Updated: January 31, 2011

Career Guidance Handbook
Internal Medicine

Match Process: Regular

Program Director: Lloyd Rucker, M.D., UC Irvine Medical Center, City Tower, Suite 400, (714) 456-7539, lrucker@uci.edu

Career Specialty Advisor: Same as Above

Residency Coordinator: Norma Hardgrove, UC Irvine Medical Center,  City Tower, Suite 400, (714) 456-5691, nhardgro@uci.edu

List the fourth year elective courses you feel are most helpful to a student considering your specialty.

  1. Infectious Diseases
  2. Nephrology
  3. Rheumatology
  4. Allergy
  5. Endocrinology
  6. Heart Station
  7. Dermatology
  8. GI
  9. Occupational Medicine
  10. Sports Medicine
  11. Women's Health
  12. Medicine Sub-internship
  13. MICU
  14. Ophthalmology
  15. Neurology
  16. ENT
  17. CAM Elective
  18. Pathology
  19. Ambulatory Oncology

Consider your fourth year of medical school as the first year of your residency. Subspecialty experiences that you can take in the 4th year will help with residency and supplement your residency experience. You may choose to focus more on the allied fields such sports medicine, dermatology, or even the general medicine ambulatory clinic.

What are the most important characteristics a student should evaluate in a residency program in your discipline?

  1. How satisfied the residents are with their training.
  2. The range and variety of patients in all the program's training sites, including access to both male and female patients.
  3. The opportunity to make management decisions and to have primary responsibility for your patients.  In other words, that you work mostly with a single ward attending who gives you latitude to make decisions and not with an excessive number of private attendings.
  4. The board passing rate for the program should be at least 80%
  5. The rate at which residents who want to do so enter subspecialty programs and whether they are able to obtain excellent subspecialty programs.
  6. The program's accreditation status and the deficiencies which were cited at the most recent review.
  7. The presence at the home institution of that program of residency programs in at least two other disciplines other than Internal Medicine (such as pediatrics or ob/gyn).
  8. The financial and administrative stability of the program.

What are the pros of a career in your specialty?

  1. Interesting medical and intellectual and challenges, including a broad and rapidly evolving knowledge base.
  2. Contact with people and continuity of care
  3. Many possible career paths including careers with complicated procedures and highly specialized, hospital-based foci.

What are the cons of a career in your specialty?

  1. A very broad and rapidly evolving knowledge base must be skillfully utilized.
  2. Need to enjoy patient contact or it can be very stressful.
  3. Must be able to commit to considerable time staying current in your area.

How long is the training in your specialty and, in general, how vigorous?
Three-years for general internal medicine with one to four years additional training for subspecialties.  The training is moderately to extremely rigorous, depending upon the program.
Internal Medicine also offers a Research Pathway for those who are committed to research careers and who are willing to cut out some clinical time in return for a commitment to three years of research.

What is the lifestyle experience in your specialty? All lifestyles across the board from part-time outpatient careers to very intensive, 100+ hours per week primary care or consulting practices.  IM provides considerable flexibility and range of salary.  In general, a full time practicing general internist can make between $130,000 - $250,000 and a sub-specialist could make up to $400,000 in a very busy, very hard working, 80 - 100 hours per week practice with considerable call, procedures and inpatient responsibilities.

How competitive are training programs in your specialty?  What kind of record would a student realistically need to match? There are nearly 400 internal medicine programs in the country, and they do not all fill so a student interested in internal medicine who is willing to travel should be able to get a decent spot.  To stay in California at a University based program or a strong affiliate, one would need a minimum of 210+ on USMLE Part 1 and a very strong pass in the medicine clerkship with good narratives on the Dean's letter for medicine and all other core rotations.  For the top IM programs, think Part I of 230+ and honors in medicine and two other clerkships, plus some other activities which set one apart such as significant research, creative activities, or extensive public service.

In order to obtain a fellowship after residency, one should do one's residency in a University program or at a hospital with a strong and extensive affiliation with a University hospital.

Which disciplines should letters of recommendations come from?
You will need a Chair's letter from the Department of Medicine and one other letter from an Internal Medicine attending with whom you worked directly.  The other letters can be from any clinician or researcher who knows you well and with whom you worked extensively during medical school.

At UC Irvine, contact Lloyd Rucker, M.D., Vice Chair for Education in the Department of Medicine for a Chair's Letter.

Should students approach faculty in the first and second year of medical school to do research and for letters of recommendation?
Research is helpful if it is meaningful and if the student contributes in an important way.  A month washing test tubes as an undergraduate is not important.  A summer spent in a lab that leads to a single poster presentation with the student's name as fourth author is slightly helpful.  Several papers with the student as first author are extremely helpful.
Letters from first and second year experiences are much less important than those from faculty in the clinical years.

Will research in this field improve chances for obtaining residency?
See above

If research is beneficial, what is the minimum length of time to obtain a meaningful experience? At least a couple months in a consistent effort which leads to important results and perhaps a presentation at a meeting or a paper.

Is it beneficial in obtaining residency in this field to complete externships? Externships may be helpful at the most competitive programs.  Most students entering IM do not do externships at the program where they find a position and most students apply to 8 or more programs so it would be impossible to do externships at all of them.  UC Irvine students who have gained entrance to the most competitive IM programs recently have not done externships at those programs.  Externships generally won't hurt but don't count on them to get you into a program if you do not have the numbers and the evaluations.

Is there a benefit to completing more than one externship in this field? No.

Is it important for the USMLE Step 2 scores to be available for review? It is becoming more important for the most competitive programs.  Most UC schools are requiring their students to take the exam early in the 4th year, so UC Irvine students will be competing against students who have already taken the exam. The Step 2 score is definitely becoming more important in the final decision process. Step 1 is more important for obtaining an interview. Step 2 CS is crucial and must be taken in time so that the scores are back well before the time of graduation.