Dual applying surgical sub and IM

[MilesDavisTheDoctor]

Hi everyone, I'm an M3 finishing clinical year at a T20 med school with decent grades (honors in IM, surg, psych, OB, HP in the rest) and have not taken step1/2 yet. I'm planning on applying to a surgical sub and will most likely take a research year. The match for the surgical sub is very competitive and in order to be sure I match into something I am strongly considering dual applying. For a while, I thought about dual applying with gen surg, gas or rads but after a lot of thought I think I would be happier in the procedural IM fellowships ( IC and EP in Cards or maybe even GI) than I would be in those other fields. As a result, I'm considering dual applying a surgical sub and IM. I wanted to see what the sdn communities opinion was on this plan and in particular what effect doing a research year in a surgical sub would have on my ability to match into a top IM program. I'm fairly confident that I would be able to match a top IM if I was only applying IM, but when I dual apply I think having to explain the research year and pubs (right now have about 10) in an unrelated field may hurt my app a lot. This question is particularly important to me because I would like to match cards from IM and going to at least a pretty good IM program would probably be important for that. Thanks for reading this message and hope you all are enjoying the holidays!

---

Members don't see this ad.

 

[GoSpursGo]

I think it would be a mistake to dual apply surgical sub and IM. You can’t serve two masters—any time you spend on your second application is time you didn’t spend maximizing your chances for the specialty you really want (through either max step 2 studying, getting honors on your rotations, churning out more pubs, etc). If your goal is “top” IM then those aren't really any easier than most surgical subs. Your app isn't going to pass the sniff test, they're going to know that you are using them as a backup and they aren't going to waste an interview slot on someone they don't think wants to come.

My advice to anyone applying to a competitive field really boils down to the fact that I recommend you be brutally honest with yourself about your competitiveness for the field, your commitment to the field (i.e. "could you see yourself happy doing anything else"), and your risk tolerance. As a student coming from a T20 with 10 pubs banked and an upcoming research year, unless there is some red flag that would make your home program less than enthusiastic in their supper then there is no good reason that I can see that you shouldn't be competitive for any specialty unless you severely underperform on step 2. So my advice would be to try and take step 2 either before or during your research year. If you do well, you can confidently commit to your specialty. If you do borderline or significantly underperform, then you have plenty of time to decide to move forward anyways vs. audible to an IM application. But I don't think there is a good way to do both at the same time.

 

[MilesDavisTheDoctor]

I think I see your argument and I may even end up taking your advice but my plan would be to spend very little effort developing my IM app besides just asking for letters (which shouldn't be that hard). I don't need to get into MGH (and probably wouldn't lol) so maybe "top" wasn't the right wording in my original post but I would probably be aiming for a top 30 IM program. I think it may be possible to do this while devoting very little effort to applying IM and basically just grinding for the surgical sub. My home IM program I think would have a very high chance of taking me and is top 30 so I don't see too much harm in dual applying. Do you still think this isn't a great idea?

 

[GoSpursGo]

I think I see your argument and I may even end up taking your advice but my plan would be to spend very little effort developing my IM app besides just asking for letters (which shouldn't be that hard). I don't need to get into MGH (and probably wouldn't lol) so maybe "top" wasn't the right wording in my original post but I would probably be aiming for a top 30 IM program. I think it may be possible to do this while devoting very little effort to applying IM and basically just grinding for the surgical sub. My home IM program I think would have a very high chance of taking me and is top 30 so I don't see too much harm in dual applying. Do you still think this isn't a great idea?

While your home program may be a different case, I just don’t see other IM programs giving you a serious look when it’s obvious they would be a back up. I could be wrong.

I think you are underestimating the effort of putting together a completely separate IM application. Separate personal statement, separate wording of activities, etc. ultimately I would spend that time on step 2 studying. But ultimately it’s your call.

 

[NotAProgDirector]

You're also very unlikely to fool anyone at your home program. They will know exactly what you're doing. They may interview you out of courtesy, and then not rank you or put you way at the bottom of their list.

 

[Dantes]

Not a PD or in admin but I know enough people who dual applied for either competitiveness reasons or even indecision and were ultimately successful. I agree it's more work and you're better off focusing efforts on Step 2, but I don't think it's -that- bad of a backup plan. Plenty of people say they change their mind, and as long as they have something to show in the other specialty it seems to turn out ok. That said life would be easier focusing on one.

 

[throwaway123342]

Dual applying is fine, idk what the people above are talking about. Rads for instance is very accepting of dual applications. Gen surg and IM are well aware that they are used for backups at times.

