Thoughts on skipping the residency?

[tr]

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I'm curious to see what others think of this.

I am 100% committed to a research career. I may in the future be interested in human-subject research, but I don't really plan on doing straight patient care after residency.

I had been planning to do a residency anyway, both for the educational value and in order to become more familiar with patient-oriented research.

But lately I've been starting to wonder whether it's worth the time. Four more years is a big commitment, and a lot of time away from the bench.


I'm just curious as to whether any others here have thought about the pros and cons of going straight to postdoc. Please share your thoughts.

 

[Gfunk6]

Probably not a good idea as an MD is virtually worthless without post-graduate training of some sort. You look like the type to follow ABIM's research track. The typically three-years of IM training is shortened to two and a three year post-doc is added to it. This way you can be a board-certified internist with a solid post-doc to your name to pursue basic research in an academic or industrial setting.

See the following link for more info:
http://www.abim.org/subspec/pathway/policy.htm

Every top-20 medical school will offer you this option.

 

[b&ierstiefel]

I share your sentiments tr. There have been a few people at my school, but not too many, who venture to not do a residency.

The question is this (and I don't really know the answer to it and perhaps someone else can help): What advantages does an MD give you if you were NOT to undergo residency training? I mainly see the MD as a great way to outcompete the straight PhDs to get tenure track positions and have an easier time getting grant money. I know this sounds cocky and arrogant but I've worked long and hard for that MD/PhD and I wanna cash in on my prize damnit!

There are so many people getting PhDs out there and in this age of credential inflation, more degrees help. However, what additional advantages does DOING a residency confer over getting the MD and calling it quits?

I personally have said to myself during the painful barrage of 3rd year clerkships, "If someone can guarantee me tenure and grant money, I would so quit after getting that MD." Fortunately, I've found a field in medicine that strikes my fancy and is very closely related to my passion for basic science research. Hence I now find myself deciding to duke it out through a residency albeit the shortest track possible.

Postdoc whether you're an MD/PhD or a straight PhD is a risky proposition. What I have learned from my experiences as a graduate student is that your success is dependent on not only your intelligence and hard work but also on a whole slew of external factors, many of which are out of your control (e.g., support of your mentor, quality of your mentor, quality of your project, the sexiness of you project, whether your lab is utilizing the right technology to answer the given research problem, LUCK and SERENDIPITY, etc.). If you're up for the risk and don't want to do patient care, one should consider doing a straight postdoc. If you're not a risktaker, then do a residency and use your medical field as a backup plan.

I know of several very intelligent people who have not done well in their postdoc labs...they will not be as competitive for tenure track positions. I know a few who have excelled tremendously in very short periods of postdoc time. I don't know where I will fall ... hence I feel I need a backup plan should research not work for me. Also, I hear that if you have a clinical appointment and are interested in research, it will be easier for you to have a lab. And considering that there are so many grants available to those who are MDs (and the number of MDs doing research is relatively scarce compared to the PhDs doing research), I don't foresee a terrible amount of difficulty in acquiring some sort of funding.

I don't know...I'm rambling here but this is what I can come up with in respect to my stream of consciousness thinking.

And if any of the above comments are wrong, please let me know. I would appreciate anybody clearing up any misconceptions that I myself would have.

 

[ears]

I think it depends on where you're trying to go. One of my friends went the route you're talking about: he finished his MD/PhD, went straight into a high-powered post-doc, and now has a prestigious faculty gig, and I think it definitely can work. In spite of the fact that he's never taken care of patients, the MD likely confers some advantage, although it may be subliminal. On one hand, he doesn't have the full benefit of his MD, but on the other hand, at four years out, he's in a good faculty position.

The question is, where do you want to go? And what's the most expedient way to get there? If you don't need the residency to get where you're going, then why do it?

 

[BDavis]

I'm curious to see what others think of this.

I am 100% committed to a research career. I may in the future be interested in human-subject research, but I don't really plan on doing straight patient care after residency.

We have had a few MSTPs go straight to a post-doc and enter faculty positions directly without doing a residency. They usually had very stellar graduate publications (Science, Nature, Neuron, Cell tier) and continued their publication record during their post-doc. As people have mentioned, the post-doc can be a little risky and like mutual funds, "past performance does not guarantee future results". I have not heard of anyone doing a post-doc and then entering residency (I suppose it can be done, but I don't know of any graudates at our program who did that route). However some students hit a "happy medium" by entering pathology residencies where there is some protected time (by reducing clinical responsibilities instead of compressing them into a shorter period of time) for doing research. One of our MSTP advisors took this pathway and is very happy doing academic research with little clinical responsiblities. These programs are designed for preparing for a tenure track faculty position with the intent that you will write for your grants during your residency. Hope this helps.

