Industry MD looking for advice on getting a residency.

[gtb]

I’m looking for advice, recommendations, etc. You know, a reality check is what I need. I’m a 2005 graduate from Colorado and finished a medicine preliminary year in ’06. Instead of beginning a residency, I went to work for Boston Scientific in a neuroscience lab researching implantable nerve stimulators for pain and other disorders. Industry has great hours, vacation, and pay, but it doesn’t offer the good vibes I experienced working directly with patients. So, I’ve opted to attempt to get a residency in Anesthesia and ideally obtain a fellowship in pain medicine.

Now I’m living in Seattle, I haven’t been a resident for 15 months, and I’m working on research projects that have nothing to do with the reason I took the job in the first place. It's only been 15 months, but I've heard that anything over 12 months creates challenges. I signed up for the ERAS and NRMP today, and am refreshing my ACLS next week. And of course I’m directly contacting the programs I’m most interested in.

So here are my questions. What are the big hurdles that I’ll face getting back into medicine and accepted to a residency? I have very good step 1 and step 2 scores, no academic problems in med school or residency. And I just took Step 3 two weeks ago.

Any suggestions on how to get rotations now that I’m unaffiliated with a medical school? What do IMGs do about rotations when they first start working toward a U.S. residency? Also, I’d appreciate ideas to get current letters of recommendation. What do you think about going back to my medical school and requesting letters from the anesthesiology rotations I did as a fourth year?

All right, I’ve bored you enough. Please share your thoughts.
Thanks.
Greg

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[nutmegs]

I'd contact helpful attendings you remember from your rotation, explain the situation to them, and ask if you can come spend time with them (informal rotation). then ask for a letter.

 

[InductionAgent]

Agree with above poster, also would contact PDs of programs you're interested in to get specific recommendations and a feel for how receptive they will be to your application.

 

[bubalus]

Send every program you may be interested in a CV and a cover letter. Not being a graduating medical student means you can go outside the match. Many programs have spots for people like you, but they're not advertised. This should be done in addition to applying through ERAS and NRMP, and like those applications, this should be done now.

I agree that contacting attendings at your home institution who may remember you would be a good way to start.

Good luck.

 

[jennyboo]

You sound like a good candidate. Overall, I think your chances of finding a job should be good and ultimately you will probably look back and see that you didn't have any significant problems.

Do you already have letters of recommendation left over from medical school? I assume that you needed them to get the prelim. A well-written letter from an academic anesthesiologist (one who works at a residency program) will be helpful (but, I'm told, not absolutely necessary). If you haven't already done an anesthesia rotation, you might consider doing one to at least demonstrate that you've tried the field out before applying for residency. The trouble is that many rotations require you to have proof of current malpractice coverage. My medical school provided malpractice coverage to students, but if you are no longer in medical school and you have no coverage this may be a hurdle to obtaining a rotation. Call the rotation coordinators and ask whether the malpractice coverage is needed.

Gear up to apply through the Match, but also call/email/send letter and CV around now to say that you are ready to start next year, not the year after. There are many outside-the-Match positions, including at highly competitive residency programs, that are not advertised. While your chances of getting a residency through the Match are probably excellent, your chances of getting a residency outside the Match is also good, and this also enables you to start a year earlier.

 

[gtb]

Thanks for the words. I hadn't thought about positions that might be available outside the match. Are programs ever in the position to let somebody start mid year? You know, maybe to help cut down on the call requirements for current residents if somebody left the program?

Are there any programs you know of that are especially interested in research of emerging technologies for intraoperative/postoperative pain control? I'm living in Seattle so I plan to contact Virginia Mason and University of Washington directly. Still, I would greatly appreciate any further insight to programs that are technology driven.

Thanks again,
Greg

 

[bubalus]

Some programs have positions that start mid year, but I think most would typically start in July because that's when they're set up for all the intro to anesthesia orientation stuff for newbies.

As I've thought more about it, I don't know that you need to do any rotation kind of stuff. You should be able to get a letter from an attending from your prelim year, and there should be good letters from someone in your company. That should suffice.

 

[jennyboo]

Are programs ever in the position to let somebody start mid year? You know, maybe to help cut down on the call requirements for current residents if somebody left the program?

I know of one program that will let new residents start off cycle at any time during the year.

