ABIM research track for IMGs

[CRUCS_2015]

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Hey all,

I have been looking around for a while to get some info on this but couldn't find much - would be very grateful if anyone could help/advice please!

I am an IMG (a graduate from a prestigious UK univ), finished 2-years of training here and currently doing a PhD in GI. My original intention was to use the PhD to get a better attending job here in the UK, but more time I spent on research (I do both clinical and bench), more I fell in love with it.

Basically, I see myself doing this for life - and I really want to be an physician scientist who spend ~80% of time in clinical/bench research and I was also recently offered a place for a integrated research/clinical training here in the UK. But it looks like due to family reasons, I have to move to US (shame, cuz its my dream job!).

So I've searched around like crazy, and found out that there is a similar program called ABIM research track, which is essentially,
- Shortened IM residency (2 years)
- Shortened GI fellowship (2 years)
- 3 years of protected research time!

Which would be amazing for me and perfect to get the ball rolling before I start my lab at the end of training (although I will have 4 years gap in research...).

My questions are
1) How does this actually work? Do people go on to the research tract only after they have already started their PGY1 or is this (i.e. full package - IM+GI+3yr research) something that you can apply for at the tie of residency application cycle?

2) Are IMGs eligible (I need to get visa)? I ask because, presumably the research component of the program would be nationally funded? if so, don't they require recipient to be US citizen/permanent resident (I am a UK citizen)?

3) How competitive is it? Presumably highly competitive, as I can imagine lots of MD/PhDs apply to these posts. I am yet to take my USMLEs but would do soon. I was in the top 25% in medical school. My academic credentials are: masters degree, 3 first author publications in high-impact journals (top 10 in GI/Hep journals), 8 oral presentations + 3 posters in international conferences, 2x best oral presentation prizes, 3 travel grants, clinician scientist award (which funds my PhD and clinical salary). I have also been doing 1 GI clinic and 1 ward-cover during this time to keep my hands dirty. I also did ID elective in US when I was a student. What do you think my chances are? Do I realistically have any chance of getting in? If not what can I do to improve my chances? I really can't see myself being full time clinician, although if worst comes to worst I could probably tolerate being faculty who only do clinical research.

So sorry for the long post guys but ANY piece of info/advice would be very helpful indeed!

 

[gutonc]

So I've searched around like crazy, and found out that there is a similar program called ABIM research track, which is essentially,
- Shortened IM residency (2 years)
- Shortened GI fellowship (2 years)
- 3 years of protected research time!

So let's clarify a few things before we go any further. Yes, your time in IM is shortened (but typically more intense since you need to get the ABIM mandated # of certain experiences...I did more inpatient/ICU months as a PGY2 than I did as an intern). And the fellowship is actually extended, that 3 years of protected research time is still part of the fellowship and includes a certain amount (theoretically no more than 25%, preferably no more than 10%) of clinical time. Again, in some programs, you may have to squeeze more clinical time into those first two years and you may still have significant clinical duties, and call, during the research years.

My questions are
1) How does this actually work? Do people go on to the research tract only after they have already started their PGY1 or is this (i.e. full package - IM+GI+3yr research) something that you can apply for at the tie of residency application cycle?

Both types of programs exist.

2) Are IMGs eligible (I need to get visa)? I ask because, presumably the research component of the program would be nationally funded? if so, don't they require recipient to be US citizen/permanent resident (I am a UK citizen)?

This is a question I don't really have the answer to. Although, I suspect that since many of these programs (although not all) are funded by T32 grants then no, you wouldn't be eligible. But you're going to have to do a bunch of research on that.

3) How competitive is it? Presumably highly competitive, as I can imagine lots of MD/PhDs apply to these posts. I am yet to take my USMLEs but would do soon. I was in the top 25% in medical school. My academic credentials are: masters degree, 3 first author publications in high-impact journals (top 10 in GI/Hep journals), 8 oral presentations + 3 posters in international conferences, 2x best oral presentation prizes, 3 travel grants, clinician scientist award (which funds my PhD and clinical salary). I have also been doing 1 GI clinic and 1 ward-cover during this time to keep my hands dirty. I also did ID elective in US when I was a student. What do you think my chances are? Do I realistically have any chance of getting in? If not what can I do to improve my chances? I really can't see myself being full time clinician, although if worst comes to worst I could probably tolerate being faculty who only do clinical research.

I can't comment on GI but in general, they're no more competitive (for the right applicant) than a general IM or GI program at the same institution would be. I mean, you need to have the research chops (which you seem to have) in addition to the clinical requirements (which I can't really comment on for you) as well as the Step scores everyone else does.

Above all, I think you need to really consider whether this is something you need to do in order to have the career you want. You know the UK system better than I and have a better idea of your chances of getting the type of job at home that you seem to want. But keep in mind that you're looking at another 8-12 years (a year to take your Steps, another year for applications/interviews, 7 years of training and then probably another 1-3 years as an adjunct/instructor prior to having the chance to "start you lab at the end of training" at the assistant professor level. If you're currently 25, this may be a reasonable plan. If you're over 30, think long and hard about this.

