You know what... Nevermind.

[Neuronix]

Before I write this, I know the responses I'll get in advance. Neuronix is so negative. You're so bitter. You're so cynical. Yadda yadda yadda. I'm close to the happiest I have ever been in my life. I leave for Thailand in 3 days. No, the reality is that I've been at this MD/PhD thing a long time and I've finally had enough negative feedback that it's beginning to stick.

That is: I'm getting increasingly discouraged the further down the MD/PhD rabbit hole I go. I think I'm getting to the point where for the first time I'm thinking I wouldn't have done MSTP had I known what I know now. Never before have I felt this way, no matter how much adversity I faced.

What brings this post on is a meeting I had with my residency advisor a few days ago. It isn't the first time I heard any of the things he had to tell me, it's just the first time I've had to seriously face them. Here's the main topics of discussion that stick in my mind:

Today's Lessons

1) MD/PhDs are widely viewed as being sub-par residents. All of the residents they've had that have struggled in their program have been MD/PhD. As such they grant MD/PhD students no clinical slack in their residency program and are increasingly reluctant to provide protected research time (a trend I have noticed nationally). It is far more important to them that a residency applicant shows clinical honors, preferably AOA or close to it, and the PhD really means very little for admissions. It's the icing on the cake. The strength of the PhD, the number of publications, etc... It means pretty much nothing. This is a program that is thought to be among the strongest for research nationally.

I'll insert a short and semi-related paragraph here. The fellows always told me get out of my PhD as soon as possible. The strength of the PhD doesn't matter for residency. It doesn't matter for fellowship. And all anyone cares about when it's time to become faculty is fellowship. Never, ever stay on board longer to try to get a stronger PhD, as I was given extreme pressure to do.

2) I shouldn't do a research residency. This isn't the first time I've heard this advice. Because I'm going to be sub-par clinically coming back to clinics and I might want to do research someday, I better get the strongest clinical training I can get. His recommendation is to go to whatever residency will take me. I can come back to research as a fellow, though I better be a very strong clinical resident to get one of these fellowships at a top program. You see there are extremely few research fellowships, and even at those clinical aptitude comes first.

On that topic, PhDs are very happy to recruit me. As such I am a slightly stronger candidate for research residencies. Every one of the basic scientists will tell me they'd love to have me in their lab, but they have no say in residency admissions. The simple reason? I am very talented in what I do and have a strong research background. The demand is very high for qualified people in my field. The PIs I have worked for all have little idea what I'm doing and how this field is progressing, and rely entirely on their post-docs and grad students to provide publications with almost zero guidance. Hence, these PhDs would love for me to come work for them--as a technician, someone who generates papers for them, someone who floats the lab for all those assistants who aren't nearly as technical.

But on the topic of progressing to an independent investigator, good luck. The clinical departments are not willing to provide me anything. If anything I am scrutinized for too much "dedication to research". Tenure does not exist. Protected time is in short supply. Grants are hard to obtain.

I only want to work for someone who is technically stronger than I am. I hate to sound like I'm tooting my own horn, but there aren't many out there. It's the only way I'll grow. One of the most technical guys in my field is at UCSF. My odds of getting residency there? Next to none my advisor says. So that's the trap. If I want to go to the places where I can grow in research I need to be top both in the clinics and in research. I've just been unable to play the honors game, but I'll try when I get back to clinics, four years since I've been in med school.

3) I'm a mediocre applicant. I don't have to worry about staying at my home program because I have almost no chance of getting in. I'd need AOA or close to it, and because I have all HPs in clinics so far, that's impossible. But I've been told that's what all the big name programs want, whether they're strong in research or not. Again, PhD means little. My best chance would be at a place like Jefferson or another Rads program that has minimal research. Strong research = very competitive, but again that competition is all based on clinical things. I talked to an adcom at another program in a less competitive location in the 20s for research funding in my specialty nationally, and they told me similar things. Ohhh, you don't have mostly honors grades in rotations... Hmmm... Well maybe we might take you on a research track. Maybe. Try to get a lot more honors. Oh, and your high Step I score? Not high enough. Take Step II early and try to score in the 95th+ percentile this time.

So what have I learned?

The take home message for me has been--I spent several years of my life obtaining a PhD to what end? I've already talked in the past about how a research career seems silly with its less pay, more hours, less stability, more restriction. Now to me it seems to me that even though I obtained a highly technical PhD directly applicable to my clinical specialty, it means little to nothing and the opportunities for research are minimal and not worth it.

So my new goal in life is to be a part-time or teleradiologist in a ski town like Park City or Sun Valley or Jackson. Or maybe on the Florida keys. Life is too short to worry about this stuff. I just want to be happy in life. If I just sit back and relax and stop worrying about it, I'll match somewhere, and I'll become a clinician no matter what I do. My options as a clinician will be much broader. I'll have much more ability to negotiate my hours, my salary, my office space, my location, my support staff, etc...

I feel a lot better talking to the others who are near me in training level. The other grad students feel the same way I do about PIs who don't know anything just exploiting us for free labor with zero support and as a buffer for their political battles. The MD/PhD fellows and attendings are mostly either in private practice or heading there for all these reasons I'm talking about.

Why research at all?

So why should I stay in research? There's only three reasons I've heard.

a) Prestige. So what, I don't give a rats ass about prestige, and you're talking to the wrong guy on this one.

b) Private practice is going to become a bad option and you'll be begging to come back to academics. Yeah whatever, been hearing that the sky is falling for over five years and little has changed.

c) I wasted my PhD or my talent. Nah, I didn't waste three years of my life. Med school is still free. I got a lot of time off to explore the world for the first time. If I am talented... If I had something to share with the world, you'd think the world would want to support it. It's very bizzare to me to train all these MD/PhDs to go into a clinical world that doesn't care about research. All those MD/PhDs who have to battle for 30th percentile K08 funding rates and 10th percentile R01 funding rates.

On that topic of exploring the world... Maybe that's why I did this to begin with. I've been so insulated, so busy fighting my way out of a paper bag that I was born into, that I never got to see there was a world out there. I had no idea what I was getting myself into. I worked for a few years before MD/PhD and my buddies who didn't even go to college have been making close or over 100k the whole time I've been in my program. There is a world out there, and my goal is to enjoy it, not spend the rest of it fighting for a grant. Not constantly proving myself over and over and over again. Not wishing that I wasn't so lonely or that the women I loved could stay near me but oh crap they have to go find a med school or a residency and guess what... So do I.

My graduate PI always said anyone with a MD or MD/PhD is a bozo and their work should more or less be ignored because they are sub-par researchers. So why bother doing research at all?

Addendum: Doomsday

Before anyone accuses me of tunnel vision, I've been around. I've seen a few other departments now, and it seems like doomsday. The only difference is that at some institutions the clinical department supports the basic department. Where the clinical department doesn't provide any support to the basic department, I'm amazed at how bad things are. I've seen PIs with tenure run out of funding and get sent home. These guys are bickering over who will pay for equipment worth $100 or how rotating students will get paid for. I've seen PIs miserable with life due to politics out of their control that strongly impede their research. These politics born out of policies that are more to paranoidly protect the institution and its clinical practices, the #1 priority. The belief everywhere that, hah, if you don't like things, go somewhere else. Oh wait, it's bad everywhere, so you're stuck here. I'm just glad I'm not a PhD.

