Anybody else disappointed

I've heard that from a lot of graduating students as well. I guess I'm not very surprised, because in all honesty, residency is still pretty much about training doctors over anything else, but I do agree that it is annoying to spend so much time for so little benefit.

I've only heard of a few instances when the PhD actually was the saving grace for a student and that was really only because they worked with researchers who were big names in the field they wanted to do their residencies in (i.e. pharmacologists with a lot of connections in anesthesiology, neuroscience researchers with big names in the neurosurgery or radiology world, etc.) Other than that, I haven't seen that the PhD really boosts the residency apps much.

Talk to me after this season.

I think this is very context-dependent. I'm now an intern in a PSTP program at a research-intensive institution. When I was applying to IM programs last year I think my PhD helped get me interviews pretty much wherever I applied, but it was no secret that I wanted to pursue a research career and I sold that pretty hard. My medical school record was pretty good too and that didn't hurt my case. At the end of the day, residency is about training physicians first, your science record helps separate you a little bit above the pack, but you have to be able to get over the measuring sticks that programs use to screen your application (USMLE scores, clerkship grades, USMLE scores, letters of rec, USMLE scores, you get the idea).

So far I think the PhD has been helping me tremendously. I am applying for ENT and I am a below-average candidate board score and grade wise (top 1/3 of class, not AOA). So far I have 13 interviews and they are all at big research places (Hopkins, UCLA, Michigan, etc). I just don't think there is any way I would have been offered these interviews based solely on academic performance.

Again I will obviously know more after the interview season is over.

I am a PhD-to-MD (separate degrees). So far, it appears that the main reason why I've been doing well with getting interviews is my clinical evals/board scores/Dean's letter, not my PhD. The PhD does come up at interviews, but more in the context of a desirable bonus, not the major reason why they're interested in me. And it seems like what I think are my biggest strengths aren't always what they're thinking of first. For example, I have been asked about an unusual elective I did in med school at every program where I've interviewed so far, but no interviewer has ever asked me to describe my PhD research in detail beyond what I wrote on ERAS yet!

While it's kind of disheartening to all of us who have put so much time and effort into getting a PhD, I'd argue that valuing clinical/boards performance over the PhD is understandable and even sensible on the programs' part. Like MadMnkey and nomogram said, they are primarily hiring us to work as clinicians while we're residents, not as post docs. An MD/PhD with clinical performance on par with their MD classmates or better is going to stand out positively because of having a PhD. But an MD/PhD with subpar clinical performance and/or a low Step1/2 score is not going to be saved by having a PhD in many cases.

Finally, I agree with Neuro that there are more obstacles for MD/PhDs branching out into less traditional research specialties (i.e., not IM/peds/path/neuro/psych). Particularly if you're going into an untraditional specialty that has few MD/PhDs and no fast track, your clinical and academic credentials really ought to be on par with your MD-only fellow applicants if you want to be competitive for that specialty.

I'm virtually certain that having a PhD made me a more desirable residency applicant. That being said, I went into pathology, which probably has a little more affinity for research-oriented folks than do most specialties. I have the sense that being MD/PhD isn't the golden ticket that it once might have been; nevertheless, in my case, I think having the PhD really did help.

On the other side of the coin, though, I was speaking to a former radiology attending from my medical school (he is no longer faculty there) who told me that they had been burned by MD/PhD residents and, in so many words, told me that the program is now somewhat 'suspicious' of applicants who are MD/PhD. He didn't exactly elaborate how their radiology program had been burned by these MD/PhD residents, but implied that their performance as residents had been substantially less than stellar.

The bottom line, I think, is that while the PhD may garner you some extra love from some residency programs, you cannot count on that. Your best bet is to try to prepare yourself to be a competitive residency applicant just like any MD-only applicant would, shoot for good grades and good USMLE scores.

Neuronix said:

Now that I'm applying I'm really scared. I have few interviews and I'm applying in a competitive specialty. I did my PhD in that specialty and in related work, but it doesn't really seem to matter much at all.

