1 year to go ... was it supposed to be this tough?

[QofQuimica]

Ha. I was a little touchy, but not that bad. (And FWIW, I'm a radiologist, not a pathologist, so don't blame them for my sins.)

I guess what I'm getting at is this: it would be a shame for anyone to take a specialty (any specialty!) as a consolation prize. It seems to me to be a recipe for both dissatisfaction and under-achieving.

I completely agree. To someone who really wants to be a radiologist, being forced to go into *any* other specialty would be a let-down, and it would be unfortunate for all involved if the person did not find another specialty they liked. But it's not about path in particular. Path got maligned because it was already being discussed upthread, and the thread was getting kind of contentious and personal, not because Neuro has a particular antipathy to path (pun intended).

Joking aside, I think we are all glad to hear that you are happy in rads and are finding it to be a specialty that is compatible with research. Anyone thinking about going into any specialty not traditionally chosen by MD/PhDs will feel encouraged to see someone like you making it work.

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[LadyLightning20]

I just wanted to thank you, Neuronix, for posting about your experience and keeping us updated. I just got my first acceptance (didn't put it in the acceptance thread because the school only gave out one other so far and I would like to remain at least semi-anonymous) and I'm already shifting to thinking about and planning for programs. Hearing you and a few others talk about actually being in training has been really helpful for me - at least theoretically I know more about what's expected/what I need to do. (It also gives me something to ask about when interviewers ask me "Do you have any questions?")

Good luck with everything - I hope it works out for you.

 

[Neuronix]

Just to give you all an idea of how competitive things are at my school.
My Peds shelf grade is a 76. This is 77th percentile nationally.
The mean for my testing group at my school was 83.4. This is 95th percentile nationally.
The range for a HP on the shelf is 75 - 84 (73rd percentile to 96th percentile).
Any lower than a 74 (69th percentile) counts as a pass shelf score and automatically excludes a student from honors in the rotation.

Note: Percentile calculations are based on the following info in the score report.
"The subject examination score is scaled to have a mean of 70 and a standard deviation of 8 for a group of first-time takers from U.S. LCME-accredited medical schools who took this examination as a final clerkship examination under standard testing conditions."

The shelf is 25% of my grade. I'm hoping my evals are stellar and then I might honor

 

[gstrub]

I hear you. At our program, you have to beat last year's top 15% shelf score to even be eligible for honors. So despite my stellar OBGYN evals, my 78 on the exam (79 was the cutoff) means I can't get the H. They say the shelf is only worth 35%, but really it's 100% if you happen to be strong on evals. Sucks...

 

[Neuronix]

I guess what I'm getting at is this: it would be a shame for anyone to take a specialty (any specialty!) as a consolation prize. It seems to me to be a recipe for both dissatisfaction and under-achieving.

FWIW, one of the four students from my program who failed to match last year did contact me on here. That student did not match in Radiology. Now that they're applying in something less competitive, that's yielding many more interviews at many of the same schools that did not interview for Radiology.

I'm extremely grateful for that person's advice and I'm hoping in part with that advice I can avoid the same fate. It's unfortunate that the only rumor I heard before that contact was "the people who didn't match have personality issues." From my interactions with those very unfortunate students, I would strongly disagree.

I think we all know the real reasons they didn't match. It's unfortunate but true that a PhD can simply not get one interviews in competitive specialties if the applicant does not meet a very high step I cutoff. There's some other issues here that are going to have to be addressed by programs.

These are:

How are we going to schedule the rest of third year and fourth year when MD/PhD students tend to come back late and thus have a truncated remaining 2 years? On the flip side, to not truncate the remaining 2 years increases time to graduation.

When are students going to take Step 2 if their Step 1 score isn't high enough? Regardless, Step 2 scores are becoming more and more required. Step 2 requires the student to have completed all third year clerkships to do well. But third year clerkships tend to get pushed back too far to allow for Step 2 scores to be in pre-interview and often pre-match.

How are MD/PhDs supposed to figure out what specialty they want to do when they have limited elective time due to schedule truncation?

Similarly, when are MD/PhDs supposed to get letters of recommendation? Everyone says fourth year. I'm looking at my schedule, it's relatively spacious compared to most Md/PhDs at my school, and even I can't figure out where I'm supposed to get 3 LORs!

The advice when I started my program was always that Step I score didn't matter much... It was always that you'll get whatever residency you want as a top-tier MD/PhD... Nope. How things change in a few years. I wish I was still applying when the average Step I score for Radiology was 10 points lower... i.e. When I took Step I.

 

[echod]

FWIW, one of the four students from my program who failed to match last year did contact me on here. That student did not match in Radiology. .

Neuronix, do you think you would be able to have the four people who didn't match come to SDN and share their experience/stories? It would be helpful for us to learn more about their specific circumstances.

 

[Neuronix]

Neuronix, do you think you would be able to have the four people who didn't match come to SDN and share their experience/stories? It would be helpful for us to learn more about their specific circumstances.

That's a great question. I'll see what I can do.

 

[Neuronix]

They say the shelf is only worth 35%, but really it's 100% if you happen to be strong on evals. Sucks...

Our cutoff is a 78 on OB/GYN (84th percentile nationally). I hope I can do at least as well as you did. I do think you got the shaft though. I strongly believe they should get rid of grades in medical school.

 

[BozoSparky]

for your letters...

here's what i did last year for radiation oncology: one good medicine letter (try to get a chairman's letter, in either your 3rd year rotation or sub-I, whichever you did better in), 2 radonc, and one from the thesis advisor...

