You know what... Nevermind.

[smq123]

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.

Research experience doesn't always = clinical experience, though.

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.

Derm? Rad Onc? Even anesthesia, to some extent.

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[NGN47]

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.
...
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.

Wow! This is the exact opposite of what I experienced during my MS4 year and during interviews! Granted I'm not doing diagnostic rads, but really, this is totally the opposite of what I have seen. In fact, I have been told that, generally, the MSTPs at my program tend to have BETTER clinical evals during MS3, and usually match higher on their list than their MD "only" counterparts.

Best of luck Neoronix - but I really suspect things will work out alright for you!

 

[JHopRevisit]

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

Hmm, didn't know that. Apparently 4th year is good for something after all. That in and of itself may explain a huge portion of the deficit in clinical skills that Nix described. I fully expect to be terrible for at least two rotations when I get back.

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.

I didn't describe my thinking about this clearly in the previous post. Nix wants to do imaging research combined with radiology. Apparently, this is really difficult (I have no idea, no interest in radiology). But that doesn't mean he can't be a physician scientist. In fact, when I interviewed the thing interviewers stressed the MOST was that success as a physician scientist is highly field-dependent. They all asked whether I had found mentors that had succeeded in the fields I was interested in.
If he prefers radiology to being a physician-scientist, then he can be a radiologist. If he wants to be a physician-scientist more, than he should pick another field, apparently. But if he wants to do both, and be a trail blazer, I don't think he should be surprised that the path will be extremely difficult and that programs won't bend over backward to accommodate this new path. If he has it in him, I think he should try it, the potential translations between imaging and radiology seem readily apparent even to me. But I don't think its fair to criticize residency programs for not accommodating one particular path when so many paths for physician scientists are out there, and so many programs do bend over backwards to accommodate the research trajectory (just not in radiology).
And, the best part is, it seems that whichever path he chooses he'll be in great shape. I'm sure he's a smart guy, even if things don't work out exactly as he planned in his personal statement he'll still be in an envious position: either a radiologist (people work their butts off for this opportunity) or a physician scientist (only us crazies want this one). And there's always opportunity later in life to adjust your path - I think the MD-PhD has given him a tremendous amount of flexibility. He'll always have the skills and credibility to become a researcher.
So in summary, let me quote the fortune cookie I just got at PF Changs: Don't let life's great ambitions overshadow life's small victories.

In bed.

PS As for my money comments, my only point was that if there is a significant disparity between your clinical earning potential and your research earning potential, your department will push you toward the more lucrative endeavor. Pediatricians and certain specialties of medicine make good MD-PhDs not only because their research synergizes with their clinical stuff, but because their clinical time is not as valuable, so they are given more freedom to "waste time" in the lab.

 

[Doctor&Geek]

Hmm, didn't know that. Apparently 4th year is good for something after all. That in and of itself may explain a huge portion of the deficit in clinical skills that Nix described. I fully expect to be terrible for at least two rotations when I get back.

In highly competitive specialties, residents at top programs are most likely very very good clinically. MD/PhD students are most likely not going to be amongst that category, so in comparison to their resident peers they are subpar.

I think I've seen some data that MD/PhD students as a whole do not have a lower Step 2 score average when compared to the general medical school population - it's just when at top programs the average radiology resident was AOA, honored everything, and had a board score of >250, the run of the mill MD/PhD graduate is probably going to be less stellar in comparison clinically.

By the way, the criticism is extended as well to physician scientist faculty, whose clinical skills are most certainly not going to be as good as a full time clinician.

If he prefers radiology to being a physician-scientist, then he can be a radiologist. If he wants to be a physician-scientist more, than he should pick another field, apparently. But if he wants to do both, and be a trail blazer, I don't think he should be surprised that the path will be extremely difficult and that programs won't bend over backward to accommodate this new path. If he has it in him, I think he should try it, the potential translations between imaging and radiology seem readily apparent even to me. But I don't think its fair to criticize residency programs for not accommodating one particular path when so many paths for physician scientists are out there, and so many programs do bend over backwards to accommodate the research trajectory (just not in radiology).

Neuronix cannot be a "trail blazer" - hundreds of MD/PhD graduates have gone before him into radiology, and we don't know how successful those graduates have been towards advancing health care (even those at programs accommodating a research career). If they have not been successful as some have suggested, one has to wonder why - is it the students succumbing to the siren call of easy hours and money, or the residency programs selling a rich research experience when in reality, research is not supported, or the MD/PhD program for not providing sufficient advising to students? I'm not about to criticize residency programs exclusively - its probable that each group in reality plays a role.

 

[gbwillner]

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.

Pretty much THIS.

I went into Pathology and my experience was the complete opposite. I had top residency programs flying me out to see them and paying for my meals and hotels. It wasn't why they would want ME but why I should choose THEM.

 

[gbwillner]

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.


Where's all the hotties that <3 me

Dude... seriously, that may mean something if you didn't live in Philly. If you seriously think Philly is at all more inhabitable than St. Louis, I have a bridge to Alaska to sell you.

/Sorry I'm so late to this flame-fest

 

[Vader]

In highly competitive specialties, residents at top programs are most likely very very good clinically. MD/PhD students are most likely not going to be amongst that category, so in comparison to their resident peers they are subpar.

I think I've seen some data that MD/PhD students as a whole do not have a lower Step 2 score average when compared to the general medical school population - it's just when at top programs the average radiology resident was AOA, honored everything, and had a board score of >250, the run of the mill MD/PhD graduate is probably going to be less stellar in comparison clinically.

I know you are pointing out a "top program MD/PhD vs. MD clinical comparison." I am not sure whether your conclusion is necessarily true.

I think we should make it crystal clear here that is it simply a myth that MD/PhD students make subpar clerks or residents. The board score data you have seen do contradict this notion. Yet as an MD/PhD student and resident (and faculty) one has to work continuously to counter to this stereotype, unfortunately. I think it is a myth just perpetuated by non-MD/PhD colleagues to make themselves appear better and more qualified in the clinical realm. As self-fulfilling prophecies go, the more one buys into the myth, the worse off one actually does.

There are subspecialist MD/PhDs who are experts in their niche field who are simply better than any other clinician in that area. I have seen many examples of MD/PhDs who are both excellent clinicians and researchers.

There are certainly MD/PhDs (and MDs for that matter) who shouldn't (and don't) get anywhere near patients (or their scans). I think this is what residency program directors are trying to screen out, particularly in clinically-heavy fields like radiology. The quick screen is 3rd year honors and AOA (who reads those written summary evaluations included in the Dean's letter anyway?). The "red flags" of no honors and no AOA becomes a huge red banner ad that reads "LAB RAT" in the eyes of many program directors. How else are they to assess your clinical acumen, after all?

