MD/PhD not matching residency? Options?

[Gotti]

Hey guys,
As the match comes up and as I am trying to match in a very competitive specialty, I was just wondering what has happened to MD/PhDs who don't match. Some of the options I've thought of have been to go scramble for like pathology or anesthesiology. I don't have any letters for anything other than my chosen field, so is this a possibility? What have other MD/PhDs who don't match done. After going through the interview process, I don't think I will ever interview in this field ever again. Initially I thought I would keep applying until I got into this field, but now I think the sting of rejection would prompt me to not do it again and also a re-application makes program directors think what is wrong with this guy. There was only one guy from my school with MD/PhD who ever had to scramble and he ended up in a top 3 program, albeit this was Internal Medicine where they can almost just make a new spot. I imagine a MD/PhD has a huge advantage in the scramble as with the original application. Please advise us how we should approach if scrambling is necessary.

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[dl2dp2]

curious about your story. Without disclosing which specialty it is, could you elaborate on why the interview process was so rough?

Btw, there was one student at my school (considered a top school) who applied to a certain very competitive specialty who didn't match last year, but he very fortunately scrambled into a spot in the same specialty. This occurs at some frequency, especially more recently, where more and more MDPhDs are going into ROAD + surgical subspecialties--even at top schools.

Off the topic, I have a feeling that the recent counter-intuitive increased competitiveness of the MDPhD programs has to do with the even more significant squeeze at the PhD level. It becomes kind of unrealistic to do basic science unless you were in the top 5-10%, which has a lot to do with luck. Be that as it may, I don't know if postdoc is an option for you? Also consider things like PM&R. And even within ROAD, the degree of competition is very different. If you dig surgery, maybe ophtho is a good (and easier) option.

 

[Neuronix]

Btw, there was one student at my school (considered a top school) who applied to a certain very competitive specialty who didn't match last year,but he very fortunately scrambled into a spot in the same specialty. This occurs at some frequency, especially more recently, where more and more MDPhDs are going into ROAD + surgical subspecialties--even at top schools.

I don't want people to think this is a normal outcome. There was one scramble spot in that specialty in the entire nation, it was not at a desirable program, and location bias probably factored heavily into that acceptance. There were several other MD/PhDs nationally, including one at my program, who did not scramble successfully into that specialty.

 

[nomogram3]

It becomes kind of unrealistic to do basic science unless you were in the top 5-10%, which has a lot to do with luck.

That is NOT at all accurate. It my travels applying to IM programs (most of the top 10 in NIH funding for departments of medicine) to short-track, it really has not seemed to matter where you did your MD/PhD program so long as 1) you have good board scores 2) decent clinical grades and 3) published. The "5-10%" cutoff is completely unrealistic.

 

[Neuronix]

I think there's a lot of concern that there are more physician-scientists being trained than are supportable in the real world by grant funding. I think top 5-10% may be a bit too restrictive, but maybe there's only research jobs for the top 25% of MD/PhDs. Or maybe the top 50% of MD/PhDs. Then what?

I found this thread on this topic interesting:

http://forums.studentdoctor.net/showthread.php?t=323850 (in particular, see post 21 onwards)

FWIW, Rad Onc is supposed to be one of the more research friendly fields.

 

[Neuronix]

Please advise us how we should approach if scrambling is necessary.

What I've seen from people who have not matched is:

1) Try to scramble. Maybe success, maybe not.

2) Did you get a pre-lim year? Do you want to scramble into a pre-lim year in surgery (aka hell)?

3) Scramble into an alternate specialty. There's always spots available in Peds, FP, IM.

4) Apply next year, same specialty or different specialty. What to do with year off? Probably research in the academic department you plan to apply in next year.

Obviously nothing is guaranteed there. You may not match again the second time around.

5) Forget the "physician" part and do post-doc.

 

[QofQuimica]

I am not applying for a competitive specialty, but for those of you who are, I think it's a good idea to also apply for a prelim year, at least at your own institution. Rank it very last on your list if you want, but just have it there as a fallback. That was my plan when I was going to do anesthesiology, which requires a prelim year anyway.

OP, in your case, I think I would at least try to scramble into a prelim year of some type if you can't scramble into your own specialty. Granted that it's harder to go on interviews when you're an intern, but I think it's better to not have that gap in clinical training. I'm assuming, of course, that you don't want to go research-only, in which case you could just go for a postdoc like Neuro said.

If you don't mind sharing, I would also be interested in hearing what about your interviews was so rough that you wouldn't ever want to reapply in the same specialty.

 

[jckut10]

.

 

[QofQuimica]

[ I've been made aware that others would appreciate it if I posted these types of questions elsewhere -- so I will. ]

I didn't see your question, but since the OP is looking for advice about the match and scrambling, this thread is not really the best place for you to post premed questions. However, you are more than welcome to post any questions you have related to being a physician scientist in this forum. Start by searching for the topic you want to ask about first; if you don't find a previous thread that answers your question, you can make your own thread. We'll do our best to help.

 

[Neuronix]

The question was what does it mean to scramble.

The scramble is a process that goes on about the same time as the match when students who didn't get a spot and programs that didn't fill try to meet up in a confused, hurried rush. Typically there are far more students trying to scramble than positions available. Typically the programs that have to scramble are not the desirable ones.

