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Core IM and IM


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What I usually hear about is that IM is 4 years length in canada while it is 3 years long in the USA. However it seems that people planning to pursue a fellowship after, ie: cardio... can apply in pgy-3?! is that correct?

Yes, for general internal medicine, you do four years. If you do a fellowship you apply as a PGY-3 and start fellowship in your PGY-4 year.

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If you google "r4 match", you get a website from U of A that shows the progress of the match to the various subspecialties in medicine beginning the first full week of November each year. It lists the schools, programs, number of spots, number of offers, and number of acceptances and declines.


Depending on the discipline, an application to a subspecialty program (with references, CV, program-specific forms, etc) has to be submitted sometime between the end of July (cardio deadline) and mid-September in your PGY-3 year. Inteviews are in September and October with about two weeks' notice, and the match is done in early November. The specialties involved include GIM, Geriatrics (1 year), Endo, Resp, Critical Care, Nephro, Rheum, GI, Allergy, Heme, Onc (2 years) and Cardio (3 years).


Right now the match is a phone-call or e-mail based match; you can apply to a number of programs, and they can contact you with an offer as early as the first Monday of November. You have the option to accept the offer, decline the offer, or hold the offer.

Here's where it gets confusing. You can hold two simultaneous offers for a total of 48 hours, and you can hold one offer for the entire length of the match.


As an example, Dr. J desperately wants Cardiology in Winnipeg. They apply to Cardiology in Winnipeg, Calgary, Toronto and Vancouver, and General Internal Medicine in Winnipeg too. They get an offer from Vancouver, which they decline. They get an offer from Calgary on Monday, which they hold, so they have a spot in Cardiology now. They get an offer from Winnipeg GIM on Tuesday, which they also hold. Dr. J now has to decide whether to pick specialty (Calgary Cardio) or location (Winnipeg GIM) before Thursday, as they have to drop one of their offers; Dr. J can also accept one of the offers or hold one, hoping a spot in Cardio in Winnipeg comes up. While checking the website for the R4 match, they notice the number of accepted offers for Winnipeg Cardio is the same as the number of spots --- it's full. Decision time.


Like I said it gets confusing. And when you are waiting a week for a spot in a program you REALLY want that isn't full to open up, it's a little soul-sucking too. IM PGY-3s are either very happy or very bitter the first week of November.



Every internal medicine resident will write their FRCP© exams in two parts in the spring of PGY-4; for GIM, that's it, for the others, there's a subspecialty exam usually in September after the final year of fellowship.


Hope that helps... I had to wait a week in November, but now I'm off to Toronto for GIM in the summer!

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