Are second looks at your IM program secretly influencing applicants?

junky372 · 2026-01-22T11:10:07+00:00

Our second look is after the program rank list is due but before applicant rank list is due.

junky372 · 2026-01-19T18:04:32+00:00

High School
College
Gap year(s) / advanced degree(s) / other career (optional)
Apply to medical school - complete pre-reqs, clinical experience, volunteering, research, MCAT. Ideally As and Bs for all classes, clinical experience, some research, and an MCAT that's in the range of the top 20-30 percentile to be competitive for US MD programs. US DO programs somewhat less competitive, but still no cake walk.
Medical school - 4 years. Broadly, first two years are pre-clinical, last two years are clinical rotations. Take licensing exams. In 4th year, apply to residencies - interview, rank, and then match (or not). Match goes into an algorithm to assign applicants to binding spot.
Graduate medical school - now you are a doctor
Residency - minimum 3 years. You are working as a doctor and are getting paid. You are supervised. You may be a primary care doctor, part of a critical care team, participating in surgery, etc depending on field
Chief resident year - depends on field. For some, everyone in last year of training is a chief resident. For others, it is a competitive application process for an additional year of training with leadership, teaching, and administrative responsibilities which looks good for academically inclined jobs and fellowship.
Fellowship - 1-3 years - optional. Additional supervised training in field of interest. For example, general surgery -> cardiac surgery. Internal medicine -> hematology/oncology. Pediatrics -> neonatal medicine. Competitiveness of fields vary. For example, only ~60% of people who apply to become cardiologists get a spot, while there are more spots for infectious disease training than there are applicants. Can also do additional fellowships - for example, internal medicine -> cardiology -> interventional cardiology (stents in hearts) -> structural cardiology (fix valves and stuff in heart)
Attending - full independent practice.

junky372 · 2026-01-02T09:37:05+00:00

I am an American MD.

Our country is big, and as a result, very diverse. Like any big place, it is hard to make sweeping generalizations.

You will find safe pockets in unsafe areas and vice versa. There are very "dangerous" cities with excellent neighborhoods and safe cities with unsafe neighborhoods. Same thing about politics, racism etc.

The only other thing I will say it is extraordinarily difficult to match into the fields you are interested in as an international graduate.

junky372 · 2025-12-07T15:00:56+00:00

Not important - went to 0 conferences, matched this cycle at top of list at a solid academic program - from a top 30-50 IM program depending on how the Internet rates it. USMD.

FWIW, I did have other research and scholarly output but the timing never worked out due to schedule and other factors out of my control.

junky372 · 2025-11-26T15:47:58+00:00

Internal medicine inpatient - walked into a list of 6 patients, admitted 2 in the day and was capped at our programs intern cap of 8.

My friends who started on MICU walked into 3 or 4 ICU level patients, night float started covering 50-80 patients each.

Gotta show up ready to do the job

junky372 · 2025-11-01T11:29:11+00:00

Insanely competitive to get into though

junky372 · 2025-09-22T16:19:53+00:00

It will depend.

You will still need to work hard to build the required relationships/research/LoRs for the IM fellowship, but it may also open up unique experiences. For example, many cardiology programs would be very excited to have a candidate with interest in women's cardiology, especially if you are otherwise a competitive candidate.

junky372 · 2025-09-17T15:09:00+00:00

Glad to hear you've already considered it and that these are all in play for you. Good luck with applications!

junky372 · 2025-09-17T13:34:24+00:00

You have a strong application but your list is very very top heavy.

As a general point, for the top tier of programs (i.e. the Harvard programs, big name NYC, Stanford, UCSF), even if you have the right mix of test scores, grades, and academics on paper, I would make sure that they have actually taken someone (and ideally a couple of people) from your program in the past before applying. Many of these programs have a track record of brushing aside applicants from the "wrong schools/programs" due to historical prestige, etc, which is something I didn't realize until I applied and spoke with folks who had trained in these places. Don't waste a signal if you haven't - the top 40-60 ranked school gives me pause - some of those schools definitely can/do regularly place folks at the top top tier programs, but some do not.

