GS Research Years

[RIPSanto]

I know this has been discussed quit a bit, and I went back and read some older threads and a few online articles regarding residency and research years. However, as I prepare my final list of programs for ERAS, I am shamelessly asking some questions on here, as it seems like the issue of required research is rather fluid. All in all, I am really struggling to decide whether or not I would want to do research years.

For me the pro's of research would be that I enjoy doing it, I enjoy going to conferences and presenting/learning what others are doing, and feel 65% confident I would like to continue research into my career (probably more outcomes, not basic science).

The cons- I have >250K in med school loans alone and interest rates are now 6.8-7.9%. All subsidized loans went away for good during my MS1 year and the interest is already starting to accumulate rapidly. Even if I pay income based repayment during residency I will still be "Neg Aming" until I become an attending. I know this sounds like I am whining about my loans. I don't mean to be. I am excited about being in medicine regardless of how much it costs. Its just hard not to think about them as I plan for my future.

With respect to the financial issue of pursing research years, I was recently told by a resident who did lab years that he received some loan reimbursement during his research years. He also mentioned that you can make pretty decent money if you moonlight while doing lab years. Does anyone know how common it is to get some sort of loan repayment during residency years (obviously not all of it, but just something to help offset the burden of postponing attending salary). Also, do most residents moonlight?

Last question- do the required lab years have to be all research, or can it be, for instnace, 1 year research and 1 year critical care fellowhsip?

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[filter07]

The NIH has a loan repayment program for research that will pay back up to 35K a year. The catch is that you have to sign up a year before you go into the lab, and only about a third get the grant.

If I were you I would sign up for the IBR right away. You would probably only have a year or two to pay off with an attending salary, and at 7% interest a good amount of your loan will probably be forgiven.

 

[ACSurgeon]

I know this has been discussed quit a bit, and I went back and read some older threads and a few online articles regarding residency and research years. However, as I prepare my final list of programs for ERAS, I am shamelessly asking some questions on here, as it seems like the issue of required research is rather fluid. All in all, I am really struggling to decide whether or not I would want to do research years.

For me the pro's of research would be that I enjoy doing it, I enjoy going to conferences and presenting/learning what others are doing, and feel 65% confident I would like to continue research into my career (probably more outcomes, not basic science).

The cons- I have >250K in med school loans alone and interest rates are now 6.8-7.9%. All subsidized loans went away for good during my MS1 year and the interest is already starting to accumulate rapidly. Even if I pay income based repayment during residency I will still be "Neg Aming" until I become an attending. I know this sounds like I am whining about my loans. I don't mean to be. I am excited about being in medicine regardless of how much it costs. Its just hard not to think about them as I plan for my future.

With respect to the financial issue of pursing research years, I was recently told by a resident who did lab years that he received some loan reimbursement during his research years. He also mentioned that you can make pretty decent money if you moonlight while doing lab years. Does anyone know how common it is to get some sort of loan repayment during residency years (obviously not all of it, but just something to help offset the burden of postponing attending salary). Also, do most residents moonlight?

Last question- do the required lab years have to be all research, or can it be, for instnace, 1 year research and 1 year critical care fellowhsip?

1- consider programs with research options without requiring all residents. This can be a double edged sword as you might be pushed into research or not allowed to do research depending on the number of residents entering/exiting the lab.

2- You can do some research throughout 5 years of general surgery without dedicated time off. This requires commitment and excellent time management skills, as well as great mentorship (i.e. joining ongoing research projects rather than starting from scratch.

3- different programs allow/require different things. Some will allow you to do CC fellowship, some won't. Traditionally, those who CC fellowships in the middle of residency do it at their home program (so look for GS programs that have a CC fellowship). You can apply to do CC fellowships elsewhere, but it is much less common than doing it at your home program.

 

[doc05]

avoid 7 year programs. all that research won't make you a better surgeon, it'll just waste 2 years of your life. also, do count on 1-2 of fellowship training, because it's unlikely you'll practice without that.

 

[thedrjojo]

avoid 7 year programs. all that research won't make you a better surgeon, it'll just waste 2 years of your life. also, do count on 1-2 of fellowship training, because it's unlikely you'll practice without that.

What fellowship you suggesting with that recommendation?

Things to consider : internal research vs outside the program research (some places don't guarantee your spot if you leave), mandatory vs optional, 1 vs 2 years, additional degrees during lab year (I completed an MPH during research, other degrees like an MS or even MBA would be possible, PhD less likely in 2 years).

 

[filter07]

There are plenty of fellowships that don't require lab time. From my program, people have matched into Peds, Surg Onc, Plastics, Colorectal, Vascular, MIS, Transplant all without dedicated research time. Dedicated lab time is good for one thing: a future career in academics. I spent time in the lab and that did not make me a better surgeon than the ones who went straight through. To me, investing 2 years up front for a chance at a 1-2 year fellowship that may or may not require research time, is not really worth it.

 

[addy]

There are plenty of fellowships that don't require lab time. From my program, people have matched into Peds, Surg Onc, Plastics, Colorectal, Vascular, MIS, Transplant all without dedicated research time. Dedicated lab time is good for one thing: a future career in academics. I spent time in the lab and that did not make me a better surgeon than the ones who went straight through. To me, investing 2 years up front for a chance at a 1-2 year fellowship that may or may not require research time, is not really worth it.

