, and for IM especially do some relevant electives. Even if you have 5 derm electives and 2 family electives you can very validly say that you were interested in another specialty early on and then found that FM is the life for you. It's not a secret that people apply to multiple specialties, they are not going to ask you if you're applying to something else, you just have to show that even if you don't match your first choice that you'd still be happy and do well in your back-up.

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3 minutes ago, offmychestplease said:

Stats aside, it's the general sentiment of disrespect that's frustrating. 

Nothing OP said was disrespectful. They could only be applying to IM and wants to know how to make their application stand out and demonstrate that they only want to do IM. And its not disrespectful to say that there are more competitive specialties out there that people also apply to other specialties in case they don't match. That's not a knock against IM/FM, it means that its a desirable field that a lot of people could see themselves doing, among other things. It's also a numbers game as together they have more spots than the rest of the other specialties combined.

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19 hours ago, cotecc said:

Considering IM and FM are often backups for more competitive specialties, what do PDs in IM and FM look for in candidates? For sure they must know lots of applicants use them as backups.

What type of commitment to the program they are looking for and students should demonstrate

I have participated in IM candidate review before, and genuine interest in the specialty is part of the criteria but there's a strong emphasis on many other qualities

Letters of reference and CV tend to be important, I would say backing-up with IM can be a little bit riskier that you may not get as desirable a location if your strategy is apparent to the reviewers

Nowadays with limits on applicant electives, it may not be as difficult to explain various electives 

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I think the original question stated they are “often” used as a backup. I didn’t interpret this as saying “most” or that they’re not also mostly applied to as a first choice.  
 

Truth is, they are often a parallel plan for other specialties. That doesn’t mean they’re not worthy specialties in their own right! I think of family medicine and internal as very universally relevant and valuable regardless of what other specialties you are also applying to (if that’s the case) and that’s why I think many people choose to parallel with them! 

I can imagine thinking of FM and IM as “backup” specialties (which I don’t think is fair, btw) is probably a source of tension for people who chose them as their 1st.  I also don’t think it’s fair to say that someone is being disrespectful for asking what these PDs look for because these programs are more often 2nd choice compared to, say plastics.  That’s not a value judgment, the latter would just be poor strategy!

Just hoping to add some understanding to this stressful time❤️❤️❤️

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On 2/15/2021 at 12:53 AM, offmychestplease said:

Stats aside, it's the general sentiment of disrespect that's frustrating. 

  Not only I didn't see any sentiment of disrespect but I also have a hard time finding what exactly can be considered as such.

Topic-wise. Our IM PD told us that multiple electives in IM usually show a student's genuine commitment to IM.

 

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On 2/14/2021 at 9:24 PM, bearded frog said:

 

Or, you know, you could not make up statistics? CaRMS publishes this data plainly (tables 9 and 11).

For CMGs, in 2020 there were 953 first choice FM applicants and 2125 total, meaning that only 44.8% of total applicants to FM had it as their first choice, and the majority of FM applicants literally are applying it as a second or lower choice. The numbers for IM are 453 first choice applicants of 885 total spots, or 51.2% of all IM applicants ranked it as their first choice. So for IM, it's technically true that the majority have it as their first choice, but I wouldn't say its clear at all.

And when you say "It's often their only choice specialty" we can see that would only apply if you consider 30% (640) for FM and 17% (148) for IM often...

I'm not hating on FM or IM, its just how things are. Only 17 people only applied to peds last year (I was one of them in my year).

Frankly, it's not at all controversial that people often back up with IM and FM. To answer OP's question, they look to see if you would make a good family medicine/internal medicine resident and doctor, same as if someone was gunning it. You can't just apply and cross your fingers. You'll need to plan ahead and get FM/IM specific letters of reference, write personal letters about why you want to do FM/IM at X program, and for IM especially do some relevant electives. Even if you have 5 derm electives and 2 family electives you can very validly say that you were interested in another specialty early on and then found that FM is the life for you. It's not a secret that people apply to multiple specialties, they are not going to ask you if you're applying to something else, you just have to show that even if you don't match your first choice that you'd still be happy and do well in your back-up.



I apologize, I was post-call. What i MEANT to say is " The majority ACCEPTED FM and IM applicants had it as their first choice, and often their only specialty"

Table 17:  

 929 of 1193 FM ACCEPTED applicants, had FM as their 1st choice. The VAST majority of those who ultimately are accepted into FM, have it as their 1st choice discipline.

408 of 455 IM ACCEPTED applicants, had IM as their 1st choice discipline.

