Confused about doing a PhD or internal medicine residency

[gappa]

I am an international student. My future goal is to do research in bioscience field in USA with seeing patients (80/20 ratio).
As a general norm, most people do residency in their preferred fields and then do post docs so that they could become physician scientists. However, going through medical school, I have realised that I am not keen in patient management aspects rather than studying medicine (I don’t hate clinical medicine but I don’t like it either).
As I am a visa requiring student, most probably I will most probably be getting a J1 visa in a community hospital which will reduce my opportunities of basic science research. And even after finishing residency, I will have to return to India or work in USA in an underserved area for 3 years as a clinician (J1 visa requirements). I don’t suppose I will be motivated to do research thereafter.
Hence, I was wondering if i should come to USA for a PhD position and then get a residency in an university hospital after which I could continue my research work as a physician scientist. I will be 23 when I graduate so I can still finish my PhD before I turn 30.
However, I am worried if I could get research positions and opportunities during and after my residency, I could waste potential years doing PhD.
What do you guys think about it?

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[mszzeta]

I am an IMG now in a major academic center and worked with physician scientist.

1. becoming a physician scientist is highly competitive, even for AMG. And this would become much more difficult for IMG like us. However, there are people who succeed and I don't want you to be very disencourged at this time. Also, physician scientist can be clinical-epidemiology focused vs lab focused. The later would require many additional years of intense training

2. the most caveat part of becoming a physician scientist in US is low salary. Your salary will be MUCH LOWER than those who just do clinical work. And if you want to do lab research, additional training (such as PhD) is requisite which will add 5 years of no meaningful income

3. If you come to US straight and and do residency and fellowship, you will not have a chance to have basic lab training. Doing PhD first is wise if you are very sure about doing basic science research. There might be some impact of your residency match given long YOG.

4. "I am worried if I could get research positions and opportunities during and after my residency, I could waste potential years doing PhD." As I mentioned, becoming a physician scientist in lab research with IMG and no research background, is almost slim to none. Being a physician scientist in clinical-epidemiology research is slightly possible though still highly difficult

5. Doing less competitive specialties (such as nephrology, ID, endo, rheum) will be much easier to set foot on academic than competitive specialty for IMG.

6. Try to get H1b, rather than J1. The later is MUCH WORSE regarding finding a job after training.

 

[gappa]

Thank you for your reply.
1. I want to have a career in basic science. I have read about people who have done research in residency and fellowships and entered into postdoc research fellowships to become physician scientist. Most of them have told that PhD is not necessary. However, being an IMG is certainly a disadvantage.
I was wondering if I could do about 2 years of postdoc research and then apply for residency. That might make me better candidate for research opportunities after residency.
2. What do programs require from a candidate for which they would sponsor a h1b visa?
3. Also, what are the chances of an IMG getting into a Physician Scientist Training Program?

 

[mszzeta]

Thank you for your reply.
1. I want to have a career in basic science. I have read about people who have done research in residency and fellowships and entered into postdoc research fellowships to become physician scientist. Most of them have told that PhD is not necessary. However, being an IMG is certainly a disadvantage.
I was wondering if I could do about 2 years of postdoc research and then apply for residency. That might make me better candidate for research opportunities after residency.
2. What do programs require from a candidate for which they would sponsor a h1b visa?
3. Also, what are the chances of an IMG getting into a Physician Scientist Training Program?

To disclose, I am primarily doing clinical/epi research. But I know people who do basic research. So take my words as a grain of salt.

Doing serious basic science research (80/20 means you need to apply for grant to support your research, which is highly competitive) will require extensive skillset training in addition to the clinical training. I highly doubt 2 years would be enough. 4-5 years sounds more reasonable. Doing it as PhD vs post-docs vs other titles probably not matter much

Theoretically, you could do these training after residency or even fellowship. But imaging you are choosing between a 60K post-doc job and 200K attending job for 4-5 years. This will be a hard decision. Doing 2 years before residency, and then 2 years after residency probably also ok. Bottom line is that you need to be aware of the long learning curve for doing basic lab research.

There are around 50-100 internal medicine residency programs which sponsor H1b, if I remember it correctly. It is simply a matter of their GME policy

Physician Scientist Training Program for residency is extremely competitive for IMG without any research background, the chance is close to zero. You will likely have some chance if you have PhD first. Physician Scientist Training Program is something like a 4 years of clinical training + 2 years of research training for a subspecialty board. So it is only 2 years of research which itself not enough for becoming a basic lab scientist

 

[AHDCard]

Physician Scientist Training Program for residency is extremely competitive for IMG without any research background, the chance is close to zero. You will likely have some chance if you have PhD first. Physician Scientist Training Program is something like a 4 years of clinical training + 2 years of research training for a subspecialty board. So it is only 2 years of research which itself not enough for becoming a basic lab scientist

I don't have anything to add re: IMG/immigration, but most PSTP trainees in IM follow the ABIM research pathway, which consists of:
-2 years of IM (Generally PGY1 is the same, PGY2 has slightly more inpatient requirements than a normal PGY2)
-1-2 years of clinical fellowship (1 year for 2-year fellowships like rheum or ID; 2 years for 3-year fellowships like GI or cards)
-3 years of research (~80/20 research/clinical split)
-Additional years for any super-fellowships (like interventional cards, EP, hepatology, advanced endoscopy, interventional nephrology, etc.)