But I'm very glad I had a year off so I can sit around and take it easy and reflect on life. That's the greatest thing the MD/PhD program and freedom from debt gave me. Would I recommend MD/PhD to others? I don't know. Freedom from crushing debt is still a damn good reason to do it, no matter what you end up doing in life. Oops, did I say that out loud, that doing MD/PhD for the money isn't a bad thing? Shoot me.

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[echod]

Residency admissions is controlled by clinicians who do not really know what is basic science research. They might have done some research during undergrad, med school, and fellowship--they have not experienced the depth of despair that comes when a project hasn't been progressing for two years. When it comes time to get funding, all the peer reviewers do not care about our performances in the clinics. Add to that, there are too few physician scientists to matter in any type of decision making.

 

[dl2dp2]

I think the biggest lesson learned from your rant is this:
if you want to do research, don't do radiology.

it's just kinda sad though that radiology as a field is so antagonistic to researchers, but not by any means surprising, and historically accurate.

I hear a completely different tune from residency directors in neurology, psychiatry, internal medicine, pediatrics and pathology. And even radiation oncology and optho. Rads happen to be a very special case, in league with OB/GYN, gen surg and some others. Just want to make sure you don't mislead anyone on the board here.

 

[solitude]

I think the biggest lesson learned from your rant is this:
if you want to do research, don't do radiology.

it's just kinda sad though that radiology as a field is so antagonistic to researchers, but not by any means surprising, and historically accurate.

I hear a completely different tune from residency directors in neurology, psychiatry, internal medicine, pediatrics and pathology. And even radiation oncology and optho. Rads happen to be a very special case, in league with OB/GYN, gen surg and some others. Just want to make sure you don't mislead anyone on the board here.

is this really true? I have heard the same thing at my school...Neuronix your thoughts? It just seems really extreme to me that your chances for getting a good residency are poor given your research credentials. But maybe it really is particular to Rads? Do you think you would feel differently if you were interested in IM or Peds or Neuro or whatever?

and thanks for writing up your thoughts. It's really interesting to hear that introspection, and there is a lot of validity there in my opinion.

 

[Neuronix]

is this really true? I have heard the same thing at my school...Neuronix your thoughts? It just seems really extreme to me that your chances for getting a good residency are poor given your research credentials. But maybe it really is particular to Rads?

My research credentials just don't matter to clinicians. I think echod summed it up very well. They don't know about research and they don't care about research. All they care about is clinical grades and step scores and the same stuff they care about for MD students. I might have an increased shot at "research" residencies, but even those are very competitive in specialties like Radiology and MDs are very competitive for those spots with a few months to a year of research.

and thanks for writing up your thoughts.

No problem. I was concerned I'd get a lot of negative feedback, but I'm glad I didn't. To summarize, I always thought my PhD would be an asset, but in reality it doesn't seem to benefit me at all. It's very frustrating to me to see how little the real world (in my field) seems to value physician-scientists after all I invested into it.

 

[QofQuimica]

I think the biggest lesson learned from your rant is this:
if you want to do research, don't do radiology.

it's just kinda sad though that radiology as a field is so antagonistic to researchers, but not by any means surprising, and historically accurate.

I hear a completely different tune from residency directors in neurology, psychiatry, internal medicine, pediatrics and pathology. And even radiation oncology and optho. Rads happen to be a very special case, in league with OB/GYN, gen surg and some others. Just want to make sure you don't mislead anyone on the board here.

This was my thought too. It's hard to make headway when you're constantly fighting against the tide. There's a reason why most MD/PhDs go into certain select specialties like path, IM, peds, rad onc, neuro, and maybe a few others. You can still be a researcher in surgery, but IMO your path will be a lot smoother in these kinds of fields if your research is clinical, not basic. I'm doing clinical research for my post doc in a field (anesthesiology) that has not traditionally had a lot of MD/PhDs. But I've been getting a lot more positive responses from PDs than you unfortunately have, Neuro. I'm not sure you should necessarily be so down though. You seem to have this habit of beating all the odds in spite of people saying that you won't.

Have fun in Thailand, and take lots of pics.

P.S. We are your (virtual) friends. Friends don't kick a man when he's down.

 

[Neuronix]

There's a reason why most MD/PhDs go into certain select specialties like path, IM, peds, rad onc, neuro, and maybe a few others.

The crazy thing is that according to JPaik's data (http://www.dpo.uab.edu/~paik/match.html) Rads is #4 most popular for MD/PhDs!

I'm not sure you should necessarily be so down though. You seem to have this habit of beating all the odds in spite of people saying that you won't.

I can beat the odds if I really fight for it. That's what I've been doing all my life. I think anyone can do it. It just takes the willpower, and I'm not sure I'm interested in fighting anymore.

Have fun in Thailand, and take lots of pics.

Thanks will do

 

[Doctor&Geek]

Friends don't let friends go into radiology.

EDIT: Also, the more residency directors clamp down on MD/PhDs going into a dead-end research "career" in radiology, the better it will be for the research enterprise as a whole. I think I might grow the hate those PDs and faculty (not only Rads) that offer an illusion of a research heavy career in their specialty prior to residency, only to have our poor graduates wake up from a bad dream (and a lucrative position in private practice). Too bad these guys stuck the US government with their $300,000+ training bill.

The solution? Start right now. Actively dissuade MD/PhDs from going into radiology, unless so well-qualified to obtain a position at institutions which really do support research (of which I might count less than five).

 

[QofQuimica]

Friends don't let friends go into radiology.

Heh. I have to confess that radiology, while incredibly useful and necessary, really bores me. During radiology rounds, I can barely keep my eyes open, and I swear it screws up my circadian rhythm to be sitting in such a dark, quiet room in the middle of the morning. But I wish I loved rads, because the rads residents are seriously some of the happiest trainees I have ever encountered in the whole hospital. And yeah, the nice income and lifestyle they get afterward if they're full-time clinicians is pretty sweet too.

 

[Tradewind]

Friends don't let friends go into radiology.

Food for thought:

1. You'll be heavily recruited by other fields. You will.

2. Give psychiatry, neurology, IM, pathology, nuclear medicine a chance on your clinicals. You might find you like them a lot more than even your radiology rotation. After all, correct me if I'm wrong, but your exposure to radiology is all in the research setting. Not what a resident actually does.

3. If you decide you want to go into radiology and become a clinician, you will get in somewhere. Maybe not the most competitive places in the nation (I don't know; I'm not familiar with radiology residency application stats), but if you want to be a clinician, who cares where you go? There are plenty of good programs outside of UCSF radiology, right?

4. Start on psychiatry when you go back to clinicals. Don't do OB/GYN near the beginning.

5. Program directors are typically MD's with little research experience, so of course if they are insecure (or even if they aren't) they are going to have some resistance to someone who emphasizes research too much. Don't emphasize it with them, and take what they say with a grain of salt. You are a very desirable commodity in the big picture. Chairmen and full professors will view your research more positively, and they will have a say in the selection process when it comes to residency applications.