 

[tr]

Thanks for the input, everyone.

Regarding path or IM residencies, I am definitely focused on brain sciences, so it would be either a neuro or a psych residency for me.

[I was originally pretty much set on neuro, but I've come to realize that, oddly enough, it's far easier to get protected time for research in a psych residency (e.g., UCSD and Stanford both have residency tracks that allow you to spend a good chunk of time in the lab). Since my primary interest is research anyway, I figure that should take priority over what kind of patient care I'd rather do during my residency.]

Unfortunately, both of those residencies are four full years, and while there are some research-oriented positions available as stated above, they vary a great deal and are generally run at the discretion of the residency directors of each facility.

Furthermore, the real problem with that is the research options are much more limited. Presumably I'll be required to do research with faculty members who are affiliated with the psych dept. If I go for straight postdoc, I can just choose the research I like; but if I go for residency-with-research, my options will be more circumscribed.

While UCSD has several people whose stuff looks interesting, none of it is the kind of thing I would want to do in my own laboratory. So I'd probably have to do a postdoc afterwards *anyway*, in which case by the time I finally start looking for entry-level faculty positions, I'll be in my late thirties. That's a scary prospect. 🙁

 

[BDavis]

Thanks for the input, everyone.
Unfortunately, both of those residencies are four full years, and while there are some research-oriented positions available as stated above, they vary a great deal and are generally run at the discretion of the residency directors of each facility.

Furthermore, the real problem with that is the research options are much more limited. Presumably I'll be required to do research with faculty members who are affiliated with the psych dept. If I go for straight postdoc, I can just choose the research I like; but if I go for residency-with-research, my options will be more circumscribed.
🙁

My wife is a psych resident and she also looked at the UCSD residency (the neuropsych track) and she seemed to really like it. Although she quit the MSTP, she still wanted to do research. Other programs that she liked was Wash U in St. Louis and U. Wash in Seattle where there was also heavy emphasis on research with claims of protected time from the program director.

 

[ears]

Two thoughts:

First, a research-friendly residency program wouldn't necessarily limit you to mentors in the department. It would depend on the program; I know lots of programs in my intended field (radiology) would let me work in many kinds of labs in the area. So you might want to double check on it. And even if they say, "The policy is that you do research with someone in the department", ask if there's any flexibility in that. You might be surprised.

Second, I think it's nuts to do a residency unless you're really interested in actually practicing that kind of medicine. I'm not saying, be committed to doing it your whole life, but I think it'd be a big mistake and a waste to do a psychiatry residency (no matter how much research time you had) unless you wanted to become trained as a psychiatrist. Wouldn't you do better to spend those four years as a post-doc?

And it really sounds like you're not particularly into any medical field, you just want to get your research career going. So I'd say just do it; you'd just be miserable in a residency (to say nothing of internship!), and it wouldn't really get you where you're going.

Now, for some cheap psychotherapy (and worth what you paid for it! 🙂): Are you worried about "wasting" your medical education? Are you under pressure from family somehow? From an advisor, from someone in your MSTP? It sounds like you know what you should do, and you think you need permission from someone to do it.

 

[Habari]

Echoing other sentiments - it matters what you intend to do. if you are confident in your abilities, or more importantly, know you do not enjoy medicine (taking a 4 years for a neuro/psych residency to further confirm that seems much), don't bother. though most people from this program do end up doing a residency, even if they had excellent graduate careers - quite a few go straight to a post-doc. most of these people are driven, sure they want a research career, and amazingly successful afterwards.

while there are examples of great 'translational' research that have been inspired by clinical settings, a lot that is produced seems quite unimaginative and constrained by whatever niche the clinician-scientist finds themself in; not quite the type of science that many hope to do during the best of times in the process of working on their thesis. this isn't an attack on clinical research or the 'translation' process, simply that one has to be vigilant, especially during their clincial training not to find oneself pushed into the type of 'translational research' that gives the phrase a bad name. if this doesn't make sense, then it probably doesn't apply.

i would suggest that you don't look to your peers for cues on what to do - and don't worry about not fitting a mold or expectation. constructive advice certainly has its place, but at some point peoples anecdotes/advice are so freighted with their own experience, goals, or missteps that it may not be relevant to you and your aspirations. four years of residency is a long time, and shouldn't simply be the next step in the march through this physician-scientist 'track' - hopefully whether you choose to pursue it or not - it will be with a specific purpose in mind, whether academic or personal.

