MD/PhD and non-research focused residency

[StLupulin]

Haven't seen a ton of recent postings on this topic, so hoping to stimulate conversation.

I'm an MSTP student wrapping up my PhD and returning to clerkships. I have started to think about residency (Internal Medicine) and what my options are moving forward (basically, choosing ABIM research track vs. traditional categorical and then fellowship). I obviously would like to get into the strongest program that I can for clinical training.

I had strong preclinical grades (mostly honors) and top 25th percentile Step 1 score. By graduation, I'll have 5 first authored papers (3 in mid-tier journals, 2 reviews) and a couple second/middle authored. I had an F30 funded.

I am on the fence with the research-track residency. My MD/PhD program expects we pursue PSTPs if they are available in our specialties, so I'm getting a biased view on things. My PhD experience was frustrating (my PI left the institution, had to finish in 3 instead of 4 years due to funding/space issues with PI leaving and not wanting to start all over on a new project, lots of politicking that I got stuck in the middle of that detracted from my productivity and enthusiasm). It really has dissuaded me from a basic science research career. I still am interested in research, but I would want to focus on clinical/translational instead of basic science, which I know is still a possibility in the "short-track" pathway.

Additionally, I *think* I know what I want to specialize in for fellowship, however this is really only based on my interest in the topic from a scientific perspective and some half-day clinic I worked in during grad school. Hardly enough to say that I would enjoy treating patients in this field long-term. Also trying to keep an open mind to other specialties during clerkships. It would seem premature for me to commit a fellowship straight out of med school.

I'm hoping to get some advice who chose against the "short-track" or research focused options after completing the PhD. My gut tells me if I'm not 100% committed to a research career, I shouldn't do it. But, did you feel you were overlooked or received backlash by PDs for not wanting to do research with a PhD? I would suspect I need a good response to "why don't you want to do any more research?" but if afraid if I'm honest I would no longer be seriously considered. What would your response to this question be? My fear is I'll get stuck in a trap where top academic programs won't want anything to do with me because I'm less interested in their research tracks...

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[Neuronix]

I did not do internal medicine, but I did turn down the research residency option we have in my field for a more clinical track, even though the research track was offered.

The main reason I did not take the research track was because the research I wanted to do was simply not available at my residency institution. When I applied to residency, most programs that I thought would be very interested in my research did not interview me. A few places that did have my area of research did interview me, though the interview day was not geared towards research and many of the residency interviewers seemed antagonistic towards my research and research in general. These interviews tended not to go very well, and I either ranked them low or I fell past them on the rank list (I matched in the middle of my list). I matched where I did because the chair at my residency institution was interested in my research, but he got fired as chair before I started residency. After I started, the institution told me point blank numerous times that I would not be allowed to pursue my area.

I did also have a difficult time finishing my PhD (similar issues to what you described), and this also made me less than 100% sure I'd want a basic research career.

So that's my background, let's get to your questions:

Additionally, I *think* I know what I want to specialize in for fellowship, however this is really only based on my interest in the topic from a scientific perspective and some half-day clinic I worked in during grad school. Hardly enough to say that I would enjoy treating patients in this field long-term. Also trying to keep an open mind to other specialties during clerkships. It would seem premature for me to commit a fellowship straight out of med school.

This is a legit question that I'm not sure of the answer to. I thought that PSTP applicants could choose a fellowship once they start residency. You also have fourth year to help you decide. But this is something you should talk to your IM mentors about.

I'm hoping to get some advice who chose against the "short-track" or research focused options after completing the PhD. My gut tells me if I'm not 100% committed to a research career, I shouldn't do it. But, did you feel you were overlooked or received backlash by PDs for not wanting to do research with a PhD? I would suspect I need a good response to "why don't you want to do any more research?" but if afraid if I'm honest I would no longer be seriously considered. What would your response to this question be? My fear is I'll get stuck in a trap where top academic programs won't want anything to do with me because I'm less interested in their research tracks...

My experience was that residency PDs love it when you don't do research. It's more clinic coverage. Many programs don't support the research track residency for this reason. It robs them of a resident for a year. That's going to be the reality for the rest of your life. Unless you are very successful in research, you're always going to be pushed towards the clinic. I suppose if they really loved your research and only recruited you because they had their hearts set on you doing some sort of research, they might be mad at you for dropping the research part. But, I've never heard of such a thing in practice.

