Internal Medicine

Internal Medicine (IM) residency is a three-year program that prepares its participants for a wide variety of future careers. Well-known among IM residency’s end-points are the subspecialties, which can be practiced in a private office or academic setting. These specialties require a 1-3 year fellowship after residency, and include: General Internal Medicine, Adolescent Medicine, Allergy and Immunology, Cardiology, Endocrinology, Gastroenterology, Geriatrics, Infectious Disease, Nephrology, Hematology/Oncology, Pulmonology, Rheumatology, Sports Medicine, Palliative Care, and Critical Care. In addition, several unaccredited fellowships exist that allow Internists to pursue unique career paths, including fellowships in Global Health, Refugee Health, Medical Informatics and Clinical Pharmacology. Those who decide not to specialize have numerous other career paths to choose from in general adult medicine. As an outpatient adult physician, doctors spend time focusing on more chronic, sub-acute issues. It is becoming increasingly popular to pursue a career in hospitalist medicine as it allows for a more malleable schedule and relatively good financial compensation. Hospitalists spend the majority of their time on inpatient floors, handling patients with more acute disease for shorter periods of time.

(NOTE: if you wait until later in your 3rd year of residency or subsequently decide to pursue a fellowship, that's fine as well. In the time between residency and fellowship, physicians may work as hospitalists or do research).

Internal Medicine is a 3 year residency.The breakdown of each year varies between programs, but in general as you progress through the years you have decreasing time on general inpatient wards and increasing time for electives. Throughout the 3 years you will have time in the ICU (Intensive Care Unit) and CCU (Coronary Care Unit), ER, and some combination of various non-elective (sub) specialty rotations such as Neurology, Geriatrics, Heme/Onc, Cardiology, etc.

The amount of ambulatory time varies significantly among programs, and even within programs depending on certain tracks. One big change is the way in which programs incorporate the residents’ longitudinal continuity clinic, which is classically the clinic that residents maintain throughout their 3 years of residency – the intent being to develop long relationships with a personal cohort of patients.

Many programs are moving towards an “X+Y” system, where the X corresponds to number of weeks devoted to inpatient and Y corresponds to number of weeks devoted to outpatient. (For example, in a “3+1” schedule the resident has 3 continuous weeks of inpatient floors or ICU/CCU without clinic, followed by 1 week of their longitudinal continuity clinic mixed in with other outpatient/ambulatory/elective responsibilities.) There are many variations of the X+Y! In other residency programs, residents spend ½ day every week in their clinic, regardless of inpatient responsibilities. Ask about this during interviews, because this can have a big impact on how many residents feel about their clinic experience. The ambulatory schedule may be different for interns and residents – so ask how the schedule changes from years 1 through 3 if this is important to you.

Residency programs in Internal Medicine differ in whether they are university (academic-) or community-based. University programs are generally more competitive, offering better chances to match into a fellowship or to launch an academic career (which incorporates teaching and/or research into clinical work, as well). Many university programs also have affiliations with Veteran’s Affairs (VA) Hospitals and/or community hospitals, as multiple training sites within one program increases patient diversity. The kind of residency you choose should reflect your plans in the long run.

Some institutions offer a variety of “tracks” during residency, which allow you to tailor your training to your personal interests. These include but are not limited to: Primary Care Tracks (more ambulatory months vs inpatient), Physician Scientist Tracks (2 years of IM residency before “fast-tracking” into fellowship training/research), Clinician Educator Tracks (more time allocated to medical student/resident teaching and curriculum development), or Global Health Tracks (some programs have extended 4-year IM/global health residencies). By and large, you do not have to join a track in residency. However, if particular tracks in certain programs appeal to you, make sure to check online if the track has a separate NRMP code from the categorical program itself. If that’s the case, you may have to apply to it separately in ERAS, and rank it separately as well.

This is a rough idea of what your fourth year schedule will look like. For more in-depth information about items here (i.e. away rotations, ERAS, LORs, interviews, rank lists, etc.) look for more details below the timeline!

April-July

Start looking at programs online (they no longer send out brochures). Useful sites include:

• AMA-FREIDA (Training statistics on individual programs)
• NRMP Website (Provides match statistics)
• Meet with Dr. Wolfsthal (Maryland IM Residency Program Director) to discuss programs you wish to consider (she’ll send out an email when it’s time to set these meetings up). She knows the ins and outs of each program and she is an invaluable resource to IM candidates! Think about what type of program you want (university vs. community), future career plans (subspecialty vs. primary care), and which logistical factors matter to you (geography, reputation, etc.) before you meet with her – you’ll leave your meeting with some solid plans for places to apply.
• Think about who your LOR writers are going to be. More details on the LOR timeline are below, but at any time of the year if you begin to feel committed to IM and you have a good experience with a Medicine attending (on clerkship or on elective), don't hesitate to ask for a LOR at the end of that rotation with that attending. Then, at this time of year, feel free to reach out and remind them. They will usually ask you for at least a CV.

