Residency Application Specialists
Internal Medicine is a broad specialty, covering each of the major systems. An internist is able to provide care both in community practices and in hospitals, and will be as much at home treating a geriatric patient as an adolescent. Diagnostic ability is key to success in the field, as well as communication skills and the ability to form strong relationships with patients. Primary care elements of the role mean that training in disease prevention, substance abuse, mental health and other areas is also vital. Average salaries for internists are $251,000, which is a little lower than some other specialties. Note that one can complete subspecialty training, in turn raising the salary quite significantly. Private practice will pay much higher than academic roles.
Internal Medicine is a three year Residency, with the three years being in an ACGME-accredited internal medicine residency training program. There are around 400 programs offering training, with almost 10,000 spots available. Subspecialty training is available and covers a range of different areas. In particular, popular subspecialties include: cardiology, endocrinology, diabetes and metabolism, gastroenterology, hematology, infectious diseases, medical oncology, nephrology, pulmonary disease and rheumatology.
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Internal Medicine had a total of 11,598 applicants in the most recent available data, competing for 9809 spots. This works out as a 1.18 applicants per position, making the specialty one of the less competitive. 3689 US MD Seniors applied in this same year, and only 73 of them did not match. Therefore the overall competitiveness for internal Medicine for US MD Seniors in particular is very low. If a US MD Senior offers a Step 1 Score of 200, the probability of matching is 91%, and a Step 1 score of 240 or more means a probability of matching of 98%.
What are the two major approaches to tachycardia?
The two approaches are rate control or rhythm control. Rate control uses beta-blockers, calcium channel blockers or digoxin. Rhythm control may either involve chemical cardioversion, through amiodarone or flecainide, or electrical cardioversion through DC shock. Typically, a symptomatic patient with well rate controlled AF will have the same outcome as someone in sinus rhythm, so cardioversion is not necessary. However, for patients with new-onset AF, LV dysfunction secondary to AF, a reversible cause of AF, or those with a reasonable chance of maintaining sinus rhythm, will be considered for cardioversion. If we take AVRT as an example, electrical cardioversion will be the best initial option, although flecainide may be used for a chemical cardioversion. Pathway ablation is curative. Note that tachycardia is not a diagnosis, rather an umbrella term for various diagnoses, which will have different treatment pathways.
What subspecialties are you interested in? What is the training pathway for them?
I’m interested in Cardiovascular Medicine – in particular, Interventional Cardiology or Heart Failure and Transplant Cardiology. Being able to conduct procedures to tackle heart disease interests me, as does the chance to become a true specialist in the end, whilst being able to build up a truly broad understanding of Medicine beforehand. I understand that the pathway for Interventional Cardiology is the internal medicine residency, then a three year fellowship in cardiovascular disease, and finally an additional year of training in interventional cardiology. Heart Failure and Transplant Cardiology equally allows one to conduct procedures in a highly-specialised field, having first undergone broader training; I need to truly dedicate myself to the field to differentiate between these areas. Equally, there may well be other subspecialties which become more appealing during my training. The path for this subspeciality is the same as for interventional cardiology – the residency, then fellowship of three years, then an additional year of training.
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