 

[Red Leader]

OFFTOPIC:

Should I check into a psych ward if I still want to do MD-PhD after reading this?

Seems like it would make me a sadomasochist to endure those YEARS of frustration for what appears from this thread to be little to no reward. Not to mention "MDPHD4LYFE" is probably taken for a custom license plate.

 

[Sulfinator]

OFFTOPIC:

Should I check into a psych ward if I still want to do MD-PhD after reading this?

Seems like it would make me a sadomasochist to endure those YEARS of frustration for what appears from this thread to be little to no reward. Not to mention "MDPHD4LYFE" is probably taken for a custom license plate.

Well, you have to realize that the experience can be quite variable. Neuronix's experiences cannot be generalized. Some MD/PhD students do feel like they devote many years of their life for little or no reward when they finish, but many (and I would say most) do not. All the students that have graduated from my program have had glowing things to say about the residency interview process. They all have said that they were heavily recruited by several "top" programs (and only about 1/3 to 1/2 of our grads end up being AOA). In fact (this is partly rumor here), I was told that one of our students that graduated last year successfully matched into a quality Derm program (that's a fact) even though that person had <200 Step I score (that's the rumor, which I, personally, believe).

I will be hitting the interview trails myself this fall, and will happily report my experiences as a soon-to-be MD/PhD grad.

So, don't be overly disheartened by Neuronix's woes (not that I wish to minimize them); So much depends on your own idiosyncratic experience, your perspectives, expectations, goals, etc. Just be thoughtful about whether you think the MD/PhD journey would be "right" for you before you embark.

 

[Hard24Get]

Neuronix, it's been a long time:

You make some great points about medicine, science and the MD-PhD program. However, I'm a little concerned about the advice you've been getting. Sure, MD-PhDs have to prove their clinical acumen but I have seen no evidence that we are or are viewed as sub-par. Most of the time there is no research to distract us during residency, anyway. I also think all residencies care about research to an extent. Although I was no clinical slouch, I was well-received for my research credentials and aspirations despite going into a field that does very little.

I did much better in the clinics after my PhD. Maybe it was the improved maturity and work ethic, I don't know. But with all HPs before, you can still be in the top 20% of one of the best medical schools in the country. That's nothing to sneeze at, and you underestimate yourself. Is your advisor MD-PhD? Have you talked this over with any of the program chairs? It seems wrong, and it is hard for a potential residency to evaluate you without having done the bulk of your clinical stuff. Plus, you are at Penn. Something like 90% of us matched in our top 3, and most got their #1 last year, straight MD and MD-PhDs alike.

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.

I understand your frustration. Things probably seem bleaker than they are, but it is true with research going downhill the way it has been, it is hard to justify the MD-PhD. But, you are at the end of your journey, and I believe you can definitely pull off a great match with a little work, though you may or may not still want Rads after you do the rotation....

To those attacking him, try getting some experience first

 

[Gyric]

Radiology …. Research? … Really?? I know a few rads residents and I am at one of those elite places; they are working like dogs … I can’t imagine it being very popular if one of their co-residents was kicking back on a “research track.”

Neuronix, your experience is not unusual, in some ways you are facing certain realities sooner than many MD/PhD trainees. My path program has lots of MD/PhDs and I have noted over the years a growing bias against MD/PhDs with overbalanced research credentials (eg 5+ excellent papers but not AOA, not honoring clinical electives, <240 step II); we have matched a few and they are terrible. Other residents have to pick up their slack, and, in the end, they are performing at a much lower level (?dangerous) than our clinical residents. Fortunately they fast track to postdoc and everyone is happy, but their legacy has made it more difficult for this subset to match into our program. The researchers may still want them, but the clinical faculty usually get their pick in the interest of good patient care. Medicine and pediatrics seem most accepting; I have been at meetings where they flat out tell the MD/PhD residents that they will need to rely on clinical colleagues to practice safely and that they should go ahead and minimize clinical training in favor of fast track research training (but do you really want to be the barely competent heme/onc that everyone dreads rotating on service).

I think that the most important message for MD/PhD trainees is that in the end you WILL have to choose between science and medicine; the sooner you make this choice the better (I know what you are thinking … I did not believe that old burnt out guy who told me this when I was just starting either). If you want to be a basic scientist then you are best served by going straight to a postdoc, the MD is more than enough clinical exposure to inform your work. The escape route that you think clinical training represents is an illusion, just go for it; I have tremendous respect for these people. Please don’t match into my path department, you will be miserable (really you will).

I think that efficient combined training can make for outstanding (perhaps even the best in some specialties) academic clinicians and should not be restricted to only those who are going to be scientists. I think MSTPs should move away from the party line that every trainee will be an R01 funded basic scientist; this does not happen and it fosters disillusionment. Also in specialties where there is a big difference between academic and private practice pay (path, rads, anesth, etc) the absence of debt allows us to choose to stay in academic clinical practice and, arguably, that is some return on the government’s investment.

As a side-note, it is a very dangerous time to choose a specialty based on income and lifestyle; the ground is shifting and you can be certain that radiology reimbursement is firmly in the government’s crosshairs, make sure you get some first hand experience before you choose that road, it is likely to be an entirely different landscape when you finish training.

 

[gstrub]

My path program has lots of MD/PhDs and I have noted over the years a growing bias against MD/PhDs with overbalanced research credentials (eg 5+ excellent papers but not AOA, not honoring clinical electives, <240 step II); we have matched a few and they are terrible. Other residents have to pick up their slack, and, in the end, they are performing at a much lower level (?dangerous) than our clinical residents. Fortunately they fast track to postdoc and everyone is happy, but their legacy has made it more difficult for this subset to match into our program. The researchers may still want them, but the clinical faculty usually get their pick in the interest of good patient care. Medicine and pediatrics seem most accepting; I have been at meetings where they flat out tell the MD/PhD residents that they will need to rely on clinical colleagues to practice safely and that they should go ahead and minimize clinical training in favor of fast track research training (but do you really want to be the barely competent heme/onc that everyone dreads rotating on service).

I think that the most important message for MD/PhD trainees is that in the end you WILL have to choose between science and medicine; the sooner you make this choice the better (I know what you are thinking &#8230; I did not believe that old burnt out guy who told me this when I was just starting either). If you want to be a basic scientist then you are best served by going straight to a postdoc, the MD is more than enough clinical exposure to inform your work. The escape route that you think clinical training represents is an illusion, just go for it; I have tremendous respect for these people. Please don't match into my path department, you will be miserable (really you will).

I think that efficient combined training can make for outstanding (perhaps even the best in some specialties) academic clinicians and should not be restricted to only those who are going to be scientists. I think MSTPs should move away from the party line that every trainee will be an R01 funded basic scientist; this does not happen and it fosters disillusionment. Also in specialties where there is a big difference between academic and private practice pay (path, rads, anesth, etc) the absence of debt allows us to choose to stay in academic clinical practice and, arguably, that is some return on the government's investment.