6. You still have all of 3rd year to decide (I think?), but if you're still unsure about what specialty to go into, apply to 2. I guess the only difficulty would be if you selected one in the normal match process and one in the early match process... But cross that bridge when you get to it. See how you do in your clinical rotations first. I just read in the psychiatry forum that sometimes a specialty selects/finds you. That often happens - see what finds you in 3rd year.

7. Maybe radiology is not for you. I don't know. I do know a handful of radiologists who despised it so much they switched over to psychiatry. They felt depressed, lonely and isolated in the dark room for hours upon hours. And viewing so many films and regurgiating dictations made them sick. I can't speak for the radiologists who are happy, because I don't interact with them much. They are probably PP docs working on their laptops on the beach.

8. Thailand, huh... Be safe.

 

[Neuronix]

6. You still have all of 3rd year to decide (I think?)

7. Maybe radiology is not for you. I don't know. I do know a handful of radiologists who despised it so much they switched over to psychiatry.

Thanks everyone for your comments. On this one I just wanted to chime in that I've had six months of third year including Neurology, Psychiatry, and IM. I was glad at the time because my experiences solidifed my desire to do Radiology. So I did my PhD in Radiology expecting something that I never found -- stable and abundant careers in basic Radiology research. I also thought it might give me a leg up for residency and my future career, but it turns out that academics means mostly clinical and the research that is done is almost always very clinically oriented.

 

[Tradewind]

Right, I remember something like that...So have you actually rotated on a standard radiology rotation in that 6 months? And what made you decide radiology was the one, as opposed to the other clinicals you rotated on? What rotations do you have left?

 

[Neuronix]

So have you actually rotated on a standard radiology rotation in that 6 months?

No. I tried to squeeze one into my schedule in various places, but the rotation is in high demand and not always offered. I shadowed a MD/PhD in Rads numerous times, though he ended up dying one night in his sleep

And what made you decide radiology was the one, as opposed to the other clinicals you rotated on? What rotations do you have left?

I've just liked all my Radiology exposures. I was much more drawn to the Radiology cirricula within each block than I was the individual cirricula. I don't want to bash on other specialties, but I couldn't see myself doing Neuro or Psych. I didn't like IM at all. In fact, I hung out with the dual board Rads/nucs guy at the hospital where I did IM whenever I had free time.

Remaining of my cores I have:

Surg, gas, ob, peds

When I started med school I was extremely interested in surgery and I still do think it's really cool. But I just don't want that lifestyle.

After the cores I have to essentially make a decision. If I want to do Rads I should probably do an away because I want to go to mountains or west coast. I need to take Step II CK early and do very well. This leaves time for maybe one elective outside of Radiology before I have to decide.

 

[ClarinetGeek]

I think the biggest lesson learned from your rant is this:
if you want to do research, don't do radiology.

it's just kinda sad though that radiology as a field is so antagonistic to researchers, but not by any means surprising, and historically accurate.

I hear a completely different tune from residency directors in neurology, psychiatry, internal medicine, pediatrics and pathology. And even radiation oncology and optho. Rads happen to be a very special case, in league with OB/GYN, gen surg and some others. Just want to make sure you don't mislead anyone on the board here.

I had the exact same reaction as sluox to Neuronix's post. I have seen a number of departments bend over backwards for physician-scientists-to-be both during residency and especially during fellowships. I don't think the outlook is as bleak outside of radiology. However, I agree that every aspect that Neuronix mentioned pops up for ALL of us along the way, but the situtation may not be as severe and the fight not as difficult. Boy I am glad that I wanted to poke both of my eyes out during my rads rotation. I was so bored. I enjoy the preclinical imaging project for my dissertation, but I could not be clinical radiologist.

Keep fighting Neuronix! I hope you find a path that makes you happy whatever that path may be.

 

[Tradewind]

Okay, I see your dilemma.

But there's still time, and you could change your mind about things.

And, in addition to radiology, which still sounds like a clear possibility, there's still anesthesiology or a surgical subspecialty. And maybe pathology, derm, optho or PM&R? Or what about going into NM first, getting your foot in the door, then getting the radiology training? Somehow, I don't really see peds, though maybe I'm wrong, and I think OB/GYN is out.

Yes, we'll be cheering you on!

 

[Kickback]

Thanks everyone for your comments. On this one I just wanted to chime in that I've had six months of third year including Neurology, Psychiatry, and IM. I was glad at the time because my experiences solidifed my desire to do Radiology. So I did my PhD in Radiology expecting something that I never found -- stable and abundant careers in basic Radiology research. I also thought it might give me a leg up for residency and my future career, but it turns out that academics means mostly clinical and the research that is done is almost always very clinically oriented.

This is what I have heard from a number of different people already. An MD/PhD that I know went back into industry to do research, because of a lack of protected research time.

A comment that my PhD advisor in BME made to me is sticking even more now: "I haven't ever really needed the MD for any of my research". If the MD doesn't help, is a b*!@# to get and life-draining, and I want to do cutting edge technical research (like programming stuff), I'm beginning to think that the MD isn't worth it.

 

[Neuronix]

Or what about going into NM first, getting your foot in the door, then getting the radiology training?

Everyone says I should match, so foot in the door tactics shouldn't be necessary. I hope. If I don't match I'll be surprised, but devistated. It's just a question of things like where to apply, how many to apply to (30ish it seems), how to rank, etc... Also transitional years. Ugh!

 

[QofQuimica]

Everyone says I should match, so foot in the door tactics shouldn't be necessary. I hope. If I don't match I'll be surprised, but devistated. It's just a question of things like where to apply, how many to apply to (30ish it seems), how to rank, etc... Also transitional years. Ugh!

At some point, you have to make the best decision you can with the info you have so far, and then let the computer decide. Sure, we all know anecdotal cases of this or that person who was a "sure thing" and had to scramble. But as with med school admissions, we never know the whole story (LORs, interview results, etc.). And the vast majority of people don't scramble if they get enough interviews and they rank enough programs. So I think you may be overthinking this whole thing right now. It's way too early to be in this much despair over a few negative discussions with a few individual PDs. For now, just get through the rest of your rotations. You aren't applying until next summer anyway, so you have plenty of time to figure out what you want to be when you grow up. There's no need to stress yourself out by trying to get it all settled right this second.

 

[Neuronix]

There's no need to stress yourself out by trying to get it all settled right this second.

Very true. What brought this all up is trying to make a schedule for the remainder of third year and fourth year. In that process I had questions like do I need to take Step II CK early and should I do away rotations. I also need to figure out how to prioritize taking rotations in other specialties. But also in those conversations with a couple residency adcoms, they wanted to speculate on how well I'd match, where I should try to match (lower tier academic was the consensus), etc...

 

[Neuronix]

And maybe pathology, derm, optho or PM&R?

While we're on the topic, how am I supposed to know I don't want to do Rads, Rad Onc, Derm, Path, or PM&R? There's no required rotation at my school in any of these specialties and MD/PhDs don't have time to rotate in all of them.

 

[Tradewind]

Good question, but for you, it sounds like you could get in an extra 6 months of clinicals prior to applications, since you have 6 months under your belt already. That is, unless you're deadset on returning to med school in January 2010...