Click to expand...

Don't worry, Neuro... with the 20% medicare reimbursement cuts on Rads, the competitiveness is sure to be down this year!

/silver lining

Sometimes, it seems like students who did just 1-year research fellowship programs in med school seem to have the same added benefit of those who did 4yr+ PhDs.

Most disappointment about the benefit a PhD offers during residency selection is about inappropriate expectations. A PhD definitely helps one's residency application, but only to a point because it is only one feature of a broader application. If you expect it to be some sort of magic wand that erases gross deficiencies in other areas of your application, you will be disappointed.

When a residency interviews you and ranks you, they are going to score you on certain criteria (say from 0-10). Each factor may be weighted, such as:

Step 1 score (20%)
Rank of medical school (20%)
Clinical grades/AOA (20%)
Research experience (20%)
Personality/interest in field/interview performance (20%)

You may have a PhD and get all 10/10 points for research, but that's only 10 out of a possible 50 points. Consider 3 candidates:

Candidate 1: MD from top 25 med school, minimal research experience, average grades, average step 1, good personality

Step 1 score - 5/10
Rank of medical school - 8/10
Clinical grades/AOA - 5/10
Research experience - 1/10
Personality/interest in field/interview performance - 9/10

total = 28/50

----------

Candidate 2: MD/PhD from top 25 med school, average grades, average step 1, good personality

Step 1 score - 5/10
Rank of medical school - 8/10
Clinical grades/AOA - 5/10
Research experience - 10/10
Personality/interest in field/interview performance - 9/10

total = 37/50

----------

Candidate 3: MD from top 25 med school, 1 year research experience with a publication, great clinical grades and AOA, great step 1, good personality

Step 1 score - 9/10
Rank of medical school - 8/10
Clinical grades/AOA - 9/10
Research experience - 5/10
Personality/interest in field/interview performance - 9/10

total = 40/50

----------

So, when the program sits down to make it's rank list, the candidate with 1 yr research experience (candidate 3) wins out, quite frankly because step 1 and grades were a bigger part of the equation. It will vary with field, particularly in the more competitive fields. In fields where research is almost compulsory (like rad onc), almost every candidate might get 8-10/10 on research. That's going to exaggerate the importance of the other features.

These program rank lists end up coming down to hundredths of a point. In a field like medicine, where big programs may take 50 people/year, maybe the program is big enough for all 3 candidates. Smaller fields... maybe not

Shifty B said:

When a residency interviews you and ranks you, they are going to score you on certain criteria (say from 0-10). Each factor may be weighted, such as:

Step 1 score (20%)
Rank of medical school (20%)
Clinical grades/AOA (20%)
Research experience (20%)
Personality/interest in field/interview performance (20%)

Click to expand...

Are these % breakdowns typical for residency programs? I was hoping that research would account for 20% and the PhD giving another extra 20% as added "bonus."

Rumit said:

By how little it seems the PhD helps during residency match. As I recall, we were all told how easy it was to match as an MD/PhD, that we were a sought-after commodity by residency programs. I'm a pretty good candidate without the PhD, and am applying into IM which isn't supposed to be the most competitive of fields. I'm just a little surprised by how little difference the extra degree seems to make in getting interview invites, at least comparing myself to my MD-only classmates. Anyone else have a similar experience, or thoughts?

Click to expand...

Just in reference to the OP's post, I don't see very much to be disappointed about after perusing the IM interview invites thread. Practically an interview at ALL of the best programs in the country.

Rumit said:

I've done alright so far, but I would have been a decent candidate without the extra degree as it turns out. I'm also not the only person I know who's going through the process at the moment. Anyhow, the lesson for those who are still early on is that you can't expect the PhD to carry you anywhere that the rest of your application won't take you.

Click to expand...

