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Jetonblu
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[Residency] Applying for competitive IM Fellowship as /r/MedicalSchool
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a DO/IMG/FMG -- A fellow's experience community for medical students
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So, you’re a medical student/ current resident and want to go into a competitive subspecialty Members Online Rank by size
Gaming
out of medicine… but, you’re also a DO/IMG/FMG?

Sports Well then, I’m Jetonblu and I’m here to try and guide you on your journey to the stars. It’s not
going to be a walk in the park but, there is no reason to think it can’t be done! r/medicalschool
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DISCLAIMER: I am writing this based on my experiences as a DO that wanted to go into GI. Mount Sinai wants to defund
Crypto Currently a GI fellow. My advice is reflective of what I saw during my training as well as advice Family Medicine Residency…
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collected from fellow residents, faculty, and people in high places in fellowship programs who I
258 upvotes · 53 comments
Television had the opportunity to talk to. User experience will vary. I’ve decided to write out this post after
a number of people DM’ed me based off of my replies to other peoples’ posts on the subject. If
Celebrity you have any further questions, please feel free to ask! r/medicalschool

Who needs all the brainstem

See more Chapter 1: Medical School
nuclei anyway?
My story began as a DO medical student. Towards the end of medical school, I was acutely
2.2K upvotes · 93 comments
aware that my future lay in taking long scopes with a camera attached to them and putting
RESO U RC ES
them far up people’s colons. I knew it would be challenging to match GI, so I reached out to
r/medicalschool
some attendings with experience in fellowship applications and this was the advice I received:
About Reddit
New Residency Program
1. You need to try and go to a University based residency program for IM. I was told that at
Advertise Combines Anesthesiology and…
some fellowship programs, it went as far as applications being placed in two separate piles: anesthesio…
University trained and Community trained (after which point, they went through the U 65 upvotes · 50 comments
Help
trained ones first). I will add that from my interview experience for fellowship, I rarely met
people from community programs (unless you are really going to put Cleveland clinic as a r/medicalschool
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“community program”).
[Serious] hate medicine, what do I apply to?
2. Oh snap, University program is out of reach/ isn’t going to happen. Should I leave
Careers
medicine and join Mario in the world of plumbing? NO. It is not the end of the world, even 61 upvotes · 33 comments
if the world becomes tougher. If you do go to a community program however, it is
Press
important that the program has its own GI fellowship. This is important for several reasons: r/medicalschool
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a. You may be able to land in house through your face time with faculty M1-M3s who feel like you will never make it...
let me tell you my story.
b. Programs think that if there is no fellowship in your competitive field (abbreviated CF from
POPU L A R POSTS 927 upvotes · 51 comments
here on out) at your program, then any CF interaction you get at the hospital is not of the
“teaching” and “academic” pedigree. This is also the warped reason of why programs want to
see U trained residents rather than community trained ones. Now whether these two claims hold
water is arguable, but this is how current belief systems are set up in the academic world.

3. When you interview at a program with a fellowship, whether it be U based or not, look at their
fellows. If you are seeing that nobody from the residency is staying for fellowship in your
competitive field of interest, this means that they likely do not take in house (you can also ask
the PD straight up). Obviously, you should try to go to a program that takes their own to
improve your own odds of matching.

4. When programs show you match lists, they never actually show you who did not match. So,
when you see 3 people matched into CF, you have no idea if that is a 100% match rate or a 50%
match rate. It is important to gather that info by asking the residents during interview dinners or
other interactions. They will usually be honest about it and the info can help you figure out what
the pipeline for CF is like from that institution.

5. Some people have asked me about community affiliates of university programs. Is having that
U name attached to your community institution good enough? Will it count as an academic
institution? The answer is unfortunately, no. I was told that that is not fooling anyone. However,
maybe certain affiliates allow you to do rotations at the U. That may be helpful to get your foot
in the door.

6. Bonus: Medical school is busy as it is. However, if you are one of those people that knows
early on that you want a certain CF, trying to do some sort of research in the field will be helpful
from the stand point on showing your dedication to the field. Absolutely not a requirement!