The other way would be to select required alternatives that will serve you as electives. Ie, if you're required to complete an acting internship in surgery, pick something you might actually do - say, ENT? Or see if they'll bend the rules for you, so that for your required medical subspecialty rotation or subI, you could select derm, radonc, PM&R or pathology. If you throw calls in and beef it up, they might agree. Or maybe you could substitute a required ER rotation with anesthesiology. Not sure they'll go for these alternatives, but it doesn't hurt to ask..

If you only have 1-2 elective months, I guess you'll be triaging which rotations you're most interested in. Probably radiology then something else (?)

I know at Columbia, MD/PhD students have very little required in terms of clinicals. You could try to compare your clinical expectations with those of Columbia, and say, "Hey, look at all this that I'll be doing!"

But first, you should totally enjoy your vacation! You certainly deserve it, especially before going back to clinicals.

 

[gstrub]

You should seriously consider radiation oncology as an elective and potential alternative to straight rads. It seems to me that field might assuage some of the concerns you've raised (not enough value in the MD/PhD, little protected time, etc), while at the same time staying somewhat relevant to what you've already done (it says radiation in the title!). Plus those guys make bank and have great lifestyles from what I've heard...plenty of opportunity for you to see the world, so to speak.

 

[mercaptovizadeh]

Thanks everyone for your comments. On this one I just wanted to chime in that I've had six months of third year including Neurology, Psychiatry, and IM. I was glad at the time because my experiences solidifed my desire to do Radiology. So I did my PhD in Radiology expecting something that I never found -- stable and abundant careers in basic Radiology research. I also thought it might give me a leg up for residency and my future career, but it turns out that academics means mostly clinical and the research that is done is almost always very clinically oriented.

I would think IM and neurology are important to do well on for a radiology application. It sounds like you may not have gotten honors on them. Can you try to compensate by doing a medicine AI and acing it, and then perhaps radiology electives (neuroradiology?) either at Penn or as away rotations at other prestigious institutions, and then do well on these? Are you able to identify what it is that's preventing you from getting honors? You're a smart hardworking person, so I have to think it's somehow personality issues that are clashing with the resident/attending. Perhaps you are as outspoken on the rotation as you are here, which is a no-no at this level; it seems they want complete and voluntary submission and subordination from medical students.

You're right, though, for many specialties Step I and 3rd year are >> than PhD. I didn't realize that was the case with radiology, unfortunately.

If you are interested in a particular field of radiology, can you try to enter it from another route, i.e. neurology > interventional neuroradiology?

 

[mercaptovizadeh]

Another question is what's drawing you to radiology in the first place. I could see it as being more of a pathology/disease focused discipline rather than interacting with patients, the fact that it involves physics, the money, and the lifestyle.

There are other specialties that offer some of the above as well. Rad onc is probably closest, with more patient involvement, but still interesting medical physics going on there. Path is another. Anesthesia another - not much physics but a lot of pharm and physio there and patient interaction is minimal, so to speak.

You said you found surgery interesting but didn't want the lifestyle. What about a medicine subspecialty that's highly procedural, like GI?

At any rate, it does sound like you'll end up doing radiology, and if that's your first love, that's what you should do.

 

[RxnMan]

Before I write this, I know the responses I'll get in advance...

A couple of things.

1) I have read your posts over the last few years, and I understand your frustrations. I chose not to go for a full PhD for many of the reasons you've outlined, but plain and simple - it's a brutal path with uncertain rewards. No matter what you choose, some will see you as a mediocre clinician or scientist.

2) You made a good decision to take time off. Get your head clear. Find out what is valuable to you. You're doing some of it already. Try different thoughts out - like telerads - and see how they fit. If it doesn't work, try another idea. You've been through hell, but you got what you wanted - the PhD - so there is no better time to clear yourself from the things that have been holding you down.

3) Others should read Neuronix's story and understand that his experience is pretty common. Common for grad students and for med students. Grad students get taken advantage of, and they only get their degree when their PI can't keep them in slavery any more.

Many of my medical classmates are finding out that they can't have everything anymore. There are some doors shut to them. What they feel is important (hobbies, Africa mission trip) isn't always important to PDs.

...My research credentials just don't matter to clinicians...

There are some real anti-research clinicians out there. I don't know if some clinicians feel it is a waste of resources, or if they are intimidated, or if comes from ignorance. The lesson here is that, just like getting into med school - you need to have what admissions is looking for. In med school it was GPA + MCAT. Residency, it's clinical grades + USMLE. Research may be a nice add-on, but I think it's disingenuous to say that it can replace poor performance (clinicals or USMLE) or change an average applicant into a star.

The crazy thing is that according to JPaik's data (http://www.dpo.uab.edu/~paik/match.html) Rads is #4 most popular for MD/PhDs!...

I think a lot of MD/PhDs get fed up during their training, bail on research careers, and go into ROAD residencies on the back of their federally-funded degrees. I've met a number of MD/PhD students, and many tell me "oh, if I don't like research, I can always go into PP Rads/Derm/Optho/etc.

...The solution? Start right now. Actively dissuade MD/PhDs from going into radiology, unless so well-qualified to obtain a position at institutions which really do support research (of which I might count less than five).

This is what the deans and counselors of med schools are supposed to do. They are supposed to look at the student's records, before they apply, before they choose a field, and see what they're competitive for.

 

[itsallthesame]

"a) Prestige. So what, I don't give a rats ass about prestige, and you're talking to the wrong guy on this one."

You are lying to yourself. If there is one thing that I have learned from reading your posts over the years, you CARE about rankings. You CARE about money. You care about being at the best schools.

The only person who is technically better than me at rads research is at UCSF. Right.

If you are as good as you say you are, you should be able to do your residency in the Caribbean with a cardiologist as your PI and succeed.

You know what? You can't win at everything. You can't have your cake and eat it too. Just because you are a pretty smart dude who got into a good md/phd program, doesn't mean that you can just have a perfect career that's exactly how you design it. ALMOST NO ONE IN THE WORLD GETS THIS. Suck it up. Stop lying to yourself, play the game as well as you can, and DEAL WITH IT.

If you want to do practice medicine, clinical skills SHOULD BE PUT FIRST BECAUSE YOU WILL KILL PEOPLE IF YOU DON'T. You have only yourself to blame for not being AOA.

You need to pick a life: do you want money? Focus on clinical stuff from here on out and forget research entirely. Do you want research? Then go for a post-doc with the best PI you can and forget residency and money. Do you want to be a physician/scientists? Forget money and years of your life, do a residency and then maybe a post-doc if you have to work with the best of the best and try for a basic science dept appointment.

AND finally... if you're really surprised that you can't make great money, do the research under the best PIs, and do a residency in the competitive field of your choosing, ALL WITHOUT HAVING BOTH A GREAT PHD AND BEING AN HONORS STUDENT, you should have done your homework before starting the program, worked harder to get AOA, or more realistically assessed your ability to be a strong medical student.

 

[mercaptovizadeh]

"a) Prestige. So what, I don't give a rats ass about prestige, and you're talking to the wrong guy on this one."

You are lying to yourself. If there is one thing that I have learned from reading your posts over the years, you CARE about rankings. You CARE about money. You care about being at the best schools.

The only person who is technically better than me at rads research is at UCSF. Right.

If you are as good as you say you are, you should be able to do your residency in the Caribbean with a cardiologist as your PI and succeed.