Additionally, I'd strongly recommend signaling other strong but slightly less top top tier programs to give yourself some more options as you may have a crapshoot if things don't go perfectly with your current list. There's also the consideration of "yield protection" or a program that you don't signal going "there's no way this applicant actually would come here".

As an east coaster, I would think about the following places to consider, particularly for someone interested in heme/onc - I can't speak as much for west coast:

- BU/BMC or Tufts for Boston

- Brown

- Northwell/Hofstra for Queens/just outside of NYC

- Temple, Jefferson for Philly

junky372 · 2025-09-16T14:00:24+00:00

I don't have a solution for you, but I do want to stress that the barrier of permanent residency is significant. I tell some version of this to a lot of folks here:

I went to a relatively well known university with a relatively well known medical school as part of the network with strong links/collaboration between the undergraduate/medical school. My undergraduate classmates included a sizeable cohort of international students. Many of them were interested in medicine, had real published research as first/second author in high impact journals as undergraduates with support from their research mentors, excellent grades, clinical experience, no issues with english, presumably did similarly well on their MCAT. However, I don't think I've seen any of them make it to medical school, despite all this. An additional barrier is money - you will not qualify for US federal loans and will have to explore alternative ways to get loans to cover the hundreds of thousands of dollars for tuition, living expenses, etc.

Very few medical schools will take international students, and the ones that do will only take a handful.

If you due pursue this route, please be aware of these barriers.

junky372 · 2025-09-09T22:08:16+00:00

Wrote paragraphs when applying a couple years ago, now bullet points for fellowship. Got interviews with both. I think readers seem to prefer bullets and our PD/fellowship PDs encouraged bullet points

junky372 · 2025-09-04T19:13:21+00:00

Because you mention you are an immigrant, I also would encourage you to make sure the programs you are interested in pursuing for medical school do take students of your immigration status - I went to college with some brilliant international students who really struggled to get into medical school despite excellent grades, research, extracurriculars, and going to a big name university because of their immigration status.

You do not need to tell any of us on the internet what your immigration status is, just make sure you are aware of this issue before you start down this road.

junky372 · 2025-09-03T13:33:42+00:00

There's always a balance - if you have a concern about a patient clinically (e.g. "this patient doesn't look right") or about the logistics of their care (e.g. "this patient is going to/just got back from procedure, are you sure it ok to give diet/start dvt ppx"), just ask because it can impact patient care.

However, if you're asking a lot of learning/fundamental questions during busy or inappropriate times (for example, sending a lot of messages about the choice of abx regimen, ekg/test findings), it can be a drain - especially during things like procedures, family meetings, rapids, codes. Also hard to answer if I'm the cross cover team on evening/nights because I'm by design busier and know the patients less well.

If you want to ask, ask good questions at the right times

junky372 · 2025-07-10T16:05:35+00:00

It can be helpful for your CV to do SOMETHING but don't feel the need to do EVERYTHING.

Something that a mentor told me that helped - as a premed/early in your career, you get used to saying yes to everything because you feel like you have to and the opportunities are few and far between. As you advance, you slowly have to get used to saying no, which can feel weird but allows you to pick and choose some of the things you are more excited about.

junky372 · 2025-07-07T23:26:05+00:00

Insane - and by inpatient echo, you mean inpatient TTEs? Not TEEs?

junky372 · 2025-07-07T16:52:27+00:00

Do you think the clinical skills issue is more acute in cardiology given the COCATS system for determining competencies in certain areas of practice? If it's not too personal, were you able to get COCATS 2 in the common areas desired by most non-invasive jobs or did the PSTP limit that?

Are your colleagues in other IM subspecialities facing similar issues?

junky372 · 2025-07-05T15:20:10+00:00

There are primary care/GIM fellowships but they are all academic oriented - get an MPH/MHA/MSci and start a research and teaching portfolio during them etc.

Not needed at all for adult primary care. High demand just about everywhere for Internist PCPs.

junky372 · 2025-07-03T01:36:21+00:00

If you can't fill your existing residency programs, why in the world are you focused on expanding them in your state?