Summer

• Make sure you have a photograph of yourself ready to submit to OSA for them to upload to ERAS. The media staff at Maryland takes excellent senior photos and touches them up nicely for you (you will receive an email in the wintertime about scheduling these photos, but you have until late summer to get them done).
• Meet with the dean of your choice so they can get to know you and compile a draft of your MSPE. All MSPEs are automatically released to residency programs on October 1st. Your dean will send you a draft to proofread, so make sure to review it!
• Start working on ERAS (the website becomes available on July 1st).
• Make sure the grades and courses listed on your transcript are accurate – OSA will upload it to ERAS.
• Start checking the status of your letters in ERAS. (REMEMBER – you can “complete” the ERAS application and send it to your programs without having all of your LORs turned in.

September-October

• Finish ERAS – the first day residency programs can see your application is September 15th. However, if you certify and submit on this day, ERAS might be bogged down from a high number of users. There's typically a date earlier in September at which you can begin certifying applications, so I would recommend getting it submitted earlier. Again, no program will see your application until 9/15.
• REGISTER FOR THE MATCH AT WWW.NRMP.ORG BY THE END OF NOVEMBER ($85) to avoid paying late fees. You need to register here in order to submit your rank list by the middle of February.

Late October-January

• Interviews!! The majority of these will be in November and December, though some programs sent out invitations later than usual this year and held interviews all the way until the end of January.
• NRMP has an app (called Prism) which allows you to input the programs you’ve applied to, the ones at which you’ve interviewed, etc. For each interview you attend there are options to “grade” standard features of a program as well as type notes to yourself about each program. It could be helpful, especially in the days immediately after an interview, to enter this information for yourself so that you have a nice real-time evaluation of the program.

January-February

• Decide on your rank list and meet with faculty members who advised you earlier in the process. Ask a faculty member who knows you (or Dr. Wolfsthal ) to make a phone call on your behalf to your #1 program – this can be especially useful if that faculty member has ties to the institution.
• Enter rank list – opens in mid-January, due in late February.

March

• MATCH DAY!!! (3rd Friday of the month)

• 1. Consider away rotations at programs of interest. While away rotations are certainly not required to apply to IM, this option allows you to observe how medicine is practiced outside of UMD, as well as a chance to create a favorable impression on the program’s faculty. In addition, away rotations can give you an opportunity to get the feel of living in a certain city or area. Many schools are using a centralized application process (VSLO) for scheduling these electives that can be found here: VSLO
  2. If you are applying for an away rotation because of an interest in that geographic area, apply to multiple programs to ensure you will get a rotation. The months of July/August/September often fill up with the home institution’s students, so having sent in numerous applications will increase your chances of getting to do a rotation during the month you want.
  3. If you are doing an away rotation you should take the following steps ASAP (it will be better to have this done early, i.e. Jan/Feb, and get it out of the way). Most places do not require a background check/fingerprints/drug screen – if any place you MAY apply to requires this, just get it done early, as it’s better than deciding you want to apply later and realizing you don’t have what you need:
  • Go to student health and make sure all of your vaccinations are up to date – print out the required immunization forms for each institution on VSLO (or the program-specific website) and turn them in to student health
  • Get your immunization titers and a 10-12 panel drug screen at student health
  • Get a federal and state background check along with fingerprints (if you need it)
• ON YOUR ROTATION: Set up a meeting with the program director early on in your rotation. This will give you the opportunity to introduce yourself, let them know you’re there for a rotation and why you’re interested in the program, and will make sure they remember you when your application comes along in a few months.
• ERAS: Have your ERAS application complete with your programs selected and documents assigned EARLY, so you can SUBMIT ERAS AS SOON AS IT OPENS on 9/15 (even if all of your letters are not uploaded) – IM programs are one of the few that will start to download and look at applications as soon as ERAS opens, so submitting your application late will hurt you.
• Letters of Recommendation:
  • Most programs require 3 letters but recommend 4, not including your MSPE. One letter will be from the department chair, which is written for all IM applicants by Dr. Gambert/Dr. Davis (you will schedule a meeting with Dr. Gambert) – there will be an informational meeting held late in the spring of your 3rd year to discuss the details of this process. Other letters should be obtained from medicine attendings you worked with (sub-I letters are stronger than those from 3rd year rotations or 4th year medicine electives, but all are good). Letters from research mentors who know you well are also well-received.
  • You should complete and certify your ERAS application even without all required letters of recommendation, and then submit additional letters as your letter writers complete them. The goal is to have all letters uploaded by the end of September/start of October. Don’t hesitate to remind letter writers frequently if they’re falling behind – they expect (and probably need) to hear from you!

