 The field of internal medicine is one of the most sought out fields after completing medical school. But even after completing their internal medicine residency, there are multiple fellowships that these physicians choose to apply for. And these fellowship specialties can be super competitive and require tons of work to get into while already being busy as a brand new doctor. So today we're going to cover the top five most competitive internal fellowships that you can apply for. Now to understand the competitiveness of these specialties, we're going to break it into three categories. The first one is going to be the average matrate, essentially assessing for how many people don't get in when you apply for that specific fellowship program. Number two is going to be your length of training, and number three is going to be a combination of both your salary and lifestyle, so let's get into it. Now coming in at number five is the field of rheumatology. Now these are physicians who specialize in both musculoskeletal as well as autoimmune diseases such as lupus, rheumatoid arthritis, normal osteoarthritis, as well as things like vasculitis. Now in terms of competitiveness, the matrate for rheumatology is right at 74%, so about one out of every four applicants won't match into the field when they apply. In terms of length of training, most rheumatology fellowships will be anywhere from two to three years, and if there is a third year, most of that will be spent doing research. Now breaking down the lifestyle and salary for rheumatology, the average salary goes about $289,000, so definitely less than our hematology oncology colleagues, but it comes with a nice perk. As a rheumatologist, it's very uncommon for you to work nights, and often if you have to work a weekend, you're just kind of covering within your group or your colleagues, and it's not that bad. So in terms of work-life balance, I would say it's good to grade depending on the practice you're in, and if you're dealing with just one part of rheumatology, you just deal with lupus or arthritis, or if you're somebody who's a little bit more of a generalist or rheumatologist, and you get to see a lot of things, that may be a little bit of a busier and more active clinic life. Now fourth on our list is the field of hematology and oncology. Now I would say in both of my personal experience that this happens to be the most attractive fields for people who are very young and early in their training, somebody who's in college or in medical school who wants to tell themselves, I'd love to be a doctor who takes care of cancer. And because of that initial attraction, or perhaps even having experienced cancer within their loved ones, many people continue to pursue the field of hematology and oncology. That's making it number four on our top most competitive internal medicine specialties. Now in terms of numbers, the average match rate for hematology and oncology is right at 75%, very similar to our field of rheumatology. In terms of length of training, the average fellowship for hematology and oncology is three years after completing internal medicine residency. There are a few options where if you choose that you just want to be a board certified oncologist or hematologist, but not both, you could just do two years and then immediately start working, but that is very institution dependent. Now talk about salary and lifestyle. The average salary for a hematologist oncologist is about $411,000. Now keep in mind, this is a geographic variable. It also depends on which side of the field you go on. So for example, you can choose to just practice hematology and deal with blood disorders, or you can choose to go ahead and deal with cancer and oncology. And depending on the practices that you work in, in both these categories, your salaries can vary very drastically. But the lifestyle can be very similar between the two that it's very clinic-centric. You see patients, you follow up with them, either for their cancer or the blood disorders or anemia, you'll see them repeatedly with some responsibilities of seeing patients in the hospitals as consults. Now in terms of work-life balance, compared to other fields in internal medicine, hematology oncology has a very good to fair work-life balance. But the one disclaimer is that your work-life balance and mental wellness can definitely be affected if you choose to go in a very advanced route. For example, if you're an oncologist and you choose to go ahead and practice in pancreatic cancer or lung cancer, if you see patients, which you will, that are very advanced when they first get diagnosed, it's very tricky. There's very limited treatment options and you know most of them unfortunately will not do well. So dealing with that emotional turmoil of taking care of patients who are just getting this brand new diagnosis that often is terminal and dealing with them, their families, their lifestyles and then knowing that there's a good chance that what you try to do despite your best effort may not work, definitely can take a toll, particularly on the field of oncology. Now before we get back into today's episode, let's take a quick second to talk about today's sponsor, which is Picmonic. Now if you're unfamiliar with Picmonic and you're on your medical journey, they have hundreds and hundreds of videos for literally any class or material that you may need. And what makes Picmonic so unique is that in addition to having so many videos on literally any topic you need, so for example here, we're in microbiology, you can click on any video, so here's Staph Aureus and the videos themselves are very short, so this video is about one minute, 54 seconds, but essentially we'll break down the most high yield components that you have to know in the setting about Staph Aureus in this very nice story format using images. So here's a very nice Oreo cookie that essentially will link an image to your brain on an important concept about that. And the future videos, you may find that the same memorable images included in another related video, so then you can link together concepts. For example, here, this venom jar with green represents food poisoning, so any bacteria that may cause food poisoning may have this image in their overall picture and video, so you can say, okay, I know all different bacteria that have food poisoning. And then whenever you feel comfortable with a relatively short story, you can easily go into the review and quiz phase and actually quiz yourself on the various different high yield components. Now in addition to having a very unique and easy way to remember information for your quizzes and tests, you can also add all of the videos you're watching into a relative playlist. So if you're studying for a microbiology class, you can go ahead and essentially click all the videos that you add and add it to those playlists. And then whenever it's time, you can come back to your individual playlist and either watch those individual videos again or ask for specific quiz questions related to the videos that you've now said that