Chapter 2: Residency

One anxiety fueled bender is over. You made it into residency. Doesn’t matter where or what
program. At the end of the day, you are going to be an internal medicine doc! You are going to
be helping people and have a very rewarding career. That being said, you still want that CF out
of medicine. What to do?

Being a good resident. You can’t expect to do a bad job and then get strong letters of rec. It’s
not going to happen and that will hurt you. That being said, you’ll hear chiefs and faculty say
“being the best resident is the most important thing for applying for fellowship. If you do that,
everything else will fall into place.” YEAH, THAT AIN’T IT, CHIEF. If you just work yourself to death
being a resident, you are NOT setting yourself up for CF. You need to do right by your patients,
but you also need to dedicate yourself to CF early on. But how do you show programs that get
100 apps per spot that they should pick you? Is it with community service? Research? Cold
calling programs and offering your left kidney/ first born? The answer is not that simple.

When trying to figure out your future, it’s important to set up realistic expectations to best line
yourself up for success. There are primarily two types of fellowship programs: those that are
clinically focused and those with a big research component (physician scientist). If you want the
latter, you are already at a disadvantage being a non US MD as those institutions are more likely
to be of the elite university caliber. If you want the former: a clinical experience, then you have a
greater fighting chance. For me, personally, I want to be a clinician first and foremost.

1. Volunteering: I can’t comment here as I did close to non (read: none). Did not affect my
application as far as I can tell in the least. Nobody brought it up. If you can do it, by all
means. But the residency lifestyle leaves little room for it.
2. Educational activities: Do as many things that even remotely sound like you being a
resident teacher. In my experience, programs love this. My residency had something where
we could learn how to be medical educators for fellow junior residents and students and
every interviewer I had for GI talked to me about it quite a bit. Def will set you apart.
3. Away Rotations: Some programs let you do them, others don’t. These are certainly not a
requirement but, if you have a program that you really really love, you can try and see if
something can be set up. Make sure you impress them though!
4. Research: This one is trickier. For a research program this is going to be crucial. For a
clinical program, it’s a bit different. All programs want to see continued interest in the field
(so not just that towards the end of residency you decided you wanted CF because it pays
out and now you did a case report). My strategy was to try and show my dedication to the
field by continuously going to conferences (and presenting there) as well as pumping out
as many publications as possible. Though quality is always important, quantity can be as
well. My strategy below:

a. Avoid trying to make your own IRB. It will take forever and you do not control the timeline.
Last thing you want is to go three years of residency and have no completed projects

b. Case reports, case reports, and case reports. These are easy to write up! I’d even recommend
you make sure and write up any case report abstracts so that you show project completion as
well as more published material. Unfortunately, case reports are hard to publish these days.
Legit journals aren’t eager to publish these. Don’t waste your time waiting months to get back
rejections! Submit to journals such as Cureus which are free and pub med indexed and much
easier to publish in (with much faster turn around time). Again, programs are seeing this as your
dedication/ interest in the field rather than you being a CF titan (which you couldn’t possible be
in residency).

c. If possible, other types of research are also encouraged. Whether it be database analysis
which doesn’t require IRB approval (data already available) or review papers, it doesn’t matter. It
is all “original” and looks more solid than a case report. Be aware though that review papers are
by invite only, so check out if any attendings in CF at your institution have been invited to write
up something and see if you can join in. These projects will also help your chances of getting
fellowship at your home institution as the attendings get to know you better.

d. Try to start early! Obviously you have more pressing issues the first half of intern year but I
suggest starting to get those CF wheels moving by the second half of intern year.

Chapter 3: Applying for fellowship

The blood, sweat, and tears are in. Now, the last ingredient must be added to the toxic mix:
money.