As a side-note, it is a very dangerous time to choose a specialty based on income and lifestyle; the ground is shifting and you can be certain that radiology reimbursement is firmly in the government's crosshairs, make sure you get some first hand experience before you choose that road, it is likely to be an entirely different landscape when you finish training.

What the hell are you talking about? Terrible residents? Needing to rely on clinical only counterparts to be safe? We're not all a bunch of pipetting lab rats here.

Basically you are saying that the entire path is worthless, and this is simply not true.

And I can't stand when people use terms like "return on government investment." No one can tell Neuronix, or me, what field I should choose. I should get a return on MY investment. The government takes what it likes anyway.

 

[Hard24Get]

Neuronix, your experience is not unusual, in some ways you are facing certain realities sooner than many MD/PhD trainees. My path program has lots of MD/PhDs and I have noted over the years a growing bias against MD/PhDs with overbalanced research credentials (eg 5+ excellent papers but not AOA, not honoring clinical electives, <240 step II); we have matched a few and they are terrible. Other residents have to pick up their slack, and, in the end, they are performing at a much lower level (?dangerous) than our clinical residents.

Hmm, are you really a resident? It's one thing if you are saying that some MD-PhDs are terrible, or that the disconnect reflects a relative disinterest, but are you telling me that everyone who wasn't AOA, didn't honor clinical electives, or had a Step II less than 240 is a bad/terrible doctor? Then why even let people with such credentials graduate at all? Gimme a break... And are you a chief on the selection committee since you are privy to so much info about them? If so, what was your n?

Also, no one "kicks back" on a research track. It usually involves an extra year or two ON TOP OF clinical work. Even though fast-tracking in some programs may shave off a little time, during the time they are on service they are expected to work just as hard as everyone else.

 

[dl2dp2]

I think that efficient combined training can make for outstanding (perhaps even the best in some specialties) academic clinicians and should not be restricted to only those who are going to be scientists. I think MSTPs should move away from the party line that every trainee will be an R01 funded basic scientist; this does not happen and it fosters disillusionment. Also in specialties where there is a big difference between academic and private practice pay (path, rads, anesth, etc) the absence of debt allows us to choose to stay in academic clinical practice and, arguably, that is some return on the government’s investment.

I'm very suspicious of this guy's comments. At MGH/Brigham/UCSF pathology departments, they don't just "match a few" MD/PhDs-->50% of the program is constituted of MSTP grads. Thus far I have NEVER heard of any such concerns for clinical incompetency for MD/PhDs in pathology. If there's ever a popular "refuge" if you will for MD/PhDs, it's pathology. In fact, if you want to go academia, many, if not most of your superiors will be MD/PhDs. Most of the department chairs are MD/PhDs. Most of the section chiefs are MD/PhDs. Face the facts--pathology is not competitive, and regular med students who go into pathology, even into top programs, are HARDLY ever AOA/>240 material. In fact, if you indeed go to a top program, it will be the research that'll make your career. If you want to go PP in pathology, it's probably worth more of your time to go to a high volume community program. And a lot of the basic science stuff (i.e. molecular) is actually applicable in clinical practice in path. Also, the pay differential in pathology between academic and private is NOWHERE close to that of gas/rads. (Yah, good luck getting that derm path job in podunk.)

Similar things go on in neuro, IM and peds. Programs bend over backwards for MD/PhDs. Very very often department chair/section chiefs have MD/PhDs. People get matched DIRECTLY into cards fellowships straight out of med school. You'll find that increasingly top academic programs are full of researchers. Top academic programs are there to train researchers and academics and to advance the field. It's just the reality of specialization. Ok, sure you don't have to do a PhD. But you have to do MPH + N years of "research fellowships".

I think the same argument can be made for MD onlys who want to do academia, especially in neuro that I have seen, where they are competing with MD/PhDs toward the end of their training--and they have no credibility of being able to do research, and you should see their anxieties, not knowing the difference between an R01 and a K08. There's no free lunch in this game.

Yes, if you end up in mostly clinical practice, then it IS a "waste of time". But hindsight is 20/20. How would you know you couldn't make it/didn't wnat to do it BEFORE you even tried?

 

[echod]

Radiology …. Research? … Really?? I know a few rads residents and I am at one of those elite places; they are working like dogs … I can’t imagine it being very popular if one of their co-residents was kicking back on a “research track.”

Have you spent more than 3 years continuously working full time in the lab managing your own project? Have you published first author in a basic science journal with an impact factor higher than 7? To those who haven't, lab work is DECEPTIVELY easy--the lab might be empty, people might come in late, etc However, that doesn't mean we are not working. We might be in a different room, at the library, working in other labs, coming in 7 days a week or staying late at night to finish up experiments. Five 12 hour days is the same as seven 8.5 hour ones.

 

[Red Leader]

Well, you have to realize that the experience can be quite variable. Neuronix's experiences cannot be generalized. Some MD/PhD students do feel like they devote many years of their life for little or no reward when they finish, but many (and I would say most) do not. All the students that have graduated from my program have had glowing things to say about the residency interview process. They all have said that they were heavily recruited by several "top" programs (and only about 1/3 to 1/2 of our grads end up being AOA). In fact (this is partly rumor here), I was told that one of our students that graduated last year successfully matched into a quality Derm program (that's a fact) even though that person had <200 Step I score (that's the rumor, which I, personally, believe).

I will be hitting the interview trails myself this fall, and will happily report my experiences as a soon-to-be MD/PhD grad.

So, don't be overly disheartened by Neuronix's woes (not that I wish to minimize them); So much depends on your own idiosyncratic experience, your perspectives, expectations, goals, etc. Just be thoughtful about whether you think the MD/PhD journey would be "right" for you before you embark.

Thanks, yeah I realize this now after reading the whole thread. No straitjacket for me. Cool!

 

[Gyric]

What the hell are you talking about? Terrible residents? Needing to rely on clinical only counterparts to be safe? We're not all a bunch of pipetting lab rats here.
.

Hmm, are you really a resident? It's one thing if you are saying that some MD-PhDs are terrible, or that the disconnect reflects a relative disinterest, but are you telling me that everyone who wasn't AOA, didn't honor clinical electives, or had a Step II less than 240 is a bad/terrible doctor? Then why even let people with such credentials graduate at all? Gimme a break... And are you a chief on the selection committee since you are privy to so much info about them? If so, what was your n?