you've mastered or at least learned the first time. And that's just scratching the surface in terms of features that pick monocas to help you on your medical journey. Other cool things include having a weakness guide so you can see which topics you're the weakest in, as well as their study scheduler, so you can actually say these are the topics that I need to know and here's my test day. And then it will essentially will give you a study schedule based off of that. So if you're looking for an all in one resource to your on your medical journey, you haven't quite found it, definitely recommend checking out pick monoc. If you're interested, there'll be a link down below. And our friends at pick monoc have also been nice enough to include an extra 20% discount if you use the code, the MD journey at checkout. And so if you're interested in learning more about pick monoc, that link will be down below. And as always, thanks to pick monoc for being today's sponsor. Now number three on our list is the field of both pulmonary and critical care medicine. Now prior to starting medical school, I thought these were two separate things. I had no idea that people usually are trained in both pulmonary and critical care medicine under the same fellowship. But in terms of competitiveness, pulmonary and critical care medicine attracts some of the most smartest as well as individuals who love working with their hands and dealing with emergencies with an average match rate of only 67.8%. So that means that there's tons of applicants applying every single year that are not able to get a spot. In terms of length of training, most pulmonary fellowships will be three years with a combination of both critical care and pulmonary electives and rotations that are on each and every single year. And how much you're trained on both the pulmonary versus the critical care side would really depend on the institution that you're working with. Now, breaking down the salary and lifestyle for a pulmonary, quick care doctor, it really varies because typically you will practice one or the other. While you do a fellowship in pulmonary or critical care, most doctors will pick one field or the other. Either you're working in ICU as a critical care doctor and that's pretty much your lifestyle or it's going to be working in a clinic setting as a pulmonologist seeing patients in the hospital occasionally. Now the average salary that's reported is about $369,000 and keep in mind there's a wide spectrum. On one end, if you're a critical care doctor who works in an institution who builds you for the complexity of the patients that you're seeing, well, there's a lot of complex patients that come in critical care medicine. You'll be able to just naturally bill higher just based on the complexity of the patients that you see for your field. And so you tend to be making a little bit more on that side. For example, if you're a critical care doctor who works in an institution who pays you based off your R views or essentially how much you bill, which is a reflection of how complex of a job you're having to do, well, just the nature of critical care medicine is you're taking care of patients who are dealing with terminal illnesses all the time. And so you're going to be able to naturally bill higher just because the complexity of the patient that you see is on average higher than most doctors see in the hospital. And so that's so you can guess that a critical care doctor, particularly one who's working in a private hospital who is essentially paying you based off of R views, you'll be making a lot more. On the flip side, a pulmonary doctor tends to have a very typical clinical schedule like the fields that we talked about for Monday to Fridays with some consults, maybe some weekend responsibilities, eight to five, and again, that will depend on just the group that you work with, probably closer to the average that we mentioned around the 350, $360,000. And number two on our list is the field of cardiology. Now, I'm particularly biased and attracted towards this field because I'm about to start my cardiology fellowship in just a few months as a making of this episode. But I would argue in addition to our field of oncology as we talked about before, the field of cardiology happens to be the other field in medicine that people early on in their journey are really attracted towards. You typically think of a heart doctor or a cancer doctor if you're thinking about somebody in medicine, and thus it happens to be one of the most competitive fields to apply to with an average match rate of just 69.7%. And at the very end of the episode, we'll talk about other factors that help applicants be competitive in case you're interested in any of these fields, but particularly in the field of cardiology, research is super important, thus making it more competitive because so many applicants are having to try to fit in three years of residency while still trying to do research during those three years. In terms of length of training, the field of cardiology is typically three years with often that last year spent doing a lot of research or electives and coordination with whatever you wanna do within the field of cards. Now, getting into salary and lifestyle and just enjoyment of the job. Now, first of all, I'm very biased. I know that because I'm going into cardiology as a fellow in just a few months, it's making this episode. And so take all of this with a grain of salt. But if we start with the average salary for cardiologists ends up being about 490,000 dollars. And this comes with a very big asterisk as this does for all the specialties that we'll talk about today. And that asterisk is there is because this salary is very inflated by those doctors who are doing a lot more invasive procedures. Somebody who's doing stents or cats or electrophysiology procedures, somebody who's doing valve repairs, technically is still considered a cardiologist, but they're making tons more money just because they're billing for more hospitals or making more money off those procedures. Compared to somebody who is a general cardiologist, somebody you'll see in clinic for a heart attack, for a lipid evaluation, somebody who will evaluate your echoes may make something a little bit less than this. So I would say the average is 490,000, but there's doctors in cardiology who are making tons more just because they're doing a lot of more invasive procedures and doctors who are probably making closer to 350, 400K range, which is again, still an amazing salary. But there is a wide spectrum depending on how much invasive hands-on procedures you do within the field. Now in terms of lifestyle, the field of cardiology can definitely have a big spectrum in addition to the salary. There are some cardiologists who are very general, who work with clinic Monday to Fridays, maybe some weekend responsibilities, and definitely is on the better side of the lifestyle spectrum. Then finally, number one, the field of gastroenterology. Now I'm biased because this is my least favorite field within the field of