 

[Neuronix]

It's like you're reading my mind... I've been e-mailing my registrar over the past few weeks to figure out where I'm supposed to get letters of rec. So far, no response. It's really rare here to get them during third year. Your attendings change way too quickly for that. Not having letters outside Radiology has been identified to me as another red flag . But with the truncated fourth year schedule and some of the goofy policies/setups at my school, I can't figure out where I'm supposed to get letters.

One cannot get a letter from the 4th year medicine Sub-I here. The way the service is setup makes that impossible. The medicine chair's policy is to only write letters for people going into medicine. My rotation in medicine the first time was early in 2005. I'm going to try for a letter from whatever medicine elective I end up doing before my Sub-I.

It's even their policy not to write you a LOR for Radiology until you've done the core one month elective, and then a subspecialty month. Where's the time to do all that? I'm still not even sure I want to Radiology! Oh well, there's no time to rotation in anything else, so I guess that's what I'll do!

 

[BozoSparky]

hmm... maybe you can get a letter from surgery this year...or maybe a letter from someone who knows you at a primary care/internal medicine oupatient clinic (try to get the medicine department to cosign it). before deciding what area of medicine to go into near the ~end of august, i had done one elective and a medicine sub-I. i was really unsure what to do and was a little angry at my med school to say the least, but once i finally committed in my mind, everything felt right. if you've been mostly thinking about radiology, it's probably right for you....unless you barf at the idea after your rotations. how many elective months will you have before the end of the summer? ps i don't know why my post is coming up in one big paragraph...sorry.

 

[Shifty B]

So, I don't really browse these forums very much and I just saw this thread today, but after reading it I felt I should comment about matching into radiology. I am an MD/PhD graduate who matched into radiology last year. I couple-matched with my wife at a large academic program that is probably in the low half of the top tier (probably 12-25, or something like that), and interviewed mostly at top-tier to mid-tier academic programs (top 50).

Radiology is a tough match, no debate. It's up there with derm, rad onc, etc. It would be easier to match into path, sure. Path is a much easier match, and don't let anyone tell you otherwise. However, you can match into radiology in a mid to higher tier program as long as the rest of your application is decent. If your institution had people not match into radiology last year, there is probably something badly wrong with their application or the way they applied. A PhD will get you in the door even when your step 1 isn't quite high enough, or can make up for mostly high pass.

The problem is, at a lot of MSTPs it is a relatively new development to have people going into competitive specialties like rad onc, derm, and radiology. The old model would have you do only IM or path and basically become a lab rat. These days are over. A lot of advisors are uncomfortable even with the idea of you not doing what they did and will give you bad advice like this. Don't let them tell you it is going to be too hard or too easy. It will be a little of both.

My advice is:
- apply to plenty of places in your own geographic region, including community and lower tier programs. These programs know you have a vested interest in the region and are more likely to interview you. If a community program in your area doesn't give you an interview, call them, say your interested in staying in the area, and want to interview. 4 out of 5 times they will interview you if you're good enough.

- if applying to places out of your region, clearly state why you are interested in your personal statement you send to that program

- bust your ass on USMLEworld and try to do well on Step 2 before application season

- as for letters, you should get 2 clinical letters (combination of med/surg), one radiology, and one research. Regardless of your school's policy about letters, if you get to know a medicine attending in 2-4 weeks on the wards, then ask them for a letter! Ideally it would be someone who got to know you well over this time. Same for surgery.

- when it comes to radiology letters, try to do your rotation in one area where you will work with 1/2 faculty the most. Let them know at the beginning you are interested and radiology and will need a letter. Then spend time getting to know them throughout the month. If the official policy is that you need 2 months, frack it and ask the individual faculty anyway. Explain your reasoning. If you got to know them during the 4 weeks, it shouldn't be a problem

- in your interviews, emphasize your desire to focus on clinical education during your residency (particularly at smaller programs). Say you want to get back into research after residency or at the end. This is the only practical approach anyway at all but a few research oriented programs, and even at those it will work. Say you want to work hard during your residency building your clinical skill set because that is the time to focus.

You can match in a good-to-great radiology program, and you should match somewhere. A PhD and 1 or more publications goes a long way towards getting you in the door. It is not, however, a free pass to a top 10 program (as it is in more than one specialty). If people are busting your balls about it being impossible, you need to find new people to give you advice.

PM me if you want more information.

 

[Neuronix]

Thanks so much for that post .

 

[Gyric]

You might also consider audition rotations. We are filled with visiting students from Aug through Jan, not sure how common this is in radiology.

We get hundreds of qualified applicants for a few spots and every year our match list is filled with those med students who rotated with us and who we know will fit in well. Also, I agree that you need at least one publications, a PhD without publications is a big red flag.

 

[orrghead16]

Also, I agree that you need at least one publications, a PhD without publications is a big red flag.

How many MD/PhD programs, on the grad side of things, actually let students (moreover their committees ) leave without ONE publication????

 

[Neuronix]

How many MD/PhD programs, on the grad side of things, actually let students (moreover their committees ) leave without ONE publication????

I've seen it twice at my program. Things happen that are out of a grad student's control. The two cases I've seen are that the PI dies or the student gets scooped. How many years should a grad student have to work if they've been working hard and get screwed? Different people have different opinions about this.

Something undergrads don't realize about the real world is this: in the real world you can work very hard and be very good and still not be successful due to things out of your control.

 

[Shifty B]

I've seen it twice at my program. Things happen that are out of a grad student's control. The two cases I've seen are that the PI dies or the student gets scooped. How many years should a grad student have to work if they've been working hard and get screwed? Different people have different opinions about this.

Something undergrads don't realize about the real world is this: in the real world you can work very hard and be very good and still not be successful due to things out of your control.

This is actually true. I've seen this on 1 or 2 occasions as well, and it was almost always extenuating circumstances. In one, a PI refused to let a particular work be published in a journal other than Nature, and he was constantly stalling the student based on future experiments that were going to be included in this Nature paper. The committee basically stepped in and allowed the student to graduate.