I'm very suspicious of this guy's comments. At MGH/Brigham/UCSF pathology departments, they don't just "match a few" MD/PhDs-->50% of the program is constituted of MSTP grads. Thus far I have NEVER heard of any such concerns for clinical incompetency for MD/PhDs in pathology. If there's ever a popular "refuge" if you will for MD/PhDs, it's pathology. In fact, if you want to go academia, many, if not most of your superiors will be MD/PhDs. Most of the department chairs are MD/PhDs. Most of the section chiefs are MD/PhDs. Face the facts--pathology is not competitive, and regular med students who go into pathology, even into top programs, are HARDLY ever AOA/>240 material. In fact, if you indeed go to a top program, it will be the research that'll make your career. If you want to go PP in pathology, it's probably worth more of your time to go to a high volume community program. And a lot of the basic science stuff (i.e. molecular) is actually applicable in clinical practice in path.

I clearly stated in my first post that I was talking about a subset of MD/PhD applicants, I was not generalizing to all MD/PhDs. Yes, a majority of my program is MD/PhD and most are stellar, but a few bad apples has lead to scrutiny of applicant clinical interest and competence (similar to what Neuronix described).

Sluox-
It is not uncommon for us to match individuals who have achieved AOA or high step scores. When 12% of matched pathology applicants are AOA and the average step 2 is 228, I am not sure why this is a surprise; certainly it is incorrect to describe pathology applicants as HARDLY ever achieving these milestones.

I also am not surprised to learn that I am the first to inform you of this concern; unless of course you are tapped into the internal politics of multiple high powered pathology departments... I also disagree with your assessment of what it takes to succeed in academic and private surgical pathology practice, but that is another topic.

Have you spent more than 3 years continuously working full time in the lab managing your own project? Have you published first author in a basic science journal with an impact factor higher than 7?

Yes, I have paid my dues at the bench ...

 

[GliaGirl]

I have been at meetings where they flat out tell the MD/PhD residents that they will need to rely on clinical colleagues to practice safely ... I think that the most important message for MD/PhD trainees is that in the end you WILL have to choose between science and medicine

MD/PhD students still have to successfully complete medical school. I don't understand why having an extra degree and 3-5 more years more maturity would lead to having to "rely on clinical colleagues to practice safely". Programs that are being irresponsible and admitting clinically under qualified people just because they have a PhD have no one to blame but themselves, and should stop immediately. But someone who is just as qualified at medicine and comes with a bonus research ability should be welcomed. Its is silly to assume that this is in any way applicable to people who are legitimately good at both. Does the process of research some how destroy the ability to diagnose illness? Does the PhD somehow negate the great and mystical properties of the MD? I don't think that it does.

And I don't think that it is naive to want to both practice medicine and do research. Maybe its not as common as programs make it out to be, but I have met plenty of people who do both. It is simply untrue to say that there WILL have to be a choice, unless you are referring to the fact that there is almost never a 50/50 split in time between the two activities.

 

[fairalexfield]

I think people are seeing things that Gyric didn't say. He's only referring to those MD/PhDs with UNBALANCED clinical vs. research credentials. Those with excellent research creds yet subpar clinical skills. He's not saying that it's impossible to be great at both and match into good departments (in fact, he says that many in his department are exactly that), just that programs should be cautious about those with unbalanced skills.

 

[Vader]

I think people are seeing things that Gyric didn't say. He's only referring to those MD/PhDs with UNBALANCED clinical vs. research credentials. Those with excellent research creds yet subpar clinical skills. He's not saying that it's impossible to be great at both and match into good departments (in fact, he says that many in his department are exactly that), just that programs should be cautious about those with unbalanced skills.

Yes, this is precisely the issue. Basically, it's a case of a few bad apples ruining the bunch.

Because of this, applicants who are MD/PhDs are under increased scrutiny to have both great clinical and research credentials, particularly for clinically-heavy fields.

I noticed this during last residency application cycle, not for my main specialty, but for prelim medicine programs which really only care about your clinical potential/interest. If they see you come labeled as "LAB RAT" from your application (i.e. PhD, pubs, personal statement referring to desire to be a physician-scientist), then you are in trouble.

 

[dl2dp2]

Yes, this is precisely the issue. Basically, it's a case of a few bad apples ruining the bunch.

Because of this, applicants who are MD/PhDs are under increased scrutiny to have both great clinical and research credentials, particularly for clinically-heavy fields.

I noticed this during last residency application cycle, not for my main specialty, but for prelim medicine programs which really only care about your clinical potential/interest. If they see you come labeled as "LAB RAT" from your application (i.e. PhD, pubs, personal statement referring to desire to be a physician-scientist), then you are in trouble.

Except what does this "imbalance" really mean? Someone with non-AOA (but top 40%, at a TOP medical school, say like Neuronix), and <240 step I but with multiple good papers...is that "subpar"? Maybe compare to the average MGH radiology resident, but not to the average radiologist per se. So are you then implying the average radiologist is incompetent?

So then the question becomes, what's the point of doing radiology at MGH? What do these "high-end" departments really want? While I'm not entirely familiar with radiology, in pathology and neurology, the overwhelming story (unless they ALL lie) is that they want to train academics who either (1) go into research and advance the field (2) do lots of admin/teaching. While high end PP groups might ALSO prefer someone who trained at a top program (this I hear, apparently, is true in the northern cali pathology job market), I dare you to write in your essay for MGH that you want to be a private practice dermpath.

Gyric--you are right there's a lot of politics going on in the academic medical departments. However, at "high-end" departments, the politics tends to be going the other way. Everyone wants/needs his own grant, and a vast portion of the department's budget comes from grants. Hence full time clinicians get subjugated into a worker-bee/under-appreciated position. Non-MD/PhD residents who want to go into academics, as I stressed, are just as likely be held up against the other end of the bargain--prove to me and NIH that you are capable of getting that grant. Superb clinicians who can't get grants AND don't like to teach at top programs invariably leave academia and go into PP--I hope this isn't new to you. And for competitive path fellowships, you need research. (I wonder why being a superb clinician is, again, not enough.)

I have also heard of stories of such and such despicable MD/PhD resident who didn't want to do much clinical work. However, invariably the point of the story is that he ends up becoming a research rockstar who got the first tenure track job before the rest of the lot...and you know what, since he's (however incompetently) board certified, he's getting his 20% clinical work and being paid a clinician salary, while his co-residents are scrambling funding for their 5th year "research fellowship" and doing an MPH. Again, there is NO FREE LUNCH. And this is what I think why MSTPs are getting MORE competitive increasingly, instead of less. If it's such a worthless program, market forces would dictate that fewer, however clueless premeds would apply to it.

So it boils down to the top PP groups want a "superb" clinician (read: lots of hours and very fast), and they don't care about research. If you aren't a "superb" clinician, you work as an attending neurologist at a community hospital or a staff pathologist at a reference lab (gee, that must just kills me, making 200k!). So yes, if you want to make that 450k+ salary as a partner at one of the "elite" PP groups, you do need that whatever quality it takes for the AOA/240+.

