very few will support *real* research during residency.
This statement echoes the sort of bias against those specialties that my program officials seem to have. So being the PITA that I am, I will challenge it.
What residencies do support *real* research during residency? Internal Medicine residency is a balls to the wall 80+ hours a week crapstorm of scut as far as I can tell. To address that a few programs let you can shave a year off the scut and put that towards research and we call that fast tracking. That is a very small minority. Residency is still mostly about clinical work.
I don't know about Dermatology, so I'll speak to Radiology. A few programs in Radiology give you a year protected time during your residency to do research. I think this is similar to fast-tracking in that it provides for more research time. Of course most residencies are most are mostly clinical because again, that's what residency is for. Residency is a clinical time to train. Just like in IM subspecialties, there are many research intensive fellowships in Radiology to go around.
The MD/PhDs are ending up at the research heavy Radiology programs however, like MGH and Penn and such and these *DO* support real research during residency during that year or this other option...
http://www.theabr.org/RO_Holman.htm
which is a very research intensive pathway funded by the American Board of Radiology.
It's up to the applicant whether or not they want to make research a part of their career. What I see happening with increased frequency is the following. Let's call them student A and student B.
Student A fast tracks into an IM residency, then does a minimal-procedural, traditionally low-paying IM fellowship. Student A then fights tooth and nail 80+ hours a week for many years fighting for funding and promotions. Maybe they're successful, maybe they aren't. Maybe their children know who they are, maybe they don't. If they're lucky they break $150k and get 2 weeks a year of vacation, which they spend revising grants anyways. The private practice options for their area isn't all that much better, so they don't really have other great options anyways.
Student B takes the research track of a Radiology residency. Sure they're interested in research at first but they're also interested in Rads. They might even be as gung ho about research as Student A. Then student B realizes around the age of 35 or so that they can take a 60 hour a week job upon graduation in the real world with 3+ months of vacation per year and make $400k/year. Meanwhile if they stay in research they face the same fate as student A, being 40 and still working 80+ hours a week fighting tooth and nail for grants.
So Student B chooses the private practice pathway. Who can blame them? In the real world you have better job stability, MUCH higher pay (2-3x), better hours, more vacation, more location flexibility... For all you early 20something applicants, you can play the I'M BETTER THAN THAT card all you want. But after year after year of busting your *** with no end in sight it's certainly nice to have a payoff to your 15 years of post-high school education. This is especially true when you have kids to see and outside interests you want to persue.
This is as much a problem for the Rads departments. They can't pay a lot because of NIH salary caps. They can't really afford it anyways. The Rads department is busy propping up the rest of the hospital so it doesn't collapse under Medicare funding cuts. Student As department is losing money and so Student B's department has to make up for it. But there's a caveat there too. Good luck recruiting the people to work there and keep the whole scheme afloat.
Maybe this won't be as much an issue in the future. If Rads gets slashed or Derm takes some kind of major ding and the job options are equalized between private practice and the clinical world. Something else will have to replace them or numerous hospitals will collapse because the profit from the lucrative subspecialties are saving many of the inner city hospitals from complete failure. Maybe NIH funding will come back on line such that a research track is almost guaranteed to be a success as long as you are competent and you don't have to spend all your time fighting well into your 40s.
I'm sorry boys and girls, but if the future really is as bleak as the one I've painted here, I'm glad I have the out if I go into a high paying specialty. I love Radiology research. I'm not willing to sacrifice the rest of my life for it. For the curious, I am a 5th year (going on 6th year) and I'm probably the most passionate about continuing to do basic science research of any of the 5th years I've talked to.