But my advice to all those current students out there is: when you are doing your PhD work you should be working on at least one side project (if not more). When your main project inevitably blows up in your face, then you can seamlessly transition to one of your side projects. Or at the very least you can get some smaller publications, like procedure papers and whatnot.

Failures to publish adequately during a PhD is almost always tied to problems with the PI. However, as a PhD student you need to anticipate problems and have a backup plan. You can save yourself a lot of grief.

 

[achamess]

But my advice to all those current students out there is: when you are doing your PhD work you should be working on at least one side project (if not more). When your main project inevitably blows up in your face, then you can seamlessly transition to one of your side projects. Or at the very least you can get some smaller publications, like procedure papers and whatnot.

Failures to publish adequately during a PhD is almost always tied to problems with the PI. However, as a PhD student you need to anticipate problems and have a backup plan. You can save yourself a lot of grief.

Good stuff! Very sound advice. I'm not at the graduate level yet, but I've always got 2 or 3 projects going on at once, both for the reason you stated, and because I don't want to waste the 'down time' when cells are growing or long assays are running. Plan B all the way!

 

[ears]

Shifty B's advice is sound. Radiology is a tough match for everyone, but unlike in radonc or derm, numbers are actually on your side: there are about 1000 slots. An MD/PhD who can walk and chew gum at the same time can have one if he/she wants.

I'll also second the advice about emphasizing that you want to concentrate on your clinical training during residency (because that's what the time is there for). I know that some programs are concerned about the board pass rates of residents who have outside interests.

And true that about Plan B: not just for contraception any more!

 

[Neuronix]

As hard as I tried on Pediatrics I only managed a high pass. My evals were heavily tainted by my performance in the first few days of the rotation--my first few days back from the PhD. I had no idea what the team wanted, was open to feedback, and improved my performance dramatically over the rotation. It didn't matter. I don't even know who wrote one of my evals--it doesn't even make much sense. Whoever wrote it is just stabbing me in the back because all the feedback I was receiving in the last two weeks of the rotation was positive. It almost seems like it was an attending who only evaluated me at the beginning or something.

I'm really really close to quitting. I can't get honors here. I've been working very hard for years and I'm simply not good enough. Now I'm far behind my classmates because I did a PhD. Yet I'm told my clinical grades won't permit me to get the specialty I want. It's a big red flag for my residency application. What's the point of trying anymore. All these years and it's just a waste. I hate this.

 

[smq123]

As hard as I tried on Pediatrics I only managed a high pass. My evals were heavily tainted by my performance in the first few days of the rotation--my first few days back from the PhD. I had no idea what the team wanted, was open to feedback, and improved my performance dramatically over the rotation. It didn't matter. I don't even know who wrote one of my evals--it doesn't even make much sense. It almost seems like it was an attending who only evaluated me at the beginning or something.

I'm really really close to quitting. I can't get honors here. I've been working very hard for years and I'm simply not good enough. Now I'm far behind my classmates because I did a PhD. Yet I'm told my clinical grades won't permit me to get the specialty I want. It's a big red flag for my residency application. What's the point of trying anymore. All these years and it's just a waste. I hate this.

I'm sorry, Neuronix. I'm very, very, very sorry. It sucks, no question.

 

[BozoSparky]

As hard as I tried on Pediatrics I only managed a high pass. My evals were heavily tainted by my performance in the first few days of the rotation--my first few days back from the PhD. I had no idea what the team wanted, was open to feedback, and improved my performance dramatically over the rotation. It didn't matter. I don't even know who wrote one of my evals--it doesn't even make much sense. It almost seems like it was an attending who only evaluated me at the beginning or something.

I'm really really close to quitting. I can't get honors here. I've been working very hard for years and I'm simply not good enough. Now I'm far behind my classmates because I did a PhD. Yet I'm told my clinical grades won't permit me to get the specialty I want. It's a big red flag for my residency application. What's the point of trying anymore. All these years and it's just a waste. I hate this.

dude, peds can be crazy...i had a similar experience in med school and i just had a awful experience last month (transitional internship)...really, there were some folks who just did not like me despite a tremendous effort and great attitude. i was miserable.

it's not you, so don't beat yourself up...although i find it hard to follow my own advice.

you'll match in radiology and it will all be worth it. just don't quit.

 

[gstrub]

I'm really really close to quitting. I can't get honors here. I've been working very hard for years and I'm simply not good enough. Now I'm far behind my classmates because I did a PhD. Yet I'm told my clinical grades won't permit me to get the specialty I want. It's a big red flag for my residency application. What's the point of trying anymore. All these years and it's just a waste. I hate this.

Dude, seriously? Waste of time? Quitting?? Red flag because you didn't get honors??? WTF?

I talked with my MD/PhD director the other day about my concern that I got HP on my first two rotations (OB and psych). I won't bore you with how our grading system punishes us this year, but my concern was that I would get all HPs if I was lucky.

He told me that NO MD/PhD student had gotten honors in medicine or surgery in our program for the last 3 years. These students did not do poorly in the match. Rad onc at Pitt. Plastics at Stanford. Fast track med/ID at Vandy. Neurosurg at UCSF x2. Med/Cards at Duke. RADS at Yale. I do NOT attend a top 20 MD/PhD program. These students were NOT all AOA, step I 299, whatever. They were normal, outgoing students interested and accomplished in research. It was their research experience that allowed them to apply to those programs...the top places want to train academic physicians. They see your publications in real journals next to some schmo's case report and high board score with cookie cutter letters and it's a no brainer. I know you think I am wrong, but it's true.