It is NOT something you want to go through. Most students who go through the scramble get nothing or scramble into a different specialty.

 

[QofQuimica]

Ah, I see. Well, in that case, for the benefit of jckut10 and our other premed colleagues, here is a brief SDN article that explains the gist of the scramble and why it strikes fear in the hearts of residency applicants.

 

[gstrub]

Gotti,
I PM'd you.

 

[tiedyeddog]

I think there's a lot of concern that there are more physician-scientists being trained than are supportable in the real world by grant funding. I think top 5-10% may be a bit too restrictive, but maybe there's only research jobs for the top 25% of MD/PhDs. Or maybe the top 50% of MD/PhDs. Then what?

I found this thread on this topic interesting:

http://forums.studentdoctor.net/showthread.php?t=323850 (in particular, see post 21 onwards)

FWIW, Rad Onc is supposed to be one of the more research friendly fields.

This is semi off topic,

but I read the thread you linked in and I'm sort of confused. So people worry that the MD/PhD'ers in only radiology and rad/onc departments are saturated or that ALL positions that would be held by MD/PhD'ers are saturdated, in every department?

 

[Neuronix]

This is semi off topic,

but I read the thread you linked in and I'm sort of confused. So people worry that the MD/PhD'ers in only radiology and rad/onc departments are saturated or that ALL positions that would be held by MD/PhD'ers are saturdated, in every department?

It's all speculation and worry. But with funding rates as low as they are and competition for research jobs as high as they are... Who knows. But also who knows what it will be like 10-20 years down the line.

 

[Gotti]

Hey guys,
I'm probably over panicking as I did get ten interviews, but I have other reasons to worry. My thread was meant more as where does an MD/PhD go after not matching to still have both a clinical and research future as is meant for us. Its pretty rare, but that's what would make it disheartening and even embarrassing. I think people forever will say something is wrong with that guy who couldn't match. I admit I'm not the greatest fit for a surgical specialty, but its really what I want to do. Went through all these years of training, only to not be able to get even a simple residency. Even if I got a prelim year, everyone would ask why a MD/PhD had to get a prelim year and not get a categorical. I still really want to pursue academics and research so if there are only community programs left, should I even scramble into those? I guess in the grand scheme of everything, at least I still will have my MD and PhD and should just count my blessings.

 

[Clueless Cell]

I guess in the grand scheme of everything, at least I still will have my MD and PhD and should just count my blessings.

So, a little off topic but...I am a 2nd year resident at a top-5 competetive program (but not a competitive specialty). I did my MD/PhD at a top MSTP program, which took 8 yr of my life, excellent board scores, publications, etc. Not AOA but decent clinical grades (most HP, some Hon).

When I returned to MS3/MS4, I did some rotations in Path and Rad, but ultimately decided I would miss working with patients. I'm telling you right now as a PGY2 I am SO miserable I have go to bed every night and come back to work here the next day. At times I seriously consider leaving the program, but I feel by doing so I would be letting down many family members, friends, and faculty mentors who were excited about where I matched. Yes be thankful you have the MD/PhD, and if you need to take that extra prelim year to REALLY decide what specialty you want, then do so and stick with it. Don't try to scramble into a program that doesn't fit your interests-they wont care about your PhD r research background, and u will just be another cheap source of labor to them. Right now I'm serously considering looking for a post-doc or research job, and putting these 2 years behind me.

Just my 2¢...

 

[Gotti]

I agree the shame of telling faculty and family is the worst part of not matching or quitting. I have another friend also MD/PhD end up at top 5 program in surgical specialty, who's also miserable as heck and is encouraging me to not worry about matching and reapply toward Path/Rad/Anes or something easier. He's miserable enough and for the first time, I believe he may actually quit after intern year. Like you, the only obstacle is telling people he wants to quit. I've heard of multiple MD/PhDs burning out and quitting. The only thing to say, I guess, is who cares what people think? They'll get over it. Its probably just one day of shame and then move on with the rest of your life which is still long and full of other promising things to do.

With that said, why do we need to go to top programs that tend to be malignant? We can go to any random nice program because clinical training is clinical training no matter what and find other ways toward research later on. My match list will very much consider this as I hardly cared about prestige and am ranking a bunch of lower-tier programs with people I really like over top-tier programs.

 

[Neuronix]

Don't try to scramble into a program that doesn't fit your interests-they wont care about your PhD r research background, and u will just be another cheap source of labor to them. Right now I'm serously considering looking for a post-doc or research job, and putting these 2 years behind me.

Just my 2¢...

I appreciate your 2¢ very much. I can't decide how I want to apply to programs... Should I apply to a large number of programs and rank them all, including as my department advises--to many community programs? Or should I only apply to strong academic programs in areas where I want to live and risk not matching? Then what is my backup? Another specialty? Post-doc?

I have the same concerns about internship year. The programs where you're not just cheap labor are extremely competitive. But I have to do some kind of internship for the specialties I'm interested in. So I guess I should just be okay with sacrificing a year of my life? Ugh.

I'm not convinced that big name necessarily means malignant. Maybe in some specialties? Big name tends to mean research opportunities/funding, which is what we usually want.