Academic departments care about you being licensed, and specialized, and able to bring in grants. Top academic departments care about you being original, enterprising, able to play the science game and get name recognition. A whole different set of games. A whole different set of characteristics that AOA/240+ isn't gonna get you.

I don't think you can excel at everything, though the few physician scientists I've seen are generally excellent clinicians, at least within their very narrow scope of practice. But the point is there *is* a very established tract for MD/PhDs going into 80/20 careers, and if this is what you want, MD/PhD is probably the best training program. Maybe not everyone can get that type of career, but there's no reason to dissuade people from trying, especially when they are in the best possible position to achieve it. Becoming an average practicing physician is VASTLY easier than becoming a tenure-track researcher with an R01...and being an average physician is by far, to me at least, a better exit strategy than most of the "other" jobs you can get as a postdoc. I don't see why people shouldn't think of his/her clinical training as a possible safety net should the research option not pan out. People who don't do a straight postdoc don't know how miserable it is like--you will never have a safe job wherever you want with a guaranteed high salary no matter how good you are.

 

[Vader]

I would say that in the case of Neuronix, his research appears to be the stronger suit. It is not that he is poor clinically--in fact, being in the top 30% at top-ranked medical schools is no walk in the park and actually reflects that he is excellent clinically. Look at the positive side: at least Neuronix has "high pass". At my alma mater, there is only "pass" or "honors", so if you don't get honors, you are lumped in with everyone else, including people who goofed off during the rotation. Of the top programs that do have "high pass", plenty of superb medical students that will become great physicians do not even get "high pass" at these schools. The sad thing is that if Neuronix had chosen to go to a "lower ranked" medical school he no doubt would have gotten honors. It is entirely possible to trade name for grades.

At the top schools, you have to compete with students who are virtually all superstars. This can hurt MD/PhDs these days because residency program directors for clinically-intensive fields (or at programs that are less research-focused) are placing increasing emphasis on the "clinical" markers of grades, USMLE scores and AOA. The research tracks at the most competitive programs are few enough that they can still cherry-pick the top MD/PhD applicants who have all aspect of their application excellent.

If you have a first-author Science paper but "only" high passes on your clinical grades, what aspect of your application do you think gets noticed? Where do you think someone's perceived "strengths" lie? The implicit assumption is that one cannot possibly be both a great clinician and great researcher, so with the balance appearing tilted toward research, what do you think the conclusion becomes?

This is not an argument to avoid the MD/PhD pathway. But it does point to a very real issue that has arisen as a result of a few bad characters plus the increasingly clinical emphasis of inpatient services at academic centers.

 

[pseudoknot]

The sad thing is that if Neuronix had chosen to go to a "lower ranked" medical school he no doubt would have gotten honors. It is entirely possible to trade name for grades.

I doubt that very much. The top students at every school are excellent, and if anything I think the more prestigious schools tend to coddle their students a little more.

The research tracks at the most competitive programs are few enough that they can still cherry-pick the top MD/PhD applicants who have all aspect of their application excellent.

Well, yes, obviously if you have two students with PhDs and one has better grades, why wouldn't you pick that one? In any competitive enterprise, the person who is good at everything will outshine the one who is good at only one thing. That doesn't mean the system is stacked against anyone.

Residency is still primarily clinical training, so it's natural that they will look at applicants through that lens.

Also, I think Vader said something earlier about Step I being related to clinical acumen. No one has actually shown that and there are multiple published studies that have failed to find any correlation between Step I and clinical competence. Whether this is because Step I is worthless or we don't know how to measure clinical competence is impossible to say, so far.

 

[gstrub]

If you have a first-author Science paper but "only" high passes on your clinical grades, what aspect of your application do you think gets noticed? Where do you think someone's perceived "strengths" lie? The implicit assumption is that one cannot possibly be both a great clinician and great researcher, so with the balance appearing tilted toward research, what do you think the conclusion becomes?

I am hoping, and I think within reason, that a residency program would look favorably on a candidate who, despite having slightly lower board scores (235 vs 255) and less stellar clinical marks (2 honors/ 4 HP vs 5 honors, 1HP), demonstrates dedication and maturity vis a vis an established and successful commitment to research. This, of course, presumes you are not inept at interviewing.

 

[malchik]

Interesting discussion.
Just a few thoughts. It is not entirely a myth that MSTPs are often inferior clinically DURING MED SCHOOL. I was certainly one of them. I rocked step 1 and barely passed step 2, performed very averagely in clinical courses. This is because I attended a program that had the traditional PhD inserted in between basic medical and clinical rotations, and by the time I returned to clerkships I might as well had never taken M1/2. And I was not the exception, several of my MSTP classmates had similar experiences. If I had applied to IM or Rads, I would have had a tough time. But I went into pathology, and all of the top programs heavily recruited me. From residency onward, medical fields are idiosyncratic and divergent, so one should be careful generalizing. In the case of pathology, it is removed enough from clinical minutiae that my erstwhile clinical mediocrity is a non-issue, and I am doing better than average as a resident at a "top" place.

Pathology-specific observation: I also don't think it is true that these academic powerhouses are only interested in training future researchers or even clinical academicians. They try to get a mix of MD/PhDs and MDs, even some who state at the outset an interest in private practice. It sounds cheesy but in my experience it is true. Otherwise you would see these places loaded up with AP only and CP only people. Sluox mentioned MGH--take a look at their residents. How many are AP or CP only? No this does not mean they are not doing academics, but I guarantee you more than half will not, and David Louis et al. know this and welcome it. In any case it doesn't matter, because even in the MD/PhD-heavy pathology field, there are still many more residency slots and all programs invariably end up with a mix.

 

[Vader]

I doubt that very much. The top students at every school are excellent, and if anything I think the more prestigious schools tend to coddle their students a little more.

Well, yes, obviously if you have two students with PhDs and one has better grades, why wouldn't you pick that one? In any competitive enterprise, the person who is good at everything will outshine the one who is good at only one thing. That doesn't mean the system is stacked against anyone.

Residency is still primarily clinical training, so it's natural that they will look at applicants through that lens.

Also, I think Vader said something earlier about Step I being related to clinical acumen. No one has actually shown that and there are multiple published studies that have failed to find any correlation between Step I and clinical competence. Whether this is because Step I is worthless or we don't know how to measure clinical competence is impossible to say, so far.

If 25% of your class is "excellent" versus 75%, it makes a big difference in terms of competing for a limited number of honors grades.

I agree completely that residency overall is still primarily about clinical training--it is exactly my point that most PDs in most fields look at applicants through that lens. The "clinical accumen" markers that they have available are clinical grades, USMLE, and AOA, so that's what they use. I put this in quotes because I don't personally believe that these things are very strongly related at all and have poor predictive value of what makes a good physician.