You know what? You can't win at everything. You can't have your cake and eat it too. Just because you are a pretty smart dude who got into a good md/phd program, doesn't mean that you can just have a perfect career that's exactly how you design it. ALMOST NO ONE IN THE WORLD GETS THIS. Suck it up. Stop lying to yourself, play the game as well as you can, and DEAL WITH IT.

If you want to do practice medicine, clinical skills SHOULD BE PUT FIRST BECAUSE YOU WILL KILL PEOPLE IF YOU DON'T. You have only yourself to blame for not being AOA.

You need to pick a life: do you want money? Focus on clinical stuff from here on out and forget research entirely. Do you want research? Then go for a post-doc with the best PI you can and forget residency and money. Do you want to be a physician/scientists? Forget money and years of your life, do a residency and then maybe a post-doc if you have to work with the best of the best and try for a basic science dept appointment.

AND finally... if you're really surprised that you can't make great money, do the research under the best PIs, and do a residency in the competitive field of your choosing, ALL WITHOUT HAVING BOTH A GREAT PHD AND BEING AN HONORS STUDENT, you should have done your homework before starting the program, worked harder to get AOA, or more realistically assessed your ability to be a strong medical student.

In all honesty though, while there may be some truth here, you lack perspective to be talking this way to him. You don't understand what the Step 1/2 are like till you've done them, nor do you understand what's involved in getting AOA, nor in getting a PhD.

The reality is that we're all very lucky and that most of the rest of the world doesn't have the luxury to have all these career options (and money options!) open to them.

 

[RxnMan]

"a) Prestige. So what, I don't give a rats ass about prestige, and you're talking to the wrong guy on this one."...

Of course, because we live in the land of black and white, where nobody can change their mind.

...You know what? You can't win at everything. You can't have your cake and eat it too. Just because you are a pretty smart dude who got into a good md/phd program, doesn't mean that you can just have a perfect career that's exactly how you design it. ALMOST NO ONE IN THE WORLD GETS THIS. Suck it up. Stop lying to yourself, play the game as well as you can, and DEAL WITH IT...

Watch out buddy, this applies to you too. Hope you don't find yourself down the road a few years, crying and having a hard time walking after your PI gave it to you good because you couldn't get your experiment to work.

...AND finally... if you're really surprised that you can't make great money, do the research under the best PIs, and do a residency in the competitive field of your choosing, ALL WITHOUT HAVING BOTH A GREAT PHD AND BEING AN HONORS STUDENT, you should have done your homework before starting the program, worked harder to get AOA, or more realistically assessed your ability to be a strong medical student...

You have no idea of the amount of work it takes to do any of what you suggest. You have no idea of the amount of work it takes to do what Neuronix did, as much as you look down on him. And if you think you have an idea, you don't.

Well, there you have it Neuronix, your negative response. Funny how it came from the pre-med...

 

[smq123]

You are lying to yourself. If there is one thing that I have learned from reading your posts over the years, you CARE about rankings. You CARE about money. You care about being at the best schools.

Since when? Since when has Neuronix EVER, since being a med student, posted anything about how much the best schools and the best rankings matter to him? Or are you just pulling these insults out of your a**?

And yeah, he cares about money. So what? I care about money, too. So do 99% of all med students I've ever met. What would your point be?

The only person who is technically better than me at rads research is at UCSF. Right.

If you are as good as you say you are, you should be able to do your residency in the Caribbean with a cardiologist as your PI and succeed.

a) Obviously you don't know that much about the little rads research that is being done. The cutting edge stuff isn't being done everywhere - the most technologically advanced stuff is coming out of a small select group of institutions. UCSF is one of those places.

b) Your statement that he ought to "be able to do a residency in the Caribbean with a cardiologist and succeed" makes ZERO sense whatsoever. What are you trying to even say?

You know what? You can't win at everything. You can't have your cake and eat it too. Just because you are a pretty smart dude who got into a good md/phd program, doesn't mean that you can just have a perfect career that's exactly how you design it. ALMOST NO ONE IN THE WORLD GETS THIS. Suck it up. Stop lying to yourself, play the game as well as you can, and DEAL WITH IT.

The more I read your post, the more it seems like you were just waiting for an excuse to jump down Neuronix's throat for no apparent reason.

He's not lamenting the fact that he can't have a picture perfect career that is exactly how he designed it. He's (understandably) frustrated at the fact that research matters less than he had thought. That the ideas he had before starting grad school turned out to be false ones. And that he's interested in a career that doesn't seem to value either his research skills, or the extra time he put in getting that PhD.

NOW do you get it?

If you want to do practice medicine, clinical skills SHOULD BE PUT FIRST BECAUSE YOU WILL KILL PEOPLE IF YOU DON'T. You have only yourself to blame for not being AOA.

WHERE in that post did Neuronix say that clinical skills DON'T matter? Go ahead and quote it, because I sure as heck don't see it.

And, while you may not realize this yet at the extremely early point in your training, but there are many aspects to medicine. There are, of course, the clinical aspects. There are also the research and teaching aspects. THESE ALSO NEED TO BE VALUED BECAUSE PEOPLE DIE WHEN THERE IS LITTLE RESEARCH BEING DONE IN CERTAIN DISEASES OR BECAUSE PEOPLE WERE POORLY TRAINED.

Not everything in medicine needs to center around the clinical aspects.

You have only yourself to blame for not being AOA.

And he has only himself to blame for not being AOA?

Yeah, sure, you keep telling yourself that. Let's see what happens in a few years after you finish your first rotation of third year, and then run to SDN to whine that you worked hard, and studied REALLY hard, and stayed late, and came in on weekends, and you STILL only got a "Pass" on internal medicine.

What, you think it's just that easy? You just waltz into third year, fake enthusiasm, come to work on time everyday, and study for the shelf, and that will get you honors every time?

Let me tell you, after having survived two years on the wards, that it is DEFINITELY not that easy. No way, no how. But you keep pretending to yourself that it is that easy. Go right ahead.

AND finally... if you're really surprised that you can't make great money, do the research under the best PIs, and do a residency in the competitive field of your choosing, ALL WITHOUT HAVING BOTH A GREAT PHD AND BEING AN HONORS STUDENT, you should have done your homework before starting the program, worked harder to get AOA, or more realistically assessed your ability to be a strong medical student.

**FACEPALM**

Not only are you naive, with little understanding of how the whole rotation/match/residency system works, but you didn't even understand the basic gist of Neuronix's post.

Well, there you have it Neuronix, your negative response. Funny how it came from the pre-med...

Agreed. Although I don't think it's strange or ironic that it came from a pre-med - what else could you expect? Only the people who haven't been there have no idea of how hard it can actually be....

 

[LadyLightning20]

I can beat the odds if I really fight for it. That's what I've been doing all my life. I think anyone can do it. It just takes the willpower, and I'm not sure I'm interested in fighting anymore.

I have been following this forum for a while and this is the scariest thing I have heard anyone say here. Because I have believed all my life that I can do whatever I want to as long as I fight hard enough for it and it terrifies me that someone with your credentials and drive (and clearly endurance) can get hit hard or long enough to not make it worth fighting anymore.