 

[Shifty B]

I'm not convinced that big name necessarily means malignant. Maybe in some specialties? Big name tends to mean research opportunities/funding, which is what we usually want.

Unfortunately, for medicine and surgery intern years big name is associated with malignant. The big name programs tend to be affiliated with bigger, busier hospitals where they depend more on you for labor. Also, programs with big names sometimes have this attitude that they don't need to sell you on having a nice lifestyle or good work hours because they will fill their PGY-1 spots anyway.

The good thing is, no one cares where you do your internship/transitional year. Find one in a decent location with reasonable hours and happy residents. There are a lot of these programs in every part of the country. TY can be very competitive, but there are a lot of good medicine PGY-1 years where you aren't treated like crap and work somewhere between 40-60 hours a week.

For the advanced programs, it depends a lot on the specialty as you said.

 

[Gotti]

Boy, just learned that 87 MD/PhDs didn't match last year. Wish they would offer advice on how to approach picking up our careers.

 

[Neuronix]

Boy, just learned that 87 MD/PhDs didn't match last year. Wish they would offer advice on how to approach picking up our careers.

In my experience, nobody really wants to talk about it. It's the biggest secret in MD/PhD training. Those who are uninformed or very successful just look down upon those who didn't match. Those who didn't match internalize it and hide in shame. Program directors won't talk about this possibility because it makes them look bad. I've been bringing it up through my blog and many forum posts, but most replies are in simple disbelief.

"Oh Neuronix stop worrying you'll be fine" (as if I'm always talking about myself only, when I'm talking about a general issue)

and

"There must be something seriously wrong with those who didn't match"

just compounds and further obscures this problem. What to do...

PS: The data I have from Charting Outcomes 2009 is 73 out of 624 MD/PhD graduates failed to match.

 

[Doctor&Geek]

The data I have from Charting Outcomes 2009 is 73 out of 624 MD/PhD graduates failed to match.

http://www.nrmp.org/data/chartingoutcomes2009v3.pdf

Table 2 says:
4.2% PhDs within 13646 Matching US Seniors = 573
3.9% PhDs within 1312 Unmatched US Seniors = 51 (not 87 or 73, please correct me if I'm wrong)

Match failure rate = 8.2%

Caveats:

1) Includes graduates from MD/PhD programs as well as people who had a PhD prior to going to medical school
2) Doesn't include early match
3) People who successfully scramble are not counted in this analysis as match "failures"

 

[Gotti]

Looks like good chances. But my question is how those 8% who fail recover their careers. I think a MD/PhD not matching is more devastating than a normal MD not matching. We're older and have worked harder for longer. Many of us may have families to take care of now or want to go back home or be somewhere geographically. These MDs have the prime of their lives to go find what they can do, but what do we do? Take a prelim year and then match only to repeat intern year again? Man, it scares me. Does someone know if the scramble process is any easier for us? Will PDs be calling us to give us scramble spots?

 

[Neuronix]

http://www.nrmp.org/data/chartingoutcomes2009v3.pdf

Table 2 says:
4.2% PhDs within 13646 Matching US Seniors = 573
3.9% PhDs within 1312 Unmatched US Seniors = 51 (not 87 or 73, please correct me if I'm wrong)

You're right. I was using the file referred to in the file currently on their website as:

"An earlier version of Charting Outcomes in the Match, 2009 contained significant errors that have been corrected."

Grrrr.... You'd think they could have called the updated file v4. That would make too much sense. That same file freaked out other forums as well because it made every specialty look more competitive than it really was. Thanks for pointing that out and I will update my blog entry.

 

[Gfunk6]

I appreciate your 2¢ very much. I can't decide how I want to apply to programs... Should I apply to a large number of programs and rank them all, including as my department advises--to many community programs? Or should I only apply to strong academic programs in areas where I want to live and risk not matching? Then what is my backup? Another specialty? Post-doc?

The number of programs that you apply to is largely speciality dependent but it also depends on your personal goals. When I was applying to Rad Onc, of course, I wanted to wind up at highly academic programs that would help me pursue an ideal research-based career. At the same time I was realistic about my chances. I honestly asked myself, "would I rather match in a small-community based program in the middle of nowhere or not match at all?" For me the answer was easy, so I ended up applying to every single Rad Onc program in the nation. My backup was (as Q allueded to) my home Prelim Medicine program.

Fortunately, things worked out for me but you have to be realistic. When I first started my MSTP I was misled into thinking that an MD/PhD is basically a free ticket into any residency. I think we all agree that is patently untrue. So for competitive specialities you may have to suck it up and go to a community program for your clinical training and then follow-up with a research fellowship. From extensive personal experience however, I can tell you that if you go to a community based program your research career is most probably dead. Very few MD/PhDs can muster up the motivation to embark on a research career after five years in a quasi-private practice setting.

 

[calvinNhobbes]

Well, I didn't match last year in ortho, and it sucked. But honestly it turned out to actually be a good thing. I've been on the same train for 13 years, but suddenly it stopped. I didn't panic, I didn't scramble, I took my time and reevaluated my life. I didn't have to get back on the medical train. I could go into consulting, industry, academia, or switch specialties. I wasn't loaded down with debt; I had complete freedom.

And I decided I really loved surgery and orthopaedics. It's what I wanted to do. So I applied again and got more interviews than was possible go on. Hopefully it works out this time in March!