Clearly, but remember we still stand apart for the goals we're trying to achieve, and we still gain a lot of currency for it. Half of the programs I applied to wouldn't take a whiff at me without the commitment made to academics and to a research career. It's a difference in perspective; the "haves" don't find the PhD helpful, while the "have nots" find it very helpful, considering they would have none without the PhD.

I'll have more to say later.

echod said:

Are these % breakdowns typical for residency programs? I was hoping that research would account for 20% and the PhD giving another extra 20% as added "bonus."

Click to expand...

No.

Shifty B said:

Step 1 score - 5/10
Rank of medical school - 8/10
Clinical grades/AOA - 5/10
Research experience - 1/10
Personality/interest in field/interview performance - 9/10

total = 28/50

----------

Candidate 2: MD/PhD from top 25 med school, average grades, average step 1, good personality

Step 1 score - 5/10
Rank of medical school - 8/10
Clinical grades/AOA - 5/10
Research experience - 10/10
Personality/interest in field/interview performance - 9/10

total = 37/50

----------

Candidate 3: MD from top 25 med school, 1 year research experience with a publication, great clinical grades and AOA, great step 1, good personality

Step 1 score - 9/10
Rank of medical school - 8/10
Clinical grades/AOA - 9/10
Research experience - 5/10
Personality/interest in field/interview performance - 9/10

total = 40/50

These program rank lists end up coming down to hundredths of a point. In a field like medicine, where big programs may take 50 people/year, maybe the program is big enough for all 3 candidates. Smaller fields... maybe not

Click to expand...

As you say, this may be typical for medicine or surgery, where they have to weight hundreds or thousands of applicants. In smaller fields it doesn't work this way at all. This may be useful for deciding WHO to interview, but it really breaks down after that... I will use similar examples for a real-world perspective in my department... Basically, any one of these applicants may get in at the exclusion of the other two based on specific examples.


Dude 1- FMG with good scores, is quiet, but not homicidal.
Step 1 score - 9/10
Rank of medical school - 2/10
Clinical grades/AOA - 1/10
Research experience - 4/10
Personality/interest in field/interview performance - 9/10

total = 25/50

----------

Candidate 2: MD/PhD from top 25 med school, average grades, average step 1, good personality

Step 1 score - 5/10
Rank of medical school - 8/10
Clinical grades/AOA - 5/10
Research experience - 10/10
Personality/interest in field/interview performance - 9/10

total = 37/50

----------

Candidate 3: MD from top 25 med school, 1 year research experience with a publication, great clinical grades and AOA, great step 1, good personality

Step 1 score - 9/10
Rank of medical school - 8/10
Clinical grades/AOA - 9/10
Research experience - 5/10
Personality/interest in field/interview performance - 9/10

total = 40/50

Real world additions...

Dude 1- may not get an interview. But it turns out he did a 6-month long reasearch project with one of the attendings in the department, so he gets one anyway. He's also an IMG who's already completed his residency but wants the bling from the US. Great step scores (as usual for IMGs who get in), and gets a 2 from the school which means you may have actually heard of it. Clinical grades and LORs are useless because you can't read Farsi or whatever.
Why they get in- they can be the workhorse for the entering class. Sure they did research and are interested in it... but the department wants him to do the gruntwork. Probably won't even get a fellowship in the department unless they are desperate. But they can get this guy outside the match, and they know what they are getting- someone who's already completed residency.
Why they don't get in- the guy is creepy/can't speak english/antisocial too many other, more impressive candidates.

Candidate 2-
Why they get in- Will be sought after as a future faculty member. The chairman may personally recruit him to get him involved in science off the bat. If he's truly interested in research and is good, that is $$ for the department and its reputation. This is clearly a different track than applicants 1 & 3. May likely get the "rank to match" phone call.
Why they don't get in- doesn't give confidence to the program that they want to stay in academics, hints interest in private practice. Why take this guy when there are better drones out there, who like doing gruntwork? May waffle at the direct communications with chair or other department heads. May be kind of a douche, and turn people off.