Based on what our chair of peds surg has told me, I find this hard to believe.

 

[filter07]

Based on what our chair of peds surg has told me, I find this hard to believe.

It's hard and may take some luck, but not impossible. Its been done before. That's all I can say.

Personally I don't understand what makes Peds or Surg Onc so appealing that would make adults want to jump through hoops like 2 years of mouse torture to impress other people. Those who are interested in the research and serious about academics are different, but just to pad a CV? I'm way past that point in my life.

 

[SouthernSurgeon]

It's hard and may take some luck, but not impossible. Its been done before. That's all I can say.

Personally I don't understand what makes Peds or Surg Onc so appealing that would make adults want to jump through hoops like 2 years of mouse torture to impress other people. Those who are interested in the research and serious about academics are different, but just to pad a CV? I'm way past that point in my life.

a) I'm genuinely interested in the research I'm doing and plan on pursuing a career in academics (at least for now - I'm well aware of the data that even those who start out in an academic job have a 70% conversion rate to PP)

b) I know that I want to do surgical oncology. I also know that the top fellowships are incredibly hard to match into. Sure I could roll the dice and see what happens without the research years, but it is analogous to any other part of the medical application process - why shortchange yourself rather than do the smart thing and maximize your chances?

c) Research years are awesome. I know they come at some degree of opportunity cost. But it is by FAR the least amount of time crunch and responsibility you will have from the day you start intern year to the day you retire. I'm living the good life right now. Doing a lot of interesting work, but also spending time with family, working out, vacationing, etc.

d) While it doesn't compare to an attending salary, I'm also making a pretty decent surplus on my base resident salary by moonlighting and consulting.

In other words...I'm doing research that is really cool and getting some great experience out of it. I'm building a skill set that will benefit my career. I'm also getting to enjoy life outside of work, and making some nice money on the side.

I'm 30 years old so I'm really enjoying a couple of years outside the "fast lane". The perks are nice too - because of all my conference travel I now have medallion status and have gotten a couple of flight upgrades as a result (which should persist through my fellowship interviews).

But yes, if you have no interest in research nor in a competitive fellowship, I would not recommend it. But it meshes with my career and fellowship interests, and has some pretty nice perks.

 

[thedrjojo]

There are plenty of fellowships that don't require lab time. From my program, people have matched into Peds, Surg Onc, Plastics, Colorectal, Vascular, MIS, Transplant all without dedicated research time. Dedicated lab time is good for one thing: a future career in academics. I spent time in the lab and that did not make me a better surgeon than the ones who went straight through. To me, investing 2 years up front for a chance at a 1-2 year fellowship that may or may not require research time, is not really worth it.

was that 20 years ago?

yes, people regularly match MIS and Transplant without research. MIS is one of the fields that research doesn't seem to influence much yet. Transplant there are so many programs that you will get a spot without research... but to get into a major academic transplant program (UCSF, WashU, Wisc, NW, etc) I'd still like my chances much better after research. Peds, Surg Onc, Plastics have, what, around a 50% match rate as it is, so, sure you can match without research, but your odds of doing so is astronomically low (my guess is peds the rate of matching without research is probably single digit, same with surg onc). Colorectal is an interesting field as far as matching.

And your characterization is incorrect. Investing 2 years up front for a chance at a fellowship that may or may not require research time... sure, because it has happened once every few years, an anomaly, does not a rule make. And those people probably had high 90's on absites, publications without dedicated lab time, and other extenuating circumstances to get those matches.

It's hard and may take some luck, but not impossible. Its been done before. That's all I can say.

Personally I don't understand what makes Peds or Surg Onc so appealing that would make adults want to jump through hoops like 2 years of mouse torture to impress other people. Those who are interested in the research and serious about academics are different, but just to pad a CV? I'm way past that point in my life.

It's an investment in your future. The entire medical process is investments. Peds is appealing for those that enjoy working with kids and helping kids. And as I am currently on a peds heavy rotation, I am gaining a much, much greater appreciation for the skills required for Peds surgery (performing an ex-lap, colectomy on a 650gram 5 day old premie, where I was wearing my loops and it was still tiny af and my attending was doing it without any loops), and surg onc are the big whacks that many people are very much drawn to.

 

[DermViser]

I'd strongly second this. I can say with confidence, anyone who did match to peds surg or surg onc without dedicated research time, must have had something else setting them apart as an outstanding applicant.

Me, not having whatever that special something they had is, I need the research time to build my academic CV.

Peds Surgery has always been that way I've heard. Is this a new phenomenon for Surg Onc across the board or just for Surg Onc at big name places?

 

[ACSurgeon]

Surg onc has always been one of the more competitive fellowship applications, due to the small number of programs mostly. But there is generally considered a pretty big hierarchy within it

Of course you have HPB, which as I understand is a less competitive match (esp the lower tier programs)

 

[ACSurgeon]

That assumes I want to do HPB

I wasn't talking about you specifically. Just that many people applying surg onc also apply HPB.

