srbutros
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I have two quetions and the feedback I will get from you guys will appear to be very critical in making some decisions.
I was wondering if preliminary spots or categorical spots are more competitive in university based programs in internal medicine?
Also what are the chances of switching into categorical after doing a preliminary year? I know there is no such thing as a guarantee but is it usually achieved one way or another, say switching to another PGY2 program but still landing in a good spot?
Thank you very much
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| doc_droc_apurva
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surg / med?
apurva
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| docmle
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surgery........
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| adeelmd
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Prelim surgery is one of the easiest spots to get in the match, cat surgery is one of the hardest spots to get... so it will be tough. Most imgs I have seen do one year of prelim surgery and then apply to categorical the next year, meaning you are doing an extra year of residency.
As far as internal medicine goes... prelim spots are generally harder than categorical spots; except at some community based hospitals that have a heavy workload for prelims and are very easy to get. I think it is very easy to get a pgy-2 medicine for a prelim medicine resident. Whether or not you can jump into a good univ program is purely based on the luck of a good program having an empty slot (fairly common) and how obsessive you are about finding it (constantly looking and e-mailing programs). Generally, if you are a good prelim resident, you can get a pgy-2 at your current program.
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| docmle
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well.......suppose u join pgy2 after prelim pgy1, then u catch the ladder of categorial residency and u do not waste a year... and u no more required to apply for pgy3/pgy4 so on m i right...
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| srbutros
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actually I meant medicine, sorry!
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| srbutros
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as far as I know you get someone else's categorical position who supposedly left the program and that means if you go on with PGY-2 you don't have to apply for PGY-3 and so on...
Okey, I have another question then....
I am thinking of applying for radiology but I am thinking of applying to internal medicine as well as a back-up. I was thinking that if I don't get mathced in radiology, I would go on with medicine after doing the preliminary but according to your post I am kind of taking a risk because if I never apply for rad and just go for categorical I might land in a better spot... uuuuhh that's not good.
Do you guys know any way of applying for both preliminary and categorical in medicine and also rads as well. I'm all mixed up. Does this in anyway work out?
Thanks a lot!!!
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| adeelmd
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I just answered this same question for someone else via e-mail. Here was my response (cut and paste below)
It's unethical to apply to a categorical program with
the intention of leaving after one year. It is done
all the time though, because many people want to just
get that one year of medicine and move on. The
benefit of doing so is that you might get into a
better medicine program (categorical being more easier
than prelim), but there are a lot of other variables
that can change that. The problem (and the reason I
didn't do this) is that you will have to lie on your
interviews, personal statements, etc. When you are
going for a categorical medicine interview, you can't
tell them that you are applying to rads (or they won't
consider you serious about medicine). You would need
a separate personal statement about how you always
wanted to do internal medicine, etc, etc. It can
get tricky keeping all the stories straight in your
head, but you could pull it off.
A lot of people tried to convince me to apply to
categorical medicine; but i didn't because I didn't
want to lie to anyone, and most importantly I didn't
want a back up. When you've put in 15 hour days of
constantly interviewing, thank you letters, and other
crap (with people telling you you don't have a
chance).. that prematch offer from a categorical
medicine program will look VERY GOOD. It will be soo
tempting to just take the medicine residency and not
to go on the second looks, no more constant weird
looks by everyone thinking you have no shot, and no
more getting dressed at 5am for an interview. Not
having any back up is what pushed me to go the extra
mile, to obsess over radiology.. to the point where
you could probably see it in my eyes; and that's why I
think I got the position.
In reality, I always had a back up- my prelim medicine
year. Getting a pgy-2 position for categorical
medicine is extremely easy as a prelim resident. What
i am saying is that it is very easy to go from a
prelim to a categorical spot, but taking a categorical
with the hope of doing a prelim year will involve
lying, and probably make someone angry in the end.
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| LifeInTheFastLane
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Adeel, looks like you just missed your career: You could have been a motivational writer and made $$ outta it!
Great going dude, great going!
I wonder whether having to go through what IMGs typically go thru makes their spirit indomitable, or is it that guys with indomitable spirit choose to "become IMGs"...
Either way, you have paved your way through one of the most IMG-non-friendly roads, ...keep it up!(as they told me in kindergarten!!)