EDIT: A comment about community programs. I applied to several last year and this year, but was mostly rejected by them for interviews, and when I did interview at a few community programs they pretty much assumed I was not interested since I had the PhD and wanted to do academics. Their rank list obviously reflected this and I failed to match. For competitive specialities, it is not easier to get into community programs, especially as an MD/PhD since many have no interest in training researchers and academicians. This holds true for many less academic university programs as well.

 

[Gotti]

Hey calvinNhobbes,
That must have been rough to not match. I agree with you about non-academic places not wanting us. I've even been to university programs that told me they weren't very academic and couldn't give me the type of training I'm looking for. I almost wanted to reply that it wasn't a problem, I just want to get in and worry about getting research training later.

I'm also going for a surgical specialty and we are even more challenged as MD/PhDs to get into these. I don't understand this deal with RadOnc not taking us as that's so cerebral a field requiring fewer clinical skills that our probably mediocre clinical skills couldn't screw up, its perfect for us.

How did you recover yourself to reapply again? What did you do the second time around to get more interviews. What did you do with the next year? I heard places that gave you an interview the first-go around probably won't interview you again and any new interviews will ask what you did wrong the first time around. Man, I can already imagine those interviews end up being negative as heck.

So calvinNhobbes, let's hope we get in done next month. I'm nervous as heck, don't know about you. Good luck to you.

 

[calvinNhobbes]

How did you recover yourself to reapply again?

Not matching was not even close to the hardest thing I've had to overcome in my life. I've never been a quitter. But much more importantly, I have balance in my life. I have a wonderful wife, family and friends. When something goes wrong professionally, it is good to have a personal life to pull you back up. Let's just say, finding out I didn't match on Black Monday was not even close to the most important thing that happened that day.

What did you do the second time around to get more interviews.

Applied to alot more places, but even more importantly I applied to the right places, ie. top rated academic programs. I did not limit myself by geography or where I thought I had a chance to get in like last year.

What did you do with the next year?

Clinical research in ortho department. Focused on getting the best LORs I could.

I heard places that gave you an interview the first-go around probably won't interview you again...

I did not get a single reinterview, except from my home program. But really, there was only one or two places I interviewed at last year that I actually wanted to interview at again. And if I had, I don't think they would have made my top tier. But then a couple places I didn't get interviews at last year gave me offers this year. So you never know.

...any new interviews will ask what you did wrong the first time around. I can already imagine those interviews end up being negative as heck.

Almost every program asked that question. They were usually my most positive. My numbers are about average for ortho, before you even add my publications and the PhD. Most were completely surprised, especially after chatting for 15-20 mins and realizing I wasn't an asocial wierdo.

So calvinNhobbes, let's hope we get in done next month. I'm nervous as heck, don't know about you. Good luck to you.

Good luck as well. I'm actually less nervous than last year. I think I have a better feeling this year about my chances, but I also know that not matching is not the end of the world. In fact, it could just be a new beginning.

 

[Gotti]

calvinNhobbes,
That's inspiring as heck....And a great attitude. It really isn't the end of the world and I don't know why I'm treating it like that. In the end, there are more important things in life. If I don't match, I would look forward to spending more time with family.

I am beginning to question how socially normal I am though and that's what this process does to you. Applying to a surgical specialty has made me especially wary of myself and I've learned through the interview season that either I don't fit in with surgeons or I really am such a weirdo. But there were some programs I really felt like I fit in and hopefully I get into those. But boy, it was tough that my own home program was the worst fit for me, and it was after my interview with them that I started this nay-saying post.

 

[gbwillner]

So, a little off topic but...I am a 2nd year resident at a top-5 competetive program (but not a competitive specialty). I did my MD/PhD at a top MSTP program, which took 8 yr of my life, excellent board scores, publications, etc. Not AOA but decent clinical grades (most HP, some Hon).

When I returned to MS3/MS4, I did some rotations in Path and Rad, but ultimately decided I would miss working with patients. I'm telling you right now as a PGY2 I am SO miserable I have go to bed every night and come back to work here the next day. At times I seriously consider leaving the program, but I feel by doing so I would be letting down many family members, friends, and faculty mentors who were excited about where I matched. Yes be thankful you have the MD/PhD, and if you need to take that extra prelim year to REALLY decide what specialty you want, then do so and stick with it. Don't try to scramble into a program that doesn't fit your interests-they wont care about your PhD r research background, and u will just be another cheap source of labor to them. Right now I'm serously considering looking for a post-doc or research job, and putting these 2 years behind me.

Just my 2¢...

Good god......
Sounds like you went into GYN. I think it is time to serioulsy consider switching fields before giving up on medicine. You still have a few years of govt funding- that's good. Why are you so worried about letting others down? Better to not be miserable, IMHO.

 

[gbwillner]

EDIT: A comment about community programs. I applied to several last year and this year, but was mostly rejected by them for interviews, and when I did interview at a few community programs they pretty much assumed I was not interested since I had the PhD and wanted to do academics. Their rank list obviously reflected this and I failed to match. For competitive specialities, it is not easier to get into community programs, especially as an MD/PhD since many have no interest in training researchers and academicians. This holds true for many less academic university programs as well.

