One question I have that’s been on my mind recently, is, what happens if you’re not matched for the residency that is in the sub-specialty you wish to practice?
Secondly, if you were to sign up for a program where your medical school tuition is taken care of in return for your services as a PCP in an underserved area, does that then require that your residency be in primary care, or could you work as a resident for something like hema/onc and then work as a PCP to fulfill your service obligations first?
You match into a specialty initially. If you’re planning to apply for a competitive specialty, you’re wise to have another specialty that would make you pretty happy as a backup. Your advisor will be able to help you with this. If you do not match, you can participate in the crazy one-day-dance call the SCRAMBLE the day before match day, where applicants vie for spots in unfilled programs. Again, the competitive specialties are likely to have few, if any, unfilled spots.
Towards the end of residency, you will apply for fellowship in the area of your subspecialty of interest and go through another match process.
You would have to check the terms of your specific underserved/PCP agreement. I would suspect you would have to complete your commitment and then apply for fellowship in your chosen subspecialty, but I am not certain.
- In reply to:
One question I have that's been on my mind recently, is, what happens if you're not matched for the residency that is in the sub-specialty you wish to practice?
Technically, you don't match into sub-specialties right out of med school, you match into a specialty. A sub-specialty is something you do a fellowship in after completing an initial residency. For example - to be a cardiologist, you would do specialty training in internal medicine, but then do a cardiology fellowship. To be a vascular surgeon, you would do a general surgery residency followed by a vascular surgery fellowship.
But, to answer your question . . . it depends. And, it depends on several things.
So, match day is on a Thursday in March every year (for allo schools, earlier for DO positions). On Monday of that week, you get an e-mail telling you whether or not you matched (or partially matched if you were applying for a 1st year position then a specialty).
If you didn't match, you have a few options. The first is to try and "scramble" into an open residency spot in the specialty you didn't match in. You might ask how are there spots open if you didn't match? You might not have applied to or interviewed at the programs that didn't fill or either you or the program decided you didn't like each other and didn't rank the other. How feasible this is depends on a lot of things . . . how many spots are open (for example, there were ~ five OB/gyn spots unfilled this year, ~10 EM spots, etc), how competitive of a candidate you are, whether or not you're willing to go to one of the open programs (geography, reputation) and so on.
Second option . . . scramble into another specialty. Specialties such as family medicine, internal medicine, psychiatry typically don't fill all of their spots and tend to take quite a few people in the scramble.
Third option . . . scramble into a preliminary or transitional year, usually preliminary medicine or surgery. These are one year spots after which there is no guarantee of staying with the program. You then reapply the following year.
Fourth option . . . don't scramble, take the year off, figure out how to strengthen your application, and reapply. Med schools will defer your graduation or do some other creative things to keep you from having to pay back your loans. Some people will do a research year or take other graduate coursework (MPH, MBA, etc).
- In reply to:
Secondly, if you were to sign up for a program where your medical school tuition is taken care of in return for your services as a PCP in an underserved area, does that then require that your residency be in primary care, or could you work as a resident for something like hema/onc and then work as a PCP to fulfill your service obligations first?
Typically, if you sign up for one of these programs, you are obligated to complete a residency in the primary care specialty first, then fulfill your practice obligation. After you have fulfilled your obligation, you could then pursue another residency or fellowship. I have heard of people doing exactly that.
Heme/onc is a fellowship. In order to work as a oncologist, you would first need to do a 3 year internal medicine residency and then a heme/onc fellowship (another 2 years).
Hope that makes sense.
- samenewme Said:
Again, the competitive specialties are likely to have few, if any, unfilled spots.
That's what I've read. I've also read that some of what is competitive and what isn't changes from year to year, sometimes pretty unexpectedly. Fun.
- Emergency! Said:
Technically, you don't match into sub-specialties right out of med school, you match into a specialty. A sub-specialty is something you do a fellowship in after completing an initial residency.....
Fourth option . . . don't scramble, take the year off, figure out how to strengthen your application, and reapply. Med schools will defer your graduation or do some other creative things to keep you from having to pay back your loans. Some people will do a research year or take other graduate coursework (MPH, MBA, etc).
Fourth option . . . don't scramble, take the year off, figure out how to strengthen your application, and reapply. Med schools will defer your graduation or do some other creative things to keep you from having to pay back your loans. Some people will do a research year or take other graduate coursework (MPH, MBA, etc).
I'm sure my mind is likely to change before that time comes (it's seven to eight years away after all), but the fourth option sounds the most appealing.
- In reply to:
Typically, if you sign up for one of these programs, you are obligated to complete a residency in the primary care specialty first, then fulfill your practice obligation. After you have fulfilled your obligation, you could then pursue another residency or fellowship. I have heard of people doing exactly that.
Heme/onc is a fellowship. In order to work as a oncologist, you would first need to do a 3 year internal medicine residency and then a heme/onc fellowship (another 2 years).
Hope that makes sense.
Heme/onc is a fellowship. In order to work as a oncologist, you would first need to do a 3 year internal medicine residency and then a heme/onc fellowship (another 2 years).
Hope that makes sense.
It did, thanks! That really makes the programs in question difficult to consider. I've read recently of "Hospitalists", which makes Primary Care a more attractive area of interest for me, but still not one of my top choices. Adding eight years to this process when it's already a twelve to thirteen year experience to switch specialties isn't reasonable at my age.
How competitive is IM->Heme/Onc at this time? I've read conflicting information on that, although I'm not sure the answer matters with a seven to eight year lag between now and when it will be relevant for me.
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It did, thanks! That really makes the programs in question difficult to consider.
My advice - if you're at all unsure about what specialty you want to pursue, do NOT sign an agreement during med school with one of the programs where they are paying your tuition. Some of these programs have rather severe financial penalties (you owe THEM the money like a loan, but the interest rate is really high) if you decide not to go into primary care. You're better off waiting until you're doing with residency and then signing an agreement to work in primary care in a geographic shortage area in exchange for loan repayment.
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How competitive is IM->Heme/Onc at this time? I've read conflicting information on that, although I'm not sure the answer matters with a seven to eight year lag between now and when it will be relevant for me.
No idea, and you're correct. It could change quite a bit between then and now. Obviously, the better the reputation of your school and the better you do in school, the better residency spot you are likely able to obtain. The better (i.e. more well-known) the residency, the better the odds of obtaining a fellowship. A lot of people try and do their residencies at places where they think they might want to do their fellowship. In some cases, this can increase your chances of doing a fellowship there.