 

[smq123]

It is not entirely a myth that MSTPs are often inferior clinically DURING MED SCHOOL. I was certainly one of them. I rocked step 1 and barely passed step 2, performed very averagely in clinical courses. This is because I attended a program that had the traditional PhD inserted in between basic medical and clinical rotations, and by the time I returned to clerkships I might as well had never taken M1/2. And I was not the exception, several of my MSTP classmates had similar experiences.

Interesting. But why do you think that was the case? Was it fatigue after going through grad school? I understand your point about being far from M1 and M2, but I honestly didn't feel like M1 and M2 helped all THAT much for M3. Sort of, at least for the knowledge part (but that's fixable - keep up with your reading as much as possible), but for other parts....I felt like M1 and M2 were almost more of a hindrance, in some ways.

 

[Vader]

I am hoping, and I think within reason, that a residency program would look favorably on a candidate who, despite having slightly lower board scores (235 vs 255) and less stellar clinical marks (2 honors/ 4 HP vs 5 honors, 1HP), demonstrates dedication and maturity vis a vis an established and successful commitment to research. This, of course, presumes you are not inept at interviewing.

It depends on the residency. For radiology, optho, anesthesia or derm this might not be the case (as Neuronix is realizing). If it is in IM, psych, neuro, path, and some others, then the research may be weighed more heavily. It also highly depends on the PD and what the particular program is looking for--some love future physician-scientists and some hate them. For some, the goal is to train clinicians. For others, the goal is to both provide good clinical training and to groom the residents for future faculty positions.

I was surprised that even in an "academic" field like neuro (which I am headed into), there are a variety of programs looking for different things. Overall, yes much more research-loving and my PhD work and research pedigree did seem to impress quite a few people. But not across the board. There were definitely some programs where I left feeling that they were less than enthusiastic about my application because it appeared "imbalanced" in favor of research (even though my clinical evaluations were fabulous). Some of them surmised (incorrectly) that I didn't care about clinical medicine. In the end, however, I matched into my #1 program, so I didn't mind too much about the naysayers.

As far as prelim medicine programs, to which I was applying simultaneously, at best they couldn't care less about my PhD work. At worst, the PhD worked against me because it gave the impression of an imbalance in my application, that I didn't care about clinical medicine (again, incorrectly).

So in essence, I am just advising people here to make sure you do your best to max out all aspects of your residency application, the most critical of which is honors in 3rd year clerkships and USMLE scores (+/- AOA).

 

[mercaptovizadeh]

I wonder how much the alleged clinical "sub-par-ness" of MD/PhD applicants to residency is due to intrinsic abilities, i.e. clinical acumen is completely independent of research ability, and therefore, just as in the MD-only class you have a distribution, you'll have the same with MD/PhDs, with only a small minority truly excelling on the wards. Or, because many MD/PhDs are under the (false?) impression that it doesn't matter how they do in the MD portion - the PhD gives them a golden ticket? This thinking was displayed all too often in my program, where people would not strive for pre-clinical honors and would do less well on the Step 1 than they probably could because they reasoned they had a PhD and wanted to go into peds anyway.

 

[Hard24Get]

I think people are seeing things that Gyric didn't say. He's only referring to those MD/PhDs with UNBALANCED clinical vs. research credentials. Those with excellent research creds yet subpar clinical skills. He's not saying that it's impossible to be great at both and match into good departments (in fact, he says that many in his department are exactly that), just that programs should be cautious about those with unbalanced skills.

and my point is that it's ok to be unbalanced as long as both sides are up to par, ie stellar research + 230 board and not aoa does not necessarily make you a bad doctor. So Gyric, while I agree it's possible to have a bad subset, great research+ok clinicals is fine as long as the resident meets the basics for the program. Obviously sub-par clinical work is bad in anyone

 

[Hard24Get]

I wonder how much the alleged clinical "sub-par-ness" of MD/PhD applicants to residency is due to intrinsic abilities, i.e. clinical acumen is completely independent of research ability, and therefore, just as in the MD-only class you have a distribution, you'll have the same with MD/PhDs, with only a small minority truly excelling on the wards. Or, because many MD/PhDs are under the (false?) impression that it doesn't matter how they do in the MD portion - the PhD gives them a golden ticket? This thinking was displayed all too often in my program, where people would not strive for pre-clinical honors and would do less well on the Step 1 than they probably could because they reasoned they had a PhD and wanted to go into peds anyway.

I definitely remember sayin' "I gotta pace myself" during pre-clinicals.
Another honor or 2 then and I would have been AOA. Oh well...

 

[Hard24Get]

Except what does this "imbalance" really mean? Someone with non-AOA (but top 40%, at a TOP medical school, say like Neuronix), and <240 step I but with multiple good papers...is that "subpar"? Maybe compare to the average MGH radiology resident, but not to the average radiologist per se. So are you then implying the average radiologist is incompetent?

ah, this was my point. I think we are all realizing by now though that Gyric was referring to a subset of the unbalanced subset, perhaps some of those that the program dipped below it's standards to get. And they would be terrible compared to the other residents, I suppose. It just came out the wrong way

 

[Gyric]

and my point is that it's ok to be unbalanced as long as both sides are up to par, ie stellar research + 230 board and not aoa does not necessarily make you a bad doctor. So Gyric, while I agree it's possible to have a bad subset, great research+ok clinicals is fine as long as the resident meets the basics for the program. Obviously sub-par clinical work is bad in anyone

I agree it is ok to match a resident with great research and average clinical skills. What is not ok, what is hard to judge in an interview, and what is a major concern when someone is not uniformly stellar, is that this type of resident will lack the level of interest and attitude needed to be a good clinical resident (of course, only a subset of this type of applicant might have this problem and it is unfair to generalize, but when trying to match into a competitive spot you are not in a position to expect fairness…).

For the match, it is less about your true clinical skill/interest and more about the interview. We all are usually pretty good at walking the line between medicine and research, but if your interviewer is a clinician (e.g. a surgical pathologist, in my world), and sees you as a future researcher, and you fail to convince them that you will put in 100% effort towards clinical care when on service, then they will do everything in their power (which can be considerable … unlike what was described in a previous post, the clinical faculty in my “research friendly” program have tremendous power and prestige, bring in $$$ in consults, and have outstanding resources) to prevent you from being ranked. Even if the residents get a sense that you will not carry your weight on the busy services, while having lunch with you etc, then you are history.

So don’t give up hope for a great match Neuronix, just polish your interview skills, be enthusiastic about taking care of patients, and know your audience.

 

[Hard24Get]

I agree it is ok to match a resident with great research and average clinical skills. What is not ok, what is hard to judge in an interview, and what is a major concern when someone is not uniformly stellar, is that this type of resident will lack the level of interest and attitude needed to be a good clinical resident (of course, only a subset of this type of applicant might have this problem and it is unfair to generalize, but when trying to match into a competitive spot you are not in a position to expect fairness…).