 

[Smurfette]

Dual applying is fine, idk what the people above are talking about. Rads for instance is very accepting of dual applications. Gen surg and IM are well aware that they are used for backups at times.

Exactly. And if they think they're being used for a backup, they rank that person lower. Why rank someone who is less interested over other good, actually interested candidates? They don't want someone who is going to bail to another field if they get a chance.

 

[throwaway123342]

Exactly. And if they think they're being used for a backup, they rank that person lower. Why rank someone who is less interested over other good, actually interested candidates? They don't want someone who is going to bail to another field if they get a chance.

Dont know what to tell you. Rads programs rank backup candidates highly all the time.

 

[NotAProgDirector]

This is going to be very program dependent. Some will interview those clearly applying to other fields -- either because they have decided that it's worth it to get some good candidates that way (i.e. in IM, those candidates that don't match derm are often very competitive for IM) or because they don't screen for it. Other programs may decline to invite these candidates at all, not wanting to "waste" an interview spot on someone who has low interest or who might bail after a PGY-1. Hard to say which is more frequent.

 

[GoSpursGo]

Dual applying is fine, idk what the people above are talking about. Rads for instance is very accepting of dual applications. Gen surg and IM are well aware that they are used for backups at times.

I mean sure, yes it happens all the time. I just don't think it's a particularly good idea. Again, time spent on the secondary application is time that could be spent just maximizing your primary application. If you match your backup specialty you're always going to wonder "what if" you had gone all in for your preferred specialty, or whether they could have matched better in their backup specialty had they truly committed to that specialty up front. Agree that once you get to the interview, they are going to rank the applicants based on their strength, but in an era where "top" programs are getting way more applicants than they could ever interview there is risk you're not going to waste an interview on someone they're pretty sure is not coming.

For the OP specifically, they are very clearly a strong applicant to a surgical subspecialty barring a suboptimal Step 2 score. If they hit the median score for accepted applicants in their field and they are above the median for publications, then coming from a T20 school with a full research year I think they're very likely to match just fine. So unless they get a letter that says specifically " @MilesDavisTheDoctor was very committed initially to surgical subspecialty x, but I'm so thankful he saw the light and decided to pursue IM and become a cardiologist," I just think that the tier of IM programs that the OP would likely be hoping to match at would be more likely to offer interview slots to someone else. I could certainly be wrong. But I just feel that once you're going through the trouble of doing a full research year you may as well commit full-on for your preferred specialty and then accept that you could face a gap year if you get unlucky in the match. He could certainly still get IM at the kind of program he would want on his second application.

 

[DOVinciRobot]

Dual applying is fine, idk what the people above are talking about. Rads for instance is very accepting of dual applications. Gen surg and IM are well aware that they are used for backups at times.

Dont know what to tell you. Rads programs rank backup candidates highly all the time.

Gen Surg programs rank back up candidates low.

I do think dual applying is ok, but you have to have two completely separate applications. Not very many people pull it off. And those that do typically still match weaker than they would have if they had gone all in.

 

[mistafab]

I think dual applying sub surg and IM is a terrible idea. You need to decide medicine or surgery. If you don't make it in either the sub spec or the IM-> procedural route, would you rather be a general surgeon or general medical doctor? Completely different careers. Need to decide now so you have time to get letters and other things together before applying.

 

[voxveritatisetlucis]

I would say from a T20 school, you’re fine applying to one. School tier is more important now that Step1 is pass/fail. People from my low tier school who are applying ortho, urology, ophthalmology, etc. are all being recommend to dual apply for the most part.

Also depends on age. Research/gap year at 26 is probably more feasible for most than one at 30

 

[GENEius]

ya, type of school is super important. good luck!

 

[Anakinmemer]

The real question is why on earth would you take a research year with 10 publications from a T20? No matter what specialty you're considering that is extremely competitive and you would not only match, but likely match at a great program. Unless you meant 10 research experiences ie mostly abstracts and presentations and not actual pubs

 

[Anonymoose_65]

Your plan sounds fine but keep in mind that you'll probably have to do two sub-I's (one in surg/the sub-specialty and one in IM) in addition to away rotations for your surgical sub-specialty. It would be strange to apply IM without having done a sub-I with the kind of strong letter you would get from there.

Dual applying takes a lot of work and I wouldn't assume you'll match at a high ranking program in IM unless you can really sell your story. Taht said, I don't think research in a different field is a major red flag.