So keep your head up man. You are the moderator around here, act like it! Don't let the clinical side of things discourage you. Remember, you are MD/PhD, that means you are a total bad-ass. Don't fall into the thinking that it's an overrated waste of time...if you do, the terrorists win.
-G

 

[Neuronix]

Sorry for the earlier post. That was just anger and frustration talking. I post that sort of thing because I want people to know what your average senior MD/PhD student is thinking. I don't think I'm far off from what others in similar positions to mine are thinking.

I don't think you're wrong, I just get wildly varying estimates of my competitiveness. Shrug, if only I could pre-match now and get it over with . I already know exactly where I want to go.

 

[QofQuimica]

Sorry about the HP, but Neuro, you should try to just let this stuff go a little. Third year grades are almost completely subjective except for the shelfs. If I am perfectly honest, I got some evals last year that were better than I deserved, and a few that were worse than I deserved. It happens to everyone.

Peds is over, so forget about it. Focus on honoring your next rotation. You're not just coming off your PhD now; you're back in the groove. You have a completely fresh slate with a completely different attending and team on a completely different service. Man up and make it happen. We're all rooting for you.

 

[Ariodant]

Peds is often recommended as the first rotation after PhD because it's chill, but maybe that's not the case at Penn?

Somehow I felt more stressed during my peds preceptorship than the one in the ED

 

[Neuronix]

PMed Ariodant given that his question is very specific to my school. I'm happy to send such info to anyone at my school if they wanna contact me.

 

[Neuronix]

Peds is often recommended as the first rotation after PhD because it's chill, but maybe that's not the case at Penn?

Mine was not at all chill. I came back with the other students who were on their last block, and two told me they put more hours in on inpatient peds then on surgery. Several interns commented to me how malignant they thought their program was. This wasn't at Penn though--Penn has no children's hospital. It was at our affiliate.

I did manage to honor OB/GYN Now I can't say I didn't honor anything in third year, and thus the "huge red flag" is removed. So I met with a different adviser in the residency program to which I've been planning to apply, and he told me that since I'm not AOA and I don't have a "99" on my Step I, I won't get many interviews. Whatever, I think I'm going to switch specialties.

 

[solitude]

Mine was not at all chill. I came back with the other students who were on their last block, and two told me they put more hours in on inpatient peds then on surgery. Several interns commented to me how malignant they thought their program was. This wasn't at Penn though--Penn has no children's hospital. It was at our affiliate.

I did manage to honor OB/GYN Now I can't say I didn't honor anything in third year, and thus the "huge red flag" is removed. So I met with a different adviser in the residency program to which I've been planning to apply, and he told me that since I'm not AOA and I don't have a "99" on my Step I, I won't get many interviews. Whatever, I think I'm going to switch specialties.

congrats on the H! Are you really going to switch? Don't do anything rash just because of a grumpy adviser--I still think you'll make it. (I know, my opinion doesn't count for much but moral support .)

 

[Freak]

So, I had an advisor in undergrad tell me I would never get into any MD/PhD program (due to not having perfect grades/1000's of extracurriculars) ... now I am at a top 5. Advisors need to be ignored sometimes.

 

[QofQuimica]

I did manage to honor OB/GYN Now I can't say I didn't honor anything in third year, and thus the "huge red flag" is removed. So I met with a different adviser in the residency program to which I've been planning to apply, and he told me that since I'm not AOA and I don't have a "99" on my Step I, I won't get many interviews. Whatever, I think I'm going to switch specialties.

With your score, how can you not have a 99 on your Step 1? What do you have, a 98 that barely missed being a 99? Come on, give me a break. (more at your advisor than at you).

Congrats on the honors in OB/gyn, BTW.

 

[Shifty B]

Mine was not at all chill. I came back with the other students who were on their last block, and two told me they put more hours in on inpatient peds then on surgery. Several interns commented to me how malignant they thought their program was. This wasn't at Penn though--Penn has no children's hospital. It was at our affiliate.

I did manage to honor OB/GYN Now I can't say I didn't honor anything in third year, and thus the "huge red flag" is removed. So I met with a different adviser in the residency program to which I've been planning to apply, and he told me that since I'm not AOA and I don't have a "99" on my Step I, I won't get many interviews. Whatever, I think I'm going to switch specialties.

I recommend psych or neuro for your first rotations. If you don't do well on these rotations, no one is really going to care. Also, physical exam doesn't really matter in either of these so you have some time to practice. Then get to medicine and surgery, peds. That is, if you have a choice. I don't think it really matters.

Regarding not matching radiology and changing specialties, I've given my opinion in one of the other posts, and I'm not going to go into that again.

I'm going to give you some harsh advice. You will match if you apply, but if this is how you are going to respond to small frustrations and setbacks, maybe you aren't cut out for the radiology match. The need for constant validation you exhibit in some of these posts will not be met in the radiology match. The application process is frustrating, interview selection inexplicable, and the process is nerve wracking. You will have no idea why you were selected at one place and not at another. You'll leave your interviews wondering what they thought of you. You will be uncertain of yourself all the time until that day when you find out you matched, and then you will have 3 more days to think about where you wind up. And then you probably won't get your first choice, particularly if you aim for the best programs in the country.

So what. You'll match. It's like the joke about medical school. "What do you call the person who matches at the worst radiology program in America? A radiologist."

All the whining in the world isn't going to make you any better, and it will actually make you worse. So man up, get your nexium (or effexor, or whatever you need) prescription filled, and apply to the specialty you want.

Don't take this personally, but it's just the way it is.