For the match, it is less about your true clinical skill/interest and more about the interview. We all are usually pretty good at walking the line between medicine and research, but if your interviewer is a clinician (e.g. a surgical pathologist, in my world), and sees you as a future researcher, and you fail to convince them that you will put in 100% effort towards clinical care when on service, then they will do everything in their power (which can be considerable … unlike what was described in a previous post, the clinical faculty in my “research friendly” program have tremendous power and prestige, bring in $$$ in consults, and have outstanding resources) to prevent you from being ranked. Even if the residents get a sense that you will not carry your weight on the busy services, while having lunch with you etc, then you are history.

So don’t give up hope for a great match Neuronix, just polish your interview skills, be enthusiastic about taking care of patients, and know your audience.

Very true, 100% true. I knew this was what you meant but couldn't resist nit-picking.

I have met Neuronix and know he will be great (although how radiologists, however critical they may be, get inspired by their work or patient care is beyond me...)

 

[Neuronix]

I have met Neuronix and know he will be great

Thanks.

(although how radiologists, however critical they may be, get inspired by their work or patient care is beyond me...)

It's ok. Different strokes for different folks.

I'm kind of off of this thread given my current surroundings. I'm too busy, tired, and separated from that world to really care. I saw two of the fish in my avatar today. The first one played around with my dive companions and nipped at the one's finger. Pufferfish in general are pretty smart, playful, and curious. The second was scared of me and hid in a bunch of coral. Other things I saw: seahorses, a bunch of parrotfish types I'd never seen before, lionfish, two zebra sharks, etc...

 

[strangeglove]

Why are you bothering with radiology? It seems that, despite being a very technically-oriented field, they don't value research very highly in their academic departments. It would seem, instead, that they are focused primarily on clinical service, which makes sense, given the primary revenue stream for radiology (i.e. they make more money from radiologists reading films than from radiologists obtaining research grants). From what I gather on this forum, you are interested in fMRI research, in particular the physics of fMRI. Last I checked, clinical radiologists are not particularly interested in fMRI, since this method has relatively little to say about at this point about the functioning of individual brains (as opposed to groups of brains). Now, there are two specialties that are very friendly to research in general and to fMRI research in particular: psychiatry and neurology. You could easily be the head of a lab doing fMRI technical research (not simply cognitive neuroscience, but the technical development of fMRI methods) in a psych or Neuro department. Maybe you don't like either of these specialties - I don't know. But, as others on this thread have alluded to, you would have an easy time parlaying your research experience (presuming you have some decent publications) into a match at a top 10 program.

Now, at the risk of misreading your intentions, I'm guessing that you are interested in radiology not because of some very deep interest in the day to day work of radiologists, e.g. reading chest x-rays and, in the case of neuroradiologists, MRIs of the spine. Rather, you are interested in radiology for it's tie-in to your research interests. So, why not consider specializing in something that is much more sympathetic to these research interests? Just a thought.

 

[Neuronix]

From what I gather on this forum, you are interested in fMRI research, in particular the physics of fMRI.

I am not at all interested in fMRI, unless we are talking about the development or implementation of novel neuroimaging techniques that may be functional in nature. I find run of the mill functional MRI to be extremely boring and often barely scientific.

Last I checked, clinical radiologists are not particularly interested in fMRI, since this method has relatively little to say about at this point about the functioning of individual brains (as opposed to groups of brains).

The only specialty I'm aware of that uses fMRI clinically is neurosurgery. They use it for neurosurgical planning around tumors. If one uses a functional paradigm for say motor cortex, they can see if a tumor has invaded motor cortex or merely displaced it.

Now, there are two specialties that are very friendly to research in general and to fMRI research in particular: psychiatry and neurology.

I want to grow in my physics abilities. Nobody I'm aware of in a Psychiatry or Neurology department will help me do that.

You could easily be the head of a lab doing fMRI technical research (not simply cognitive neuroscience, but the technical development of fMRI methods) in a psych or Neuro department. Maybe you don't like either of these specialties - I don't know.

I strongly disliked both Neurology and Psychiatry after rotating in those fields. I could go into why, but why insult those of you in those fields? Psychiatry I did like more than Neurology, however Psychiatry patients hit too close to home for me and this makes it too emotional for me.

But, as others on this thread have alluded to, you would have an easy time parlaying your research experience (presuming you have some decent publications) into a match at a top 10 program.

True. But I'm realizing that if my research doesn't pan out, I'm just going to do a 6 months on 6 months off locum tenens Rads position and spend the off portion exploring or in adventure sports.

Now, at the risk of misreading your intentions, I'm guessing that you are interested in radiology not because of some very deep interest in the day to day work of radiologists, e.g. reading chest x-rays and, in the case of neuroradiologists, MRIs of the spine.

I think I like Rads based on the things I've been exposed to. I'll let you know after I do my elective.

Rather, you are interested in radiology for it's tie-in to your research interests. So, why not consider specializing in something that is much more sympathetic to these research interests? Just a thought.

No problem. Many have been suggesting similar things to me and I'm taking the advice into consideration. So far I just haven't found a specialty I really wanted to do other than Radiology. Sure Radiology has its negatives (darkness and emphasis on rapid reading of routine films), but I've found it far less negative and more in line with my interests than anything else so far.

 

[Neuronix]

Dude... seriously, that may mean something if you didn't live in Philly. If you seriously think Philly is at all more inhabitable than St. Louis, I have a bridge to Alaska to sell you.

The beach and mountains for skiing are both within 1.5 hours drive from Philadelphia. I also think Philly is a great city to live in. It's extremely walkable (third densest urban area in the country), has a lot of nice parts, a lot of young people, and good ethnic food which is important to me. None of these things are exceptional in Philly, but all are available which makes it reasonably well rounded especially with the cost of living. But believe me, I want out of Philly, preferably to where the beaches and/or mountains are better.

 

[gbwillner]

The beach and mountains for skiing are both within 1.5 hours drive from Philadelphia. I also think Philly is a great city to live in. It's extremely walkable (third densest urban area in the country), has a lot of nice parts, a lot of young people, and good ethnic food which is important to me. None of these things are exceptional in Philly, but all are available which makes it reasonably well rounded especially with the cost of living. But believe me, I want out of Philly, preferably to where the beaches and/or mountains are better.

Look dude, I'm not going to say St. Louis is the bee's knees or anything, but other than the ocean business St. Louis has all of those things you mentioned. Being situated on the Mississippi and Missouri rivers, there are TONs of parks to go camping at. It is a reasonably short drive to the Ozarks. The city is old (founded in the 1700s) so the original city grid is small and thus the city is also extremely walkable. Yes, urban flight severely affected St. Louis (more than Philly) but you can easily get by without a car here (this was one of my requirements for residency training). Some of the coolest neighborhoods to live in are either walking distance to WashU or along the light rail line, that has a stop in the middle of campus. In terms of cost of living- St. Louis>>Philly. It's ridiculous what you can buy here. My friends in Philly that wanted to buy a place either had to go way out in the burbs (eliminating the walkability factor) or bought in west Philly (one guy REALLY regretted this... long story).