 

[MilesDavisTheDoctor]

Hey guys just wanted to update this thread. Got step 2 back this week and it was in the 260s which I'm pretty happy about. I'm starting to move away from the idea of dual applying but given how competitive ortho is I still feel like I need a back up plan (also recently completed a cardiology elective rotation which helped me realize that would probably be my second choice of specialty after ortho). I will be doing a research year with my home ortho department before I apply. What do you guys think?

 

[operaman]

Hey guys just wanted to update this thread. Got step 2 back this week and it was in the 260s which I'm pretty happy about. I'm starting to move away from the idea of dual applying but given how competitive ortho is I still feel like I need a back up plan (also recently completed a cardiology elective rotation which helped me realize that would probably be my second choice of specialty after ortho). I will be doing a research year with my home ortho department before I apply. What do you guys think?

Congrats on a solid s2 score!

Hard to say what the right move is. I guess a lot depends on the quality of those 10 pubs you already have. If they’re all Ortho and a few first author papers, then maybe you can skip the research year. If half of those are from you pipetting in undergrad, and the other are just Nth author low quality case reports, then you might need the boost.

What do your mentors in your home department say?

How well does your department know you? How good do you think your letters will be? This can be another reason to consider a research year; if you’re very productive and show initiative, it may lead to stronger letters.

What’s the quality of the research year itself? How productive have past students been? Support for meetings/travel?

As for the dual applying, it’s a great idea for some people. You’re not really those people. You’ve got a very solid chance to match in any field you want. The dual app is more likely to hurt you than help. It will undermine anything you try to say about your enthusiasm for Ortho. Most Ortho residents are not also cool with 3 years of internal medicine rounds every day. It’s going to look weird.

Now, let’s say you had low scores, lower tier school, maybe no home program. Your odds of matching Ortho would be super low anyhow so dual app would be less likely to hurt. It might even been seen more positively as everyone can see you probably won’t match. I’ve had a couple students successfully dual apply surg sub/IM over the last 2 years (both matched IM), but they were low marginal applicants for the more competitive position.

Your best bet is to pick one field and go for it.

 

[MilesDavisTheDoctor]

@operaman thanks a lot for the great reply. To answer your questions:

1. Of my 8 pubs 3 are ortho the rest are from gap year/undergrad. Those 3 ortho papers are first author but they are low quality.

2. Mentor in home department says he thinks research year could help... but he is also the one offering me a research year lol (our PD).

3. The home department does not know me super well which is maybe one of my top reseason for wanting to do the research year. My home program is one of the top programs and I would really like to stay here. I have worked with a few people in the department but I don't think they know me well and one of them has a reputation for being kind of a jerk lol (so wouldn't really trust him for a LOR). The other one is kinda quiet and I can't really get a read on. Both of those guys also have dedicated research year fellows so my LOR would almost certainly be worse than theirs.

4. My mentor says all of his previous fellows for research year have matched (which is one of the reasons I agreed to work with him). I think the quality of the research is high and students have been very productive in the past. Many have matched at the home program. This mentor is also the type of guy to call other PDs and advocate for students a lot which is another reseason I agreed to work with him. I do think there is support for meetings and travel but the position is unpaid which is kinda brutal ( but not super bad because I got a big scholarship for med school).

I agree with you about dual applying being kinda weird at this point but I don't know what to do about having a back up plan. Even though my app is pretty strong, especially if I have a strong research year, I feel like I should be prepared in case I somehow fall through the cracks.

 

[Billiam95]

position is unpaid

 

[LucidSplash]

I guess my question to you, in addition to the excellent advice you've already been given, is what happens if you match IM and then fail to match to the (competitive) IM specialties you mentioned? Will you be happy in IM?

Once upon a time, I considered doing OBGYN with the idea of doing a urogyn fellowship. This was when I first realized I liked the OR while on my OBGYN rotation, but for some reason was still stuck on this (wrong) idea that general surgery and its sub-specialties were too scary (hadn't rotated yet), and I worked with a Urogyn guy on my rotation who I thought was amazing. But also, I absolutely HATED run of the mill OBGYN. I realized it would be essentially impossible for me to enjoy a career as an OBGYN if I failed to match to the competitive Urogyn fellowship. Of course for me it was all moot because I rotated on surgery and realized I was home.

But if you're worried enough to feel you need a backup plan in case you don't match ortho, what is your backup plan if you fail to match to your IM subspecialty?