I think the key here is: if you are applying to community programs and are willing to kiss research goodbye, you've ALREADY wasted 4 years of your life. I've seen it many times that MSTPs don't match to these programs for the reasons you state.

IMHO, if you finish your training and still want to be a physician-scientist, but have to choose between a community residency and switching fields, you should switch fields. You can aways study the same subject from a different lens. You will learn to aprpeciate your new field.

 

[Gotti]

I don't understand the negativity with doing research after a community program. I'm not a resident myself yet so maybe I don't know anything. But what does clinical training have to do with academics? Clinical training is all about learning protocol and implementing therapies based on percentages and probably similar anywhere if you want to escape litigation. If you go to a community program, you may have time to read up on the latest advances in science or even find a local university lab and do some research. As far as I know, clinical residencies give you only 3-4 months of research time anyway so why not go to some small program, get a nice fellowship anyway because of your MD/PhD, and do good research there.

 

[gbwillner]

I don't understand the negativity with doing research after a community program. I'm not a resident myself yet so maybe I don't know anything. But what does clinical training have to do with academics? Clinical training is all about learning protocol and implementing therapies based on percentages and probably similar anywhere if you want to escape litigation. If you go to a community program, you may have time to read up on the latest advances in science or even find a local university lab and do some research. As far as I know, clinical residencies give you only 3-4 months of research time anyway so why not go to some small program, get a nice fellowship anyway because of your MD/PhD, and do good research there.

academic-based programs will have tons of opportunities for research. Some residency programs have significant research time. I have a 2-year post-doc built into my residency, which includes fast-tracking through some training to get into lab faster. My institution also has tons of research positions, and being a research-track applicant essentially fast-tracks you into a faculty position. I am also able to fudge my schedule more to my liking, as I am here to train and not here to serve as scutmonkey for the hospital.

During residency, I can rotate through perspective post-doc labs, get to know people, and have my department pay for my post doc. I am already well-connected. I will be writing grants during residency, in fact, I already have one. The faculty in the department do their own research, and it is easy to find mentorship.

If I was at a community program, I would get no support for doing any research during residency. I would have no connections. I would have to wait until residency is over, and then start e-mailing my CV to random labs for a post-doc. I would have no recognizable references. In other words, I would be at a huge disadvantage. I would be totally disconnected to research, and would probably just take a PP job somewhere. How would I be able to get back into research?

 

[StIGMA]

academic-based programs will have tons of opportunities for research

What if you do not take advantage of these opportunities (or if they are not as frequently available for your speciality, or if you do not get offered fast-tracking, etc.)? Is there still an advantage to academic programs compared to community-based programs in these situations?

 

[Gotti]

Overall, I admit doing what gbwillner is doing is a better bet than going to a community program. But burnout at a tough program has also been an issue and I've had interviewers admit that concern. However, it sounds like gbwillner is going to get into lab as a fellow anyway, in which case, his main advantage is fast-tracking and connections. Furthermore, it sounds like he is in IM, which is admittedly the best residency to do real basic science later on and not some clinical mumbo-jumbo. However, I don't think it matters in a surgical specialty. They won't let you fast-track anyway. I think you have to be personally motivated to do research as a surgeon.

 

[Shifty B]

Wow, there is a lot going on in this thread. I'll only try to add what I can, particularly regarding the academic vs community debate.

I think if you are primarily interested in basic science research, what gbwillner has pointed out about going to an academic institution in a different field might be worth it. It is true that there are fast track programs that will help you get out of some of your residency time, but they are something of a misnomer. They really only exist for internal medicine and maybe path or peds. Most of them will take a 3 yr residency and 3 yr fellowship and do something to build in some research time. For instance, they may shorten your residency to 2 yrs, build in 2 years of devoted research, and make your clinical fellowship time 2 years, so that you get 2 years of devoted research in the 6 yrs total.

A lot of people I know didn't really like this path. First, only a few spots for this exist at each institution and it can be extremely competitive (and this group is already talking about being concerned about not matching at all!). Plus, it doesn't really put the "fast" in fast track when it is a commitment to stay at an institution another 6-7 years and choose your subspecialty well in advance. It is an option though, and will save you the hassle of applying for fellowships in a couple of years.

However, if you want to have a significant clinical component to your career there can sometimes be nothing worse than being in a field you don't like. In this case, you have to consider going to a community program and getting back into academics if that's your bag later. In a field like surgery, it shouldn't be a problem because academic departments can't get enough people as it is. In others there may be varying degrees of difficulty but there is always a way to get back in. You may not be as "connected", but I think you can make it happen, probably starting with clinical research and then transitioning back in.

I guess I'm just suggesting to see how much of a clinical component you see in your future. If it's a lot, stay in your field of choice. If not, then maybe you can make path or some other field work.

 

[Shifty B]

Hey calvinNhobbes,
That must have been rough to not match. I agree with you about non-academic places not wanting us. I've even been to university programs that told me they weren't very academic and couldn't give me the type of training I'm looking for. I almost wanted to reply that it wasn't a problem, I just want to get in and worry about getting research training later.