 

[tr]

"I think it's nuts to do a residency unless you're really interested in actually practicing that kind of medicine. I'm not saying, be committed to doing it your whole life, but I think it'd be a big mistake and a waste to do a psychiatry residency (no matter how much research time you had) unless you wanted to become trained as a psychiatrist. Wouldn't you do better to spend those four years as a post-doc?"

Hm. I'm not really certain I agree with that.

Even the two years of medical education I've had have already given me a much broader perspective (to re-use an overused but accurate phrase) than most of the straight PhD students seem to possess. I'd guess the same will be true of residency.

At no point in this process did I think I wanted to become a practicing clinician. On the other hand, I'm deeply interested in the brain, and specifically the human brain; and I think there is no better way to get insight into how it all happens than to work with actual humans who have actual brains that behave in various different ways. 🙂

So it's not that I don't think a residency would be valuable for me; I think it would be very valuable. It's just that I'm starting to get a little freaked out by the realization of how long it's all going to take. I guess the question is not whether it's valuable, but whether its value is four years' worth, if you understand what I mean. 🙂


"And it really sounds like you're not particularly into any medical field, you just want to get your research career going. So I'd say just do it; you'd just be miserable in a residency (to say nothing of internship!), and it wouldn't really get you where you're going."

I suppose I can't really say how I feel about the actual practice of medicine until I get back in the clinic and see it for myself. On the other hand, at my school MD-PhD students in the research years do spend time hanging around with clinicians to keep their hands in the game. I've been pleasantly surprised at how interested and engaged I was in the patient contact part.

(I say surprised because I never found the clinical bits of the first two years of med school very rewarding. But it turns out that the brain-focused parts of clinical medicine *are* interesting to me. Which in retrospect shouldn't have been all that startling, since I think I was first turned on to the brain by reading some of Oliver Sacks' clinical vignettes, around age 12 or so.)



"Now, for some cheap psychotherapy (and worth what you paid for it! 🙂): Are you worried about "wasting" your medical education? Are you under pressure from family somehow? From an advisor, from someone in your MSTP? It sounds like you know what you should do, and you think you need permission from someone to do it."

I definitely think there is pressure - or at least very strong suggestion - from the MSTP program here to complete residency training. But there's really no incentive on my part to knuckle under to it if I don't want to. It's my life, right? 🙂
My dithering is really more about whether the training will be worth the time to me, rather than a response to any external pressures.

 

[ears]

Hm. I'm not really certain I agree with that.

I think you and I agree, but look at it different ways.

And you're definitely preaching to the choir about the broad perspective that MD/PhD students seem to have. (I wonder if it's an effect of the education or selection bias?)

But I think residency might be a little different, just because it's so service-oriented; that is, residency programs take their educational mission seriously, but there's a lot of work to be done, too, and that comes first. That can boil down to less flexibility to let you find your own way than you have in grad school or med school. But that's more or less an aside.

It's my life, right? 🙂
My dithering is really more about whether the training will be worth the time to me, rather than a response to any external pressures.

I hear you. Here's the nutshell version of what I think. if you're amped up to get your research career going, it can definitely work out for a MD-PhD to skip residency training. (It doesn't sound like that's you.) If you're gung-ho to train/practice some kind of clinical medicine, that obviously works well, though it can be a long path. (This doesn't sound like you, either.) The key point is, either path can work well.

It sounds like you're somewhere in between. You're not rarin' to go into a post-doc, but you haven't found a field of clinical medicine that frosts your cupcake, either. But it also sounds like you haven't done clinical rotations is psych or neuro yet, either; maybe they'll help you pick one way or the other.

Good luck.

 

[poutsara]

keep in mind that if you don't do a residency right after med school you never will. once you get off the bus you can't get back on, so if you are 100% certain that you don't want to be a physician then go roll the dice as a post-doc. but if your priorities change, as they often times do when you get older and jaded by the politics of academics, you are stuck.

 

[NGN47]

poutsara, you should be in lab malaka!

 

[poutsara]

poutsara, you should be in lab malaka!

sostos!

 

[lumanyika]

...and like mutual funds, "past performance does not guarantee future results".

BDavis, nice mutual fund analogy. it applies to so many things in life!

i think i'll skip the residency and go the Post-doc route.my goal is a bit different from many (Sub-Saharan infectious diseases, HIV/AIDS in particular) in that i'll eventually persue a Faculty position out of the US. however, Since the US is my research foundation if you will, i'll have to acquire a faculty position here in the US first in order to establish some kind of network support or a link between the US and my home country.


So as the Op said, there so many factors that are out of our control. which i think in return makes the risk a little worthwhile.

 

[tr]

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