Most Competitive Fellowships After Internal Medicine Residency

Two things generally contribute most to the competitiveness of a fellowship specialty : Post-fellowship Salary levels and/or Lifestyle. In the US, the more 'procedural' a specialtiy is, the better is gets paid - since insurance companies reimburse procedures higher than just physician consults...example : Cardio guys have their cath labs, GI guys have endoscopies, Nephro docs got dialysis and Allergists got skin-tests and allergy shots as their 'cash cows' ..while Endo and primary care is mostly non-procedural with lower salaries


Very Competitive:

• Cardiology
• Gastroenterology
• Allergy Immunology
• Hematology - Oncology
  

Moderately Competitive:

• Nephrology
• Pulmonary - Critical Care
• Endocrinology : Although Endocrinology fellowship programs experience low fill rates, H1b sponsoring Endocrinology fellowships are fewer in number and make those competitive amongst the H1b IMG population

Not too competitive:

• Infectious Diseases
• Rheumatology
• Geriatrics and the rest of the Internal Medicine sub-specialty fellowships such as Adolescent Medicine, Hospice Medicine, etc.

"Hospitalist" is an emerging fellowship yet to become main-stream - but candidates can get employed as "hospitalists" even after completing Internal medicine residencies without any fellowship training, since the demand is high and fellowship-trained hospitalists have just started to emerge. I am thinking later Hospitalist Fellowship will be moderately competitive too, given the good salary levels and the now famous "one-week-on, next-week-off" schedules


Also read:

- Medical Fellowship Stipends in America
- Specialty-wise salary levels of doctors in United States
- Why J1-waiver Jobs tougher after Fellowships than those without fellowships
- Direct Fellowships without Residency ?

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INTERNAL MEDICINE & IMGs

What exactly is Internal Medicine ?

An Internist is a physician who completes a residency in Internal Medicine. A good way of describing an Internist is a doctor trained in managing hospital inpatients. It is akin to doing a Post-Graduate(PG) course in "General Medicine" in countries like India.

According to the Association of American Medical Colleges an Internist is : "A personal physician who provides long-term comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of of cancer, infections, and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems"

If a Family Practitioner is likened to a General Practitioner in other countries like UK, India etc. - then an Internist can be likened to a hospital general practitioner !

Why does it remain the top favorite amongst IMGs ?

The lure of Internal medicine lies in the impressive list of specializations that one can pursue in the form of Fellowships in the following fields AFTER a residency in Internal Medicine:

• Allergy and Immunology
• Cardiovascular Disease
• Critical Care Medicine
• Endocrinology, Diabetes & Metabolism
• Gastroenterology
• Geriatric Medicine
• Hematology
• Hematology & Oncology
• Hosptalist (Upcoming Hot Fellowship Option)
  
• Infectious Disease
• Interventional Cardiology
• Nephrology
• Oncology
• Pulmonary Disease
• Pulmonary Disease and Critical Care Medicine
• Rheumatology
• Sports Medicine

If you dont do a fellowship, you may work as an Internist - also called as a Hospitalist when exclusively working in hospital settings. A person I heard of notched an earning of 186,000/- as a hospitalist + Moonlighting in Philly after his IM residency.

This reminds me...I was talking to an American generalist physician who was in charge of recruting docs to fill up their Hospitalist position (Hospitalist is an internist or pediatrician or a family medicine physician who devotes more than 25% work time to inpatients - and some even devote 100%). He told me that a lot of IMGs certified as Internists were competing for the position, but he was kinda wary of hiring IMGs because : "as a general rule - IMGs never wanna stay as Generalists, they ALWAYS think of specialization" - meaning he was concerned that they will NOT stick to the job long enough but move on as soon as they secure a Fellowship.

At the same time he understood why that was the trend- he said he knew that IMGs spent a lot of money and hardwork to get here and wish to keep trying to get the best of what they have invested...

Another big, undeniable reason why Internal Medicine remains an IMG favorite is that other high-paying specialties like Anesthesia, Surgery, Radiology, Dermatology, etc. remain favorites of American Medical Graduates and aren't available for IMGs anyways :-) Which means a HUGE number of Internal Medicine programs would go unfilled, had it not been for IMGs !