 

[Treg]

I'm going to give you some harsh advice. You will match if you apply, but if this is how you are going to respond to small frustrations and setbacks, maybe you aren't cut out for the radiology match. The need for constant validation you exhibit in some of these posts will not be met in the radiology match. The application process is frustrating, interview selection inexplicable, and the process is nerve wracking. You will have no idea why you were selected at one place and not at another. You'll leave your interviews wondering what they thought of you. You will be uncertain of yourself all the time until that day when you find out you matched, and then you will have 3 more days to think about where you wind up. And then you probably won't get your first choice, particularly if you aim for the best programs in the country.

As an applicant in general surgery looking at most of the 'top programs', I can say that this will probably be your experience applying in most specialties. I am currently in the phase of trying to figure out (ignore?) the letters, calls etc that I/my friends are receiving and I/my friends are not. To not be called by a top program's chair this week knowing that other people were, and then be told a few days later by a different program that 'you are one of the top two or three applicants in the country this year' just proves this point. The match process is only somewhat predictable (the need for good scores to get you through the interview filter, etc).

I think that if you want a certain specialty, and it is 'competitive', apply to a lot of programs, and have a few 'safer' back up specialty interviews as well. You will hopefully know by late October how the interview invites are going in your top choice, leaving you the option of sending out more back up applications if need be. It will never hurt you to try for your top choice, just have a sensible back up plan to make sure you get enough interviews to have a solid rank list.

Advisors are just that--and as we all know, there is good advice and bad advice.

Treg

 

[Neuronix]

All the whining in the world isn't going to make you any better, and it will actually make you worse. So man up, get your nexium (or effexor, or whatever you need) prescription filled, and apply to the specialty you want.

Don't take this personally, but it's just the way it is.

I always appreciate your advice, but really the flames aren't necessary. I probably should have made it more clear why I'm thinking of doing something else. But, really since I haven't made up my mind yet, I don't want to go into it. Too many people know who I am so I don't want to trash one specialty vs. another specialty.

I just like to use SDN a bit as my blog about the thoughts of an MD/PhD student. Is that really so bad?

I don't take any prescription meds, btw. My mom takes enough for both of us. She's back to the homeless shelter this weekend.

 

[smq123]

I'm going to give you some harsh advice. You will match if you apply, but if this is how you are going to respond to small frustrations and setbacks, maybe you aren't cut out for the radiology match. The need for constant validation you exhibit in some of these posts will not be met in the radiology match.

To be frank, I think it is unfair to judge Neuronix based solely on his posts here, which are written at specific times (generally when he is the most frustrated), and it is hard to encapsulate the whole picture in a few sentences.

I don't think that these are "small" frustrations and setbacks. The lack of support from Neuronix's school is pretty disgusting, to be truthful. I never saw anything like it at my school. To the MD/PhD program, if you don't want to do a research heavy specialty, they write you off. The radiology program there, it seems, wants your first-born as "proof" that you're commited to the field before they'll give you the time of day. Like I said, I had never seen that level of disregard for student advising before. As a med student looking for any kind of guidance, being treated that way is discouraging and, yes, extremely frustrating.

Furthermore, to have the few people who DO agree to meet with you dismiss your accomplishments in grad school as "We don't know what that is; don't care" is ludicrous and disrespectful. If someone spent 70 hours a week for 4 years doing work on this project, you should listen to what that person has to say on the matter. They don't talk about residency that way, and (from what I gather) radiologists spend MUCH less than 70 hours a week doing work.

I don't think that it's fair to equate a genuine anger over being flippantly dismissed by all the "advisors" at your school to a "constant need for validation." I've been through the Match as well, and realize that it is a nerve wracking process that tests your self-confidence to the core. But the process of matching is made 100 times worse when your school does next to nothing to help you through it...or, worse, sets up road blocks to make the process harder than it really needs to be. I mean...refusing to give people an LOR after doing "only" one rotation in that specialty? Really now? REALLY?

I recommend psych or neuro for your first rotations. If you don't do well on these rotations, no one is really going to care. Also, physical exam doesn't really matter in either of these so you have some time to practice. Then get to medicine and surgery, peds. That is, if you have a choice. I don't think it really matters.

He didn't. I think it would have mattered. Making people do rotations BEFORE they spend 4-5 years doing basic science research is kind of stupid, in my opinion. But that's the school's policy.

 

[Shifty B]

I always appreciate your advice, but really the flames aren't necessary. I probably should have made it more clear why I'm thinking of doing something else. But, really since I haven't made up my mind yet, I don't want to go into it. Too many people know who I am so I don't want to trash one specialty vs. another specialty.

I just like to use SDN a bit as my blog about the thoughts of an MD/PhD student. Is that really so bad?

I don't take any prescription meds, btw. My mom takes enough for both of us. She's back to the homeless shelter this weekend.

Let me start by saying I don't mean any harm by the post I made. I only made statements that were this direct because I hoped you would take the truth in them and use it to temper your negativity.

However, I felt there was a need to contradict your previous posts because they demonstrate an overly negative reality. Granted, the title of this thread is "was it supposed to be this tough?" My point is that it's actually not as tough as you make it sound. I'll go on the record right here, one year in advance, saying that you will match your first choice specialty. I don't want people coming on this forum and saying, "wow, it must really be bad."

If you're thinking of changing specialties for another reason, then that's something else entirely.

It's ok to use this as your sounding board for your frustrations, but it might be good to take a step back and look at the good:

- You're going to a top 10 medical school... for free... with a stipend.
- You got a phd, published some papers, met some cool people, had a great lifestyle for 4 years or so.
- The MD/PhD you're getting is going to offer you an advantage at every step of your career, including your residency application.
- Right now you have more career opportunities than the average person can even imagine.
- You have basically a guaranteed job and salary for life.