So, this happened to me quite a bit. I matched in radiology, even many top academic institutions aren't really pushing research. At top 10 places, maybe 70% of people still choose private practice. It would often come up at very solid academic places (let alone community programs) that they didn't feel like they would be that interesting to me. I would say to them almost exactly what you suggested:

"Look, I'm really looking for a place that offers strong clinical training, like here at X. To me, residency is a time to focus on clinical skills because it is the only time you'll have to become a good clinician. I'm aware that most residents will spend at most a few months doing research, which is small compared to the time I have spent already already. After getting the base of clinical skills that I need. I plan on getting back into research as time allows toward the end of my residency and as I transition into a fellowship."

Not only is this what the programs want to hear because it reassures them of your real interest, it is actually true. You'd better get your clinical skills while you can because that's harder than getting back into research later.

I wonder if some people who don't match overemphasize research during their interviews. If you are really into research, and talk about that during your interview a little too much, it may seem like you're not into clinical training and are just waiting to get back into research. Even for top programs, that's not what they are looking for from residents. They are looking for strong clinical residents who take call without complaining and give good medical care to their 15 patients, regardless of research interests. It's never a mistake on your interviews to say you are focusing this part of your career on clinical skills.

 

[Gotti]

Boy, man I really needed this advice earlier. Looking back, which is stupid to do now, I should have emphasized clinical training now. My initial thought was that the only reason they were interviewing me wasn't because of my clinical prowess, but that I definitely had an interest in academics so I kept going on about research this and academics that.

 

[Neuronix]

I have a wonderful wife, family and friends.

I have some friends, but of course they all have their own families. I don't have my own family or wife. You're lucky in this regard. I don't feel that this is within my control, and thus I have nothing to fall back on if I don't match.

What if you do not take advantage of these opportunities (or if they are not as frequently available for your speciality, or if you do not get offered fast-tracking, etc.)? Is there still an advantage to academic programs compared to community-based programs in these situations?

Those who are not interested in research still typically want to go to big name programs regardless of academic/research bias. The reasons are much the same as they are for pre-meds applying to top med schools.

1) Prestige
2) Can't rule out academics, so it *may* help them get an academic position down the line. Will often tell other applicants they hate research, but do research in med school and tell interviewers they have an interest in research.
3) Think it may help them get a private practice job in a desirable location or a competitive fellowship down the line
4) Can work with biggest names in the field--implies better training, more opportunities.

It's all very much like being a pre-med all over again. I have been chairing the interest group for years. Many people want to sign up solely to get their name on as chair of the interest group. Nobody helps me with events, budgeting, etc one bit.

Hence you are always competing with top MD students. Even if the residency requires some research, the private practice bound student is typically happy to do it for the big name residency spot. At my home program I see a lot of MD students who have no desire to do academics or research, and most have some required research that they use to do clinical research or even research in things like economics so they can make more money in their own private practice someday! I worked in the basic science arm of the department with PhDs, but almost no residents ever come over and do basic science research. Still, if you read the forums for that specialty, you will often hear from a lot of MD-only students with no experience in basic science research about how the basic science research opportunities at my school make it a reason to come here. It provides more exposure to the future of the field or some nonsense?

Meanwhile I have extensive basic science research experience and ability and I have no chance. Yawn. If it's any consolation, I am frequently told I should come back for fellowship. My advisers don't seem to have any clue that community programs and even lesser academic programs don't want to match a research-oriented MD/PhD. I feel stuck in the middle and I feel like the entire situation is very ridiculous.

As always Shifty I appreciate your perspective and advice. I will use it.

 

[Gotti]

I have some friends, but of course they all have their own families. I don't have my own family or wife. You're lucky in this regard. I don't feel that this is within my control, and thus I have nothing to fall back on if I don't match.

Man, Neuronix, you sound like you need this more than I do. Yeah, I stayed single too waiting to get my career figured out before trying to settle down, but these dark times in our careers is when having somebody could really ease disappointment and so I feel your pain.

I will just say that you should learn to talk like the people in the specialty you want, because from my interviews, it is apparent that fitting in is the most important thing even if you think you are a normal guy. I personally don't talk enough like a surgeon and if I don't get in, now I am quite sure that was what happened. Forget trying to be yourself, because we have MD/PhD personalities and that may not be good for residency interviews.

 

[Neuronix]

Man, Neuronix, you sound like you need this more than I do. Yeah, I stayed single too waiting to get my career figured out before trying to settle down, but these dark times in our careers is when having somebody could really ease disappointment and so I feel your pain.

I tried... But I got my heart shattered a couple times. I started dating again and got laughed at and dumped too many times. Now I have a **** it kind of attitude.

 

[Gotti]

I tried... But I got my heart shattered a couple times. I started dating again and got laughed at and dumped too many times. Now I have a **** it kind of attitude.

Did you know that marriage is statistically the number #1 factor to success in med school? If we had gotten married, we would have done better in med school and not worry about getting a residency. But really, being single was why I could apply so broadly across the nation and think about a long hard surgical career without having any burdens. So count your blessings.

But dude, you are about to have a MD/PhD so you're about to move up a couple of class levels in this regard. But then again, it won't be as "meaningful" because she'll be into you for your success. Its sad, I use to scoff at my colleagues getting married before they got their degrees.