1. Apply as broadly as possible. Some people will have anchors and that is understandable.
That being said, apply as broadly as your life allows you to. Beggars can’t be choosers.
2. When deciding on whether to apply to a program, look up their current fellows and see if
any resemble you in terms of academic pedigree. If you are a DO and they don’t even
know what an osteopath is (? Bone wizard ?) you can probably skip them as your odds of
an interview are minimal.
3. Call up former residents from your program currently in your desired CF fellowship and ask
them to put in a good word. When there are so many applications, you become but a
number to the PD’s. This can really change things for you.
4. Look up SDN *internal screaming commences* for the fellowship thread for your app cycle.
I think this is important because you will know when certain programs are sending invites.
If you see that you aren’t getting one from a place you really want, you may choose to call
to reinforce your interest a couple of days later. You can’t do it too late because all of their
interview invites will be out.
5. If you have a low step 1 score (or I guess step 2 in the future given P/F for Step 1) you may
want to call programs after you apply because most, if not all, have automatic board score
cut offs and may not even see your app if you fall below their cut off range.
6. Go to all your interviews. Or as many as possible. This is not the time to save money.

Applying for a competitive subspecialty as someone that isn’t a US MD is tough but, not
impossible. You will need to work to make your application that much stronger to level the the
playing field. If you go into this with that kind of mindset and work hard throughout (and trust
me, I know residency on its own is grueling enough) you will make it out and achieve your
goals!

I wish each and every one of you the best of luck!

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[deleted] • 3 yr. ago

Thank you so much for taking the time to write this! I'm a DO student and just finished
my IM rotation and absolutely loved it. Always thought I wanted to do cards but I'm
leaning more towards GI now. It makes me so happy to hear that a university IM
program is the best route to either because that's what I've always hoped to do!

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[deleted] • 3 yr. ago

osteopathetic • 3 yr. ago

Thanks for this. Saved it for later reads 😃

What’s the common step 1 cutoff you encountered for GI (or other competitive
fellowships)? Are you out of the game with a low 220s step?

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[deleted] • 3 yr. ago

Ghatdamn, I thought step one was hard enough but nope, there's levels to this!
Wouldn't really be the complete IMG experience if these important challenges were
missing now, would it?

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Jetonblu OP • 3 yr. ago

The medical education climb is the equivalent of a 90’s arcade game: levels on
levels. The good news is that the view is nice from the top! Just gotta lose/ gray
the hair a bit along the way.

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[deleted] • 3 yr. ago

Hah! Whatchutalkmbout? All the hair done gone went on a one way rocket
to Mars a la Space X lol.

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[deleted] • 3 yr. ago

kzbro10 • 3 yr. ago

Thank you for your post, this is really helpful

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[deleted] • 3 yr. ago

asdfgghk • 3 yr. ago

Discrimination is still alive in America

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[deleted] • 3 yr. ago

Thanks for the post! Would this advice largely translate well for DO people who want to
go into a CF immediately from medical school? Such as ortho, ENT, urology, PM&R
maybe?

Obviously I’m an M1 so I don’t know what I want to do for the rest of my life but I
know I do not want to be an IM doctor lol.

Also to any premeds reading this: although matching anything as a DO is entirely

possible and has been done for the most competitive fields, trust me when I say this,
you don’t want to go to a DO school. Retake that MCAT, get a good clinical gig,
improve your app essays, anything to boost your MD chances. OMM is not fun. I don’t
hate being at a DO school, but I think about what it would be like at a USMD all the
time, particularly for matching to where you want. If DO is all you got, it’s all you got
however- still gonna be a physician :D

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Jetonblu OP • 3 yr. ago

Great question! Let me first preface my response by saying that I am not an

expert in this and my opinion is one formed by what I saw/see and have heard.

My advice would be to take the “show interest in the field” part of my write up
and really start up as soon as you can in med school. Try to get involved in
projects and write ups over the summer after M1. You can start by finding
hospitals near you and seeing if you can “shadow” a specialist in the field of your
choice just so you can get access to potential projects and cases to write up. Then,
try to keep in contact with those attendings after the summer and see if they can
send you cases to write up, etc. towards 4th year, away rotations in your CF are
going to be crucial as well, especially as a DO applying.

I don’t know if some DO schools still discourage taking USMLE in addition to

COMLEX, but if they do IGNORE THEM. You will not get into a competitive ACGME
residency (for the most part) without a USMLE score.

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Tsornai • 3 yr. ago

Feels tough to do right now because of the pandemic

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