It is very difficult to believe that I am already more than halfway done with residency at this point, and that it is time to figure out what I want to do after these three years are up. Once again, what’s surprising and different to me is the structure for training in the United States: having to apply at the end of year 2 for a fellowship that will start after year 3, seems so early, but I am learning to accept that these are the American ways.
In my case, a lot of people just ask: “Well, you are going to do a GI fellowship of course, right?” And as much as it surprises me, I am not sure if this is what I still want to do. Don’t get me wrong, I enjoy hepatology a lot and that is what I used to do during most of my German life as a physician. However, one of the biggest differences that I have encountered since starting to work as a physician in the United States is that once you are subspecialized, you are only a consultant. You will not be treating the whole person anymore. The reason why I chose medicine back in 2015 (!) was because I wanted to treat the whole human, to understand how and why a body reacts to certain stressors in a specific way, and I did not picture myself being reduced to (very simplified): “Scope or no scope?” And the thought of spending another three to four years in fellowship, me being close to 40 by the time I would finally be done with training, seems daunting.
So, I have also been exploring all the other options that are available to someone trained in IM, and I am certain that a lot of IM folks can relate to those thoughts. Personally, I had never done outpatient medicine before and I am surprised to see how much I enjoy that line of work. I am just not certain if this is “enough” for me for the next 30 years to come (as I have done a lot of critical care in my previous life). Could I be a hospitalist? Obviously, patients are sicker, I would get to treat the whole human and keep continuously learning, but my two kids are so young, that I am not sure if I want to be working an average of two weekends out of every month and/or holidays. Lastly, I found that specializing in infectious disease (ID) still requires you to consider the whole human before you can make your ID specific recommendations, and I have been very intrigued by that subspecialty (sidenote: in Germany, ID used to be headed by the department of GI/hepatology, so I had my fair share of exposure back in Germany, but more and more hospitals start to make it an individual department nowadays).
I am nervous to apply for fellowships, as I do not feel that I am very open geographically and am concerned my only option in the area will not pick me. The memory is still so fresh on how disappointed I was that few residency programs were even willing to interview me because I had finished medical school more than three years prior to me applying for IM residency or because my Step 1 score was not high enough.
But there is the silver lining: obviously, I haven’t matched into a fellowship yet, so this is said with caution, but by talking to fellowship program directors and people who are part of the fellow selection process, it appears that my previous work and research experience finally becomes an advantage for a fellowship application. And I find this so hopeful to know that this is my one take-away that I wanted to share with everyone reading these lines: if you are an IMG and you felt discouraged by your residency application because previous training and work experience have felt neglected: for a fellowship you have the chance to turn your individual path into something that makes you stand out compared to other fellow applications!
Regardless of what I chose, the most important thing for me is to make a decision that feels right at the end and that is not just in my best interest, but also in the best interest of my family at this point.
As always: feel free to comment below or reach out to me if you have any questions!
I am an international medical graduate in internal medicine residency (IM/G), sharing my experiences with all of you. If you are an IMG, hopefully you can relate to some of the stories and feel encouraged, because we are not alone. If you are an American-based resident: I hope these stories help you better understand your IMG colleagues a bit better. And above all, I am hoping to hear from you as well: let’s share knowledge, experiences, and pave a path for the many other IMGs seeking to fulfill their dreams in the United States.
Resident Physician Columnist
Hillsboro Medical Center
Aline went to medical school at the University of Essen in Germany. She started training at the University Hospital Essen in Internal Medicine with the focus on GI/Hepatology. She then followed one of her former supervisors in 2017 to the University Hospital Magdeburg and continued her training for two years. In 2019, she started a two-year research fellowship at Johns Hopkins University with a scholarship by the German Research Foundation. During that time, she decided not to return to Germany and instead attempt to become a physician in the US. She has started her internal medicine residency this year at Hillsboro Medical Center in Oregon.
Surviving IM/G
I am an international medical graduate in internal medicine residency (IM/G), sharing my experiences with all of you. If you are an IMG, hopefully you can relate to some of the stories and feel encouraged, because we are not alone. If you are an American-based resident: I hope these stories help you better understand your IMG colleagues a bit better. And above all, I am hoping to hear from you as well: let's share knowledge, experiences, and pave a path for the many other IMGs seeking to fulfill their dreams in the United States.