 

[CRUCS_2015]

Gutonc - great, thank you so much for your reply. It really helps getting an insider's view who have been through the system.

So let's clarify a few things before we go any further. Yes, your time in IM is shortened (but typically more intense since you need to get the ABIM mandated # of certain experiences...I did more inpatient/ICU months as a PGY2 than I did as an intern). And the fellowship is actually extended, that 3 years of protected research time is still part of the fellowship and includes a certain amount (theoretically no more than 25%, preferably no more than 10%) of clinical time. Again, in some programs, you may have to squeeze more clinical time into those first two years and you may still have significant clinical duties, and call, during the research years.

OK - that's not a problem, and I am used to that kind of setting (e.g. 25% clinical time...etc) and it works well I think because you can recruit patients from specialist clinics and endoscopy lists...etc.

2) Are IMGs eligible (I need to get visa)? I ask because, presumably the research component of the program would be nationally funded? if so, don't they require recipient to be US citizen/permanent resident (I am a UK citizen)?
This is a question I don't really have the answer to. Although, I suspect that since many of these programs (although not all) are funded by T32 grants then no, you wouldn't be eligible. But you're going to have to do a bunch of research on that.

Ouch - I knew this would be the case. I searched various programs but as you said, majority are T32 funded (we have similar stuff here in the UK). So I guess my options are,

1) Be prepared to take **** from family members and stay in UK academic training program.

2) Off to US for pure clinical training (as many are open to IMGs) and keep the family happy and try my luck at the end of fellowship. Is it true that majority of fellowship program gives you 6~12 month of protected research time (correct me if I am wrong!) anyway, typically in 3rd year? Presumably you could use that year as "post-doc" and continue after the fellowship?

Above all, I think you need to really consider whether this is something you need to do in order to have the career you want. You know the UK system better than I and have a better idea of your chances of getting the type of job at home that you seem to want. But keep in mind that you're looking at another 8-12 years (a year to take your Steps, another year for applications/interviews, 7 years of training and then probably another 1-3 years as an adjunct/instructor prior to having the chance to "start you lab at the end of training" at the assistant professor level. If you're currently 25, this may be a reasonable plan. If you're over 30, think long and hard about this.

What is the difference between instructor and assistant professor? Aren't they similar in terms of clinical and research commitment and also salary? If so it would be better since this would mean that I will have more time to establish myself before my "assistant professor clock" runs out so better chance of tenured post in the future...? Please let me know if I am talking complete garbage as you have been through the system.

So... (so sorry for a long post!) having been through the system, which path would you take if you had a choice between (setting family aside for now...),

1) Combined Clinical/Research Training in the UK, 8-10 years of duration (yup, UK training is extremely long to start with), typically 50%/50% split from year 3, so at the end of training one would have "substantial" research portfolio with 3 years of full time research at post-doc level.

2) US IM residency + GI fellowship (6 years, but little research time) + post-doc or instructor post for 1-3 years.

Of course, no one can make the decision for me - but I am just curious about how other people thinks. Both path would take me 10 years anyway, and I am in early 30s and don't mind being a trainee for another 10 years if this is what it takes to become what I really want and enjoy.

Thanks so much for reading a long post and I really appreciate your help!

Cheers,

CRUCS

 

[McSap]

Fellow UK IMG here, applying to IM residencies this year. Our backgrounds are a little different as I'm more interested in the purely clinical side of things, but I think gutonc raised a valid point about the time needed to complete your USMLEs and apply/interview at programs - you'll need to think about the logistics of making that happen. Generally speaking, for any IMG, you need to try and score as high as possible on the USMLEs to have a decent shot at applying to any competitive program in the US. I was 3 years post-grad before deciding to make the move (also for family reasons), which meant I was many years away from the basic science content of step 1 - so I ended up leaving my training post and studying full time for about a year while working part-time locum shifts in order to get the scores I needed on the steps. You also need to have all the exams done in time to have the results in and be ECFMG certified by the time you apply in Sept, or wait until the following Sept. Interviewing for residencies would typically require you to be in the country from Sept through Jan the year you apply. So you need to think about the time commitment the exams and interviewing requires and how you can fit that in with whatever your situation in the UK is. Either way, at least for me, it was a bit of a gamble as getting back into the program I was in in the UK could be difficult having left the system.

All that aside, more specific to your questions - Some IM residencies offer physician-scientist or medical research tracks which could be an option to increase your research time during residency, and I would think you should be in a competitive position to apply for that given your background.

Im not sure about GI, but in the fellowships im interested in most offer protected research time of a few months in 2nd/3rd year plus a few months electives, which I assume could be used for research. Most residencies also offer at least a few months electives time which you could use for research also.

Feel free to PM me if you have questions about the UK to US move more generally.

 

[gutonc]

All that aside, more specific to your questions - Some IM residencies offer physician-scientist or medical research tracks which could be an option to increase your research time during residency, and I would think you should be in a competitive position to apply for that given your background.

This is the ABIM Research Pathway we described above.

 

[gutonc]

What is the difference between instructor and assistant professor? Aren't they similar in terms of clinical and research commitment and also salary? If so it would be better since this would mean that I will have more time to establish myself before my "assistant professor clock" runs out so better chance of tenured post in the future...? Please let me know if I am talking complete garbage as you have been through the system.