The only thing I know about cancer surgery is that I want nothing to do with it

 

[RIPSanto]

Getting loan repayment during residency is unfortunately extremely uncommon. There are some programs where if you commit to serving in an underserved area, etc, they will pay back part of your loans. I've also heard stories of some people signing lucrative private practice gigs with signing bonuses in the form of loan payback. I am far from an expert on these.

The most common thing people are banking on these days is IBR with PSLF. One way to think about things from the research years standpoint is that if you are doing PSLF, you do 7 years residency + 2 years fellowship and that means you only have one year left so you'd only get hit with a higher payment in your first year as an attending before getting the loans forgiven. This however is a long-haul bet on not getting screwed by the government and you obviously wouldn't be paying down the loans in the meantime.

You should check out the finance sub-forum and the white coat investor's blog. Not surgeon specific, but a great resource. And I don't know that there is anything surgeon specific really about the questions you are asking, except that you are looking at a well above average length of training.

Moonlighting is definitely common, but the amount and opportunities vary program by program. I've heard tales of residents doubling or tripling their take home salary, but I don't think it is reasonable to count on making that much at the average program. It's a totally reasonable thing to ask the research residents at the night before dinners if they moonlight, imo.

The ABS allows you to do a critical care fellowship in the middle of your residency (have to have completed 3 clinical years, I believe). I imagine it varies program to program whether they would be amenable to that.

Thanks for the replies everyone-

In terms of "not getting screwed by the govt"- are you getting at the fact that they can do away with this whenever they want? I believe the current 2015 budget proposal is set to cap PSLF @ 60K. This is by no means passed into law yet, and may very well not become law. However, that is concerning that sometime within the next 10 years PSLF will be done away with.

That being said, I was reading online about PSLF, and as I understand it- PSLF is written into our notes. Meaning, the govt cannot take this option away from loans that have already been disbursed?

Does anyone have any insight into the future of PSLF? - maybe this would be better discussed in the finance forum.

 

[thedrjojo]

Well the real problem for HPB is jobs.

Especially if you're going to a new or "lower tier" HPB program, and then you're trying to compete with a Pitt or MSKCC surg onc grad for the same (few) jobs available each year.

I thought hpb fellowships, were also very competitive and often are super fellowships after surg onc?

When did the surg onc and hpb matches split?

Transplant has their own hpb certification for there fellowships too

 

[thedrjojo]

HPB fellowships are stand-alone 2 year programs. They've existed in some form for a while though I admittedly don't know their whole history. Some surg onc fellowships also allow super-specialization in HPB within their fellowship - usually though it's just that your second year is more HPB focused.

The top HPB fellowships are competitive but after that they drop off pretty markedly.

back like 4-5 years ago, Surg onc and HPB operated their matches under a single match because they knew many people were applying to both.

according to the AHPBA website, many of the HPB programs (like Cleveland Clinic) is a 1 year program...

 

[thedrjojo]

The requirement from the fellowship council is a minimum of 12 months clinical training; I thought that most of the programs were 2 years but I have really not done much research into the HPB programs.

Surgical Oncology fellowships are transitioning to ACGME fellowships so that may have something to do with the change in the match - supposedly in the next year or two surg onc match will move to spring of PGY4 instead of fall PGY5.

What will be interesting I think is if any changes in the training programs actually shake out of this "consensus meeting" between AHPBA, SSO, and ASTS next month or whether it will end up being a lot of blustering from all sides.

i wasn't aware of a "consensus" meeting. Will be interesting. I'll be applying next year for transplant, but interested in HPB as well and hope to go to one of the programs that have strong HPB in the transplant program, so would be interested in seeing if things change given the "HB and HPB" designations that some of the transplant fellowships have.

 

[vhawk]

HPB programs are almost exactly split 50/50 whether they are 1 or 2 years. They all receive about the same amount of dedicated HPB-focused clinical time, and that is 12 months. The 1 year programs provide very little else, and the 2 year programs provide some additional feature which is different at each program. For example, Mayo is 2 years, and it has ~12 months of HPB and 12 months of dedicated research time. Duke is 2 years and has ~12 months of HPB and 12 months of other surg onc rotations, partly because it is in the process of transitioning. Toronto and OHSU both have about a years worth of transplant built in.

Agree with previous poster who said that the competitiveness overall of HPB is very top heavy. The best 5-6 programs are very competitive, the rest are less so, and some programs (3) did not fill their spots this year (though for one of them it was their own fault, and it is a pretty big name program).

 

[tima]

If you plan on working in private practice or a non-academic hospital, how would 2 years of research benefit you as a general surgeon? I understand that research can help in seeking fellowships, but what are the incentives for non-academic surgeons.

 

[tima]

Because you want to be more competitive for a fellowship - For GS, no fellowship needed. Will help if applying for a fellowship later in the career.
Because you legitimately care about the research - Might help if going into academics later in the career.
Because you want a break from the grind of residency - 2 years of research means you will become an attending 2 years later. At an expense of 250k (salary estimate) a year, it will cost you half a mill. Not a good financial decision.

The first 2 reasons make more sense.