 

[GliaGirl]

Yeah, this is a fantastic mess that we've all gotten ourselves into. What kind of psycho WANTS to go into a career with ~80 hour work weeks? And to have to deal with all of the stress and politics on top of it is cruel and unusual punishment. We're all mental! I'm sure I'll be feeling pretty much the same way in a few years...

Who can shed some light on this for me: neuroimaging - the same problems or not?

I think that its super cute how much everyone <3s Neuronix.

 

[mercaptovizadeh]

I think that its super cute how much everyone <3s Neuronix.

Probably because he demonstrates a candidness about touchy issues few others do.

 

[Neuronix]

You should seriously consider radiation oncology as an elective and potential alternative to straight rads.

That's the specialty I'm most considering now instead of Rads, though it's entirely because of what others say. I have had no exposure to it and have no idea what they do. So I'm not sure if I should be interested or not We'll see.

But first, you should totally enjoy your vacation! You certainly deserve it, especially before going back to clinicals.

Thanks I'll be structuring my electives with my program to come out with something. It's just a matter of balancing other possible electives with Step II CK and aways. I'm told I should schedule my Rads aways about a year in advance or else they fill up, but am I even sure about Rads yet?

I would think IM and neurology are important to do well on for a radiology application. It sounds like you may not have gotten honors on them.

Straight high passes with almost all positive evals, except for being told I'm too slow because I spent too much time with patients on FP (this sunk my honors on that one).

Can you try to compensate by doing a medicine AI and acing it, and then perhaps radiology electives (neuroradiology?) either at Penn or as away rotations at other prestigious institutions, and then do well on these?

The advice I have gotten is to honor as many things clinically as I can. Though I should let everyone know that nobody cares about honors in Radiology. In Rads little is expected of med students, because there's little they know about Rads and few ways in which they can help, and it's typical that all students going into Rads get an automatic honors in Radiology. It's typical for no letters to come from Radiologists, and the Radiologists want to see honors in patient care specialties.

Are you able to identify what it is that's preventing you from getting honors?

Unfortunately I have been unable to identify it. I could speculate, but this worries me. I have no plan of attack.

You're a smart hardworking person, so I have to think it's somehow personality issues that are clashing with the resident/attending. Perhaps you are as outspoken on the rotation as you are here, which is a no-no at this level; it seems they want complete and voluntary submission and subordination from medical students.

Yeah, that would be a convenient reason and something easy for me to fix if it were the case. But I don't think it is. I'm a very different person IRL than I am on this board.

If you are interested in a particular field of radiology, can you try to enter it from another route, i.e. neurology > interventional neuroradiology?

That's not my interest, but thanks anyways.

2) You made a good decision to take time off. Get your head clear. Find out what is valuable to you. You're doing some of it already. Try different thoughts out - like telerads - and see how they fit. If it doesn't work, try another idea. You've been through hell, but you got what you wanted - the PhD - so there is no better time to clear yourself from the things that have been holding you down.

Unfortunately I have no idea what a telerads job is like. I don't know any teleradiologists. There's not really any way to find out as far as I can tell. Asking about it is a sure way to provoke the ire of everyone around you.

Many of my medical classmates are finding out that they can't have everything anymore. There are some doors shut to them. What they feel is important (hobbies, Africa mission trip) isn't always important to PDs.

That's fair. I just thought research would be important to PDs. It seems that if you read the Radiology forums (not on SDN) a few months of fourth year research is that "research" required to break into the top "academic" programs.

Residency, it's clinical grades + USMLE. Research may be a nice add-on, but I think it's disingenuous to say that it can replace poor performance (clinicals or USMLE) or change an average applicant into a star.

For the record, my performance is in no way poor. Apparently it just isn't good enough.

I think a lot of MD/PhDs get fed up during their training, bail on research careers, and go into ROAD residencies on the back of their federally-funded degrees. I've met a number of MD/PhD students, and many tell me "oh, if I don't like research, I can always go into PP Rads/Derm/Optho/etc.

I've met a number of MD/PhDs going into IM/Path/Peds who also have no desire to continue in research. I think the ROAD specialties are unfairly stereotyped in this regard. To be fair though, I have seen those set on research in Radiology bail into private practice due to these reasons I'm discussing.

You are lying to yourself. If there is one thing that I have learned from reading your posts over the years, you CARE about rankings. You CARE about money. You care about being at the best schools.

No idea where you got this crap.

The only person who is technically better than me at rads research is at UCSF. Right.

Ok, MGH, NINDS... There's a few others, all at top places, though I wonder how would you do research at the NIH during residency? To be fair, WashU has some strong people, but St. Louis *Shudder*. Oh crap, this exposes a serious weakness in my argument. Location matters to me also. It's not 100% all about the research. It's very limiting and I don't really know how to prioritize.

If you are as good as you say you are, you should be able to do your residency in the Caribbean with a cardiologist as your PI and succeed.

I have considered this. Though I would like to grow under a very knowledgeable mentor, not stagnate.

AND finally... if you're really surprised that you can't make great money

Where did I mention anything about money?!

Well, there you have it Neuronix, your negative response. Funny how it came from the pre-med...

It's ok. I got my share from the SDN chatters too. Though I scared the heck out of the other guy going into Rads I mean there is a good point there from the pre-med, if I'm going into a competitive specialty--I should expect it to be competitive. I just expected my research to matter.

I wanted to post what I did as a warning to the other students. As always, I could internalize all my thoughts, but why keep it all inside? I don't think my experiences and thoughts are very atypical and I think I serve to inform others going through or to be going through the same process. But hey, this fear of hearing "you're a bitter, angry, cynical person" or "you're a weirdo and nobody else feels this way" or "stop complaining because you're not good enough" or "nobody else cares what you think" does stop most other students from posting so frankly.

I have been following this forum for a while and this is the scariest thing I have heard anyone say here. Because I have believed all my life that I can do whatever I want to as long as I fight hard enough for it and it terrifies me that someone with your credentials and drive (and clearly endurance) can get hit hard or long enough to not make it worth fighting anymore.

Who can shed some light on this for me: neuroimaging - the same problems or not?

I did my PhD in Neuroimaging you know

I think that its super cute how much everyone <3s Neuronix.

Where's all the hotties that <3 me

 

[pseudoknot]

My apologies if I missed discussion of this option (I think I've read the whole thread but could have overlooked something).

Since it seems like you shouldn't have a problem matching somewhere decent for radiology, could you just go to whatever program and focus on clinical training, then do a research fellowship at a better institution? It doesn't sound like you'd likely be able to do a substantial amount of research during residency proper anyway, since AFAIK they don't have much protected time for it in that field.

 

[echod]

You could ask PDs when interviewing whether they would allow you to go somewhere and do research during the protected research times. I don't know if a question like this would offend PDs by implying their research sucks though.

 

[Kickback]

To be fair, WashU has some strong people, but St. Louis *Shudder*

HEY HEY HEY... don't be hating. It's not *that* bad. On a scale of backward-ness from modern to stone age, we're about renaissance

The weather now doesn't help the cause much, though.

 

[Doctor&Geek]

Beware the same sorts of things occur in Radiation Oncology as well, though I'm sure not to the same level as Radiology. They like research, but they have few real 80/20 physician scientists. Ask how many R01-funded investigators a department has - chances are 0, 1 in a mid level department, and any more than that you're looking at the top programs.