----

And also:

Table 34:

953 CMGs had FM as their 1st choice discipline. 

453 CMGs had IM as their 1st choice discipline.

It wouldn't really be a relevant point for me to argue that most applicants to either field are true 1st choicers, cause yes obviously there are loads of people backing up throwing applications to FM and IM. And most PDs can see it, and will happily interview many of them(but not all, UofT and UBC will cut down their giant interview lists with the too obvious backups) and put them lower on the rank lists to fill their programs if it comes down to it. But most competitive/popular FM and IM programs, are without a doubt, being filled by people who actually want those fields as their first choice - and their elective choices, and CV generally make it very obvious and clear. Not to say you can't match to those fields backing up - but often it doesn't materialize in the "more desirable" programs, or those people simply just match to their true desired field in the first place.

 

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I think the main point I wanted to bring across is: Historically IM and FM are seen as backup fields to apply to due to the large # of spots.  But the statistics show, that the vast majority who actually end up in those fields are aiming for them as 1st choice disciplines.

Long gone are the days where you can throw in a luke-warm back up application to FM/IM and end up in a nice urban big city program. Those programs anecdotally are being filled by people gunning for those spots as 1st choice disciplines. Often it will be the less desirable(whatever that means to an applicant) spot that those backing up will fill, if they for some reason don't match to their true desired specialty.  Or going unmatched. 

For those backing up, the key is to make sure you actually try and show some effort and get electives, LORs and some CV items for the back-up too. Programs don't want to have someone who has no exposure to their field, and have someone who is miserable in their backup program. So do some due diligence to ensure you can satisfy their thoughts, "Well, if they don't match to Rad Onc, they seem like they are still a good clerk, and will work hard to train to become a competent Internist in our program". Etc.

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On 2/14/2021 at 9:24 PM, bearded frog said:

I'm not hating on FM or IM, its just how things are. Only 17 people only applied to peds last year (I was one of them in my year).

I'm not sure you're making the point you're trying to make haha...

177 applied to peds as their 1st choice, 137 matched of which 128 had it as their first choice, with 9 people who matched to peds as their back up discipline.

In total, there were 305 applicants to peds, only 17 of which only applied to peds.   

So, the clear inference here is, there were a fair number of people who backed up with peds - but only 9 of the 128 actually matched to peds as a back up.  And that the majority of people who applied to peds as their 1st choice - smartly backed up with other fields, likely FM and IM.

Now, take FM for example:

2125 total applicants to FM, of which 640 only applied to FM.  Now unlike smaller programs like peds where there so few seats, it is plausible that a non-negligible amount of the difference between 2125 and 640, likely only applied to a couple FM programs in their home program city or desired local, and not very broadly. (This is the usual back up pattern seen with FM. I.e. apply broadly across canada to Derm, but then just apply to a few FM programs in big cities that are desirable). So the magnitude of difference between the two numbers is likely not as much. Thus pointing to a larger than expected proportion of "true FM gunners" implied by that 640 number.

So as you can see, while 9xx had FM as their 1st choice discipline,  3xx of those actually applied to other disciplines as "backups" or "alternates". Strange phenomena!  Contrary to popular belief, some people have various personal choices/preferences/requirements/restrictions, where they can conceive a plan where they would have other programs, such as Peds, IM, Psych (combinations I have seen), as their backups if they don't get into their desired FM programs. Usually in the case where applicants are region locked. I.e. "if I don't get into the FM programs in the GTA, I wouldn't mind backing up with peds, im or psych locally".  Or something else I can't think of at the moment!

Carms stats are very interesting, and I encourage all applicants to read through them to get a better appreciation of what plays out, and how to make informed decisions. 
 

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31 minutes ago, JohnGrisham said:



I apologize, I was post-call. What i MEANT to say is " The majority ACCEPTED FM and IM applicants had it as their first choice, and often their only specialty"

Table 17:  

 929 of 1193 FM ACCEPTED applicants, had FM as their 1st choice. The VAST majority of those who ultimately are accepted into FM, have it as their 1st choice discipline.

408 of 455 IM ACCEPTED applicants, had IM as their 1st choice discipline.

----

And also:

Table 34:

953 CMGs had FM as their 1st choice discipline. 

453 CMGs had IM as their 1st choice discipline.

It wouldn't really be a relevant point for me to argue that most applicants to either field are true 1st choicers, cause yes obviously there are loads of people backing up throwing applications to FM and IM. And most PDs can see it, and will happily interview many of them(but not all, UofT and UBC will cut down their giant interview lists with the too obvious backups) and put them lower on the rank lists to fill their programs if it comes down to it. But most competitive/popular FM and IM programs, are without a doubt, being filled by people who actually want those fields as their first choice - and their elective choices, and CV generally make it very obvious and clear. Not to say you can't match to those fields backing up - but often it doesn't materialize in the "more desirable" programs, or those people simply just match to their true desired field in the first place.