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| doc_droc_apurva
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another technical point over the ethical concepts very well put by adeel
u cannot match into a categ medicine and a categ radio spot at the same time.. the nrmp algorithm wont allow it.. so if u take up a categ medicine - u will have automatically sealed out ur rad spot and u will be scramblin for unexpected open rad spots after 1 yr..
so i u want to keep categ im as backup u will have to indicate to the im prog u are interested in both prelim and categ.. rank the rads first in primary list and prelims first in the secondary list.. and the categ im lower down in the primary list..
apurva
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| srbutros
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I didn't even know we could get matched at a categorical med program and a radiology program at the same time...
So the system lets us do that?? Interesting...
So at the end of the year you just say surprise: I'm gone!!
How could they not be aware of each other. It doesn't make sense. You get a spot for 3 years in med and 4 years in rad excluding the first year??
This is like matching at surgery and medicine at the same time.
I don't get it, anyways, I guess I won't choose to lie either. Things will become much more complicated, different CV's, personal statements, and I won't have the chance to mention I'm a reseach assistant in one position to another and also cannot use the recom. letters as well. sucks!
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| srbutros
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apurva,
how would you cover up for saying I'm interested in cat and prelim together? What would be the reasoning for that? I guess you would have to confess that you want rads primarly then? which I guess would lower your chances of getting a cat spot pretty much.
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| doc_droc_apurva
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i repeat u CANNOT get matched into categ medicine and categ radio at the same time.. i think u misustood my post..
u cud say that u havent yet made up ur mind - makes u weaker candid.. or u cud apply to prelim im and categ im at different places - more expenses..
apurva
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| adeelmd
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you can't match in both rad and im cat programs (everything apurva said is right). Say you then matched in a categorical medicine position, you wouldn't be able to scramble into radiology(nrmp would lock you out). Then when next year comes around, you won't/can't apply to radiology because you are stuck in categorical; (sneaking around your program for days off to interview would not be easy) whereas in prelim you would be encouraged to apply and if nothing worked out,, if the program is halfway decent, they would help you out somehow. When interviewers asked what my back up was I told them it was to apply again next year. My biggest selling point for prelim medicine was that there was a very good chance I wouldn't get radiology, so I would have to work twice as hard as a resident to get good LORs and evals to get radiology in the next match.
The only justification to apply to both prelim/categorical is if you really want the categorical, but will settle for the prelim to "prove" yourself to the program (this is very common in surgery, or people with low scores/mutlpie attempts applying for IM)
Edited by adeelmd on 06/14/06 - 05:00 PM
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| srbutros
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Some last questions that I need to ask 
What did you do in the year of gap, btw the preliminary year and rads? What would be the options? Just sit and wait?
What do you think about entering a cat program and applying in the second year for rads just as if you were applying for fellowship? This way you could have two board certifications and still could go through a better IM program?
Did you ever consider going through nucs after the preliminary? I am considering to apply to both rads and nucs during that time if I'm unlucky with this match. Then try to find way to switch into rads if I end up in nucs.
I sent you a private message adeelmd, I would be glad if you could take a look at it when you have the time,
Thanks
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| doc_droc_apurva
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dont ustand where the gap comes
in gap do research to further solidy ur credentials
would like to hear ur and adeels views on nuclear med..
apurva
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| adeelmd
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You can do research, do a pgy-2 year, or just sit and do nothing during the gap... it depends on what you want/need to do.
second question, I would recomend this to people who have low scores and want radiology. Doing another residency (im) should get u a spot. There is a HUGE warning though, because technically the hospital only gets federal for only one residency per person... and you can't get funding for doing another residency. It is a complicated issue, and some perople say that the government never really checks if someone is doing another residency, while others are very adamant about the issue... so confirm this with many people (maybe even ACGME) before planning this.
Don't do nucs. It's soo overplayed. I just feel that everyone doing nucs wants rads and you are still going to have to compete with them, not to mention that if you don't get radiology, nucs is going nowhere. They are making nucs a three year program now... so it's 4 extra years (one prelim just for nucs, then maybe 2-3 years for radiology... plus the funding issue i mentioned above)
My plan was if i don't get in to radiology, was to apply the next year for radiology and neurology, as I was confident I was going to get prelim medicine at least. As a neurologist, I could actually get to read my own images and could even get into inr (which is the fellowship I am planning for)... so that was my plan...
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