As for the prescription joke, I thought that was sufficiently outrageous that you would take it for a joke. My apologies if it was too mean. I mainly thought of that because during my 4th year I thought I needed a little nexium, or effexor, or something. I had sleepless nights, constant anxiety, ugh, it was not good. You can benefit from taking these things a little less seriously.

And my sympathies for your family situation. That sounds like a tough one.

 

[Shifty B]

To be frank, I think it is unfair to judge Neuronix based solely on his posts here, which are written at specific times (generally when he is the most frustrated), and it is hard to encapsulate the whole picture in a few sentences.

This is true. However, this has been a consistent theme throughout this entire thread. And I do understand that there is a certain benefit to posting your frustrations.

I don't think that these are "small" frustrations and setbacks.

Uh, they definitely are small. Compared to say, your mom being in a homeless shelter. It's important to keep in mind that getting an HP instead of H in a rotation is relatively meaningless in the overall scheme of life. Think back 5 years about something you really worried about at the time, and ask yourself if it is now important

The lack of support from Neuronix's school is pretty disgusting, to be truthful. I never saw anything like it at my school. To the MD/PhD program, if you don't want to do a research heavy specialty, they write you off. The radiology program there, it seems, wants your first-born as "proof" that you're commited to the field before they'll give you the time of day. Like I said, I had never seen that level of disregard for student advising before. As a med student looking for any kind of guidance, being treated that way is discouraging and, yes, extremely frustrating.

Now on this, you and I agree. I've never heard such an extreme example of an MSTP program being so unhelpful in terms of people who aren't necessarily interested in bench research only. This does in fact bring up a very important point for people who are applying. I would ask specifically about how many people pursue competitive, less research oriented specialties, and how the program feels about it.

And the radiology department is even worse. Who tells there own, highly qualified student, that they don't think they'll match. At all. Of course radiology is competitive, and you might go to a program that doesn't meet their sterling reputation. But they should do everything they can to help you.

I don't think that it's fair to equate a genuine anger over being flippantly dismissed by all the "advisors" at your school to a "constant need for validation." I've been through the Match as well, and realize that it is a nerve wracking process that tests your self-confidence to the core. But the process of matching is made 100 times worse when your school does next to nothing to help you through it...or, worse, sets up road blocks to make the process harder than it really needs to be. I mean...refusing to give people an LOR after doing "only" one rotation in that specialty? Really now? REALLY?

Yea, this is pretty rude, and a pain in the ass. If you were a regular MD student you might have a little more time to meet with people who were more helpful, like just scheduling an elective at another hospital.

He didn't. I think it would have mattered. Making people do rotations BEFORE they spend 4-5 years doing basic science research is kind of stupid, in my opinion. But that's the school's policy.

Yea, this is stupid. Anything you learn you will just forget. But, it does give you slightly more flexibility for returning from your PhD a little late.

In all, I only mean that you need to step back and keep things in perspective. Of people matching radiology: 75% are not AOA. 95% don't have a PhD. 60% didn't go to a top 40 medical school. His chance of matching is still >90%. I would say his chances of matching a top 25 program are > 50%.

I apologize again if I was to aggressive in my post. My advice is to stay strong, don't let this bull**** stop you from doing what you want.

 

[Neuronix]

You can benefit from taking these things a little less seriously.

I you and all the other residents who offer me advice. I don't take it personal. I think my real life personality is quite different than one could surmise from this thread. I do sometimes have sleepless nights, but it's because I drink way too much coffee!!! I'm more of the narcoleptic type--yawn in the middle of surgery, fall asleep in lecture kind of guy. I've been spotted sleeping with books on my face more times than I want to admit I require too much sleep, and it's one of my personal handicaps. That and that my personal life is a complete mess and as far as I can tell always will be.

I find truth in what you say. I will probably match into whatever specialty I want (though PRS might be a stretch ). That's the fortunate part that not every MD/PhD student can say (and this is the continuing public service announcement to the juniors that is approaching ). I'm just finding that there might be other specialties that will be more supportive of my love of technology, research, and life outside of the hospital. Maybe Radiology though will turn out to be the best choice. I'm not sure. I wish I had more time to decide. I wish I could take clinical electives before being done core rotations. Oh well...

Believe me, I'm the master of negativism. I should probably explain that. I was born with a big cone head and covered with hair--mom cried because she thought she had a ******. My first day of kindergarten I went straight into the special education class. I went around high school asking everyone if they wanted fries with that. My guidance counselors and teachers formed a uniform front to try to get me to shape up. "You're going to end up working at McDonald's!" "If you don't finish high school, you'll regret it!" I only had to apply to college three times and get yelled at by the admissions director for annoying them so much with my calls and applications. Then I couldn't possibly succeed as a pre-med without the proper high school background. I couldn't get into an MD/PhD program since I didn't have enough research and publications. It just goes on... and on... and on... I'd never have a successful PhD is what one graduate department chair told me, because I didn't have the proper physics/engineering background for research in my area. I dedicated my PhD thesis to everyone who told me I couldn't (http://forums.studentdoctor.net/showpost.php?p=7298307&postcount=10), because that's just about all I'm ever told. I'm getting it some more now.

Nowadays I just laugh about it and move on. You're right that I'm fortunate to be where I am. I've been hungry, I've been cold, I've lived in some places I'm not proud of. I actually appreciate it very much when people tell me I CAN do something, that I SHOULD do something, that things will turn out if I do X, Y, and Z in an unbiased fashion. My graduate PI did that, and it's a big reason why I chose his lab. I get sick of everyone else's negativism after awhile. Now the negativism is from my own program. Apply to a good range of community programs (Radiologists). Pick a backup specialty (administrator). You shouldn't go into anything that isn't IM, Peds, Path, Neuro, or Psych because you won't have a research career (director). Yawn. Whatever.

