3-4-1 MD-PhD and applying for residency

[nysw]

I'm currently a MS3 in a 3-4-1 track. My school traditionally does 2-4-2, so there aren't a ton of people that can help me out and my academic adviser is also clueless.
My classmates are all gearing up for applying to residency and that made me realize that I had no plan for residency/letters/fourth year. Most of my core clerkships are over and I'm gearing up to take Step 2 at the end of this year.
My question is - where/who do I get LORs from? Do I just have to get letters from my AIs and aways four years from now, and hope that my attending remembers me then? Do I get letters now and request that they hold on to them? I'm not trying to go into anything super competitive - just Gen Surg - but I still want to go to the best place I can.

Any advice or suggestions? I'm pretty clueless - I didn't expect to be near the end of my 3rd year so soon... Thanks in advance.

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[OddNath]

Our program was the same way- it will be wonderful to get step 2 out of the way before disappearing in the lab!

My letters were from my PI, AI, other random MS4 rotation which went well, chairman. So, nothing from MS3 specifically.

However, you are in a unique position to cultivate relationships that start during MS3 but continue during lab, making for some very strong letters. For example, my AI letter was someone I had worked with briefly during MS3, but had continued to go to his clinic around once every month or 2, and would see him whenever I went to Grand Rounds (which I went to more towards the end of my PhD). With doing the PhD after MS3, you have the unique position of setting yourself up for letters fd attendings who will have known you for many years.

 

[ValentinNarcisse]

Huge disadvantage to this structure is that your major publications will not likely be out in time for ERAS. I would try to get those done at least 6 months before you return to M4.

 

[Gastrapathy]

Bail on the PhD, do research in residency. The only reason to do a PhD is if you want to do bench science or rad onc. Want to be a pediatric surgeon, you'll spend 3 years in a lab anyway. MD/PhD just creates poorly paid workerbees to spend their days turning the crank for the tenured kings. You only need one terminal degree.

 

[nysw]

Our program was the same way- it will be wonderful to get step 2 out of the way before disappearing in the lab!

My letters were from my PI, AI, other random MS4 rotation which went well, chairman. So, nothing from MS3 specifically.

However, you are in a unique position to cultivate relationships that start during MS3 but continue during lab, making for some very strong letters. For example, my AI letter was someone I had worked with briefly during MS3, but had continued to go to his clinic around once every month or 2, and would see him whenever I went to Grand Rounds (which I went to more towards the end of my PhD). With doing the PhD after MS3, you have the unique position of setting yourself up for letters fd attendings who will have known you for many years.

Thank you so much for your insight! I really appreciate it. How do y'all handle going back into 4th year vs. 3rd year? Is the transition not as terrible as people make it seem?

Huge disadvantage to this structure is that your major publications will not likely be out in time for ERAS. I would try to get those done at least 6 months before you return to M4.

I hadn't taken that into consideration, but now I will. Thanks!

Bail on the PhD, do research in residency. The only reason to do a PhD is if you want to do bench science or rad onc. Want to be a pediatric surgeon, you'll spend 3 years in a lab anyway. MD/PhD just creates poorly paid workerbees to spend their days turning the crank for the tenured kings. You only need one terminal degree.

From a purely utilitarian standpoint, my PhD in medical humanities would be considered worthless anyway. I actually thinking seriously about pedi surgery, but haven't ironed out the details yet. The bench research absolutely has to be during residency? Double dipping with humanities and bench science work informally during the 3 years out wouldn't work? Totally wishful thinking here...

 

[Gastrapathy]

Yeah. That's wishful thinking. If you want to be a surgeon, don't get a humanities PhD, get a surgery residency. Peds surg needs dedicated research years before a fellowship app. The opportunity cost of that PhD from a lost income perspective, plus making yourself potentially less competitive is pretty extreme. If you've decided on surgery, get their take on your plan. It's an active forum.

 

[OddNath]

Thank you so much for your insight! I really appreciate it. How do y'all handle going back into 4th year vs. 3rd year? Is the transition not as terrible as people make it seem?

The transition back isn't bad, especially if you've gone to clinic occasionally during the PhD years. I went back and re-read some of my step 2 stuff after defending to prepare, so keep those books! We all did one "warm-up" rotation in July, then the AIs and away rotations after that. My extra letter actually came from my July rotation which went a little better than expected

The publications part- 2 of my first authors were already out, and the 3rd was accepted just before ERAS opened, so I guess that's my n of 1. I suppose if all of your work is going to be funneled into one giant paper, then this may be an issue, although one of my classmates did this, hadn't published the paper yet, and still got interviews everywhere she applied. She discussed the work during her interviews and had presented it extensively. I guess it's arguable if the one-monstrous-paper idea is a good strategy in general (there are other threads about that), but for her n of 1 she did pretty well.

 

[Neuronix]

The only reason to do a PhD is if you want to do bench science or rad onc.

Why do you need a PhD to be a rad onc?

I agree with Gastrapathy about not understanding why you're doing a humanities PhD to be a pediatric surgeon.


I would speculate that one nice thing about transitioning back into fourth year is that it's not nearly as difficult as third year with the exception, maybe, of the sub-I.

 

[nysw]

Why do you need a PhD to be a rad onc?

I agree with Gastrapathy about not understanding why you're doing a humanities PhD to be a pediatric surgeon.


I would speculate that one nice thing about transitioning back into fourth year is that it's not nearly as difficult as third year with the exception, maybe, of the sub-I.

It's complicated. Started out as a pharm tox, transferred for personal reasons. Had an inkling I wanted to do surgery but didn't know if I wanted to commit to that lifestyle, so I continued pursuing pediatrics. Third year rolls around and I am absolutely loving surgery and being in the OR....way more than I thought I would. None of my situation was really planned, so now I am seriously considering all of my options at the possible expense of angering my program and being way behind the ball re: MS4 planning.


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[Neuronix]

I think you should consider how you can merge a PhD with pediatric surgery and go from there. Find mentors in surgery both on SDN and your institution who can help you figure that out. I would be flexible as to your PhD type. If you can find a specialty surgeon at your institution for a PhD mentor or at least thesis committee member, that would be ideal.