 

[operaman]

@operaman thanks a lot for the great reply. To answer your questions:

1. Of my 8 pubs 3 are ortho the rest are from gap year/undergrad. Those 3 ortho papers are first author but they are low quality.

2. Mentor in home department says he thinks research year could help... but he is also the one offering me a research year lol (our PD).

3. The home department does not know me super well which is maybe one of my top reseason for wanting to do the research year. My home program is one of the top programs and I would really like to stay here. I have worked with a few people in the department but I don't think they know me well and one of them has a reputation for being kind of a jerk lol (so wouldn't really trust him for a LOR). The other one is kinda quiet and I can't really get a read on. Both of those guys also have dedicated research year fellows so my LOR would almost certainly be worse than theirs.

4. My mentor says all of his previous fellows for research year have matched (which is one of the reasons I agreed to work with him). I think the quality of the research is high and students have been very productive in the past. Many have matched at the home program. This mentor is also the type of guy to call other PDs and advocate for students a lot which is another reseason I agreed to work with him. I do think there is support for meetings and travel but the position is unpaid which is kinda brutal ( but not super bad because I got a big scholarship for med school).

I agree with you about dual applying being kinda weird at this point but I don't know what to do about having a back up plan. Even though my app is pretty strong, especially if I have a strong research year, I feel like I should be prepared in case I somehow fall through the cracks.

You should definitely have a backup plan but in your case that can be SOAP or second application cycle. Since your odds of matching would be so high, that’s probably the best way. The key is knowing what you would actually like to do so you can pivot quickly when the time comes. It also allows you to build connections and rotate in that dept more as a fourth year. Maybe worth a couple IM electives in M4 so you have more opportunities for letters of you end up needing it. That makes much more sense in your situation.

Sounds like the research year is a good bet, especially if you’re eyeing the home program and they’ve taken their fellows in the past. 3 first author papers is a solid start though and may be enough to get things moving along, but if you’ve got the time and a position on the table, I think it would make you as close to a guaranteed match as you can get these days.

Pro tip: once you decide to do it, start setting up projects right now. Get protocols and IRBs submitted before the year starts so you can start doing actual work on day one.

 

[VincentAdultman]

Your update makes it an easy choice. Don’t dual apply.

 

[Just D.O. it]

Dual applying is fine, idk what the people above are talking about. Rads for instance is very accepting of dual applications. Gen surg and IM are well aware that they are used for backups at times.

Sure, most community IM programs are aware and accepting.

T30 programs.... not so much. They have plenty of quality applicants who are clearly committed to IM as a first choice.

Also agree with @VincentAdultman. You should just go full send on your surgical sub. It just doesn't make sense to dual apply any more.

 

[CJhooper123]

Congrats OP, on the great application. Amazing Step 2 score and pre-clinical/clinical grades. IMO you have solid research experience. You mentioned being concerned about the quality of your ortho publications - are they case reports or actual research projects? If the former, I think a research year would be helpful to bolster your application.

Ortho is very competitive - there are several 260+ AOA candidates who have failed to match over the past couple of years (even at T20 schools). The goal of a research year would be to demonstrate productivity (e.g. gain a few extra projects/pubs) and to network. I honestly think that networking is more important. To be less likely to fall through the cracks, you need strong LOR writers who are involved in the academic community, and who can also make phone calls on your behalf when it's time to make rank lists. If you feel that your PD can do this for you, it might be worth it. Also - ortho is filled with selfish people who don't really care about others outside pushing their own personal/research agendas. It's important that you feel this situation out and maybe ask ortho alumni from your MD school what their thoughts are.

Personally, I would strongly consider the research year - whether it's with your PD or at another academic institution. Go to the annual ortho conferences and meet different program directors. If it works out, you will (hopefully) be practicing ortho for 25+ years. Sure you will lose an attending salary for a year, but it would greatly improve your odds of matching into your ideal specialty and fellowship prospects down the road... only 55-60% are matching into ortho right now. A research year between M3/M4 year looks more favorable than a research year after going unmatched.

Also, I would recommend a backup plan. It doesn't need to be a different specialty at first. If you chose to go forward with the match this year, your backup can be a research year or prelim surgery year (which I wouldn't actually recommend). Then reapply with two specialties the following year (or only ortho if you are ortho or bust). Just make sure to have this plan set in stone (e.g. have a cover letter for RY positions prepared before match day, have a CV prepared, etc.). I landed an ortho spot this year without a RY, but I fell quite far down my list despite having many interviews.

Good luck!

