I've discovered that I really enjoy research and have taken an extra year in medical school to get an MS in clinical investigation while working on several clinical research projects.
I did very well on Step 2 (267) but am not sure if I can compete with MD/PhDs for spots in PSTPs. What are the other ways to becoming an RO1 funded physician scientist?
Do I apply categorical IM and then pursue research during fellowship? Do I do a postdoc? Can I stay general IM and do this?
I appreciate any insight, especially from those who might have walked this path.
At this stage what you need to do is identify a residency program that will provide you significant protected time for research. This may be a PSTP, but does not have to be.
I am not familiar with current competitiveness for PSTP slots in IM. Some programs may not be able to fill all their PSTP slots with MD/PhDs, in which case you could be competitive with an MD + research year. If your home program has a PSTP, I would ask for a brief meeting with the director to try to understand more about how realistic this is for you. Otherwise talk to your dean or the PD of the regular IM residency at your program about it.
Some programs also have formalized PGY4 research 'capstone' projects that end up as QA fluff for those not interested, but can be productive research time for those with sufficient background and motivation.
I would definitely try to match at a program that has a T32. These are NIH-funded slots for research fellowships after residency, and they are usually filled by internal candidates and often are not very competitive to obtain. As long as you have the desire and financial ability to commit to 2+ years of 80-100% research after residency (which you essentially will have to do in order to become a majority-time researcher in academia), it will be a viable option in a residency that has a T32 program. Without an available T32, you will need to find your own funding to cover post-residency research time, which is a lot more work and has lower probability of success.
You then use the time in the T32 to accumulate preliminary data and apply for a career development award (K series).
Agree that categorical makes the most sense, as a separate intern year will contribute nothing to a research trajectory.
When you do your interviews, ask the program PDs about 1) availability of protected research time in residency and 2) whether there is a T32 program. Also try to gauge from the PD's level of enthusiasm in answering these questions whether they are likely to be supportive of your interest in research. Ideally, aim to match someplace where all three of these criteria are met.
After that, your research trajectory will be up to your productivity and persistence during residency and research fellowship, together with a huge serving of blind luck.