Instead, what's more pressing to me are other matters that I'm writing about here.

First, MD/PhDs have a shortened fourth year.

This means we have insufficient time to get letters, choose a specialty, take Step II, etc for competitive specialties.

Second, MD/PhDs are held to the same standards as MD students.

This means we're under a very clear disadvantage. First because I came back to clinics with all the students finishing their rotations. Second because how much do you really remember after that break?

I was rather in the dark about all this until I actually finished my PhD and came back. Unfortunately now I get so much conflicting advice I don't really know who or what to believe. FWIW, the advice I get online is much more optimistic than the advice I get offline.

Before all this I was a big believer in pace myself, don't worry about grades, just have a good time and help people. I'm still all about the latter. I really care about people, and I find that helping pre-meds on SDN is more valuable than taking blood pressures in a free clinic. It's my own way of volunteering.

Unfortunately, the real world shocked me about the former. You know--pace yourself, enjoy the ride, find balance in your life. I'm still recoiling a bit from it. I thought I was doing something cool here. I'm really good at what I do in the research world. I have directly clinically translatable abilities that few others have. I'm trying to do something meaningful here. All I need is to be at the place where I can do it. On the same token, I'm not good enough to match at those kinds of places. It's like everyone is talking out of two sides of their mouths. "We care about research" -- sure... As long as it doesn't interfere with money, useless markers like step scores and AOA, and prestige. You must be the best in every way to get that sort of career... But then what happened to that balance? There is no balance at 80 hours a week.

Ah well, at least I know there is one thing I know I will always enjoy if nothing else. Skiing. I'm not really sure if doing that with my one week a year of vacation is ever going to cut it...

 

[Neuronix]

Uh, they definitely are small. Compared to say, your mom being in a homeless shelter. It's important to keep in mind that getting an HP instead of H in a rotation is relatively meaningless in the overall scheme of life. Think back 5 years about something you really worried about at the time, and ask yourself if it is now important

I just ask that you put yourself in my shoes. The adcom at the program I really really want to go to told me--"Try to get more honors when you go back to med school." "If you don't have any third year honors that's a big red flag for us." This is direct from the mouth of a person who decides whether I can come there or not. That to me is extremely important.

My personal life is like a water boiler. It's always churning. Always this contained potential for violence. Sometimes it needs adjusting. Sometimes it ruptures. Sometimes it explodes. Mom is always crazy. Dad is always a step away from death. My heart is often getting broken. Usually only one of these things demands my attention at a time. At least all of these things aren't happening at the same time like it did when I was a second year. That's the "it could always be worse" sentiment that I keep in my mind.

This does in fact bring up a very important point for people who are applying. I would ask specifically about how many people pursue competitive, less research oriented specialties, and how the program feels about it.

In their defense, I think a few things have happened. First, more students are applying in those competitive, less research oriented specialties. Things have gotten much more competitive in those specialties, including with increasing reliance on step scores and grades. There's been a recent spike in unmatched MD/PhD students. Besides, I'm not sure there's much they can do to help me. It's not up to them. Program directors tend to be from the old school--medicine, peds, and path docs who could easily help us get big name positions in IM, Peds, and Path. What do they know about applying to Radiology? Maybe if all Radiology can seem to care about is whether I have a 99 on my Step I (which the Rads PD assures me is a cutoff at many programs), should I really be going into that specialty? Q is right, I barely missed a 99 two-digit on Step 1, but that seemed to matter a lot to my local PD. There's nothing I can do about it now, so I'm just trying to do better on Step 2.

Of course MD/PhD directors also have a vested interest in producing researchers. There's data out there showing MD/PhDs are more likely to go into academics vs. private practice from certain specialties. There's future NIH funding on the line if a program looks like it's producing a big batch of clinicians only. They of course really really don't want students not to match. It looks very bad on the program. It drives down the morale of the students. So my odds of matching a top-25 program in something like IM would be >99%. Why shouldn't I do that? I could fast-track, have protected research time and funding, etc... When I've asked about doing a Holman in Radiology I've been laughed at.

I mean this is just me speculating as to what the perspective of the program director is. I can't speak for them. I don't think there's much my program can do for me to help with these things I've discussed. The only thing I can do is suggest how things can be improved, which I have done. But not everyone has these problems and not everyone agrees with me.

And the radiology department is even worse. Who tells there own, highly qualified student, that they don't think they'll match. At all. Of course radiology is competitive, and you might go to a program that doesn't meet their sterling reputation. But they should do everything they can to help you.

Also in their defense, I got in to meet with the residency director and he was more helpful than the first adviser I met with. He rolled his eyes at certain statements given to me by the first, very highly regarded, faculty member at my school I met with. He offered to make the phone call for me when the time came. He says I will match, assuming I apply to around 30 programs. He's a bit handicapped though. The student who applied last year to 30 programs, got 3 interviews, and went on to not match sat right where I was sitting just a year ago. I'm fortunate to have two things he didn't--20 more points on Step 1 and research within the department.

If you were a regular MD student you might have a little more time to meet with people who were more helpful, like just scheduling an elective at another hospital.

It is unfortunate I need to do two rotations in Radiology to get a clinical Radiology letter. I have to make some difficult compromises to fit everything in before ERAS goes out. Fortunately, if things go okay I will have time to do one elective elsewhere. It's a good thing I did OB/GYN at an outside hospital so I could get a LOR out of it, otherwise it was very unclear where I could actually get enough non-research LORs to apply. It's really screwy here sometimes. I can't get a LOR out of my sub-I, I can't get a LOR out of my Radiology elective, and I can't get a LOR out of my core clerkships. WTF?!