Candidate 3- why they get in- future chief resident potential. Everything about his resume is stellar. Will be highly ranked for their poteintial in serfdom. May get the "rank to match" call, depending on how many other excellent applicant like this are out there. May get fellowship of choice if they are really that good.
Why they don't get in- is a douche.

Not to demistify residency or anything, but the department will not hire you because you are super awesome. They will hire you because they need scrubs to do the work. If you show you can do that well, you will get a spot. In all reality, for major academic departments, candidates 3 & 2 will get a spot 95% of the time, provided they are not douche bags. They will be on different career tracks however. If you are candidate #2 and don't know if you want to do academics or not, you've just poisoned the well from which your strengh flowed (that's as poetic as I get). Candidate #1 is basically interchangable with 2-300 other people.

Regarding the post above, there are many intangible things that can get you an interview or get your a spot. If one of your parents is an attending at the program, you're looking a lot better. Other than that, I'm not really sure what argument you're making. You gave all three 9/10 for personality despite referring to them as "not homicidal", "kind of a douche", and "a douche". I'm not sure how that works.

And of course there are many other features at play. Are you a woman or underrepresented minority? In some fields that makes a huge difference.

However, these numbers are not that far off, and many programs are using some sort of weighted numerical scheme. That's really the only way to factor in opinions of multiple interviewers. I realize it was an elaborate example, but my point was that in competitive programs in many fields, grades, step 1, and interview performance are huge factors that can overshadow a PhD.

Shifty B said:

Regarding the post above, there are many intangible things that can get you an interview or get your a spot. If one of your parents is an attending at the program, you're looking a lot better. Other than that, I'm not really sure what argument you're making.

Click to expand...

That is my point... it hardly boils down to a mathematical formula in smaller residency programs. Again, if you interview 300 applicants, you might have to do that to keep them straight. If you interview 60, you probably remember most if not all of them.

Also, program directors run their departments in different ways. not all have some sort of formula. There are lots of committees for interviewing applicants, but in the end the program director will finalize a list and they can pretty much do whatever they want. At my program I know the program director really wants people who want to be here... and telling the program you want to be here means something. I've also found you are more likely to match here if you have family here or grew up here.

gbwillner said:

Candidate 2-


If you are candidate #2 and don't know if you want to do academics or not, you've just poisoned the well from which your strengh flowed (that's as poetic as I get). Candidate #1 is basically interchangable with 2-300 other people.

Click to expand...

How good are the programs in assessing applicant's intention, ability, and potential in becoming future funded faculty? Is a 5 year PhD with only one JBC level publication solid enough or are they looking for the super stellar genius?

echod said:

How good are the programs in assessing applicant's intention, ability, and potential in becoming future funded faculty? Is a 5 year PhD with only one JBC level publication solid enough or are they looking for the super stellar genius?

Click to expand...

In research-track residency programs I would say they are pretty good. If you've been productive during the PhD, and are good at selling yourself you can go far. If you waffle, you won't. Like I said, there are 2 types of positions out there for us. We are the MOST QUALIFIED for the research-track positions, and if you are not sure that's your path then the PhD gives you NO advantage. They will see your passion for research and be moved. Again, look at this from the program's perspective. Once you are in the door, they don't care what your Step 1 score was or if you were AOA. They want you to be a good resident, do the monkey work the drives the department's revenues, and hopefully be good enough that once they are done training you, you will make them proud and represent the program well. What does having a resident with AOA give the department? Nothing. It's only a way for them to feel like you may do your job better than others. However, it may just mean you have a browner nose. The interview may settle that.
A PhD with a JBC-quality paper is nothing to scoff at, and you'll see many MD/PhDs graduate with far less. It might be (should be) enough to get you in the door for the interview, and then you need to impress the directors and possibly the chair. At many top places (with a research track) they will invite you to give a talk- that is really your chance to shine.