However, I think the majority of programs will want you to start in July if you are completely new to anesthesia (i.e. not a transfer from another anesthesia residency) since they will have to train you from the very basics.

But you can say, "I'm available to start at any time" or ask "When can I start?" and see what they tell you.

 

[cchoukal]

gtb, as a corollary, what advice do you have for someone in residency who's thinking about exploring industry jobs after finishing? What kind of stuff is out there? What's the role like? Pay? Having never had a real job, how do I get this kind of search started?

 

[granolabar2]

its possible you might not need malpractice insurance for a rotation if you do the rotation on an "observation only" basis i.e. 'cannot touch a patient'.
you won't get in any procedure experience, obviously, but it is probably plenty to get a recommendation letter

 

[Gern Blansten]

gtb, as a corollary, what advice do you have for someone in residency who's thinking about exploring industry jobs after finishing? What kind of stuff is out there? What's the role like? Pay? Having never had a real job, how do I get this kind of search started?

At the ASA this year, there will be a panel of 3 speakers discussing career opportunities. One for academics, one for private practice, and one for industry. Look it up in the meeting program.

 

[cchoukal]

Thanks, Gern. Have you seen the ASA program? It's pretty big. Do you happen to know what "track" it's in, or what they're calling the session?

 

[Gern Blansten]

Thanks, Gern. Have you seen the ASA program? It's pretty big. Do you happen to know what "track" it's in, or what they're calling the session?

pg 404 in the program-Monday Oct 15th 7AM-815AM rm 3001 MOscone center west
Charles McLeskey is the speaker for that section
I was mistaken, it is a breakfast panel, and not a lecture. They will also discuss political career options in addition to the others I mentioned.

 

[gtb]

For a residency-trained physician, two options are either working directly for a company as an employee, or consulting for companies as a physician expert. From my own personal observation, working as a consultant provides more control over your life.

Within industry, direct hire positions are probably dependent on your background before beginning medical school and your current training. They might include: research scientist, medical affairs officer, physician liaison, hospital administration/management, marketing, clinical training, intellectual property, etc. Consulting positions include the above list, but usually require that your primary job remain clinical medicine. This is because companies need physicians: as investigators in clinical trials, to make physician-to-physician presentations, to help with develop surgical procedure for new devices, to help refine product features, to assist with marketing, to support regulatory protocol development and approval, etc. Obviously there are many positions for physicians available in industry. I believe companies expect physicians not to be interested in these positions, so they fill lots of them with Ph.D., PharmD, and nurses. I suspect the reason for physician disinterest is in part salary. The pay is less than that for a practicing physician, especially a full-time anesthesiologist. Starting salaries would be in the 150’s I expect for a board certified physician, but there are sometimes strong stock benefits associated with the job. For the stock benefits to be meaningful, the stock performance has to be strong. For a counterexample, look at the chart on BSX.

My experience is working for a medical device company (Boston Scientific) in the neurostimulation division, so I am clueless about service based companies. The net hours you work in industry are likely higher than in practice. I work an average of 55 hours / week, but if you consider time that I spend away from home on business travel, then, it’s even higher. There is no call, however, depending on the job, you do sleep in hotels on occasion.

A couple of strategies can help initiate a job search. Monster.com, careerbuilder.com, and hotjobs.com are useful to identify the bulk of positions available. You might use keywords: “physician liaison,” or, “research scientist.” One search phrase you can try on monster.com is “(medical OR clinical) (device OR science OR product) AND NOT (associate OR sales OR lab OR technologist OR nurse OR tech OR laboratory)”

Directly searching a companies open jobs is another possibility. For example, Boston Scientific jobs are at http://www.bostonscientific.com/Careers.bsci/,,/navRelId/1000.1007/seo.serve

Recruiters can help. Just be aware that recruiters generally could care less about your life, and are interested in their own goals. Usually money. They are best considered a professional agent, to help match you with a job and potentially negotiate a higher compensation package. But, in my opinion, they are working not for you, but for the company that pays them after a successful candidate placement. Yikes. That sounds harsh. Still, I’ll say it; in my experience, recruiters have no interest in your happiness and well being, and instead are interested in closing the deal.