Instructor is a non-tenure track position. Salary is typically 50-60% of Asst Prof. Typically little or no department/division/institutional support (a friend of mine was offered a $50K "startup package") and you'll need to find somebody else to support you, including lab space and supplies/reagents, or get your own grants (which will be subject to some of the same issues as a T32).

Finally, I think you need to consider the state of basic research funding in general in the US at the moment before you hang your hat on a bench research career 10 or 15 years down the road. It's a freaking horror show over here at the moment. The people who are getting money are the ones who already have money. NCI (the ones I care about) pay lines are ~8% (other institutes are better...or worse...NIKDD is a little better, or was the last time I checked). And foundation grants have pay lines in the 1-2% range (an ASCO grant reviewer told me they had over 450 applications for 4 grants the year I applied for one, everyone who received a grant already had a K-level award).

 

[McSap]

This is the ABIM Research Pathway we described above.

Oh. Blind leading the blind...

 

[CptNemo]

Finally, I think you need to consider the state of basic research funding in general in the US at the moment before you hang your hat on a bench research career 10 or 15 years down the road. It's a freaking horror show over here at the moment. The people who are getting money are the ones who already have money. NCI (the ones I care about) pay lines are ~8% (other institutes are better...or worse...NIKDD is a little better, or was the last time I checked). And foundation grants have pay lines in the 1-2% range (an ASCO grant reviewer told me they had over 450 applications for 4 grants the year I applied for one, everyone who received a grant already had a K-level award).

That's what I was thinking when I was reading OP's post. The old time established guys with connections are still doing relatively well, but I've seen quite a few young investigators recently give up the research pathway after either being unable to get a K08/K23 after T32/F32 or then being unable to get an R01 after a K grant. Even pretty accomplished young researchers are scrambling for more clinical work around the U as they only get a meager R03 for some hobby research project on the side (feasible with clinical research, but not so much with basic, as it won't give you enough $ to keep the lights on).

If you really love research much more than clinical work, you have a great CV and can go to a great institution where you can develop great connections with people who go to NIH study sections, then go for it. But, realize there is a high chance that you'll still end up doing mainly clinical work to pay the bills.

 

[CRUCS_2015]

Guys, thank you so much for your sharing your experiences. OK- So the grant situation looks grim over in US, which is surprising as I thought that US heavily invest on medical research. There seems to be many hoops to jump through if I make a move to US!
Probably best to do normal IM+GI route and assess the situation later on, if not, I guess I can always become full-time clinician with "hobby clinical research projects" and keep on writing papers although the chance for grant would be very slim without bench research.

 

[drstatinatorva]

Hi, I am an IMG, MBBS with little research experience. Is it possible for IMGs to get into research heavy residencies (IM, Ped) ? And is lab research heavy fellowship possible if I get into purely clinical residency? Or should I pursue Phd instead?

 

[bashwell]

Hi, I am an IMG, MBBS with little research experience. Is it possible for IMGs to get into research heavy residencies (IM, Ped) ? And is lab research heavy fellowship possible if I get into purely clinical residency? Or should I pursue Phd instead?

If by "research heavy residencies (IM, Peds)" you mean academic or university or affiliated places, then sure yes it's "possible". But that's going to depend on your USMLE scores, USCE, LORs (ideally from US physicians), visa status (are you able to get a visa?), etc.

As you probably know, a PhD is setting you up for a career in research rather than clinical medicine. Otherwise you could do research with "just" an MD. But you say you have "little research experience" so what makes you suddenly want to pursue a PhD? More to the point, are you asking because you want a career in research, or because you don't think you can get into a residency program and hope to use a PhD to network with the relevant people (e.g., PDs) or otherwise improve your CV/resume in order to get into a residency program?

 

[drstatinatorva]

Ideally, I would want a career as a lab based physician scientist. If I match in a non academic residency, what will be my chances of getting into research fellowships? Or some other way to get research training ?
Actually I did MBBS ( which is done directly after high school) and we are neither expected nor have any oppurtunity to do research.
thanks for the reply.

 

[bashwell]

Ideally, I would want a career as a lab based physician scientist. If I match in a non academic residency, what will be my chances of getting into research fellowships? Or some other way to get research training ?
Actually I did MBBS ( which is done directly after high school) and we are neither expected nor have any oppurtunity to do research.
thanks for the reply.

I'd say your "chances of getting into research fellowships" are going to depend primarily on (1) which "non academic residency" you match for IM, (2) which fellowship you're hoping for, and (3) your visa status. For example, if you end up at a decent community IM program, and you want ID, then if you do well during your IM residency (e.g., make helpful connections, publish a paper), and have no issues with your visa, then it's possible you could end up at an academic ID fellowship. After finishing fellowship, you could potentially become an ID physician and work for an academic center as "a lab based physician scientist" (again depending on things like your visa status since some jobs may not hire you if you need a visa to work). Or if you can't stay in the US, then perhaps you could go back to your home nation as an ID physician and work as "a lab based physician scientist" in your home nation.