Some programs mandate the research years before clinical fellowship, some programs mandate research after fellowship, and some let you decide.

Fellowship appears to be one year shorter because the last year of fellowship (for all IM subspecialties, not just ABIM research pathway fellows) can be 100% clinical, 100% research, or a mix, depending on what the program mandates and/or what the trainee wants. For example, a 3-year GI or cardiology fellowship includes 2 years of mandatory clinical training, plus one year of research or clinical electives. The ABIM research pathway uses that entire final year as research, which is often mandated for general fellows anyways at programs focused on training academics.

Note that a PSTP =/= the ABIM research pathway. PSTPs are programs run by individual institutions to support trainees interested in physician-scientist careers. The ABIM research pathway is a board-certification mechanism for trainees which requires one less year of IM training in lieu of two additional research years. So, total length to IM and subspecialty board-certification is one year longer. Most PSTP trainees do the ABIM research pathway (and most trainees doing the ABIM research pathway are part of PSTPs), but not always. There are PSTPs that don't do the ABIM research pathway, and there are IM residents who do the ABIM research pathway outside of a formal PSTP.

I don't have any hard data on research background, but this year, I would estimate that people interviewing at well-organized PSTPs at "top 20" type institutions are >80% MD/PhDs. The non-MD/PhDs have generally done at least 1-2 years of research with publications. The idea is that you already know how to do research and are able to join a group, churn out a few publications within 2-3 years, and have a K (or other career development award) in hand by the end, thus making you competitive in the job market for 75/25 research/clinical faculty positions. Those that don't get external support (which is not uncommon) and still aspire to majority-research faculty positions often go into instructorships to preserve their research time until they get a K award. Instructors generally have 75/25 research/clinical splits and are paid slightly higher than fellows (but not near what a faculty gets paid), because they are attendings during their clinical time. Rarely, I have come across faculty that are not funded who have >=50% research positions. I've seen this mostly at upper-mid tier institutions that aspire to become top research institutions, who hire promising internal trainees that 1) are a known entity to the institution and 2) were able to convince leadership they were likely to secure funding.

Most PSTP trainees do basic science/bench research, but programs are typically willing to support any kind of research (basic science, translational, clinical/epi, computational), at least on paper. I have noticed that some programs have a bent towards certain types of research, due to preferences of the admissions committees, the inherent strengths of the division/institution, and preferences of the trainees themselves (most of whom are MD/PhD grads who did bench work during their PhDs).

I don't know how IMG/visa status affects things, but I imagine it makes admissions more difficult.

 

[gappa]

To disclose, I am primarily doing clinical/epi research. But I know people who do basic research. So take my words as a grain of salt.

Doing serious basic science research (80/20 means you need to apply for grant to support your research, which is highly competitive) will require extensive skillset training in addition to the clinical training. I highly doubt 2 years would be enough. 4-5 years sounds more reasonable. Doing it as PhD vs post-docs vs other titles probably not matter much

Theoretically, you could do these training after residency or even fellowship. But imaging you are choosing between a 60K post-doc job and 200K attending job for 4-5 years. This will be a hard decision. Doing 2 years before residency, and then 2 years after residency probably also ok. Bottom line is that you need to be aware of the long learning curve for doing basic lab research.

There are around 50-100 internal medicine residency programs which sponsor H1b, if I remember it correctly. It is simply a matter of their GME policy

Physician Scientist Training Program for residency is extremely competitive for IMG without any research background, the chance is close to zero. You will likely have some chance if you have PhD first. Physician Scientist Training Program is something like a 4 years of clinical training + 2 years of research training for a subspecialty board. So it is only 2 years of research which itself not enough for becoming a basic lab scientist

So, considering if I received a PhD and completed residency, do I still have to go to postdoc or can I directly become an attending for having a 80/20 clinical-research work?

 

[mszzeta]

So, considering if I received a PhD and completed residency, do I still have to go to postdoc or can I directly become an attending for having a 80/20 clinical-research work?

Short answer is yes. The only thing that matters for you to become a 80/20 attending physician-scientist or not depends on whether you have secured or believed to have strong tendency to secure major research grants, which are overall competitive. If you cannot secure these grants, most institutions will not let you do 80/20 no matter how many PhD/post-docs/publications you have done in the past. The exception is probably that a small number of institutions (typically big name ones) allow people to be "instructor" for 80/20 with a very low pay, as mentioned with AHDCard in #5.