 

[QofQuimica]

One other thing that some posts in this thread have kind of danced around but not directly come out and said is that networking in general is really helpful. In Real Life, a lot of people get jobs based on their connections, and I don't think that getting a residency is all that different. Definitely make use of your home program director, chairman, MSTP program director, etc, but don't stop there. If you know alums who have gone into your specialty of choice, they're good people to talk to in terms of getting advice on a successful match, too.

I just talked to an alum from my school last night, as a matter of fact, which is why it's on my mind. This person is an intern at a program that I plan to apply to, and some of the advice I got was just mind-boggling, mainly because I had never thought of it myself and should have. I'm talking about everything from taking an elective that will make me a stronger candidate, to deciding which attendings to ask for letters, to strategizing about which programs might be most interested in a candidate like me, to thinking about how to best get across my interest in the clinical side of the specialty in my personal statement. I now feel like I have a much better sense of direction that I hadn't really had up to this point. Not that my school hasn't given me support also, but they aren't the ones who have gone through the match over the past few years.

Of course, MD/PhD programs are much smaller than MD programs, and you may not know anyone from your program who matched in your specialty. But, there are bound to be some more research-oriented MDs who matched in that specialty over the past year or two. You may want to look into contacting them; your school's alumni association can probably help you. I really feel like it was more than worth my time, and I'm considering maybe contacting one more alum.

 

[Treg]

One other thing that some posts in this thread have kind of danced around but not directly come out and said is that networking in general is really helpful. In Real Life, a lot of people get jobs based on their connections, and I don't think that getting a residency is all that different. Definitely make use of your home program director, chairman, MSTP program director, etc, but don't stop there. If you know alums who have gone into your specialty of choice, they're good people to talk to in terms of getting advice on a successful match, too.

I just talked to an alum from my school last night, as a matter of fact, which is why it's on my mind. This person is an intern at a program that I plan to apply to, and some of the advice I got was just mind-boggling, mainly because I had never thought of it myself and should have. I'm talking about everything from taking an elective that will make me a stronger candidate, to deciding which attendings to ask for letters, to strategizing about which programs might be most interested in a candidate like me, to thinking about how to best get across my interest in the clinical side of the specialty in my personal statement. I now feel like I have a much better sense of direction that I hadn't really had up to this point. Not that my school hasn't given me support also, but they aren't the ones who have gone through the match over the past few years.

Of course, MD/PhD programs are much smaller than MD programs, and you may not know anyone from your program who matched in your specialty. But, there are bound to be some more research-oriented MDs who matched in that specialty over the past year or two. You may want to look into contacting them; your school's alumni association can probably help you. I really feel like it was more than worth my time, and I'm considering maybe contacting one more alum.

I completely agree with this. Don't have any rose colored glasses about the MD-PhD meaning anything. You all know that there are people in our classes that are doing anything and everything to be competitive, and you shouldn't do any less. On the interview trail, when asked about research, I said that I wanted to be somewhere with lots of opportunities for projects and mentorship. Then I emphasized that getting top notch clinical training was my FIRST priority. I said that I already new how to do research, but now I wanted to learn how to be the best possible surgeon. I said I don't want a long hiatus from research so I am still competitive for fellowship--which means I am open to doing more along the way, even 1-2 years out. All of these sentiments were very well received.

I discussed answers to these questions and asked for general advice from residents WITHOUT the MD-PHD who had matched at top programs in the specialty I am applying. They were incredibly insightful and definitely helped me fine tune my thoughts/answers.

Bottom line: you don't want to be perceived as prioritizing research opportunities>>clinical training, but you definitely don't want to be perceived as the MD-PHD that is sick of research, wants to use the PHD to get into a good program and then blow through without doing any research.

Good luck everyone with the match! A little over three weeks now...

Treg

 

[Gotti]

Boy, I wish you guys were around when I was interviewing at more clinically-oriented programs. I suppose I did say something along those lines but could have been so much more explicit like the way you are putting it.

Now I'll be kicking myself until the match. Am I overreacting or does everyone kick themselves for something they didn't say or didn't say as well as they would have liked?

 

[smq123]

Now I'll be kicking myself until the match. Am I overreacting or does everyone kick themselves for something they didn't say or didn't say as well as they would have liked?

Most people, I think, walk away from residency interviews second-guessing their responses. It's not that uncommon.

calvinNhobbes,
That's inspiring as heck....And a great attitude. It really isn't the end of the world and I don't know why I'm treating it like that. In the end, there are more important things in life. If I don't match, I would look forward to spending more time with family.

I am beginning to question how socially normal I am though and that's what this process does to you. Applying to a surgical specialty has made me especially wary of myself and I've learned through the interview season that either I don't fit in with surgeons or I really am such a weirdo. But there were some programs I really felt like I fit in and hopefully I get into those. But boy, it was tough that my own home program was the worst fit for me, and it was after my interview with them that I started this nay-saying post.

I'm also going for a surgical specialty and we are even more challenged as MD/PhDs to get into these. I don't understand this deal with RadOnc not taking us as that's so cerebral a field requiring fewer clinical skills that our probably mediocre clinical skills couldn't screw up, its perfect for us.

I don't think that it's a question of "cerebral" field vs. "non-cerebral field". I think it's more of a question of where a particular field wants to head.

