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This year I have noticed many of my classmates opting for specialties that are direct, shorter term commitments, and do not necessarily rely on a fellowship for a decent career. In fact, the majority of the most competitive specialties are direct paths: radiology, dermatology, anesthesia, EM, and all the surgical subspecialties. I feel like many of the brightest go for these fields when they could have such a substantial impact on fields like endocrinology, nephrology, heme-onc etc.

I am NOT saying internal medicine doesn't not attract the best students; this is actually far from the truth. I think they could have an even better pool to choose from if they made a few changes. Provide the option of direct subspecialty training via IM. For example, to finish as a cardiologist you apply for a combined cardiology program with 2 years IM + 3 years cardiology. It prevents the headache and uncertainty of applying for a fellowship while allowing a student to become a trained sub-specialist in 5 years. Sure these programs may become a bit more competitive but I think the advantages may outweigh the costs. Why aren't urology or ENT requiring someone to complete a surgery residency before applying for their fellowship?

If there is something I am missing here please inform me. It just seems as though medical students have already put in so much effort and time to prove they intelligent so why make those students suffer through another application if they are only interested in allergy or GI. It seems as though combined IM + subspecialty programs would benefit the student, the specialty, and subtract one year of medicare funding for fellows.
 
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