Anyway, both cities have negatives in spades and they are probably nearly the same... including a mish-mash of good and bad neighborhoods that makes the city an overall minefield of dangerous zones you have to know to avoid, and old, corrupt politics that has left many areas desolate and, quite frankly, ugly.

I'm not saying that St. Louis is better than Philly- both have their charm and problems. I will grant you the quality of the ethnic food is lacking here. But both are actually quite similar in a lot of ways IMHO. Based on the attitudes from people who had never been to this city I was also turned off on WashU. But then I saw it for myself.

 

[Neuronix]

Ok ok you got me. There's skiing in the Ozarks. I never knew. Come ski our 310 feet of vertical over 30 acres!!! ZOMG!!!! I can't ski that, I might break my other leg@$%@$#%@#

So given that I really want serious mountains (for serious downhill skiing) and/or beaches (for scuba or surfing), St. Louis sounds like the absolute last place I would want to go. As for St. Louis vs. Philadelphia otherwise, that wasn't really the point of this thread. Still, I imagine the others reading this thread now have enough sales pitch to make up their own minds to see whether they want to see either city.

I'm pretty happy with what I have in Philly btw. I rent a large 1BR apartment in the best part of town with a 200sq ft deck and it's far less than half of my take home stipend. Sure, you could find cheaper. I mean, you can always find cheaper. I might as well go to Rochester. Then I can have the cheapest place in the tundra! But in all seriousness, everyone who bought places lost their asses or didn't make money thanks to that huge condo/housing bubble, unless they got in really early (before I started). So I'm glad I never had the money (or desire) to buy anything.

 

[MNIkid87]

Have you ever considered coming to beautiful Montreal?
The uni (McGill) is not too shabby, we have tons of good food from all over the world, there are ski opportunities (e.g. Mont Tremblant), we have a fake beach (in the summer it gets warm enough to go there, although the lack of waves will make surfing difficult), and the cost of living is not too expensive considering the size of the city

 

[Neuronix]

Have you ever considered coming to beautiful Montreal?

Montreal is in Canada. This isn't undergrad anymore. You can't just do residency anywhere in the world. One is restricted to their home country with some rare exceptions.

 

[GliaGirl]

Montreal is my favorite city in the world. It's like Europe, but with (slightly) less of a language barrier and a drinking age of 18!

 

[flashback]

Wow... the original post was the most depressing things I've read in a long time. I appreciate the follow ups....

 

[MNIkid87]

Montreal is my favorite city in the world. It's like Europe, but with (slightly) less of a language barrier and a drinking age of 18!

It's not quite like Europe (sorry, as a European I have to insist ) but it comes quite close

Hm, I thought a Canadian rads residency would be accepted in the US, since a US rads residency is accepted as equivalent in Canada - seem like I was wrong though, didn't mean to offend you Neuronix

 

[Neuronix]

Hm, I thought a Canadian rads residency would be accepted in the US, since a US rads residency is accepted as equivalent in Canada - seem like I was wrong though, didn't mean to offend you Neuronix

A Canadian Rads residency would be accepted in the US, but the hurdles to gaining a Canadian residency and Canadian licensing then switching back to America make this route unappealing. There are a lot of specialty specific issues here. For example, I've been told US Peds residencies don't fulfill the requirements for Canadian Peds licensing. But, in any case one still has to take the licensing exams appropriate for that country. In the case of Canada, many specialties (I hear Rads is one of them) are more competitive than in the USA. Plus you're applying as an outsider and I don't know if there's other reasons for this, but unless you're from Canada there's very significant bias against you for that as well. All these reasons add up to it being very rare to switch countries for residency. If anything, it's much more common to switch into the USA, but mostly for certain non-competitive specialties.

Don't worry, I'm not offended.

 

[bd4727]

I certainly don't mean to hijack this very interesting thread, but I am still confused about the term "research residency," which I have seen discussed in this thread.

So I know about the ABIM research residency pathway. I know Neuronix is interested in Rads, but could anyone comment on what his competativeness would be in an ABIM research residency program? More generally, are the ABIM paths often pursued by MD/PhDs? I had one faculty person (who I don't think knew much about them) tell me "it doesn't sound like you would need that."

Also, can someone tell me if this perception is correct: I get the impression that some schools have more "research-geared" residency programs, although it may not be formally called a "research pathway." For instance, I noticed some schools in RadOnc (just randomly looking) had you spend 1 year doing research while others were not as long. Is this what people are generally talking about, especially with regard to non-IM residencies, when they refer to research specialities?

I guess I would just be interested in hearing as much as possible about research during residency, ABIM research pathway as MD/PhD, "research pathways" in non-IM specialities, etc.

 

[RxnMan]

...So I know about the ABIM research residency pathway....More generally, are the ABIM paths often pursued by MD/PhDs?...

There's three general fields that are involved in the research pathways - peds, IM, and path. Within those, I can't tell you for sure which specialities are usually taken, but I'd guess cards and gastro for IM.

...Also, can someone tell me if this perception is correct: I get the impression that some schools have more "research-geared" residency programs, although it may not be formally called a "research pathway."...

That's generally true. Within IM programs, some are more geared towards producing researchers and academicians than clinicians. Some will have separate tracks for research-interested residents. Some residencies just don't have the infrastructure for research opportunities.

...For instance, I noticed some schools in RadOnc (just randomly looking) had you spend 1 year doing research while others were not as long. Is this what people are generally talking about, especially with regard to non-IM residencies, when they refer to research specialities?...

In non-peds/IM/path specialities, various residency programs will integrate research years in with their curriculum. For example, most g-surg programs just go 5 straight years of operating. Others will allow you to take 1-2 years off to work in the lab. It depends on the program and funding. Other specialties (n-surg) have, generally across the board, a requirement for 1-2 years of research.

 

[NGN47]

There's three general fields that are involved in the research pathways - peds, IM, and path. Within those, I can't tell you for sure which specialities are usually taken, but I'd guess cards and gastro for IM.

Don't forget the ABR (American Board of Radiology) Research/"Holman" pathway which works for either Radonc or Rads, and it actually gives you more time for research than the ABIM does.

 

[Doctor&Geek]

Don't forget the ABR (American Board of Radiology) Research/"Holman" pathway which works for either Radonc or Rads, and it actually gives you more time for research than the ABIM does.

That is, if residency directors allow you to even apply for one.

FYI again:

http://homepage.uab.edu/paik/rr.html