 

[longhaul3]

Congratulations on a strong CV. If you want to do ortho you should go all in for ortho. Coming from a good school with a good home program and good scores, you are on track to match. The best way to not match is to knock yourself off track by going off book and doing something like dual applying. Practically speaking, almost none of your peers in the match will be dual applying and it will only hurt your ortho application.

In today's match there are people who will fall through the cracks no matter what. The best thing to do is to do everything you can to avoid falling through the cracks, rather than to handicap your application in order to come up with a contingency plan for falling through the cracks.

If you don't match ortho despite your best efforts without dual applying, you will still be in a good position to SOAP, to find a good prelim position that can lead to a categorical spot, or to reapply in ortho or IM the following year.

I hate research and the research culture in competitive surgical specialties, but in keeping with the above advice to maximize your chance of success the first time, I agree with others that the research year is the best bet.

 

[obiwan]

So you're sure you're ok with writing 15 problem assessment and plans as opposed to nice little POD#3, DVT prophylaxis, therapy, outpatient follow-up in 2 weeks ??

I'm in medicine and just telling you now, don't dual apply. Just apply to ortho

 

[MilesDavisTheDoctor]

Hey everyone just wanted to give another update. I started the research year at my home program and plan on not dual applying at this point. Some other posters have mentioned some backup plans if I don't end up matching. Right now my plan after not matching would be to do a medicine sub-i or some anesthesia rotations at my school to get letters for a dual application to ortho again for the following cycle as a reapplicant (maybe also get involved with some medicine or anesthesia research). I would probably stay on with my current ortho research group at my home institution during the reapplication cycle so that they would continue advocating for me strongly. Can anyone speak to the pros and cons of doing something like this rather than just accepting a pre-lim medicine/surgery spot and then reapplying ortho and medicine/anesthesia at the end of my pgy-1 year?

 

[operaman]

Hey everyone just wanted to give another update. I started the research year at my home program and plan on not dual applying at this point. Some other posters have mentioned some backup plans if I don't end up matching. Right now my plan after not matching would be to do a medicine sub-i or some anesthesia rotations at my school to get letters for a dual application to ortho again for the following cycle as a reapplicant (maybe also get involved with some medicine or anesthesia research). I would probably stay on with my current ortho research group at my home institution during the reapplication cycle so that they would continue advocating for me strongly. Can anyone speak to the pros and cons of doing something like this rather than just accepting a pre-lim medicine/surgery spot and then reapplying ortho and medicine/anesthesia at the end of my pgy-1 year?

I think your plan sounds great. The thing that typically prevents people from doing what you’re planning is funding. If you are sure you can have a funded position or if you have the financial means to support yourself through the reapp cycle then you’re fine. Many schools will make you graduate at that point so you’re not eligible for loans.

You will want to make sure the groundwork is laid for this well in advance. The dilemma that hits most unmatched folks is that to participate in SOAP you cannot apply to research years. And funded research positions can also be very competitive - one of the better ones in my field used to have a S1 minimum of 250. The more you can nail down your plan B in advance, the better.

if you can manage it financially and logistically, an extra research year to reapply dual fields is probably the best bet. If you can’t, then prelim and dual apply also works.

 

[aldol16]

I think you should figure out what you want and go whole heartedly for that. It is much easier explaining things when your application is all geared towards one thing than when you have to split up the focus on multiple things. But if you're down for the extra work, then go for it.

 

[CJhooper123]

I think your plan sounds great. The thing that typically prevents people from doing what you’re planning is funding. If you are sure you can have a funded position or if you have the financial means to support yourself through the reapp cycle then you’re fine. Many schools will make you graduate at that point so you’re not eligible for loans.

You will want to make sure the groundwork is laid for this well in advance. The dilemma that hits most unmatched folks is that to participate in SOAP you cannot apply to research years. And funded research positions can also be very competitive - one of the better ones in my field used to have a S1 minimum of 250. The more you can nail down your plan B in advance, the better.

if you can manage it financially and logistically, an extra research year to reapply dual fields is probably the best bet. If you can’t, then prelim and dual apply also works.

^Yeah, I agree with everything here. The research year really allows you to immerse yourself into the ortho community (e.g. networking with mentors, attending conferences, and becoming a known entity). The biggest con with this is funding. People definitely match after doing prelim, but I think the benefits of an RY outweigh (minus the income). If you do a prelim at program that has an orthopedic residency, you will have the opportunity to demonstrate your capability as a resident. This can be huge for that program, but potentially limiting during reapplication.

Best of luck!