> you go into a scramble mode to try to get picked up unless you want to wait a year and try again. Those scrambled slots are almost all in family medicine, Th

> you go into a scramble mode to try to get picked up unless you want to wait a year and try again. Those scrambled slots are almost all in family medicine, There's some errors/gross oversimplification in this post. Most scrambled spots are one year prelims, not family medicine. Of the minority categorical scrambled slots more are actually internal medicine, next is FM (but again this is the minority), then neuro, psych, etc. Also minor point, if you fail to SOAP ("scramble" is kind of outdated), you can find job openings outside of the match system entirely, so waiting a year is not inevitable. > and largely in toxic training programs or very undesirable areas. Actually, most of these programs know this and they target FMGs - they tend to fill most of their spots through the regular match. Meanwhile numerous top academic programs SOAP/scramble their prelim spots. > very likely didn't dream of sitting in that seat the way a surgeon or ICU doc or neurologist very likely did. IM, Peds, EM, rads, anesthesia, neurology (not competitive at all), PM&R, psych, even gen surg are all relatively non-competitive. You may be surprised about surgery, but all those surgical subspecialty hopefuls that fail to match - many of them end up in gen surg via a "scramble" to a prelim, some may make it on round 2, but many will not and they will go on to an open categorical gen surg program - ie amongst the relatively "competitive" there is the not competitive that doesn't end up where they want to be. Meanwhile whether your doctor was bottom of the class/poor academic pedigree has more to do with region. The IM and FMs at the top academic major regional centers will often be AOA/top of class/top programs. IM/FM is just a hell of a lot more variable - it's also very large. > If you have a disease or condition requiring specialty treatment..... I dunno if this really has to do with academic pedigree/the process you're calling out as much as scope of practice. Even amazing GPs, unless they have a particular personal interest in something cannot faux subspecialize in everything.