Again, only a handful of residency programs will support research anywhere to the level required to successfully transition to independent investigatorship, except this time, the number of positions available is like 10% that of radiology.

EDIT: FYI if I applied to RadOnc and matched anywhere outside of these programs, chances would be high I would leave academia: UCSF, Stanford, Yale, Chicago, Harvard, Michigan, WashU, Sloan Kettering, Penn, Vanderbilt, and MDAnderson. That's about 40 or so positions per year, and I'd say about a third are filled by MD/PhDs.

 

[smq123]

Where's all the hotties that <3 me

Just be sure that all of the Thai hotties that<3 you are biologically female hotties....just sayin'.

 

[Neuronix]

Since it seems like you shouldn't have a problem matching somewhere decent for radiology, could you just go to whatever program and focus on clinical training, then do a research fellowship at a better institution?

This has been suggested to me. It comes with its own worries, like about how fellowships primarily care about clinical acumen and residency prestige. Also I'm concerned that fellowships are about to get much more competitive as Radiology residents are now all going to be forced to do fellowship, whereas in the past only ~50% have done fellowship. But, I think it may be a good idea to just forego research completely for residency. It would definitely lower my stress level. How much research can I get done in a year of time anyway? I've seen the research residents in Rads and they tend to treat the year as vacation for a few reasons.

This idea of not finding a "fast track" or "research" residency is very opposed to what the MD/PhD program has been telling me I should look for. But why fight the system?

HEY HEY HEY... don't be hating. It's not *that* bad. On a scale of backward-ness from modern to stone age, we're about renaissance

Backwardness doesn't bother me. It's just that my hobbies include beach sports and mountain sports.

 

[RxnMan]

...For the record, my performance is in no way poor. Apparently it just isn't good enough...

My statement was more of a warning to other prospective students reading your thread, and wasn't meant to reference your performance at all.

...I wanted to post what I did as a warning to the other students. As always, I could internalize all my thoughts, but why keep it all inside? I don't think my experiences and thoughts are very atypical and I think I serve to inform others going through or to be going through the same process. But hey, this fear of hearing "you're a bitter, angry, cynical person" or "you're a weirdo and nobody else feels this way" or "stop complaining because you're not good enough" or "nobody else cares what you think" does stop most other students from posting so frankly...

I think it's great that you tell your story. I don't think it's rare to have these sorts of situations happen. Applicants need to hear this when they're getting a rectal dose of aerosolized carbon from MD/PhD program directors.

 

[Vader]

My advice would be to just do your best on the remainder of your clinical rotations, Step 2 CK, and apply to a variety of programs. Radiology is an extremely competitive specialty, which you now well know. On the residency interview trail, I ran into an MD/PhD at one of my prelim interviews who was applying in rads and he mentioned many of the same issues/concerns that you have mentioned in your post. He was very surprised at how few programs actually considered his research an asset. This was quite a bit different from my own experience applying in neurology, which at most of the major academic programs, loves research and the PhD.

In a way, I agree with the gist of itsallthesame's post (though not the incendiary "tone"). I think it is really important to be realistic and have an accurate assessment of your potential for successfully applying in your field of interest. I also think that it is a very important lesson to learn that you really can't expect to have it all any longer. It is impossible to maximize all aspects of your life and there are by necessity trade-offs that must be made. For example, if you like beaches and mountains, that will obviously limit your program selection. If you like places that have strong research programs, that will further limit it. If you get involved in a relationship that becomes serious, this may limit the places you can go. Etc, etc.

As children of modern times we are used to being told that we can excel in everything, that the sky is the limit, that if you work hard enough and play by the rules, there is no barrier that cannot be overcome. This has strong roots in the ideal of the American Dream, Manifest Destiny, etc. Along the way, however, life teaches us the very difficult lesson that this simply is not true, that no matter how hard we work, sometimes it is beyond our capability to win or simply bad luck that results in poorer outcomes. This is certainly not a reason to give up if you find that you still believe in the "Dream".

I think the question you are facing is do you still believe in the "Dream" or was that dream just an illusion with no possibility for manifesting in reality? That is a question only you can answer.

 

[platon20]

I might have an increased shot at "research" residencies, but even those are very competitive in specialties like Radiology and MDs are very competitive for those spots with a few months to a year of research.

I think you're wrong about this. There's no freakin way an MD grad with 3-5 months of research is going to outshine a PhD with 3+ years of research experience and many more publications than the MD would ever have a shot at getting.

At research residencies, the only people you are competing with are other MD/PHDs. MDs dont stand a chance, unless the program director is really not as dedicated to research as he should be.

 

[Doctor&Geek]

At research residencies, the only people you are competing with are other MD/PHDs. MDs dont stand a chance, unless the program director is really not as dedicated to research as he should be.

Happens quite often.

 

[dl2dp2]

I think you're wrong about this. There's no freakin way an MD grad with 3-5 months of research is going to outshine a PhD with 3+ years of research experience and many more publications than the MD would ever have a shot at getting.

At research residencies, the only people you are competing with are other MD/PHDs. MDs dont stand a chance, unless the program director is really not as dedicated to research as he should be.

No. He's not wrong about it. While your statement is true for "research" residencies in IM, neuro, psych, peds and path, it's just patently false at rads. Actually, for rads, if your clinical grades aren't as good, it doesn't matter if you do a million years of research. My PD actually told me that if your grades are bad, having a PhD actually HURTS you when you apply. And I'm assuming she is also talking about the "research" residencies.

At the end of the day, there's some logic to it. There's VERY LITTLE applicable material any basic science research project has on the practice of radiology. What they are looking for are people who are willing to put up with scut and do hard work, not people who have extensive research background. And as far as the kind of research that people in high end radiology departments are doing--you definitely don't need a PhD to do it.

Whatever man. If the field of radiology doesn't care about MD/PhDs, then it's their loss.

Btw, my intrepertation of the fact that rads is #4 on JPaikman's list is that that's where all the MD/PhDs who got sick of research default on for a private practice career. According to Penn's data, the vast majority of MSTPs going into rads end up in private practice. So per se this doesn't mean that rads is good for research.

I think Vadar's post is an excellent one, and at the end of the day you have to realize that you have to make compromises, and "optimize" your career. Nothing's perfect, but some things are better than others, and different people have different priorities. You have to give up being on the treadmill forever.

 

[Neuronix]

As children of modern times we are used to being told that we can excel in everything, that the sky is the limit, that if you work hard enough and play by the rules, there is no barrier that cannot be overcome.

Sorry but this just doesn't apply to me. I was never told this growing up. I was told I was stupid, ugly, and later that I would never get into college. My parents were neglectful and abusive and I had virtually no friends since I had to move around a lot and was an awkward fat, nerdy teenager with severe cystic acne and huge glasses. I spent a year in high school asking everyone "do you want fries with that?" as joking practice for the future career at McDonald's my advisors had envisioned for me since I was dropping out. In college I was told I'd have to walk on water to get the highest recommendation for med school coming in the backdoor as a high school dropout with no science education. I was told MD/PhD was a really stupid idea and was strongly discouraged from applying.