From personal experience, I was definitely Applicant #2 in Shifty B's list (although my step 1 score was probably more like 3-4/10). I met the chairman at every institution that interviewed me. Most applicants will not get that opportunity. They are very busy and only meet with a very select few individuals.

echod said:

How good are the programs in assessing applicant's intention, ability, and potential in becoming future funded faculty? Is a 5 year PhD with only one JBC level publication solid enough or are they looking for the super stellar genius?

Click to expand...

I think they are actually not very good at predicting who is interested in academics and what kind of career success you may have. They try, but its hard to predict even who will want to do academics or private practice, let alone who may be successful. I think that's part of the reason they end up falling back on grades, step 1, etc. Part of this is because I think individuals themselves are not very good at predicting what they are going to want to do years later.

Many people end up changing their mind. They spend some time in research and find that its a drag and want to do private practice. Or, alternatively, they see people in private practice busting their ass and decide its not for them.

gbwillner said:

From personal experience, I was definitely Applicant #2 in Shifty B's list (although my step 1 score was probably more like 3-4/10). I met the chairman at every institution that interviewed me. Most applicants will not get that opportunity. They are very busy and only meet with a very select few individuals.

Click to expand...

I was like applicant #2 also, and like you I got interviews at most top ranked places I applied. I also met several department chairs and most program directors. At the same time, there were several places where I was passed over both for interviews and on the rank list by people who probably had less research experience than me.

Gbwillner and I agree on most everything though. I merely wanted to provide an example scenario as to how an MD/PhD might be passed over both for interview selection and ranking.

I will say this though. Having a PhD is a big advantage. You will get your foot in the door at places that otherwise wouldn't have interviewed you. You have an automatic topic of discussion during your interviews. If you did a good job during your PhD, can talk about it in layperson terms, and are semi-normal, it will help.

Overall, I think having a PhD will likely allow you to match at a program 1 tier higher than you might have otherwise.

Shifty B said:

I think they are actually not very good at predicting who is interested in academics and what kind of career success you may have. They try, but its hard to predict even who will want to do academics or private practice, let alone who may be successful. I think that's part of the reason they end up falling back on grades, step 1, etc. Part of this is because I think individuals themselves are not very good at predicting what they are going to want to do years later.

Many people end up changing their mind. They spend some time in research and find that its a drag and want to do private practice. Or, alternatively, they see people in private practice busting their ass and decide its not for them.

Click to expand...

I think this is exactly the reason programs with research-tracks ask you to give a talk. I think even if you SAY you want to do academics, your interest in science and depth of understanding is hard to fake while presenting a talk to the department. At my institution, what you say was definitely true. They used to spend $$ trying to recurit the top MD/PhDs and would get burned routinely. Now that people give talks I think it will be different. It is definitely more of a committment from the applicant from the beginning.

I am interviewing right now, and I agree with all that has been said. My personal take has been that the PhD has been tremendously helpful at big name places in terms of simply getting the interview. It seems that in this field (ENT) the majority of applicants are pretty stellar on paper. Simply using board scores and grades to select candidates is increasingly difficult as there is much less variation, and thus things like LORs and research experience can set a candidate apart and often result in an interview offer. I suspect this is the same at the most competitive IM spots as well, or any other programs that will draw a disproportionate amount of top students. In my case, I am certainly around "average" or below, numbers wise, for this field. Yet I have several interviews at some top ten programs and have been offered more interviews than I can go on or ever thought I would get. I am certain the PhD has helped in this regard, as evidenced by my interviews being 90% at large, research heavy programs while my rejections (so many) are all at the smaller, community based places.

Having the PhD has also been helpful during interviews, even with people who aren't interested in my research, or who may believe that having the PhD will not help for a surgical career. Being able to talk about my PhD as an experience that shaped my character, built maturity, developed organizational skills, etc has been extremely helpful for the "what makes you special/what about you makes you better than the next guy" questions that invariably arise during interviews. The skill set that comes with 4+ productive years in a lab goes beyond increasing scientific knowledge and experience writing/publishing.