 

[Gyric]

IMO, nothing (not $, lifestyle, or prestige) is more important than fundamentally enjoying the clinical work (unless, I suppose, your strategy is to bank enough for a very early retirement from medicine); so definitely make sure you want to be radiologist. If that is the case, then you really do not have a choice; it sounds like you need to apply to as many radiology programs as possible and play the game, odds are you will match somewhere and, truly, that is the best you can hope for in any specialty given the subjectivity of applicant selection.

I have come to realize that the greatest benefit to the MSTP training path is our lack of debt and the resulting freedom to pursue our interests as they evolve (which will no doubt continue during your residency); so you have that going for you, unlike most MD students.

 

[Neuronix]

for your letters...

here's what i did last year for radiation oncology: one good medicine letter (try to get a chairman's letter, in either your 3rd year rotation or sub-I, whichever you did better in), 2 radonc, and one from the thesis advisor...

The Department of Medicine here doesn't write chairman's letters for students unless they're going into Internal Medicine. Is that unusual?

 

[EaglesPA]

The Department of Medicine here doesn't write chairman's letters for students unless they're going into Internal Medicine. Is that unusual?

No it's not unusual - unless you are talking about a letter a Prelim medicine application?
Where I was, they wrote Chairman's letters for both Prelim and Categorical Medicine applicants.

 

[Neuronix]

No it's not unusual - unless you are talking about a letter a Prelim medicine application?
Where I was, they wrote Chairman's letters for both Prelim and Categorical Medicine applicants.

The department here won't write you a letter for prelim medicine programs UNLESS the prelim program specifically requires a chairman's letter. I don't know if that will matter for my own internship applications.

It seems like the chairman's letter is still a popular thing to get for prelim years, Rad Onc, and other very internal medicine related specialties. I don't think my school would write a letter in this case. I was just curious if this was the norm since BozoSparky brought it up.

 

[yeastfan21]

Mine was not at all chill. I came back with the other students who were on their last block, and two told me they put more hours in on inpatient peds then on surgery. Several interns commented to me how malignant they thought their program was. This wasn't at Penn though--Penn has no children's hospital. It was at our affiliate.

This really confused me. CHOP is not part of Penn?

 

[Neuronix]

This really confused me. CHOP is not part of Penn?

First, I didn't say it was at CHOP. Second, CHOP is just a Penn affiliate that is next door. It's not owned by Penn. You're reminded of this any time you have a meeting in there and you need to get a "visitor" sticker since your Penn IDs aren't recognized. Meeting with anyone at the research building is particularly annoying because they actually have to come downstairs to escort you personally. You need a separate CHOP IRB to do anything patient-related there.

Now I'd appreciate it if we could stick to the topic of MD/PhDs returning from the lab and leave these kinds of details for elsewhere.

 

[calvinNhobbes]

When I went back, my program required all MD/PhDs to start with 3 months of internal medicine. Wow, was that painful! The only saving grace was that if you managed to schedule it so you started back on cycle in October, you got a one week break after the first month for Thanksgiving, then a 2 week break after the second month for Winter Break. I studied my butt off during those breaks in order to catch up and it definitely helped.

 

[nomogram3]

When I went back, my program required all MD/PhDs to start with 3 months of internal medicine. Wow, was that painful! The only saving grace was that if you managed to schedule it so you started back on cycle in October, you got a one week break after the first month for Thanksgiving, then a 2 week break after the second month for Winter Break. I studied my butt off during those breaks in order to catch up and it definitely helped.

Ouch, that could not have been pleasant. I was able to structure my schedule so that I started with Psych, then did Peds and Medicine. That way I had some free time to review some basics while I was doing Psych as the hours were cush. At the end of the day, I'm not sure it really mattered that much though. Each clerkship class was graded against itself, not against the other classes. If you did Surgery first, a lot of the group flunked the shelf because a lot of the exam is medicine, and as they couldn't fail the whole group if you did reasonable in your evals and scored better than the class average you got honors. This may not be how it works everywhere, but its a little food for thought.

 

[calvinNhobbes]

Ouch, that could not have been pleasant.

Even worse, while every other MS3 got to spend one month doing a cushier sub-specialty, all the MD/PhDs had to stay on their inpatient services. But of course, we were still expected do as well on the oral exam and shelf even though we didn't have that easier month for studying.

 

[gstrub]

That's a bunch of crap! The programs should make things easier for MD/PhD students. At our program, you can pick any rotation to start with, and you can bounce from one group to the other if you want a specific order. You are not required to do a critical care month or an AI, which the MD students have to. You can move any rotation to M3 so you can do an AI or away during third year to ensure you get letters on time.

It's the university's highest degree program...they should treat its students as such.

 

[Maebea]

That's a bunch of crap! The programs should make things easier for MD/PhD students. At our program, you can pick any rotation to start with, and you can bounce from one group to the other if you want a specific order. You are not required to do a critical care month or an AI, which the MD students have to. You can move any rotation to M3 so you can do an AI or away during third year to ensure you get letters on time.

It's the university's highest degree program...they should treat its students as such.

While I agree that MD-PhD students need to have flexibility in the scheduling of clerkships and electives, I do not support the idea that they should be treated as if they are masters of the universe. The attitude that MD-PhDs are somehow better than MDs & thus deserve special treatment is dead wrong. (They need special treatment in order to ameliorate conflicts caused by the structure of their training, not because they are enrolled in an institution's "highest degree program".) Hitting the wards with an attitude that everyone else should be in awe of your mighty PhD degree is the surest way to earn the animus of everyone on the floor, from the chief of service down to the nursing staff. I have seen this happen many times over the years.

MD-PhDs would be wise to learn some humility & political savy before they start clinics. Even if everyone else on the wards is an idiot compared to you, they know how to care for patients far better than you. Furthermore, they are what stands between you and Honors.