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A quick thread for any medical students, FYs or IMTs considering a career in the amazing world of Acute Internal Medicine who are looking at this scary-looking competition ratio and panicking.
(TL;DR - DON'T PANIC)
(TL;DR - DON'T PANIC)
Firstly, it's worth noting that 2020 was unusual. The change from CMT to IMT meant this was the last year you could enter training at ST3. This meant applicant numbers were inflated across the board as CT2s AND post-CMT fellows all tried to get their foot in the door.
Applicants for AIM almost doubled due to this. I imagine once this bottle neck evens out, IMT3s applying for ST4 in Acute Internal Medicine from 2022 onwards are unlikely to see competition ratios this heinous as the numbers of applicants will almost certainly fall.
It's also worth noting that - of the 510 applicants to AIM - only 22% of these were "unique". This means 78% of people applied to AIM and at least one another medical specialty.
(By comparison, 62% of cardiology applications and 58% of haematology applications were "unique")
(By comparison, 62% of cardiology applications and 58% of haematology applications were "unique")
Though it pains me to say, a considerable proportion of the "non-unique" applicants will have applied to AIM as their back up. If their portfolio screams GASTRO, they won't score as well in the "commitment to specialty" section as someone who is genuinely enthusiastic about AIM.
More importantly, they're less likely to take up job even if they score well in the interview and receive an offer in the first round. These jobs can then be offered to candidates who didn't score quite so well in interview, but may well be more committed!
In practical terms: if there are 8 jobs in your region and you are ranked 9th based on your interview score, you may (and probably will) still get an offer. All it takes is for one of those 8 people to say no to their offer. This is very common and happened to many of my friends!
Also worth evaluating these numbers alongside the fill rates, i.e. how many of these jobs are actually taken up once the dust has settled. No data for this year yet, but in 2019 only 88% of AIM posts were filled. By comparison, 99% of resp and 100% of gastro jobs were filled.
All of this suggests that Acute Medicine still desperately needs talented, enthusiastic new recruits to join this wonderful, supportive, innovative community of awesome people at ST4 (to say nothing of the vacancies at consultant level that @jfdwolff has posted about elsewhere).
The good news: even ignoring last year's dramatic jump in applicants - applications to AIM were already rising, going from 203 in 2015 to 298 in 2019. This suggests the amazing work being done by @take__AIM and others is encouraging more and more doctors to become acute medics!
However, jobs available have gone from a high of 130 in 2018 to just 91 in 2020, the lowest number since 2015. Hopefully the rising numbers of applicants will mean that more ST4 jobs are made available from 2022 
(but full disclosure: I have no idea how that works)
(but full disclosure: I have no idea how that works)
Most importantly though? Not everyone gets a job first time and that's okay. First time round, I messed up my interview and didn't get a job in my chosen region. So I took a year out and applied again. Am now ST3 and loving it as much as I could be expected to during a pandemic!
In summary: ignore the numbers. They're just a distraction. If you want it, you can do it! In the words of Han Solo...