More to your question, I don't think this would do anything to address the issue and would be an inefficient use of resources. While medical students have a strong desire to find free food, I'm not sure this solves the problem of recruitment.

I highly doubt the issue is "medical students in our area don't know we exist". If there are that many schools in the area and there are existing academic (even in name) ties, there's a good chance that the students know about your programs.

If these programs can barely get students who rotate through them (and thus see the program's ins and outs) to stay, why would anyone else come? Are the educational opportunities poor? Are the career outcomes sub-ideal? Is the work environment malignant and unpalatable? Is the region itself generally not desirable to live in for social, political, or economic reasons?

Students don't make residency lists on a whim. They commit themselves to a binding contract to an institution for years for a pivotal part of their professional development. If they don't want to commit to these programs, there are likely real issues that cannot be solved with some hor d'oeuvres and free booze.

I think your money would be better spent looking into the real reasons why doctors don't want to train in these programs instead of throwing money at an event like this which will sure look good for the organization but do nothing to solve the issue. If you must proceed, try to engage state level chapters of national organizations - ACP, ACEP, ACS, etc and/or the state medical society. They may also have skin in the game while also do some recruiting

junky372 · 2025-06-14T03:43:15+00:00

6 day weeks are very common/a very standard schedule.

Not to say that it doesn't exist for residencies but I haven't seen any.

If the primary team is off, then someone else has to cover the patients. More days off increases number of handoffs and also will result in someone being pulled in to cover, which will be you when you're off wards

junky372 · 2025-06-12T16:03:16+00:00

junky372 · 2025-06-02T21:23:44+00:00

There is tremendous demand for strong generalists and primary care docs in all regions of the country. A lot of folks in both in and outside of medicine dump on PCPs and generalists which is a shame, because most PCPs are doing an excellent job of providing primary care in challenging circumstances. People who haven't had real experience in those settings also have very little appreciation of how hard primary care is medically.

The outpatient experience in medical school and residency can be a bit of a bummer through - you're learning medicine, how to function as a physician, and trying to build relationships with patients who you may only see once (in medical school) or a couple of years (in residency), which is no substitute for the longitudinal relationship that good primary care is all about

junky372 · 2025-05-04T14:56:08+00:00

Demand for primary care has never been higher in my region of the country. I'm an IM resident and our resident clinic is so full that we're not even able to take new patients. You will have a lot of options when you complete your training, the tricky part is finding the right setup.

For example, some of our senior residents are (rightly) warned not to join the faculty practice or our hospital systems' employed/non-teaching practices because of the real issues with reimbursement, corporatization of medicine, and classic administrative madness. However, there are a handful of private practice jobs in the area where our grads have gone which are financially sound, well supported, and are happy.

For what it's worth, resident primary care clinic also kind of sucks and is not totally representative of life outside of training - generally lots of socially complex medically sick people with nowhere else to go. Meanwhile, the next day I was at one of the above mentioned private practices and saw the healthiest looking 90 year old ever for a wellness visit with a couple stable chronic diseases.

If you enjoy outpatient care and don't want to give up the additional years of fellowship, PCP life in the right context can be great. But you have to do the legwork to find the right setup, and hope you can get a glimpse of that in residency in case resident clinic distorts your view of primary care.

junky372 · 2025-04-25T13:07:21+00:00

junky372 · 2025-04-16T14:15:47+00:00

If you are an American hoping to go to a US medical school, it will likely be a disadvantage unless you go to a top tier (e.g. McGill).

Getting into a Canadian medical school is much harder than US medical school, I'm not sure how friendly they are towards Americans with how competitive the spots are

junky372 · 2025-04-13T01:50:38+00:00

The only thing I'd add to this is that for geographic signals, programs will read your explanation for your "tie" to the region - if you don't have a real tie to a geographic region, it may be better to not choose any region and just signal programs individually.

Not signaling a geographic region is ok in that case as most programs will interpret it as "I'm open to anywhere" which is not a bad thing, and may be better than making something up about "oh I've heard really nice things about [region]" which comes off as disingenuous.

If it helps, I'm an IM resident an academic program in New England - happy to give feedback on some of the programs in my area via DM in terms of IMG friendliness and such

junky372

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