 

[gappa]

I don't have anything to add re: IMG/immigration, but most PSTP trainees in IM follow the ABIM research pathway, which consists of:
-2 years of IM (Generally PGY1 is the same, PGY2 has slightly more inpatient requirements than a normal PGY2)
-1-2 years of clinical fellowship (1 year for 2-year fellowships like rheum or ID; 2 years for 3-year fellowships like GI or cards)
-3 years of research (~80/20 research/clinical split)
-Additional years for any super-fellowships (like interventional cards, EP, hepatology, advanced endoscopy, interventional nephrology, etc.)

Some programs mandate the research years before clinical fellowship, some programs mandate research after fellowship, and some let you decide.

Fellowship appears to be one year shorter because the last year of fellowship (for all IM subspecialties, not just ABIM research pathway fellows) can be 100% clinical, 100% research, or a mix, depending on what the program mandates and/or what the trainee wants. For example, a 3-year GI or cardiology fellowship includes 2 years of mandatory clinical training, plus one year of research or clinical electives. The ABIM research pathway uses that entire final year as research, which is often mandated for general fellows anyways at programs focused on training academics.

Note that a PSTP =/= the ABIM research pathway. PSTPs are programs run by individual institutions to support trainees interested in physician-scientist careers. The ABIM research pathway is a board-certification mechanism for trainees which requires one less year of IM training in lieu of two additional research years. So, total length to IM and subspecialty board-certification is one year longer. Most PSTP trainees do the ABIM research pathway (and most trainees doing the ABIM research pathway are part of PSTPs), but not always. There are PSTPs that don't do the ABIM research pathway, and there are IM residents who do the ABIM research pathway outside of a formal PSTP.

I don't have any hard data on research background, but this year, I would estimate that people interviewing at well-organized PSTPs at "top 20" type institutions are >80% MD/PhDs. The non-MD/PhDs have generally done at least 1-2 years of research with publications. The idea is that you already know how to do research and are able to join a group, churn out a few publications within 2-3 years, and have a K (or other career development award) in hand by the end, thus making you competitive in the job market for 75/25 research/clinical faculty positions. Those that don't get external support (which is not uncommon) and still aspire to majority-research faculty positions often go into instructorships to preserve their research time until they get a K award. Instructors generally have 75/25 research/clinical splits and are paid slightly higher than fellows (but not near what a faculty gets paid), because they are attendings during their clinical time. Rarely, I have come across faculty that are not funded who have >=50% research positions. I've seen this mostly at upper-mid tier institutions that aspire to become top research institutions, who hire promising internal trainees that 1) are a known entity to the institution and 2) were able to convince leadership they were likely to secure funding.

Most PSTP trainees do basic science/bench research, but programs are typically willing to support any kind of research (basic science, translational, clinical/epi, computational), at least on paper. I have noticed that some programs have a bent towards certain types of research, due to preferences of the admissions committees, the inherent strengths of the division/institution, and preferences of the trainees themselves (most of whom are MD/PhD grads who did bench work during their PhDs).

I don't know how IMG/visa status affects things, but I imagine it makes admissions more difficult.

Thank you for giving a broader view. I was wondering what do only-MD candidates do that increases their chance for a PSTP? Is it number of years doing research, citations, grants, etc.?

 

[gappa]

Short answer is yes. The only thing that matters for you to become a 80/20 attending physician-scientist or not depends on whether you have secured or believed to have strong tendency to secure major research grants, which are overall competitive. If you cannot secure these grants, most institutions will not let you do 80/20 no matter how many PhD/post-docs/publications you have done in the past. The exception is probably that a small number of institutions (typically big name ones) allow people to be "instructor" for 80/20 with a very low pay, as mentioned with AHDCard in #5.

Ok. Feels like going in direction of PhD is a better option. Thank you so much for replying.

 

[AHDCard]

Thank you for giving a broader view. I was wondering what do only-MD candidates do that increases their chance for a PSTP? Is it number of years doing research, citations, grants, etc.?

I'm a PSTP applicant and have nothing to do with admissions. But I would think number of years, papers (especially 1st author), good recommendation letter from your research mentor, some research interest/vision described in personal statement. I'm not sure what kind of grant a non-PhD would have, but if you were able to successful get funding then that would be a positive. I had an F30 which I'm sure helped.

 

[gappa]

I'm a PSTP applicant and have nothing to do with admissions. But I would think number of years, papers (especially 1st author), good recommendation letter from your research mentor, some research interest/vision described in personal statement. I'm not sure what kind of grant a non-PhD would have, but if you were able to successful get funding then that would be a positive. I had an F30 which I'm sure helped.

Ok. Thanks for replying.