• START ON YOUR PERSONAL STATEMENT EARLY! 
• Many applicants work on multiple revisions after seeking advice from various faculty members, family members, and friends. People do read your personal statement, so become familiar with it and be prepared to talk about what you wrote when you go on interviews.

• How many interviews to go on?
• There is no “magic number” – applicants apply to and interview at more programs than in the past. The most recent data suggests that residents who matched in Internal Medicie had a median of 12 ranked programs. You should not shoot for a superhuman number of interviews, as you willl be exhausted (and broke) by the end of the interview season. You should use Dr. Wolfsthal and the OSA to help you decide the optimal number of programs to apply to/interview at.
• When should I expect to receive interview invitations? What month should I take off for interviews?
• SOME programs will send out interview invitations very early (i.e. one to two weeks after you submit ERAS), but most will wait until your MSPE is uploaded, so expect the majority of your interview invites to come in October. While it is less important than in other specialties, you should respond to the interview invitations ASAP – if you respond early you will be able to get one of your first choices for scheduling, and some of the more competitive programs will fill up if you don’t respond soon enough. Interviews will run November through January, so plan to take one of these months off along with scheduling a rotation one of the other months that will be flexible for you to take days off – that will give you more than enough time! The OSA compiles information regarding programs applied to and when applicants typically received interview invitations from specific programs – if you are concerned that you are not receiving enough interview invitations, the OSA can give you advice as to whether or not you should apply to more programs.
• Should I go to the social events the evenings before the interviews?
• Almost all programs have a happy hour or dinner the night before – GO TO THEM!!! These are relaxed and informal, and give you the best opportunity to get your questions answered. By the end of the interview season you will be tempted to skip out, but if you truly want to get to know a program you should go to the pre-interview socials – otherwise you will have only the interview day (where there may not be a lot of time to socialize with residents) to decide if that’s where you want to be for the next three years! Don’t be shy to ask some difficult questions at these dinners – you really want to find out about life as a resident and whether or not this could be a good fit for you. Don’t forget that residency is three years – so try to ask questions beyond what the specifics of intern year are. Some good questions to start with: How did you choose XYZ program for residency? Where do the residents live? What is the camaraderie like among the residents and do they spend time together socializing outside the hospital? Is there anything you don’t like about the program or wish was different?
• What is the interview day like?
• Internal Medicine interviews are VERY relaxed. While you certainly want the institution to come away with a favorable impression of you, programs will tell you the main goal here is for you to decide where the best “fit” is for you!
• As mentioned before, the interview days for IM can be long and tiring, and can include attending rounds, conferences, multiple presentations, and question/answer sessions. As for the interviews themselves, expect to have ~2 interviews, each between 30-45 minutes. By far the most common question you will get from interviewers (and sometimes the ONLY one) is if you have any questions for them – HAVE QUESTIONS TO ASK EVERY INTERVIEWER! You don’t need to have an exhaustive list, but think of things that are important to you in a program and this should help guide your questioning – for example: What are the strengths of the program and what do the residents leave the program excelling at? Are the residents happy and is there camaraderie among the house staff? How does the interviewer see the resident autonomy – and if they are an attending, what type of responsibility do they expect their residents to have as a 1st, 2nd, or 3rd year? What is the patient population like? What changes do they foresee in the program? What was their path to that program?
• Interview visits for physician scientist track positions typically span two days and involve an extra 4 to 8 interviews. In addition to the standard residency interview experience you will usually interview with your chosen fellowship program and potential research mentors.
• What about after the interview?
• Many programs are starting to follow a “post-interview communication policy” that discourages applicants from communicating with programs following the interview day regarding routine communication like thank yous – there are no set rules, but do what you think is appropriate! Your thank you note should have no bearing on how that program views you as an applicant/where you end up on their rank list, so if a program strongly discourages sending them, don’t! However, if  you have remaining questions about the program, you should feel free to contact and ask them.
• Other interview advice?
• Before you go on interviews or on your interview day, see if any Maryland grads are there – these will be some of your best sources of information about the program! If you find anyone at that institution, contact them BEFORE you go – don’t assume you’ll see them at the dinner or during your interview day.
• Perhaps most important during the process is to ask yourself the question: “Do I see myself fitting in here?” This becomes clearer as you are further along on the interview trail and have more schools to compare. Do not be afraid to say you are specifically interested in a certain specialty when interviewing! It can be tempting to be vague when interviewed by someone in a specialty other than the one you are interested in, but be honest about your own career goals, as this will help you determine the best place for you.

OSA is a great resource! If you are uncertain about anything throughout the process – programs to apply to, your personal statement, your ERAS application, LORs, your rank list, interviewing, etc. - ASK THEM! Either they can help or they can guide you to someone who can.

Feel free to reach out if you have any questions!

Emily Min

Last Revision:December 13, 2019