I get the impression that oncologists (both medical and radiation) want to provide good clinical care to their patients, but are acutely aware of their limitations. They know that chemotherapy agents have terrible side effects, and that radiation therapy can be very taxing on the body. They also know that our ability to detect cancers early is pretty bad. Finally, I think a lot of them recognize that research is the only way that we're going to solve these problems, which is why heme/onc and rad onc have an unusually high focus on research.

Compare that to radiology or the surgical fields. The surgery fields are already facing declining reimbursements...and you want to cut your group's income even more by disappearing into the lab for a few months? What interest exists in the surgery world to keep advancing the field from a basic science perspective? As an outsider, it doesn't seem like there's a whole lot.

Applying to a surgical specialty has made me especially wary of myself and I've learned through the interview season that either I don't fit in with surgeons or I really am such a weirdo.

Out of curiosity, if you feel like you don't fit in with surgeons or that you don't talk enough like a surgeon to fit in, then why are you applying for a surgical subspecialty? Wouldn't that mean spending the next 40-some years in the company of surgeons?

These MDs have the prime of their lives to go find what they can do, but what do we do? Take a prelim year and then match only to repeat intern year again? Man, it scares me. Does someone know if the scramble process is any easier for us? Will PDs be calling us to give us scramble spots?

I think that the biggest mistake that a student who is applying for a competitive surgical specialty can make is the one that you're making right now - they head into March with no idea of how the Match works. This is a little off-topic, since it has more to do with the fact that you're applying to a competitive surgical subspecialty than the fact that you're an MD/PhD, so I'm sending you a PM. I will just say, however, that I find it highly unlikely that having a PhD makes the scramble any easier.

 

[dl2dp2]

There are a couple of things that I think are worth re-emphasizing, especially for entering 1st year MD/PhDs.

(1) By design, MD/PhD is made for research intense specialties like IM/Path/Neuro/Psych/Peds, and for the research intense subspecialties within each of these fields (my dad's colonoscopist is an MD/PhD...). Obviously over the course of the training, your goals change, and for certain competitive specialties, the PhD still helps (i.e. Optho and rad onc, as well as derm). But if you go into med school with an eye on a surgical subspecialty like urology, orthopedic surgery or ENT, please don't do MD/PhD unless you are very ready to blow away 4-5 years of your life that's completely worthless to you later on, or if you know exactly what you are doing (i.e. engineering PhD or something).

(2) In specialties like surgical subs and rads, sure, you can match into a community program, but be realistic, what are the chances that at the end of that training, you'll turn down your 350k and go back and do basic science? The answer is 0%. Sure you can sell your research interest, but you should make a decision at that point. If you want to continue doing basic science research, surgical subs, rads, rad onc, etc. are terrible residency choices for most people. You need to ask yourself: is basic science research important enough for me? (The vast majority of people, I know, by the way, say no to that question.) Do I like radiology enough? Pick one. If you are a superstar you match into a top rads program and research is still open to you, but you aren't...stop trying to do everything and make everyone miserable.

(3) The entire academic medical/research enterprise is becoming more and more competitive. The competitive clinical fields are saturated with excellent candidates who can handle the long hours and memorization. The research fields are scrambling for the very limited grants. People who are into basic science are ditching PhD to do an MDPhD, which makes MDPhD programs paradoxically more and more competitive. MDPhDs scrambling to do competitive specialties, which make those even more competitive. The good news is that if you want to do lab research in a non-competitive specialty, MDPhD still positions you relatively nicely, but the training track is way too long to be reasonable--but it still compares favorably with PhD-only. If you want to do research in a competitive specialty, god bless, you chose the most competitive of all tracks--and please try to be as excellent a candidate as possible as you can from day 1, and never stop working as hard as you can.

(4) I have yet to figure out how some med students get honors all over the place in 3rd year...and after 3-4 yrs of away from the clinic, but if this is what you want to do, then please try to make it happen--oh yeah, don't blow off Step 1...try to get 260. This game is so skewed in that MDPhDs from a well ranked program matching into the top academic places in IM/Path can basically get quite a few Ps here and there and 220 and nobody cares. (This by the way, is making IM more competitive, especially considering everyone who wants to do cards and GI--please see the previous paragraph.) Whereas, people really don't match in rads and surgical subs...people stress out...really! Think very carefully.

Each of these tracks have distinct goals and designs. If you end up doing what it's designed for, you get some bonus points. The earlier you can make up your mind and the fewer mistakes you make, the better off you are.

 

[Shifty B]

Boy, I wish you guys were around when I was interviewing at more clinically-oriented programs. I suppose I did say something along those lines but could have been so much more explicit like the way you are putting it.

Now I'll be kicking myself until the match. Am I overreacting or does everyone kick themselves for something they didn't say or didn't say as well as they would have liked?

I think you'll be ok. A lot of people are down on themselves after interviews because you have so much time to second guess yourself. I've often thought that people who feel like they give perfect interviews must lack a certain bit of self-awareness.

I did really laugh when I was thinking about you trying to talk like a surgeon. I couldn't think of a way to work "Why don't you call me back when there is a surgical problem with this patient?" into an interview.

 

[smq123]

I did really laugh when I was thinking about you trying to talk like a surgeon. I couldn't think of a way to work "Why don't you call me back when there is a surgical problem with this patient?" into an interview.

 

[Gotti]

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