Working as a direct hire within industry has some odd ramifications that might not be immediately obvious. At least they were not for me. Well run for-profit companies are limited in the number of projects they can fund, and so the projects are vetted based on many factors including: return on investment, time to market, company expertise, competition, barrier to entry, insurance reimbursement, market size, manufacturing abilities, regulatory hurdles, etc. You rely on the project’s goal to align with you own research interests, and from the list above, you can appreciate how challenging it is to match these interests.

Business is also dynamic, and so companies are continuously evaluating their on-going projects. Sometimes current projects are shelved. That can happen for many reasons. Maybe because of reimbursement decisions on similar products, a more promising project is initiated, significant schedule slips, or perhaps you just run out of money. If that happens, the next project you lead might not capture your own clinical interest. In my example, I was hired to research DBS and cortical stimulation for chronic pain management, but after just a few months, because of corporate marketing decisions, I ended up tasked onto something completely unrelated to pain medicine. The project has great promise for financial success; it is just not aligned with my clinical interests.

I could go on and on about this. Maybe it’s better to contact me directly through PM for more detail.

Cheers,
Greg

 

[cchoukal]

pg 404 in the program-Monday Oct 15th 7AM-815AM rm 3001 MOscone center west
Charles McLeskey is the speaker for that section
I was mistaken, it is a breakfast panel, and not a lecture. They will also discuss political career options in addition to the others I mentioned.

Thanks, Gern!

 

[TaiShan]

I would not worry too much about it. There are plenty of IMGs who have done multiple years of research/graduate school/other jobs before getting a residency spot.

However, be prepared to answer some tough "why you changed your mind" type of questions during the interview.

 

[Pharm Life]

gtb, thanks a lot for your info about industry. If someone knows for sure they want to do research, what do you think they should do for training after med school? Just internship? Internship plus residency? If it's better to get a residency, what field should it be in? I've been given the impression that pharm companies want people to pick a disease to study. But that sounds like it will make it hard to do anesthesiology unless the field you want to study is pain. Would you pretty much have to do an IM residency if you want to work for a drug company or would they be ok with someone having an anesthesiology background?

 

[gtb]

gtb, thanks a lot for your info about industry. If someone knows for sure they want to do research, what do you think they should do for training after med school? Just internship? Internship plus residency? If it's better to get a residency, what field should it be in? I've been given the impression that pharm companies want people to pick a disease to study. But that sounds like it will make it hard to do anesthesiology unless the field you want to study is pain. Would you pretty much have to do an IM residency if you want to work for a drug company or would they be ok with someone having an anesthesiology background?

Now, after being out of residency for over a year, it’s clear that I should have transitioned directly into a residency following my intern year. I’ve now learned that it is nearly impossible to obtain any meaningful clinical rotation in anesthesia once you are out med school/residency. This is true even though I’ve just passed step 3 with a good score. The dean from my old med school noted that this is in part because malpractice liability leaves them too exposed, but also that there are tons of students and residents needing the rotations just to graduate. So, I would most definitely recommend completing a residency without taking a break for research. Maybe I’ll change that opinion if I am accepted into a residency program.

You asked which specialty if your goal is research? That decision depends most definitely upon what you want to research, and whether you are doing basic science, translational, or pure clinical research. If you are doing anything associated with drugs, definitely consider pathology. This is probably the best specialty to prepare you for lab and bench research combined with excellent physician training. Another big plus for choosing pathology is that most programs do not require you to complete either a transition or preliminary medicine year. Internal medicine and the fellowships provide great clinical training, but unless you enter a program with dedicated research years, I still think pathology is the way to go. And I suppose the surgical subs if you're interested in researching any of those diseases. My particular research interest is using electrical stimulation to mitigate pain. It works, we know it does, but the details of why are still in the guesswork phase. Anyway, for me, that makes anesthesia the perfect match. You’re right that companies want you to be a, “disease champion.” They will want you to be the expert on some disorder that is treated by their product. An important consideration is, what do you do if the company changes strategies, and you abruptly find yourself working on a disorder or syndrome that you have absolutely no interest in. Sure you can change jobs. Although if you want to reenter clinical medicine and you’ve completed a residency, you’ll only have to prove competency before restarting practice. Without completing a residency, if you choose to reenter clinical medicine, you’ll wind up in the very intimidating process that I am currently enduring. I can’t recommend that to anyone.