 

One thing that I think it might be good to point out is that even if the majority of people who eventually match to FM/IM did rank them first, this is also contributed to by most applicants who backed up with those specialities just matching to their first-choice specialities. It's impossible to say whether these applicants would have eventually matched to FM/IM if they didn't match to their first choice, but I don't think the numbers your provided above give the true picture.

Of course, programs across the board definitely do have a strong predeliction for applicants who have shown interest in their speciality, but with the new 8-week limit on electives, I'd reckon it's possible to be a competitive applicant to two competitive/semi-competitive specialties and still potentially be able to do enough electives to apply to FM (depending on how many weeks of electives you get at your school).

Even in the past it was possible to spin doing electives in other specialities towards either your first or backups specialty (unless you went crazy and did 20 weeks in plastics, in which case, good luck if you don't match to plastics...). For example, I could easily explain doing a couple electives in Rad Onc or ENT as being related to my interest in providing comprehensive cancer care (radiation/surgical treatment) because my ultimate career goal is become a medical oncologist through IM.

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10 hours ago, zxcccxz said:

One thing that I think it might be good to point out is that even if the majority of people who eventually match to FM/IM did rank them first, this is also contributed to by most applicants who backed up with those specialities just matching to their first-choice specialities. It's impossible to say whether these applicants would have eventually matched to FM/IM if they didn't match to their first choice, but I don't think the numbers your provided above give the true picture.

I agree completely, i think the point was to dispel myths that FM/IM are filled with people who didn't actually want to be there. Most of the people who back up with those fields, do in fact end up in their main choice specialty program. 

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10 hours ago, JohnGrisham said:

I'm not sure you're making the point you're trying to make haha...

That is the point I was making, with only 17 people only applying to peds its clear that the significant majority either applied as a back-up or were backing-up, similar to FM/IM. In fact we can calculate that 52.5% applied to peds first and backed up with something else, and 42.0% applied to something else with peds as a backup. In terms of overall numbers, peds is 3rd in terms number of people who applied to it as their not-first choice, then psych is 4th.

I think we are in agreement. As you say a good proportion (32.8%) have a second choice after choosing FM as first choice, and I would agree with your suspicion that its likely people who were highly location preferenced. Interestingly of the 313 that did "back-up" with something else after FM, only 8 of them did in the end match to something else, which is a very small proportion of total applicants to FM. In fact FM has a uniquely small proportion of people who apply to a secondary discipline, as seen in this graph of percent of first choice applicants who applied to a second specialty:

https://i.imgur.com/mTuuLmZ.png

I hypothesize that the lest back-upper specialties may be for different reasons. Family because I suspect a very high percentage just want to do family, and it's seen as less compeditive. Nsx, ortho, gen surg, optho are relatively compeditive and I imagine these may be gunners who would rather go unmatched and do a research year and try again then back-up. The pathologies are relatively noncompetitive.

2/3 of people who ranked IM first backed up with something else.

Another interesting graph is if we ask what proportion of total applicants are applying as their not-first choice (ie what percent of total applicants are backing up with it):

https://i.imgur.com/MgccTLy.png

Again I suspect the patholgoies are quite "inbred" in terms of their ranking and probably prioritize location over which subtype of pathology. I suspect as well that peds-neuro is an obvious co-apply back-up with pediatrics, or perhaps IM if really interested in neurology and split between adult/peds.

Then comes nuclear medicine which I have no idea. I think public health is in the same boat as as family. No idea about vascular surgery, other than people co applying with cardiac surgery?

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20 hours ago, zxcccxz said:

Even in the past it was possible to spin doing electives in other specialities towards either your first or backups specialty (unless you went crazy and did 20 weeks in plastics, in which case, good luck if you don't match to plastics...). For example, I could easily explain doing a couple electives in Rad Onc or ENT as being related to my interest in providing comprehensive cancer care (radiation/surgical treatment) because my ultimate career goal is become a medical oncologist through IM.

Not really. If you were applying for something even moderately competitive many people would usually use at least half their elective time for their specialty of interest (and often more than that) because declaring your interest in that manner vastly increased your chances of matching to your desired competitive specialty in anglophone Canada.

People who "went crazy and did 20 electives in plastics" were the norm in such specialties. The exceptions were those who did a few weeks and still matched.

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To actually answer OP's question, FM programs don't expect much. You need to have a variety of electives so i would do most of your electives in your main specialty of interest, do an elective related to family (eg psych, ob), and at least 1 FM elective but 2 is ideal. CV matters almost not at all. Strong letters that specifically talk about your strengths as a family applicant (it's more common than you think for someone to submit a letter that ends to saying nothing about family or worse says they are an ideal candidate for another specialty). Strong MSPR comments help too. Frankly my standards are low for FM applicants and all I look for is a commitment to the specialty.

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