You can always apply to residency with the attitude that you did the PhD, you think you might want to do some research later, but you're not committed to a PSTP at this time. Most MD/PhDs aren't doing research track residencies. The rest of your application is up to snuff. It'd probably be just fine and you'd probably match just as well.


Here's the warning I want to make for you though. To have a significant research career as an MD/PhD the stars have to align. There are very few physician-scientist jobs out there. The competition is fierce. You will end up finishing fellowship in a catch-22. To get any research time or resources they will want you to have grants. But, to get grants you will need research time and resources. Most faculty jobs are 80-100% clinical these days. So even though you're saying "I might want to do some translational research", you'll have minimal opportunity to do it as faculty unless you start doing important stuff before you even get into that faculty job. You probably won't get that from a clinical residency and fellowship. So you'll end up in your mid-30s with a choice: either you sit an extra year (or several) in some fellowship/post-doc/clinical instructor la-la land hoping that someday it'll work out and you get to do 80/20 or 50/50 research, or you can go into a mostly clinical job like everyone else where you'll likely never have another chance to do serious research.

If you do that research track, you'll have a better chance. You might get enough data to put together a K award and get it funded out of fellowship. Or maybe you get a fundable score and do another year in la-la before the 80/20 job. Score! Maybe someone likes what you did/are doing enough to give you 50% protected time. Or maybe you flail around, get nowhere, and end up in a clinical job anyway. The reality is: as long as you get that board certification, nobody on the clinical side will ever care that you fast-tracked. They'll never notice. You can be out there in private practice making big $$$ and they'll probably be advertising you as a former big shot PSTP researcher from *insert big name here*.

So in summary, a fast track/research residency can only benefit you. It really can't hurt you. You should probably do it if you might want to continue doing research and you have good opportunities.

Good luck

 

[dl2dp2]

^^ exactly right

I'm currently en route to a career that is hopefully *primarily* research supported by sponsored projects, which will involve lots of grants management. But my clinical practice, small as it may be, drives all kinds of other factors in my career, not the least of which involves money and time. The more flexibility you get during training the better, and as far as I know, PTSPs don't necessarily lock you down, it just gets rid of things you don't need. That's generally speaking a good idea.

The weird thing is that the main reason that I can comfortably sit around and do research has to do with how I optimized my clinical involvement. In fact, I can say that your clinical involvement is basically your lifeline/"tenure". This is not just me--I think almost all of us veterans here agree with this--you do your clinical work, and sit around see how the research thing works itself out. There are people out there who have more of a "Chinese wall" approach to clinical work, but they end up less happy because clinical work can be really just working for the sake of working if you don't like it. If you need more time to figure out if you want to do cardio vs. GI, don't worry about spending more time to figure that out. Research will work itself out...and it's really not a big loss if you end up not being able to do one thing vs. another, or not at all. If you pick the wrong clinical specialty, we are talking about literally MILLIONS of dollars of opportunity cost and years of repetitive work (i.e. call) of something you don't enjoy.

However, be mindful that the training track for PTSP ends up being longer because you get more time to write grants.

 

[QofQuimica]

Similar to Neuro, I too chose not to do a PSTP residency in large part because there wasn't one available in my subspecialty. I also realized that I didn't envision myself becoming a basic science PI. Instead, I chose to go to a residency program that had an affiliated large, research-oriented fellowship program with the thought that I would apply for fellowship at the same institution subsequently and stay on there. That did not end up happening for various life reasons, and I will be doing my fellowship (in the same subspecialty) a few years later and at another institution. But I do not regret not having chosen a PSTP, *especially* since I went into residency knowing for sure what subspecialty I wanted to do, and I couldn't have done it via a PSTP. If I hadn't known what specialty I wanted but did want to be a lab PI....hmm, I don't know how much sense it makes to do a PSTP in that case, unless you can have some flexibility to change your fellowship selection during your intern year. Do any of the programs you're considering allow that option? Might be worth inquiring into this.