The only time I started getting actual positive feedback was when I applied MD/PhD. In the MD/PhD program I've always heard that great academic positions were out there for me, that top/research (same thing) residencies would want me if I was decent as a medical student and in research, and that a career as a physician-scientist was a worthwhile endeavor. That was where the real positivity sunk in. But, I don't believe any of that anymore. For the first time in my life, in the MD/PhD program I actually felt like I had a set path for the future but that's gone now.

In the research world I get a lot of respect outside of my graduate school lab. Every PhD wants to recruit me to come work in their lab. Yet, they all tell me immediately that they have no say in residency or fellowship admissions and that the clinical departments pay research "lip service" but is a very low priority for them.

Fortunately I am a very good medical student, just not excellent. So I'll be ok. I suspect I will match, and hopefully I'll be surprised and match to one of the places I'd really like to go. No matter what I can still choose based on location and try as much as possible to just have a good time and learn and perform what's expected of me clinically. I agree I need to do my best into the future to maximize my chances of this. But, I wanted to say that this thread just comes out of shock. Everything I'm hearing now that I'm returning to clinics runs counter to all the positive feedback I had received in my program. I had clues about the state of academics when I was in grad school, but I wanted so much to ignore them. I wanted to believe in what I was doing, especially since I was so miserable. But, I can't ignore it anymore. This thread comes out of the realisation that it doesn't seem to me that I'm wanted as a physician-scientist. As much as I thought I'd like to be a researcher, the incentives and support to do so just aren't there. I'm wondering if my PhD was something of a waste, outside of the flexibility the MD/PhD program gave me to explore other interests I was never able to explore growing up in poverty.

I was always told I'd be recruited by residency programs, that I definitely need to do a research residency, that one needs to go to certain programs that will support physician-scientists... It all runs counter to the advice I get in my specialty. i.e. That I should do a clinical track, the top programs mostly care about clinical things like AOA medical students, and that careers in research are very difficult to obtain and have a very high attrition rate. Who am I supposed to believe? Well I can believe whatever I want, but if I say I envision a career of 80% research at my interviews, I'll never get a residency spot. Even 50/50 is considered pretty extreme.

Of course not everything is as black and white as I've made it in this post and in this thread. There's a lot of shades of grey in there and it's a complicated situation with many factors. But hopefully this gives everyone a good sense of the kinds of thoughts that are going through my (just an average MD/PhD student's) mind.

I think the question you are facing is do you still believe in the "Dream" or was that dream just an illusion with no possibility for manifesting in reality? That is a question only you can answer.

What is the dream anyways? I have far less certainty about what I want to do with my life than I ever have before.

At research residencies, the only people you are competing with are other MD/PHDs.

I wish this were true. Besides, there are very few spots nationally for research residencies anyway and they are pretty wimpy in some specialties compared to others. I mean 6 months of research time is common. Even 1 year is a lot, and that gets seriously eaten into by all sorts of other clinical duties.

 

[ioncell]

Sorry but this just doesn't apply to me.
The only time I started getting actual positive feedback was when I applied MD/PhD.

hehe

DONT let them fool you.

You re full blown adult now and you can read between the lines .
Rads HANDS DOWN if you are competitive enough .

peace.

 

[ClarinetGeek]

This thread comes out of the realisation that it doesn't seem to me that I'm wanted as a physician-scientist. As much as I thought I'd like to be a researcher, the incentives and support to do so just aren't there. I'm wondering if my PhD was something of a waste, outside of the flexibility the MD/PhD program gave me to explore other interests I was never able to explore growing up in poverty.

I am still naive so please feel free to ignore the following...however, what residency programs are looking for in their residents is not the same thing as when academic programs are looking to hire physician scientists as faculty. I think we just have to continue to play the stupid games that is medical training realizing that because we got a PhD we will likely not be the very best resident. Thus, we will not be highly sought after. However, that doesnt' mean later on in our careers we won't be recruited as physician scientists.

Neuronix, it's clear that you have seen incredible adversity in your life. Right now the future seems more challenging than ever before; however, from my view, it seems to me that you have already overcome MUCH GREATER challenges than matching in a great rads program and continuing in your training as physician scientist. Keep figthing. I think the outcome will be better than you imagine right now. Just be smart about how you move forward.

 

[Tradewind]

...what residency programs are looking for in their residents is not the same thing as when academic programs are looking to hire physician scientists as faculty.

Yes. Program directors and chairmen look for different things.

It's clear you'll match somewhere excellent in something you want to pursue. The question is really will you be able to go to UCSF or one of two other radiology programs in the U.S.. With all of your specialty training in radiology-related research, I can see how not making that would be disappointing. But those are stark odds for anyone. So having alternative plans is smart. Sometimes, 'backup plans' work out better in the large scheme of things. And your 'backup plans' are actually still amazing!

What ever happened to the bunny rabbit avatar?

 

[JHopRevisit]

I'm sorry, but after all of these posts, I'm still a little confused as to what the problem is.

You're a "mediocre" student, you'll get into a "mediocre" program.
Fine, who gives a crap, you'll be a radiologist and no one will care.


I can't decide if I like radiology, there's not enough time for rotations.
Yes, this sucks, but its the same problem all MDs face. If anything we have more time and experience (research experience and the potential at some programs for longitudinal clerkships) to make our decision.

Radiology doesn't value research.
As others have mentioned, there are a large number of residency programs that do bend over backwards for MD-PhDs. I get the impression that you're complaining about all MD-PhD programs and all medical specialities, when your situation really only pertains to 10-15% of them.
Furthermore, I'm really surprised that this hit you as a shock. Radiologists make $$$$. Any field where doctors make $$$$$ will be difficult to balance with a research career, because grant money doesn't compare to doctor money. Also, I'm surprised that you seem, who seem to already be pointing out the flaws of academic medicine, are just now coming to the realization that balancing a research career and clinical career is difficult and many people don't achieve it.
Over the past year or so we've argued about MD-PhD programs, with me coming out as the optimist and you as the pessimist. And yet when you describe your complaints I usually shrug my shoulders and think "So?" I think the problem might be that you're an incurable optimist and perfectionist who is constantly getting his hopes dashed. Your situation is still very, very good. You're gonna match in an EXTREMELY competitive field that a huge number of students don't get the opportunity to practice, and your worst case scenario is that you'll be a radiologist that makes twice as much as us poor saps in academia. Buck up buddy.

 

[Doctor&Geek]

You're a "mediocre" student, you'll get into a "mediocre" program.
Fine, who gives a crap, you'll be a radiologist and no one will care.

What was the PhD for anyways, then?

I can't decide if I like radiology, there's not enough time for rotations.
Yes, this sucks, but its the same problem all MDs face. If anything we have more time and experience (research experience and the potential at some programs for longitudinal clerkships) to make our decision.

Some programs chop off a large portion of fourth year in an effort to get students out earlier.

Radiology doesn't value research.
As others have mentioned, there are a large number of residency programs that do bend over backwards for MD-PhDs. I get the impression that you're complaining about all MD-PhD programs and all medical specialities, when your situation really only pertains to 10-15% of them.

For radiology:
1) The number of programs that support research is not large
2) Even within those programs, not all slots are "for" research positions
3) Competition is keen, even amongst MD/PhDs, and even amongst top programs, subpar clinical performance amongst MD/PhDs are not helping when it comes next time to rank.