medicine, but this definitely has the best combination of doctors who wanna deal with both clinical medicine as well as doing hands-on procedures all the time, typically in their practice. It's very common for a gastroenterologist to see patients in their clinic as well as do consults in the hospital and then doing procedures on those patients, such as an EGD or a colonoscopy, to evaluate for things such as polyps, or some bleeding, source of malnutrition and malabsorption. So there's tons of opportunities within the field of GI to do very cool hands-on procedures as well as using your clinical acumen to help make diagnosis for patients. Now as an aside, while the field of GI is number one on our list, it was the bottom of my list when I was considering fellowships because I hate poop. But apparently a lot of people like it. Let's talk about competitiveness. In addition to the salary, which we'll get to in a second, this is what makes GI one of the most competitive specialties with the average match rate of 63.3%. I can easily say that I've unfortunately had many colleagues and friends or people that I've known who have not successfully matched the GI on their first try just because it's so competitive for the reasons that we talked about. In terms of length of training, GI fellowship typically have since to be three years, just like our cardiology colleagues. Now in terms of salary and lifestyle, your average GI doc will probably make $450,000 plus. And again, this will depend a lot on how many procedures you do. While most GI doctors are very specialized in being able to do EGTs and colonoscopies and seeing patients as consults and in clinics, how much you do those procedures will definitely determine the amount of salary you're getting. There are a lot of GI docs who typically won't see a lot of patients in clinic, but they love doing procedures. And so they tend to go ahead and set themselves up for a higher salary just because they're doing more procedures. So in terms of lifestyle, comparatively to a lot of the fields that we talked about already, field of GI probably gets a fair to good lifestyle because you get that nice mixture of just variety in your day. You get to do procedures, see patients, see consults and actually be able to see your procedures quickly help and improve both diagnose as well as manage your patients. And so while I personally hate poop, apparently a lot of people do and I can understand why the field of GI is a great field to consider. Now, while we talked about what makes these fields competitive, let's talk about things that really can make a difference if you're considering any of these fields to make yourself competitive. Number one is your letter of recommendations. Now, once you get into the fellowship pool, just the community becomes smaller and smaller, particularly in the field of cardiology, everyone knows everyone. And so it really just matters on who you know from your institution that you've worked with that is able to vouch for you and ideally at a high quality and level. So for me, the people and the aims that I had at the bottom of my letters, I was very fortunate to have the chance to work with them, but their leaders within their field. So for example, for me, when I was applying the cards, people could see in my fellowship application the name at the end of those letter of recommendations. There were big names reputable and I just had the good fortune of being able to work with them during my residency program. But when somebody from a different program can see that this very respective cardiologist is speaking very highly of this person as a future cardiologist, that holds more weight. And so if you have the option and opportunity of working with the biggest names within your institution, you should definitely go for it. Number two is your residency performance evaluation or typically called your dean's letter or program director letter. This is more of a templated document, but essentially it will take all of the valuations you've had from every single rotation. And this will include the great feedback as well as the average or below average feedback. It'll basically become a big templated document that will go out to these fellowship programs. So regardless of what rotation you're on, you definitely want to put your best foot forward and try to get the best evaluation from your attendings and colleagues that you're working with. And then finally, number three is the reputation of the residency program. If you're very early on in medical school and considering where you should go to residency, you should definitely consider that if you're thinking about any of these fellowship programs or any fellowship program for a different field, ask yourself, have people match into this field of cardiology and GI and rheumatology and surgery, whatever you may be considering, because if they don't, then you want to ask why have people tried and have been successful? This is the best place for me to get my training because you do want to have some kind of bridge with Gateway. Ideally, you can see that the program that you're doing your residency has an option for you to continue for their training. Maybe you wanted to go to cardiology. Ideally, your residency program already has a cardiology program associated with it. But even if it doesn't, the name and reputation of your residency program does make a big difference. When I was interviewing for fellowship spots, I rarely had to talk about my competency as just a clinician because people understood that where I went to training definitely trained their residents hard, we were busy, we got to see a lot. And so people trusted the name of my residency program was good enough to essentially qualify me as being a good enough doctor as a future fellow there. But those guys are the things to consider as well as the top five competitive specialties within the field of IM. Now, I'm sure I've missed some things, so if you have any questions, go ahead and drop them in the comment section down below. Happy to answer them, as well as while you're down there, hit that like button. And if you enjoyed this episode and you want more tips on how to study better, be more productive, essentially making your entire medical journey more stress-free, everything I wish I was told in the first day of med school, go ahead and click down below. There's a free document there called the Med School Success Handbook. It's something that I update on a weekly basis of all the tips and step-by-step strategies I wish somebody had just had told me. Against absolutely free, go ahead and click down below if you guys are interested. But if you enjoyed this episode, go ahead and check out this episode of why I chose the field of internal medicine in the first place, as well as this episode right here on why I made the transition into going into cardiology. Enjoy those. And as always, my friends, thank you so much for being a part of our journey. Hopefully we were a little helped to you guys on yours, and we'll catch you guys in the next one. Peace.